By: D2- Gil Legarda/ Joanalyn Balino
INTRAPERITONEAL CALCITRIOL IN INFANTS ON PERITONEAL DIALYSIS
Francisco J. Cano,1 Marta A. Azocar,1 Jose Luis Guerrero,1 Maria A. Delucchi,1 Ana Maria Lillo,1 Marcos Emilfork,2 and Eugenio E. Rodríguez1
This research study is done in an experimental design. The purpose of this study is to assess the safety, effectiveness and efficacy of the intraperitoneal calcitrol for infants undergoing peritoneal dialysis. The researcher used a purposive sampling just to study the efficacy and safety of Intraperitoneal calcitrol use for infants undergoing peritoneal dialysis. There were 6 infants undergoing domiciliary peritoneal dialysis included in this research study. This study used a multi stage random sampling, the patients undergoing peritoneal dialysis is the big cluster and the infants using intraperitoneal calcitrol in peritoneal dialysis is the small cluster. The protocol for the subjects to be included in the study should have an iPTH plasma level less than 1000 pg/mL for the past 3 months follow up check up. Patients excluded in this study are those who had any conditions such as peritonitis for 2 months previous to the entry, intestinal absorption disease, nephrotic syndrome, endocrine or metabolic disease, chronic diarrhea,allergic reaction to calcitrol or other Vitamin D compound, serum calcium level and plasma phosphate. The settings of this study held inLuis Calvo Mackenna Children’s Hospital, University of Chile. The residual kidney function was measured in a 24-hour urine sample. A urine collection pad was installed and connected to a urine-collecting bag system on an outpatient basis until the next day, when the patient was cited again to the hospital with the collected 24-hour sample. If the collected sample was not reliable, the procedure was repeated for a second time. If it failed again, a Foley catheter was installed for 24 hours under antibiotic prophylaxis therapy. Growth hormone was not used before or during the study in any patient included in this protocol. Biochemical determinations were done before starting IP calcitriol and at monthly intervals over a 12-month follow-up. Gathered data were reported as mean ± standard error. The Wilcoxon signed rank test was used to assess differences in the measurements for each pair of values. The interval differences between median in terms of confidence was 96.9 percent.
There are 6 male children on peritoneal dialysis range 7 to 18 months were included. All the patients completed the 12 months of follow up. 12 hypercalcemic episodes were observed during therapy and serum phosphorus was found to be higher then DOQI recommendation on 10 occasions. After 9 months of therapy the serum iPTH levels showed a significant decrease although the said decrease was found each month.
As the main therapy for secondary hyperparathyroidism in end stage renal disease, calcitrol has been long used especially in those patients having dialysis. Most of the pediatric patient manifest a high turnover bone disease with a high iPTH plasma levels and enhanced number of osteoclast leading to increased bone resorption and growth failure. This condition often progresses therefore an alternative therapeutic intervention has been used to improve the clinical and biochemical response to active vitamin D. The present study was planned to determine whether P administration of calcitriol would be a more effective and safer treatment of secondary hyperparathyroidism than oral administration in PD infants with high iPTH levels. The results showed that IP administration was safe and effective for suppressing hyperparathyroidism in these patients.
Cano, J. et. al. ( 2007). Intraperitoneal calcitrol in infants on peritoneal dialysis. Peritoneal Dialysis International Vol 27 pages 681-686.Retrieved June 22,2009 from http://www.pdiconnect.com/cgi/reprint/27/6/681?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&searchid=1&FIRSTINDEX=0&minscore=5000&resourcetype=HWCIT
Goodman W, Coburn J, Slatopolsky E, Salusky I. (1999) Renal Osteodystrophyin adults and children Lippincott Williams & Wilkins347–63.
Malluche HH, Faugere M.(1990) Renal bone disease. An unmet challenge for the nephrologist. Kidney Int ; 38: 193–211.
Kuizon B, Salusky I.(2002) Cell biology of renal osteodystrophy. Pediatr Nephrol 17:777–89.
Coburn J.(2003) An update on vitamin D as related to nephrology practice:. Kidney Int Suppl 87:S125–30..
2ND POSTING MEDICATION
By: D2- Gil Legarda and Joanalyn Balino
Title: Repetitive Fragmentation Products of Albumin and
α1-Antitrypsin in Glomerular Diseases Associated with
Giovanni Candiano,* Luca Musante,*† Maurizio Bruschi,*† Andrea Petretto,‡
Laura Santucci,*† Piero Del Boccio,§_¶ Barbara Pavone,§_¶ Francesco Perfumo,**
Andrea Urbani,§_¶ Francesco Scolari,†† and Gian Marco Ghiggeri*
There were 23 participants involved in the study. These patients have nephrotic syndrome and have different pathologic backgrounds. Clinical data and renal histology are the basis of diagnosis. The criteria were there should be a presence of nephrotic syndrome (proteinuria >40 mg/h per m2) with onset at less than 16 yr of age and in cases of steroid dependence and/or resistance, availability of a renal biopsy; there is absence of familial traits of nephrotic syndrome and/or relevant mutations of slit-diaphragm genes (NPHS2, CD2AP, and ACTN4); and presence of nephrotic syndrome at any age with MGN.
Albumin fragments account for 25 to 30% of total albumin in urine of nephrotic patients while their proportion in serum does not exceed 5%. There are almost 30 g of fragments is cleared monthly from plasma, accounting for 30% of the albumin pool in a patient who weighs 30 kg considering that in nephrotic syndrome at least 2 to 3 g of albumin is lost every day in urine and that up to 1 g (30%) is represented by fragments.
Albumin fragments in nephrotic urine high concentration suggests a preferential urinary excretion and it reflects the partial maintenance of size selectivity properties of the kidney. Preferential urinary excretion of albumin fragments in nephrotic patients represents an efficient depurative mechanism that restores normal albumin composition in plasma, and similar considerations apply to 1AT.
Candiano et al. (2006). Repetitive Fragmentation Products of Albumin and α1-Antitrypsin in Glomerular Diseases Associated with Nephrotic Syndrome. J Am Soc Nephrol 17: 3139-3148. Retrieved June 21, 2009 from http://jasn.asnjournals.org/cgi/reprint/17/11/3139?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&searchid=1&FIRSTINDEX=0&minscore=5000&resourcetype=HWCIT
Last edited by gillegarda/joanalynbalino on Tue 07 Jul 2009, 2:12 am; edited 3 times in total