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Acute neonatal hyperammonemia is associated with poor neurological outcomes and high mortality. We developed, based on kinetic modeling, a user-friendly and widely applicable algorithm to tailor the treatment of acute neonatal hyperammonemia. A single compartmental model was calibrated assuming a distribution volume equal to the patient’s total body water (V), as calculated using Wells’ formula, and dialyzer clearance as derived from the measured ammonia time–concentration curves during 11 dialysis sessions in four patients (3.2 ± 0.4 kg). Based on these kinetic simulations, dialysis protocols could be derived for clinical use with different body weights, start concentrations, dialysis machines/dialyzers and dialysis settings (e.g., blood flow QB). By a single measurement of ammonia concentration at the dialyzer inlet and outlet, dialyzer clearance (K) can be calculated as K = QB∙[(Cinlet − Coutlet)/Cinlet]. The time (T) needed to decrease the ammonia concentration from a predialysis start concentration Cstart to a desired target concentration Ctarget is then equal to T = (−V/K)∙LN(Ctarget/Cstart). By implementing these formulae in a simple spreadsheet, medical staff can draw an institution-specific flowchart for patient-tailored treatment of hyperammonemia.
Sunny Eloot; Jonathan De Rudder; Patrick Verloo; Evelyn Dhont; Ann Raes; Wim Van Biesen; Evelien Snauwaert. Towards an Algorithm-Based Tailored Treatment of Acute Neonatal Hyperammonemia. Toxins 2021, 13, 484 .
AMA StyleSunny Eloot, Jonathan De Rudder, Patrick Verloo, Evelyn Dhont, Ann Raes, Wim Van Biesen, Evelien Snauwaert. Towards an Algorithm-Based Tailored Treatment of Acute Neonatal Hyperammonemia. Toxins. 2021; 13 (7):484.
Chicago/Turabian StyleSunny Eloot; Jonathan De Rudder; Patrick Verloo; Evelyn Dhont; Ann Raes; Wim Van Biesen; Evelien Snauwaert. 2021. "Towards an Algorithm-Based Tailored Treatment of Acute Neonatal Hyperammonemia." Toxins 13, no. 7: 484.
Summary Introduction Scarce data is available in literature about the upper urinary tract outcomes of patients with Exstrophy–Epispadias Complex (EEC). After bladder closure during childhood, EEC bladders can become hostile to the upper tracts after bladder by exposing them to high pressures, leading to hydronephrosis (HN) and kidney damage. Similarly, vesicoureteral reflux (VUR) may be present and increase the likelihood for pyelonephritis. Objective We sought to assess long-term upper urinary tract outcomes by evaluating renal function, HN and VUR; and to assess if upper urinary tract outcomes are associated with continence status. Study design A retrospective review of EEC patients having ≥1 surger(y) (ies) at our institution from 1990 until 2019 was performed. Renal function was assessed by evaluating last available estimated glomerular filtration rate (eGFR) and creatinine values. HN was assessed on ultrasound and classified according to the SFU-classification. Patients with recurrent febrile urinary tract infections (UTI) or pyelonephritis underwent a voiding-cystourethrogram (VCUG) assessing VUR, graded following the ‘International system of radiographic grading of VUR'. Descriptive and comparative statistical analysis were performed to assess if upper tract outcomes are associated with continence status. Results Forty-eight patients (75% male) had a median (IQR) follow-up of 18 (10–21) years. The table shows upper tract outcomes for the entire group and stratified by continence status. The median creatinine was 0.6 (0.2–0.9) mg/dL and median eGFR was 108 (72–160) mL/min/1.73 m [2]. In two patients (4.2%), HN (SFU-grade 2) was detected. Thirty-six patients (75%) underwent VCUG, revealing high-grade VUR (stage IV-V) in 8 patients (17%) and low-grade VUR (stage I-III) in 7 patients (15%). Continence was associated with a higher need for VCUG (p = 0.02) and a higher presence of VUR (p = 0.03). Discussion Renal function in EEC patients and non-EEC patients is comparable when age matched. Only 6% had low-grade HN which was asymptomatic. 17% had high-grade VUR, which is little compared to literature (40–70%). However, results in literature are described in patients with a ‘one-stage' bladder closure, whereas some of our patients had a ‘two-stage' procedure. A one-stage procedure creates higher bladder pressures resulting in higher VUR-rates. Statistical analysis has showed that continence is associated with a higher prevalence of recurrent febrile UTI's or pyelonephritis and of VUR. Conclusions No statistically differences were found between continent and incontinent patients concerning creatinine and eGFR value (p = 0.52 and p = 0.29), nor in the prevalence of hydronephrosis (p = 0.36). However, results of this study suggest that continent patients may portend a higher risk of upper tract deterioration with recurrent febrile UTI's and pyelonephritis due to VUR. Close monitoring of the upper tract status is therefore as important as focus on continence. Large-scale prospective studies defining renal function as well as pyelonephritis rates are needed to optimize the management of the upper tracts in EEC patients.Summary Table 1Overview of the population and main renal function outcomes, in the continent and the incontinent population.Summary Table 1Upper tract outcomeAll (n = 48)Continence statusContinent (n = 42)Incontinent (n = 6)P-valueRenal function (median, IQR)Creatinine, mg/dL0.6 (0.2–0.9)0.7 (0.1–0.9)0.4 (0.2–0.4)0.52eGFR, mL/min/1.3m2108 (72–160)106 (72–162)127 (124–158)0.29Hydronephrosis (asymptomatic), n (%)Yes2 (4.17)2 (4.76)00.36No46 (95.8)40 (95.4)6 (100)SFU, n (%)1-22 (4.17)2 (4.67)03-4000VCUG for recurrent pyelonephritis, n (%)Yes36 (75.034 (81.0)2 (33.3)0.02No12 (25.0)8 (19.0)4 (66.7)VUR, n (%)Yes15 (31.3)14 (33.3)1 (16.7)0.03No21 (43.8)20 (47.6)1 (16.7)No VCUG12 (25.0)8 (19.0)4 (66.7)VUR grade, n (%)1-37 (14.6)6 (14.3)1 (16.7)0.184-58 (16.7)8 (19.0)0No VUR21 (43.8)20 (47.6)1 (16.7)No VCUG12 (25.0)8 (19.0)4 (66.7)Treatment VUR, n (%)Subureteral injection bulking agent7 (14.6)6 (14.3)1 (16.7)0.65Ureteral reimplant8 (16.7)8 (19.0)No VUR21 (43.8)20 (47.6)1 (16.7)No VCUG12 (25.0)8 (19.0)4 (66.7)
Céline Sinatti; Anne-Françoise Spinoit; Ann Raes; Erik Van Laecke; Piet Hoebeke. LONG-TERM fate of the upper urinary tract and ITS association with continence in exstrophy patients. Journal of Pediatric Urology 2021, 1 .
AMA StyleCéline Sinatti, Anne-Françoise Spinoit, Ann Raes, Erik Van Laecke, Piet Hoebeke. LONG-TERM fate of the upper urinary tract and ITS association with continence in exstrophy patients. Journal of Pediatric Urology. 2021; ():1.
Chicago/Turabian StyleCéline Sinatti; Anne-Françoise Spinoit; Ann Raes; Erik Van Laecke; Piet Hoebeke. 2021. "LONG-TERM fate of the upper urinary tract and ITS association with continence in exstrophy patients." Journal of Pediatric Urology , no. : 1.
Imbalanced colonic microbial metabolism plays a pivotal role in generating protein-bound uraemic toxins (PBUTs), which accumulate with deteriorating kidney function and contribute to the uraemic burden of children with chronic kidney disease (CKD). Dietary choices impact the gut microbiome and metabolism. The aim of this study was to investigate the relation between dietary fibre and gut-derived PBUTs in paediatric CKD. Sixty-one (44 male) CKD children (9 ± 5 years) were prospectively followed for two years. Dietary fibre intake was evaluated by either 24-h recalls (73%) or 3-day food records (27%) at the same time of blood sampling for assessment of total and free serum levels of different PBUTs using liquid chromatography. We used linear mixed models to assess associations between fibre intake and PBUT levels. We found an inverse association between increase in fibre consumption (g/day) and serum concentrations of free indoxyl sulfate (−3.1% (−5.9%; −0.3%) (p = 0.035)), free p-cresyl sulfate (−2.5% (−4.7%; −0.3%) (p = 0.034)), total indole acetic acid (IAA) (−1.6% (−3.0%; −0.3%) (p = 0.020)), free IAA (−6.6% (−9.3%; −3.7%) (p < 0.001)), total serum p-cresyl glucuronide (pCG) (−3.0% (−5.6%; −0.5%) (p = 0.021)) and free pCG levels (−3.3% (−5.8%; −0.8%) (p = 0.010)). The observed associations between dietary fibre intake and the investigated PBUTs highlight potential benefits of fibre intake for the paediatric CKD population. The present observational findings should inform and guide adaptations of dietary prescriptions in children with CKD.
Amina El Amouri; Evelien Snauwaert; Aurélie Foulon; Charlotte Vande Moortel; Maria Van Dyck; Koen Van Hoeck; Nathalie Godefroid; Griet Glorieux; Wim Van Biesen; Johan Vande Walle; Ann Raes; Sunny Eloot. Dietary Fibre Intake Is Associated with Serum Levels of Uraemic Toxins in Children with Chronic Kidney Disease. Toxins 2021, 13, 225 .
AMA StyleAmina El Amouri, Evelien Snauwaert, Aurélie Foulon, Charlotte Vande Moortel, Maria Van Dyck, Koen Van Hoeck, Nathalie Godefroid, Griet Glorieux, Wim Van Biesen, Johan Vande Walle, Ann Raes, Sunny Eloot. Dietary Fibre Intake Is Associated with Serum Levels of Uraemic Toxins in Children with Chronic Kidney Disease. Toxins. 2021; 13 (3):225.
Chicago/Turabian StyleAmina El Amouri; Evelien Snauwaert; Aurélie Foulon; Charlotte Vande Moortel; Maria Van Dyck; Koen Van Hoeck; Nathalie Godefroid; Griet Glorieux; Wim Van Biesen; Johan Vande Walle; Ann Raes; Sunny Eloot. 2021. "Dietary Fibre Intake Is Associated with Serum Levels of Uraemic Toxins in Children with Chronic Kidney Disease." Toxins 13, no. 3: 225.
Amina El Amouri; Evelien Snauwaert; Aurélie Foulon; Charlotte Vande Moortel; Maria Van Dyck; Koen Van Hoeck; Nathalie Godefroid; Griet Glorieux; Wim Van Biesen; Johan Vande Walle; Ann Raes; Sunny Eloot. Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain. Pediatric Nephrology 2021, 36, 1589 -1595.
AMA StyleAmina El Amouri, Evelien Snauwaert, Aurélie Foulon, Charlotte Vande Moortel, Maria Van Dyck, Koen Van Hoeck, Nathalie Godefroid, Griet Glorieux, Wim Van Biesen, Johan Vande Walle, Ann Raes, Sunny Eloot. Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain. Pediatric Nephrology. 2021; 36 (6):1589-1595.
Chicago/Turabian StyleAmina El Amouri; Evelien Snauwaert; Aurélie Foulon; Charlotte Vande Moortel; Maria Van Dyck; Koen Van Hoeck; Nathalie Godefroid; Griet Glorieux; Wim Van Biesen; Johan Vande Walle; Ann Raes; Sunny Eloot. 2021. "Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain." Pediatric Nephrology 36, no. 6: 1589-1595.
Protein-bound uremic toxins (PBUTs) play a role in the multisystem disease that children on hemodialysis (HD) are facing, but little is known about their levels and protein binding (%PB). In this study, we evaluated the levels and %PB of six PBUTs cross-sectionally in a large pediatric HD cohort (n = 170) by comparing these with healthy and non-dialysis chronic kidney disease (CKD) stage 4–5 (n = 24) children. In parallel β2-microglobulin (β2M) and uric acid (UA) were evaluated. We then explored the impact of age and residual kidney function on uremic toxin levels and %PB using analysis of covariance and Spearman correlation coefficients (rs). We found higher levels of β2M, p-cresyl glucuronide (pCG), hippuric acid (HA), indole acetic acid (IAA), and indoxyl sulfate (IxS) in the HD compared to the CKD4–5 group. In the HD group, a positive correlation between age and pCG, HA, IxS, and pCS levels was shown. Residual urine volume was negatively correlated with levels of β2M, pCG, HA, IAA, IxS, and CMPF (rs −0.2 to −0.5). In addition, we found overall lower %PB of PBUTs in HD versus the CKD4–5 group, and showed an age-dependent increase in %PB of IAA, IxS, and pCS. Furhtermore, residual kidney function was overall positively correlated with %PB of PBUTs. In conclusion, residual kidney function and age contribute to PBUT levels and %PB in the pediatric HD population.
Evelien Snauwaert; Els Holvoet; Wim Van Biesen; Ann Raes; Griet Glorieux; Johan Vande Walle; Sanne Roels; Raymond Vanholder; Varvara Askiti; Karolis Azukaitis; Aysun Bayazit; Nur Canpolat; Michel Fischbach; Nathalie Godefroid; Saoussen Krid; Mieczyslaw Litwin; Lukasz Obrycki; Fabio Paglialonga; Bruno Ranchin; Charlotte Samaille; Franz Schaefer; Claus Peter Schmitt; Brankica Spasojevic; Constantinos J. Stefanidis; Maria Van Dyck; Koen Van Hoeck; Laure Collard; Sunny Eloot; Rukshana Shroff. Uremic Toxin Concentrations are Related to Residual Kidney Function in the Pediatric Hemodialysis Population. Toxins 2019, 11, 235 .
AMA StyleEvelien Snauwaert, Els Holvoet, Wim Van Biesen, Ann Raes, Griet Glorieux, Johan Vande Walle, Sanne Roels, Raymond Vanholder, Varvara Askiti, Karolis Azukaitis, Aysun Bayazit, Nur Canpolat, Michel Fischbach, Nathalie Godefroid, Saoussen Krid, Mieczyslaw Litwin, Lukasz Obrycki, Fabio Paglialonga, Bruno Ranchin, Charlotte Samaille, Franz Schaefer, Claus Peter Schmitt, Brankica Spasojevic, Constantinos J. Stefanidis, Maria Van Dyck, Koen Van Hoeck, Laure Collard, Sunny Eloot, Rukshana Shroff. Uremic Toxin Concentrations are Related to Residual Kidney Function in the Pediatric Hemodialysis Population. Toxins. 2019; 11 (4):235.
Chicago/Turabian StyleEvelien Snauwaert; Els Holvoet; Wim Van Biesen; Ann Raes; Griet Glorieux; Johan Vande Walle; Sanne Roels; Raymond Vanholder; Varvara Askiti; Karolis Azukaitis; Aysun Bayazit; Nur Canpolat; Michel Fischbach; Nathalie Godefroid; Saoussen Krid; Mieczyslaw Litwin; Lukasz Obrycki; Fabio Paglialonga; Bruno Ranchin; Charlotte Samaille; Franz Schaefer; Claus Peter Schmitt; Brankica Spasojevic; Constantinos J. Stefanidis; Maria Van Dyck; Koen Van Hoeck; Laure Collard; Sunny Eloot; Rukshana Shroff. 2019. "Uremic Toxin Concentrations are Related to Residual Kidney Function in the Pediatric Hemodialysis Population." Toxins 11, no. 4: 235.
Resistance rates for ciprofloxacin, which is labeled for treating complicated urinary tract infections in children, are rapidly rising. As there is limited knowledge on developmental pharmacology of ciprofloxacin, the primary aim of this study was to develop a population pharmacokinetic model for ciprofloxacin in children treated for complicated urinary tract infections.
Kevin Meesters; Robin Michelet; Reiner Mauel; Ann Raes; Jan Van Bocxlaer; Johan Vande Walle; An Vermeulen. Results of a Multicenter Population Pharmacokinetic Study of Ciprofloxacin in Children with Complicated Urinary Tract Infection. Antimicrobial Agents and Chemotherapy 2018, 62, 1 .
AMA StyleKevin Meesters, Robin Michelet, Reiner Mauel, Ann Raes, Jan Van Bocxlaer, Johan Vande Walle, An Vermeulen. Results of a Multicenter Population Pharmacokinetic Study of Ciprofloxacin in Children with Complicated Urinary Tract Infection. Antimicrobial Agents and Chemotherapy. 2018; 62 (9):1.
Chicago/Turabian StyleKevin Meesters; Robin Michelet; Reiner Mauel; Ann Raes; Jan Van Bocxlaer; Johan Vande Walle; An Vermeulen. 2018. "Results of a Multicenter Population Pharmacokinetic Study of Ciprofloxacin in Children with Complicated Urinary Tract Infection." Antimicrobial Agents and Chemotherapy 62, no. 9: 1.
CYP3A enzymes are involved in the metabolism of calcineurin inhibitor tacrolimus as well as vitamin D. In this review, we summarize the clinical aspects of CYP3A-mediated metabolism of tacrolimus and vitamin D with emphasis on the influence of single-nucleotide polymorphisms on tacrolimus disposition. We describe the utility of 4β hydroxycholesterol as a marker of CYP3A activity. Then, we discuss the possible interaction between calcineurin inhibitors and vitamin D in solid organ transplant recipients. Also, we review other mechanisms which may contribute to side effects of calcineurin inhibitors on bone. Lastly, suggestions for future research and clinical perspectives are discussed.
Agnieszka Prytuła; Karlien Cransberg; Ann Raes. Drug-metabolizing enzymes CYP3A as a link between tacrolimus and vitamin D in renal transplant recipients: is it relevant in clinical practice? Pediatric Nephrology 2018, 34, 1201 -1210.
AMA StyleAgnieszka Prytuła, Karlien Cransberg, Ann Raes. Drug-metabolizing enzymes CYP3A as a link between tacrolimus and vitamin D in renal transplant recipients: is it relevant in clinical practice? Pediatric Nephrology. 2018; 34 (7):1201-1210.
Chicago/Turabian StyleAgnieszka Prytuła; Karlien Cransberg; Ann Raes. 2018. "Drug-metabolizing enzymes CYP3A as a link between tacrolimus and vitamin D in renal transplant recipients: is it relevant in clinical practice?" Pediatric Nephrology 34, no. 7: 1201-1210.
Pediatric renal transplantation with a living donor (LD) has superior outcome, but there is a paucity of studies analyzing the reasons for not undertaking living donation in West-European countries. The aim of this study was to retrospectively review the choice of donor source in our center. We also aimed to identify factors which prevented transplantation with a LD. This retrospective study was performed including children aged 2-19 years who underwent kidney transplantation (KT) at the Ghent University Hospital between 1996 and 2016. Relevant data were collected from medical files to identify the main medical, psychological, and socio-economic factors influencing the choice of the donor source. There were 48 patients (boys n = 33) who underwent KT. Thirty-nine patients received a deceased donor (DD) kidney and nine patients received a LD kidney. Sixteen of 48 transplantations were preemptive. The reasons for DD KT included socio-economic factors such as single caregiver families, one or both parents with a criminal record or convictions and religious or cultural constraints (n = 15), medical considerations (n = 13), refusal of the close relatives/parents to donate (n = 7), and acceptance of an organ from a DD while prospective donor was undergoing medical screening (n = 4). The low incidence of living kidney donation can be explained by socio-economic and medical factors. Refusal to donate is a potentially modifiable factor and strategies aimed at education and guidance of the families might contribute to a higher incidence of living donation in our setting.
Katty Van Cauwenberghe; Ann Raes; Lut Pauwels; Jo Dehoorne; Luc Colenbie; Clement Dequidt; Lien Dossche; Johan Vande Walle; Agnieszka Prytuła. The choice between deceased- vs living-donor renal transplantation in children: Analysis of data from a Belgian tertiary center. Pediatric Transplantation 2018, 22, e13140 .
AMA StyleKatty Van Cauwenberghe, Ann Raes, Lut Pauwels, Jo Dehoorne, Luc Colenbie, Clement Dequidt, Lien Dossche, Johan Vande Walle, Agnieszka Prytuła. The choice between deceased- vs living-donor renal transplantation in children: Analysis of data from a Belgian tertiary center. Pediatric Transplantation. 2018; 22 (2):e13140.
Chicago/Turabian StyleKatty Van Cauwenberghe; Ann Raes; Lut Pauwels; Jo Dehoorne; Luc Colenbie; Clement Dequidt; Lien Dossche; Johan Vande Walle; Agnieszka Prytuła. 2018. "The choice between deceased- vs living-donor renal transplantation in children: Analysis of data from a Belgian tertiary center." Pediatric Transplantation 22, no. 2: e13140.
Katty Van Cauwenberghe; Ann Raes; Lut Pauwels; Jo Dehoorne; Luc Colenbie; Clement Dequidt; Lien Dossche; Johan Vande Walle; Agnieszka Prytuła. The choice between deceased- vs living-donor renal transplantation in children: Analysis of data from a Belgian tertiary center. Pediatric Transplantation 2018, 22, 1 .
AMA StyleKatty Van Cauwenberghe, Ann Raes, Lut Pauwels, Jo Dehoorne, Luc Colenbie, Clement Dequidt, Lien Dossche, Johan Vande Walle, Agnieszka Prytuła. The choice between deceased- vs living-donor renal transplantation in children: Analysis of data from a Belgian tertiary center. Pediatric Transplantation. 2018; 22 (2):1.
Chicago/Turabian StyleKatty Van Cauwenberghe; Ann Raes; Lut Pauwels; Jo Dehoorne; Luc Colenbie; Clement Dequidt; Lien Dossche; Johan Vande Walle; Agnieszka Prytuła. 2018. "The choice between deceased- vs living-donor renal transplantation in children: Analysis of data from a Belgian tertiary center." Pediatric Transplantation 22, no. 2: 1.
Levamisole has been considered the least toxic and least expensive steroid-sparing drug for preventing relapses of steroid-sensitive idiopathic nephrotic syndrome (SSINS). However, evidence for this is limited as previous randomized clinical trials were found to have methodological limitations. Therefore, we conducted an international multicenter, placebo-controlled, double-blind, randomized clinical trial to reassess its usefulness in prevention of relapses in children with SSINS. The efficacy and safety of one year of levamisole treatment in children with SSINS and frequent relapses were evaluated. The primary analysis cohort consisted of 99 patients from 6 countries. Between 100 days and 12 months after the start of study medication, the time to relapse (primary endpoint) was significantly increased in the levamisole compared to the placebo group (hazard ratio 0.22 [95% confidence interval 0.11–0.43]). Significantly, after 12 months of treatment, six percent of placebo patients versus 26 percent of levamisole patients were still in remission. During this period, the most frequent serious adverse event (four of 50 patients) possibly related to levamisole was asymptomatic moderate neutropenia, which was reversible spontaneously or after treatment discontinuation. Thus, in children with SSINS and frequent relapses, levamisole prolonged the time to relapse and also prevented recurrence during one year of treatment compared to prednisone alone. However, regular blood controls are necessary for safety issues.
Mariken P. Gruppen; Antonia H. Bouts; Marijke C. Jansen-Van der Weide; Maruschka P. Merkus; Aleksandra Zurowska; Michal Maternik; Laura Massella; Francesco Emma; Patrick Niaudet; Elisabeth Cornelissen; Thierry Schurmans; Ann Raes; Johan van de Walle; Mieke van Dyck; Ashima Gulati; Arvind Bagga; Jean-Claude Davin. A randomized clinical trial indicates that levamisole increases the time to relapse in children with steroid-sensitive idiopathic nephrotic syndrome. Kidney International 2017, 93, 510 -518.
AMA StyleMariken P. Gruppen, Antonia H. Bouts, Marijke C. Jansen-Van der Weide, Maruschka P. Merkus, Aleksandra Zurowska, Michal Maternik, Laura Massella, Francesco Emma, Patrick Niaudet, Elisabeth Cornelissen, Thierry Schurmans, Ann Raes, Johan van de Walle, Mieke van Dyck, Ashima Gulati, Arvind Bagga, Jean-Claude Davin. A randomized clinical trial indicates that levamisole increases the time to relapse in children with steroid-sensitive idiopathic nephrotic syndrome. Kidney International. 2017; 93 (2):510-518.
Chicago/Turabian StyleMariken P. Gruppen; Antonia H. Bouts; Marijke C. Jansen-Van der Weide; Maruschka P. Merkus; Aleksandra Zurowska; Michal Maternik; Laura Massella; Francesco Emma; Patrick Niaudet; Elisabeth Cornelissen; Thierry Schurmans; Ann Raes; Johan van de Walle; Mieke van Dyck; Ashima Gulati; Arvind Bagga; Jean-Claude Davin. 2017. "A randomized clinical trial indicates that levamisole increases the time to relapse in children with steroid-sensitive idiopathic nephrotic syndrome." Kidney International 93, no. 2: 510-518.
There is evidence pointing to a decrease of the glomerular filtration rate (GFR) in a subgroup of nephrotic children, likely secondary to hypovolemia. The aim of this study is to validate the use of urinary potassium to the sum of potassium plus sodium ratio (UK/UK+UNa) as an indicator of hypovolemia in nephrotic syndrome, enabling detection of those patients who will benefit from albumin infusion. We prospectively studied 44 nephrotic children and compared different parameters to a control group (36 children). Renal perfusion and glomerular permeability were assessed by measuring clearance of para-aminohippurate and inulin. Vaso-active hormones and urinary sodium and potassium were also measured. Subjects were grouped into low, normal, and high GFR groups. In the low GFR group, significantly lower renal plasma flow (p = 0.01), filtration fraction (p = 0.01), and higher UK/UK+UNa (p = 0.03) ratio were noted. In addition, non-significant higher plasma renin activity (p = 0.11) and aldosteron (p = 0.09) were also seen in the low GFR group.
Werner Keenswijk; Mohamad Ikram Ilias; Ann Raes; Raymond Donckerwolcke; Johan Vande Walle. Urinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome: a provisional study. European Journal of Pediatrics 2017, 177, 79 -84.
AMA StyleWerner Keenswijk, Mohamad Ikram Ilias, Ann Raes, Raymond Donckerwolcke, Johan Vande Walle. Urinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome: a provisional study. European Journal of Pediatrics. 2017; 177 (1):79-84.
Chicago/Turabian StyleWerner Keenswijk; Mohamad Ikram Ilias; Ann Raes; Raymond Donckerwolcke; Johan Vande Walle. 2017. "Urinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome: a provisional study." European Journal of Pediatrics 177, no. 1: 79-84.
Chronic kidney disease (CKD) in childhood is characterised by the accumulation of uraemic toxins resulting in a multisystem disorder that has a negative impact on quality of life. Childhood CKD is predominantly defined by a decrease in glomerular filtration rate, estimated (eGFR) by a single serum measurement of endogenous biomarkers, e.g. creatinine. The objective of this study was to evaluate how accurately eGFR predicts the concentration of uraemic toxins in a paediatric CKD cohort. In 65 children (10.8 [5.1; 14.7] years) with CKD (eGFR 44 [20; 64] mL/min/1.73 m2), serum concentrations were determined of small solutes (uric acid [UA], urea, symmetric dimethylarginine [SDMA], asymmetric dimethylarginine [ADMA]), middle molecules (β2-microglobulin [β2M], complement factor D [CfD]) and protein-bound solutes (p-cresylglucuronide [pCG], hippuric acid, indole acetic acid, indoxyl sulphate [IxS], p-cresylsulfate [pCS] and 3-carboxy-4-methyl-5-propyl-furanpropionic acid [CMPF]). Spearman’s correlation coefficients (r) were calculated to correlate uraemic toxin concentrations with three different eGFR equations, based on either serum creatinine or β2M. Updated Schwartz eGFR was correlated reasonably well with concentrations of creatinine (r = −0.98), urea (rs = −0.84), SDMA (r = −0.82) and middle molecules CfD and β2M (both rs = −0.90). In contrast, poor correlation coefficients were found for CMPF (rs = −0.32), UA (rs = −0.45), ADMA (rs = −0.47) and pCG (rs = −0.48). The other toxins, all protein-bound, had rs between −0.75 and −0.57. Comparable correlations were found between the three evaluated eGFR equations and uraemic toxin concentrations. This study demonstrates that eGFR poorly predicts concentrations of protein-bound uraemic toxins, UA and ADMA in childhood CKD. Therefore, eGFR only partially reflects the complexity of the accumulation pattern of uraemic toxins in childhood CKD.
Evelien Snauwaert; Wim Van Biesen; Ann Raes; Els Holvoet; Griet Glorieux; Koen Van Hoeck; Maria Van Dyck; Nathalie Godefroid; Raymond Vanholder; Sanne Roels; Johan Vande Walle; Sunny Eloot. Accumulation of uraemic toxins is reflected only partially by estimated GFR in paediatric patients with chronic kidney disease. Pediatric Nephrology 2017, 33, 315 -323.
AMA StyleEvelien Snauwaert, Wim Van Biesen, Ann Raes, Els Holvoet, Griet Glorieux, Koen Van Hoeck, Maria Van Dyck, Nathalie Godefroid, Raymond Vanholder, Sanne Roels, Johan Vande Walle, Sunny Eloot. Accumulation of uraemic toxins is reflected only partially by estimated GFR in paediatric patients with chronic kidney disease. Pediatric Nephrology. 2017; 33 (2):315-323.
Chicago/Turabian StyleEvelien Snauwaert; Wim Van Biesen; Ann Raes; Els Holvoet; Griet Glorieux; Koen Van Hoeck; Maria Van Dyck; Nathalie Godefroid; Raymond Vanholder; Sanne Roels; Johan Vande Walle; Sunny Eloot. 2017. "Accumulation of uraemic toxins is reflected only partially by estimated GFR in paediatric patients with chronic kidney disease." Pediatric Nephrology 33, no. 2: 315-323.
Chronic kidney disease (CKD) in childhood is poorly explained by routine markers (e.g. urea and creatinine) and is better depicted in adults by other uraemic toxins. This study describes concentrations of representative uraemic toxins in non-dialysis CKD versus healthy children. In 50 healthy children and 57 children with CKD Stages 1-5 [median estimated glomerular filtration rate 48 (25th-75th percentile 24-71) mL/min/1.73 m2; none on dialysis], serum concentrations of small solutes [symmetric and asymmetric dimethyl-arginine (SDMA and ADMA, respectively)], middle molecules [β2-microglobuline (β2M), complement factor D (CfD)] and protein-bound solutes [p-cresylglucuronide (pCG), hippuric acid (HA), indole-acetic acid (IAA), indoxyl sulphate (IxS), p-cresyl sulphate (pCS) and 3-carboxy-4-methyl-5-propyl-furanpropionic acid (CMPF)] were measured. Concentrations in the CKD group were expressed as z-score relative to controls and matched for age and gender. SDMA, CfD, β2M, IxS, pCS, IAA, CMPF and HA concentrations were higher in the overall CKD group compared with controls, ranging from 1.7 standard deviations (SD) for IAA and HA to 11.1 SD for SDMA. SDMA, CfD, β2M, IxS and CMPF in CKD Stages 1-2 with concentrations 4.8, 2.8, 4.5, 1.9 and 1.6 SD higher, respectively. In contrast, pCS, pCG and IAA concentrations were only higher than controls from CKD Stages 3-4 onwards, but only in CKD Stage 5 for ADMA and HA (z-score 2.6 and 20.2, respectively). This is the first study to establish reference values for a wide range of uraemic toxins in non-dialysis CKD and healthy children. We observed an accumulation of multiple uraemic toxins, each with a particular retention profile according to the different CKD stages.
Evelien Snauwaert; Wim Van Biesen; Ann Raes; Griet Glorieux; Valerie Van Bogaert; Koen Van Hoeck; Marc Coppens; Sanne Roels; Johan Vande Walle; Sunny Eloot. Concentrations of representative uraemic toxins in a healthy versus non-dialysis chronic kidney disease paediatric population. Nephrology Dialysis Transplantation 2017, 33, 978 -986.
AMA StyleEvelien Snauwaert, Wim Van Biesen, Ann Raes, Griet Glorieux, Valerie Van Bogaert, Koen Van Hoeck, Marc Coppens, Sanne Roels, Johan Vande Walle, Sunny Eloot. Concentrations of representative uraemic toxins in a healthy versus non-dialysis chronic kidney disease paediatric population. Nephrology Dialysis Transplantation. 2017; 33 (6):978-986.
Chicago/Turabian StyleEvelien Snauwaert; Wim Van Biesen; Ann Raes; Griet Glorieux; Valerie Van Bogaert; Koen Van Hoeck; Marc Coppens; Sanne Roels; Johan Vande Walle; Sunny Eloot. 2017. "Concentrations of representative uraemic toxins in a healthy versus non-dialysis chronic kidney disease paediatric population." Nephrology Dialysis Transplantation 33, no. 6: 978-986.
A 4-year-old girl with diarrhea-associated hemolytic uremic syndrome (D+HUS) was transferred to the PICU of our center due to deteriorating renal function and neurological involvement. On admission, a comatous child was seen with hypoventilation and she was placed on mechanical ventilation. Hemodialysis was commenced but plasma exchange was discontinued due to repeated hypersensitivity reactions. A trial of eculizumab was given in light of the worsening of her neurologic condition with development of a pyramidal syndrome and deepening of the coma. Hematological and renal improvement were noted but severe neurologic involvement persisted. MRI revealed extensive bilateral zones of corticocerebral infarction and neurological damage proved to be irreversible. Diarrhea-associated hemolytic uremic syndrome is a common cause of Acute Kidney Injury associated with severe short- and long-term complications. Neurologic involvement is frequent but often reversible. Currently, no effective treatment strategies are available and a paucity of data exists concerning the efficacy of potential treatment options such as early plasma exchange, eculizumab, and high dose corticosteroids. A concerted effort is needed to early identify patients at risk for poor outcome with trials aimed at evaluating the efficacy of potential treatment options for this subgroup.
Werner Keenswijk; Evelyn Dhont; Ann Raes; An Bael; Johan Vande Walle. A devastating case of diarrhea-associated hemolytic uremic syndrome associated with extensive cerebral infarction; why we need to do better. Acta Clinica Belgica 2017, 73, 151 -155.
AMA StyleWerner Keenswijk, Evelyn Dhont, Ann Raes, An Bael, Johan Vande Walle. A devastating case of diarrhea-associated hemolytic uremic syndrome associated with extensive cerebral infarction; why we need to do better. Acta Clinica Belgica. 2017; 73 (2):151-155.
Chicago/Turabian StyleWerner Keenswijk; Evelyn Dhont; Ann Raes; An Bael; Johan Vande Walle. 2017. "A devastating case of diarrhea-associated hemolytic uremic syndrome associated with extensive cerebral infarction; why we need to do better." Acta Clinica Belgica 73, no. 2: 151-155.
Background: Information on the epidemiology of Acute Kidney Injury (AKI) in children is scarce. We performed a single center retrospective cohort study to analyze the incidence of AKI, the male/female ratio, the underlying etiology, and age at presentation. We also aimed to assess outcome measured by mortality, duration of PICU stay, and development of Chronic Kidney Disease (CKD). Methods: Records were searched for children presenting with or developing AKI between 1st January 2008 and 1st January 2015. AKI was classified according to the pediatric Rifle criteria while the cause of AKI was defined as the major underlying disease. Results: Of the 28,295 children admitted, 167 episodes of AKI were identified, equaling 5.9 cases per 1000 children. Patients classified as Failure at presentation according to pRifle criteria where significantly more likely to need dialysis (27/50, 54%) compared to those presenting with Injury (12/57, 21.1%) or Risk (6/60, 10 %). Diarrhea-associated Hemolytic Uremic Syndrome (D+HUS) was the most frequent cause (20.3 %) peaking during the summer months, followed by cardiac surgery (13.7%), medication-related nephrotoxicity (13.2%), and acute Glomerulonephritis (12%). The median age of children admitted with AKI was 6.1 years (range 0.1–17) and 50.8% of cases were male. Twenty five (15%) children died while 27 (16.1%) developed CKD. Conclusions: Pediatric AKI poses a significant problem and strategies aimed at prevention, early detection, treatment, and adequate follow-up are needed. D+HUS is the most common underlying cause and effective surveillance of Enterohemorrhagic E. coli infections in association with additional measures is highly recommended.
Werner Keenswijk; Jill Vanmassenhove; Ann Raes; Evelyn Dhont; Johan Vandewalle. Epidemiology and outcome of acute kidney injury in children, a single center study. Acta Clinica Belgica 2017, 72, 405 -412.
AMA StyleWerner Keenswijk, Jill Vanmassenhove, Ann Raes, Evelyn Dhont, Johan Vandewalle. Epidemiology and outcome of acute kidney injury in children, a single center study. Acta Clinica Belgica. 2017; 72 (6):405-412.
Chicago/Turabian StyleWerner Keenswijk; Jill Vanmassenhove; Ann Raes; Evelyn Dhont; Johan Vandewalle. 2017. "Epidemiology and outcome of acute kidney injury in children, a single center study." Acta Clinica Belgica 72, no. 6: 405-412.
Diarrhea-associated hemolytic uremic syndrome (D+HUS) is a common thrombotic microangiopathy during childhood and early identification of parameters predicting poor outcome could enable timely intervention. This study aims to establish the accuracy of BUN-to-serum creatinine ratio at admission, in addition to other parameters in predicting the clinical course and outcome. Records were searched for children between 1 January 2008 and 1 January 2015 admitted with D+HUS. A complicated course was defined as developing one or more of the following: neurological dysfunction, pancreatitis, cardiac or pulmonary involvement, hemodynamic instability, and hematologic complications while poor outcome was defined by death or development of chronic kidney disease. Thirty-four children were included from which 11 with a complicated disease course/poor outcome. Risk of a complicated course/poor outcome was strongly associated with oliguria (p = 0.000006) and hypertension (p = 0.00003) at presentation. In addition, higher serum creatinine (p = 0.000006) and sLDH (p = 0.02) with lower BUN-to-serum creatinine ratio (p = 0.000007) were significantly associated with development of complications. A BUN-to-sCreatinine ratio ≤40 at admission was a sensitive and highly specific predictor of a complicated disease course/poor outcome.
Werner Keenswijk; Jill Vanmassenhove; Ann Raes; Evelyn Dhont; Johan Vande Walle. Blood urea nitrogen to serum creatinine ratio is an accurate predictor of outcome in diarrhea-associated hemolytic uremic syndrome, a preliminary study. European Journal of Pediatrics 2017, 176, 355 -360.
AMA StyleWerner Keenswijk, Jill Vanmassenhove, Ann Raes, Evelyn Dhont, Johan Vande Walle. Blood urea nitrogen to serum creatinine ratio is an accurate predictor of outcome in diarrhea-associated hemolytic uremic syndrome, a preliminary study. European Journal of Pediatrics. 2017; 176 (3):355-360.
Chicago/Turabian StyleWerner Keenswijk; Jill Vanmassenhove; Ann Raes; Evelyn Dhont; Johan Vande Walle. 2017. "Blood urea nitrogen to serum creatinine ratio is an accurate predictor of outcome in diarrhea-associated hemolytic uremic syndrome, a preliminary study." European Journal of Pediatrics 176, no. 3: 355-360.
The aim of the study was to analyze the incidence of hypertension in pediatric liver transplantation (LT) recipients using ambulatory blood pressure measurements (ABPM) and to identify factors associated with hypertension. We also investigated whether hypertension or tacrolimus predose concentration (TAC C0) was associated with increased left ventricular (LV) wall thickness. On a retrospective longitudinal base, we included 39 pediatric LT recipients. Median time since transplantation was 65 months (range: 11–183). Two consecutive ABPM were analyzed with a median time interval of 13 months. Data from echocardiographic evaluation parallel to the baseline ABPM were analyzed. All patients except 1 were prescribed tacrolimus. The median TAC C0 was 4 ng/mL (range 0.9–11.2). Univariate and multivariate logistic regression models were fitted to identify factors associated with systolic and diastolic hypertension and LV wall thickness. Twenty-two of 39 children were hypertensive at baseline and 19 of 32 were hypertensive at follow-up. At baseline 10 (26%) children had masked systolic hypertension. TAC C0 was associated with systolic (P = 0.007, Exp(B) 2.02, 95% CI 1.2–3.3) and diastolic (P = 0.044, Exp(B) 1.48, 95% CI 1.0–2.2) hypertension. LV wall thickness was increased in children after LT compared with healthy population, but it was not associated with hypertension or TAC C0. Given the high prevalence of masked hypertension, ABPM should be performed in all pediatric LT recipients. Systolic and diastolic hypertension is associated with TAC C0; therefore, children with a higher target TAC C0 require a more intensive blood pressure surveillance.
Agnieszka Prytula; Kristof Vandekerckhove; Ann Raes; Daniel De Wolf; Jo Dehoorne; Johan Vande Walle; Ruth De Bruyne. Tacrolimus Predose Concentration Is Associated With Hypertension in Pediatric Liver Transplant Recipients. Journal of Pediatric Gastroenterology & Nutrition 2016, 63, 616 -623.
AMA StyleAgnieszka Prytula, Kristof Vandekerckhove, Ann Raes, Daniel De Wolf, Jo Dehoorne, Johan Vande Walle, Ruth De Bruyne. Tacrolimus Predose Concentration Is Associated With Hypertension in Pediatric Liver Transplant Recipients. Journal of Pediatric Gastroenterology & Nutrition. 2016; 63 (6):616-623.
Chicago/Turabian StyleAgnieszka Prytula; Kristof Vandekerckhove; Ann Raes; Daniel De Wolf; Jo Dehoorne; Johan Vande Walle; Ruth De Bruyne. 2016. "Tacrolimus Predose Concentration Is Associated With Hypertension in Pediatric Liver Transplant Recipients." Journal of Pediatric Gastroenterology & Nutrition 63, no. 6: 616-623.
Background There is a high comorbidity between nocturnal enuresis, sleep disorders and psychological problems. The aim of this study was to investigate whether a decrease in nocturnal diuresis volume not only improves enuresis but also ameliorates disrupted sleep and (neuro)psychological dysfunction, the major comorbidities of this disorder. Methods In this open-label, prospective phase IV study, 30 children with monosymptomatic nocturnal enuresis (MNE) underwent standardized video-polysomnographic testing and multi-informant (neuro)psychological testing at baseline and 6 months after the start of desmopressin treatment in the University Hospital Ghent, Belgium. Primary endpoints were the effect on sleep and (neuro)psychological functioning. The secondary endpoint was the change in the first undisturbed sleep period or the time to the first void. Results Thirty children aged between 6 and 16 (mean 10.43, standard deviation 3.08) years completed the study. The results demonstrated a significant decrease in periodic limb movements during sleep (PLMS) and a prolonged first undisturbed sleep period. Additionally, (neuro)psychological functioning was improved on several domains. Conclusions The study demonstrates that the degree of comorbidity symptoms is at least aggravated by enuresis (and/or high nocturnal diuresis rate) since sleep and (neuro)psychological functioning were significantly ameliorated by treatment of enuresis. These results indicate that enuresis is not such a benign condition as has previously been assumed.
Charlotte Van Herzeele; Karlien Dhondt; Sanne P. Roels; Ann Raes; Piet Hoebeke; Luitzen-Albert Groen; Johan Vande Walle. Desmopressin (melt) therapy in children with monosymptomatic nocturnal enuresis and nocturnal polyuria results in improved neuropsychological functioning and sleep. Pediatric Nephrology 2016, 31, 1477 -1484.
AMA StyleCharlotte Van Herzeele, Karlien Dhondt, Sanne P. Roels, Ann Raes, Piet Hoebeke, Luitzen-Albert Groen, Johan Vande Walle. Desmopressin (melt) therapy in children with monosymptomatic nocturnal enuresis and nocturnal polyuria results in improved neuropsychological functioning and sleep. Pediatric Nephrology. 2016; 31 (9):1477-1484.
Chicago/Turabian StyleCharlotte Van Herzeele; Karlien Dhondt; Sanne P. Roels; Ann Raes; Piet Hoebeke; Luitzen-Albert Groen; Johan Vande Walle. 2016. "Desmopressin (melt) therapy in children with monosymptomatic nocturnal enuresis and nocturnal polyuria results in improved neuropsychological functioning and sleep." Pediatric Nephrology 31, no. 9: 1477-1484.
Our and literature data suggest that most heterozygous CYP24A1 mutation carriers have a normal 25OHD/24,25(OH)2D ratio, are usually asymptomatic and have a normal skeletal status but may possibly be at increased risk of nephrocalcinosis. A review of the available literature suggests that an elevated 25OHD/24,25(OH)2D ratio may be associated with symptoms of IHH, irrespective of carrier status.
M. Cools; S. Goemaere; D. Baetens; A. Raes; A. Desloovere; J.M. Kaufman; J. De Schepper; I. Jans; D. Vanderschueren; J. Billen; E. De Baere; T. Fiers; R. Bouillon. Calcium and bone homeostasis in heterozygous carriers of CYP24A1 mutations: A cross-sectional study. Bone 2015, 81, 89 -96.
AMA StyleM. Cools, S. Goemaere, D. Baetens, A. Raes, A. Desloovere, J.M. Kaufman, J. De Schepper, I. Jans, D. Vanderschueren, J. Billen, E. De Baere, T. Fiers, R. Bouillon. Calcium and bone homeostasis in heterozygous carriers of CYP24A1 mutations: A cross-sectional study. Bone. 2015; 81 ():89-96.
Chicago/Turabian StyleM. Cools; S. Goemaere; D. Baetens; A. Raes; A. Desloovere; J.M. Kaufman; J. De Schepper; I. Jans; D. Vanderschueren; J. Billen; E. De Baere; T. Fiers; R. Bouillon. 2015. "Calcium and bone homeostasis in heterozygous carriers of CYP24A1 mutations: A cross-sectional study." Bone 81, no. : 89-96.
Background There is a growing evidence for autoimmunity in acute central nervous system (CNS) disorders and treatment with therapeutic plasma exchange (TPE) may be considered. The aim was to share our experience on the clinical application of TPE in these disorders and to present a reproducible protocol which can be used even in small children. Methods We present a series of 8 children aged 2-12 years with transverse myelitis, Bickerstaff's brainstem encephalitis, neuromyelitis optica, and acute paraneoplastic or unspecified encephalitis in whom TPE was used as a second-line or rescue treatment. Results A total of 104 TPE sessions were performed where 80–110 ml/kg of plasma was exchanged using 4% albumin solution and fresh frozen plasma. Six episodes of TPE-related adverse events were documented. Fibrinogen concentrations decreased after the first TPE, whereas platelets decreased gradually. One patient died in the course of the acute illness. Three children achieved a complete resolution of symptoms, 2 children have mild sequelae; whereas 2 children remain paraplegic after a follow-up of 3 to 17 months. Conclusions We report 8 children with presumably autoimmune-mediated, acute CNS disorders treated with TPE as a rescue therapy. Although the effect of TPE can only be inferred, 5 children had a good clinical outcome. TPE is feasible even in small children with acute autoimmune CNS disorders.
Agnieszka Prytuła; Johan Vande Walle; Helene Verhelst; Sunny Eloot; Stefaan Claus; Annick De Jaeger; Jo Dehoorne; Ann Raes. Therapeutic Plasma Exchange in Children with Acute Autoimmune Central Nervous System Disorders. The International Journal of Artificial Organs 2015, 38, 494 -500.
AMA StyleAgnieszka Prytuła, Johan Vande Walle, Helene Verhelst, Sunny Eloot, Stefaan Claus, Annick De Jaeger, Jo Dehoorne, Ann Raes. Therapeutic Plasma Exchange in Children with Acute Autoimmune Central Nervous System Disorders. The International Journal of Artificial Organs. 2015; 38 (9):494-500.
Chicago/Turabian StyleAgnieszka Prytuła; Johan Vande Walle; Helene Verhelst; Sunny Eloot; Stefaan Claus; Annick De Jaeger; Jo Dehoorne; Ann Raes. 2015. "Therapeutic Plasma Exchange in Children with Acute Autoimmune Central Nervous System Disorders." The International Journal of Artificial Organs 38, no. 9: 494-500.