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Background. Escherichia coli O157:H7 is the leading cause of hemolytic uremic syndrome (HUS). Risk factors for development of this complication warrant identification. Methods. We enrolled children infected with E. coli O157:H7 within 1 week of the onset of diarrhea in this prospective cohort study. The study was conducted in 5 states over 9.5 years. The primary and secondary outcomes were HUS (hematocrit <30% with smear evidence of hemolysis, platelet count <150 × 103/μL, and serum creatinine concentration > upper limit of normal for age) and oligoanuric HUS. Univariate and multivariable and ordinal multinomial regression analyses were used to test associations between factors apparent during the first week of illness and outcomes. Results. Of the 259 children analyzed, 36 (14%) developed HUS. Univariate analysis demonstrated that children who received antibiotics during the diarrhea phase more frequently developed HUS than those who did not (36% vs 12%; P = .001). The higher rate of HUS was observed across all antibiotic classes used. In multivariable analysis, a higher leukocyte count (adjusted odds ratios [aOR] 1.10; 95% CI, 1.03—1.19), vomiting (aOR 3.05; 95% CI, 1.23—7.56), and exposure to antibiotics (aOR 3.62; 95% CI, 1.23—10.6) during the first week of onset of illness were each independently associated with development of HUS. Multinomial ordinal logistic regression confirmed that initial leukocyte count and antibiotic use were independently associated with HUS and, additionally, these variables were each associated with the development of oligoanuric HUS. Conclusions. Antibiotic use during E. coli O157:H7 infections is associated with a higher rate of subsequent HUS and should be avoided.

Recently, Schwartz et al. (J Am Soc Nephrol 20:629–637, 2009) used data from the National Institutes of Health-funded Chronic Kidney Disease in Children (CKiD) study to generate new equations for estimating the glomerular filtration rate (eGFR), including an update of the commonly used bedside equation. However, it is unclear if the equation can be generalized to a broader pediatric population. We have used the updated equation on a sample of pediatric patients with less impaired renal function to evaluate the correlation between the new Schwartz equation and measured GFR by iothalamate clearance. We retrospectively analyzed 738 iothalamate clearance tests from 503 patients with a mean serum creatinine of 0.50 mg/dl whose ages ranged from 1 to 16 years. We measured bias, precision, and accuracy and performed a Bland–Altman plot to determine the measure of agreement between the two methods. The mean GFR by iothalamate clearance was 110.6 ml/min/1.73 m 2 and by the new Schwartz estimation 104.7 ml/min/1.73 m 2 . The mean difference was 5.84 ml/min/1.73 m 2 (95% CI 4.00–7.67). The newly purposed bedside Schwartz equation therefore demonstrated good agreement with the iothalamate renal clearances in our patient population and appears to be a valid bedside estimating equation for GFR in this sample of children.

BackgroundMeasurement of glomerular filtration rate by iohexol disappearance (iGFR) has become a gold standard in the pediatric chronic kidney disease (CKD) population. The need for serial phlebotomy can be difficult and minimizing venipunctures would be beneficial. Furthermore, finger stick collection for dried blood spot (DBS) may be more tolerable in the pediatric population, and equivalence between these two methods may further simplify the process.MethodsThis was a cross-sectional study in children and adolescents 1 to 21 years with stages I–IV CKD. Iohexol was infused and blood drawn 10, 30, 120, and 300 min later. Blood spots on filter paper were collected by finger stick after each of the latter two blood draws. The rate of iohexol plasma disappearance was used to calculate GFR. Pearson’s correlation coefficient and bias, Students t test, and Bland-Altman graphical representations were used to compare methods.ResultsForty-one patients were recruited. The mean creatinine was 1.13 mg/dL (SD 0.45), the mean 4-point iGFR was 73.2 ml/min/1.73m2 (SD 27.5) and the mean 2-point iGFR was 75.6 ml/min/1.73m2 (SD 27.3). Correlation between 2-point and 4-point venous GFR was r = 0.97; p < 0.001. The correlation between the DBS and the 2-point venous GFR was r = 0.95; p < 0.001, with no significant bias. Ninety-four percent of the 2-point GFR’s were within 10% of the 4-point GFR’s and 80% of DBS-GFRs were within 10% of the 2-point GFR’s.ConclusionsThe 2-point iGFR was highly correlated and agreed well with the 4-point iGFR. The same was true for the DBS method and the 2-point venous method. DBS sampling by finger stick sampling at 2 time points after iohexol infusion gave an acceptably accurate measurement of GFR.

This essay examines the construction of the \"safari adventure\" through the motion picture films of amateur, semi-professional and professional filmmakers in Africa during the 1920s, 1930s and 1940s. It is argued that new forms of transportation and cinematic technologies (especially color and sound) created new modes of mobility and visuality on safari that allowed for the reinvention and recycling of narrative tropes and stereotypes of Africa. The archival films considered in this essay illustrate the creation of imaginary geographies of Africa in the popular medium of film and demonstrate persistent western fascination with the exotic and cultural difference.

C1q nephropathy (C1qN) is an uncommon disorder seen in children and adults with nephrotic syndrome and non-specific urinary findings. It has been described with minimal change nephrotic syndrome (MCNS), focal segmental glomerulonephritis and isolated mesangial proliferative glomerulonephritis. We describe nine children with MCNS and mesangial C1q deposition. These children had a median age of 2.7 years at diagnosis (range 1.3–15 years), 56% were male and 78% were Hispanic. We compared these children to concurrent patients with nephrotic syndrome and biopsy-proven MCNS. We found that the C1qN patients were more likely than MCNS children to require chronic immunosuppression with calcineurin inhibitors or mycophenolate mofetil to maintain remission. However, all children were able to achieve and sustain clinical remission of nephrotic syndrome. Children with C1qN and minimal change histology have an increased frequency of frequently relapsing and steroid-unresponsive disease, but they can attain prolonged remission and stable renal function with calcineurin inhibitor or mycophenolate mofetil therapy.

BackgroundMost studies of neonatal acute kidney injury (AKI) have focused on the first week following birth. Here, we determined the outcomes and risk factors for late AKI (>7d).MethodsThe international AWAKEN study examined AKI in neonates admitted to an intensive care unit. Late AKI was defined as occurring >7 days after birth according to the KDIGO criteria. Models were constructed to assess the association between late AKI and death or length of stay. Unadjusted and adjusted odds for late AKI were calculated for each perinatal factor.ResultsLate AKI occurred in 202/2152 (9%) of enrolled neonates. After adjustment, infants with late AKI had higher odds of death (aOR:2.1, p = 0.02) and longer length of stay (parameter estimate: 21.9, p < 0.001). Risk factors included intubation, oligo- and polyhydramnios, mild-moderate renal anomalies, admission diagnoses of congenital heart disease, necrotizing enterocolitis, surgical need, exposure to diuretics, vasopressors, and NSAIDs, discharge diagnoses of patent ductus arteriosus, necrotizing enterocolitis, sepsis, and urinary tract infection.ConclusionsLate AKI is common, independently associated with poor short-term outcomes and associated with unique risk factors. These should guide the development of protocols to screen for AKI and research to improve prevention strategies to mitigate the consequences of late AKI.

In the 1950s, the World Bank sought to mediate the Anglo-Iranian oil crisis and to provide Western funding for the Aswan High Dam in Egypt. The lack of success in trying to separate economic from political issues in these two crises provides a window on the way in which World Bankers constructed their identity as global corporatist managers of international economic relations.

BackgroundHypertension occurs in up to 3% of neonates admitted to the Neonatal Intensive Care Unit (NICU), and is a potentially under-recognized condition. The aim of this study was to examine the incidence of documented and undiagnosed hypertension from the 24-center Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) database, and to assess risk factors for hypertension according to gestational age.MethodsDiagnosed hypertension was documented if an infant had a discharge diagnosis of hypertension and/or discharged on antihypertensive medications. Undiagnosed hypertension was defined when infants did not have a diagnosis of hypertension, but >50% of the lowest mean, diastolic and systolic blood pressure recordings were >95th percentile for gestational age.ResultsOf the 2162 neonates enrolled in the study, hypertension was documented in 1.8%. An additional 3.7% were defined as having undiagnosed hypertension. There was a significant correlation with neonatal hypertension and acute kidney injury (AKI). Additional risk factors for neonatal hypertension were hyperbilirubinaemia, Caucasian race, outborn, vaginal delivery, and congenital heart disease. Protective factors were small for gestational age, multiple gestations, and steroids for fetal maturation.ConclusionsNeonatal hypertension may be an under-recognized condition. AKI and other risk factors predispose infants to hypertension.

Background Coronavirus disease of 2019 (COVID-19) has disproportionately affected adults with kidney disease. Data regarding outcomes among children with kidney disease are limited. The North American Pediatric Renal Trials Collaborative Studies Registry (NAPRTCS) has followed children with chronic kidney disease (CKD) since 1987 at 87 participating centers. This study aimed to evaluate the impact of COVID-19 among participants enrolled in the three arms of the registry: CKD, dialysis, and transplant. Methods This was a retrospective cohort study of COVID-19 among participants in the NAPRTCS CKD, dialysis, and transplant registries from 2020 to 2022. Where appropriate, t -tests, chi-square analyses, and univariate logistic regression were used to evaluate the data. Results The cohort included 1505 NAPRTCS participants with recent data entry; 260 (17%) had documented COVID-19. Infections occurred in all three registry arms, namely, 10% ( n  = 29) in CKD, 11% ( n  = 67) in dialysis, and 26% ( n  = 164) in transplant. The majority of participants (75%) were symptomatic. Hospitalizations occurred in 17% ( n  = 5) of participants with CKD, 27% ( n  = 18) maintenance dialysis participants, and 26% ( n  = 43) of transplant participants. Fourteen percent ( n  = 4) of CKD participants and 10% ( n  = 17) of transplant participants developed acute kidney injury (AKI), and a total of eight participants (one CKD, seven transplant) required dialysis initiation. Among transplant participants with moderate to severe illness, 40–43% developed AKI and 29–40% required acute dialysis. There were no reported deaths. Conclusions COVID-19 was documented in 17% of active NAPRTCS participants. While there was no documented mortality, the majority of participants were symptomatic, and a quarter required hospitalization. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information