RESUMEN
OBJECTIVES: To identify clinical variables predictive of the risk of thromboembolism (TE), and to confirm the incidence of TE in primary and secondary childhood nephrotic syndrome (NS). STUDY DESIGN: A comprehensive chart review identified 326 children with NS from any cause evaluated between 1999 and 2006. These patients had a total of 1472.8 patient-years of follow-up. Comparison statistics, survival analysis, and logistic regression were used to define TE epidemiology and clinical risk factors. RESULTS: We found that 9.2% of our cohort had experienced at least 1 TE. The overall incidence was 20.4 patients with TEs/1000 patient-years. The median time to the first TE was 70.5 days after diagnosis of NS. Deep venous thrombosis was the most common TE (76%) and was frequently associated with the use of a central venous catheter (45%). Significant independent predictors of TE included age > or = 12 years at onset of NS (P < .0001), severity of proteinuria (P < .0001), and history of TE preceding diagnosis of NS (P < .0001). Life- or limb-threatening TEs represented 23.7% of the events. CONCLUSIONS: Children with NS should be carefully followed for TE, particularly those who are age 12 years or older, have severe proteinuria, or have a previous history of TE.
Asunto(s)
Síndrome Nefrótico/epidemiología , Tromboembolia/epidemiología , Adolescente , Factores de Edad , Edad de Inicio , Cateterismo Venoso Central , Niño , Preescolar , Estudios de Cohortes , Creatinina/orina , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Michigan/epidemiología , Análisis Multivariante , Ohio/epidemiología , Proteinuria/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
We determined the dialytic clearance of amino acids involved in ammoniagenesis and nitrogen excretion in a neonate with argininosuccinate synthetase deficiency who underwent acute hemodialysis. Plasma ammonia and plasma and dialysate amino acid concentrations were obtained at baseline, 30-minute intervals during hemodialysis, and 30 minutes after the completion of hemodialysis. Plasma ammonia concentrations declined by 56% during the 90-minute hemodialysis treatment, whereas arginine, citrulline, glutamine, and glycine concentrations decreased by 65%, 55%, 40%, and 34%, respectively. Mean dialytic clearances for arginine, citrulline, glutamine, and glycine were 24, 282, 263, and 189 mL/min per 1.73 m(2), respectively. The high dialytic clearance of citrulline suggests a novel mechanism of hemodialysis removal of nitrogen. Dialytic clearances of glutamine and glycine may prevent further ammoniagenesis in hyperammonemic patients. However, our data suggest that hemodialysis affects the precursors of alternative pathway removal of ammonia. Further study is needed to optimize the intradialytic and interdialytic dosing of substrates.