ABSTRACT
BACKGROUND: Vitamin D plays an important role in the mineral and bone disorder seen in chronic kidney disease (CKD). Deficiency of 25-hydroxyvitamin D (25OHD) is highly prevalent in the adult CKD population. METHODS: The prevalence and determinants of 25OHD deficiency (defined as a level <20 ng/ml) were examined longitudinally in 506 children in the CKiD cohort. Predictors of secondary hyperparathyroidism and the determinants of 1,25-dihydroxyvitamin D (1,25(OH)2D) levels were also evaluated. RESULTS: Deficiency of 25OHD was observed in 28 % of the cohort at enrollment. Significant predictors of 25OHD deficiency were older age, non-white race, higher body mass index, assessment during winter, less often than daily milk intake, non-use of nutritional vitamin D supplement and proteinuria. Lower values of glomerular filtration rate (GFR), serum 25OHD, calcium and higher levels of FGF23 were significant determinants of secondary hyperparathyroidism. Lower GFR, low serum 25OHD, nephrotic-range proteinuria, and high FGF23 levels were significant determinants of serum 1,25(OH)2 D levels. CONCLUSIONS: Deficiency of 25OHD is prevalent in children with CKD and is associated with potentially modifiable risk factors such as milk intake, nutritional vitamin D supplement use, and proteinuria. 25OHD deficiency is a risk factor for secondary hyperparathyroidism and decreased serum 1,25(OH)2D in children with CKD.
Subject(s)
Renal Insufficiency, Chronic/epidemiology , Vitamin D Deficiency/epidemiology , Vitamin D/analogs & derivatives , Adolescent , Age Factors , Animals , Biomarkers/blood , Body Mass Index , Child , Child, Preschool , Dietary Supplements , Female , Fibroblast Growth Factor-23 , Humans , Hyperparathyroidism, Secondary/blood , Hyperparathyroidism, Secondary/diagnosis , Hyperparathyroidism, Secondary/epidemiology , Infant , Longitudinal Studies , Male , Milk , North America/epidemiology , Nutritional Status , Parathyroid Hormone/blood , Prevalence , Prognosis , Prospective Studies , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/therapy , Risk Assessment , Risk Factors , Seasons , Time Factors , Vitamin D/blood , Vitamin D Deficiency/blood , Vitamin D Deficiency/diagnosis , Vitamin D Deficiency/therapyABSTRACT
The present study investigated the impact of a manualized high school transition program, the Peer Group Connection (PGC) program, on the graduation rate at a low-income, Mid-Atlantic high school. The program utilized twelfth grade student peer leaders to create a supportive environment for incoming ninth grade students. Results of a randomized control trial demonstrated that male students who participated in the program during ninth grade were significantly more likely to graduate from high school within four years than male students in the control group (81% versus 63%). Findings suggest that peers can be effective in delivering a school-based, social emotional learning intervention and that it is possible to intervene in the ninth grade to influence the probability of high school graduation.
ABSTRACT
BACKGROUND: Focal segmental glomerulosclerosis (FSGS) recurs in 20-40 % of allografts. Plasmapheresis (TPE) has been one of the mainstays of treatment with variable results. Rituximab (RTX), a monoclonal antibody to the protein CD20, is being used for treatment of recurrent FSGS (recFSGS) but pediatric experience is limited. METHODS: We conducted a retrospective review of eight patients with recFSGS, treated with RTX (1-4 doses) after having minimal response to TPE. Complete response was defined as a decrease in urine protein creatinine ratio (Up/c) to less than 0.2 and partial response was a decrease in Up/c ratio by 50 % of baseline and in the sub-nephrotic range (U p/c <2). RESULTS: Complete response was seen in two of eight patients, and partial response was seen in four of eight patients. Two patients had no response. At last follow-up, all the partial responders had sub-nephrotic range proteinuria (Up/c ratios ranging from 0.29 to 1.6). Delayed response, up to 9 months post-RTX, was also seen in some of the patients. Significant complications such as rituximab-associated lung injury (RALI), acute tubular necrosis, and central nervous system(CNS) malignancy were also observed in our case series. CONCLUSIONS: Rituximab can be used with caution as a treatment for recFSGS. Efficacy is variable from none to complete response. Even partial reduction in proteinuria is of benefit in prolonging the life of the allograft. Long-term, multicenter studies are needed to prove its sustained efficacy in those who respond and to monitor for serious adverse effects.
Subject(s)
Antibodies, Monoclonal, Murine-Derived/therapeutic use , Glomerulosclerosis, Focal Segmental/drug therapy , Immunologic Factors/therapeutic use , Kidney Transplantation , Adolescent , Child , Child, Preschool , Female , Glomerulosclerosis, Focal Segmental/complications , Glomerulosclerosis, Focal Segmental/therapy , Humans , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/surgery , Male , Plasmapheresis , Proteinuria/etiology , Recurrence , Retrospective Studies , Rituximab , Treatment OutcomeABSTRACT
Little is known about the effects of thalassaemia on the kidney. Characterization of underlying renal function abnormalities in thalassaemia is timely because the newer iron chelator, deferasirox, can be nephrotoxic. We aimed to determine the prevalence and correlates of renal abnormalities in thalassaemia patients, treated before deferasirox was widely available, using 24-h collections of urine. We calculated creatinine clearance and urine calcium-to-creatinine ratio and measured urinary ß(2) -microglobulin, albumin, and protein. We used multivariate modelling to identify clinical, therapeutic, and laboratory predictors of renal dysfunction. One-third of thalassaemia patients who were not regularly transfused had abnormally high creatinine clearance. Regular transfusions were associated with a decrease in clearance (P = 0·004). Almost one-third of patients with thalassaemia had hypercalciuria, and regular transfusions were associated with an increase in the frequency and degree of hypercalciuria (P < 0·0001). Albuminuria was found in over half of patients, but was not consistently associated with transfusion therapy. In summary, renal hyperfiltration, hypercalciuria, and albuminuria are common in thalassaemia. Higher transfusion intensity is associated with lower creatinine clearance but more frequent hypercalciuria. The transfusion effect needs to be better understood. Awareness of underlying renal dysfunction in thalassaemia can inform decisions now about the use and monitoring of iron chelation.
Subject(s)
Kidney Diseases/etiology , Thalassemia/complications , Adolescent , Adult , Aged , Albuminuria/etiology , Blood Urea Nitrogen , Calcium/urine , Child , Creatinine/blood , Cross-Sectional Studies , Female , Humans , Hypercalciuria/etiology , Kidney Diseases/blood , Kidney Diseases/urine , Male , Middle Aged , Proteinuria/etiology , Thalassemia/blood , Thalassemia/therapy , Thalassemia/urine , Transfusion Reaction , Young Adult , beta 2-Microglobulin/urineABSTRACT
To explore what mediates relationships between coping styles and substance use, different types of coping, proximal precursors of substance use, and reported substance use/intentions to use were examined in a study of low income, urban, high school freshmen from American ethnic minority groups. Regression analyses showed evidence for two mediators. The relationship between a tendency to depend upon parents to cope with problems and increased substance use was mediated by lowered perceptions of harm from use. The relationship between a tendency to use substances to cope with problems and increased substance use was mediated by increased tolerance for and use by friends.