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Background The ESPN/ERA-EDTA Registry collects data on European children with end-stage renal disease receiving renal replacement therapy (RRT) who are listed on national and regional renal registries in Europe. In this paper we report on the analysis of demographic data collected from 2009 to 2011. Methods Data on primary renal disease, incidence, prevalence, 4-year survival, transplantation rate and causes of death in paediatric patients receiving RRT were extracted from the ESPN/ERA-EDTA Registry for 37 European countries. Results The incidence of RRT in paediatric patients in Europe during the study period was 5.5 cases per million age-related population (pmarp) in patients aged 0-14 years and varied markedly between countries (interquartile range 3.4 7.0 years). The prevalence of RRT was 27.9 pmarp and increased with age, with 67% of prevalent patients living with a functioning graft. The probability of receiving a transplant within 4 years was 76.9% and was lowest in patients aged 0-4 years (68.9%). Mortality in paediatric patients treated with RRT was 55-fold higher than that of the general EU paediatric population. Overall survival at 4 years was 93.7%, with the poorest survival in patients aged 0-4 years and in patients starting on dialysis. Infections (19.9%) were the primary cause of death in European paediatric RRT patients. Conclusion Considerable variation exists in the current demographics of children treated with RRT across Europe. Keywords Paediatrics * Renal replacement therapy * Chronic kidney failure * Europe * Incidence * Prevalence * Survival, Introduction End-stage renal disease (ESRD) is a very rare condition in children [1]. Information on the number of new cases (incidence), the size of the problem (prevalence) and the outcomes [...]

Background Encapsulating peritoneal sclerosis (EPS) is a serious complication of long-term peritoneal dialysis (PD), but only a few cases have been described in the pediatric patient population. There is no established medical treatment, and surgery has been reported with variable success. The number of reports of EPS being successfully treated with tamoxifen, based on its anti-fibrotic effects, are increasing. The role of sirolimus, an mTOR inhibitor with immunomodulatory and anti-proliferative properties, has been less well-defined. Case-Diagnosis/Treatment A 17-year-old kidney transplant recipient, with a previous cumulative time on PD of 8 years and 3 months, developed severe bowel obstruction 8 months after undergoing a second kidney graft. Her immunosuppressive regimen consisted of tacrolimus, mycophenolate mofetil, and prednisolone. The patient underwent laparotomy, which revealed multiple thick leathery adhesions with an encapsulated small bowel. Enterolysis was performed, and total parenteral nutrition was commenced after surgery to provide an adequate food intake. Treatment with tamoxifen was initiated, but the patient developed significant liver toxicity 2 weeks later, and the drug was withdrawn. The immunosuppressive regimen was changed to an increased dose of prednisolone, and tacrolimus was replaced with sirolimos. At 20 months of follow-up, the patient remains symptom-free, with a functioning kidney transplant. Conclusion Although EPS is a very rare condition in the pediatric population, it should be considered when a child or adolescent with a long-term history of PD presents with nonspecific gastrointestinal symptoms or with signs of bowel obstruction. There is an urgent need for alternative immunosuppressive protocols. The use of sirolimus in this group of patients remains controversial, Introduction Encapsulating peritoneal sclerosis (EPS) is a serious, long-term complication of peritoneal dialysis (PD), first described in 1978 by Gandhi et al. [1]. The condition is characterized by intestinal obstruction [...]

The prevalence of hypertension among the paediatric population is 1%-2%. The emergency physician should recognise potentially harmful blood pressure (BP) levels and ensure they are adequately treated, in order to avoid life-threatening complications. A hypertensive emergency is a severely elevated BP complicated by target organ dysfunction (cardiovascular, cerebrovascular and/or renal). Hypertensive urgency, however, is a severe elevation in BP without target organ dysfunction. This distinction is critical for the clinical approach. The authors present a case of a severe hypertension due to primary focal segmental glomerulosclerosis. In this case, the lack of BP measurement in the infant surveillance and the devaluation of an albuminuria detected in a previous routine urine examination, have culminated in a late diagnosis of a severe hypertension, with subsequent effects on target organs. [ABSTRACT FROM AUTHOR]

The prevalence of hypertension among the paediatric population is 1%-2%. The emergency physician should recognise potentially harmful blood pressure (BP) levels and ensure they are adequately treated, in order to avoid life-threatening complications. A hypertensive emergency is a severely elevated BP complicated by target organ dysfunction (cardiovascular, cerebrovascular and/or renal). Hypertensive urgency, however, is a severe elevation in BP without target organ dysfunction. This distinction is critical for the clinical approach. The authors present a case of a severe hypertension due to primary focal segmental glomerulosclerosis. In this case, the lack of BP measurement in the infant surveillance and the devaluation of an albuminuria detected in a previous routine urine examination, have culminated in a late diagnosis of a severe hypertension, with subsequent effects on target organs.

Background: The optimal immunosuppressive therapy in kidney transplantation remains controversial. Since 1990, we included, in our department, anti-T-Lymphocyte globulin Fresenius® (ATG-F) in a sequential immunosuppressive therapy in pediatric recipients of deceased donor kidneys. We analysed retrospectively the complications and long-term outcomes., Material/methods: Ninety eight kidney transplants were performed in 91 children and adolescents between November 1990 and October 2009, using deceased donor source grafts. In 86.8% of the recipients ATG-F was used as antibody induction and in 12.2% of the recipients no ATG-F induction was used., Results: Overall graft survival rates at 1, 5, 10 and 15 years were 91.8%, 86.1%, 75.9% and 61.9% respectively. In the ATG-F group the graft survival at 1, 5, 10 and 15 years was 93%, 89.1%, 79%, 62.4% and in group without ATG-F it was 83.3%, 66.7%, 55.6% at 1, 5, 10 years respectively (p=0.27). The overall incidence of infection was 1.6/patient in the first year post-transplantation and almost all were of mild or moderate intensity. A papillary thyroid carcinoma was diagnosed in one patient and no lymphoid malignancies were observed during the observational period. All patients were alive at the end of follow-up, except one who died of cardiovascular disease, 7 months after graft loss., Conclusions: These results indicate that ATG-F induction in pediatric kidney transplantation using deceased donor kidneys is associated with good graft and patient survival rates, and with low levels of complications.