Subject(s)
Catheters, Indwelling/adverse effects , Intestinal Perforation/etiology , Peritoneal Dialysis/instrumentation , Polycystic Kidney, Autosomal Recessive/therapy , Anastomosis, Surgical , Device Removal , Equipment Failure , Fatal Outcome , Humans , Infant , Intestinal Perforation/surgery , Nephrectomy , Polycystic Kidney, Autosomal Recessive/diagnostic imaging , Polycystic Kidney, Autosomal Recessive/surgery , RadiographyABSTRACT
An open-label study was conducted to characterize the pharmacokinetics and antihypertensive response to irbesartan in children (1-12 years) and adolescents (13-16 years) with hypertension. Patients received single once-daily oral doses of irbesartan 2 mg/kg (maximum of 150 mg once daily) for 2 to 4 weeks (+/- nifedipine or hydrochlorothiazide). Plasma irbesartan concentrations were determined by a validated high-performance liquid chromatography/fluorescence method from blood samples taken predose, up to 24 hours after dosing on Day 1, and up to 48 hours after the final dose. The plasma concentration-time profiles were similar between the 6- to 12-year and the 13- to 16-year age groups and to that previously determined from a study of adult subjects receiving approximately 2 mg/kg (i.e., 150 mg) oral irbesartan once daily. Mean reductions in systolic/diastolic blood pressure were 16/10 mmHg at Day 28 with irbesartan monotherapy (n = 8). Irbesartan was well tolerated and may be a treatment option for pediatric hypertensive patients.
Subject(s)
Antihypertensive Agents/pharmacokinetics , Biphenyl Compounds/pharmacokinetics , Tetrazoles/pharmacokinetics , Administration, Oral , Adolescent , Antihypertensive Agents/blood , Antihypertensive Agents/therapeutic use , Area Under Curve , Biphenyl Compounds/blood , Biphenyl Compounds/therapeutic use , Child , Child, Preschool , Female , Half-Life , Humans , Hypertension/drug therapy , Infant , Intestinal Absorption , Irbesartan , Male , Metabolic Clearance Rate , Tetrazoles/blood , Tetrazoles/therapeutic useABSTRACT
The incidence of CMV infection in pediatric renal transplant recipients has increased as immunosuppression levels deepen following the use of newer immunosuppressive agents. It has been thought that 3-5 months of anti-CMV prophylaxis offers sufficient protection for these patients. We present a case of late-onset fatal CMV disease in a pediatric renal transplant recipient who received prolonged anti-CMV prophylaxis while on "quadruple" immunosuppression with daclizumab, mycophenolate, tacrolimus, and prednisone. Our case has prompted us to reassess CMV surveillance, prophylaxis, and immunosuppression levels in our pediatric renal transplant patients.
Subject(s)
Cytomegalovirus Infections/etiology , Kidney Transplantation , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Child, Preschool , Cytomegalovirus Infections/prevention & control , Daclizumab , Drug Therapy, Combination , Fatal Outcome , Female , Humans , Immunoglobulin G/therapeutic use , Immunosuppressive Agents/therapeutic use , Mycophenolic Acid/therapeutic use , Postoperative Care , Prednisone/therapeutic use , Risk Factors , Tacrolimus/therapeutic useABSTRACT
Nicardipine is the first dihydropyridine calcium channel blocker capable of intravenous administration. Seven pediatric patients with hypertensive emergencies attributable to various pathological processes were treated with intravenous nicardipine, starting at 1 microg/kg/min. Nicardipine appeared to be safe and effective in controlling hypertension in these patients. Two patients who received nicardipine through peripheral lines developed superficial thrombophlebitis. None of the five patients receiving nicardipine through a central line experienced phlebitis, and no other adverse effects were noted.
