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Protein-energy wasting in children with chronic kidney disease

Chinese Journal of Applied Clinical Pediatrics.2014;29(5):321-323. doi:10.3760/cma.j.issn.2095-428X.2014.05.001

Protein-energy wasting is a common complication in patients with chronic kidney disease and also an independent risk factor for poor prognosis.The pathogenesy and diagnosis of protein-energy wasting in children with chronic kidney disease,assessment of nutritional status were summarized.

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Application of rituximab therapy on refractory nephrotic syndrome in children

Jianping HUANG ; Juan DU

Chinese Journal of Applied Clinical Pediatrics.2014;29(5):324-326. doi:10.3760/cma.j.issn.2095-428X.2014.05.002

Primary nephrotic syndrome (PNS) is one of the most common forms of glomerular disorder in chil dren.It is reported that over 90％ of patients are due to minimal change disease and most respond to glucocorticoid (GC) therapy.However,76％-93％ cases have relapses and 40％-50％ frequently relapses nephritic syndrome or steroid dependent nephritic syndrome when steroid is tapered.Long-term courses of GC and immunosuppressant will place them at increased risk for severe side effects.Not all patients do respond to therapy.Although most reports on rituximab use in pediatric patients have not recognized significant side effects,the long-term adverse events of rituximab are not known.Thus,controlled long-term studies are required to be done to assess the risk-benefit profile of rituximab in childhood nephrotic syndrome.

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Introduction of diagnosis and treatment of lupus nephritis

Hongmei SONG ; Ji LI

Chinese Journal of Applied Clinical Pediatrics.2014;29(5):326-330. doi:10.3760/cma.j.issn.2095-428X.2014.05.003

Following great progress on the pathogenesis of lupus nephritis (LN) and publication of many high quality (prospective,randomized,multicenter) clinical trials of glucocorticoids-plus-immunosuppressive interventions,the American College of Rheumatology (ACR),European League Against Rheumatism (EULAR)/European Renal Association-European Dialysis and Transplant Association (ERA-EDTA),and Kidney Disease:Improving Global Outcomes (KDIGO) published or renewed in succession in 2012 special guidelines or recommendations for screening,casedefinition,treatment and management of LN.The paper introduces the key contents to provide reference for the clinical practice.

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Hui WANG ; Ying SHEN ; Ying LIANG

Chinese Journal of Applied Clinical Pediatrics.2014;29(5):330-332. doi:10.3760/cma.j.issn.2095-428X.2014.05.004

This article makes a summary on the vascular access issues related to pediatric blood purification and progress,especially in view of the characteristics,principles of selection,maintenance and development direction of various vascular access in application of children patients.

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Physiology and metabolism in perioperative blood transfusion therapy in pediatric patients

Xuewu JIANG ; Manqing YANG ; Lian MA

Chinese Journal of Applied Clinical Pediatrics.2014;29(6):401-403. doi:10.3760/cma.j.issn.2095-428X.2014.06.001

Blood transfusion therapy is widerly used in pediatric surgery as it's validity in many acute and chronic pediatric diseases.Compared to adults,pediatric perioperative transfusion therapy,particularly the approach to massive blood transfusion can be quite complex because of the unique physiologic characteristics.Perioperative transfusion therapy in children can cause significant metabolic disturbance,and further,cause severe complications.This paper presents an overview of the physiologic characteristics which related to pediatric perioperative transfusion therapy.And also the metabolisms related to massive perioperative blood transfusion in children.These may accordingly primarily useful to treat the pediatric patients.

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Perioperative transfusion of blood components in pediatric patients

Bo XIANG ; Zude CHEN ; Yiyang ZHAO

Chinese Journal of Applied Clinical Pediatrics.2014;29(6):404-405. doi:10.3760/cma.j.issn.2095-428X.2014.06.002

Circulatory state and metabolic homeostasis could be more easily disturbed during perioperative periods for children compared with those of adults especially when receiving massive transfusions.Patient's age would be an important factor for clinical evaluation if certain amount of blood was lost.Component transfusions have now gained wide recognitions.Specific blood components should be considered according to different diseases,which would make transfusion more accurate and blood resources used more efficiently.This article focused on the indications,doses and several specific issues for perioperative component transfusions among pediatric patients.

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Perioperative blood transfusion of coagulation factor deficiency in children

Lian MA ; Hongwu WANG ; Xuewu JIANG

Chinese Journal of Applied Clinical Pediatrics.2014;29(6):410-413. doi:10.3760/cma.j.issn.2095-428X.2014.06.004

Perioperative blood transfusion therapy for coagulation factor deficiency in children is very important to save patient's life or conducive to the postoperative recovery.With the advances in transfusion medicine,the cooperation through pediatric hematologists and surgeons in the perioperative period,more and more operation of children accompany coagulation factor deficiency can be safety finished.Different types of coagulation factor deficiency in children are treated by high-purity clotting factor,in order to correct abnormal coagulation factors levels.Clinical data showed that coagulation factor deficiency in children after proper treatment can be safely performed surgical procedure.

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Clinical characteristics and therapeutic strategy of severe craniocerebral injury in children

Gang YU ; Hao LONG

Chinese Journal of Applied Clinical Pediatrics.2014;29(6):413-415. doi:10.3760/cma.j.issn.2095-428X.2014.06.005

The chance of craniocerebral injury in children is high.Severe craniocerebral injury is still the difficult point in current clinical treatment.Children severe head trauma is different from adults.It is characteristic of severe primary injury,rapid progressing secondary injury,confusing vital signs,less contrecoup injury,high incidence of epilepsy,cerebral ischemia in familiar,and good prognosis.This article focused on 2 hot issues in recent therapeutic strategy of severe craniocerebral injury in children——intracranial pressure monitoring and hypothermia therapy.The former is simple,convenient,safe and practical,is worth popularizing widely.

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Analysis of relationship between stress hyperglycemia and variation of serum insulin in critical ill children

Bo YIN ; Guoping LU ; Zhujin LU ; Lingen ZHANG

Chinese Journal of Applied Clinical Pediatrics.2014;29(6):416-418. doi:10.3760/cma.j.issn.2095-428X.2014.06.006

Objective To study the relationships between the level of blood glucose in critical ill children with the degree of critical illness and the variation of immunoreactive insulin (IRI) and true insulin (TI).Methods Fiftyeight children form the Neonatal Intensive Care Unit (PICU) and Department of Respiration were enrolled in this study.The children were divided into PICU group (42 cases) and control group (16 cases).The PICU group were scored pediatric critical score in 24 hours after admission.The 42 critical ill children were divided into stress hyperglycemia group (20 cases) and non-stress hyperglycemia group (22 cases) according to their blood glucose levels.The IRI,TI,C-Peptide and blood glucose were measured.Results The pediatric critical illness score of stress hyperglycemia group [(74.80 ± 8.07) scores] was significantly lower than that of non-stress hyperglycemia group [(84.36 ±9.46) scores] (t =1.964,P ＜ 0.05).The death rate of stress hyperglycemia group (45.0％,9/20 cases) was significantly higher than that of non-stress hyperglycemia group (13.6％,3/22 cases) (x2 =5.05,P ＜ 0.05).The IRI,TI and C-Peptide of stress hyperglycemia group were significantly higher than those of non-stress hyperglycemia group and control group(F =136.90,61.25,45.89,all P ＜ 0.05).The TI/IRI of stress hyperglycemia group was significantly lower than that of non-stress hyperglycemia group and control group (F =27.64,P ＜ 0.05).The TI,IRI and C-Peptide of stress hyperglycemia group were higher than after admission (t =2.241,2.087,2.014,all P ＜ 0.05).Conclusions The children with critical illness have stress hyperglycemia and the component of insulin is changed,and the absolute level as well as the rate of TI and TI/IRI are descended.

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Effect of prostaglandin E1 lipid microsphere on cardiac haemodynamics and oxygen metabolism during the perioperative period in the infants with ventricular septal defect and severe pulmonary artery hypertension

Mu JIN ; Shuwen LI ; Jiakai LU ; Weiping CHENG

Chinese Journal of Applied Clinical Pediatrics.2014;29(6):470-473. doi:10.3760/cma.j.issn.2095-428X.2014.06.020

Objective To measure the effect of prostaglandin E1 (PGE1) lipid microsphere on cardiac haemodynamics and oxygen metabolism during the perioperative period in the infants with ventricular septal defect(VSD)and severe pulmonary artery hypertension (PAH).Methods Forty infants [(7.1 ± 3.3) years old] with VSD and severe PAH who underwent surgery under cardiopulmonary bypass were involved in the study.They were divided into 2 groups averagely:control group (20 cases) and experimental group (20 cases).All the patients were continuously intravenous pumping of nitroglycerin or PGE1 during the perioperative period.The effect of PGE1 on cardiac haemodynamics and oxygen metabolism between the 2 groups were measured during 72 hours postoperatively.Results The statistical analysis demonstrated that the values trend of mean arterial blood pressure (mABP),mean pulmonary arterial pressure (mPAP),mPAP/mABP,pulmonary vascular resistance index (PVRI),left ventricular stroke work index (LVSWI) were affected during 72 h postoperative period (P ＜0.05).The mABP at 48 h,LVSWI at 48 h,72 h in experimental group were significantly higher than those in control group (all P ＜0.05).The mPAP at 8 h,48 h,PVRI at 72 h and pulmonary arterial wedge pressure (PAWP)at 12-48 h in experimental group were significantly lower than that in control group (all P ＜ 0.05).Compared to postoperative period,mABP at 12 h,72 h,mPAP at 4-12 h,48 h were increased significantly in control group (P ＜ 0.05) ; mABP and LVSWI at 8-72 h,right ventricular stroke work index at 48 h,72 h and cardiac index at 72 h were significantly increased (P ＜0.05),while PVRI and PAWP at 72 h,mPAP/mABP at 24-72 h were significantly decreased in experimental group (P ＜ 0.05).There were no significant differences in the values of oxygen metabolism between both groups (P ＞0.05).Conclusions LipoPGE1 can significantly decrease the pulmonary arterial pressure,which can enhance cardiac function and decrease the duration of intubation after surgery.

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