Renal transplantation in familial dysautonomia: report of two cases and review of the literature.

BACKGROUND AND OBJECTIVES: Chronic kidney disease (CKD) is an increasingly recognized complication of familial dysautonomia (FD), a neurodevelopmental disorder with protean systemic manifestations that are the result of sensory and autonomic dysfunction. Progressive renal dysfunction occurs due to chronic volume depletion and cardiovascular lability with supine hypertension and orthostatic hypotension. By age 25, nearly one-half of all patients with FD will have reached stage 3 CKD. Furthermore, dialysis for ESRD in FD patients is associated with multiple complications and poor outcomes. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS: We report two patients with FD who developed ESRD at ages 27 and 16, respectively, and underwent renal transplantation. Transplant was performed after 3 months on intermittent hemodialysis (HD) in the first case and after 1 month on twice-weekly continuous veno-venous hemodialysis (CVVHD) in the second case. RESULTS: Both patients tolerated surgery well and have maintained good graft function at 20 and 24 months posttransplantation, respectively. Symptomatic and functional improvements have included lower supine BP and increased sensitivity to antihypertensive agents. CONCLUSIONS: As general supportive care improves the lifespan of FD patients, issues related to the management of ESRD will become more important. Renal transplantation provides a viable alternative to dialysis for FD patients with ESRD.

Application of ICP-MS as a multi-element detector for sulfur and metal hydride impurities in hydrocarbon matrices.

Maturation of inductively coupled plasma-mass spectrometry (ICP-MS) in terms of size, reliability, and cost has had a significant impact on its consideration as a viable detector for gas chromatography. Its generally excellent sensitivity for those elements it can measure has been a contributing factor. A method for sulfur speciation in various hydrocarbon products is investigated, as well as sulfur and metal hydride contaminants in high purity hydrocarbon feed stocks. Detection limits for sulfur species in hydrocarbon liquids and gases are approximately 5 and 10 ppb, respectively, as sulfur. Lower detection limits on the order of 100 parts per trillion are achieved for arsine. The use of collision cell technology (CCT) is exploited to remove interferences. CCT has been described elsewhere (1) using helium or helium-hydrogen mixtures for suppression of (16)O(16)O(+) interference with (32)S. In this work, a novel approach is investigated which uses oxygen to remove this interference by shifting it in a comprehensive fashion. The advantage of operating the system at full power with a tandem gas and liquid interface is also discussed.

Hypothesis: Dent disease is an underrecognized cause of focal glomerulosclerosis.

BACKGROUND AND OBJECTIVES: Dent disease is a hereditary form of progressive renal failure characterized by hypercalciuria and proximal tubular dysfunction. The clinical presentation is often insidious with the majority of patients remaining asymptomatic throughout childhood. Despite the seemingly mild, early course, more than 20% of 32 asymptomatic patients in one study had biopsy evidence of focal glomerulosclerosis. Furthermore, end-stage renal disease often occurs in men in early to middle adulthood. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This article describes two male patients who presented with asymptomatic proteinuria and were found to have focal glomerulosclerosis. Despite the absence of nephrocalcinosis on renal ultrasound, the diagnosis of Dent disease was considered because of unexplained proteinuria. Subsequent history revealed renal calculi in each maternal family. RESULTS: The clinical diagnosis of Dent disease was established by intermittent hypercalciuria and low molecular weight proteinuria and confirmed through mutational analysis. CONCLUSIONS: It is hypothesized that a diagnosis of Dent disease may be unrecognized in patients with unexplained proteinuria and idiopathic focal glomerulosclerosis.

Developments with anion exchange stationary phases for HPLC-ICP-MS analysis of antimony species.

Novel HPLC-ICP-MS methodologies are developed using strong anion exchange (Phenomenex SAX-SB) and weak anion exchange (Alltec HAAX) stationary phases in conjunction with a range of aqueous mobile phases to enable simultaneous separations of inorganic Sb(III), Sb(V) and organic trimethylantimony dichloride (TMSb) species in synthetic solutions. Optimum isocratic separations of inorganic Sb(V) and Sb(III) species are achieved using mobile phases comprised of ammonium tartrate under controlled pH conditions, and rapid pH gradient elution profiles are developed to facilitate separations of the Sb(V), Sb(III) and TMSb species in a single chromatographic run. Optimum peak resolution is achieved when using the 100 x 4.6 mm HAAX column at 20 degrees C and 100 mM ammonium tartrate mobile phases with a gradient from pH 3.0 to pH 1.2, although a system peak co-elutes with TMSb under these conditions and precludes quantitative analyses. Interestingly, the elution order of Sb(V), Sb(III) and TMSb species reverses when the temperature of the HAAX stationary phase is increased to 60 degrees C, and concurrent use of a less acidic pH gradient elution profile from pH 2.3 to pH 1.5 is shown to enable successful species separations whilst preventing occurrence of the co-eluting system peak. Limits of detection are achieved in the sub ng mL(-1) range using these novel HPLC-ICP-MS methodologies and provide scope for future environmental analysis applications.

Long versus standard initial steroid therapy for children with the nephrotic syndromeA report from the Southwest Pediatric Nephrology Study Group.

A retrospective cohort study was conducted by the Southwest Pediatric Nephrology Study Group (SPNSG) to address whether a longer initial course of corticosteroids in patients with idiopathic nephrotic syndrome (INS) provides superior protection against relapse without increased adverse effects. In order to be included in the evaluation, patients with INS must have responded to an initial steroid course, either standard or long regimen as defined here, and completed at least 1 year of follow-up. The standard regimen consisted of prednisone 2.0+/-0.3 mg/kg per day or 60+/-10 mg/m(2) per day for 28+/-4 days, followed by alternate-day prednisone for 4-12 weeks. The long regimen consisted of daily prednisone 2.0+/-0.3 mg/kg per day or 60+/-10 mg/m(2) per day for 42+/-6 days, followed by alternate-day prednisone for 6-14 weeks. The primary outcome measure was relapse of NS within 12 months of discontinuing the initial course of prednisone. There were 151 children who met the criteria for the study; 82 received the standard regimen and 69 the long regimen. The two groups did not differ in age, race, blood pressure, serum albumin, or serum cholesterol prior to the initial steroid course. The cumulative prednisone dose was 49% higher in the long regimen group than in the standard regimen group. Relapse within 12 months was reported in 72.5% of patients who received the long regimen versus 84.1% of those who received the standard regimen. The odds ratio for relapse within 12 months was 0.496 (95% confidence interval 0.22, 1.088), long versus standard regimen. This did not reach statistical significance ( chi(2)=3.058, P=0.08). The odds ratio of experiencing at least one side effect was 3.76, long relative to standard regimen ( n=133, P<0.001). Our data suggest that prolongation of the steroid treatment for the initial episode of steroid-sensitive NS may have a beneficial effect, but at the cost of increased side effects. However, definitive conclusions are limited by the retrospective design of the study and the number of patients. This may have caused failure to achieve statistical significance on the basis of a type II error.