The natural history of nephrocalcinosis in premature infants treated with loop diuretics.

PURPOSE: We investigated the natural history of nephrocalcinosis in premature infants treated with furosemide and attempted to identify factors to predict infants most at risk. MATERIALS AND METHODS: We evaluated 13 preterm infants in this longitudinal pilot study. During hospitalization and while receiving a loop diuretic nephrocalcinosis developed in each patient. Patients were divided into groups based on resolution (6) and nonresolution (7) according to spontaneous resolution of nephrocalcinosis at any point during followup. The 2 groups were compared to each other and to a control group. RESULTS: Mean followup after discontinuation of furosemide in the resolution versus nonresolution groups was 10.3 and 7.7 months, respectively. Between the 2 groups there was no significant difference in average gestational age, birth weight, number of days hospitalized or on furosemide, or total furosemide dose. Mean calcium-to-creatinine ratio while receiving furosemide at the time nephrocalcinosis developed was 0.38 in the resolution group but 2.23 in the nonresolution group (p < 0.005). Initial calcium-to-creatinine ratio in age matched infants who did not have nephrocalcinosis was 0.4. Frank renal stones developed in 2 of the 7 patients without resolution and 0 of the 6 with resolution. When nephrocalcinosis resolved, it was at a mean of 5.2 months following discontinuation of the diuretic. CONCLUSIONS: Early data indicate that nephrocalcinosis resolves in approximately 50% of premature infants 5 to 6 months after discontinuation of furosemide. The only factor that appears to be predictive of the infants who will have resolution is the calcium-to-creatinine ratio when nephrocalcinosis is diagnosed. In patients without resolution this ratio is much higher than in age adjusted normal controls, while in those with resolution it appears normal for age.

Management of the patient receiving simultaneous kidney-pancreas transplantation.

For patients with severe diabetes complicated by renal failure, simultaneous kidney-pancreas transplantation offers some hope. The National Dialysis and Kidney Transplantation Study reports that transplant patients have a higher quality of life, higher employment, and higher perceived health beliefs than patients on dialysis. With this thought in mind, simultaneous kidney-pancreas transplantation can be seen as an appropriate and attractive alternative. That is, simultaneous kidney-pancreas transplantation is a viable option for the patient with type I diabetes mellitus and ESRD.

Simultaneous kidney-pancreas transplantation.

Simultaneous kidney-pancreas transplantation has emerged as a viable option for a select population of patients with type I diabetes mellitus and end stage renal disease. Nurses caring for this type of patient must be knowledgeable about the intricacies of the procedure. This article reviews indications for kidney-pancreas transplantation, selection criteria for both donors and recipients, organ procurement and transplant surgical procedures, potential postoperative complications, nursing considerations, and the impact this treatment modality has on the management of the patient with insulin-dependent diabetes mellitus.

OKT 3: nursing considerations for use in acute renal transplant rejection.

The development of monoclonal antibodies represents a significant biomedical advancement. The increasing use of muromonab-CD3 (Orthoclone OKT 3) for the treatment of acute rejection requires that the health care professional has a thorough understanding of its effects and regimen for proper and safe administration. This article reviews monoclonal antibody production and administration with an emphasis placed on the nursing implications associated with the use of OKT 3 in acute renal transplant rejection.