Stephanie Nguyen

Sugar-Sweetened Beverages, Serum Uric Acid, and Blood Pressure in Adolescents

OBJECTIVE To evaluate whether sugar-sweetened beverage consumption, a significant source of dietary fructose, is associated with higher serum uric acid levels and blood pressure in adolescents. STUDY DESIGN We analyzed cross-sectional data from 4867 adolescents aged 12 to 18 years in the National Health and Nutrition Examination Survey, 1999-2004. Dietary data were assessed from 24-hour dietary recall interviews. Sugar-sweetened beverages included fruit drinks, sports drinks, soda, and sweetened coffee or tea. We used multivariate linear regression to evaluate the association of sugar-sweetened beverage consumption with serum uric acid and with blood pressure. RESULTS Adolescents who drank more sugar-sweetened beverages tended to be older and male. In the adjusted model, serum uric acid increased by 0.18 mg/dL and systolic blood pressure z-score increased by 0.17 from the lowest to the highest category of sugar-sweetened beverage consumption (P for trend, .01 and .03, respectively). CONCLUSIONS These results from a nationally representative sample of US adolescents indicate that higher sugar-sweetened beverage consumption is associated with higher serum uric acid levels and systolic blood pressure, which may lead to downstream adverse health outcomes.

Being Overweight Modifies the Association Between Cardiovascular Risk Factors and Microalbuminuria in Adolescents

OBJECTIVE. The goal was to determine the association between cardiovascular risk factors and microalbuminuria in a nationally representative sample of adolescents and to determine whether being overweight modifies this association. METHODS. We analyzed cross-sectional data from the National Health and Nutrition Examination Survey(1999–2004) for 2515 adolescents 12 to 19 years of age. Cardiovascular risk factors included abdominal obesity, impaired fasting glucose, diabetes mellitus, insulin resistance, high triglyceride levels, low high-density lipoprotein cholesterol levels, hypertension, smoking, and the metabolic syndrome. Microalbuminuria was defined as a urinary albumin/creatinine ratio of 30 to 299 mg/g in a random morning sample. Overweight was defined as BMI of ≥95th percentile, according to the Centers for Disease Control and Prevention 2000 growth charts. RESULTS. Microalbuminuria was present in 8.9% of adolescents. The prevalence of microalbuminuria was higher among nonoverweight adolescents than among overweight adolescents. The median albumin/creatinine ratio decreased with increasing BMI z scores. The association of microalbuminuria with cardiovascular risk factors differed according to BMI category. Among nonoverweight adolescents, microalbuminuria was not associated with any cardiovascular disease risk factor except for overt diabetes mellitus. Among overweight adolescents, however, microalbuminuria was associated with impaired fasting glucose, insulin resistance, hypertension, and smoking, as well as diabetes mellitus. CONCLUSION. For the majority of adolescents, microalbuminuria is not associated with cardiovascular risk factors. Among overweight adolescents, however, microalbuminuria is associated with cardiovascular risk factors. The prognostic importance of microalbuminuria in overweight and nonoverweight adolescents with regard to future cardiovascular and renal disease needs to be defined in prospective studies conducted specifically in children.

Excess weight as a risk factor for kidney failure.

Purpose of reviewThe increasing incidence of end-stage renal disease and the epidemic of obesity are major public health problems. We review recent epidemiological evidence that excess weight is an important risk factor for chronic kidney disease and end-stage renal disease. Recent findingsA cohort study of over 300 000 adults and 8 million years of follow-up determined that elevated BMI was a significant risk factor for end-stage renal disease. This relationship was evident starting at a BMI of 25 kg/m2 and persisted after adjustment for hypertension and diabetes. A population-based case–control study showed that a BMI of at least 25 kg/m2 at age 20 was significantly associated with development of advanced chronic kidney disease. This was true even among those without diabetes or hypertension. SummaryExcess weight is a common, strong and modifiable risk factor for chronic kidney disease and end-stage renal disease. Even individuals who are not overtly obese are at risk. Excess weight contributes to chronic kidney disease and end-stage renal disease over and above its role in hypertension and diabetes. Weight loss may represent a novel intervention to reduce risk of chronic kidney disease development and progression.

Efficacy of bortezomib for reducing donor-specific antibodies in children and adolescents on a steroid minimization regimen.

AMR is increasingly being recognized as an important cause of renal allograft injury, contributing to significant morbidity and graft loss. There are few controlled trials and no well‐established treatment guidelines for AMR in renal transplant recipients. We retrospectively reviewed the outcome of four pediatric renal transplant recipients on a steroid minimization immunosuppression protocol treated with bortezomib for elevated DSA and acute AMR from 2012 to 2013. All patients received four doses of bortezomib 1.3 mg/m2 given on days one, four, eight, and 11. All patients also received other treatments prior to bortezomib, which may have included rituximab, methylprednisolone, plasmapheresis, and/or IVIg. While bortezomib in addition to other therapies significantly decreased DSA titers, DSA remained very elevated months after treatment. All four patients had immediate improvement or stabilization of renal function but one eventually lost her graft. There were no adverse events related to bortezomib six months after treatment.

Wait list status of pediatric dialysis patients in North America.

Nguyen S, Martz K, Stablein D, Neu A. Wait list status of pediatric dialysis patients in North America.
Pediatr Transplantation 2011: 15: 376–383.

Bartonella Endocarditis–Associated Glomerulonephritis: A Case Report and Review of the Literature

Infectious endocarditis is associated with a number of systemic manifestations, including kidney disease. Kidney manifestations, including hematuria, parenchymal infarction, and glomerulonephritis, may affect as many as 40%-50% of patients with infective endocarditis. In a minority of cases of infective endocarditis, routine bacterial cultures do not yield an offending organism. Bartonella species are a known and relatively common cause of culture-negative endocarditis and have been associated with the development of endocarditis-associated glomerulonephritis. We present a case of Bartonella endocarditis-associated glomerulonephritis in which recognition of a characteristic immunofluorescent pattern and thorough investigation of the clinical history led to this uncommon diagnosis.

Gross hematuria as a sign of acute rejection.

In the contemporary era of potent immunosuppressive regimens, previously encountered signs of renal allograft rejection such as fever and hematuria are rarely encountered. We report a teenager with severe recurrent acute humoral and cellular rejection whose presenting feature was gross hematuria with the presence of blood clots in the urine. We want to highlight that severe rejection even in the setting of modern immunosuppressive drugs can present as gross hematuria. Contrary to conventional wisdom that gross hematuria with the presence of blood clots in the urine is indicative of pathology in the renal collecting system, a parenchymal disease process should also be considered in renal transplant recipients.

Just a spoonful of sugar helps the blood pressure go up

While thoroughly endearing, Mary Poppins isn’t a doctor, and her medical advice is highly suspect. Hypertension, both as a primary phenomenon and as a component of the metabolic syndrome, has been increasing in prevalence over the last two decades [1,2]. Naturally, dietary indiscretion is the main culprit, but which dietary factor? The US FDA recently announced plans to regulate salt consumption in an effort to curb this epidemic [3]. But might they have missed something? Could it be our sugar intake as well?

Response to childhood immunizations in congenital nephrotic syndrome.

Infections are a leading cause of morbidity in children following transplantation. It is therefore imperative to ensure that children are immunized before a transplant. Contrary to this recommendation, it has long been suggested that children with congenital nephrotic syndrome (CNS) not receive immunizations due to their perceived lack of response. We report a child with CNS who was immunized before transplantation per the routine pediatric immunization protocol and responded appropriately. The intent of this report is to encourage health care providers to immunize children with CNS, as the practice of withholding immunizations in these patients may have adverse health implications.

Hemodialysis in Adolescents

Hemodialysis is the most common initial treatment for end-stage renal disease in adolescents. The goal of this chapter is to review important aspects of hemodialysis as a treatment for end-stage renal disease in adolescents. Specifically, considerations regarding vascular access, the hemodialysis prescription, potential complications, and patient outcomes are reviewed.