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With the use of information from a database of pediatric patients with concomitant nuclear GFR and serum creatinine (Cr), estimated GFR equations were derived on the basis of local laboratory methods and population. These formulas then were compared with those recommended by the National Kidney Foundation for estimating GFR in children. For this, their ability to estimate accurately an individual's true GFR and chronic kidney disease stage, identify patients whose true GFR was <60 ml/min per 1.73 m 2 , and to identify correctly deterioration in an individual's GFR over time was compared. Next, two methods to estimate GFR in children without the use of height or weight were developed. The first was a height-and weightindependent formula; the second was a novel approach using the Schwartz formula and calculating a Cr cutoff based on age-based estimates of height and GFR level of interest, i.e., <60 ml/min per 1.73 m 2 . Our results suggest that if local laboratory constants are derived and a height is known, then the Schwartz formula offers the most accuracy with least mathematical complexity to perform in the clinical setting. If height is not available but the local laboratory constants have been derived, then the British Columbia's Children's Hospital 2 formula is of value; however, in the setting of estimating pediatric renal function in the outpatient laboratory, where neither of these factors is commonly known, an approach whereby a Cr cutoff for a GFR of interest is developed is suggested. Provided are Cr levels that are based on a reference method of Cr measurement to facilitate this approach for the clinician. . The National Kidney Foundation (NKF) has recognized that to "further improve dialysis outcomes, it is necessary to improve the health status of those who reach ESRD . . . from earliest kidney damage through the various stages of progression to kidney failure" (3). As a first step toward achieving this goal, the NKF developed a chronic kidney disease (CKD) classification system, the NKF Disease Outcomes Quality Initiative (NKF-DOQI) classification, to "improve/standardize" care of the patient at all stages of CKD (3).In the adult nephrology literature, a move toward classification and management of CKD on the basis of GFR has led to the proposal for widespread implementation of equations to calculated estimated GFR (eGFR) (4). These equations are often derived from studies in patients with particular illnesses, e.g., cancer (5,6), renal dysfunction (7,8), and organ transplantation (9 -11). They use some combination of easily obtained demographics (e.g., height, weight, gender, race) and serum measurements (e.g., creatinine [Cr], urea, albumin) (12) to calculate the individual's GFR or Cr clearance.Similarly, the pediatric members of the NKF CKD working group clearly stated that "major emphasis is placed on the identification of children and adolescents with CKD by measuring the protein-to-Cr ratio in spot urine specimens and by estimating the GFR from serum Cr using prediction equations" (13).Recog...

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Vitamin C deficiency is prevalent and sustained in patients in a Canadian teaching hospital. The abnormality can be prevented by providing a diet sufficient in vitamin C or by prescribing a multiple vitamin tablet.

Thirty-seven matched cerebrospinal fluid (CSF) and plasma samples from 34 human immunodeficiency virus type 1 (HIV-1) -infected patients with suspected meningitis were analyzed for levels of HIV-1 RNA and markers of inflammation. Patients with tuberculous (n Å 9) or cryptococcal (n Å 6) meningitis had the highest CSF virus loads, which in many cases exceeded the levels in plasma, compared with patients with meningococcal meningitis (n Å 3), aseptic meningitis (n Å 8), tuberculoma (n Å 2), or AIDS dementia complex (n Å 4) or with normal lumbar punctures (n Å 3). CSF virus load correlated significantly with the number of infiltrating lymphocytes (r Å .60, P õ .001) but not with plasma virus load, the levels of b 2 -microglobulin in the CSF, or the integrity of the blood-brain barrier. These data suggest significant intrathecal HIV-1 replication in patients with lymphocytic meningeal infections such as tuberculous and cryptococcal meningitis.Nervous system pathology is a common manifestation of logic impairment, particularly cognitive dysfunction in AIDS dementia complex (ADC) [8 -11], few studies have looked at human immunodeficiency virus type 1 (HIV-1) infection [1,2]. The virus enters the central nervous system (CNS) early in the effects of meningeal infection on the virus load in the CSF. The aim of this study was, therefore, to assess the effect of the course of HIV-1 infection and has been shown to be present at all stages of disease, irrespective of neurologic symptoms active infection in the CNS on the HIV-1 RNA load in the CSF and to correlate this with markers of inflammation and lymphocytes were counted in blood collected in EDTA (Onyx

Short-term therapy with vitamin C improves mood and reduces psychological distress in acutely hospitalized patients with a high prevalence of hypovitaminosis C and D. No conclusion is possible regarding the effects of vitamin D because the dose and duration of therapy were insufficient to raise 25(OH)D concentrations into the normal range. This trial was registered at clinicaltrials.gov as NCT01630720.

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