Ruchika Sharma
Nationwide Children's Hospital
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Publication
Featured researches published by Ruchika Sharma.
Journal of Pediatric Hematology Oncology | 2014
Ruchika Sharma; Dagmar Stein
Desmopressin (DDAVP) 1-deamino-8-D-arginine vasopressin is used in patients with bleeding disorders, including mild factor VIII deficiency, types 1 and 2 von Willebrand disease, and platelet function defects, undergoing surgeries to help control bleeding. We conducted a retrospective chart review of bleeding disorder patients undergoing inpatient surgery at Toledo Children’s Hospital, OH, from 2005 to 2009. Our study population included 107 patients aged 2 to 19 years with platelet function defects and von Willebrand disease. Our study aimed to evaluate the extent of hyponatremia caused by DDAVP and to propose a safe and effective treatment regimen for these patients. The mean change in sodium level before and after DDAVP was statistically significant within each age group. Thirteen patients had second dose of DDAVP withheld, and 11 patients had postoperative sodium levels ⩽130 mEq/L. There were 2 patients with significant complications: a 6-year-old with postoperative bleeding and a 2-year-old with post-DDAVP tonic-clonic seizures. We conclude that DDAVP causes significant hyponatremia, despite appropriate fluid restrictions. On the basis of our analysis, we recommend monitoring sodium levels before each dose of DDAVP and fluid restriction. These patients should be observed in the hospital setting after DDAVP administration for complications such as seizures and postoperative bleeding.
Journal of The American Society of Nephrology | 2017
Ruchika Sharma; Amanda P. Waller; Shipra Agrawal; Katelyn J. Wolfgang; Hiep Luu; Khurrum Shahzad; Berend Isermann; William E. Smoyer; Marvin T. Nieman; Bryce A. Kerlin
Nephrotic syndrome is characterized by massive proteinuria and injury of specialized glomerular epithelial cells called podocytes. Studies have shown that, whereas low-concentration thrombin may be cytoprotective, higher thrombin concentrations may contribute to podocyte injury. We and others have demonstrated that ex vivo plasma thrombin generation is enhanced during nephrosis, suggesting that thrombin may contribute to nephrotic progression. Moreover, nonspecific thrombin inhibition has been shown to decrease proteinuria in nephrotic animal models. We thus hypothesized that thrombin contributes to podocyte injury in a protease-activated receptor-specific manner during nephrosis. Here, we show that specific inhibition of thrombin with hirudin reduced proteinuria in two rat nephrosis models, and thrombin colocalized with a podocyte-specific marker in rat glomeruli. Furthermore, flow cytometry immunophenotyping revealed that rat podocytes express the protease-activated receptor family of coagulation receptors in vivo High-concentration thrombin directly injured conditionally immortalized human and rat podocytes. Using receptor-blocking antibodies and activation peptides, we determined that thrombin-mediated injury depended upon interactions between protease-activated receptor 3 and protease-activated receptor 4 in human podocytes, and between protease-activated receptor 1 and protease-activated receptor 4 in rat podocytes. Proximity ligation and coimmunoprecipitation assays confirmed thrombin-dependent interactions between human protease-activated receptor 3 and protease-activated receptor 4, and between rat protease-activated receptor 1 and protease-activated receptor 4 in cultured podocytes. Collectively, these data implicate thrombinuria as a contributor to podocyte injury during nephrosis, and suggest that thrombin and/or podocyte-expressed thrombin receptors may be novel therapeutic targets for nephrotic syndrome.
Pediatric Surgery International | 2013
Ruchika Sharma; Brenda J. Kitchen; Rajen Mody; Aghiad Chamdin; Steven W. Bruch; Rama Jasty
Malignant rhabdoid tumor (MRT) of the kidney is a rare pediatric tumor characterized by its aggressive nature and chemoresistance. Our patient had MRT of the right kidney with tumor thrombus in the renal vein, inferior vena cava, and right atrium. He developed transfusion-resistant hematuria. This was successfully controlled with right renal artery embolization allowing completion of his neoadjuvant chemotherapy. He then underwent complete resection of the tumor and thrombus avoiding cardiopulmonary bypass.
American Journal of Hematology | 2016
Ruchika Sharma; Joseph Stanek; Terah Koch; Linda Grooms; Sarah H. O'Brien
Menstruating women, with or without underlying bleeding disorders, are at increased risk for developing iron deficiency‐related fatigue, even in the absence of anemia. Oral iron therapy has limitations which include poor absorption and non‐adherence due to gastrointestinal side effects. We performed a prospective clinical trial of post‐menarchal adolescent females with iron‐deficiency with or without mild anemia and fatigue who received a standardized regimen of intravenous iron sucrose. The baseline mean (SD) hemoglobin was 11.96 g dl−1 (1.05) in 20 girls (ages 14–21 years); with a range of 10.3–14.1 g dl−1. In this cohort, intravenous iron was well tolerated and patients demonstrated a sustained increase in ferritin levels with means (SD) of 13.4 ng ml−1 (13.1) at baseline to 141.5 ng ml−1 (104.5) at 6 weeks and 85.2 ng ml−1 (128.4) at 6 months after the infusions. We used a standardized (Peds QLTM Multidimensional) fatigue scale to objectively measure fatigue and proxy scores by parents with mean screening scores (SD) of 35.2 (16.8) and 31.9 (19.6), respectively. We demonstrated a clinically significant improvement both in patient as well as parent fatigue scores (in 19 out of 20 subjects) at 6 weeks (Mean (SD) 58.3 (21.3) [P < 0.0001] and 57 (24.4) [P < 0.0001], respectively); as well as 3 and 6 months after the iron infusions. In nonanemic patients, iron administration did not significantly influence hemoglobin concentration. Therefore, the fatigue‐reducing effects of iron therapy reflect the nonhematological functions of iron. Am. J. Hematol. 91:973–977, 2016.
Journal of The American Society of Nephrology | 2015
Bryce A. Kerlin; Amanda P. Waller; Ruchika Sharma; Melinda A. Chanley; Marvin T. Nieman; William E. Smoyer
Thrombotic disease, a major life-threatening complication of nephrotic syndrome, has been associated with proteinuria and hypoalbuminemia severity. However, it is not fully understood how disease severity correlates with severity of the acquired hypercoagulopathy of nephrotic syndrome. Without this knowledge, the utility of proteinuria and/or hypoalbuminemia as biomarkers of thrombotic risk remains limited. Here, we show that two well established ex vivo hypercoagulopathy assays, thrombin generation and rotational thromboelastometry, are highly correlated with proteinuria and hypoalbuminemia in the puromycin aminonucleoside and adriamycin rat models of nephrotic syndrome. Notably, in the puromycin aminonucleoside model, hyperfibrinogenemia and antithrombin deficiency were also correlated with proteinuria severity, consistent with reports in human nephrotic syndrome. Importantly, although coagulation was not spontaneously activated in vivo with increasing proteinuria, vascular injury induced a more robust thrombotic response in nephrotic animals. In conclusion, hypercoagulopathy is highly correlated with nephrotic disease severity, but overt thrombosis may require an initiating insult, such as vascular injury. Our results suggest that proteinuria and/or hypoalbuminemia could be developed as clinically meaningful surrogate biomarkers of hypercoagulopathy to identify patients with nephrotic syndrome at highest risk for thrombotic disease and potentially target them for anticoagulant pharmacoprophylaxis.
Journal of Pediatric Hematology Oncology | 2011
Ruchika Sharma; Dagmar Stein; Waqar Khan
We are reporting a rare case of a primary squamous cell carcinoma of lung with skeletal metastases in a 7-year-old boy. The patient received chemotherapy with initial improvement but eventually died of the disease. A brief literature review is also presented.
Haemophilia | 2017
Ruchika Sharma; A. L. Dunn; D. Aschman; D. Cheng; Arthur P. Wheeler; A. Soni; Catherine E. McGuinn; C. Knoll; Dagmar Stein; Guy Young; J. French; J. Sanders; J. Davis; Michael Tarantino; M. Y. Lim; Ralph A. Gruppo; Robert F. Sidonio; S. Ahuja; S. L. Carpenter; Steven W. Pipe; Amy D. Shapiro
Open Journal of Pathology | 2014
Ruchika Sharma; Melissa Rhodes; Elizabeth Varga; Samir B. Kahwash
Blood | 2014
Ruchika Sharma; Terah Koch; Sarah H. O'Brien
Blood | 2015
Ruchika Sharma; Gary M. Woods; Susan Creary; Kan Hor; Cody Young; Christina Gallagher; Emily McLain; Trevorline Mongol; Brooke Cohen; Riten Kumar; Amy L. Dunn
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The Research Institute at Nationwide Children's Hospital
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