Stefan G. Kiessling

Bio: Stefan G. Kiessling is an academic researcher from University of Kentucky. The author has contributed to research in topics: Kidney disease & Body mass index. The author has an hindex of 9, co-authored 15 publications receiving 115 citations.

Vitamin D in incident nephrotic syndrome: a Midwest Pediatric Nephrology Consortium study.

Abstract: Cross-sectional studies of children with prevalent nephrotic syndrome (NS) have shown 25-vitamin D (25(OH)D) deficiency rates of 20–100 %. Information on 25(OH)D status in incident patients or following remission is limited. This study aimed to assess 25(OH)D status of incident idiopathic NS children at presentation and longitudinally with short-term observation. Multicenter longitudinal study of children (2–18 years old) from 14 centers across the Midwest Pediatric Nephrology Consortium with incident idiopathic NS. 25(OH)D levels were assessed at diagnosis and 3 months later. Sixty-one children, median age 5 (3, 11) years, completed baseline visit and 51 completed second visit labs. All 61 (100 %) had 25(OH)D < 20 ng/ml at diagnosis. Twenty-seven (53 %) had 25(OH)D < 20 ng/ml at follow-up. Fourteen (28 %) children were steroid resistant. Univariate analysis showed that children prescribed vitamin D supplements were less likely to have 25(OH)D deficiency at follow-up (OR 0.2, 95 % CI 0.04, 0.6). Steroid response, age, and season did not predict 25(OH)D deficiency. Multivariable linear regression modeling showed higher 25(OH)D levels at follow-up by 13.2 ng/ml (SE 4.6, p < 0.01) in children supplemented with vitamin D. In this incident idiopathic NS cohort, all children at diagnosis had 25(OH)D deficiency and the majority continued to have a deficiency at 2–4 months. Supplemental vitamin D decreased the odds of 25(OH)D deficiency at follow-up, supporting a role for supplementation in incident NS.

A guideline for the inpatient care of children with pyelonephritis.

Abstract: BACKGROUND AND OBJECTIVES: Febrile urinary tract infections and pyelonephritis are common in children and frequently lead to hospitalization for management, especially in the child who appears toxi...

Rabson-Mendenhall syndrome: medullary sponge kidney, a new component

Abstract: Rabson-Mendenhall syndrome is a rare genetic disorder characterized by severe insulin resistance, extreme hyperinsulinemia, postprandial hyperglycemia, growth retardation, and dysmorphisms. Enlargement of the kidneys and nephrocalcinosis have been described previously. We report a 10-year-old boy who presented with gross hematuria, unilateral hydronephrosis, and the initial diagnosis of bilateral extensive medullary nephrocalcinosis. Medullary sponge kidney (MSK) was included in the differential diagnosis given the ultrasound findings. Further evaluation by intravenous pyelogram confirmed the suspected bilateral MSK. Given the patient’s history of hydronephrosis due to an obstructing renal stone and MSK, urine calcium excretion was assessed and found to be markedly increased at 9.5 mg/kg per day. To our knowledge, this is the first report of Rabson-Mendenhall syndrome and an association with MSK. We recommend evaluation for nephrocalcinosis, MSK, and hypercalciuria in all children diagnosed with Rabson-Mendenhall syndrome.

Hypertension in infancy: diagnosis, management and outcome.

Abstract: Advances in the ability to identify, evaluate, and care for infants with hypertension, coupled with advances in the practice of Neonatology, have led to an increased awareness of hypertension in modern neonatal intensive care units. This review will present updated data on blood pressure values in neonates, with a focus on the changes that occur over the first days and weeks of life in both term and preterm infants. Optimal blood pressure measurement techniques as well as the differential diagnosis of hypertension in the neonate and older infants will be discussed. Recommendations for the optimal immediate and long-term evaluation and treatment, including potential treatment parameters, will be presented. We will also review additional information on outcome that has become available over the past decade.

Foetus into Man. Physical Growth from Conception to Maturity

Abstract: This book gives an excellent account of current knowledge of the control of human growth from conception to the end of the adolescent growth spurt. One important principle derived from experimental observation is that a cessation of growth at the time of growth by cell division has permanent sequelae. Regrowth starts at a rate appropriate to chronological age. In contrast, a cessation at the time of growth by cell enlargement has no permanent aftereffects and 'catch-up' is usually complete. The section on growth before birth includes the recent information obtained by ultrasonography. In accordance with the principle stated above, retardation of growth in the first half of pregnancy tends to be associated with permanent small size and mental retardation. Later retardation, due to maternal malnutrition or small maternal size, tends to be followed by full catch-up growth if postnatal conditions are favourable. The section on the development of sexual dimorphism incorporates recent developments in endocrinology. Particularly striking is the narrow sensitive period in the rat (just 5 days after birth) in which the hypothalamus is switched to the male pattern of non-cyclical activity by testosterone. It is not yet known whether there is a corresponding similar sensitive period (this would be the 12th to 14th weeks after conception) in man. Again, in the rat there is evidence of similar critical differentiation of a centre controlling mating behaviour. The account of the endocrine control of growth includes the recent advances in knowledge of the regulation of secretion of pituitary growth hormone which in man controls the production of somatomedin. The section on genetic and environmental influences over the control of adult stature is wellbalanced, though the author does attempt an estimation of heritability. Chinese and Japanese children, even under optimal conditions, are smaller than north Europeans, and are even shorter when full-grown because of earlier maturity (menarche is about 6 months earlier). Negroes, and, even more, Australian aboriginals, have relatively greater leg length in relation to sitting height than Chinese and Japanese, while Europeans are intermediate in this respect. These are genetic differences. It is noteworthy that differences in Sweden in full adult height by social class of parents appear to have disappeared. Further, the secular increase in full adult stature appears to be coming to an end in northern Europe. These were presumably environmental effects. Professor Tanner does not discuss the origin or the duration of the secular change, but it is the reviewer's belief that much of it represents a recovery from the stunting of children associated with the chronic malnutrition and long hours of work of young children at the time of the industrial revolution. Professor Tanner gives an equally well-balanced account of the controversial topic of the effects of malnutrition on brain growth. A long chapter on the Standards of Normal Growth reflects the expertise and extensive experience of the author and his colleagues in longitudinal growth studies, including a convenient method of allowing for parental height in estimating a child's expected position in relation to his peers. Here, perhaps, the author might have included an explanation of the genetic reasons why individual children in a family tend to vary widely round the midparental mean, and why a child's height at age 10 (even after correcting for skeletal age) is only of limited value in predicting his full adult height. The books ends with an admirably complete set of references. C. 0. CARTER

Salt and blood pressure in children and adolescents. Commentary

Abstract: To study the relationship between salt intake and blood pressure in children and adolescents, we analysed the data of a large cross-sectional study (the National Diet and Nutrition Survey for young people), which was carried out in Great Britain in 1997 in a nationally representative sample of children aged between 4 and 18 years. A total of 1658 participants had both salt intake and blood pressure recorded. Salt intake was assessed by a 7-day dietary record. The average salt intake, which did not include salt added in cooking or at the table, was 4.7±0.2g/day at the age of 4 years. With increasing age, there was an increase in salt intake, and by the age of 18 years, salt intake was 6.8±0.2g/day. There was a significant association of salt intake with systolic blood pressure as well as with pulse pressure after adjusting for age, sex, body mass index and dietary potassium intake. An increase of 1 g/day in salt intake was related to an increase of 0.4 mm Hg in systolic and 0.6 mm Hg in pulse pressure. The magnitude of the association with systolic blood pressure is very similar to that observed in a recent meta-analysis of controlled trials where salt intake was reduced. The consistent finding of our present analysis of a random sample of free-living individuals with that from controlled salt reduction trials provides further support for a reduction in salt intake in children and adolescents.

Update and future of systemic acne treatment

Abstract: Systemic treatment is required in patients with moderate-to-severe acne, especially when acne scars start to occur. Antibiotics with anti-inflammatory properties, such as tetracyclines (oxytetracyclin