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Article: Investigating the human spirit and spirituality in pediatric patients with kidney disease.

Woroniecki, Robert / Moritz, Michael L

2023 Volume 11, Page(s) 1104628

Abstract: Human spirit is an integral part of the medicinal art and science trifecta: body-mind-spirit, and it is contained in the World Health Organization definition of health. Human spirit is defined as our purpose in life, relationships with all living ... ...

Abstract	Human spirit is an integral part of the medicinal art and science trifecta: body-mind-spirit, and it is contained in the World Health Organization definition of health. Human spirit is defined as our purpose in life, relationships with all living creatures or "Higher Power", and in general our place on planet Earth. Spirituality is a required part of patient care according to Joint Commission on Accreditation of Health Care Organizations. There is an abundant medical literature that documents discrepancies in the results between studies and populations, and points to the importance of cultural, ethnic, spiritual or religious differences. Validated questionnaires used in research for last several decades demonstrated an association of spirituality with clinical outcomes, coping, and quality of life in different adult chronic diseases. There are also validated scales to measure hope in children based on the premise that children are goal directed and that their goal-related thoughts can be understood, yet their purposefulness, meaning of life and spirit in pediatric nephrology remains mostly unexamined. Although pediatric nephrology has made significant advances in molecular techniques, artificial intelligence, machine learning, and started to address more broad social issues such as racism, health equity, diversity of our work force, etc, it lacks both systematic ways of studying and philosophical approach to fostering human spirit. This mini review examines the place and knowledge gaps in human spirit and spirituality in pediatric nephrology. We review the concept of the human spirit and medical literature pertaining to its role in pediatric nephrology.
Language	English
Publishing date	2023-02-23
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2023.1104628
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Ambulatory blood pressure monitoring in children during the COVID-19 pandemic.

Woroniecki, Robert P / Flynn, Joseph T

Blood pressure monitoring

2022 Volume 27, Issue 5, Page(s) 305–309

Abstract: The pandemic caused by severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) had profound effects on healthcare delivery in the USA and abroad. Although ambulatory blood pressure monitoring (ABPM) is the recommended method for confirming ... ...

Abstract	The pandemic caused by severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) had profound effects on healthcare delivery in the USA and abroad. Although ambulatory blood pressure monitoring (ABPM) is the recommended method for confirming hypertension (HTN) diagnosis and management, it is unclear how the pandemic affected ABPM utilization. We surveyed 81 pediatric nephrologists from 54 pediatric nephrology centers regarding their ABPM practices during the pandemic; 56.8% of providers continued to provide ABPM to their patients, but only 21% used disposable cuffs, and only 28.4% had specific equipment cleaning protocols in place. Only a minority of 81 practitioners felt comfortable (26.2%) or very comfortable (11.2%) in following published guidelines on ABPM during the pandemic, and 22.5% felt uncomfortable or very uncomfortable (7.5%). Additionally, only about half (49.4%) of practitioners were comfortable with managing HTN via telehealth. Our findings underscore the need to supplement existing and future guidance on how to manage HTN protocols, HTN patients, and equipment during healthcare crises.
MeSH term(s)	Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; COVID-19/epidemiology ; Child ; Humans ; Hypertension/diagnosis ; Hypertension/epidemiology ; Pandemics ; SARS-CoV-2
Language	English
Publishing date	2022-05-02
Publishing country	England
Document type	Journal Article
ZDB-ID	1324472-3
ISSN	1473-5725 ; 1359-5237
ISSN (online)	1473-5725
ISSN	1359-5237
DOI	10.1097/MBP.0000000000000603
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Zs.A 4626: Show issues

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Book ; Online: Nephrotic Syndrome in Pediatric Patients

Kaskel, Frederick Jeffrey / Woroniecki, Robert P. / Swiatecka-Urban, Agnieszka

2017

Abstract: Nephrotic syndrome (NS) - characterized by heavy glomerular protein loss (proteinuria), edema, hypoalbuminemia, and hyperlipidemia - has diverse causes and frequently leads to chronic kidney disease. This E-book encompasses articles on a variety of ... ...

Abstract	Nephrotic syndrome (NS) - characterized by heavy glomerular protein loss (proteinuria), edema, hypoalbuminemia, and hyperlipidemia - has diverse causes and frequently leads to chronic kidney disease. This E-book encompasses articles on a variety of topics in NS, including a historical perspective on understanding and treatment of NS, followed by state-of-the-art reviews of the molecular pathomechanisms, clinical outcomes, as well as current and emerging treatment strategies for NS. We hope that this comprehensive review will help to reduce the gaps between the research and the day-to-day care of patients with NS and inspire new research efforts towards updating and expanding the treatment armamentarium for the future
Keywords	Medicine (General) ; Pediatrics
Size	1 electronic resource (85 p.)
Publisher	Frontiers Media SA
Document type	Book ; Online
Note	English ; Open Access
HBZ-ID	HT020097437
ISBN	9782889452989 ; 2889452980
Database	ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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Article: Diabetes Insipidus Complicating Management in a Child with COVID-19 and Multiorgan System Failure: A Novel Use for Furosemide.

Gungor, Sara D / Woroniecki, Robert P / Hulfish, Erin / Biagas, Katherine V

Case reports in critical care

2021 Volume 2021, Page(s) 5942431

Abstract: Judicious balance of fluids is needed for optimal management of acute respiratory distress syndrome (ARDS). Achieving optimal fluid balance is difficult in patients with disorders of fluid homeostasis such as diabetes insipidus (DI). There is little data ...

Abstract	Judicious balance of fluids is needed for optimal management of acute respiratory distress syndrome (ARDS). Achieving optimal fluid balance is difficult in patients with disorders of fluid homeostasis such as diabetes insipidus (DI). There is little data on the use of Furosemide to aid in balancing fluid and electrolytes in patients with DI. Here, we present a critically ill 11-year-old female with developmental delay, septo-optic dysplasia, central DI, and respiratory failure secondary to COVID-19 ARDS. She required careful titration of a Vasopressin infusion in addition to IV Furosemide for successful management of fluid and electrolyte derangements. On admission, she demonstrated high-volume urine output with mild hypernatremia (serum sodium 156 mmol/L). Despite her maximum Vasopressin infusion rate of 8 mU/kg/hr, by day two of admission, she voided a total of 4 L resulting in severe hypernatremia (serum sodium 171 mmol/L). With continually high Vasopressin infusion rates, her overall fluid balance became increasingly net positive, although her hypernatremia persisted. Her ARDS continued to worsen. After 48 hours of the addition of intermittent Furosemide, successful diuresis along with resolution of hypernatremia was achieved. The combination of IV Furosemide with Vasopressin infusion resulted in tailored diuresis and more controlled titration of serum sodium levels than adjustment in Vasopressin and fluids alone. These results are in contradistinction to the published literature, which focuses on the use of thiazide diuretics in managing DI. This experience highlights the potential for loop diuretics to aid in establishing a desired fluid and electrolyte status in managing patients with both DI and ARDS.
Language	English
Publishing date	2021-08-04
Publishing country	United States
Document type	Case Reports
ZDB-ID	2927720-6
ISSN	2090-6439 ; 2090-6420
ISSN (online)	2090-6439
ISSN	2090-6420
DOI	10.1155/2021/5942431
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Article: Hypertension in Childhood Nephrotic Syndrome.

Shatat, Ibrahim F / Becton, Lauren J / Woroniecki, Robert P

Frontiers in pediatrics

2019 Volume 7, Page(s) 287

Abstract: Arterial hypertension (HTN) is commonly encountered by clinicians treating children with steroid sensitive (SSNS) and steroid resistant nephrotic syndrome (SRNS). Although the prevalence of HTN in SSNS is less documented than in SRNS, recent studies ... ...

Abstract	Arterial hypertension (HTN) is commonly encountered by clinicians treating children with steroid sensitive (SSNS) and steroid resistant nephrotic syndrome (SRNS). Although the prevalence of HTN in SSNS is less documented than in SRNS, recent studies reported high prevalence in both. Studies have estimated the prevalence of HTN in different patient populations with NS to range from 8 to 59.1%. Ambulatory HTN, abnormalities in BP circadian rhythm, and measures of BP variability are prevalent in patients with NS. Multiple mechanisms and co-morbidities contribute to the pathophysiology of HTN in children with NS. Some contributing factors are known to cause acute and episodic elevations in blood pressure such as fluid shifts, sodium retention, and medication side effects (steroids, CNIs). Others are associated with chronic and more sustained HTN such as renal fibrosis, decreased GFR, and progression of chronic kidney disease. Children with NS are more likely to suffer from other cardiovascular disease risk factors, such as obesity, increased measures of arterial stiffness [increased carotid intima-media thickness (cIMT), endothelial dysfunction, increased pulse wave velocity (PWV)], impaired glucose metabolism, dyslipidemia, left ventricular hypertrophy (LVH), left ventricular dysfunction, and atherosclerosis. Those risk factors have been associated with premature death in adults. In this review on HTN in patients with NS, we will discuss the epidemiology and pathophysiology of hypertension in patients with NS, as well as management aspects of HTN in children with NS.
Language	English
Publishing date	2019-07-16
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2019.00287
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Article ; Online: Atypical presentation of atypical haemolytic uraemic syndrome.

Basak, Ratna / Wang, Xiaotong / Keane, Caitlin / Woroniecki, Robert

BMJ case reports

2018 Volume 2018

Abstract: A 17-year-old girl presented with fever, myalgia, vomiting for 1 month and oliguria and dyspnoea for 4 days. She was tachycardic,hypertensive, with pedal oedema and decreased breath sounds. She had high serum creatinine (3 mg/dL), anaemia, ... ...

Abstract	A 17-year-old girl presented with fever, myalgia, vomiting for 1 month and oliguria and dyspnoea for 4 days. She was tachycardic,hypertensive, with pedal oedema and decreased breath sounds. She had high serum creatinine (3 mg/dL), anaemia, thrombocytopenia, leucocytosis and eosinophilia with schistocytes. Lactate dehydrogenase, transaminases were high , with low haptoglobin and high ferritin (5269 ng/mL). Complement C3/C4 and fibrinogen were normal. Urinalysis showed large blood and protein and stool studies were negative. Her ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) was normal. Kidney biopsy showed acute interstitial nephritis (AIN) in addition to thrombotic angiopathy. The differentials - haemolytic uraemic syndrome (HUS), thrombotic thrombocytopenia (TTP) and haemophagocytic lymphohistiocytosis (HLH) were ruled out. Her genetic testing was abnormal for large CFHR1-CFHR3 homozygous deletion and heterozygous missense variant in exon 2 of DGKE making the diagnosis of atypical HUS. She received eculizumab and was discharged on oral steroids for AIN and biweekly eculizumab infusions with excellent recovery.
MeSH term(s)	Adolescent ; Antibodies, Monoclonal, Humanized/therapeutic use ; Atypical Hemolytic Uremic Syndrome/complications ; Atypical Hemolytic Uremic Syndrome/diagnosis ; Atypical Hemolytic Uremic Syndrome/drug therapy ; Atypical Hemolytic Uremic Syndrome/genetics ; Blood Proteins/genetics ; Complement C3b Inactivator Proteins/genetics ; Female ; Fever/etiology ; Gene Deletion ; Humans ; Immunosuppressive Agents/therapeutic use ; Myalgia/etiology ; Treatment Outcome ; Urinalysis
Chemical Substances	Antibodies, Monoclonal, Humanized ; Blood Proteins ; CFHR1 protein, human ; CFHR3 protein, human ; Complement C3b Inactivator Proteins ; Immunosuppressive Agents ; eculizumab (A3ULP0F556)
Language	English
Publishing date	2018-02-11
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2017-222560
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Article: Editorial: Nephrotic Syndrome in Pediatric Patients.

Woroniecki, Robert P / Swiatecka-Urban, Agnieszka / Kaskel, Frederick J

Frontiers in pediatrics

2017 Volume 5, Page(s) 167

Language	English
Publishing date	2017-08-03
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2017.00167
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Article ; Online: Caffeine and kidney function at two years in former extremely low gestational age neonates.

Harer, Matthew W / Griffin, Russell / Askenazi, David J / Fuloria, Mamta / Guillet, Ronnie / Hanna, Mina / Schuh, Meredith P / Slagle, Cara / Woroniecki, Robert / Charlton, Jennifer R

Pediatric research

2023 Volume 95, Issue 1, Page(s) 257–266

Abstract: Background: Extremely low gestational age neonates (ELGANs) are at risk for chronic kidney disease. The long-term kidney effects of neonatal caffeine are unknown. We hypothesize that prolonged caffeine exposure will improve kidney function at 22-26 ... ...

Abstract	Background: Extremely low gestational age neonates (ELGANs) are at risk for chronic kidney disease. The long-term kidney effects of neonatal caffeine are unknown. We hypothesize that prolonged caffeine exposure will improve kidney function at 22-26 months. Methods: Secondary analysis of the Preterm Erythropoietin Neuroprotection Trial of neonates <28 weeks' gestation. Participants included if any kidney outcomes were collected at 22-26 months corrected age. Exposure was post-menstrual age of caffeine discontinuation. Primary outcomes: 'reduced eGFR' <90 ml/min/1.73 m Results: 598 participants had at least one kidney metric at follow up. Within the whole cohort, postmenstrual age of caffeine discontinuation was not associated with any abnormal measures of kidney function at 2 years. In the stratified analysis, for each additional week of caffeine, the no BPD group had a 21% decreased adjusted odds of eGFR <90 ml/min/1.73m Conclusions: Longer caffeine exposure during the neonatal period is associated with differential kidney outcomes at 22-26 months dependent on BPD status. Impact: In participants born <28 weeks' gestation, discontinuation of caffeine at a later post menstrual age was not associated with abnormal kidney outcomes at 22-26 months corrected age. When assessed at 2 years of age, later discontinuation of caffeine in children born <28 weeks' gestation was associated with a greater risk of reduced eGFR in those without a history of BPD and an increased odds of hypertension in those with a history of BPD. More work is necessary to understand the long-term impact of caffeine on the developing kidney.
MeSH term(s)	Infant, Newborn ; Child ; Humans ; Infant ; Child, Preschool ; Gestational Age ; Caffeine/adverse effects ; Bronchopulmonary Dysplasia/prevention & control ; Kidney ; Hypertension
Chemical Substances	Caffeine (3G6A5W338E)
Language	English
Publishing date	2023-09-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	4411-8
ISSN	1530-0447 ; 0031-3998
ISSN (online)	1530-0447
ISSN	0031-3998
DOI	10.1038/s41390-023-02792-y
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Zs.A 564: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: The Impact of a Smartphone App on the Quality of Pediatric Colonoscopy Preparations: Randomized Controlled Trial.

Brief, James / Chawla, Anupama / Lerner, Diana / Vitola, Bernadette / Woroniecki, Robert / Morganstern, Jeffrey

JMIR pediatrics and parenting

2020 Volume 3, Issue 2, Page(s) e18174

Abstract: Background: Smartphone apps have been successfully used to help adults prepare for colonoscopies. However, no study to date has investigated the effect of a smartphone app on pediatric colonoscopy preparation.: Objective: The aim of this study is to ... ...

Abstract	Background: Smartphone apps have been successfully used to help adults prepare for colonoscopies. However, no study to date has investigated the effect of a smartphone app on pediatric colonoscopy preparation. Objective: The aim of this study is to determine if an app (SB Colonoscopy Prep) designed to educate and guide patients through their colonoscopy preparation will yield benefits over paper-based instructions and information. Methods: In total, 46 patients aged 5-18 years received either app-based or written material with instructions on how to take their prep medications as well as information about the colonoscopy procedure. Prep quality, the number of calls to the gastroenterology service, and patient arrival time were recorded. After the procedure, a questionnaire was given to each patient through which they graded their knowledge of the procedure both before and after receiving the app or written material. Results: App users had higher mean Boston scores versus control subjects receiving written instructions (7.2 vs 5.9, P=.02), indicating better colonoscopy preps. In total, 75% (15/20) of app users and 41% (9/22) of written instruction users had preps categorized as "excellent" on the Boston scale. We found no significant differences in knowledge about the procedure (app users: 10/20 [50%], written instruction users 8/22 [36%]; P=.37), phone calls to the gastroenterology clinic (n=6 vs n=2; P=.27), or arrival times at the endoscopy suite (44 min vs 46 min before the scheduled procedure time; P=.56). Conclusions: Smartphone app use was associated with an increased number of colonoscopy preps classified as "excellent" on the Boston scale. There was no significant difference between app users and the control group regarding the number of calls to the gastroenterology clinic, patient arrival time, or patient knowledge about the procedure. Trial registration: ClinicalTrials.gov NCT04590105; https://clinicaltrials.gov/ct2/show/NCT04590105.
Language	English
Publishing date	2020-11-10
Publishing country	Canada
Document type	Journal Article
ISSN	2561-6722
ISSN (online)	2561-6722
DOI	10.2196/18174
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Article ; Online: Cumulative Application of Creatinine and Urine Output Staging Optimizes the Kidney Disease: Improving Global Outcomes Definition and Identifies Increased Mortality Risk in Hospitalized Patients With Acute Kidney Injury.

Sutherland, Scott M / Kaddourah, Ahmad / Gillespie, Scott E / Soranno, Danielle E / Woroniecki, Robert P / Basu, Rajit K / Zappitelli, Michael

Critical care medicine

2021 Volume 49, Issue 11, Page(s) 1912–1922

Abstract: Objectives: Acute kidney injury is diagnosed according to creatinine and urine output criteria. Traditionally, both are applied, and a severity stage (1-3) is conferred based upon the more severe of the two; information from the other criteria is ... ...

Abstract	Objectives: Acute kidney injury is diagnosed according to creatinine and urine output criteria. Traditionally, both are applied, and a severity stage (1-3) is conferred based upon the more severe of the two; information from the other criteria is discarded. Physiologically, however, rising creatinine and oliguria represent two distinct types of renal dysfunction. We hypothesized that using the information from both criteria would more accurately characterize acute kidney injury severity and outcomes. Design: Prospective cohort study. Setting: Multicenter, international collaborative of ICUs. Patients: Three thousand four hundred twenty-nine children and young adults admitted consecutively to ICUs as part of the Assessment of the Worldwide Acute Kidney Injury, Renal Angina and Epidemiology Study. Measurements and main results: The Kidney Disease: Improving Global Outcomes creatinine and urine output acute kidney injury criteria were applied sequentially, and the two stages were summed, generating an Acute Kidney Injury (AKI) Score ranging from 1 to 6. The primary outcome was 28-day mortality; secondary outcomes were time until ICU discharge and nonrecovery from acute kidney injury. Models considered associations with AKI Score, assessing the relationship unadjusted and adjusted for covariates. Twenty-eight-day mortality and nonrecovery from acute kidney injury were modeled using logistic regression. For 28-day ICU discharge, competing risks analysis was performed. Although AKI Scores 1-3 had similar mortality to no Acute Kidney Injury, AKI Scores 4-6 were associated with increased mortality. Relative to No Acute Kidney Injury, AKI Scores 1-6 were less likely to be discharged from the ICU within 28 days. Relative to AKI Score 1, AKI Scores 2-6 were associated with higher risk of nonrecovery. Within the traditional Kidney Disease: Improving Global Outcomes Stage 3 acute kidney injury cohort, when compared with AKI Score 3, AKI Scores 4-6 had increased mortality, AKI Scores 5-6 had prolonged time to ICU discharge, and AKI Score 6 experienced higher nonrecovery rates. Conclusions: Cumulative application of the creatinine and urine output criteria characterizes renal excretory and fluid homeostatic dysfunction simultaneously. This Acute Kidney Injury score more comprehensively describes the outcome implications of severe acute kidney injury than traditional staging methods.
MeSH term(s)	Acute Kidney Injury/diagnosis ; Acute Kidney Injury/epidemiology ; Acute Kidney Injury/mortality ; Acute Kidney Injury/urine ; Adolescent ; Child ; Creatinine/blood ; Critical Illness/epidemiology ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Prospective Studies ; Severity of Illness Index ; Urination/physiology ; Young Adult
Chemical Substances	Creatinine (AYI8EX34EU)
Language	English
Publishing date	2021-05-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000005073
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