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Browsing by Author "Vidal, E"

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  • Aetiology, Course and Treatment of Acute Tubulointerstitial Nephritis in Paediatric Patients: a Cross-Sectional Web-Based Survey
    Publication . Wente-Schulz, S; Aksenova, M; Awan, A; Ambarsari, CG; Becherucci, F; Emma, F; Fila, M; Francisco, T; Gokce, I; Gülhan, B; Hansen, M; Jahnukainen, T; Kallash, M; Kamperis, K; Mason, S; Mastrangelo, A; Mencarelli, F; Niwinska-Faryna, B; Riordan, M; Rus, RR; Saygili, S; Serdaroglu, E; Taner, S; Topaloglu, R; Vidal, E; Woroniecki, R; Yel, S; Zieg, J; Pape, L
    ackground: Acute tubulointerstitial nephritis (TIN) is a significant cause of acute renal failure in paediatric and adult patients. There are no large paediatric series focusing on the aetiology, treatment and courses of acute TIN. Patients, design and setting: We collected retrospective clinical data from paediatric patients with acute biopsy-proven TIN by means of an online survey. Members of four professional societies were invited to participate. Results: Thirty-nine physicians from 18 countries responded. 171 patients with acute TIN were included (54% female, median age 12 years). The most frequent causes were tubulointerstitial nephritis and uveitis syndrome in 31% and drug-induced TIN in 30% (the majority of these caused by non-steroidal anti-inflammatory drugs). In 28% of patients, no initiating noxae were identified (idiopathic TIN). Median estimated glomerular filtration rate (eGFR) rose significantly from 31 at time of renal biopsy to 86 mL/min/1.73 m2 3-6 months later (p<0.001). After 3-6 months, eGFR normalised in 41% of patients (eGFR ≥90 mL/min/1.73 m2), with only 3% having severe or end-stage impairment of renal function (<30 mL/min/1.73 m2). 80% of patients received corticosteroid therapy. Median eGFR after 3-6 months did not differ between steroid-treated and steroid-untreated patients. Other immunosuppressants were used in 18% (n=31) of patients, 21 of whom received mycophenolate mofetil. Conclusions: Despite different aetiologies, acute paediatric TIN had a favourable outcome overall with 88% of patients showing no or mild impairment of eGFR after 3-6 months. Prospective randomised controlled trials are needed to evaluate the efficacy of glucocorticoid treatment in paediatric patients with acute TIN.
    2021Journal article Open access Show more
  • Associations of longitudinal Height and Weight with Clinical Outcomes in Pediatric Kidney Replacement Therapy: Results from the ESPN/ERA Registry
    Publication . Bonthuis, M; Bakkaloglu, SA; Vidal, E; Baiko, S; Braddon, F; Errichiello, C; Francisco, T; Haffner, D; Lahoche, A; Leszczyńska, B; Masalkiene, J; Stojanovic, J; Molchanova, MS; Reusz, G; Barba, AR; Rosales, A; Tegeltija, S; Ylinen, E; Zlatanova, G; Harambat, J; Jager, KJ
    Background: Associations between anthropometric measures and patient outcomes in children are inconsistent and mainly based on data at kidney replacement therapy (KRT) initiation. We studied associations of height and body mass index (BMI) with access to kidney transplantation, graft failure, and death during childhood KRT. Methods: We included patients < 20 years starting KRT in 33 European countries from 1995-2019 with height and weight data recorded to the ESPN/ERA Registry. We defined short stature as height standard deviation scores (SDS) < -1.88 and tall stature as height SDS > 1.88. Underweight, overweight and obesity were calculated using age and sex-specific BMI for height-age criteria. Associations with outcomes were assessed using multivariable Cox models with time-dependent covariates. Results: We included 11,873 patients. Likelihood of transplantation was lower for short (aHR: 0.82, 95% CI: 0.78-0.86), tall (aHR: 0.65, 95% CI: 0.56-0.75), and underweight patients (aHR: 0.79, 95%CI: 0.71-0.87). Compared with normal height, patients with short and tall statures showed higher graft failure risk. All-cause mortality risk was higher in short (aHR: 2.30, 95% CI: 1.92-2.74), but not in tall stature. Underweight (aHR: 1.76, 95% CI: 1.38-2.23) and obese (aHR: 1.49, 95% CI: 1.11-1.99) patients showed higher all-cause mortality risk than normal weight subjects. Conclusions: Short and tall stature and being underweight were associated with a lower likelihood of receiving a kidney allograft. Mortality risk was higher among pediatric KRT patients with a short stature or those being underweight or obese. Our results highlight the need for careful nutritional management and multidisciplinary approach for these patients. A higher resolution version of the Graphical abstract is available as Supplementary information.
    2023Journal article Open access Show more