Browsing by Author "Franz Schaefer"

Now showing 1 - 6 of 6

Behavioural abnormalities in children with nephrotic syndrome
(Oxford University Press, 2010) Om P. Mishra; Biswanath Basu; Shashi K. Upadhyay; Rajniti Prasad; Franz Schaefer
Background. Glucocorticoid therapy in children with nephrotic syndrome can lead to many adverse effects including behavioural problems. The present study was undertaken to assess the changes in individual behaviour among different sub-groups of patients with idiopathic nephrotic syndrome (INS) and also to find out the relationship, if any, between different behavioural problems with cumulative dose of steroid therapy.Methods. This was a prospective hospital-based study. We assessed behavioural patterns in 131 children and adolescents with steroid-responsive INS aged 1.5-15 years. Fifty healthy children matched for age and gender were included to serve as controls. The Achenbach Child Behaviour Checklist was used to assess individual behaviour. Patients were sub-grouped according to age (1.5-5 and 6-15 years) and disease status (first attack before and after 12-week prednisolone, infrequent relapser, frequent relapser/steroid-dependent).Results. All groups had significantly elevated mean behavioural abnormality scores for dimensions assessed in both age groups, except rule-breaking behaviour. Besides sleep problems, frequent relapsers/steroid-dependent patients exhibited maximum scores in comparison to first attack and infrequent relapsers in the 1.5- to 5-year age group. Total and individual behavioural scores showed close associations with cumulative prednisolone dose in both groups.Conclusions. It is evident that nephrotic syndrome patients should be given due consideration in clinical practice for behavioural abnormalities especially after steroid therapy. © The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
Behavioural abnormalities in children with new-onset nephrotic syndrome receiving corticosteroid therapy: results of a prospective longitudinal study
(Springer Verlag, 2016) Aishvarya Upadhyay; Om P. Mishra; Rajniti Prasad; Shashi K. Upadhyay; Franz Schaefer
Background: Corticosteroid therapy can cause behavioural abnormalities in children with nephrotic syndrome. The objective of this study was to explore the timing of the appearance of abnormalities in their first episode. Methods: Forty-five children with a first episode of idiopathic nephrotic syndrome (30 aged 2–5 and 15 aged 6–14 years) were assessed for behavioural problems using the Child Behaviour Checklist (CBCL) before, and after 6 and 12 weeks of oral steroid treatment. Sixty healthy children were included as controls. Results: In both age groups, marked abnormalities of externalising behaviour were noticed, specifically in the domains of aggressive behaviour and attention problems. Clinical range or borderline externalising abnormalities were present in 73 % of the younger children and 60 % of the schoolchildren after 6 weeks of treatment. In the schoolchildren, abnormal internalising behaviour was also noted at 6 weeks, in 40 % at borderline level and in 20 % within the clinical range. Elevated scores were observed for the anxious/depressed and withdrawn/depressed domains. Most changes persisted at the 12-week observation. Conclusions: Children of both age groups showed significant attention problems and aggressive and abnormal externalising behaviour within 6 weeks of starting treatment. Parents should be informed and counselled about this potential adverse effect of steroid therapy. © 2015, IPNA.
Oxidative stress in children with nephrotic syndrome
(2012) Om P. Mishra; Franz Schaefer
[No abstract available]
Peritoneal dialysis in children with acute kidney injury: A developing country experience
(2012) Om P. Mishra; Aditya K. Gupta; Vishal Pooniya; Rajniti Prasad; Narendra K. Tiwary; Franz Schaefer
Background: Peritoneal dialysis (PD) is the preferred and convenient treatment modality for acute kidney injury (AKI) in children and hemodynamically unstable patients. Methods: The outcome of acute PD was studied in 57 children (39 boys) with AKI, aged 1 month to 12 years, at a tertiary care center of a teaching hospital in India. Results: Hemolytic uremic syndrome (36.8%) was the most common cause of AKI, followed by septicemia (24.6%) and acute tubular necrosis (19.3%). Treatment with PD was highly effective in lowering retention markers (p < 0.001). Overall mortality was 36.8%. The risk of mortality by multi-variate analysis was higher when patients were anuric [odds ratio (OR): 8.2; 95% confidence interval (CI): 1.3 to 49; p < 0.05], had septicemia (OR: 3.79; 95% CI: 1.55 to 25.8; p < 0.05), or severe infectious complications (OR: 8.2; 95% CI: 1.5 to 42.9; p < 001). Conclusions: Because of its simplicity and feasibility, acute PD is still an appropriate treatment choice for children with AKI in resource-poor settings. Septicemia and severity of AKI are contributory factors to high mortality in pediatric acute kidney injury.
Persistence of behavioral abnormalities following corticosteroid therapy in children with initial episode of idiopathic nephrotic syndrome: A prospective longitudinal observation; [Persistência de anormalidades comportamentais após corticoterapia em crianças com episódio inicial de síndrome nefrótica idiopática: Uma observação longitudinal prospectiva]
(Sociedade Brasileira de Nefrologia, 2022) Parichay Singh; Om P. Mishra; Shashi K. Upadhyay; Rajniti Prasad; Ankur Singh; Abhishek Abhinay; Akash Mishra; Franz Schaefer
Introduction: Treatment of nephrotic syndrome with corticosteroid can cause several side- effects including behavioral abnormalities. The objectives of the study were to observe the proportion of non-relapsers having persistence of behavioral abnormalities after completion of treatment of initial episode and compare the abnormalities with relapsers, and to determine risk factors for persistence. Methods: Seventy-five children with a first episode of idiopathic nephrotic syndrome and 60 normal children were rated by parents for behavioral problems using the Child Behavior Checklist. The Parenting Stress Index was also evaluated. The children were rated before treatment and 12 and 36 weeks after. Results: Both relapsers and non-relapsers showed abnormalities in internalizing and externalizing domains at 12 weeks of steroid therapy. Non-relapsers had abnormal scores in the internalizing domain in 63.5 % and externalizing domain in 48.1% of cases at 36 weeks. Relapsers had abnormal scores in all the three behavior domains, but a significantly higher proportion of relapsers had abnormal scores regarding total behavior (65.2% vs 28.8%, p<0.01) and child domains (100% vs 57.7%, p<0.001) of Parenting Stress Index in comparison to non-relapsers at 36 weeks. Occurrence of relapse increased the risk (odds ratio 5.76, 95% CI 1.35-10.76, p< 0.001) for persistence of abnormal total behavior at 36 weeks follow-up. Conclusion: Persistence of abnormalities was observed not only in relapsers but also in non-relapsers. Relapse was found to be a significant risk factor for persistence of abnormal behaviors in these patients. Copyright © 2021 Metallurgia Italiana. All rights reserved.
Predictive ability of urinary biomarkers for outcome in children with acute kidney injury
(Springer Verlag, 2017) Om P. Mishra; Avinash K. Rai; Pradeep Srivastava; Khushaboo Pandey; Abhishek Abhinay; Rajniti Prasad; Rabindra N Mishra; Franz Schaefer
Background: Urinary neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-beta-D-glucosaminidase (NAG), and interleukin 18 (IL-18) were found to be useful for early detection of acute kidney injury (AKI). The objective of this study was to determine the predictive ability of biomarkers for mortality and variation in levels in relation to different stages of AKI, need for dialysis, etiologies, and with duration of hospital stay. Methods: Urinary NGAL, NAG, and IL-18 levels were measured in 50 children with AKI and 30 age- and gender-matched healthy controls. AKI was classified as per pediatric Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria. Results: Median NGAL, NAG, and IL-18 values were significantly increased in AKI patients compared with controls (p < 0.001), with significant increase among risk, injury, and failure stages. Nonsurvivors had significantly higher median levels of NGAL (p = 0.008) and NAG (p = 0.018) than survivors. NGAL had highest area under the curve (AUC) at 0.750 [confidence interval (CI) 0.580–0.920], followed by NAG at 0.724 (CI 0.541–0.907), with sensitivity and specificity of 75 % each; and IL-18 (AUC 0.688, CI 0.511–0.864), with sensitivity 62.5 % and specificity 70.8 %, for predicting mortality. Values were significantly higher in patients who required peritoneal dialysis (PD) than in those in whom it was not indicated. Levels were comparable among different etiologies. Only NGAL level was found to be a significant risk factor associated with longer duration of hospital stay. Conclusions: Urinary NGAL and NAG had modest predictive ability for mortality. Children requiring dialysis had significantly raised levels, and the NGAL level had significant association with duration of hospital stay. © 2016, IPNA.