Outcomes of Early Simultaneous Removal of Ureteric Stent With Indwelling Urethral Catheter After Kidney Transplant in Pediatric Recipients: A 10-Year Review.

OBJECTIVES: A ureteric stent is routinely placed to minimize urological complications during kidney transplant. However, some complications may occur in association with the ureteric stent, such as urinary tract infections, and the optimal duration for stent placement is unclear. We reviewed the outcomes following early simultaneous removal of the ureteric stent with the urethral catheter in pediatric kidney transplant recipients. MATERIALS AND METHODS: We reviewed all kidney transplants from January 2009 to January 2019. The data we collated included demographics, donor and recipient characteristics, and perioperative details, including urological complications, stent-related complications, and kidney graft function. The financial cost of late stent removal was calculated. The early stent removal group was defined as 5 days, and the late removal group was about 4 to 6 weeks. The median follow-up time was 60 months (interquartile range, 31.5-91 months). RESULTS: There were 32 transplants in 31 patients during the study period (early vs late group = 23:9). No urine leak occurred in either group. One patient in the early group developed distal ureteric stenosis, and this condition was managed with interventional balloon dilatation. The median time for stent removal was 6 days in the early group and 39 days in the late group. There were 5 episodes of symptomatic urinary tract infections in 3 patients in the early group and 10 episodes of symptomatic urinary tract infections in 3 patients in the late group. The mean estimated glomerular filtration rate at 12 months was comparable between the 2 groups (84 ± 54 vs 64 ± 21 L/min/1.73 m²; P = .3). The average cost for each early removal was A$772.65 compared with the late group. CONCLUSIONS: Early simultaneous removal of the ureteric stent with the urethral catheter in pediatric kidney transplant recipients is feasible, safe, and cost-effective.

Metabolite diagnosis of primary hyperoxaluria type 3.

BACKGROUND: Primary hyperoxaluria type 3 (PH3) is a recently described cause of childhood renal calculi. It results from mutations in the HOGA1 gene and most cases have been diagnosed after clinical ascertainment, exclusion of other genetic hyperoxalurias and mutation testing. Metabolite testing has not been widely applied but holds promise for the rapid screening and diagnosis of patients who are not specifically suspected to have PH3. CASE-DIAGNOSIS/TREATMENT: Two cases presented with renal calculi. Urine metabolite testing by tandem mass spectrometry was performed as part of the routine diagnostic work-up for this condition. Both had significantly increased levels of the PH3 urine marker 4-hydroxyglutamate and related metabolites. The diagnosis of PH3 was confirmed by the finding of bi-allelic damaging HOGA1 mutations. CONCLUSIONS: Urine screening by tandem mass spectrometry is a rapid, high-throughput test that can detect PH3 cases that may otherwise not be diagnosed.

4-hydroxyglutamate is a biomarker for primary hyperoxaluria type 3.

Primary hyperoxaluria type 3 (PH3) is a recently identified inborn error of 4-hydroxyproline metabolism causing kidney stone disease. Diagnosis to date has relied on mutation detection. The excretion of 4-hydroxyglutamate (4OHGlu) was investigated in controls and a cohort of nine patients with PH3 and their parents using flow injection tandem mass spectrometry. 4OHGlu was stable in acidified urine samples and was not influenced by diet. Its measurement was readily incorporated into an existing multi-analyte panel for comprehensive screening for inborn errors of metabolism. There was a steady decline with age in 4OHGlu levels, expressed as µmol/mmol of creatinine, in controls. Levels in patients with PH3 ranged from 6.5 to 98 µmol/mmol of creatinine and were all significantly increased when compared to age-matched controls (<4.2). Levels in eight parents (obligatory carriers of the corresponding mutation) were moderately, but significantly increased, ranging from 0.6 to 2.5 (age-matched controls <1.4, p = 0.03). Urine 4OHGlu screening was used to prospectively diagnose PH3 in an 18-month-old boy with calcium oxalate kidney stone disease associated with hyperoxaluria. 4OHGlu was also increased in a stored newborn screening dried blood spot sample from this child (37 µmol/L, controls <2.53). 4OHGlu testing provides a robust and high-throughput biochemical screen for PH3.

Treating trismus with dynamic splinting: a case report.

Trismus is a pathological condition of the muscles of mastication which commonly affects patients who have undergone dental procedures, oral surgery, and radiation therapy for head and neck cancer. The purpose of this case report is to describe the use of dynamic splinting, a noninvasive modality to reduce trismus which occurred in a patient following multiple dental procedures. A 26 year old man of African descent was referred for severe trismus and pain following three dental procedures on the lower right molars. The patient presented with Maximal Interincisal (opening) Distance (MID) of only 5mm and mastication muscle spasticity. Following physical therapy (massage, ultra sound, NMES, moist heat) three times per week for two months and additional treatment of dynamic splinting for four weeks (TID) the patient increased his MID to 52 mm and returned to normal eating and speaking.

The Fremantle lead study part 2.

AIM: A 1993 study of blood lead levels (BLLs) in pre-schoolers living in Fremantle showed 25% had BLLs >or= 10 microg/dL. This study compares the 1993 BLLs with a sample of contemporary Fremantle pre-schoolers. METHODS: Pre-schoolers (0-5 years) living in the Fremantle area were recruited from hospital and community settings during 2005. As in the 1993 study, guardians completed a questionnaire concerning demographic, environmental and behavioural variables. BLLs were determined by the same method used in 1993. Statistical analysis compared the 1993 and 2005 samples according to demographic variables and dichotomised BLL. Multivariate linear regression was used to control for confounding variables, and linear regression was used to identify risk factors in the 2005 sample. RESULTS: Community (40) and hospital (60) participants provided blood and completed questionnaires; none had BLLs >or=10 microg/dL. Compared with the 1993 sample, 2005 participants were younger, fewer were aboriginal, more had occupied their homes for over 6 months and more had a habit of putting soil in their mouths. After controlling for these variables, the geometric mean BLL in 2005 remained significantly lower than the 1993 value (1.83 and 6.82 microg/dL respectively). As in 1993, aboriginality, presence of participants during home renovation, occupancy of home less than 6 months and living <200 m from a main road were associated with higher mean BLLs. CONCLUSIONS: The reassuring decline in the mean BLL between the1993 and 2005 samples is likely associated with the phasing out of leaded petrol. Future research should concentrate on monitoring groups at higher risk.

Blood pressure measurements on children in the emergency department.

BACKGROUND: There is no consensus on routine blood pressure (BP) measurement for children presenting to the ED. By contrast, BP measurements are performed routinely in adult ED. With increasing childhood obesity, and the knowledge that elevated BP in childhood correlates with hypertension in adulthood, routine BP measurement in children should be considered. OBJECTIVE: To review the current practice of BP measurement in children presenting to the ED of Princess Margaret Hospital for Children, Perth, Western Australia, a tertiary referral paediatric centre. METHOD: A prospective observational study of 504 children presenting to the ED over a 6 month period in 2003. RESULTS: In total, 114 children (22.6%) had their BP measured. A total of 35 (30.7%) had a BP above the 95th percentile for age and sex. In total, 19 (54.3%) of 35 with abnormal BP had their BP remeasured. Only one child of 10 with consecutive hypertensive measurements was followed up. BP measurement was more common in children aged 2 years and above, and in higher triage category patients. CONCLUSIONS: The present study demonstrates that BP measurement in the ED is both relatively infrequent and inconsistent. Further research into this area is required to determine the usefulness and feasibility of routine BP measurements in children presenting to the ED. This might improve the quality of health care and positively impact on public health for the future.

Management of septic shock in childhood.

OBJECTIVE: The object of this review is to discuss the recognition and treatment of septic shock in children based on principles of resuscitation, antibiotic use and recent therapeutic advances. METHODS: A comprehensive literature search combining these METHODS: on-line searches of Ovid, PubMed, and Medline; hand searches of 25 international journals; a trawl of 26 textbooks; searches of reference lists of pertinent articles; and scans of abstracts of recent international meetings. Various national and international units were contacted with regard to current research therapeutic strategies, both published and unpublished. CONCLUSIONS: Septic shock remains a leading cause of morbidity and mortality in children. Early administration of empirical antibiotic therapy reduces mortality. The keystone of resuscitation is aggressive volume replacement. Adjunctive therapies to modulate the inflammatory response may further enhance outcome, but do not replace principles of resuscitation.

Successful induction and maintenance of long-term remission in a child with chronic relapsing autoimmune hemolytic anemia using rituximab.

Childhood autoimmune hemolytic anemia (AIHA) of the warm type is usually successfully managed with corticosteroids and/or immunoglobulin infusions. In a small proportion of patients AIHA follows a more severe and protracted pathway resulting in the use of immunosuppressive therapy and frequently culminating with the need for splenectomy. Rituximab is an anti-CD20 (B-cell) monoclonal antibody used for the treatment of patients with relapsed or refractory low-grade or follicular, CD20 positive, B-cell non-Hodgkin's lymphoma. Case reports on the use of rituximab for childhood AIHA are scant. The authors describe the first report in which rituximab was effectively employed to induce a long-term remission in a young child with the longest history of chronic relapsing AIHA prior to receiving rituximab. All immunosuppressive therapy was successfully discontinued and splenectomy was avoided.