A Practice of Anesthesia for Infants and Children, 2019
The basic functions of the kidney are to maintain fluid and electrolyte homeostasis and metabolis... more The basic functions of the kidney are to maintain fluid and electrolyte homeostasis and metabolism. Renal disease requires the practitioner to be vigilant about fluid homeostasis, acid-base balance, electrolyte management, choice of anesthetics, and potential complications. This requires a thorough understanding of the excretory and fluid homeostatic functions of the kidney, particularly in the neonate and younger child. If not managed assiduously, perioperative renal dysfunction can deteriorate into renal failure or multiorgan system failure resulting in significant morbidity or mortality. The anesthesia provider must understand renal physiology, appropriate preoperative preparation, intraoperative management, and postoperative care of the child with renal disease.
To provide a realistic picture of the patient case load of a pediatric nephrologist in a teaching... more To provide a realistic picture of the patient case load of a pediatric nephrologist in a teaching hospital, we analyzed the number, the demographics, and the reasons for patient referral to our pediatric nephrology program over a 10-year period. Between January 1, 1978, and December 31, 1987, 1,523 pediatric patients were referred to the Medical College of Virginia for evaluation and treatment of renal and electrolyte disorders. The most common reason for referral was a fluid-electrolyte disorder (30%), followed by hematuria/proteinuria (22%), chronic glomerulonephropathies (10%), hypertension (5%), nephrotic syndrome (6%), end-stage renal disease (3%), urinary tract infections (5%), and acute glomerulonephritis (3%). More than 25% of the patients were under 1 year of age at initial presentation. The rest are equally distributed among the other pediatric age groups, including adolescents. Fifty-eight percent of these patients were white, and 41% were black. Males accounted for 54% o...
The lipid metabolic disorders in chronic renal insufficiency (CRI) are related to increased hepat... more The lipid metabolic disorders in chronic renal insufficiency (CRI) are related to increased hepatic lipid synthesis, reduced triglyceride removal coupled with insulin insensitivity and impaired lipoprotein lipase activity. Growth hormone is lipolytic, and the effects of recombinant human growth hormone (rhGH) on the hypercholesterolemia of CRI are unsettled. To test this question, we gave rhGH for 14 days at a dosage of 3 units/day intraperitoneally to two-stage, 5/6 nephrectomized, male Sprague-Dawley rats (n = 18) compared to sex- and age-matched control (n = 27) and CRI (n = 40) rats. At the end of the study, CRI rats and those treated with rhGH had a similar degree of renal impairment, as assessed by serum concentrations (mean +/- SEM) of urea nitrogen (49 +/- 3 vs. 54 +/- 4 mg/dl), creatinine (0.9 +/- 0.0 vs. 1.0 +/- 0.1 mg/dl) and cumulative food intake (311 +/- 8 vs. 290 +/- 12 g). Serum urea nitrogen (16 +/- 4 mg/dl) and creatinine (0.4 +/- 0.1 mg/dl) concentrations as well ...
Journal of the American College of Nutrition, 1996
This study was designed to assess sequentially the nutrient intake in children with chronic renal... more This study was designed to assess sequentially the nutrient intake in children with chronic renal insufficiency and its relationship to body size, the level of renal failure, and growth velocity. The nutrient intake from 401 4-day food records obtained from 120 children with renal insufficiency over a 6-month observation period was analyzed. The height and weight were measured at the beginning and end of the observation period. The glomerular filtration rate was estimated from the height and serum creatinine. The mean caloric intake in these children was 80 +/- 23% (mean +/- SD) of the Recommended Dietary Allowance (RDA) for age. Fifty-six percent of the food records obtained from these children revealed a caloric intake that was less than 80% of the RDA. Caloric intake expressed as the %RDA for age decreased with increasing age. However, the mean caloric intake when factored by body weight was in the normal range. There was no correlation between caloric intake and height velocity. The mean protein intake in these children was 153 +/- 53% of the RDA. Further, 45% of the food records indicated a protein intake greater than 150% of the RDA. There was no relationship between the degree of renal insufficiency and caloric or protein intake. Calcium, vitamin, and zinc intakes were also low. Children with chronic renal failure consume less calories than their age matched peers, but the majority of these children appear to ingest adequate amounts for their body mass. This reduction in caloric intake occurs early in renal insufficiency. They also ingest inadequate amounts of calcium, zinc, vitamin B6, and folate.
The incidence of pediatric renal stone disease is increasing dramatically, especially in teenager... more The incidence of pediatric renal stone disease is increasing dramatically, especially in teenagers. Whether measured by the number of emergency department visits, inpatient admissions or new referrals to a pediatric nephrology practice, there has been a three- to five-fold increase in the number of
Fanconi syndrome, also known as the DeToni, Debré, Fanconi syndrome is a global dysfunction of th... more Fanconi syndrome, also known as the DeToni, Debré, Fanconi syndrome is a global dysfunction of the proximal tubule characterized by glucosuria, phosphaturia, generalized aminoaciduria, and type II renal tubular acidosis. Often there is hypokalemia, sodium wasting, and dehydration. In children, it typically is caused by inborn errors of metabolism, principally cystinosis. In adults, it is mainly caused by medications, exogenous toxins, and heavy metals. Treatment consists of treating the underlying cause and replacing the lost electrolytes and volume.
... 3. Gretz N, Huber W, Gretz T, Kern M, Steiner E, Strauch M. Zur Anwendung mathematischer Mode... more ... 3. Gretz N, Huber W, Gretz T, Kern M, Steiner E, Strauch M. Zur Anwendung mathematischer Modell für die Verlaufsbeobachtung der chronischen Niereninsuffizienz . Nieren Hochdruckkrankh . ...Jess G. Thoene, MD University of Michigan, Ann Arbor, MI 48109. 6 References: 1. ...
A Practice of Anesthesia for Infants and Children, 2019
The basic functions of the kidney are to maintain fluid and electrolyte homeostasis and metabolis... more The basic functions of the kidney are to maintain fluid and electrolyte homeostasis and metabolism. Renal disease requires the practitioner to be vigilant about fluid homeostasis, acid-base balance, electrolyte management, choice of anesthetics, and potential complications. This requires a thorough understanding of the excretory and fluid homeostatic functions of the kidney, particularly in the neonate and younger child. If not managed assiduously, perioperative renal dysfunction can deteriorate into renal failure or multiorgan system failure resulting in significant morbidity or mortality. The anesthesia provider must understand renal physiology, appropriate preoperative preparation, intraoperative management, and postoperative care of the child with renal disease.
To provide a realistic picture of the patient case load of a pediatric nephrologist in a teaching... more To provide a realistic picture of the patient case load of a pediatric nephrologist in a teaching hospital, we analyzed the number, the demographics, and the reasons for patient referral to our pediatric nephrology program over a 10-year period. Between January 1, 1978, and December 31, 1987, 1,523 pediatric patients were referred to the Medical College of Virginia for evaluation and treatment of renal and electrolyte disorders. The most common reason for referral was a fluid-electrolyte disorder (30%), followed by hematuria/proteinuria (22%), chronic glomerulonephropathies (10%), hypertension (5%), nephrotic syndrome (6%), end-stage renal disease (3%), urinary tract infections (5%), and acute glomerulonephritis (3%). More than 25% of the patients were under 1 year of age at initial presentation. The rest are equally distributed among the other pediatric age groups, including adolescents. Fifty-eight percent of these patients were white, and 41% were black. Males accounted for 54% o...
The lipid metabolic disorders in chronic renal insufficiency (CRI) are related to increased hepat... more The lipid metabolic disorders in chronic renal insufficiency (CRI) are related to increased hepatic lipid synthesis, reduced triglyceride removal coupled with insulin insensitivity and impaired lipoprotein lipase activity. Growth hormone is lipolytic, and the effects of recombinant human growth hormone (rhGH) on the hypercholesterolemia of CRI are unsettled. To test this question, we gave rhGH for 14 days at a dosage of 3 units/day intraperitoneally to two-stage, 5/6 nephrectomized, male Sprague-Dawley rats (n = 18) compared to sex- and age-matched control (n = 27) and CRI (n = 40) rats. At the end of the study, CRI rats and those treated with rhGH had a similar degree of renal impairment, as assessed by serum concentrations (mean +/- SEM) of urea nitrogen (49 +/- 3 vs. 54 +/- 4 mg/dl), creatinine (0.9 +/- 0.0 vs. 1.0 +/- 0.1 mg/dl) and cumulative food intake (311 +/- 8 vs. 290 +/- 12 g). Serum urea nitrogen (16 +/- 4 mg/dl) and creatinine (0.4 +/- 0.1 mg/dl) concentrations as well ...
Journal of the American College of Nutrition, 1996
This study was designed to assess sequentially the nutrient intake in children with chronic renal... more This study was designed to assess sequentially the nutrient intake in children with chronic renal insufficiency and its relationship to body size, the level of renal failure, and growth velocity. The nutrient intake from 401 4-day food records obtained from 120 children with renal insufficiency over a 6-month observation period was analyzed. The height and weight were measured at the beginning and end of the observation period. The glomerular filtration rate was estimated from the height and serum creatinine. The mean caloric intake in these children was 80 +/- 23% (mean +/- SD) of the Recommended Dietary Allowance (RDA) for age. Fifty-six percent of the food records obtained from these children revealed a caloric intake that was less than 80% of the RDA. Caloric intake expressed as the %RDA for age decreased with increasing age. However, the mean caloric intake when factored by body weight was in the normal range. There was no correlation between caloric intake and height velocity. The mean protein intake in these children was 153 +/- 53% of the RDA. Further, 45% of the food records indicated a protein intake greater than 150% of the RDA. There was no relationship between the degree of renal insufficiency and caloric or protein intake. Calcium, vitamin, and zinc intakes were also low. Children with chronic renal failure consume less calories than their age matched peers, but the majority of these children appear to ingest adequate amounts for their body mass. This reduction in caloric intake occurs early in renal insufficiency. They also ingest inadequate amounts of calcium, zinc, vitamin B6, and folate.
The incidence of pediatric renal stone disease is increasing dramatically, especially in teenager... more The incidence of pediatric renal stone disease is increasing dramatically, especially in teenagers. Whether measured by the number of emergency department visits, inpatient admissions or new referrals to a pediatric nephrology practice, there has been a three- to five-fold increase in the number of
Fanconi syndrome, also known as the DeToni, Debré, Fanconi syndrome is a global dysfunction of th... more Fanconi syndrome, also known as the DeToni, Debré, Fanconi syndrome is a global dysfunction of the proximal tubule characterized by glucosuria, phosphaturia, generalized aminoaciduria, and type II renal tubular acidosis. Often there is hypokalemia, sodium wasting, and dehydration. In children, it typically is caused by inborn errors of metabolism, principally cystinosis. In adults, it is mainly caused by medications, exogenous toxins, and heavy metals. Treatment consists of treating the underlying cause and replacing the lost electrolytes and volume.
... 3. Gretz N, Huber W, Gretz T, Kern M, Steiner E, Strauch M. Zur Anwendung mathematischer Mode... more ... 3. Gretz N, Huber W, Gretz T, Kern M, Steiner E, Strauch M. Zur Anwendung mathematischer Modell für die Verlaufsbeobachtung der chronischen Niereninsuffizienz . Nieren Hochdruckkrankh . ...Jess G. Thoene, MD University of Michigan, Ann Arbor, MI 48109. 6 References: 1. ...
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