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Background Corticosteroid minimisation immunosuppressive protocols (CMP) for children are an approach to safely reduce unwanted medication side effects associated with long-term exposure following kidney transplantation. Here, we provide data regarding the incidence of acute rejection and growth over an extended follow-up in children receiving the CMP used in our centre. Methods We retrospectively analysed all children treated with a CMP who received a kidney transplant and had follow-up care in our centre between 2009 and 2019. Data were compared to 5 control groups from recent studies. Results Ninety-nine kidney allograft recipients were included in the study (mean follow-up 4.4 years). There was no difference in the cumulative frequency of acute rejection in CMP-treated graft recipients compared to controls. Graft function at latest follow-up was significantly lower in graft recipients experiencing acute rejection compared to those without acute rejection (53.7 mL/min/1.73 m.sup.2 vs. 66.8 mL/min/1.73 m.sup.2, p = 0.021). Children experiencing >1 acute rejection episode had a greatly elevated risk of graft failure (p = 0.0009, OR 68.25). At latest follow-up, 64/90 (71.1%) graft recipients had a normal height, and younger graft recipients demonstrated greater catch up growth than older children. CMP-treated graft recipients showed a reduced rate of height deficit (28.9% vs. 55.1%, p = 0.0025), less obesity (12.2% vs. 23.9%, p = 0.031), and reduced rates of hypertension (35.4% vs. 68.2%, p< 0.0001). Conclusions Children treated with a CMP show greater height attainment, lower frequency of obesity, and reduced rates of hypertension, without an increased risk of acute rejection., Author(s): James McCaffrey [sup.1] , Mohan Shenoy [sup.2] Author Affiliations: (1) grid.120073.7, 0000 0004 0622 5016, Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, , Cambridge, UK [...]

Background To evaluate the efficacy of adjuvant systemic corticosteroids in reducing kidney scarring. A previous study suggested that use of adjuvant systemic corticosteroids reduces kidney scarring in children radiologically confirmed to have extensive pyelonephritis. Efficacy of corticosteroids for children with febrile urinary tract infection (UTI) has not been studied. Methods Children aged 2 months to 6 years with their first febrile UTI were randomized to corticosteroids or placebo for 3 days (both arms received antimicrobial therapy); kidney scarring was assessed using .sup.99mTc-dimercaptosuccinic acid kidney scan 5-24 months after the initial UTI. Results We randomized 546 children of which 385 had a UTI and 254 had outcome kidney scans (instead of the 320 planned). Rates of kidney scarring were 9.8% (12/123) and 16.8% (22/131) in the corticosteroid and placebo groups, respectively (p = 0.16), corresponding to an absolute risk reduction of 5.9% (95% confidence interval: - 2.2, 14.1). Conclusion While children randomized to adjuvant corticosteroids tended to develop fewer kidney scars than children who were randomized to receive placebo, a statistically significant difference was not achieved. However, the study was limited by not reaching its intended sample size. Clinical Trial Registration http://clinicaltrials.gov http://clinicaltrials.gov , NCT01391793, Registered 7/12/2011, Author(s): Nader Shaikh [sup.1] [sup.2] , Timothy R. Shope [sup.1] [sup.2] , Alejandro Hoberman [sup.1] [sup.2] , Gysella B. Muniz [sup.1] [sup.2] , Sonika Bhatnagar [sup.1] [sup.2] , Andrew Nowalk [...]

Despite high risk for serious non-AIDS events (SNAEs) and accelerated age-related increases in inflammatory markers relative to HIV+ men, HIV+ women have been understudied, particularly in terms of stress impacts on immune parameters. The purpose of this study was to examine sex differences in glucocorticoid-immune stress response in mid-life HIV+ individuals, as poor glucocorticoid control of stress-induced inflammation may contribute to health risk in HIV+ women. Male and female participants completed a threat of shock laboratory stressor. Serum cortisol and cytokines [interleukin (IL)-6, IL-8, IL-10, IL-1[beta], C-reactive protein (CRP), tumor necrosis factor (TNF)-[alpha], interferon (IFN)-[gamma]] were assessed at six timepoints prior to and in response to the stressor. Participants included 8 HIV- controls (n = 5 female) and 9 HIV+ (n = 5 female) who were virally suppressed. Repeated measures mixed models revealed a significant sex by HIV status by time interaction for IL-10, IL-1[beta], TNF-[alpha], and cortisol. IL-10 response, an anti-inflammatory cytokine, was larger in males than females, regardless of HIV status. TNF-[alpha] response was blunted in HIV+ individuals compared with HIV-, and specifically in HIV+ women, IL-1[beta] and cortisol response were blunted. Individuals living with HIV may have impaired coordination between the immune system and hypothalamic pituitary adrenal (HPA) axis. HIV+ women in particular exhibited dysregulated IL-1[beta] and cortisol response to acute stress. Future work should focus on relationships among proinflammatory cytokines, stress, and SNAEs in HIV, with attention to sex as a biological variable., Author(s): Liisa Hantsoo [sup.1] , Sara Kornfield [sup.1] , Claudia Iannelli [sup.1] , Jessica Podcasy [sup.1] , David Metzger [sup.1] , Mary D. Sammel [sup.2] , C. Neill Epperson [sup.3] [...]

We conducted a retrospective study on children with primary nephrotic syndrome (NS) to evaluate the clinical course and outcome of children with steroid-sensitive NS (SSNS). The medical records of 226 children, median 3.46 years (min 1.00, max 15.08) who referred to our clinics with SSNS between January 1978 and September 2005 were reviewed and entered into the study. Minimum duration of follow-up was 5 years and maximum 20 years (median 7.25 years). Of 226 patients who were treated with corticosteroids, 38 (16.8%) had no relapse but the remaining 188 (83.2%) patients experienced several relapses of which 128 patients (56.6%) required additional immunosuppressive agents for the remission. Of these, 122 (95%) were treated with levamisole, 22 (17%) with cyclosporine, 36 (28%) with cyclophosphamide, and ten (7.8 %) treated with mycophenolate mofetil. Several patients had to switch from one medication to others due to lack of response. On the last follow-up visit, 64(28.3%) patients were still under treatment, some patients had taken all of the above-mentioned drugs but still had multiple recurrences. Only 103 (45.5%) patients were in remission off the drug more than 3 years. This study shows that nearly one-third of pediatric patients with SSNS experience frequent relapses despite the combination of multiple immunosuppressive medications, which may continue until adulthood., Author(s): Seyed Taher Esfahani [sup.2] [sup.1] , Abbas Madani [sup.1] , Fahimeh Asgharian [sup.1] , Neamatollah Ataei [sup.1] , Azadeh Roohi [sup.1] , Mastaneh Moghtaderi [sup.1] , Parvin Rahimzadeh [sup.1] [...]

A study to examine the relationship between corticosteroids and reduced bacterial meningitis among children is conducted. Results conclude that corticosteroids are not very effective in reducing bacterial meningitis among children.

The classification, diagnosis and the various treatments that are available for croup is discussed. The term croup is associated with a large number of respiratory illnesses that lead to inspiratory stridor and barking cough.

The Prevention of Asthma in Childhood (PAC) study was conducted to assess the efficacy of inhaled budesonide relative to that of placebo after a first episode of wheezing in reducing subsequent respiratory symptoms during the first three years of life. The result obtained caution against the widespread use of short courses of inhaled corticosteroids in the treatment of episodic wheezing while regular inhaled corticosteroid therapy should be reserved for young children with persistent wheezing.

To the Editor.-- In their published guidelines, the American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis (1) discounted studies that demonstrated benefit from systemic corticosteroids for bronchiolitis. [...]

One study based on a review of literature found that corticosteroids are associated with a reduced risk of experiencing an unsatisfactory recovery and that when this is administered with antiviral agents, it is associated with additional clinical benefits in the treatment of Bell's palsy. A critique of the study is presented.

Chronic lung disease (CLD) remains one of the most challenging diseases in neonatal medicine because there have been very few effective therapies for its prevention or treatment. Systemic corticosteroids, once [...]