Jan Scober
226 statements · 4 topics · summaries given as host listed separately
Featured statements
Guideline writers accept that GFR criteria for CKD staging don't apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR.
guideline ·
Peritoneal Dialysis Access
The GFR criteria in chronic kidney disease guidelines do not apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR.
guideline ·
Bladder Outlet Obstruction
Lower urinary tract management in infants with obstructive uropathy requires collaboration with pediatric urologists and includes antibiotic prophylaxis, bladder irrigations, and bladder pressure management with anticholinergics and catheterization programs.
clinical ·
Oligohydramnios
Standard chronic kidney disease staging based on GFR does not apply to children under 2 years of age because normal infants spend their first year developing normal kidney function, with GFR rising from about 50 at one month to about 100 by one year.
clinical ·
Oligohydramnios
Lower urinary tract management aims to reduce the risk of urinary tract infection through antibiotic prophylaxis and bladder irrigations, and to manage bladder pressure with anticholinergics and catheterization programs guided by urodynamic studies.
clinical ·
Bladder Outlet Obstruction
When counseling parents about infant dialysis, the focus should be on the length of time it may be needed (until the child reaches transplantable size at 8-10 kg, typically in the second year of life) and the complexity of the therapy package.
opinion ·
Peritoneal Dialysis Access
Nothing matches these filters — clear the search or widen the filters.
Jan's statements about Bladder Outlet Obstruction 24 statements
Open the Bladder Outlet Obstruction collection →
Managing Advanced Chronic Kidney Disease: Cincinnati Fetal Center
Quotation
we really like urine and we're talking about babies who have urine, if we're talking about measuring things in the urine prenatally or shunting things.
Open
Statement
Any kind of urine output is much better than no urine output, even if the urine is of poor quality and does not contain cleared metabolites.
Open
Statement
Babies with obstructive uropathy often have a concentrating defect and produce large volumes of urine.
Open
Statement
At this center, the size required for safe transplantation is typically between 8 and 10 kg, which usually occurs in the second year of life.
Open
Statement
Lower urinary tract management aims to reduce the risk of urinary tract infection through antibiotic prophylaxis and bladder irrigations, and to manage bladder pressure with anticholinergics and catheterization programs guided by urodynamic studies.
Open
Statement
Obstructive uropathy bladders can be very high pressure and can change over time, requiring regular follow-up and potentially changing management strategies.
Open
Statement
Hypertension is not commonly seen in these babies because they have high urine output and are not volume overloaded, and they tend to lose sodium due to tubular dysfunction.
Open
Statement
Normal GFR for a newborn at 1 month of age is about 50, and it takes a whole year to reach what is accepted as normal GFR in older individuals, which is about 100.
Open
Statement
Reasonable predictions based on clearance and creatinine cannot be made until a patient has spent the first year of life establishing their kidney function.
Open
Statement
The GFR criteria in chronic kidney disease guidelines do not apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR.
Open
Statement
Dialysis is indicated when chronic kidney disease management fails, specifically when the baby stops growing (including head circumference) or when hyperkalemia or metabolic acidosis cannot be medically managed.
Open
Statement
Peritoneal dialysis is the technically least difficult way to provide dialysis in small children.
Open
Quotation
typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job.
Open
Statement
Urine output remains a significant advantage because it is very difficult to manage fluid balance with dialysis alone if there is no residual diuresis.
Open
Statement
When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted, though they are challenging due to the need for blood priming and large catheters in small blood vessels.
Open
Statement
Aquapheresis (ultrafiltration with convective clearance) using slightly smaller catheters has been successfully used to maintain an anuric baby with intraperitoneal problems.
Open
Statement
Nutrition in babies with urine output is easier than in oliguric or anuric babies because the formula does not need to be as concentrated.
Open
Statement
High-output babies lose electrolytes and may require supplementation of potassium and phosphorus, which are typically restricted in older chronic kidney disease patients.
Open
Statement
The need to provide adequate protein intake may necessitate dialysis in some babies because their BUN cannot be managed otherwise.
Open
Statement
It is relatively unusual to expect these babies to drink spontaneously in amounts sufficient to supply adequate nutrition.
Open
Statement
Breast milk can be incorporated into specialized formulas that meet the baby's specific needs when mothers are motivated to provide it.
Open
Statement
The majority of these children have an NG tube or gastrostomy tube, which they keep even around transplant time for medication administration.
Open
Jan's statements about Oligohydramnios 56 statements
Open the Oligohydramnios collection →
Managing Advanced Chronic Kidney Disease: Cincinnati Fetal Center
Quotation
we really like urine and we're talking about babies who have urine, if we're talking about measuring things in the urine prenatally or shunting things.
Open
Statement
Any kind of urine output is much better than no urine output, even if the urine is of poor quality and does not contain cleared metabolites.
Open
Statement
Babies with obstructive uropathy often have a concentrating defect and produce large volumes of urine.
Open
Statement
At this center, the size required for safe transplantation is typically between 8 and 10 kg, which usually occurs in the second year of life.
Open
Statement
Lower urinary tract management aims to reduce the risk of urinary tract infection through antibiotic prophylaxis and bladder irrigations, and to manage bladder pressure with anticholinergics and catheterization programs guided by urodynamic studies.
Open
Statement
Obstructive uropathy bladders can be very high pressure and can change over time, requiring regular follow-up and potentially changing management strategies.
Open
Statement
Hypertension is not commonly seen in these babies because they have high urine output and are not volume overloaded, and they tend to lose sodium due to tubular dysfunction.
Open
Statement
Normal GFR for a newborn at 1 month of age is about 50, and it takes a whole year to reach what is accepted as normal GFR in older individuals, which is about 100.
Open
Statement
Reasonable predictions based on clearance and creatinine cannot be made until a patient has spent the first year of life establishing their kidney function.
Open
Statement
The GFR criteria in chronic kidney disease guidelines do not apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR.
Open
Statement
Dialysis is indicated when chronic kidney disease management fails, specifically when the baby stops growing (including head circumference) or when hyperkalemia or metabolic acidosis cannot be medically managed.
Open
Statement
Peritoneal dialysis is the technically least difficult way to provide dialysis in small children.
Open
Quotation
typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job.
Open
Statement
Urine output remains a significant advantage because it is very difficult to manage fluid balance with dialysis alone if there is no residual diuresis.
Open
Statement
When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted, though they are challenging due to the need for blood priming and large catheters in small blood vessels.
Open
Statement
Aquapheresis (ultrafiltration with convective clearance) using slightly smaller catheters has been successfully used to maintain an anuric baby with intraperitoneal problems.
Open
Statement
Nutrition in babies with urine output is easier than in oliguric or anuric babies because the formula does not need to be as concentrated.
Open
Statement
High-output babies lose electrolytes and may require supplementation of potassium and phosphorus, which are typically restricted in older chronic kidney disease patients.
Open
Statement
The need to provide adequate protein intake may necessitate dialysis in some babies because their BUN cannot be managed otherwise.
Open
Statement
It is relatively unusual to expect these babies to drink spontaneously in amounts sufficient to supply adequate nutrition.
Open
Statement
Breast milk can be incorporated into specialized formulas that meet the baby's specific needs when mothers are motivated to provide it.
Open
Statement
The majority of these children have an NG tube or gastrostomy tube, which they keep even around transplant time for medication administration.
Open
Fetal management of advanced chronic kidney disease: Fetal Genitourinary...
Quotation
we really like urine and we're talking about babies who have urine, if we're talking about measuring things in the urine prenatally or shunting things.
Open
Statement
Any kind of urine output, even poor-quality urine that is mostly water without cleared metabolites, is much better than no urine for both prenatal and postnatal management.
Open
Statement
Infants with obstructive uropathy often have a concentrating defect and produce large volumes of urine, which may be poor quality but is still beneficial as fluid.
Open
Statement
At this center, infants are typically transplantable at a size between 8 and 10 kg, which usually occurs in the second year of life.
Open
Statement
Lower urinary tract management in infants with obstructive uropathy requires collaboration with pediatric urologists and includes antibiotic prophylaxis, bladder irrigations, and bladder pressure management with anticholinergics and catheterization programs.
Open
Statement
Obstructive uropathy bladders can have very high pressure and can change over time, requiring regular urodynamic studies and potentially changing management strategies.
Open
Statement
Infants with chronic kidney disease from obstructive uropathy typically do not have significant hypertension because they have high urine output and are not volume overloaded, and they lose sodium due to tubular dysfunction.
Open
Statement
Chronic kidney disease management in infants requires supplementation of erythropoietin and iron to prevent anemia, which has negative cognitive, energy, and quality-of-life effects.
Open
Statement
Untreated secondary hyperparathyroidism from advanced CKD impairs bone and skeletal health, which is especially problematic in growing children.
Open
Statement
Advanced chronic kidney disease not requiring dialysis often causes metabolic acidosis, which is harmful to growth and well-being and requires buffering with citrate supplementation.
Open
Statement
Specialized nutrition management in infant CKD includes formula modification and pre-treatment with potassium-binding resins to prevent hyperkalemia.
Open
Statement
Infants with advanced CKD have feeding and swallowing difficulties and require occupational therapy, physical therapy, and feeding team involvement for developmental support.
Open
Statement
Standard chronic kidney disease staging based on GFR does not apply to children under 2 years of age because normal infants spend their first year developing normal kidney function, with GFR rising from about 50 at one month to about 100 by one year.
Open
Statement
The decision to initiate dialysis is based on failed chronic kidney disease management—inability to support growth (including head circumference) or medically manage hyperkalemia or metabolic acidosis—not on creatinine level alone.
Open
Statement
Peritoneal dialysis is the modality of choice for infant dialysis because it is the technically least difficult approach in small children.
Open
Statement
Peritoneal dialysis introduces a major additional layer of complexity and quality-of-life burden for parents, who are typically taught to perform dialysis at home.
Open
Statement
When counseling parents about infant dialysis, the focus should be on the length of time it may be needed (until the child reaches transplantable size at 8-10 kg, typically in the second year of life) and the complexity of the therapy package.
Open
Statement
Parents typically report that when their baby requires complex care including dialysis, one parent usually stops working and caring for the baby becomes their full-time job.
Open
Quotation
typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job.
Open
Statement
Residual urine output is a major advantage in managing fluid balance during dialysis; it is very difficult to manage fluid balance with dialysis alone without some residual diuresis.
Open
Statement
It is difficult to justify placing a patient on chronic dialysis without some prospect of transplantation, as this creates a never-ending one-way street that becomes very challenging.
Open
Statement
When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted but are challenging because they require blood priming of circuits and very large catheters in small blood vessels.
Open
Statement
Aquaphoresis (ultrafiltration with convective clearance) using slightly smaller catheters than hemodialysis has been successfully used to maintain anuric babies with intraperitoneal problems or those requiring major abdominal surgeries.
Open
Statement
Nutrition management is easier in infants with urine output compared to oliguric or anuric infants because formula does not need to be as concentrated.
Open
Statement
High-output infants with CKD lose electrolytes including potassium and phosphorus, requiring supplementation of electrolytes that are typically restricted in older CKD patients.
Open
Statement
Dietitians calculate required calories for growth and required protein intake while ensuring BUN does not reach dangerously high levels; the inability to provide adequate protein without excessive BUN may necessitate dialysis.
Open
Statement
It is relatively unusual to expect infants with advanced CKD to drink spontaneously in amounts sufficient to supply required nutrition.
Open
Statement
Breast milk from motivated mothers can be incorporated into specialized formulas that meet the infant's specific nutritional needs; this is typically pumped breast milk.
Open
Statement
The majority of infants with advanced CKD have either an NG tube or gastrostomy tube for feeding, which is maintained even around transplant time for medication administration.
Open
Jan's statements about Peritoneal Dialysis Access 114 statements
Open the Peritoneal Dialysis Access collection →
Managing Advanced Chronic Kidney Disease: Cincinnati Fetal Center
Quotation
we really like urine and we're talking about babies who have urine, if we're talking about measuring things in the urine prenatally or shunting things.
Open
Quotation
we really like urine and we're talking about babies who have urine, if we're talking about measuring things in the urine prenatally or shunting things.
Open
Statement
Any kind of urine output is much better than no urine output, even if the urine is of poor quality and does not contain cleared metabolites.
Open
Statement
Any kind of urine output is much better than no urine output, even if the urine is of poor quality and does not contain cleared metabolites.
Open
Statement
Babies with obstructive uropathy often have a concentrating defect and produce large volumes of urine.
Open
Statement
Babies with obstructive uropathy often have a concentrating defect and produce large volumes of urine.
Open
Statement
At this center, the size required for safe transplantation is typically between 8 and 10 kg, which usually occurs in the second year of life.
Open
Statement
At this center, the size required for safe transplantation is typically between 8 and 10 kg, which usually occurs in the second year of life.
Open
Statement
Lower urinary tract management aims to reduce the risk of urinary tract infection through antibiotic prophylaxis and bladder irrigations, and to manage bladder pressure with anticholinergics and catheterization programs guided by urodynamic studies.
Open
Statement
Lower urinary tract management aims to reduce the risk of urinary tract infection through antibiotic prophylaxis and bladder irrigations, and to manage bladder pressure with anticholinergics and catheterization programs guided by urodynamic studies.
Open
Statement
Obstructive uropathy bladders can be very high pressure and can change over time, requiring regular follow-up and potentially changing management strategies.
Open
Statement
Obstructive uropathy bladders can be very high pressure and can change over time, requiring regular follow-up and potentially changing management strategies.
Open
Statement
Hypertension is not commonly seen in these babies because they have high urine output and are not volume overloaded, and they tend to lose sodium due to tubular dysfunction.
Open
Statement
Hypertension is not commonly seen in these babies because they have high urine output and are not volume overloaded, and they tend to lose sodium due to tubular dysfunction.
Open
Statement
Normal GFR for a newborn at 1 month of age is about 50, and it takes a whole year to reach what is accepted as normal GFR in older individuals, which is about 100.
Open
Statement
Normal GFR for a newborn at 1 month of age is about 50, and it takes a whole year to reach what is accepted as normal GFR in older individuals, which is about 100.
Open
Statement
Reasonable predictions based on clearance and creatinine cannot be made until a patient has spent the first year of life establishing their kidney function.
Open
Statement
Reasonable predictions based on clearance and creatinine cannot be made until a patient has spent the first year of life establishing their kidney function.
Open
Statement
The GFR criteria in chronic kidney disease guidelines do not apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR.
Open
Statement
The GFR criteria in chronic kidney disease guidelines do not apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR.
Open
Statement
Dialysis is indicated when chronic kidney disease management fails, specifically when the baby stops growing (including head circumference) or when hyperkalemia or metabolic acidosis cannot be medically managed.
Open
Statement
Dialysis is indicated when chronic kidney disease management fails, specifically when the baby stops growing (including head circumference) or when hyperkalemia or metabolic acidosis cannot be medically managed.
Open
Statement
Peritoneal dialysis is the technically least difficult way to provide dialysis in small children.
Open
Statement
Peritoneal dialysis is the technically least difficult way to provide dialysis in small children.
Open
Quotation
typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job.
Open
Quotation
typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job.
Open
Statement
Urine output remains a significant advantage because it is very difficult to manage fluid balance with dialysis alone if there is no residual diuresis.
Open
Statement
Urine output remains a significant advantage because it is very difficult to manage fluid balance with dialysis alone if there is no residual diuresis.
Open
Statement
When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted, though they are challenging due to the need for blood priming and large catheters in small blood vessels.
Open
Statement
When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted, though they are challenging due to the need for blood priming and large catheters in small blood vessels.
Open
Statement
Aquapheresis (ultrafiltration with convective clearance) using slightly smaller catheters has been successfully used to maintain an anuric baby with intraperitoneal problems.
Open
Statement
Aquapheresis (ultrafiltration with convective clearance) using slightly smaller catheters has been successfully used to maintain an anuric baby with intraperitoneal problems.
Open
Statement
Nutrition in babies with urine output is easier than in oliguric or anuric babies because the formula does not need to be as concentrated.
Open
Statement
Nutrition in babies with urine output is easier than in oliguric or anuric babies because the formula does not need to be as concentrated.
Open
Statement
High-output babies lose electrolytes and may require supplementation of potassium and phosphorus, which are typically restricted in older chronic kidney disease patients.
Open
Statement
High-output babies lose electrolytes and may require supplementation of potassium and phosphorus, which are typically restricted in older chronic kidney disease patients.
Open
Statement
The need to provide adequate protein intake may necessitate dialysis in some babies because their BUN cannot be managed otherwise.
Open
Statement
The need to provide adequate protein intake may necessitate dialysis in some babies because their BUN cannot be managed otherwise.
Open
Statement
It is relatively unusual to expect these babies to drink spontaneously in amounts sufficient to supply adequate nutrition.
Open
Statement
It is relatively unusual to expect these babies to drink spontaneously in amounts sufficient to supply adequate nutrition.
Open
Statement
Breast milk can be incorporated into specialized formulas that meet the baby's specific needs when mothers are motivated to provide it.
Open
Statement
Breast milk can be incorporated into specialized formulas that meet the baby's specific needs when mothers are motivated to provide it.
Open
Statement
The majority of these children have an NG tube or gastrostomy tube, which they keep even around transplant time for medication administration.
Open
Statement
The majority of these children have an NG tube or gastrostomy tube, which they keep even around transplant time for medication administration.
Open
Fetal management of advanced chronic kidney disease: Fetal Genitourinary...
Quotation
we really like urine and we're talking about babies who have urine, if we're talking about measuring things in the urine prenatally or shunting things.
Open
Quotation
we really like urine and we're talking about babies who have urine, if we're talking about measuring things in the urine prenatally or shunting things.
Open
Statement
Any kind of urine output, even poor-quality urine that is mostly water without cleared metabolites, is much better than no urine for both prenatal and postnatal management.
Open
Statement
Any kind of urine output, even poor-quality urine that is mostly water without cleared metabolites, is much better than no urine for both prenatal and postnatal management.
Open
Statement
Infants with obstructive uropathy often have a concentrating defect and produce large volumes of urine, which may be poor quality but is still beneficial as fluid.
Open
Statement
Infants with obstructive uropathy often have a concentrating defect and produce large volumes of urine, which may be poor quality but is still beneficial as fluid.
Open
Statement
At this center, infants are typically transplantable at a size between 8 and 10 kg, which usually occurs in the second year of life.
Open
Statement
At this center, infants are typically transplantable at a size between 8 and 10 kg, which usually occurs in the second year of life.
Open
Statement
Lower urinary tract management in infants with obstructive uropathy requires collaboration with pediatric urologists and includes antibiotic prophylaxis, bladder irrigations, and bladder pressure management with anticholinergics and catheterization programs.
Open
Statement
Lower urinary tract management in infants with obstructive uropathy requires collaboration with pediatric urologists and includes antibiotic prophylaxis, bladder irrigations, and bladder pressure management with anticholinergics and catheterization programs.
Open
Statement
Obstructive uropathy bladders can have very high pressure and can change over time, requiring regular urodynamic studies and potentially changing management strategies.
Open
Statement
Obstructive uropathy bladders can have very high pressure and can change over time, requiring regular urodynamic studies and potentially changing management strategies.
Open
Statement
Infants with chronic kidney disease from obstructive uropathy typically do not have significant hypertension because they have high urine output and are not volume overloaded, and they lose sodium due to tubular dysfunction.
Open
Statement
Infants with chronic kidney disease from obstructive uropathy typically do not have significant hypertension because they have high urine output and are not volume overloaded, and they lose sodium due to tubular dysfunction.
Open
Statement
Chronic kidney disease management in infants requires supplementation of erythropoietin and iron to prevent anemia, which has negative cognitive, energy, and quality-of-life effects.
Open
Statement
Chronic kidney disease management in infants requires supplementation of erythropoietin and iron to prevent anemia, which has negative cognitive, energy, and quality-of-life effects.
Open
Statement
Untreated secondary hyperparathyroidism from advanced CKD impairs bone and skeletal health, which is especially problematic in growing children.
Open
Statement
Untreated secondary hyperparathyroidism from advanced CKD impairs bone and skeletal health, which is especially problematic in growing children.
Open
Statement
Advanced chronic kidney disease not requiring dialysis often causes metabolic acidosis, which is harmful to growth and well-being and requires buffering with citrate supplementation.
Open
Statement
Advanced chronic kidney disease not requiring dialysis often causes metabolic acidosis, which is harmful to growth and well-being and requires buffering with citrate supplementation.
Open
Statement
Specialized nutrition management in infant CKD includes formula modification and pre-treatment with potassium-binding resins to prevent hyperkalemia.
Open
Statement
Specialized nutrition management in infant CKD includes formula modification and pre-treatment with potassium-binding resins to prevent hyperkalemia.
Open
Statement
Infants with advanced CKD have feeding and swallowing difficulties and require occupational therapy, physical therapy, and feeding team involvement for developmental support.
Open
Statement
Infants with advanced CKD have feeding and swallowing difficulties and require occupational therapy, physical therapy, and feeding team involvement for developmental support.
Open
Statement
Standard chronic kidney disease staging based on GFR does not apply to children under 2 years of age because normal infants spend their first year developing normal kidney function, with GFR rising from about 50 at one month to about 100 by one year.
Open
Statement
Standard chronic kidney disease staging based on GFR does not apply to children under 2 years of age because normal infants spend their first year developing normal kidney function, with GFR rising from about 50 at one month to about 100 by one year.
Open
Statement
Guideline writers accept that GFR criteria for CKD staging don't apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR.
Open
Statement
Dialysis for small children remains challenging but has improved in outcomes and feasibility and should be discussed with families on an individualized basis.
Open
Statement
The decision to initiate dialysis is based on failed chronic kidney disease management—inability to support growth (including head circumference) or medically manage hyperkalemia or metabolic acidosis—not on creatinine level alone.
Open
Statement
The decision to initiate dialysis is based on failed chronic kidney disease management—inability to support growth (including head circumference) or medically manage hyperkalemia or metabolic acidosis—not on creatinine level alone.
Open
Statement
Peritoneal dialysis is the modality of choice for infant dialysis because it is the technically least difficult approach in small children.
Open
Statement
Peritoneal dialysis is the modality of choice for infant dialysis because it is the technically least difficult approach in small children.
Open
Statement
Peritoneal dialysis introduces a major additional layer of complexity and quality-of-life burden for parents, who are typically taught to perform dialysis at home.
Open
Statement
Peritoneal dialysis introduces a major additional layer of complexity and quality-of-life burden for parents, who are typically taught to perform dialysis at home.
Open
Statement
When counseling parents about infant dialysis, the focus should be on the length of time it may be needed (until the child reaches transplantable size at 8-10 kg, typically in the second year of life) and the complexity of the therapy package.
Open
Statement
When counseling parents about infant dialysis, the focus should be on the length of time it may be needed (until the child reaches transplantable size at 8-10 kg, typically in the second year of life) and the complexity of the therapy package.
Open
Statement
Parents typically report that when their baby requires complex care including dialysis, one parent usually stops working and caring for the baby becomes their full-time job.
Open
Statement
Parents typically report that when their baby requires complex care including dialysis, one parent usually stops working and caring for the baby becomes their full-time job.
Open
Quotation
typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job.
Open
Quotation
typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job.
Open
Statement
Residual urine output is a major advantage in managing fluid balance during dialysis; it is very difficult to manage fluid balance with dialysis alone without some residual diuresis.
Open
Statement
Residual urine output is a major advantage in managing fluid balance during dialysis; it is very difficult to manage fluid balance with dialysis alone without some residual diuresis.
Open
Statement
It is difficult to justify placing a patient on chronic dialysis without some prospect of transplantation, as this creates a never-ending one-way street that becomes very challenging.
Open
Statement
It is difficult to justify placing a patient on chronic dialysis without some prospect of transplantation, as this creates a never-ending one-way street that becomes very challenging.
Open
Statement
When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted but are challenging because they require blood priming of circuits and very large catheters in small blood vessels.
Open
Statement
When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted but are challenging because they require blood priming of circuits and very large catheters in small blood vessels.
Open
Statement
Aquaphoresis (ultrafiltration with convective clearance) using slightly smaller catheters than hemodialysis has been successfully used to maintain anuric babies with intraperitoneal problems or those requiring major abdominal surgeries.
Open
Statement
Aquaphoresis (ultrafiltration with convective clearance) using slightly smaller catheters than hemodialysis has been successfully used to maintain anuric babies with intraperitoneal problems or those requiring major abdominal surgeries.
Open
Statement
Nutrition management is easier in infants with urine output compared to oliguric or anuric infants because formula does not need to be as concentrated.
Open
Statement
Nutrition management is easier in infants with urine output compared to oliguric or anuric infants because formula does not need to be as concentrated.
Open
Statement
High-output infants with CKD lose electrolytes including potassium and phosphorus, requiring supplementation of electrolytes that are typically restricted in older CKD patients.
Open
Statement
High-output infants with CKD lose electrolytes including potassium and phosphorus, requiring supplementation of electrolytes that are typically restricted in older CKD patients.
Open
Statement
Dietitians calculate required calories for growth and required protein intake while ensuring BUN does not reach dangerously high levels; the inability to provide adequate protein without excessive BUN may necessitate dialysis.
Open
Statement
Dietitians calculate required calories for growth and required protein intake while ensuring BUN does not reach dangerously high levels; the inability to provide adequate protein without excessive BUN may necessitate dialysis.
Open
Statement
It is relatively unusual to expect infants with advanced CKD to drink spontaneously in amounts sufficient to supply required nutrition.
Open
Statement
It is relatively unusual to expect infants with advanced CKD to drink spontaneously in amounts sufficient to supply required nutrition.
Open
Statement
Breast milk from motivated mothers can be incorporated into specialized formulas that meet the infant's specific nutritional needs; this is typically pumped breast milk.
Open
Statement
Breast milk from motivated mothers can be incorporated into specialized formulas that meet the infant's specific nutritional needs; this is typically pumped breast milk.
Open
Statement
The majority of infants with advanced CKD have either an NG tube or gastrostomy tube for feeding, which is maintained even around transplant time for medication administration.
Open
Statement
The majority of infants with advanced CKD have either an NG tube or gastrostomy tube for feeding, which is maintained even around transplant time for medication administration.
Open
Jan's statements about Posterior Urethral Valves 32 statements
Open the Posterior Urethral Valves collection →
Fetal management of advanced chronic kidney disease: Fetal Genitourinary...
Quotation
we really like urine and we're talking about babies who have urine, if we're talking about measuring things in the urine prenatally or shunting things.
Open
Statement
Any kind of urine output, even poor-quality urine that is mostly water without cleared metabolites, is much better than no urine for both prenatal and postnatal management.
Open
Statement
Infants with obstructive uropathy often have a concentrating defect and produce large volumes of urine, which may be poor quality but is still beneficial as fluid.
Open
Statement
At this center, infants are typically transplantable at a size between 8 and 10 kg, which usually occurs in the second year of life.
Open
Statement
Lower urinary tract management in infants with obstructive uropathy requires collaboration with pediatric urologists and includes antibiotic prophylaxis, bladder irrigations, and bladder pressure management with anticholinergics and catheterization programs.
Open
Statement
Obstructive uropathy bladders can have very high pressure and can change over time, requiring regular urodynamic studies and potentially changing management strategies.
Open
Statement
Infants with chronic kidney disease from obstructive uropathy typically do not have significant hypertension because they have high urine output and are not volume overloaded, and they lose sodium due to tubular dysfunction.
Open
Statement
Chronic kidney disease management in infants requires supplementation of erythropoietin and iron to prevent anemia, which has negative cognitive, energy, and quality-of-life effects.
Open
Statement
Untreated secondary hyperparathyroidism from advanced CKD impairs bone and skeletal health, which is especially problematic in growing children.
Open
Statement
Advanced chronic kidney disease not requiring dialysis often causes metabolic acidosis, which is harmful to growth and well-being and requires buffering with citrate supplementation.
Open
Statement
Specialized nutrition management in infant CKD includes formula modification and pre-treatment with potassium-binding resins to prevent hyperkalemia.
Open
Statement
Infants with advanced CKD have feeding and swallowing difficulties and require occupational therapy, physical therapy, and feeding team involvement for developmental support.
Open
Statement
Standard chronic kidney disease staging based on GFR does not apply to children under 2 years of age because normal infants spend their first year developing normal kidney function, with GFR rising from about 50 at one month to about 100 by one year.
Open
Statement
The decision to initiate dialysis is based on failed chronic kidney disease management—inability to support growth (including head circumference) or medically manage hyperkalemia or metabolic acidosis—not on creatinine level alone.
Open
Statement
Peritoneal dialysis is the modality of choice for infant dialysis because it is the technically least difficult approach in small children.
Open
Statement
Peritoneal dialysis introduces a major additional layer of complexity and quality-of-life burden for parents, who are typically taught to perform dialysis at home.
Open
Statement
When counseling parents about infant dialysis, the focus should be on the length of time it may be needed (until the child reaches transplantable size at 8-10 kg, typically in the second year of life) and the complexity of the therapy package.
Open
Quotation
typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job.
Open
Statement
Parents typically report that when their baby requires complex care including dialysis, one parent usually stops working and caring for the baby becomes their full-time job.
Open
Statement
Residual urine output is a major advantage in managing fluid balance during dialysis; it is very difficult to manage fluid balance with dialysis alone without some residual diuresis.
Open
Statement
It is difficult to justify placing a patient on chronic dialysis without some prospect of transplantation, as this creates a never-ending one-way street that becomes very challenging.
Open
Statement
When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted but are challenging because they require blood priming of circuits and very large catheters in small blood vessels.
Open
Statement
Aquaphoresis (ultrafiltration with convective clearance) using slightly smaller catheters than hemodialysis has been successfully used to maintain anuric babies with intraperitoneal problems or those requiring major abdominal surgeries.
Open
Statement
Nutrition management is easier in infants with urine output compared to oliguric or anuric infants because formula does not need to be as concentrated.
Open
Statement
High-output infants with CKD lose electrolytes including potassium and phosphorus, requiring supplementation of electrolytes that are typically restricted in older CKD patients.
Open
Statement
Dietitians calculate required calories for growth and required protein intake while ensuring BUN does not reach dangerously high levels; the inability to provide adequate protein without excessive BUN may necessitate dialysis.
Open
Statement
It is relatively unusual to expect infants with advanced CKD to drink spontaneously in amounts sufficient to supply required nutrition.
Open
Statement
Breast milk from motivated mothers can be incorporated into specialized formulas that meet the infant's specific nutritional needs; this is typically pumped breast milk.
Open
Statement
The majority of infants with advanced CKD have either an NG tube or gastrostomy tube for feeding, which is maintained even around transplant time for medication administration.
Open
Summaries Jan gave as host · 6 summaries
Recaps of other experts' statements, not Jan's own clinical position.
Summaries Jan gave as host · Oligohydramnios 2 summaries
Open the Oligohydramnios collection →
Fetal management of advanced chronic kidney disease: Fetal Genitourinary...
Host summary
Jan Scober summarizing the discussion: Guideline writers accept that GFR criteria for CKD staging don't apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR.
Open
Host summary
Jan Scober summarizing the discussion: Dialysis for small children remains challenging but has improved in outcomes and feasibility and should be discussed with families on an individualized basis.
Open
Summaries Jan gave as host · Peritoneal Dialysis Access 2 summaries
Open the Peritoneal Dialysis Access collection →
Fetal management of advanced chronic kidney disease: Fetal Genitourinary...
Host summary
Jan Scober summarizing the discussion: Guideline writers accept that GFR criteria for CKD staging don't apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR.
Open
Host summary
Jan Scober summarizing the discussion: Dialysis for small children remains challenging but has improved in outcomes and feasibility and should be discussed with families on an individualized basis.
Open
Summaries Jan gave as host · Posterior Urethral Valves 2 summaries
Open the Posterior Urethral Valves collection →
Fetal management of advanced chronic kidney disease: Fetal Genitourinary...
Host summary
Jan Scober summarizing the discussion: Guideline writers accept that GFR criteria for CKD staging don't apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR.
Open
Host summary
Jan Scober summarizing the discussion: Dialysis for small children remains challenging but has improved in outcomes and feasibility and should be discussed with families on an individualized basis.
Open