Topics Discussed: adjust medications or dosage; antihypertensive agents; antihypertensive therapy; bleeding diathesis; creatinine clearance; creatinine clearance from a measured urine collection; creatinine tests, serum; cystic kidney; dialysis procedure; diastolic blood pressure; distal renal tubular acidosis type 1; edema; extracorporeal shockwave lithotripsy; finnish congenital nephrotic syndrome; functional proteinuria; glomerular filtration rate; hematuria; hematuria, microscopic; hemodialysis; hemolytic-uremic syndrome; hyperkalemic distal renal tubular acidosis; hypertension; hypertension, childhood; hypocomplementemia; intermittent hemodialysis; kidney failure, chronic; nephritic syndrome; nephrology; nephrotic syndrome; nephrotic syndrome, steroid-resistant; percutaneous nephrolithotomy; peritoneal dialysis; pierson syndrome; proteinuria; proteinuria, isolated; red urine; renal biopsy; renal failure, acute; renal glomerular disease; renal impairment; renal replacement therapy; renal tubular acidosis; renal tubular acidosis, type ii; renal tubular transport, inborn errors; schwartz formula; serum creatinine level; systolic blood pressure; ureteroscopic operation; ureteroscopy; urinalysis; urine specimen collection, 24 hours; urolithiasis; urology and nephrology; vesico-ureteral reflux; videocystourethrography.
Excerpt:"See www.AccessPediatrics.com or Pediatrics 2004;114(2):555(Nejm 1998;338:1428; Nejm 1998;339:1054)
- Endogenous creatinine clearance (Ccr) in mL/min estimates the GFR; this requires collection of a 24-h urine sample.
- Creatinine is actively secreted by renal tubules in very small amounts; thus, this technique may overestimate GFR by 10%20%.
- Procedure for 24-h urine collection: Empty bladder fully and discard urine before start of 24-h period. Collect all urine for 24 h. At conclusion, draw serum plasma creatinine value and verify compliance and accuracy of collection by total creatinine excretion in sample (expected amounts: neonates, 7.910.2 mg/kg/d; 1 mo1 yr, 11.914.7 mg/kg/d; girls and prepubertal boys, 15.319.8 mg/kg/d, pubertal boys, 19.224.2 mg/kg/d).
- Calculation of Ccr based on 24-h urine collection:
- Pharmacologic therapy, when indicated, should be initiated with a single drug.
- Acceptable drug classes for use in children include ACEIs, ARBs, -blockers, CCBs, (over 1 yr of age), and diuretics.
- The goal for antihypertensive treatment in children should be reduction of BP to <95th percentile unless comorbidities are present. In that case, BP should be lowered to the <90th..."
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