Medicine and Health Sciences Commons^™

Improving Nutritional Delivery To Pediatric Patients While Using Continuous Renal Replacement Therapy, Jennifer Ruiz-Boada, Sarah Brunner, Tara Benton, Vimal Chadha

Research Days

This quality improvement guide aims to enhance early nutritional delivery to pediatric patients with renal failure who require renal replacement therapy.ng renal replacement therapy.

Baclofen Induced Excessive Perspiration; A Case Report, Othman Farahneh, Lois C. Akpati, Miguel Alvarez Silva

Research Symposium

This case report highlights an unexpected side effect of Baclofen, a well-known medication, excessive sweating, a rare occurrence not typically associated with the drug. The patient, a 63-year-old woman, experienced persistent sweating despite initial attributions to postmenopausal symptoms and subsequent medication adjustments. Extensive testing revealed an association between Baclofen use and the symptoms, which resolved upon discontinuation of the drug.

The significance of this case lies in drawing attention to the underreported side effects of excessive sweating linked to Baclofen, emphasizing the importance of considering medication-related effects even with established drugs. The report urges increased awareness among healthcare professionals, addressing …

Use Of Point Of Care Ultrasound In The Pre-Op Evaluation Of Dialysis Patients Needing Creation Of Permanent Arteriovenous Access – Preliminary Study, Urvashi Mathur, Sotero Peralta

Research Colloquium

Background: Non-invasive ultrasound evaluation is part of the preoperative evaluation of patients needing creation of arteriovenous access. This study requires patients to return for an additional visit for imaging or visit an outpatient imaging facility. These visits produce delays in surgery and increase costs in healthcare. Point of care ultrasound examination at the same time of initial physician visit, allows to decrease cost, improvement of anatomical planning, and decrease timing of surgery.

Methods: We reviewed the UTRGV Vascular Surgery Database from January to December 2020, for patients who has elective outpatient arteriovenous access creation, in which has pre-operative evaluation with …

Proton-Pump Inhibitors Related Acute Interstitial Nephritis. A Case Report, Mery B. Bartl, Reham Majzoub

Research Colloquium

Background: Acute Interstitial nephritis is a common and reversible cause of Acute Kidney Injury, accounting for 15-27% of renal biopsies performed because of this condition. Its incidence has been increasing worldwide. By and large, drug-induced AIN is currently the most common etiology, with antimicrobials and nonsteroidal anti-inflammatory drugs being the most frequent offending agents. The hallmark pathologic features are interstitial edema, interstitial inflammation, and tubulitis with a predominance of CD4+ T lymphocytes and mononuclear cells, with variable numbers of eosinophils. Patients with AIN typically present with nonspecific symptoms of acute renal failure, including oliguria, malaise, anorexia, nausea, and vomiting and …

Penile Calciphylaxis In An End Stage Renal Disease Patient., Juan Enrique Garcia Lopez, Alain Velazquez Blanco, Aileen Aguilar, Sareena Siyas, Daniel Ibarias Paz, Mays Abdulazeez, Jesus Garza-Tamez, Desmond Adamu

Research Colloquium

Background: Penile Calciphylaxis occurs in about 1–4% of hemodialysis patients worldwide. Associated mortality rates are very high, and hyperparathyroidism is the second most frequently associated disorder. Addressing the resulting metabolic imbalance, and surgical intervention guided by findings of radiological studies may improve quality of life. The pathogenesis is thought to be mediated by vascular smooth muscle cells which differentiate into osteoblast-like cells. Decrease in vascular calcification inhibitory proteins fetuin-A and matrix Gla is found in patients on dialysis causing systemic medial calcification of arterioles, leading to epidermal ischemia, tissue infarction, and ulceration.

Case presentation: 47-year-old male with history of coronary …

Prevalência Do Genótipo De Risco G1/G2 Do Gene Da Apolipoproteína L1 (Apol1) E Associação Com Doença Renal Crônica Não Diabética Em Autodeclarados Negros No Sul Do Brasil, Celia Mariana Souza, Maicon Douglas Torely, Mauro Ribeiro Soares Junior, Wiliam Cardoso Silva, Bibiana Sampaio Oliveira Fam, Giovanna Giudicelli, Thayne Kwalski, Marilea Feira Furtado, Renan Barbosa Lemes, Lygia Veiga Pereira, Tábita Hunemeier, Francisco Verissimo Veronese, Fernanda Sales Luiz Vianna

AMNET XX Conferencia Internacional

Introdução: A doença renal crônica (DRC) possui uma prevalência de 10% entre os brasileiros. A presença de dois alelos de risco chamados G1 e G2 do gene da Apo lipoproteína L1 ( APOL1 ), mais frequente em indivíduos associados de ascendência africana e foram à DRC.

Objetivos: Determinar a prevalência dos alelos e genótipo de APOL1 em pacientes portadores de DRC em comparação com indivíduos afrodescendentes saudáveis.

Métodos: Estudo caso controle, realizado nos ambulatórios de Nefrologia do hospital de Clínicas de Porto Alegre, na Santa Casa de Misericórdia de Porto Alegre; Clínicas de hemodiálise Grande Porto Alegre Litoral e Cidades …

Rede Neural Para A Predição De Óbito Utilizando Biomarcadores De Pacientes Em Hemodiálise No Sistema Único De Saúde., Isadora Badalotti-Teloken

AMNET XX Conferencia Internacional

No abstract provided.

Indicadores De Qualidade Da Anticoagulação Regional Com Citrato De Sódio Em Hemodiálise Prolongada: Um Estudo De Coorte, Amanda Corrêa Dos Santos

AMNET XX Conferencia Internacional

Objetivo: Analisar Indicadores de Qualidade (QIs) de segurança e efetividade na Hemodiálise (HD) prolongada com Anticoagulação Regional com Citrato de Sódio 4% (ARCS) em sistema híbrido Genius® em pacientes de unidades de terapia intensiva (UTI) com injúria renal aguda (IRA).

Método: Coorte retrospectiva realizada entre 2019 e 2021 em uma UTI do Hospital São Lucas da PUCRS. Foram incluídos maiores de 18 anos internados em UTI com IRA e em HD prolongada com ARCS em sistema híbrido Genius®. Dados foram coletados manualmente em prontuário eletrônico e nas folhas de fluxo da diálise. Avaliou-se indicadores de segurança (completude …

Programa De Atividade Física Via Telemonitoramento E Capacidade De Exercício Em Pacientes Pediátricos Submetidos A Transplante Renal: Dados Preliminares, Ana Clara Sobotyk Santos

AMNET XX Conferencia Internacional

Objetivo: avaliar os efeitos de um programa de atividade física via telemonitoramento na capacidade funcional (Shuttle Walk Test – SWT) em pacientes pediátricos após transplante (Tx) renal.

Método: ensaio clínico randomizado em crianças acompanhadas ambulatorialmente em hospital referência no Rio Grande do Sul. O treinamento foi realizado via telemonitoramento, 2 vezes por semana durante 6 semanas. Os pacientes foram randomizados (via software) em GI - treinamento com faixas elásticas; e GC - orientações e exercícios ventilatórios. O pesquisador que realiza as avaliações está cegado.

Resultados: amostra preliminar de 21 pacientes (9 no GI e 12 no GC). A idade média …

Brash Syndrome Case Report And Brief Review, Kelly Schuitema

Rowan-Virtua Research Day

BRASH syndrome is an acronym that stands for bradycardia, renal failure, AV node blocker, shock and hyperkalemia. The syndrome is precipitated by synergism from AV nodal blocking agents and hyperkalemia. The combination of the AV nodal blockade and renal failure leads to a cycle of severe bradycardia and hyperkalemia. We will discuss a case of BRASH syndrome with a 68 year old female who presented with generalized weakness and was found to be hypotensive, bradycardia, in acute renal failure with hyperkalemia likely related to metoprolol and amlodipine use.

Prevent Vascular Access Complications By Adopting A Vascular Access Assessment Improvement Process In The Adultdialysis Unit, Ana Lopez Franco

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Contrast Induced Nephropathy, Tessa Cicchella

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Potassium Status In Pediatric Chronic Kidney Disease, Katherine L. Kurzinski

Research Days

Watch recording of live presentation.

Background: Potassium trends are well described in adult chronic kidney disease (CKD) and hyperkalemia is known to be associated with increased disease progression, morbidity, and mortality. Large scale studies assessing potassium trends and the prevalence of hyperkalemia in pediatric CKD have not been performed.

Objectives/Goal: We aimed to characterize median serum potassium levels and the prevalence of hyperkalemia for each CKD stage using the CKiD cohort. The relationship of serum potassium and hyperkalemia with patient demographics, CKD etiology (glomerular or non-glomerular), presence of acidosis, and degree of proteinuria was also evaluated.

Methods/Design: Median serum potassium …

Wilms Tumor Presenting With Spontaneous Necrosis And Clostridium Perfringens Co-Infection, Ronald Palmen, Abbey Elsbernd, Kristin Palmen

Research Days

Background: Wilm’s Tumor (WT) is the most common renal malignancy of childhood. The initial presentation of WT may mimic infection or other malignancies with nonspecific symptoms including fever, abdominal/flank pain, or hematuria. This poses a diagnostic challenge for providers, particularly when both infection and malignancy are observed. We describe a case of WT with spontaneous necrosis initially obscured by overlying Clostridium perfringens infection, making diagnosis of the cancer difficult.

Case Description: A previously healthy 5-year-old girl presented to the emergency department with a two-day history of left flank pain and fevers. In the emergency department, she was tachycardic (130 bpm), …

Long-Term Lithium Use In The Younger Population: Do The Benefits Outweigh The Risks? - A Case Report, Seema Shekar, Alexander Garcia, Rachel Shmuts

Rowan-Virtua Research Day

For decades lithium has been the mainstay treatment for bipolar disorder. While its side effect profile is extensive and varied its most notable adverse effect, and one most feared by treating clinicians, is nephrotoxicity/ end-stage renal disease (ESRD). While the link between long-term lithium use and ESRD has been accepted by the medical community at large for many years, more recent scientific studies call the association into question. In fact, newer studies on the association between Li use and ESRD have shown a negative/inconclusive correlation. Despite this controversy the consensus still remains that ESRD secondary to long-term Li use is …

A Hidden Cause For Electrolyte Derangement In The Ed: Gitelman Syndrome, Alexis Dunn, James Espinosa, Alan Lucerna, Kevin Dwyer

Rowan-Virtua Research Day

Electrolyte derangements are a common finding in the emergency department, whether incidental or the cause for presenting symptoms. Gitelman syndrome (GS) can be the cause for recurrent hypokalemia and hypomagnesemia. While often diagnosed when the patient is young, a clinician should keep this on the differential when seeing repeated visits with electrolyte deficiencies and treating them. Here we discuss a case of how Gitelman syndrome has presented in the ED and what to learn from it.

Digoxin Toxicity And Acute Renal Failure In A 75 Year-Old Female, Daniel Zaayenga, Andrew Caravello, Nicholas Tomasello

Rowan-Virtua Research Day

Digoxin toxicity can present with varying manifestations. While pathognomonic symptoms such as xanthopsia (object appearing yellow) are a board favorite it is not a required finding and is in fact not seen with most patients. Rather digoxin toxicity presents with more non-specific symptoms such as GI distress (anorexia, N/V) neurological distress (lethargy, fatigue, delirium, confusion, disorientation, weakness. EKG findings are varied and include premature ventricular contractions, bradycardia, atrial tachyarrhythmias with AV block, ventricular bigeminy, junctional rhythms, various degrees of AV nodal blockade, ventricular tachycardia, and ventricular fibrillation. Although rarely seen, digoxin is one of the only causes of bidirectional ventricular …

Case Study Of Metformin-Induced Lactic Acidosis, Kajel Patel, Kishan Patel

Rowan-Virtua Research Day

Metformin induced lactic acidosis is when high levels of metformin cause dangerously high levels of lactic acid. Here is a case report of a 72-year-old female who came in for nausea, vomiting, and diarrhea found to have a high suspicion for metformin induced lactic acidosis. She stabilized in the emergency department, nephrology and ICU was contacted, and she went for emergent dialysis. For many patients the prognosis of metformin induced lactic acidosis is poor. This patient was made comfort care by her family.

Incidental Finding Of Unusually Large Renal Cyst During Point Of Care Ultrasound, David Ho, Jeffrey Gardecki

Rowan-Virtua Research Day

Renal cysts are common, and their frequency and size increase as patients age. Renal cysts are derived primarily from tubules and can occur anywhere between Bowman’s capsule to the renal papilla. The cysts are composed of abnormally differentiated epithelial cells encapsulating a cavity of fluid. These abnormally differentiated cells are due to defects in the structure and function of cilia, the structures responsible for detecting urine flow as well as the epithelial composition of the epithelial architecture and repair. According to Campbell Urology, there are three processes in which renal cysts increase in their size – proliferation of epithelial cells …

Factors Associated With Unplanned Conversion To Open In Nephrectomy For Kidney Cancer, Young Son, Benjamin A. Fink, Justine Garfinkel, Lance Earnshaw, Brian Thomas, Thomas Mueller, David Sussman

Rowan-Virtua Research Day

Minimally invasive surgery (MIS) has been adopted as an approach in kidney surgery. Laparoscopic kidney surgery has been introduced in the 1990s with robotics emerging a decade after. The minimally invasive approach has been technically feasible and has been shown to be noninferior with preserved oncology standards to open surgery. The ubiquitous use of MIS for kidney cancer has been standard of practice; however, unplanned conversion to open kidney surgery has been characterized at 4.9% for laparoscopic radical nephrectomy compared to 6.0% in robotic radical nephrectomy. Another analysis of 54,246 patients undergoing partial nephrectomy for kidney cancer observed an unplanned …

A New Paradigm: Ecmo Therapy In Pediatric Hematology/Oncology Patients, Igor Areinamo

Research Days

Background: The use of extracorporeal membrane oxygenation (ECMO) for support of pediatric patients has significantly increased in the past years. Patients with known oncologic diseases, immunodeficiencies, or bone marrow transplants (BMT) have traditionally not been considered candidates for Extracorporeal membrane oxygenation (ECMO) due to perceived high risk for mortality. Ongoing advances have continued to push the boundaries of ECMO use and we report our recent experience with this patient population

Objectives/Goal: To evaluate survival to discharge of pediatric patients who require ECMO support and who also have an underlying hematologic or oncologic disease process. To determine specific patient characteristics that …

Association Between Blood Pressure And Esa Dose In Pediatric Patients On Dialysis, Heather A. Morgans

Research Days

Background: Hypertension is a reported side effect of Erythropoiesis Stimulating Agents (ESAs), with a mechanism of action related to elevated hematocrit levels and direct vasopressor effects. Limited information exists on the relationship between ESA dosage and hypertension in children receiving maintenance dialysis.

Objectives/Goal: The primary aim of this study was to determine whether there is a significant association between ESA dose and blood pressure (BP) in pediatric patients on dialysis. The secondary aim was to determine covariates in relation to ESA dose.

Methods/Design: Data from the International Pediatric Dialysis Network (IPDN) database was used to retrospectively analyze the association between …

Retrospective Analysis Of Post-Operative Sepsis Rates, Stone Composition, And Ureteral Stent Duration After Ureteroscopy And Laser Lithotripsy During Covid-19, Young Son, Julia T. Scali, Ian Madison, Paul Chialastri, Thomas Mueller

Rowan-Virtua Research Day

Ureteroscopy with laser lithotripsy is routinely used to remove stones but results in manipulation of the genitourinary mucosa and has a well-established relationship with post-operative sepsis under certain conditions. Postoperative sepsis represents a significant morbidity and mortality cost to patients and the healthcare system. Several studies to determine risk factors for sepsis after ureteroscopy have been completed. Such risk factors include positive preoperative urine cultures, female gender, prolonged preoperative stent time > 1 month, and patients with sepsis at the time of initial stenting. To improve sepsis rates, procedural alterations such as the use of disposable ureteroscopes have been introduced, as …

Wilms Tumor Survivorship: Does Childhood Cancer Treatment Predict Late-Term Adverse Effects?, Ava Bibergal

Grace Peterson Nursing Research Colloquium

Abstract

Background: Wilms tumor is the leading cancer to affect the kidneys in children most commonly between the age of 3 and 5 years old. Treatment of Wilms tumor typically consists of chemotherapy, radiation, or a combination of the two – which are often successful in eradicating the cancer. However, current treatment options often leave patients with a high risk of late-term adverse effects such as cardiac diseases or secondary cancers later in life. Wilms’ tumor patients currently have a 90% survival rate from their disease, however face a future of indeterminate health problems due to their treatment regimen.

Objectives: …

The Effect Of Antihypertensive Medications Dosing On Blood Pressure Control And Left Ventricular Hypertrophy In Children With Chronic Kidney Disease, Benjamin A. Matta

Research Days

No abstract provided.

Predictive Performance Of Existing Population Pharmacokinetic Models Of Tacrolimus In Pediatric Kidney Transplant Recipients, Alenka Chapron

Research Days

No abstract provided.

Chronic Renal Failure, But Why? A Case Report., Palak Patel, Michael Rothberg M.D.

Rowan-Virtua Research Day

Renal failure, both acute and chronic, can present from many different etiologies and if diagnosed with diabetes mellitus, it is commonly assumed to be due to diabetic nephropathy. Monoclonal gammopathy of renal significance (MGRS) is a disorder that combines monoclonal gammopathy of undetermined significance with end stage renal disease. Monoclonal immunoglobulins are secreted by B or plasma cells leading to deposition in the kidney causing end organ damage. Several different subtypes fall under this category of renal diseases including, but not limited to, amyloidosis, C3 glomeruopathy, and light chain proximal tubulopathy, or better known as Fanconi syndrome1. Fanconi syndrome, which …

A Case Of Atraumatic Posterior Thigh Compartment Syndrome, Nailah Mubin, Brian Katt M.D.

Rowan-Virtua Research Day

Compartment syndrome(CS) occurs when intra-compartmental pressures exceeds to a point where arterial, venous and lymphatic circulation of local tissues, muscles and nerves is compromised. CS is most common after a traumatic injury and usually occurs in the leg or forearm and less commonly in the thigh. Thigh compartment syndrome is rare due to its larger size and more compliant borders. We present a case of nontraumatic compartment syndrome in the posterior thigh associated with rhabdomyolysis and a sciatic nerve palsy which then required emergent fasciotomy. The patient's course was further complicated by acute renal failure due to the rhabdomyolysis and …

Case Report: Holmium Laser Removal Of Antegrade Ureteral Stent Suture Via Ureteroscopy, Paul Chialastri, Jerome Pietras, Thomas Mueller

Rowan-Virtua Research Day

Antegrade placement of ureteral stents is common after nephrostomy tube placement for obstruction in the septic patient and when retrograde placement fails. Ureteral stents have a nylon retaining suture attached to aid in placement. If left in place accidentally, these will not degrade and will become embedded in the renal parenchyma preventing stent removal and potentially leading to infection and stone formation. Ureteroscopic holmium ablation of the residual suture at the level of the parenchyma allows for stent removal and no urothelial defect was noted on repeat ureteroscopy 3 weeks later. Ureteroscopy with holmium lasering of retained suture appears safe …

Postoperative Cholecystitis From Nathanson Liver Retractor During Robotic-Assisted Laparoscopic Partial Nephrectomy, Lauren D. Gleich, Mihir G. Thaker, Gordon A. Brown

Rowan-Virtua Research Day

Proper visualization of the surgical field during any procedure is one of the most imperative elements of surgery. The tools used to obtain this goal come with their own set of risks. This report describes a patient who developed postoperative acalculous cholecystitis (PAC) after use of a Nathan liver retractor. PAC is a rare complication of urologic surgery and is often more severe than acalculous cholecystitis (AC), leading to significant morbidity.