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Article ; Online: Hypertension in Pediatric Solid Organ Transplant Recipients.

Hamdani, Gilad / Mitsnefes, Mark M

2023 Volume 25, Issue 5, Page(s) 51–60

Abstract: Purpose of review: To review the current literature regarding hypertension (HTN) following pediatric solid organ transplant (SOTx), including definition, prevalence, risk factors, outcomes, and treatment.: Recent findings: In recent years several new ...

Abstract	Purpose of review: To review the current literature regarding hypertension (HTN) following pediatric solid organ transplant (SOTx), including definition, prevalence, risk factors, outcomes, and treatment. Recent findings: In recent years several new guidelines for the definition, monitoring, and management of pediatric HTN have been published, but with no specific recommendations regarding SOTx recipients. HTN remains highly prevalent, yet underdiagnosed and undertreated in kidney transplant (KTx) recipients, especially when ambulatory blood pressure monitoring (ABPM) is utilized. There are little data regarding its prevalence in other SOTx recipients. HTN in this population is multifactorial and is associated with HTN status prior to Tx, demographic factors (age, sex, and race), weight status, and immunosuppression protocol. HTN is associated with subclinical cardiovascular (CV) end-organ damage, including left ventricular hypertrophy (LVH) and arterial stiffness, yet there are no recent data regarding its long-term outcomes. There are also no updated recommendations regarding the optimal management of HTN in this population. Given its high prevalence and the young age of this population facing years at increased CV risk, post-Tx HTN requires more clinical attention (routine monitoring, frequent application of ABPM, better BP control). Additional research is needed for a better understanding of its long-term outcomes as well as its treatment and treatment goals. Much more research is needed regarding HTN in other pediatric SOTx populations.
MeSH term(s)	Humans ; Child ; Hypertension/etiology ; Hypertension/complications ; Blood Pressure Monitoring, Ambulatory ; Organ Transplantation/adverse effects ; Kidney Transplantation/adverse effects ; Risk Factors ; Blood Pressure
Language	English
Publishing date	2023-03-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057367-4
ISSN	1534-3111 ; 1522-6417
ISSN (online)	1534-3111
ISSN	1522-6417
DOI	10.1007/s11906-023-01237-5
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Zs.A 5522: Show issues

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Article: [PRIMARY HYPERTENSION IN CHILDREN AND ADOLESCENTS].

Hamdani, Gilad / Dagan, Amit

Harefuah

2021 Volume 160, Issue 4, Page(s) 260–265

Abstract: Introduction: The prevalence of pediatric primary hypertension (HTN) has increased in the past few decades, most probably related to the increased prevalence of overweight/obesity in this population. According to various estimates 3.5-5% of children and ...

Abstract	Introduction: The prevalence of pediatric primary hypertension (HTN) has increased in the past few decades, most probably related to the increased prevalence of overweight/obesity in this population. According to various estimates 3.5-5% of children and adolescents have HTN. Children and especially adolescents with HTN are at an increased risk for HTN in early adulthood, and for early subclinical cardiovascular morbidity. Therefore, screening for and treatment of pediatric HTN is highly recommended, especially in high risk populations, such as overweight children. In the past few years, new guidelines for the diagnosis, evaluation and treatment of pediatric HTN were published by both the European Society of Hypertension and the American Academy of Pediatrics. The following review will discuss central aspects of the epidemiology, risk factors, definitions, and initial clinical approach of primary HTN in children and adolescents.
MeSH term(s)	Adolescent ; Adult ; Child ; Humans ; Hypertension/diagnosis ; Hypertension/epidemiology ; Hypertension/therapy ; Obesity ; Overweight ; Prevalence ; Risk Factors ; United States
Language	Hebrew
Publishing date	2021-04-25
Publishing country	Israel
Document type	Journal Article ; Review
ZDB-ID	953872-0
ISSN	0017-7768
ISSN	0017-7768
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Article ; Online: Isolated Hydronephrosis and Urinary Tract Infection by Two Years of Age: A Population-Based Study.

Hamdani, Gilad / Yaniv, Noga / Shoham, Shoval / Borovitz, Yael / Levi, Shelly / Landau, Daniel / Dagan, Amit

The Journal of pediatrics

2024 Volume 271, Page(s) 114055

Abstract: Objective: To evaluate the risk for urinary tract infection (UTI) in infants with isolated hydronephrosis (IH).: Study design: A retrospective, population-based study including all infants insured by Clalit Health Services and followed from birth to ... ...

Abstract	Objective: To evaluate the risk for urinary tract infection (UTI) in infants with isolated hydronephrosis (IH). Study design: A retrospective, population-based study including all infants insured by Clalit Health Services and followed from birth to age 2 years in 3 regions of central Israel. Infants were divided into 3 groups based on electronic medical record diagnoses by age 6 months: (1) control: no urological diagnosis; (2) IH; and (3) complicated urological diagnosis (CUD): any additional nephrological/urological diagnosis with/without HN. The primary outcome was a diagnosis of UTI in the first 2 years of life. Results: The cohort included 340 619 infants (52% male): 333 920 controls, 4369 with IH, and 2331 with CUD. Infants with IH were associated with a greater risk for UTI than control patients (17% vs 4%, P < .001). UTI risk for a male infant with IH was greater than for a female infant in the control group (12.6% vs 6.5%, P < .001). In a multivariable logistic regression analysis, both IH (OR 7.04; 95% CI 6.46-7.66) and CUD (OR 14.9; 95% CI 13.6-16.4) were independently associated with UTI. Conclusion: Infants with IH are at a greater risk for UTI in the first 2 years of life, supporting the recommendation for a high index of suspicion for UTI in this population.
Language	English
Publishing date	2024-04-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2024.114055
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Article: Ambulatory Blood Pressure and Number of Subclinical Target Organ Injury Markers in Youth: The SHIP AHOY Study.

Hamdani, Gilad / Urbina, Elaine M / Daniels, Stephen R / Falkner, Bonita E / Ferguson, Michael A / Flynn, Joseph T / Hanevold, Coral D / Ingelfinger, Julie R / Khoury, Philip R / Lande, Marc B / Meyers, Kevin E / Samuels, Joshua / Mitsnefes, Mark

medRxiv : the preprint server for health sciences

2024

Abstract: Background: Hypertension in adolescence is associated with subclinical target organ injury (TOI). We aimed to determine whether different blood pressure (BP) thresholds were associated with increasing number of TOI markers in healthy adolescents.: ... ...

Abstract	Background: Hypertension in adolescence is associated with subclinical target organ injury (TOI). We aimed to determine whether different blood pressure (BP) thresholds were associated with increasing number of TOI markers in healthy adolescents. Methods: 244 participants (mean age 15.5±1.8 years, 60.1% male) were studied. Participants were divided based on both systolic clinic and ambulatory BP (ABP), into low- (<75 Results: 47.5% of participants had at least one TOI marker: 31.2% had one, 11.9% two, 3.7% three, and 0.8% four. The number of TOI markers increased according to the BP risk groups: the percentage of participants with more than one TOI in the low-, mid-, and high groups based on clinic BP was 6.7%, 19.1%, and 21.8% (p=0.02), and based on ABP was 9.6%, 15.8%, and 32.2% (p<0.001). In a multivariable regression analysis, both clinic BP percentile and ambulatory SBP index were independently associated with the number of TOI markers. When both clinic and ABP were included in the model, only the ambulatory SBP index was significantly associated with the number of markers. Conclusion: High SBP, especially when assessed by ABPM, was associated with an increasing number of subclinical cardiovascular injury markers in adolescents.
Language	English
Publishing date	2024-03-18
Publishing country	United States
Document type	Preprint
DOI	10.1101/2024.03.15.24304137
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Article ; Online: Hypertensive crisis in children and adolescents.

Seeman, Tomáš / Hamdani, Gilad / Mitsnefes, Mark

Pediatric nephrology (Berlin, Germany)

2018 Volume 34, Issue 12, Page(s) 2523–2537

Abstract: Hypertensive crisis is a relatively rare condition in children. However, if not treated, it might be life-threatening and lead to irreversible damage of vital organs. Clinical presentation of patients with hypertensive crisis can vary from very mild ( ... ...

Abstract	Hypertensive crisis is a relatively rare condition in children. However, if not treated, it might be life-threatening and lead to irreversible damage of vital organs. Clinical presentation of patients with hypertensive crisis can vary from very mild (hypertensive urgency) to severe symptoms (hypertensive emergency) despite similarly high blood pressure (BP). Individualized assessment of patients presenting with high BP with emphasis on the evaluation of end-organ damage rather than on the specific BP number is a key in guiding physician's initial management of a hypertensive crisis. The main aim of the treatment of hypertensive crisis is the prevention or treatment of life-threatening complications of hypertension-induced organ dysfunction, including neurologic, ophthalmologic, renal, and cardiac complications. While the treatment strategy must be directed toward the immediate reduction of BP to reduce the hypertensive damage to these organs, it should not be at a too fast rate to cause hypoperfusion of vital organs by an excessively rapid reduction of BP. Thus, intravenous continuous infusions rather than intravenous boluses of antihypertensive medications should be the preferable mode of initial treatment of children with hypertensive emergency.
MeSH term(s)	Adolescent ; Antihypertensive Agents/administration & dosage ; Antihypertensive Agents/adverse effects ; Blood Pressure/drug effects ; Child ; Child, Preschool ; Humans ; Hypertension/drug therapy ; Hypertension/etiology ; Hypertension/physiopathology ; Infant ; Infant, Newborn ; Kidney Diseases/complications
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2018-10-01
Publishing country	Germany
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	631932-4
ISSN	1432-198X ; 0931-041X
ISSN (online)	1432-198X
ISSN	0931-041X
DOI	10.1007/s00467-018-4092-2
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Article: Comparison of validation protocols for blood pressure measuring devices in children and adolescents.

Stabouli, Stella / Chainoglou, Athanasia / Evripidou, Kleo / Simão, Carla / Antza, Christina / Petrou, Panagiotis / Hamdani, Gilad / Calpe, Javier / Lurbe, Empar

Frontiers in cardiovascular medicine

2022 Volume 9, Page(s) 1001878

Abstract: Accuracy of blood pressure (BP) measurement is important for the evaluation of hypertension in children and adolescents, and it is critically dependent upon the accuracy of the BP measuring device. A device that could pass validated protocols with ... ...

Abstract	Accuracy of blood pressure (BP) measurement is important for the evaluation of hypertension in children and adolescents, and it is critically dependent upon the accuracy of the BP measuring device. A device that could pass validated protocols with reliable accuracy would be desirable in clinical and research settings. Several scientific organizations have published recommendations on the validation of different BP measuring devices. Most of them focus on adults but separate recommendations and validation criteria for BP devices intended for use in children and adolescents are included in some validation protocols. In this review, we compare the validation criteria for BP measuring devices among consensus documents from different scientific organizations focusing on the pediatric population and we discuss the evidence gaps targeting the needs for validated BP measuring devices in children and adolescents. We also highlight common pitfalls in the validation studies of BP measuring devices in children and adolescents using the example of office BP devices.
Language	English
Publishing date	2022-11-23
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2781496-8
ISSN	2297-055X
ISSN	2297-055X
DOI	10.3389/fcvm.2022.1001878
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Article ; Online: Serologic response to COVID-19 infection or vaccination in pediatric kidney transplant recipients compared to healthy children.

Ziv, Noa / Gimelraikh, Yulia / Ashkenazi-Hoffnung, Liat / Alfandary, Hadas / Borovitz, Yael / Dagan, Amit / Levi, Shelly / Hamdani, Gilad / Levy-Erez, Daniella / Landau, Daniel / Koren, Gili / Talgam-Horshi, Efrat / Haskin, Orly

Transplant immunology

2023 Volume 78, Page(s) 101839

Abstract: Background: Differences in serologic response to COVID-19 infection or vaccination were reported in adult kidney transplant recipients (KTR) compared to non-immunocompromised patients. This study aims to compare the serologic response of naturally ... ...

Abstract	Background: Differences in serologic response to COVID-19 infection or vaccination were reported in adult kidney transplant recipients (KTR) compared to non-immunocompromised patients. This study aims to compare the serologic response of naturally infected or vaccinated pediatric KTR to that of controls. Methods: Thirty-eight KTR and 42 healthy children were included; aged ≤18 years, with a previously confirmed COVID-19 infection or post COVID-19 vaccination. Serological response was measured by anti-spike protein IgG antibody titers. Response post third vaccine was additionally assessed in KTR. Results: Fourteen children in each group had previously confirmed infection. KTR were significantly older and developed a 2-fold higher antibody titer post-infection compared to controls [median (interquartile range [IQR]) age: 14.9 (7.8, 17.5) vs. 6.3 (4.5, 11.5) years, p = 0.02; median (IQR) titer: 1695 (982, 3520) vs. 716 (368, 976) AU/mL, p = 0.03]. Twenty-four KTR and 28 controls were vaccinated. Antibody titer was lower in KTR than in controls [median (IQR): 803 (206, 1744) vs. 8023 (3032, 30,052) AU/mL, p < 0.001]. Fourteen KTR received third vaccine. Antibody titer post booster in KTR reached similar levels to those of controls post two doses [median (IQR) 5923 (2295, 12,278) vs. 8023 (3034, 30,052) AU/mL, p = 0.37] and to KTR post natural infection [5282 AU/mL (2583, 13,257) p = 0.8]. Conclusion: Serologic response to COVID-19 infection was significantly higher in KTR than in controls. Antibody level in KTR was higher in response to infection vs. vaccination, contrary to reports in the general population. Response to vaccination in KTR reached levels comparable to controls only after third vaccine.
MeSH term(s)	Adult ; Humans ; Child ; Adolescent ; COVID-19 Vaccines ; Kidney Transplantation ; COVID-19 ; Vaccination ; Transplant Recipients ; Antibodies, Viral ; COVID-19 Testing
Chemical Substances	COVID-19 Vaccines ; Antibodies, Viral
Language	English
Publishing date	2023-04-17
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1160846-8
ISSN	1878-5492 ; 0966-3274
ISSN (online)	1878-5492
ISSN	0966-3274
DOI	10.1016/j.trim.2023.101839
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Article: [NEPHROTIC SYNDROME RECURRENCE POST-RENAL TRANSPLANTATION: 10 YEARS' EXPERIENCE AT SCHNEIDER CHILDREN'S MEDICAL CENTER IN ISRAEL].

Fisher, Dor / Borovitz, Yael / Alfandari, Hadas / LEvi, Shelly / Hamdani, Gilad / Dagan, Amit / Davidovits, Miriam / Landau, Daniel / Haskin, Orly

Harefuah

2021 Volume 160, Issue 12, Page(s) 786–792

Abstract: Introduction: A total of 30-50% of pediatric patients presenting with steroid resistant nephrotic syndrome (SRNS) will reach end stage renal disease (ESRD). In patients with primary SRNS, the risk of post-transplant recurrence is around 60% with poor ... ...

Abstract	Introduction: A total of 30-50% of pediatric patients presenting with steroid resistant nephrotic syndrome (SRNS) will reach end stage renal disease (ESRD). In patients with primary SRNS, the risk of post-transplant recurrence is around 60% with poor graft outcomes. In the past decade new treatment modalities have emerged in an attempt to improve graft outcomes. Aims: To describe the clinical experience at the Schneider Children's Medical Center in Israel in treating children with post-transplant recurrent SRNS in the past decade, and compare its results to a similar study conducted at the same center in previous years. Methods: A retrospective chart review was conducted. Data regarding demographic characteristics, clinical course and treatment modalities of patients with post-transplant recurrent SRNS were extracted from patients' charts. Results: Eight patients with post-transplant recurrent SRNS were identified. Median age at initial nephrotic syndrome presentation was 4 (range: 0.8-15) years. Median time to reach ESRD was 43 (range: 12-132) months. All patients were treated with plasmapheresis, seven patients were treated with Rituximab. Low-density lipoprotein (LDL) apheresis, Ofatumumab and Abatacept were used in 1-2 patients each. Median follow-up time post-transplant was 47 (range: 15-93) months. Four patients (50%) responded to treatment, two achieved complete and two partial remission. Four patients reached ESRD within a median time of 24 (range: 12-84) months. Lower rates of acute tubular necrosis and immediate graft loss were observed during the last decade compared to previous years (37.5% vs. 64%; 0% vs. 28.6% respectively). Conclusions: Post-transplant recurrence of SRNS continues to pose a significant treatment challenge. Similar to previous reports, only 50% of our patients responded to treatment while 50% were unresponsive to all treatment modalities and reached ESRD. Immediate post-operative management improved over the last decade, however long-term outcome continues to be grim. There is a need to better identify disease mechanisms that will allow us to tailor more effective treatment modalities to improve patients' outcome.
MeSH term(s)	Child ; Humans ; Israel ; Kidney Transplantation/adverse effects ; Nephrotic Syndrome/etiology ; Nephrotic Syndrome/therapy ; Recurrence ; Retrospective Studies
Language	Hebrew
Publishing date	2021-12-27
Publishing country	Israel
Document type	Journal Article
ZDB-ID	953872-0
ISSN	0017-7768
ISSN	0017-7768
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Article ; Online: Blood Pressure Outcomes in NICU-Admitted Infants with Neonatal Hypertension: A Pediatric Nephrology Research Consortium Study.

Xiao, Nianzhou / Starr, Michelle / Stolfi, Adrienne / Hamdani, Gilad / Hashmat, Shireen / Kiessling, Stefan G / Sethna, Christina / Kallash, Mahmoud / Matloff, Robyn / Woroniecki, Robert / Sanderson, Keia / Yamaguchi, Ikuyo / Cha, Stephen D / Semanik, Michael G / Chanchlani, Rahul / Flynn, Joseph T / Mitsnefes, Mark

The Journal of pediatrics

2023 Volume 264, Page(s) 113765

Abstract: Objective: To describe the blood pressure outcomes of infants admitted to the neonatal intensive care unit (NICU) with idiopathic (nonsecondary) hypertension (HTN) who were discharged on antihypertensive therapy.: Study design: Retrospective, ... ...

Abstract	Objective: To describe the blood pressure outcomes of infants admitted to the neonatal intensive care unit (NICU) with idiopathic (nonsecondary) hypertension (HTN) who were discharged on antihypertensive therapy. Study design: Retrospective, multicenter study of 14 centers within the Pediatric Nephrology Research Consortium. We included all infants with a diagnosis of idiopathic HTN discharged from the NICU on antihypertensive treatment. The primary outcome was time to discontinuation of antihypertensive therapy, grouped into (≤6 months, >6 months to 1 year, and >1 year). Comparisons between groups were made with χ Results: Data from 118 infants (66% male) were included. Calcium channel blockers were the most prescribed class of antihypertensives (56%) in the cohort. The percentages remaining on antihypertensives after NICU discharge were 60% at 6 months, 26% at 1 year, and 7% at 2 years. Antenatal steroid treatment was associated with decreased likelihood of antihypertensive therapy >1 year after discharge. Conclusions: This multicenter study reports that most infants admitted to the NICU diagnosed with idiopathic HTN will discontinue antihypertensive treatment by 2 years after NICU discharge. These data provide important insights into the outcome of neonatal HTN, but should be confirmed prospectively.
MeSH term(s)	Pregnancy ; Infant, Newborn ; Infant ; Child ; Humans ; Male ; Female ; Intensive Care Units, Neonatal ; Antihypertensive Agents/therapeutic use ; Retrospective Studies ; Blood Pressure ; Nephrology ; Hypertension/diagnosis ; Hypertension/drug therapy ; Infant, Newborn, Diseases
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2023-09-29
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2023.113765
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Article ; Online: IGG3 anti-HLA donor-specific antibodies and graft function in pediatric kidney transplant recipients.

Hamdani, Gilad / Goebel, Jens W / Brailey, Paul / Portwood, Elizabeth A / Hooper, David K / Girnita, Alin L

Pediatric transplantation

2018 Volume 22, Issue 5, Page(s) e13219

Abstract: Anti-HLA DSAs are associated with ABMR and graft loss in KT recipients, yet the influence of DSA IgG subclass on outcomes in pediatric KT recipients is not completely understood. We performed a single-center retrospective chart review of pediatric KT ... ...

Abstract	Anti-HLA DSAs are associated with ABMR and graft loss in KT recipients, yet the influence of DSA IgG subclass on outcomes in pediatric KT recipients is not completely understood. We performed a single-center retrospective chart review of pediatric KT recipients with anti-HLA DSAs, aiming to study the association between specific DSA IgG subclasses and graft outcomes, including ABMR and significant graft dysfunction (graft loss or 50% decrease in eGFR). Thirty-six patients (mean age 15.4y) with DSAs initially detected 1 month-14.3 years post-transplantation were followed for a median of 2.8 years. Rates of IgG1, 2, 3, and 4 subclass detection were 92%, 33%, 58%, and 25%, respectively. Twenty-two patients (61%) had clinical ABMR, whereas 19% had subclinical ABMR, and 13 (36%) experienced significant graft dysfunction. Patients with IgG3+ DSAs had a higher risk of graft dysfunction compared with IgG3- patients (52% vs 13%, P = .03). In a multiple Cox proportional regression analysis, the presence of IgG3+ DSA was independently associated with significant graft dysfunction (HR 10.45, 95% CI 1.97-55.55, P = .006). In conclusion, IgG3 subclass DSAs are associated with graft dysfunction and may be useful for risk stratification and treatment decisions in DSA-positive pediatric KT recipients.
MeSH term(s)	Adolescent ; Biomarkers/blood ; Child ; Female ; Follow-Up Studies ; Graft Rejection/diagnosis ; Graft Rejection/immunology ; HLA Antigens/immunology ; Humans ; Immunoglobulin G/blood ; Isoantibodies/blood ; Kidney Transplantation ; Male ; Outcome Assessment (Health Care) ; Proportional Hazards Models ; Retrospective Studies ; Tissue Donors
Chemical Substances	Biomarkers ; HLA Antigens ; Immunoglobulin G ; Isoantibodies
Language	English
Publishing date	2018-05-31
Publishing country	Denmark
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1390284-2
ISSN	1399-3046 ; 1397-3142
ISSN (online)	1399-3046
ISSN	1397-3142
DOI	10.1111/petr.13219
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