Objective: To determine the effect of pre-operative isometric exercise (PIE) on vascular caliber of pediatric chronic kidney disease (CKD) Stage 2-5D patients. Materials and Methods: This is a single-blind, randomized, single-center trial of 28 CKD patients. Fourteen participants allocated in the intervention group (PIE) were provided with a handgrip device and performed handgrip exercise consisting of two sets of 30 contractions daily while another 14 participants did not perform the exercise and were considered as controls (NE). For both groups, Duplex Ultrasonography was performed at baseline, four and eight weeks post-intervention. Results: Twenty-four CKD patients were included and analyzed. The mean age was 15.8 (+/- 1.9) years. There were 16 (66.7%) females and eight (33%) Males, 10 (41.7%) underweight (<18 kg/m2 ), 23 (95.8%) right-handed, 12 (50%) with Chronic Glomerulonephritis, and 10 (41.7%) with stage 2 CKD. Both the intervention and control group revealed a statistically significant increase in the caliber of the non-dominant cephalic (ante-cubital) vein at four- and eight-weeks post-intervention. Conclusion PIE might not significantly impact vessel diameter in pediatric CKD population as compared to adult CKD patients. Further studies on reliability of ultrasonography of blood vessels utilizing a larger sample size and more controlled milieu are recommended.
Renal Insufficiency, Chronic

BACKGROUND: Amphotericin B is used in pediatrics for severe fungal infections despite its known nephrotoxic side effects. Tubular injury and renal vasoconstriction range from 15-58% with exact risk factors that predispose children to developing these complications still undefined. OBJECTIVES: To determine the risk factors for nephrotoxicity with deoxycholate Amphotericin B treatment among children 6 months-18 years old at the Philippine Children‘s Medical Center from 2006-2017 METHODS: This is a retrospective case-control study of 150 patients. Cases had decrease in eGFR by at least 25% and/or developed hypokalemia after at least one dose of Amphotericin. Those who did not develop nephrotoxicity were considered controls. Risk factors evaluated were age, sex, nutritional status, underlying medical condition, cumulative dose, concomitant use of nephrotoxic drugs used, treatment with diuretics and intravenous hydration. Results were analyzed using univariate and multivariate regression models. RESULTS: Using logistic regression, underlying malignancy had the highest odds ratio of 33.1 and nutritional status of z score=0 showed the lowest at 0.158. Duration of treatment >14 days had 1.75 times chance of developing nephrotoxicity while total cumulative dose >7.1 mg/kg had 1.5 times more chance of developing nephrotoxicity. Subjects given diuretics had 5.5 times more odds, while those not given concomitant nephrotoxic medications were 5.33% less likely to develop renal toxicity. CONCLUSION: Risk factors for nephrotoxicity were malignancy as an underlying medical condition, duration of amphotericin treatment of >14 days, cumulative dose >7.1 mg/kg and diuretic use. Normal nutritional status and no other concomitant nephrotoxic medication use had lesser odds of developing nephrotoxicity. RECOMMENDATIONS Clinicians should consider these risk factors, institute measures to monitor occurrence of nephrotoxicity and the need for alternative fungal therapy in these children. With identification of the population at risk, prospective research on determining the specific onset of renal effects and possible intervention is recommended.
Amphotericin B