Eunice John - Academia.edu (original) (raw)

Papers by Eunice John

Neonatology, 2008

Gram-negative sepsis in newborns is associated with high mortality and morbidity. Lipopolysacchar... more Gram-negative sepsis in newborns is associated with high mortality and morbidity. Lipopolysaccharide (LPS) and cytokines released upon exposure to gram-negative sepsis are well known to be involved in the pathophysiology. In this report we investigate cytokine release, hemodynamic, and renal function induced by LPS in a newborn animal model with the intention to further examine early changes in gram-negative sepsis. Five 7- to 10-day-old domestic piglets were anesthetized and catheters placed in the jugular veins, left ventricle, and femoral artery. Urine output was monitored via suprapubic cystostomy. Mean arterial pressure, heart rate, and arterial blood gases were continuously monitored. Thirty minutes after line placement and obtaining baseline values, 0.06 mug/kg LPS were administered intravenously. One, 2, and 3 h later samples were taken to monitor tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, endothelin, and nitric oxide (NO)/nitrate via ELISA. In addition, blood flow was assessed by the microsphere method. Our data show an initial surge of TNF-alpha and IL-1beta at 1 h after exposure to LPS. NO/nitrate, endothelin, and hemodynamic as well as metabolic changes became apparent mostly 3 h after exposure, by which time TNF-alpha and IL-1beta fell back to baseline. Our sepsis model suggests a brief initial TNF-alpha and IL-1beta surge following LPS challenge; however, their effects become apparent by the time the levels are already subsiding. The emergence of vasoactive substances, NO and endothelin, precedes the first substantial clinical symptoms.

Pediatric Research, 1985

u s t o determine t h e content of AVP i n donor blood. I n keeping w i t h s t a n d a r d blood... more u s t o determine t h e content of AVP i n donor blood. I n keeping w i t h s t a n d a r d blood banking p r a c t i c e s , 80 ml of blood were drawn from each of e i g h t donors, mixed w i t h 7 ml of a n t i c o a g u l a n t (CPD) i n standard blood bank bags and r e f r i g e r a t e d a t 4OC. Daily samples were drawn on each of f i v e s u c c e s s i v e days. The plasma was a c i d i f i e d and f r o z e n a t -20°C u n t i l t h e time of a s s a y . AVP was e x t r a c t e d by b e n t o n i t e procedure modified from Skowsky technique i n d u p l i c a t e and measured by radioimmunoassay i n t r i p l i c a t e . Only 2 of 8 donors had h i g h e r than normal v a l u e s (6 & 7 pg AVP/ml) a t t h e time of t h e i n i t i a l sample. AVP l e v e l s decreased from day 1 t o day 5 w i t h t h e g r e a t e s t f a l l i n t h e f i r s t 24 hours.

The Indian Journal of Pediatrics, 1994

Body electrolytes and their regulatory hormones were studied in preterm infants who suffered from... more Body electrolytes and their regulatory hormones were studied in preterm infants who suffered from bronchopulmonary dysplasia under two groups: those who were not treated with diuretics (Group II), and those who were treated with diuretics (Group III). The values were compared with a group of matched healthy controls (Group I). Lower serum Na levels, a need of higher Na intake, and higher urinary Na concentrations and urinary specific gravity were found in Group II infants. FeNa was normal and the urinary flow rate was lower than the controls. These data suggest an inability of these infants to dilute urine. Group III infants who were treated with diuretics showed higher serum Na levels and lower urinary specific gravity than Group II infants. These values, as well as water and Na intake/output ratios, were all similar to the control values. Serum aldosterone level was highest in Group II but did not reach significance. Intracellular K concentration was not different between the groups indicating an optimum total body K balance. A significant negative correlation between serum Na and aldosterone levels was found in Group II infants, which was not noted in the controls. Significant correlations were also found between FeNa and plasma aldosterone level in the BPD groups, unlike the controls. The control group of infants showed significant positive correlation between Na balance and serum Na levels. Our results suggest that inability to dilute urine appropriately might be the reason for the BPD patients to retain body water. Water restriction and diuretic therapy therefore are reasonable therapeutic approaches in such cases.

The Indian Journal of Pediatrics, 1993

We measured 24-hour fecal losses of sodium (Na) and potassium (K) in immediate post natal period ... more We measured 24-hour fecal losses of sodium (Na) and potassium (K) in immediate post natal period of preterm neonates to determine the role of this route in the electrolyte imbalances seen in such infants. The values from preterm infants were compared to a group of age matched term infants. Eleven studies were done on unfed extremely low birth weight infants (group I, birth weight <1200 gms), seven on fed preterm infants (group II, birth weight 1201-2500 gms) and nine on fed term infants (group III, birth weight 2501-4000 gms). Measured and derived variables compared between the groups were 24 hour fecal volume, total fecal electrolyte contents, Na or K lost per kg of body weight and per gm. of stool and Na or K losses as percent of intake. Although 24 hour fecal volume was lowest in group I, none of the variab!es related to Na differed between groups I and II whereas all of them were significantly lower in group I when compared with group Ill. Groups II and III differed only in terms of Na Ioss/gm stool which was lower in the previous group. Conversely K Ioss/gm of stool was significantly higher in group I when compared with both groups II and III and the only variable that differed between groups II and Ill was a higher fecal K content as fraction of intake. Fecal K/Na ratio was highest in group I, and decreased progressively with advancing gestational age, whereas creatinine clearance was lowest in group I and increased along with gestational age. Serum electrolyte levels were normal, although serum Na concentration was lowest in group I and serum K concentration highest in group II. We conclude that very low birth weight infants have relatively higher fecal K concentrations in the first week of extrauterine life, and speculate that this might have physiological significance as these infants are prone to hyperkalemia during this period. (Indian J Pediatr 1993; 60; 631-638)

Transplantation Proceedings, 2007

Cardiovascular disease is a major cause of morbidity and mortality in children and young adults w... more Cardiovascular disease is a major cause of morbidity and mortality in children and young adults with end-stage renal disease. In our study, we retrospectively analyzed the records of 11 patients who had undergone electron beam computerized tomography in our dialysis unit. Our patients, aged 11 to 24 years (median, 19.3 years) were on dialysis or had functioning grafts. Coronary calcification was observed in seven patients (64%) with a mean calcium score of 273.8 +/- 708 (range 0.8 to 1864) in our study population. We compared clinical characteristics like age, gender, duration of end-stage renal disease, time on hemodialysis, body mass index, and blood pressures between the patients with calcifications (group I) and those with out calcification (group II). We also compared the laboratory data including daily calcium and calcitriol intake, lipid profile, serum calcium and phosphorus levels, calcium/phosphorus products, and serum parathyroid hormone levels in the both groups. The mean daily dose of total calcium, triglyceride level, and calcium/phosphorus products were higher in the calcification group though not statistically significant. The mean daily dose of calcitriol was significantly higher in patients with calcification. Using Spearman multivariate correlation, we found a correlation between the coronary calcium scores and mean daily doses of total calcium and calcitriol (r = .750, P =.008 and r = .869, P = .001, respectively). We conclude that coronary calcification, which is a proven predictor of cardiovascular disease, begins at a very early age and that daily doses of elemental calcium and calcitriol seem to be important factors in our study population.

Transplantation Proceedings, 2008

Background. Cold ischemia and clamping of the renal artery contribute to acute tubular necrosis a... more Background. Cold ischemia and clamping of the renal artery contribute to acute tubular necrosis and renal dysfunction of transplant grafts. The mechanism of ischemic injury is not fully understood, but endothelin (ET)-1 and -2 have been found to participate in reperfusion injury. ET receptor blockade has been shown to have renoprotective effects in both warm and cold reperfusion injury. Objective. We sought to assess the effect of tezosentan, a competitive ET antagonist, on piglet renal function during cold ischemia and renal artery clamping. Design/Methods. Sixteen piglets (7 to 10 days old) were prepped and assigned to three experimental groups: piglets with kidneys clamped (K CLAMP ), with kidneys wrapped in ice (K ICE ), and piglets treated with tezosentan injected after 45 minutes of clamping and ice (K TEZO ). Preexperiment parameters including vital signs, urine volume, glomerular filtration rate (GFR), paraaminohippuric acid clearance (CPAH), fractional excretion of sodium and potassium (FeNa, FeK), and renal blood flow (RBF) were measured at baseline, then at 1-and 2-hour intervals. Results. The decrease in urine volume was comparable in both K CLAMP and K ICE groups, but no UV decrease was observed in K TEZO group. RBF and GFR were similar (26% to 52% decrease) in all three groups. FeNa decreased by Ͼ50% in K ICE , whereas it increased by 60% in K TEZO when compared with baseline. A similar increase in FeK was observed in all three groups. Conclusions. Cold ischemia and clamping have deleterious effects on RBF, GFR, and FeNa. ET blockade did not have a renoprotective effect except on urine volume when given soon after the injury.

Transplantation, 2008

Pediatric small bowel transplantations are associated with pronounced electrolyte disturbances in... more Pediatric small bowel transplantations are associated with pronounced electrolyte disturbances in the postoperative period. We investigated the pattern of electrolyte disturbances with regard to enteral malabsorption, renal compensation, and the influence of immunosuppression. We reviewed 11 small bowel transplantations between October 2002 and February 2007. The data collected included frequent serum, ostomy, and urine electrolyte profiles, renal function parameters, and FK 506 levels in the postoperative period up until either discharge or graft loss. Our results show enteral losses most prominent during the first 4 weeks postoperatively that are only partially compensated by the kidneys. Subsequently, enteral losses improved, although renal function remained challenged, particularly glomerular filtration and phosphorus, magnesium losses, which correlated with high FK 506 levels. Our data reveal several electrolyte imbalances different and unique to postoperative small bowel transplants. Although enteral losses improve along with graft villi formation, electrolyte abnormalities continue, to which FK 506-mediated renal toxicity might contribute.

Transplantation Journal, 2004

Transplantation, 2005

We are reporting the first known case of sequential combined living donor liver/small bowel trans... more We are reporting the first known case of sequential combined living donor liver/small bowel transplantation (LDL/SBT). A 2-year-old boy born with gastroschisis and intestinal malrotation lost his entire small bowel and colon shortly after birth. He underwent a living donor small bowel transplant at 1 year of age that was lost 4 months after implantation for posttransplant lymphoproliferative disease (PTLD). He recovered from PTLD but developed total parenteral nutrition (TPN)-induced liver failure. He received a combined left lateral liver and terminal ileum transplant that we chose to perform sequentially due to the presence of preformed antibodies against his mother&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s tissues. The mother had no complications and a cumulative hospital stay of 7 days. At 9 months postsurgery, the patient is on full enteral nutrition and has suffered neither technical complications nor rejection. The technique described here is reproducible and makes combined living donor LDL/SBT an alternative to combined cadaveric liver-small bowel transplant.

Pediatric Transplantation, 2010

Metabolic syndrome in pediatric renal transplant recipients: Comparing early discontinuation of s... more Metabolic syndrome in pediatric renal transplant recipients: Comparing early discontinuation of steroids vs. steroid group CVD is the leading cause of death in young adults who have undergone RT (1). These young adults may have an increased 10-fold risk of disease in comparison to their peers (2), which is associated with left ventricular hypertrophy arterial wall stiffening (3). As accelerated CVD lowers expected life-span of children and adolescents undergoing RT in comparison with an agematched population, there is an increased need for preventive measures of diagnosing at risk patients for CVD.

Pediatric Transplantation, 2006

Pediatric Transplantation, 2007

Pediatric Transplantation, 2007

Recurrence of primary diseases such as FSGS or HUS is known to cause early graft dysfunction afte... more Recurrence of primary diseases such as FSGS or HUS is known to cause early graft dysfunction after pediatric renal transplantation. We report the unusual occurrence of early graft dysfunction following kidney transplant in two pediatric cases. Both subjects had biopsy proven recurrence of CGN in less than a week after transplantation. We were able to sustain the renal function in one of them following aggressive treatment. Hence, early recurrence of CGN should be considered in the differential diagnosis of early graft dysfunction.

Pediatric Transplantation, 2005

Pediatric Transplantation, 2004

Pediatric Transplantation, 2005

Pediatric Surgery International, 2008

Systemic and renal hemodynamics are affected by prostaglandin production during endotoxemia. To s... more Systemic and renal hemodynamics are affected by prostaglandin production during endotoxemia. To study indomethacin effects on endotoxinemia in a neonatal piglet model, sixteen 7-10 day old piglets were anesthetized, ventilated, and catheterized. Mean arterial pressure (MAP), heart rate (HR), and urine output were continuously monitored. Endotoxin (0.06 mcg/kg) was injected after baseline measurements. We studied two groups with either endotoxinemia alone (n = 7) or an additional indomethacin infusion (0.2 mg/kg per h, n = 9). HR, MAP, renal blood flow (RBF), systemic and renal vascular resistance (SVR, RVR), cardiac index (CI), and glomerular filtration rate (GFR), were obtained at baseline, at 1, 2 and 3 h. We observed a drop in CI and an increase in SVR and HR within 3 h of endotoxinemia, while MAP remained unchanged. These effects were prevented by indomethacin. RVR was not altered significantly. Endotoxinemia triggered a drop of RBF in both control (P \ 0.01) and intervention group (P \ 0.05). In the intervention group, drop of GFR, urine volume, and paraaminohippuric acid clearance were apparent signs of nephrotoxicity (P \ 0.01, \0.05, and \0.01). In conclusion, indomethacin maintains hemodynamic parameters during endotoxinemia at the expense of nephrotoxicity. We speculate that indomethacin counteracts the renoprotective effect of prostaglandins.

Pediatric Research, 1999

This experiment was designed to understand the early pathophysiological changes that cause renal ... more This experiment was designed to understand the early pathophysiological changes that cause renal impairment in septic piglets. Nine, four-seven day old, piglets were anesthetized; the femoral artery, veins, and bladder were catheterized. After stabilization ...

Neonatology, 2008

Gram-negative sepsis in newborns is associated with high mortality and morbidity. Lipopolysacchar... more Gram-negative sepsis in newborns is associated with high mortality and morbidity. Lipopolysaccharide (LPS) and cytokines released upon exposure to gram-negative sepsis are well known to be involved in the pathophysiology. In this report we investigate cytokine release, hemodynamic, and renal function induced by LPS in a newborn animal model with the intention to further examine early changes in gram-negative sepsis. Five 7- to 10-day-old domestic piglets were anesthetized and catheters placed in the jugular veins, left ventricle, and femoral artery. Urine output was monitored via suprapubic cystostomy. Mean arterial pressure, heart rate, and arterial blood gases were continuously monitored. Thirty minutes after line placement and obtaining baseline values, 0.06 mug/kg LPS were administered intravenously. One, 2, and 3 h later samples were taken to monitor tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, endothelin, and nitric oxide (NO)/nitrate via ELISA. In addition, blood flow was assessed by the microsphere method. Our data show an initial surge of TNF-alpha and IL-1beta at 1 h after exposure to LPS. NO/nitrate, endothelin, and hemodynamic as well as metabolic changes became apparent mostly 3 h after exposure, by which time TNF-alpha and IL-1beta fell back to baseline. Our sepsis model suggests a brief initial TNF-alpha and IL-1beta surge following LPS challenge; however, their effects become apparent by the time the levels are already subsiding. The emergence of vasoactive substances, NO and endothelin, precedes the first substantial clinical symptoms.

Pediatric Research, 1985

u s t o determine t h e content of AVP i n donor blood. I n keeping w i t h s t a n d a r d blood... more u s t o determine t h e content of AVP i n donor blood. I n keeping w i t h s t a n d a r d blood banking p r a c t i c e s , 80 ml of blood were drawn from each of e i g h t donors, mixed w i t h 7 ml of a n t i c o a g u l a n t (CPD) i n standard blood bank bags and r e f r i g e r a t e d a t 4OC. Daily samples were drawn on each of f i v e s u c c e s s i v e days. The plasma was a c i d i f i e d and f r o z e n a t -20°C u n t i l t h e time of a s s a y . AVP was e x t r a c t e d by b e n t o n i t e procedure modified from Skowsky technique i n d u p l i c a t e and measured by radioimmunoassay i n t r i p l i c a t e . Only 2 of 8 donors had h i g h e r than normal v a l u e s (6 & 7 pg AVP/ml) a t t h e time of t h e i n i t i a l sample. AVP l e v e l s decreased from day 1 t o day 5 w i t h t h e g r e a t e s t f a l l i n t h e f i r s t 24 hours.

The Indian Journal of Pediatrics, 1994

Body electrolytes and their regulatory hormones were studied in preterm infants who suffered from... more Body electrolytes and their regulatory hormones were studied in preterm infants who suffered from bronchopulmonary dysplasia under two groups: those who were not treated with diuretics (Group II), and those who were treated with diuretics (Group III). The values were compared with a group of matched healthy controls (Group I). Lower serum Na levels, a need of higher Na intake, and higher urinary Na concentrations and urinary specific gravity were found in Group II infants. FeNa was normal and the urinary flow rate was lower than the controls. These data suggest an inability of these infants to dilute urine. Group III infants who were treated with diuretics showed higher serum Na levels and lower urinary specific gravity than Group II infants. These values, as well as water and Na intake/output ratios, were all similar to the control values. Serum aldosterone level was highest in Group II but did not reach significance. Intracellular K concentration was not different between the groups indicating an optimum total body K balance. A significant negative correlation between serum Na and aldosterone levels was found in Group II infants, which was not noted in the controls. Significant correlations were also found between FeNa and plasma aldosterone level in the BPD groups, unlike the controls. The control group of infants showed significant positive correlation between Na balance and serum Na levels. Our results suggest that inability to dilute urine appropriately might be the reason for the BPD patients to retain body water. Water restriction and diuretic therapy therefore are reasonable therapeutic approaches in such cases.

The Indian Journal of Pediatrics, 1993

We measured 24-hour fecal losses of sodium (Na) and potassium (K) in immediate post natal period ... more We measured 24-hour fecal losses of sodium (Na) and potassium (K) in immediate post natal period of preterm neonates to determine the role of this route in the electrolyte imbalances seen in such infants. The values from preterm infants were compared to a group of age matched term infants. Eleven studies were done on unfed extremely low birth weight infants (group I, birth weight <1200 gms), seven on fed preterm infants (group II, birth weight 1201-2500 gms) and nine on fed term infants (group III, birth weight 2501-4000 gms). Measured and derived variables compared between the groups were 24 hour fecal volume, total fecal electrolyte contents, Na or K lost per kg of body weight and per gm. of stool and Na or K losses as percent of intake. Although 24 hour fecal volume was lowest in group I, none of the variab!es related to Na differed between groups I and II whereas all of them were significantly lower in group I when compared with group Ill. Groups II and III differed only in terms of Na Ioss/gm stool which was lower in the previous group. Conversely K Ioss/gm of stool was significantly higher in group I when compared with both groups II and III and the only variable that differed between groups II and Ill was a higher fecal K content as fraction of intake. Fecal K/Na ratio was highest in group I, and decreased progressively with advancing gestational age, whereas creatinine clearance was lowest in group I and increased along with gestational age. Serum electrolyte levels were normal, although serum Na concentration was lowest in group I and serum K concentration highest in group II. We conclude that very low birth weight infants have relatively higher fecal K concentrations in the first week of extrauterine life, and speculate that this might have physiological significance as these infants are prone to hyperkalemia during this period. (Indian J Pediatr 1993; 60; 631-638)

Transplantation Proceedings, 2007

Cardiovascular disease is a major cause of morbidity and mortality in children and young adults w... more Cardiovascular disease is a major cause of morbidity and mortality in children and young adults with end-stage renal disease. In our study, we retrospectively analyzed the records of 11 patients who had undergone electron beam computerized tomography in our dialysis unit. Our patients, aged 11 to 24 years (median, 19.3 years) were on dialysis or had functioning grafts. Coronary calcification was observed in seven patients (64%) with a mean calcium score of 273.8 +/- 708 (range 0.8 to 1864) in our study population. We compared clinical characteristics like age, gender, duration of end-stage renal disease, time on hemodialysis, body mass index, and blood pressures between the patients with calcifications (group I) and those with out calcification (group II). We also compared the laboratory data including daily calcium and calcitriol intake, lipid profile, serum calcium and phosphorus levels, calcium/phosphorus products, and serum parathyroid hormone levels in the both groups. The mean daily dose of total calcium, triglyceride level, and calcium/phosphorus products were higher in the calcification group though not statistically significant. The mean daily dose of calcitriol was significantly higher in patients with calcification. Using Spearman multivariate correlation, we found a correlation between the coronary calcium scores and mean daily doses of total calcium and calcitriol (r = .750, P =.008 and r = .869, P = .001, respectively). We conclude that coronary calcification, which is a proven predictor of cardiovascular disease, begins at a very early age and that daily doses of elemental calcium and calcitriol seem to be important factors in our study population.

Transplantation Proceedings, 2008

Background. Cold ischemia and clamping of the renal artery contribute to acute tubular necrosis a... more Background. Cold ischemia and clamping of the renal artery contribute to acute tubular necrosis and renal dysfunction of transplant grafts. The mechanism of ischemic injury is not fully understood, but endothelin (ET)-1 and -2 have been found to participate in reperfusion injury. ET receptor blockade has been shown to have renoprotective effects in both warm and cold reperfusion injury. Objective. We sought to assess the effect of tezosentan, a competitive ET antagonist, on piglet renal function during cold ischemia and renal artery clamping. Design/Methods. Sixteen piglets (7 to 10 days old) were prepped and assigned to three experimental groups: piglets with kidneys clamped (K CLAMP ), with kidneys wrapped in ice (K ICE ), and piglets treated with tezosentan injected after 45 minutes of clamping and ice (K TEZO ). Preexperiment parameters including vital signs, urine volume, glomerular filtration rate (GFR), paraaminohippuric acid clearance (CPAH), fractional excretion of sodium and potassium (FeNa, FeK), and renal blood flow (RBF) were measured at baseline, then at 1-and 2-hour intervals. Results. The decrease in urine volume was comparable in both K CLAMP and K ICE groups, but no UV decrease was observed in K TEZO group. RBF and GFR were similar (26% to 52% decrease) in all three groups. FeNa decreased by Ͼ50% in K ICE , whereas it increased by 60% in K TEZO when compared with baseline. A similar increase in FeK was observed in all three groups. Conclusions. Cold ischemia and clamping have deleterious effects on RBF, GFR, and FeNa. ET blockade did not have a renoprotective effect except on urine volume when given soon after the injury.

Transplantation, 2008

Pediatric small bowel transplantations are associated with pronounced electrolyte disturbances in... more Pediatric small bowel transplantations are associated with pronounced electrolyte disturbances in the postoperative period. We investigated the pattern of electrolyte disturbances with regard to enteral malabsorption, renal compensation, and the influence of immunosuppression. We reviewed 11 small bowel transplantations between October 2002 and February 2007. The data collected included frequent serum, ostomy, and urine electrolyte profiles, renal function parameters, and FK 506 levels in the postoperative period up until either discharge or graft loss. Our results show enteral losses most prominent during the first 4 weeks postoperatively that are only partially compensated by the kidneys. Subsequently, enteral losses improved, although renal function remained challenged, particularly glomerular filtration and phosphorus, magnesium losses, which correlated with high FK 506 levels. Our data reveal several electrolyte imbalances different and unique to postoperative small bowel transplants. Although enteral losses improve along with graft villi formation, electrolyte abnormalities continue, to which FK 506-mediated renal toxicity might contribute.

Transplantation Journal, 2004

Transplantation, 2005

We are reporting the first known case of sequential combined living donor liver/small bowel trans... more We are reporting the first known case of sequential combined living donor liver/small bowel transplantation (LDL/SBT). A 2-year-old boy born with gastroschisis and intestinal malrotation lost his entire small bowel and colon shortly after birth. He underwent a living donor small bowel transplant at 1 year of age that was lost 4 months after implantation for posttransplant lymphoproliferative disease (PTLD). He recovered from PTLD but developed total parenteral nutrition (TPN)-induced liver failure. He received a combined left lateral liver and terminal ileum transplant that we chose to perform sequentially due to the presence of preformed antibodies against his mother&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s tissues. The mother had no complications and a cumulative hospital stay of 7 days. At 9 months postsurgery, the patient is on full enteral nutrition and has suffered neither technical complications nor rejection. The technique described here is reproducible and makes combined living donor LDL/SBT an alternative to combined cadaveric liver-small bowel transplant.

Pediatric Transplantation, 2010

Metabolic syndrome in pediatric renal transplant recipients: Comparing early discontinuation of s... more Metabolic syndrome in pediatric renal transplant recipients: Comparing early discontinuation of steroids vs. steroid group CVD is the leading cause of death in young adults who have undergone RT (1). These young adults may have an increased 10-fold risk of disease in comparison to their peers (2), which is associated with left ventricular hypertrophy arterial wall stiffening (3). As accelerated CVD lowers expected life-span of children and adolescents undergoing RT in comparison with an agematched population, there is an increased need for preventive measures of diagnosing at risk patients for CVD.

Pediatric Transplantation, 2006

Pediatric Transplantation, 2007

Pediatric Transplantation, 2007

Recurrence of primary diseases such as FSGS or HUS is known to cause early graft dysfunction afte... more Recurrence of primary diseases such as FSGS or HUS is known to cause early graft dysfunction after pediatric renal transplantation. We report the unusual occurrence of early graft dysfunction following kidney transplant in two pediatric cases. Both subjects had biopsy proven recurrence of CGN in less than a week after transplantation. We were able to sustain the renal function in one of them following aggressive treatment. Hence, early recurrence of CGN should be considered in the differential diagnosis of early graft dysfunction.

Pediatric Transplantation, 2005

Pediatric Transplantation, 2004

Pediatric Transplantation, 2005

Pediatric Surgery International, 2008

Systemic and renal hemodynamics are affected by prostaglandin production during endotoxemia. To s... more Systemic and renal hemodynamics are affected by prostaglandin production during endotoxemia. To study indomethacin effects on endotoxinemia in a neonatal piglet model, sixteen 7-10 day old piglets were anesthetized, ventilated, and catheterized. Mean arterial pressure (MAP), heart rate (HR), and urine output were continuously monitored. Endotoxin (0.06 mcg/kg) was injected after baseline measurements. We studied two groups with either endotoxinemia alone (n = 7) or an additional indomethacin infusion (0.2 mg/kg per h, n = 9). HR, MAP, renal blood flow (RBF), systemic and renal vascular resistance (SVR, RVR), cardiac index (CI), and glomerular filtration rate (GFR), were obtained at baseline, at 1, 2 and 3 h. We observed a drop in CI and an increase in SVR and HR within 3 h of endotoxinemia, while MAP remained unchanged. These effects were prevented by indomethacin. RVR was not altered significantly. Endotoxinemia triggered a drop of RBF in both control (P \ 0.01) and intervention group (P \ 0.05). In the intervention group, drop of GFR, urine volume, and paraaminohippuric acid clearance were apparent signs of nephrotoxicity (P \ 0.01, \0.05, and \0.01). In conclusion, indomethacin maintains hemodynamic parameters during endotoxinemia at the expense of nephrotoxicity. We speculate that indomethacin counteracts the renoprotective effect of prostaglandins.

Pediatric Research, 1999

This experiment was designed to understand the early pathophysiological changes that cause renal ... more This experiment was designed to understand the early pathophysiological changes that cause renal impairment in septic piglets. Nine, four-seven day old, piglets were anesthetized; the femoral artery, veins, and bladder were catheterized. After stabilization ...