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G R Lerner

Publications and source records attributed to G R Lerner.

7 recordsLinked to original sources
PubMed1999

Chronic dialysis in children and adolescents. The 1996 annual report of the North American Pediatric Renal Transplant Cooperative Study.

The 1996 annual report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) summarizes data submitted from 130 centers on 2,208 patients in whom 2,787 independent courses of dialysis were performed between 1 January 1992 and 16 January 1996. Approximately two-thirds of the dialysis population were maintained on peritoneal dialysis (PD), with automated PD remaining the preferred modality. There were 964 episodes of peritonitis in 1,018 patient years, yielding an overall peritonitis rate of 1 episode every 13 patient months. More PD patients attended school full time than hemodialysis (HD) patients at baseline (77% vs. 45%), which continued at 6, 12, and 24 months of followup. There were fewer Hispanic patients who were full-time students, whether on HD or PD, compared with white or black patients; 18% of Hispanic patients did not attend school, even though they were medically capable. The majority of dialysis courses terminated due to transplantation (54%), with change in dialysis modality the next most-common reason (28%). Early dialysis termination for any reason was seen more often in HD than PD (40% vs. 23% at 6 months), but by 24 months similar percentages of PD and HD courses had been terminated (75% HD, 72% PD). The most-common PD access was a Tenckhoff catheter with a single cuff, a straight tunnel and lateral exit site. The majority of HD accesses were external percutaneous catheters, with the sublcavian vein the most-common site. Erythropoietin was administered in 93% of HD and PD patients at 24 months.

Adolescent↗
PubMed1992

Renal cortical and renal medullary necrosis in the first 3 months of life.

Renal cortical necrosis, renal medullary necrosis, and combined renal cortical-medullary necrosis result from renal ischemia without vascular occlusion. Renal hypoperfusion and ischemic injury in infants have been ascribed to massive blood loss, hemolytic disease, septicemia, and severe hypoxemia. In a postmortem study we identified 82 cases among 1,638 autopsies during the 20 years between 1970 and 1989 in infants 3 months old or less at the time of death. The frequency of renal necrosis in autopsy cases increased significantly during the last 6 years of the study. The distribution of the renal lesion was cortical in 28, medullary in 23, and combined in 31. Forty infants carried diagnoses of congenital heart disease, 17 of asphyxial shock, 9 of sepsis, 3 of infectious myocarditis, 9 of major malformations, 4 of anemic shock, 1 of vascular malformation, and 1 of gastroenteritis and dehydration. A significantly higher proportion of babies with congenital heart disease had cortical involvement. Comparison of clinical characteristics revealed a significantly higher frequency of prematurity, respiratory distress syndrome, bleeding diathesis, and possibly sepsis in the children with congenital heart disease, suggesting that these factors are important in the pathogenesis of the renal lesion. Fourteen infants underwent cardiac catheterization; there was no demonstrable association between the renal lesions and the use of radiographic contrast medium. We conclude that severe congenital heart disease itself is a risk factor for life-threatening renal cortical and medullary necrosis.

Female↗
PubMed1990

[The accuracy of ophthalmological measurements].

Main principals of metrology of measurement being conducted in research studies and in practice of ophthalmologists are stated. Characteristics of casual and systematic errors are described and their causes explained. Concrete measures for increasing the accuracy of ophthalmologic measurements are proposed: coordination of works in research institutes and chairs of ophthalmological profile and metrologic organizations of the state standard on metrologic provision; publication of papers devoted to the methods of treatment of measurement results; introduction of foundations of metrology into the program of education for refreshment courses of physicians-ophthalmologists.

Ophthalmology↗
PubMed1987

Experience with renal failure during extracorporeal membrane oxygenation: treatment with continuous hemofiltration.

We use extracorporeal membrane oxygenation (ECMO) to treat respiratory and cardiac failure in children who are unresponsive to standard ventilator and pharmacologic management. All patients have cardiac and abdominal ultrasonography prior to ECMO to identify major structural anomalies and anatomically normal kidneys. Despite this, oliguric renal failure is seen in a number of patients. Acute renal failure (ARF) developed in two of the first 20 patients we placed on ECMO and both of these patients died. Six of the last 27 patients (22%) also developed ARF and were treated with continuous hemofiltration (CH) placed in-line with the extracorporeal circuit. The technique of CH removes plasma water and dissolved solutes while retaining proteins and cellular components of the intravascular space. The duration of CH ranged from 9 to 112 hours (mean 57.5 hours). Indications for CH were hypervolemia, hyperkalemia, and azotemia. The mean serum potassium prior to CH was 5.6 (range 4.3 to 7.0) compared with 4.5 after filtration. We filtered 5 to 10 mL/kg/h and replaced it with crystalloid chosen on the basis of serum and filtrate electrolytes. These six patients had a 33% mean weight gain prior to CH. We were able to remove as much as 2,200 g in the most edematous patient with significant improvement in cardiopulmonary status. Four of the patients on CH died of their primary pulmonary or cardiac disease without specific problems related to ARF. The other two patients were successfully weaned from ECMO, extubated, and have not needed further therapy for renal failure. We conclude that CH is useful in managing the complications of oliguric renal failure during ECMO.

Acute Kidney Injury↗
PubMed1987

Reflux nephropathy.

This article reviews current concepts of reflux nephropathy, including the pathophysiology, diagnosis, relationship to infection, role in causing end-stage renal disease, and appropriate treatment and management. The condition is defined from a epidemiologic point of view herein, and attention also is given to possible progressions this condition can take.

Adolescent↗
PubMed1987

Hypertension during extracorporeal membrane oxygenation: cause, effect, and management.

The major complication of extracorporeal membrane oxygenation (ECMO) for the treatment of neonatal respiratory failure is bleeding related to heparinization. Systolic hypertension has emerged as another serious side effect in our experience. Thirty-eight of the first 41 newborns we treated with ECMO developed a systolic blood pressure greater than 90 mm Hg. The mean hypertension index (HI blood = hours greater than 90/hr on ECMO) was 0.17 +/- 0.16. Possible biochemical mediators were assayed in 17 patients. Plasma renin activity (PRA), aldosterone, epinephrine, norepinephrine, prostaglandin E2, thromboxane, and antidiuretic hormone were elevated. Angiotensin-converting enzyme (ACE) and prostacyclin were not elevated. Eighteen patients (44%) had intracranial hemorrhage (ICH), and 11 patients (27%) had clinically significant ICH. The HI was significantly (p less than 0.005) lower in those patients without ICH (0.11 +/- 0.01) than in those patients with ICH (0.25 +/- 0.04). PRA at hour 12, day 2, and day 3 was significantly higher (p less than 0.05) in patients experiencing ICH (62 +/- 42; 93 +/- 15; 73 +/- 30 ng/ml/hr) than in those without ICH (27 +/- 25; 14 +/- 8; 12 +/- 4 ng/ml/hr). An aggressive approach to medical management evolved that included hydralazine, nitroglycerine, and captopril, which protected against ICH. Two of 23 patients (9%) treated with the protocol sufferred clinically significant ICH, whereas nine of 18 patients (50%) treated before implementation of the protocol experienced ICH. The ACE inhibitor captopril was most effective in the control of hypertension. We conclude that systolic hypertension is common during neonatal ECMO, is associated with ICH, and is related to a high PRA. Aggressive management of hypertension during ECMO can reduce the incidence of ICH, and captopril is an important component of this aggressive medical management.

Aldosterone↗