Gerald Arbus - Academia.edu (original) (raw)

Papers by Gerald Arbus

Research paper thumbnail of Age‐Specific Frequencies of Antibodies toEscherichia coliVerocytotoxins (Shiga Toxins) 1 and 2 among Urban and Rural Populations in Southern Ontario

The Journal of Infectious Diseases, 2003

In 173 urban residents and 232 rural dairy-farm residents (age range, 0-70 years) who were strati... more In 173 urban residents and 232 rural dairy-farm residents (age range, 0-70 years) who were stratified for age, the frequency of antiverocytotoxin 2 antibodies (VT2 Abs) (frequency in urban residents, 46%; frequency in rural residents, 65%) was significantly higher than that of antiverocytotoxin 1 antibodies (VT1 Abs) (frequency in urban residents, 12%; frequency in rural residents, 39%) (). The frequency of VT2 Abs (93%) was P р .001 also significantly higher than that of VT1 Abs (50%) in 14 patients with hemolytic uremic syndrome (HUS) associated with verocytotoxin-producing Escherichia coli (VTEC) strains that expressed both toxins. In urban residents, the frequency of both antibodies tended to decrease between the first and the second decades of life, and it then increased until the fifth decade of life, before, in the case of VT2 Abs, decreasing again. This pattern, which inversely reflects the age-related incidence of HUS, is consistent with a role for antiverocytotoxin antibodies in protective immunity. In dairy-farm residents, peak frequencies of antibodies to both toxins occurred during the first decade of life and remained elevated for 3 decades before decreasing, a pattern consistent with frequent exposure to bovine VTEC from an early age.

Research paper thumbnail of Non-steroidal anti-inflammatory drug-associated nephrotoxicity in Bartter syndrome

Pediatric Nephrology, 1998

We have followed four patients with Bartter syndrome for a mean of 25.4 years (range 21.5-28.8 ye... more We have followed four patients with Bartter syndrome for a mean of 25.4 years (range 21.5-28.8 years) after diagnosis. All patients received non-steroidal anti-inflammatory drugs (NSAID). In all patients, various degrees of renal dysfunction were noted to be temporally associated with NSAID therapy. In two patients, renal dysfunction resolved after discontinuing NSAID therapy, while maintaining other chronic medications such as potassium-sparing diuretics. Renal dysfunction persisted after NSAID withdrawal in two patients. We report these cases as a warning that NSAID should be considered an important cause of either reversible or irreversible renal dysfunction in Bartter syndrome.

Research paper thumbnail of A randomized prospective crossover trial of amlodipine in pediatric hypertension

Pediatric Nephrology, 2000

Amlodipine has potential advantages in children since it can be dissolved into a liquid preparati... more Amlodipine has potential advantages in children since it can be dissolved into a liquid preparation and has a long elimination half-life, allowing for once-daily administration. The objective of this study was to compare the efficacy and compliance of amlodipine with that of standard long-acting calcium channel blockers (felodipine or nifedipine) in hypertensive children. A randomized, prospective, crossover study of 11 hypertensive children (9-17 years of age, 10 renal transplant patients) was performed with electronic monitoring of compliance. Each treatment arm was 30 days. No significant differences were observed in mean systolic (SBP) and diastolic blood pressures (DBP) between amlodipine and the other calcium channel blockers. Using 24-h blood pressure monitoring there were no significant differences over each drug treatment period in both mean day-time and night-time SBP and DBP. Patient compliance was similar in both the amlodipine and the nifedipine/felodipine treatment periods. These data suggest that amlodipine is as effective in pediatric nephrology patients as nifedipine and felodipine. Amlodipine may be optimally suited for treatment of young children because at present it is the only calcium channel blocker which can be administered once daily as a liquid preparation.

Research paper thumbnail of Treatment of Candida peritonitis by peritoneal lavage with amphotericin B

The Journal of Pediatrics, 1975

A 14-year-old girl, who was a renal transplant recipient, developed Candida tropicalis peritoniti... more A 14-year-old girl, who was a renal transplant recipient, developed Candida tropicalis peritonitis during peritoneal dialysis and immunosuppressive and broad-spectrum antibiotic therapy. Therapeutic cure of the peritonitis followed a ten-day course of amphotericin B administered solely by peritoneal lavage.

Research paper thumbnail of Efficacy of Amlodipine in Pediatric Bone Marrow Transplant Patients

Clinical Pediatrics, 1998

The calcium antagonist amlodipine may have the potential for expanded use in children owing to it... more The calcium antagonist amlodipine may have the potential for expanded use in children owing to its physiochemistry and pharmacokinetic profile that facilitates once-daily dosing in a liquid formulation. Its safety and efficacy have not been previously evaluated in children. A retrospective analysis of 15 pediatric bone marrow transplant patients who had amlodipine incorporated into their antihypertensive drug regimen reveals significantly lower blood pressure as compared with baseline therapy (123.5+/-2.1 mmHg and 117.2+/-2.2 mmHg, systolic blood pressure before and during amlodipine, P<0.05; 81.5+/-1.8 mmHg and 75.5+/-2.6 mmHg, diastolic blood pressure before and during amlodipine, P<0.05). Amlodipine provided improved blood pressure control in this cohort and may provide a valuable pharmacologic alternative for treatment of pediatric hypertension.

Research paper thumbnail of Survival Comparison of Adul T Non-Diabetic Patients Treated with Either Hemodial Ysis or Capd for End-Stage Renal Failure

Peritoneal Dialysis International, Apr 1, 1987

The authors studied all adult patients (15 years and over), other than those with primary diagnos... more The authors studied all adult patients (15 years and over), other than those with primary diagnosis of diabetes mellitus, who were registered in the Canadian Renal Failure Register , and who had begun treatment with either hemodialysis or peritoneal dialysis. Survival was calculated only for those on hemodialysis or for those on peritoneal dialysis who changed to or continued on CAPD. The calculations were done for life and technique survival in three age groups. The age groups were: 15-44, 45-64, and 65 and over. In all age groups the survival until death was similar. The technique survival rates were higher in hemodialysis in the 15-44 group, similar in the 45-64 group, and initially lower in CAPD in the 65 and over group.

Research paper thumbnail of Cyclosporin A in children with persistent renal transplant rejection and progressively deteriorating graft function

Pediat Nephrol, 1987

The effect on renal function and growth of switching from azathioprine to cyclosporin A (CyA) was... more The effect on renal function and growth of switching from azathioprine to cyclosporin A (CyA) was prospectively evaluated in ten children with persistent renal transplant rejection. Progression of renal insufficiency during CyA therapy was compared with that before using CyA. Prednisone administration decreased after CyA was introduced and although growth retardation persisted, height velocity improved significantly. Renal function stabilized in seven patients treated with CyA for a variable time period, and four of these children remain off dialysis 0.44-1.42 years later. Renal biopsies were obtained in seven children when they were converted from azathioprine to CyA. The response to CyA could not be predicted from renal morphology or clinical features.

Research paper thumbnail of 1542 Treatment of the Hemolytic Uremic Syndrome (Hus) with Plasma

Research paper thumbnail of Protocol of the growth failure in children with renal diseases study

The Journal of Pediatrics, Feb 28, 1990

Research paper thumbnail of Non-steroidal anti-inflammatory drug-associated nephrotoxicity in Bartter syndrome

Pediatric Nephrology, Jan 10, 1998

We have followed four patients with Bartter syndrome for a mean of 25.4 years (range 21.5-28.8 ye... more We have followed four patients with Bartter syndrome for a mean of 25.4 years (range 21.5-28.8 years) after diagnosis. All patients received non-steroidal anti-inflammatory drugs (NSAID). In all patients, various degrees of renal dysfunction were noted to be temporally associated with NSAID therapy. In two patients, renal dysfunction resolved after discontinuing NSAID therapy, while maintaining other chronic medications such as potassium-sparing diuretics. Renal dysfunction persisted after NSAID withdrawal in two patients. We report these cases as a warning that NSAID should be considered an important cause of either reversible or irreversible renal dysfunction in Bartter syndrome.

Research paper thumbnail of 1542 Treatment of the Hemolytic Uremic Syndrome (Hus) with Plasma

Pediatric Research

ABSTRACT

Research paper thumbnail of Results from the Canadian Renal Failure Registry

American journal of kidney diseases : the official journal of the National Kidney Foundation, 1990

This report encompasses data collected from all Canadian patients starting treatment for end-stag... more This report encompasses data collected from all Canadian patients starting treatment for end-stage renal failure (ESRF) from 1981 until the end of 1987. Gross mortality showed an initial decline, but has stabilized since 1985. The year of entry into the system did not change the survival rate. There was an increase in the rate of acceptance of new patients between 1982 and 1987. The largest increases were in the older age groups, and resulted in a concomitant increase in the number of registered patients in older age groups. Survival on dialysis by age group declined with age. There was no difference in patient survival on hemodialysis or peritoneal dialysis. The probability of death for all patients entering the ESRF system remained constant notwithstanding year of entry into the system. It was slightly higher for males than females, much higher for patients with diabetes or renal vascular disease, higher with age, and much higher for patients not undergoing transplant.

Research paper thumbnail of Long versus standard initial steroid therapy for children with the nephrotic syndromeA report from the Southwest Pediatric Nephrology Study Group

Pediatric nephrology (Berlin, Germany), 2003

A retrospective cohort study was conducted by the Southwest Pediatric Nephrology Study Group (SPN... more A retrospective cohort study was conducted by the Southwest Pediatric Nephrology Study Group (SPNSG) to address whether a longer initial course of corticosteroids in patients with idiopathic nephrotic syndrome (INS) provides superior protection against relapse without increased adverse effects. In order to be included in the evaluation, patients with INS must have responded to an initial steroid course, either standard or long regimen as defined here, and completed at least 1 year of follow-up. The standard regimen consisted of prednisone 2.0+/-0.3 mg/kg per day or 60+/-10 mg/m(2) per day for 28+/-4 days, followed by alternate-day prednisone for 4-12 weeks. The long regimen consisted of daily prednisone 2.0+/-0.3 mg/kg per day or 60+/-10 mg/m(2) per day for 42+/-6 days, followed by alternate-day prednisone for 6-14 weeks. The primary outcome measure was relapse of NS within 12 months of discontinuing the initial course of prednisone. There were 151 children who met the criteria for ...

Research paper thumbnail of Part F: Renal Replacement Therapy in Canada 1981–1992

Replacement of Renal Function by Dialysis, 1996

ABSTRACT

Research paper thumbnail of Plasma Renin Activity (Pra) in the Assessment of Persistent Hypertension (HT) of Renal Allograft Recipients

Pediatric Research, 1977

ABSTRACT

Research paper thumbnail of A family outbreak of hemolytic-uremic syndrome associated with verotoxin-producingEscherichia coli serotype 0157:H7

Pediatric Nephrology, 1988

All five siblings (three boys and two girls, aged 1.5-9 years) in a family developed hemolytic-ur... more All five siblings (three boys and two girls, aged 1.5-9 years) in a family developed hemolytic-uremic syndrome associated with verotoxin-producing Escherichia coli O157:H7 at a lakeside vacation cottage during the fall of 1985. All five were hospitalized and made a full recovery. Both parents remained asymptomatic, and neither had evidence of this infection. In four children who were investigated prospectively, free verotoxin was still detectable in the stools for between 3 and 7 weeks. The prodromal diarrheal illness in the children occurred over a 10-day period. The epidemic curve was consistent with a point-source outbreak, but continuous exposure or person-to-person transmission could not be ruled out. The source of the infection was not identified.

Research paper thumbnail of Antibodies to intimin and Escherichia coli secreted proteins A and B in patients with enterohemorrhagic Escherichia coli infections

Pediatric Nephrology, 2002

Enterohemorrhagic Escherichia coli produce an attaching and effacing lesion upon adhering to the ... more Enterohemorrhagic Escherichia coli produce an attaching and effacing lesion upon adhering to the intestinal epithelium. Bacterial factors involved in this histopathology include the intimin adhesin and E. coli secreted proteins (Esps) A and B. In this study we investigated the serum antibody responses to recombinant E. coli O157:H7 intimin, EspA, and EspB by immunoblotting. Canadian patients with O157:H7 infection (n=10), Swedish patients with O157:H7 (n=21), non-O157 (n=18), or infection from which the serotype was not available (n=3), and asymptomatic household members (n=25) were studied and compared with Canadian (n=20) and Swedish controls (n=52). In Canadian patients, IgG antibodies to intimin, EspA, and EspB were analyzed, in Swedish patients and their household members IgA, IgG, and IgM antibodies to EspA and EspB were studied. Patients and household members mounted an antibody response to the antigens. Significantly more patients developed an acute response to EspB compared with controls (P<0.01 Canadian patients, P<0.0001 Swedish patients). EspB IgA, IgG, and IgM had a specificity of 100%, 86%, and 86%, positive predictive value of 100%, 83%, and 81%, and sensitivity of 57%, 69%, and 63%, respectively, and appear to be an appropriate assay for the detection of EHEC infection. In cases of hemolytic uremic syndrome or hemorrhagic colitis this assay may be useful when a fecal strain has not been isolated, or in epidemics of non-O157 infection.

Research paper thumbnail of Cyclosporin A in children with persistent renal transplant rejection and progressively deteriorating graft function

Pediatric Nephrology, 1987

The effect on renal function and growth of switching from azathioprine to cyclosporin A (CyA) was... more The effect on renal function and growth of switching from azathioprine to cyclosporin A (CyA) was prospectively evaluated in ten children with persistent renal transplant rejection. Progression of renal insufficiency during CyA therapy was compared with that before using CyA. Prednisone administration decreased after CyA was introduced and although growth retardation persisted, height velocity improved significantly. Renal function stabilized in seven patients treated with CyA for a variable time period, and four of these children remain off dialysis 0.44-1.42 years later. Renal biopsies were obtained in seven children when they were converted from azathioprine to CyA. The response to CyA could not be predicted from renal morphology or clinical features.

Research paper thumbnail of The 1989 report of the North American Pediatric Renal Transplant Cooperative Study

Pediatric Nephrology, 1990

Transplant Cooperative Study summarizes data contributed by 57 participating centers on 754 child... more Transplant Cooperative Study summarizes data contributed by 57 participating centers on 754 children with 761 transplants from 1 January 1989 to 16 February 1989. Data collection was initiated in October 1987 and followup of all patients is ongoing. Transplant frequency increased with age; 24% of the patients were less than 5 years, with 7% being under 2 years. Common frequent diagnoses were: aplastic/dysplastic kidneys (18%), obstructive uropathy (16%), and focal segmental glomerulosclerosis (12%). Preemptive transplant, i.e., transplantation without prior maintenance dialysis, was performed in 21% of the patients. Dialytic modalities pretransplant were peritoneal dialysis in 42% and hemodialysis in 25%. Bilateral nephrectomy was reported in 29%. Live-donor sources accounted for 42% of the transplants. Among cadaveric donors, 41% of the donors were under 11 years old. During the first post-transplant month, maintenance therapy was used similarly for live-donor and cadaver source transplants, with prednisone, cyclosporine, and azathioprine used in 93%, 83%, and 81%, respectively. Triple therapy with prednisone, cyclosporine, and azathioprine was used in 78%. 75%, and 75% of functioning cadaver source transplants at 6 months, 12 months, and 18 months as opposed to 60%, 63 %, and 54% for live-donor procedures. with single-drug therapy being uncommon. Rehospitalization during months 1-5 occurred in 62% of the patients, with treatment of rejection and infection being the main causes. Additionally, 9% were hospitalized for hypertension. During months 6-12 and 12-17, 30% and 28% of the patients with functioning grafts were rehospitalized. Times to first rejection differed significantly for cadaver and live-donor transplants. The median time to the first rejection was 36 days for cadaver transplants and 156 days for live-donor transplants. Overall, 57% of treated rejec-* A list of all participating centers and the names of the investigators is printed on pages 552-553 Offprint requests to: A. Tejani, Director.

Research paper thumbnail of Long-term neurological sequelae of hemolytic-uremic syndrome: a preliminary report

Pediatric Nephrology, 1996

Seven patients with hemolytic-uremic syndrome who had major neurological symptoms during the acut... more Seven patients with hemolytic-uremic syndrome who had major neurological symptoms during the acute illness were neurologically and cognitively evaluated prospectively several years after recovery from the illness. Four patients showed evidence of subtle neurological sequelae, including posturing, clumsiness, poor fine-motor coordination, hyperactivity, and distractibility. Psychoeducational evaluation of all seven subjects revealed mean scores within the average range in cognitive abilities, academic achievement, single word receptive vocabulary, visual/motor planning, overall adaptive functioning, and hyperactivity. The lapse of time (minimum of 7 years) between the acute illness and the psychometric evaluation could have been responsible for our normal results.

Research paper thumbnail of Age‐Specific Frequencies of Antibodies toEscherichia coliVerocytotoxins (Shiga Toxins) 1 and 2 among Urban and Rural Populations in Southern Ontario

The Journal of Infectious Diseases, 2003

In 173 urban residents and 232 rural dairy-farm residents (age range, 0-70 years) who were strati... more In 173 urban residents and 232 rural dairy-farm residents (age range, 0-70 years) who were stratified for age, the frequency of antiverocytotoxin 2 antibodies (VT2 Abs) (frequency in urban residents, 46%; frequency in rural residents, 65%) was significantly higher than that of antiverocytotoxin 1 antibodies (VT1 Abs) (frequency in urban residents, 12%; frequency in rural residents, 39%) (). The frequency of VT2 Abs (93%) was P р .001 also significantly higher than that of VT1 Abs (50%) in 14 patients with hemolytic uremic syndrome (HUS) associated with verocytotoxin-producing Escherichia coli (VTEC) strains that expressed both toxins. In urban residents, the frequency of both antibodies tended to decrease between the first and the second decades of life, and it then increased until the fifth decade of life, before, in the case of VT2 Abs, decreasing again. This pattern, which inversely reflects the age-related incidence of HUS, is consistent with a role for antiverocytotoxin antibodies in protective immunity. In dairy-farm residents, peak frequencies of antibodies to both toxins occurred during the first decade of life and remained elevated for 3 decades before decreasing, a pattern consistent with frequent exposure to bovine VTEC from an early age.

Research paper thumbnail of Non-steroidal anti-inflammatory drug-associated nephrotoxicity in Bartter syndrome

Pediatric Nephrology, 1998

We have followed four patients with Bartter syndrome for a mean of 25.4 years (range 21.5-28.8 ye... more We have followed four patients with Bartter syndrome for a mean of 25.4 years (range 21.5-28.8 years) after diagnosis. All patients received non-steroidal anti-inflammatory drugs (NSAID). In all patients, various degrees of renal dysfunction were noted to be temporally associated with NSAID therapy. In two patients, renal dysfunction resolved after discontinuing NSAID therapy, while maintaining other chronic medications such as potassium-sparing diuretics. Renal dysfunction persisted after NSAID withdrawal in two patients. We report these cases as a warning that NSAID should be considered an important cause of either reversible or irreversible renal dysfunction in Bartter syndrome.

Research paper thumbnail of A randomized prospective crossover trial of amlodipine in pediatric hypertension

Pediatric Nephrology, 2000

Amlodipine has potential advantages in children since it can be dissolved into a liquid preparati... more Amlodipine has potential advantages in children since it can be dissolved into a liquid preparation and has a long elimination half-life, allowing for once-daily administration. The objective of this study was to compare the efficacy and compliance of amlodipine with that of standard long-acting calcium channel blockers (felodipine or nifedipine) in hypertensive children. A randomized, prospective, crossover study of 11 hypertensive children (9-17 years of age, 10 renal transplant patients) was performed with electronic monitoring of compliance. Each treatment arm was 30 days. No significant differences were observed in mean systolic (SBP) and diastolic blood pressures (DBP) between amlodipine and the other calcium channel blockers. Using 24-h blood pressure monitoring there were no significant differences over each drug treatment period in both mean day-time and night-time SBP and DBP. Patient compliance was similar in both the amlodipine and the nifedipine/felodipine treatment periods. These data suggest that amlodipine is as effective in pediatric nephrology patients as nifedipine and felodipine. Amlodipine may be optimally suited for treatment of young children because at present it is the only calcium channel blocker which can be administered once daily as a liquid preparation.

Research paper thumbnail of Treatment of Candida peritonitis by peritoneal lavage with amphotericin B

The Journal of Pediatrics, 1975

A 14-year-old girl, who was a renal transplant recipient, developed Candida tropicalis peritoniti... more A 14-year-old girl, who was a renal transplant recipient, developed Candida tropicalis peritonitis during peritoneal dialysis and immunosuppressive and broad-spectrum antibiotic therapy. Therapeutic cure of the peritonitis followed a ten-day course of amphotericin B administered solely by peritoneal lavage.

Research paper thumbnail of Efficacy of Amlodipine in Pediatric Bone Marrow Transplant Patients

Clinical Pediatrics, 1998

The calcium antagonist amlodipine may have the potential for expanded use in children owing to it... more The calcium antagonist amlodipine may have the potential for expanded use in children owing to its physiochemistry and pharmacokinetic profile that facilitates once-daily dosing in a liquid formulation. Its safety and efficacy have not been previously evaluated in children. A retrospective analysis of 15 pediatric bone marrow transplant patients who had amlodipine incorporated into their antihypertensive drug regimen reveals significantly lower blood pressure as compared with baseline therapy (123.5+/-2.1 mmHg and 117.2+/-2.2 mmHg, systolic blood pressure before and during amlodipine, P<0.05; 81.5+/-1.8 mmHg and 75.5+/-2.6 mmHg, diastolic blood pressure before and during amlodipine, P<0.05). Amlodipine provided improved blood pressure control in this cohort and may provide a valuable pharmacologic alternative for treatment of pediatric hypertension.

Research paper thumbnail of Survival Comparison of Adul T Non-Diabetic Patients Treated with Either Hemodial Ysis or Capd for End-Stage Renal Failure

Peritoneal Dialysis International, Apr 1, 1987

The authors studied all adult patients (15 years and over), other than those with primary diagnos... more The authors studied all adult patients (15 years and over), other than those with primary diagnosis of diabetes mellitus, who were registered in the Canadian Renal Failure Register , and who had begun treatment with either hemodialysis or peritoneal dialysis. Survival was calculated only for those on hemodialysis or for those on peritoneal dialysis who changed to or continued on CAPD. The calculations were done for life and technique survival in three age groups. The age groups were: 15-44, 45-64, and 65 and over. In all age groups the survival until death was similar. The technique survival rates were higher in hemodialysis in the 15-44 group, similar in the 45-64 group, and initially lower in CAPD in the 65 and over group.

Research paper thumbnail of Cyclosporin A in children with persistent renal transplant rejection and progressively deteriorating graft function

Pediat Nephrol, 1987

The effect on renal function and growth of switching from azathioprine to cyclosporin A (CyA) was... more The effect on renal function and growth of switching from azathioprine to cyclosporin A (CyA) was prospectively evaluated in ten children with persistent renal transplant rejection. Progression of renal insufficiency during CyA therapy was compared with that before using CyA. Prednisone administration decreased after CyA was introduced and although growth retardation persisted, height velocity improved significantly. Renal function stabilized in seven patients treated with CyA for a variable time period, and four of these children remain off dialysis 0.44-1.42 years later. Renal biopsies were obtained in seven children when they were converted from azathioprine to CyA. The response to CyA could not be predicted from renal morphology or clinical features.

Research paper thumbnail of 1542 Treatment of the Hemolytic Uremic Syndrome (Hus) with Plasma

Research paper thumbnail of Protocol of the growth failure in children with renal diseases study

The Journal of Pediatrics, Feb 28, 1990

Research paper thumbnail of Non-steroidal anti-inflammatory drug-associated nephrotoxicity in Bartter syndrome

Pediatric Nephrology, Jan 10, 1998

We have followed four patients with Bartter syndrome for a mean of 25.4 years (range 21.5-28.8 ye... more We have followed four patients with Bartter syndrome for a mean of 25.4 years (range 21.5-28.8 years) after diagnosis. All patients received non-steroidal anti-inflammatory drugs (NSAID). In all patients, various degrees of renal dysfunction were noted to be temporally associated with NSAID therapy. In two patients, renal dysfunction resolved after discontinuing NSAID therapy, while maintaining other chronic medications such as potassium-sparing diuretics. Renal dysfunction persisted after NSAID withdrawal in two patients. We report these cases as a warning that NSAID should be considered an important cause of either reversible or irreversible renal dysfunction in Bartter syndrome.

Research paper thumbnail of 1542 Treatment of the Hemolytic Uremic Syndrome (Hus) with Plasma

Pediatric Research

ABSTRACT

Research paper thumbnail of Results from the Canadian Renal Failure Registry

American journal of kidney diseases : the official journal of the National Kidney Foundation, 1990

This report encompasses data collected from all Canadian patients starting treatment for end-stag... more This report encompasses data collected from all Canadian patients starting treatment for end-stage renal failure (ESRF) from 1981 until the end of 1987. Gross mortality showed an initial decline, but has stabilized since 1985. The year of entry into the system did not change the survival rate. There was an increase in the rate of acceptance of new patients between 1982 and 1987. The largest increases were in the older age groups, and resulted in a concomitant increase in the number of registered patients in older age groups. Survival on dialysis by age group declined with age. There was no difference in patient survival on hemodialysis or peritoneal dialysis. The probability of death for all patients entering the ESRF system remained constant notwithstanding year of entry into the system. It was slightly higher for males than females, much higher for patients with diabetes or renal vascular disease, higher with age, and much higher for patients not undergoing transplant.

Research paper thumbnail of Long versus standard initial steroid therapy for children with the nephrotic syndromeA report from the Southwest Pediatric Nephrology Study Group

Pediatric nephrology (Berlin, Germany), 2003

A retrospective cohort study was conducted by the Southwest Pediatric Nephrology Study Group (SPN... more A retrospective cohort study was conducted by the Southwest Pediatric Nephrology Study Group (SPNSG) to address whether a longer initial course of corticosteroids in patients with idiopathic nephrotic syndrome (INS) provides superior protection against relapse without increased adverse effects. In order to be included in the evaluation, patients with INS must have responded to an initial steroid course, either standard or long regimen as defined here, and completed at least 1 year of follow-up. The standard regimen consisted of prednisone 2.0+/-0.3 mg/kg per day or 60+/-10 mg/m(2) per day for 28+/-4 days, followed by alternate-day prednisone for 4-12 weeks. The long regimen consisted of daily prednisone 2.0+/-0.3 mg/kg per day or 60+/-10 mg/m(2) per day for 42+/-6 days, followed by alternate-day prednisone for 6-14 weeks. The primary outcome measure was relapse of NS within 12 months of discontinuing the initial course of prednisone. There were 151 children who met the criteria for ...

Research paper thumbnail of Part F: Renal Replacement Therapy in Canada 1981–1992

Replacement of Renal Function by Dialysis, 1996

ABSTRACT

Research paper thumbnail of Plasma Renin Activity (Pra) in the Assessment of Persistent Hypertension (HT) of Renal Allograft Recipients

Pediatric Research, 1977

ABSTRACT

Research paper thumbnail of A family outbreak of hemolytic-uremic syndrome associated with verotoxin-producingEscherichia coli serotype 0157:H7

Pediatric Nephrology, 1988

All five siblings (three boys and two girls, aged 1.5-9 years) in a family developed hemolytic-ur... more All five siblings (three boys and two girls, aged 1.5-9 years) in a family developed hemolytic-uremic syndrome associated with verotoxin-producing Escherichia coli O157:H7 at a lakeside vacation cottage during the fall of 1985. All five were hospitalized and made a full recovery. Both parents remained asymptomatic, and neither had evidence of this infection. In four children who were investigated prospectively, free verotoxin was still detectable in the stools for between 3 and 7 weeks. The prodromal diarrheal illness in the children occurred over a 10-day period. The epidemic curve was consistent with a point-source outbreak, but continuous exposure or person-to-person transmission could not be ruled out. The source of the infection was not identified.

Research paper thumbnail of Antibodies to intimin and Escherichia coli secreted proteins A and B in patients with enterohemorrhagic Escherichia coli infections

Pediatric Nephrology, 2002

Enterohemorrhagic Escherichia coli produce an attaching and effacing lesion upon adhering to the ... more Enterohemorrhagic Escherichia coli produce an attaching and effacing lesion upon adhering to the intestinal epithelium. Bacterial factors involved in this histopathology include the intimin adhesin and E. coli secreted proteins (Esps) A and B. In this study we investigated the serum antibody responses to recombinant E. coli O157:H7 intimin, EspA, and EspB by immunoblotting. Canadian patients with O157:H7 infection (n=10), Swedish patients with O157:H7 (n=21), non-O157 (n=18), or infection from which the serotype was not available (n=3), and asymptomatic household members (n=25) were studied and compared with Canadian (n=20) and Swedish controls (n=52). In Canadian patients, IgG antibodies to intimin, EspA, and EspB were analyzed, in Swedish patients and their household members IgA, IgG, and IgM antibodies to EspA and EspB were studied. Patients and household members mounted an antibody response to the antigens. Significantly more patients developed an acute response to EspB compared with controls (P<0.01 Canadian patients, P<0.0001 Swedish patients). EspB IgA, IgG, and IgM had a specificity of 100%, 86%, and 86%, positive predictive value of 100%, 83%, and 81%, and sensitivity of 57%, 69%, and 63%, respectively, and appear to be an appropriate assay for the detection of EHEC infection. In cases of hemolytic uremic syndrome or hemorrhagic colitis this assay may be useful when a fecal strain has not been isolated, or in epidemics of non-O157 infection.

Research paper thumbnail of Cyclosporin A in children with persistent renal transplant rejection and progressively deteriorating graft function

Pediatric Nephrology, 1987

The effect on renal function and growth of switching from azathioprine to cyclosporin A (CyA) was... more The effect on renal function and growth of switching from azathioprine to cyclosporin A (CyA) was prospectively evaluated in ten children with persistent renal transplant rejection. Progression of renal insufficiency during CyA therapy was compared with that before using CyA. Prednisone administration decreased after CyA was introduced and although growth retardation persisted, height velocity improved significantly. Renal function stabilized in seven patients treated with CyA for a variable time period, and four of these children remain off dialysis 0.44-1.42 years later. Renal biopsies were obtained in seven children when they were converted from azathioprine to CyA. The response to CyA could not be predicted from renal morphology or clinical features.

Research paper thumbnail of The 1989 report of the North American Pediatric Renal Transplant Cooperative Study

Pediatric Nephrology, 1990

Transplant Cooperative Study summarizes data contributed by 57 participating centers on 754 child... more Transplant Cooperative Study summarizes data contributed by 57 participating centers on 754 children with 761 transplants from 1 January 1989 to 16 February 1989. Data collection was initiated in October 1987 and followup of all patients is ongoing. Transplant frequency increased with age; 24% of the patients were less than 5 years, with 7% being under 2 years. Common frequent diagnoses were: aplastic/dysplastic kidneys (18%), obstructive uropathy (16%), and focal segmental glomerulosclerosis (12%). Preemptive transplant, i.e., transplantation without prior maintenance dialysis, was performed in 21% of the patients. Dialytic modalities pretransplant were peritoneal dialysis in 42% and hemodialysis in 25%. Bilateral nephrectomy was reported in 29%. Live-donor sources accounted for 42% of the transplants. Among cadaveric donors, 41% of the donors were under 11 years old. During the first post-transplant month, maintenance therapy was used similarly for live-donor and cadaver source transplants, with prednisone, cyclosporine, and azathioprine used in 93%, 83%, and 81%, respectively. Triple therapy with prednisone, cyclosporine, and azathioprine was used in 78%. 75%, and 75% of functioning cadaver source transplants at 6 months, 12 months, and 18 months as opposed to 60%, 63 %, and 54% for live-donor procedures. with single-drug therapy being uncommon. Rehospitalization during months 1-5 occurred in 62% of the patients, with treatment of rejection and infection being the main causes. Additionally, 9% were hospitalized for hypertension. During months 6-12 and 12-17, 30% and 28% of the patients with functioning grafts were rehospitalized. Times to first rejection differed significantly for cadaver and live-donor transplants. The median time to the first rejection was 36 days for cadaver transplants and 156 days for live-donor transplants. Overall, 57% of treated rejec-* A list of all participating centers and the names of the investigators is printed on pages 552-553 Offprint requests to: A. Tejani, Director.

Research paper thumbnail of Long-term neurological sequelae of hemolytic-uremic syndrome: a preliminary report

Pediatric Nephrology, 1996

Seven patients with hemolytic-uremic syndrome who had major neurological symptoms during the acut... more Seven patients with hemolytic-uremic syndrome who had major neurological symptoms during the acute illness were neurologically and cognitively evaluated prospectively several years after recovery from the illness. Four patients showed evidence of subtle neurological sequelae, including posturing, clumsiness, poor fine-motor coordination, hyperactivity, and distractibility. Psychoeducational evaluation of all seven subjects revealed mean scores within the average range in cognitive abilities, academic achievement, single word receptive vocabulary, visual/motor planning, overall adaptive functioning, and hyperactivity. The lapse of time (minimum of 7 years) between the acute illness and the psychometric evaluation could have been responsible for our normal results.