The immune status of uraemic children/adolescents with chronic renal failure and renal replacement therapy

Drachman, R.; Schlesinger, M; Shapira, Hava; Drukker, Alfred

doi:10.1007/bf00858537

Cited by 27 publications

(10 citation statements)

References 9 publications

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“…The results of the present study together with those of others reported so far [6, 7, 8, 9, 10, 11, 12, 14]suggest that children with CRF are not immunocompromised, though the effects of uraemia may change various components of their immune system.…”

Section: Discussionsupporting

confidence: 63%

See 1 more Smart Citation

Are Uraemic Children Immunologically Compromised?

Ensari¹,

Ekı̇m²,

İkincioğulları³

et al. 2001

Nephron

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Background: Various immunological abnormalities leading to impaired immune status have been described in uraemic adults; however, few data are available for uraemic children. Methods: In this study, peripheral blood total lymphocyte count and lymphocyte subsets (CD3+, CD4+, CD8+, CD16+, CD20+) were evaluated, skin tests with PPD and Candida antigens were performed, and serum immunoglobulin (IgG, IgA, IgM) and complement (C3, C4) levels were measured in 30 children with end-stage renal failure (10 before dialysis, 10 on continuous ambulatory peritoneal dialysis, and 10 on haemodialysis) and the results compared with those of 15 healthy controls. Results: The data showed significant lymphopenia in predialysis and haemodialysis groups. No significant change was observed in the CD4+/CD8+ ratio or in the percentages of lymphocyte subsets in either group studied, while the absolute values of some lymphocyte subsets were significantly lower in all groups as compared with controls. In skin test evaluation, only the patients in the predialysis group showed a significantly decreased response to Candida antigen. The serum immunoglobulin levels were significantly decreased in the continuous ambulatory peritoneal dialysis group as compared with the control group. Conclusion: Our results, together with those of other paediatric studies, reported in the literature, suggest that uraemic children are not immunocompromised, though the effects of uraemia may cause some variation in their immune status.

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Section: Discussionsupporting

confidence: 63%

“…According to these studies, adults with chronic renal failure (CRF) showed an impaired immune status and a poor immunological response to vaccination [1, 2, 3, 4, 5]. However, in uraemic children, these findings appear to be different from those of adults [2, 6, 7, 8, 9, 10, 11, 12]. …”

Section: Introductionmentioning

confidence: 93%

Are Uraemic Children Immunologically Compromised?

Ensari¹,

Ekı̇m²,

İkincioğulları³

et al. 2001

Nephron

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“…Children with CRF have -in contrast to adult patientsno significant immune impairment, except in a few clinical conditions (e.g., nephrotic syndrome, systemic lupus erythematosus). Reduced serum immunoglobulin concentrations have been found in children on peritoneal dialysis (PD) [8,9,10,11]. Standard vaccination schedules generally induce an antibody response in children with CRF [12,13,14,15,16,17], although specific revaccination is recommended [17].…”

Section: Introductionmentioning

confidence: 99%

Immunization in children with chronic renal failure

et al. 2002

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Infections jeopardize children on immunosuppression after organ transplantation. Immunization is protective in healthy children. The aims of this study were to analyze the rate and efficacy of immunization in 62 children undergoing dialysis and renal transplantation (RTPL) between 1987 and 2000. The analysis was based on clinical findings, vaccination certificates, and measurement of specific serum antibodies. A member of the renal unit administered vaccinations. All 62 patients were immunized against diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, and hepatitis B. Since introduction in 1991 and 1995, 44 and 42 children were also vaccinated against influenza and Hemophilus influenzae type b, respectively. Of 16 patients with a negative history, 14 were given varicella vaccine; 16 children on peritoneal dialysis (PD) or with nephrotic syndrome were immunized against Streptococcus pneumoniae. All vaccinated patients had detectable serum antibodies against measles, mumps, rubella, varicella, hepatitis B, H. influenzae, and S. pneumoniae. There were 3 infections despite vaccination; 1 patient developed varicella after RTPL and 1 patient on PD had 2 episodes of peritonitis caused by H. influenzae and S. pneumoniae. In conclusion, monitoring and administration of the vaccines by the renal team enabled a high immunization rate. Whether vaccines, as documented by antibody titers, or by the low prevalence in the general population promoted the low prevalence of infections remains open, as there were at least a few vaccination failures.

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“…Successful renal transplantation markedly improves the quality of life for children with end-stage renal disease [14], However, despite recent advances in immunosup pressive therapy, renal transplantation in children is not as successful as in adults [15,16], This may be explained by problems of surgical technique, a greater incidence of graft thrombosis in children, variable CS-A metabolism, preferential allocation of organs from pediatric donors to pediatric recipients, and a state of heightened immuno logic responsiveness in children relative to adults [17][18][19][20]. In addition, childhood viral infections such as varicella [21] and CMV may further increase the difficulties of pediatric renal transplantation.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Immunoglobulin Prophylaxis of Cytomegalovirus Infection in Pediatric Renal Transplant Recipients

et al. 1997

Am J Nephrol

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Cytomegalovirus (CMV), the most significant infectious cause of morbidity following renal transplantation, may be a greater problem for children than for adults due to their relative lack of experience with this virus. Therefore, we prospectively gave Gammagard® as prophylaxis to CMV-negative children who received CMV-positive allografts and compared the results to our experience with similar high-risk recipients transplanted prior to our use of intravenous immunoglobulin G (IvIgG). Symptomatic CMV disease developed in 17% of the IvIgG recipients as compared with 71% of the untreated patients (p = 0.01). The CMV infections that did occur in IvIgG recipients developed significantly later than in untreated children (median time of onset after transplantation 2.60 vs. 1.35 months; p < 0.05) and generally were less severe, although 1 IvIgG recipient died despite prophylaxis. IvIgG administration did not affect the frequency of rejection or graft or patient survival. We conclude that IvIgG administration to high-risk pediatric renal transplant recipients may protect against posttransplantation CMV disease and may lessen the severity of infections that do develop in patients who receive it.

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The immune status of uraemic children/adolescents with chronic renal failure and renal replacement therapy

Cited by 27 publications

References 9 publications

Are Uraemic Children Immunologically Compromised?

Are Uraemic Children Immunologically Compromised?

Immunization in children with chronic renal failure

Intravenous Immunoglobulin Prophylaxis of Cytomegalovirus Infection in Pediatric Renal Transplant Recipients

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