Despite recent advances in the management of children with chronic kidney disease (CKD), growth remains suboptimal. The purpose of this study was to evaluate factors associated with short stature in children with CKD. We evaluated the chronic renal failure registry of the North American Pediatric Renal Transplant Cooperative Studies (NAPRTCS) to determine the relations among primary diagnosis, age, race, residual renal function, acidosis, anemia, serum phosphorous, calcium, parathyroid hormone (PTH), albumin, and height at entry into the registry in children with CKD. A total of 5,615 patients were entered into the registry between January 1994 and January 2004. We found that older patients, those with glomerular filtration rate (GFR) >50 ml min(-1) 1.73 m(-2), black patients and patients with focal segmental glomerulosclerosis (FSGS) were at lower risk of being short at entry. Anemia (hematocrit below 33%) was an independent risk factor for short stature. Acidosis, serum phosphorous, calcium, albumin and PTH at registration were poor predictors of short stature. Age, race, primary diagnosis, and residual renal function were associated with short stature in children with CKD.

This is a retrospective analysis of 16 children started on tacrolimus with various types of treatment-resistant nephrotic syndrome. There are 13 patients with focal glomerulosclerosis, 1 minimal change disease, and 2 IgA nephropathy with nephrosis. The mean age of the children was 11.4 years (range 3.5-18.1 years) with a mean age at diagnosis of 5.6 years (range 1.6-13.3 years). All patients initially received prednisone 2 mg/kg per day. Other therapies for 15 of 16 included cyclosporine (n=15), chlorambucil (n=5), mycophenolate mofetil (n=5), levamisole (n=3), i.v. methylprednisolone (n=3), and cyclophosphamide (n=2). The major indication for the initiation of tacrolimus included treatment resistance/dependence (n=15) and intolerable side effects from other therapies (n=1). The average time from the diagnosis to initiation of tacrolimus was 5.3 years (range 0.3-13.3 years, median 6 years). The initial dosage of tacrolimus utilized was 0.1 mg/kg per day divided into two doses. The mean follow-up period was 6.5 months (range 2.5-18 months). Thirteen patients (81%) went into a complete remission within an average of 2 months (range 0.5-5.5 months), with 3 patients relapsing while on treatment. Three patients did not respond. Of these, 2 had partial remissions (13%) and 1 failed to respond. Adverse events included anemia (n=1), seizure (n=1), worsening or new-onset hypertension (n=5), and sepsis (n=1). All patients remain on tacrolimus. Tacrolimus is an effective, well-tolerated medication for treatment-resistant forms of nephrotic syndrome in children, with a complete remission rate of 81% and a partial remission rate of 13% (totaling 94%).

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Commentary CommentaireM edical school has long been recognized as involving numerous stressors that can affect the wellbeing of students. 1,2 In addition to coping with the normal stressors of everyday life, medical students must deal with stressors specific to medical school, which include information and input overload, financial indebtedness, lack of leisure time, and pressures of work, work relationships and career choices. [1][2][3] Comparisons between medical students and other undergraduate student groups have shown a higher level of stress and depression among medical students. 2,4 Moreover, the results of a study of 304 first-and second-year medical students revealed a 12% incidence of major depression and a lifetime prevalence of 15%; 5 the latter is 3 times higher than that of the average population. Other studies have reported incidences of depression among medical students in the range of 20% to 25%. 5,6 Predictors of depression identified in these studies included previous depression or other mental health problems, perceived medical school stress, intensity and vulnerability traits, and a family history of depression. Being married or having a stable and supportive family were found to be protective factors. [5][6][7] Reported levels of stress among medical students range anywhere from 25% to 75%. 8,9 In the United States, a survey of 9 medical schools found that 47% of student respondents had at least 1 major issue related to mental health or substance use and that stress affected 26% within this group. 9 What is equally disturbing in this study is that 70% of students indicated concerns about confidentiality and the potential impact of having stress-related issues appear on their academic record.Medical students themselves tend toward certain characteristics that place them at increased risk of stress. A study at the University of Manitoba 10 found that although medical students had high personal standards, which gave them an advantage on entry to a highly competitive profession, these standards were associated with maladaptive perfectionism leading to excessive concerns about academic performance. These characteristics were significantly correlated with baseline symptoms of neuroticism and were predictive of depression and feelings of hopelessness at follow-up.Coping strategies have also been studied in medical students. 11 Although no specific coping strategies have been identified as common to medical students, support from family and friends, exercise, recreational activities and spirituality are all reported to promote a greater sense of wellbeing. A study of 140 medical students at Hong Kong University found, not surprisingly, that optimism and a positive outlook had the strongest negative correlations with depression and anxiety. 11 One of the difficulties with stress in medical school is that students tend not to seek help from the support services available to them.The results of a survey from the University of Pennsylvania showed that although 24% of their medical students identified t...

Our data highlight 16q24.2 as a region of interest for ASD, ID and congenital renal malformations. These conditions are associated, albeit without complete penetrance, with deletions affecting C16orf95, ZCCHC14, MAP1LC3B and FBXO31. The function of each gene in development and disease warrants further investigation.

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There have been a wide variety of reported renal parenchymal diseases associated with inflammatory bowel disease, ranging from interstitial nephritis to amyloidosis to immune complex glomerulonephritis. Two pediatric cases of renal parenchymal pathology in association with Crohn disease are presented. The first is an 11-year-old child who presented with recurrent bouts of gross hematuria, biopsy-proven IgA nephropathy, and later developed Crohn disease 4 years after the initial presentation. Her renal function is normal with persistent isolated microscopic hematuria. The second case is that of a 9-year-old male who presented with the classic gastrointestinal manifestations of Crohn disease, later developed hematuria and proteinuria, and was found on a renal biopsy to have thin basement membrane disease. There have been several reported cases of IgA nephropathy associated with inflammatory bowel disease; but to our knowledge, this is the first case of thin basement membrane disease occurring in conjunction with Crohn disease. Discussion focuses on the relationship of IgA nephropathy with inflammatory bowel disease with additional comments on thin basement membrane disease.