Contrast-Associated Acute Kidney Injury (CA-AKI) in Children: Special Considerations

Windpessl, Martin,Kronbichler, Andreas Korean Society of Pediatric Nephrology 2019 Childhood kidney diseases Vol.23 No.2

Contrast-associated acute kidney injury (CA-AKI) is a major concern when iodinated contrast material is administered, especially in patients at risk. Efforts have been undertaken to understand the detrimental effects of contrast media (CM). With the use of low-osmolar or iso-osmolar CM the incidence of CA-AKI has steadily decreased within the past decade; however, especially in the pediatric population information is scarce. Incidence rates have been reported to range between 0% to 18.75%, particularly depending on indication, selection of population (i.e. preexisting co-morbidities), and definition of AKI. Different biomarkers have been proposed, but confirmatory studies are either lacking or have contributed to their lack of diagnostic power. Proteomic approaches have been employed and may pave the way to such discovery. Prevention strategies have been tested and proposed, but the recently published AMACING and PRESERVE trials have shown that commonly used strategies (such as systematic hydration or administration of N-acetylcysteine) have no role in the prevention of CA-AKI. We propose that thoughtful assessment of one's fluid state is the most appropriate approach and depending on the hydration status diuretics or fluid administration should be provided to achieve an euvolemic state ahead of contrast exposure.

Pathogenesis of minimal change nephrotic syndrome: an immunological concept

김성헌,박세진,한경희,Andreas Kronbichler,Moin A. Saleem,Jun Oh,임범진,신재일 대한소아청소년과학회 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.5

Idiopathic nephrotic syndrome (INS) in children is characterized by massive proteinuria and hypoalbuminemia. Minimal change nephrotic syndrome (MCNS) is the most common form of INS in children. The pathogenesis of MCNS still remains unclear, however, several hypotheses have been recently proposed. For several decades, MCNS has been considered a T-cell disorder, which causes the impairment of the glomerular filtration barrier with the release of different circulating factors. Increased levels of several cytokines are also suggested. Recently, a “two-hit” theory was proposed that included the induction of CD80 (B7-1) and regulatory T-cell (Treg) dysfunction, with or without impaired autoregulatory functions of the podocyte. In contrast to the well-established involvement of T cells, the role of B cells has not been clearly identified. However, B-cell biology has recently gained more attention, because rituximab (a monoclonal antibody directed against CD20-bearing cells) demonstrated a very good therapeutic response in the treatment of childhood and adult MCNS. Here, we discuss recent insights into the pathogenesis of MCNS in children.

Contrast-Associated Acute Kidney Injury (CA-AKI) in Children: Special Considerations

Martin Windpessl,Andreas Kronbichler 대한소아신장학회 2019 Childhood kidney diseases Vol.23 No.2

Contrast-associated acute kidney injury (CA-AKI) is a major concern when iodinated contrast material is administered, especially in patients at risk. Efforts have been undertaken to understand the detrimental effects of contrast media (CM). With the use of low-osmolar or iso-osmolar CM the incidence of CA-AKI has steadily decreased within the past decade; however, especially in the pediatric population information is scarce. Incidence rates have been reported to range between 0% to 18.75%, particularly depending on indication, selection of population (i.e. preexisting co-morbidities), and definition of AKI. Different biomarkers have been proposed, but confirmatory studies are either lacking or have contributed to their lack of diagnostic power. Proteomic approaches have been employed and may pave the way to such discovery. Prevention strategies have been tested and proposed, but the recently published AMACING and PRESERVE trials have shown that commonly used strategies (such as systematic hydration or administration of N-acetylcysteine) have no role in the prevention of CA-AKI. We propose that thoughtful assessment of one’s fluid state is the most appropriate approach and depending on the hydration status diuretics or fluid administration should be provided to achieve an euvolemic state ahead of contrast exposure.

Recent advances of animal model of focal segmental glomerulosclerosis

Yang, Jae Won,Dettmar, Anne Katrin,Kronbichler, Andreas,Gee, Heon Yung,Saleem, Moin,Kim, Seong Heon,Shin, Jae Il Springer-Verlag 2018 CLINICAL AND EXPERIMENTAL NEPHROLOGY Vol.22 No.4

A Review of Pre-Exposure Prophylaxis Adherence among Female Sex Workers

Ramy Abou Ghayda,홍성휘,양재원,정광훈,이금화,Andreas Kronbichler,Marco Solmi,Brendon Stubbs,Ai Koyanagi,Louis Jacob,Hans Oh,김종엽,신재일,Lee Smith 연세대학교의과대학 2020 Yonsei medical journal Vol.61 No.5

Globally and in Africa specifically, female sex workers (FSWs) are at an extraordinarily high risk of contracting human immunodeficiency virus (HIV). Pre-exposure prophylaxis (PrEP) has emerged as an effective and ethical method with which to prevent HIV infection among FSWs. PrEP efficacy is, however, closely linked to adherence, and adherence to PrEP among FSWs is a complex and interrelated process that has been shown to be of importance to public health policies and HIV control and intervention programs. This comprehensive review categorizes barriers to and facilitators of adherence to HIV PrEP for FSWs, and describes five strategies for promoting PrEP adherence among FSWs. These strategies encompass 1) a long-term educational effort to decrease the stigma associated with sex work and PrEP use, 2) education on how PrEP works, 3) lifestyle modification, 4) research on nextgeneration PrEP products to address the inconvenience of taking daily pills, and 5) integration of PrEP into existing services, such as social services and routine primary care visits, to reduce the economic burden of seeking the medication. Our review is expected to be useful for the design of future PrEP intervention programs. Multidisciplinary intervention should be considered to promote PrEP adherence among FSWs in order to help control the HIV epidemic.

Pathogenesis of minimal change nephrotic syndrome: an immunological concept

Kim, Seong Heon,Park, Se Jin,Han, Kyoung Hee,Kronbichler, Andreas,Saleem, Moin A.,Oh, Jun,Lim, Beom Jin,Shin, Jae Il The Korean Pediatric Society 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.5

Idiopathic nephrotic syndrome (INS) in children is characterized by massive proteinuria and hypoalbuminemia. Minimal change nephrotic syndrome (MCNS) is the most common form of INS in children. The pathogenesis of MCNS still remains unclear, however, several hypotheses have been recently proposed. For several decades, MCNS has been considered a T-cell disorder, which causes the impairment of the glomerular filtration barrier with the release of different circulating factors. Increased levels of several cytokines are also suggested. Recently, a "two-hit" theory was proposed that included the induction of CD80 (B7-1) and regulatory T-cell (Treg) dysfunction, with or without impaired autoregulatory functions of the podocyte. In contrast to the well-established involvement of T cells, the role of B cells has not been clearly identified. However, B-cell biology has recently gained more attention, because rituximab (a monoclonal antibody directed against CD20-bearing cells) demonstrated a very good therapeutic response in the treatment of childhood and adult MCNS. Here, we discuss recent insights into the pathogenesis of MCNS in children.

A Comprehensive Review of Coronavirus Disease 2019: Epidemiology, Transmission, Risk Factors, and International Responses

Han Li,범승원,홍성휘,Ramy Abou Ghayda,Andreas Kronbichler,Lee Smith,Ai Koyanagi,Louis Jacob,이금화,신재일 연세대학교의과대학 2021 Yonsei medical journal Vol.62 No.1

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused aworldwide pandemic. The first reports of patients with COVID-19 were provided to World Health Organization on December 21,2019 and were presumably associated with seafood markets in Wuhan, China. As of October 25, 2020, more than 42 million caseshave been confirmed worldwide, with more than 1.1 million deaths. Asymptomatic transmission contributes significantly to transmission,and clinical features are non-specific to the disease. Thus, the diagnosis of COVID-19 requires specific viral RNA testing. The disease demonstrates extensive human-to-human transmissibility and has infected healthcare workers at high rates. Clinicalawareness of the epidemiology and the risk factors for nosocomial transmission of COVID-19 is essential to preventing infection. Moreover, effective control measures should be further identified by comprehensive evaluation of hospital and community responses. In this review, we provide a comprehensive update on the epidemiology, presentation, transmission, risk factors, and publichealth measures associated with COVID-19. We also review past insights from previous coronavirus epidemics [i.e., severe acuterespiratory syndrome (SARS) and Middle East respiratory syndrome (MERS)] to suggest measures to reduce transmission.

Understanding the genetics of systemic lupus erythematosus using Bayesian statistics and gene network analysis

Nam, Seoung Wan,Lee, Kwang Seob,Yang, Jae Won,Ko, Younhee,Eisenhut, Michael,Lee, Keum Hwa,Shin, Jae Il,Kronbichler, Andreas The Korean Pediatric Society 2021 Clinical and Experimental Pediatrics (CEP) Vol.64 No.5

The publication of genetic epidemiology meta-analyses has increased rapidly, but it has been suggested that many of the statistically significant results are false positive. In addition, most such meta-analyses have been redundant, duplicate, and erroneous, leading to research waste. In addition, since most claimed candidate gene associations were false-positives, correctly interpreting the published results is important. In this review, we emphasize the importance of interpreting the results of genetic epidemiology meta-analyses using Bayesian statistics and gene network analysis, which could be applied in other diseases.

Treatment of refractory IgA vasculitis with dapsone: a systematic review

Lee, Keum Hwa,Hong, Sung Hwi,Jun, Jinhae,Jo, Youngheun,Jo, Woogyeong,Choi, Dayeon,Joo, Jeongho,Jung, Guhyun,Ahn, Sunghee,Kronbichler, Andreas,Eisenhut, Michael,Shin, Jae Il The Korean Pediatric Society 2020 Clinical and Experimental Pediatrics (CEP) Vol.63 No.5

IgA vasculitis, formerly known as Henoch-Schönlein purpura, is a systemic IgA-mediated vasculitis of the small vessels commonly seen in children. The natural history of IgA vasculitis is generally self-limiting; however, one-third of patients experience symptom recurrence and a refractory course. This systematic review examined the use of dapsone in refractory IgA vasculitis cases. A literature search of PubMed databases retrieved 13 articles published until June 14, 2018. The most common clinical feature was a palpable rash (100% of patients), followed by joint pain (69.2%). Treatment response within 1-2 days was observed in 6 of 26 patients (23.1%) versus within 3-7 days in 17 patients (65.4%). Relapse after treatment discontinuation was reported in 17 patients (65.4%) but not in 3 patients (11.5 %). Four of the 26 patients (15.4%) reported adverse effects of dapsone including arthralgia (7.7%), rash (7.7%), and dapsone hypersensitivity syndrome (3.8%). Our findings suggest that dapsone may affect refractory IgA vasculitis. Multicenter randomized placebo-controlled trials are necessary to determine the standard dosage of dapsone at initial or tapering of treatment in IgA vasculitis patients and evaluate whether dapsone has a significant benefit versus steroids or other medications.