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Ultrasonography (US) plays a major diagnostic role in the pre- and post-transplant evaluation of recipient and donor. In most cases, US remains the only necessary imaging modality. After pediatric kidney transplantation, US can ensure immediate bedside diagnosis of vessel patency and possible postoperative non-vascular complications. Criteria for US diagnosis of kidney vessel thrombosis and stenosis in the transplant will be presented. Non-vascular complications after kidney transplantation include hydronephrosis, hematoma, lymphocele, and abscess. US can detect suggestive, but nevertheless non-specific, acute signs (sudden increase in volume and elevated resistive index), and chronic rejection, which therefore remains a histological diagnosis. US is of little or no help in detection of tubular necrosis or drug toxicity, but it can exclude other differential diagnoses. This educational review provides a practical and systematic approach to a multimodal US investigation of the kidney transplant. It includes a short overview on possible indications for contrast-enhanced ultrasonography (CEUS) in children after kidney transplantation., Author(s): Doris Franke [sup.1] Author Affiliations: (1) grid.10423.34, 0000 0000 9529 9877, Pediatric Ultrasonography, Clinic for Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, , Carl-Neuberg-Str 1, 30625, Hannover, [...]

Background Children with chronic kidney disease are frequently born small for gestational age (SGA) and prone to disproportionately short stature. It is unclear how SGA affects growth after kidney transplantation (KTx). Methods Linear growth (height, sitting height, and leg length) was prospectively investigated in a cohort of 322 pediatric KTx recipients, with a mean follow-up of 4.9 years. Sitting height index (ratio of sitting height to total body height) was used to assess body proportions. Predictors of growth outcome in KTx patients with (n = 94) and without (n = 228) an SGA history were evaluated by the use of linear mixed-effects models. Results Mean z-scores for all linear body dimensions were lower in SGA compared with non-SGA patients (p < 0.001). SGA patients presented with higher target height deficit and degree of body disproportion (p < 0.001). The latter was mainly due to reduced leg growth during childhood. Pubertal trunk growth was diminished in SGA patients, and the pubertal growth spurt of legs was delayed in both groups, resulting in further impairment of adult height, which was more frequently reduced in SGA than in non-SGA patients (50 % vs 18 %, p < 0.001). Use of growth hormone treatment in the pre-transplant period, preemptive KTx, transplant function, and control of metabolic acidosis were the only potentially modifiable correlates of post-transplant growth in SGA groups. By contrast, living related KTx, steroid exposure, and degree of anemia proved to be correlates in non-SGA only. Conclusions In children born SGA, growth outcome after KTx is significantly more impaired and affected by different clinical parameters compared with non-SGA patients., Author(s): Doris Franke [sup.1] , Rena Steffens [sup.1] , Lena Thomas [sup.1] , Leo Pavicic [sup.2] , Thurid Ahlenstiel [sup.1] , Lars Pape [sup.1] , Jutta Gellermann [sup.3] , Dominik [...]

Background We analyzed the impact of birth parameters and parental height on long-term growth outcome in children with chronic kidney disease (CKD) stage 3-5. Methods Linear growth was prospectively investigated in 509 children, with a mean follow-up of 4.1 years. Growth outcome was categorized in (i) poor growth (PG): height standard deviation score (SDS) during follow-up Results PG was observed in 55 % of patients. The rate of pre-term and small for gestational age birth was significantly higher in children with PG compared to GG (43.2 vs. 25.6 % and 36.8 vs. 18.9 %; p Conclusions Birth parameters and parental height are independent predictors of growth outcome in children with CKD. Keywords Chronic kidney disease * Transplantation * Prenatal programming * Growth * Small for gestational age * Low birth weight * Parental height, Introduction Despite medical progress in dialysis, transplantation, nutrition, and pharmacological therapy, up to 60 % of patients with childhood onset of chronic kidney disease (CKD) still achieve only a reduced [...]

Background The attainment of normal growth and maturation remains a major challenge in the management of children and adolescents requiring renal replacement therapy (RRT). Methods We compared growth and maturation in 384 German children with RRT who were followed between 1998 and 2009 with 732 children who were enrolled in the European Dialysis and Transplant Association (EDTA) Registry from 1985 to 1988; of these children, 78 and 88 %, respectively, were transplanted. Results The data on the German patients included in the EDTA registry did not differ significantly from those of the patients from other European countries. Overall, the mean height standard deviation score (SDS) has improved over the past 20 years from -3.03 to -1.80 (p Conclusions Our findings demonstrate a marked improvement of growth and maturation in paediatric patients on RRT during the past 20 years. Keywords Bone age delay * Children * Growth * Menarche * Renal replacement therapy * Transplantation, Introduction Paediatric renal replacement therapy (RRT) in Europe was initiated at the end of the 1960s. The first publications on growth in children on RRT in the 1970s described severe [...]

Understanding vascular bundle systems in angiosperms is a challenge. On the one hand, the vascular tissue is extremely important in reconstructing the evolution and survivability of plants, but on the other hand, it forms a complicated three-dimensional system of controversially discussed phylogenetic and ontogenetic origin. To increase clarity, in this paper we briefly summarize histological, phylogenetic and molecular aspects of primary vascular bundle formation in angiosperms, adding histological data on early stages of vascular bundle formation, proposing a concept combining the different views and providing simplified illustrations to improve the understanding of primary vascular systems in angiosperms. Based on the auxin hypothesis, vascular bundle formation is stimulated by the development of leaf primordia. Provascular domains appear at the base of the leaf primordia and develop into two directions (leaf, internode). The low vs. high number of internodal bundles, their circular vs. scattered arrangement and the open vs. closed bundle construction in eudicots vs. monocots can be deduced to be due to processes below the shoot apical meristem. The most important processes distinguishing monocots from eudicots are the isolated bundle initiation outside the primary meristem, the enormous expansion of the leaf bases associated with a high number of vascular bundles and the early onset of primary thickening passively dislocating vascular bundles. [ABSTRACT FROM AUTHOR]