Bio

Clinical Focus


  • Pediatric Dialysis
  • Pediatric Nephrology
  • Acute Kidney Injury
  • Pediatric Renal Transplantation

Academic Appointments


Administrative Appointments


  • Physician Lead, Transplant Informatics, Lucile Packard Children's Hospital (2008 - Present)
  • Intern/Resident Selection Committee, Lucile Packard Children's Hospital (2005 - Present)

Professional Education


  • Board Certification: Pediatrics, American Board of Pediatrics (2005)
  • Fellowship:Lucile Packard Children's Hospital (2008) CA
  • Board Certification: Pediatric Nephrology, American Board of Pediatrics (2010)
  • Residency:Lucile Packard Children's Hospital (2005) CA
  • Medical Education:Yale University School of Medicine (2002) CT
  • BA, Duke University, Chemistry/Economics (1997)

Publications

Journal Articles


  • Initial Experience Using Aminophylline to Improve Renal Dysfunction in the Pediatric Cardiovascular ICU PEDIATRIC CRITICAL CARE MEDICINE Axelrod, D. M., Anglemyer, A. T., Sherman-Levine, S. F., Zhu, A., Grimm, P. C., Roth, S. J., Sutherland, S. M. 2014; 15 (1): 21-27

    Abstract

    To determine if aminophylline administration is associated with improved creatinine clearance and greater urine output in children with acute kidney injury in the cardiovascular ICU.Single-center retrospective cohort study.Pediatric cardiovascular ICU, university-affiliated children's hospital.Children with congenital or acquired heart disease in the cardiovascular ICU who received aminophylline to treat oliguric acute kidney injury and fluid overload.Patients received aminophylline after consultation with a pediatric nephrologist. Data were collected retrospectively over 7 days to assess if aminophylline was associated with improvement in creatinine clearance, urine output, and fluid overload.Thirty-one patients received 52 aminophylline courses. Over the 7-day study period, serum creatinine decreased from a mean of 1.13 ± 0.91 to 0.87 ± 0.83 mg/dL (-0.05 mg/dL/d, p < 0.001). A concomitant increase was seen in estimated glomerular filtration rate from a mean of 50.0 ± 30.0 to 70.6 ± 58.1 mL/min/1.73 m (+3.66 mL/min/1.73 m/d, p < 0.001). Average daily urine output increased by 0.22 mL/kg/hr (p < 0.001), and fluid overload decreased on average by 0.42% per day in the 7-day study period (p = 0.005). Although mean furosemide dose increased slightly (0.12 mg/kg/d, p = 0.01), hydrochlorothiazide dosing did not significantly change over the study period. There were no complications related to aminophylline administration.Our study suggests that aminophylline therapy may be associated with significantly improved renal excretory function and may augment urine output in children who experience oliguric acute kidney injury in the cardiovascular ICU. Additionally, we did not identify any aminophylline-related side effects in this high-risk cardiac population. Future prospective studies are necessary to confirm the safety profile and to ensure that the beneficial effects are independent of other clinical interventions.

    View details for DOI 10.1097/01.pcc.0000436473.12082.2f

    View details for Web of Science ID 000329368400007

    View details for PubMedID 24212284

  • Association between Maintenance Fluid Tonicity and Hospital-Acquired Hyponatremia. journal of pediatrics Carandang, F., Anglemyer, A., Longhurst, C. A., Krishnan, G., Alexander, S. R., Kahana, M., Sutherland, S. M. 2013; 163 (6): 1646-1651

    Abstract

    To evaluate whether the administration of hypotonic fluids compared with isotonic fluids is associated with a greater risk for hyponatremia in hospitalized children.Informatics-enabled cohort study of all hospitalizations at Lucile Packard Children's Hospital between April 2009 and March 2011. Extraction and analysis of electronic medical record data identified normonatremic hospitalized children who received either hypotonic or isotonic intravenous maintenance fluids upon admission. The primary exposure was the administration of hypotonic maintenance fluids, and the primary outcome was the development of hyponatremia (serum sodium <135 mEq/L).A total of 1048 normonatremic children received either hypotonic (n = 674) or isotonic (n = 374) maintenance fluids upon admission. Hyponatremia developed in 260 (38.6%) children who received hypotonic fluids and 104 (27.8%) of those who received isotonic fluids (unadjusted OR 1.63; 95% CI 1.24-2.15, P < .001). After we controlled for intergroup differences and potential confounders, patients receiving hypotonic fluids remained more likely to develop hyponatremia (aOR 1.37, 95% CI 1.03-1.84). Multivariable analysis identified additional factors associated with the development of hyponatremia, including surgical admission (aOR 1.44, 95% CI 1.09-1.91), cardiac admitting diagnosis (aOR 2.08, 95% CI 1.34-3.20), and hematology/oncology admitting diagnosis (aOR 2.37, 95% CI 1.74-3.25).Hyponatremia was common regardless of maintenance fluid tonicity; however, the administration of hypotonic maintenance fluids compared with isotonic fluids was associated with a greater risk of developing hospital-acquired hyponatremia. Additional clinical characteristics modified the hyponatremic effect of hypotonic fluid, and it is possible that optimal maintenance fluid therapy now requires a more individualized approach.

    View details for DOI 10.1016/j.jpeds.2013.07.020

    View details for PubMedID 23998517

  • AKI in Hospitalized Children: Epidemiology and Clinical Associations in a National Cohort. Clinical journal of the American Society of Nephrology Sutherland, S. M., Ji, J., Sheikhi, F. H., Widen, E., Tian, L., Alexander, S. R., Ling, X. B. 2013; 8 (10): 1661-1669

    Abstract

    Although AKI is common among hospitalized children, comprehensive epidemiologic data are lacking. This study characterizes pediatric AKI across the United States and identifies AKI risk factors using high-content/high-throughput analytic techniques.For the cross-sectional analysis of the 2009 Kids Inpatient Database, AKI events were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Demographics, incident rates, and outcome data were analyzed and reported for the entire AKI cohort as well as AKI subsets. Statistical learning methods were applied to the highly imbalanced dataset to derive AKI-related risk factors.Of 2,644,263 children, 10,322 children developed AKI (3.9/1000 admissions). Although 19% of the AKI cohort was ≤1 month old, the highest incidence was seen in children 15-18 years old (6.6/1000 admissions); 49% of the AKI cohort was white, but AKI incidence was higher among African Americans (4.5 versus 3.8/1000 admissions). In-hospital mortality among patients with AKI was 15.3% but higher among children ≤1 month old (31.3% versus 10.1%, P<0.001) and children requiring critical care (32.8% versus 9.4%, P<0.001) or dialysis (27.1% versus 14.2%, P<0.001). Shock (odds ratio, 2.15; 95% confidence interval, 1.95 to 2.36), septicemia (odds ratio, 1.37; 95% confidence interval, 1.32 to 1.43), intubation/mechanical ventilation (odds ratio, 1.2; 95% confidence interval, 1.16 to 1.25), circulatory disease (odds ratio, 1.47; 95% confidence interval, 1.32 to 1.65), cardiac congenital anomalies (odds ratio, 1.2; 95% confidence interval, 1.13 to 1.23), and extracorporeal support (odds ratio, 2.58; 95% confidence interval, 2.04 to 3.26) were associated with AKI.AKI occurs in 3.9/1000 at-risk US pediatric hospitalizations. Mortality is highest among neonates and children requiring critical care or dialysis. Identified risk factors suggest that AKI occurs in association with systemic/multiorgan disease more commonly than primary renal disease.

    View details for DOI 10.2215/CJN.00270113

    View details for PubMedID 23833312

  • The Prospective Pediatric Continuous Renal Replacement Therapy (ppCRRT) Registry: a critical appraisal. Pediatric nephrology (Berlin, Germany) Sutherland, S. M., Goldstein, S. L., Alexander, S. R. 2013

    Abstract

    Continuous renal replacement therapy (CRRT), which provides gradual, predictable clearance and fluid removal, is commonly used to manage acute kidney injury (AKI) and fluid overload in critically ill children. The Prospective Pediatric CRRT (ppCRRT) Registry, founded in 2001 and comprising 13 pediatric centers in the United States, represents the largest cohort of children receiving CRRT to date. Data from the ppCRRT has been used to describe pediatric CRRT demographics and epidemiology, improve technical aspects of CRRT provision for children, and identify novel or underappreciated risk factors affecting survival. Whereas the registry has successfully answered many questions, a number of questions remain unanswered and new ones have arisen. This article describes the ppCRRT Registry, including its major findings, the lessons learned, and the limitations inherent in its design. Additionally, using the registry as a framework, areas of future study are identified and potential methodologies examined.

    View details for DOI 10.1007/s00467-013-2594-5

    View details for PubMedID 23982708

  • Continuous renal replacement therapy in children PEDIATRIC NEPHROLOGY Sutherland, S. M., Alexander, S. R. 2012; 27 (11): 2007-2016

    Abstract

    Over the past several decades, the epidemiology of acute kidney injury (AKI) in children has changed significantly. Pediatric patients with AKI frequently have co-morbid conditions, substantial fluid overload, and marked disease severity. At the same time, continuous renal replacement therapy (CRRT) has become the preferred modality for the management of these patients. This manuscript provides a state-of-the-art review of the technical aspects of pediatric CRRT and examines the most recent data regarding CRRT indications, timing of initiation, dosing, and outcomes in critically ill children.

    View details for DOI 10.1007/s00467-011-2080-x

    View details for Web of Science ID 000309342000002

    View details for PubMedID 22366896

  • Evidence-Based Medicine in the EMR Era NEW ENGLAND JOURNAL OF MEDICINE Frankovich, J., Longhurst, C. A., Sutherland, S. M. 2011; 365 (19): 1758-1759

    View details for DOI 10.1056/NEJMp1108726

    View details for Web of Science ID 000296762800003

    View details for PubMedID 22047518

  • Fluid Overload and Mortality in Children Receiving Continuous Renal Replacement Therapy: The Prospective Pediatric Continuous Renal Replacement Therapy Registry AMERICAN JOURNAL OF KIDNEY DISEASES Sutherland, S. M., Zappitelli, M., Alexander, S. R., Chua, A. N., Brophy, P. D., Bunchman, T. E., Hackbarth, R., Somers, M. J., Baum, M., Symons, J. M., Flores, F. X., Benfield, M., Askenazi, D., Chand, D., Fortenberry, J. D., Mahan, J. D., McBryde, K., Blowey, D., Goldstein, S. L. 2010; 55 (2): 316-325

    Abstract

    Critically ill children with hemodynamic instability and acute kidney injury often develop fluid overload. Continuous renal replacement therapy (CRRT) has emerged as a favored modality in the management of such children. This study investigated the association between fluid overload and mortality in children receiving CRRT.Prospective observational study.297 children from 13 centers across the United States participating in the Prospective Pediatric CRRT Registry.Fluid overload from intensive care unit (ICU) admission to CRRT initiation, defined as a percentage equal to (fluid in [L] - fluid out [L])/(ICU admit weight [kg]) x 100%.The primary outcome was survival to pediatric ICU discharge. Data were collected regarding demographics, CRRT parameters, underlying disease process, and severity of illness.153 patients (51.5%) developed < 10% fluid overload, 51 patients (17.2%) developed 10%-20% fluid overload, and 93 patients (31.3%) developed > or = 20% fluid overload. Patients who developed > or = 20% fluid overload at CRRT initiation had significantly higher mortality (61/93; 65.6%) than those who had 10%-20% fluid overload (22/51; 43.1%) and those with < 10% fluid overload (45/153; 29.4%). The association between degree of fluid overload and mortality remained after adjusting for intergroup differences and severity of illness. The adjusted mortality OR was 1.03 (95% CI, 1.01-1.05), suggesting a 3% increase in mortality for each 1% increase in severity of fluid overload. When fluid overload was dichotomized to > or = 20% and < 20%, patients with > or = 20% fluid overload had an adjusted mortality OR of 8.5 (95% CI, 2.8-25.7).This was an observational study; interventions were not standardized. The relationship between fluid overload and mortality remains an association without definitive evidence of causality.Critically ill children who develop greater fluid overload before initiation of CRRT experience higher mortality than those with less fluid overload. Further goal-directed research is required to accurately define optimal fluid overload thresholds for initiation of CRRT.

    View details for DOI 10.1053/j.ajkd.2009.10.048

    View details for Web of Science ID 000274537000021

    View details for PubMedID 20042260

  • Two-point normalized protein catabolic rate overestimates nPCR in pediatric hemodialysis patients PEDIATRIC NEPHROLOGY Srivaths, P. R., Sutherland, S., Alexander, S., Goldstein, S. L. 2013; 28 (5): 797-801

    Abstract

    Normalized protein catabolic rate (nPCR) calculation depends on estimating the urea generation between consecutive hemodialysis (HD) treatments. Two-point nPCR using blood urea nitrogen (BUN) before and after the same HD treatment has not been validated in pediatric patients, who typically receive a more intense HD dose than adults. This study aimed to compare nPCR calculated with a two-point vs. a three-point nPCR model in pediatric HD patients.Pediatric patients receiving HD at 2 units were enrolled. Three BUN measurements were obtained around a midweek HD treatment: one prior to HD (preBUN1), one 30 s after HD (30sBUN), and one prior to the subsequent HD (preBUN2). The two-point nPCR model was calculated using preBUN1 and 30sBUN and the three-point nPCR model was calculated using preBUN2 and 30sBUN.Seventy-six BUN sets from 35 patients were analyzed. Mean age was 16.4?±?3.5 years. Mean dry weight was 51.4?±?17.1 kg. Mean spKt/V was 1.54?±?0.23. Mean preBUN2 was significantly lower than mean preBUN1 (60.2?±?18.6 vs. 64.0?±?18.9 mg/dl, p?=?0.0001). nPCR obtained from the three-point model was significantly lower than nPCR obtained from the two-point model (1.07?±?0.31 vs. 1.17?±?0.31 g/kg/day, p?=?0.00001). Seven of 76 (9.2 %) paired comparisons yielded three-point nPCR <1 vs. two-point nPCR >1.Our data show that in pediatric patients receiving HD, the ((1) two-point and three-point models lead to significantly different nPCRs, and (2) inaccurate protein intake assessment may result from reliance on a two-point model for nPCR estimates.

    View details for DOI 10.1007/s00467-012-2371-x

    View details for Web of Science ID 000316571400014

    View details for PubMedID 23212562

  • Hypertension Screening During Ambulatory Pediatric Visits in the United States, 2000-2009 PEDIATRICS Shapiro, D. J., Hersh, A. L., Cabana, M. D., Sutherland, S. M., Patel, A. I. 2012; 130 (4): 604-610

    Abstract

    Hypertension occurs in 2% to 5% of children in the United States, and its prevalence has increased during the obesity epidemic. There is no consensus among professional organizations about how frequently blood pressure should be measured in children >3 years old. The purpose of this study was to estimate the frequency of hypertension screening during ambulatory pediatric visits in the United States and to determine patient- and provider-level factors associated with screening during visits specifically for preventive care.We analyzed data from a nationally representative sample of ambulatory visits by using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 2000 through 2009. In the subset of visits involving patients aged 3 to 18 years, we estimated the frequency of screening during all visits, preventive visits, and preventive visits in which overweight/obesity was diagnosed. We used multivariable logistic regression to identify patient- and provider-level factors associated with screening.Hypertension screening occurred during 35% of ambulatory pediatric visits, 67% of preventive visits, and 84% of preventive visits in which overweight/obesity was diagnosed. Between 2000 and 2009, the frequency of screening increased in all visits and in preventive visits. Factors independently associated with screening included older age and overweight/obesity diagnosis.Providers do not measure blood pressure in two-thirds of pediatric visits and one-third of pediatric preventive visits. Providers may understand the importance of screening among overweight/obese children; however, efforts to encourage routine screening, particularly in young children, may be needed.

    View details for DOI 10.1542/peds.2011-3888

    View details for Web of Science ID 000309412100043

    View details for PubMedID 22987883

  • Rituximab treatment for recurrence of nephrotic syndrome in a pediatric patient after renal transplantation for congenital nephrotic syndrome of Finnish type PEDIATRIC TRANSPLANTATION Chaudhuri, A., Kambham, N., Sutherland, S., Grimm, P., Alexander, S., Concepcion, W., Sarwal, M., Wong, C. 2012; 16 (5): E183-E187

    Abstract

    Congenital nephrotic syndrome (CNS) of the Finnish type due to mutation in the NPHS-1 gene results in massive proteinuria due to structural abnormality in the glomerular slit diaphragm, and is usually refractory to immunosuppressive therapy. Patients eventually require bilateral nephrectomy and renal replacement therapy, with transplantation being the ultimate goal. Post-transplant recurrence of nephrotic syndrome occurs in about 25% of children and is thought to be immune-mediated secondary to antibodies formed against the nephrin protein in renal allograft. Conventional therapy with calcineurin inhibitors (CNI), cyclophosphamide and corticosteroids with or without plasmapheresis often fails to achieve remission resulting in graft loss in 12-16%. There is limited experience with use of rituximab (RTX) in pediatric organ transplant recipients. We report the first case of post-transplant recurrence of nephrotic syndrome in a 4-yr-old child with CNS due to NPHS-1 mutation in whom CNI, corticosteroid and cyclophosphamide therapy was unsuccessful, but who achieved remission after depletion of B cells with RTX, associated with a decrease in the level of anti-nephrin antibodies. The child remains in remission 5 yr following treatment. Our experience suggests that activated B cells may play a pivotal role in the recurrence of nephrosis after renal transplantation in children with CNS.

    View details for DOI 10.1111/j.1399-3046.2011.01519.x

    View details for Web of Science ID 000306131700011

    View details for PubMedID 21672106

  • Complement-fixing donor-specific antibodies identified by a novel C1q assay are associated with allograft loss PEDIATRIC TRANSPLANTATION Sutherland, S. M., Chen, G., Sequeira, F. A., Lou, C. D., Alexander, S. R., Tyan, D. B. 2012; 16 (1): 12-17

    Abstract

    Long-term outcomes following renal transplantation remain disappointing. Recently, interest has focused on the antibody-mediated component of allograft injury and the deleterious effects of DSA. We applied a novel C1q solid-phase assay in parallel with the standard IgG SAB assay to identify DSA with the potential to activate complement by binding C1q. Among 193 consecutive renal transplants at our center, 19.2% developed de novo DSA following transplantation. Of the patients with DSA, 43% had antibodies that bound C1q in vitro [C1q+ DSA]. Patients with C1q+ DSA were more likely to develop allograft loss than patients with DSA that did not bind C1q (46.7% vs. 15%; p?=?0.04); patients with C1q+ DSA were nearly six times more likely to lose their transplant than those with C1q- DSA. Additionally, patients with C1q+ DSA who underwent allograft biopsy were more likely to demonstrate C4d deposition (50% vs. 8%; p?=?0.03) and meet criteria for acute rejection (60% vs. 17%; p?=?0.02) when compared with patients with DSA that did not bind C1q. These data suggest that DSA with the ability to activate complement, as determined by this novel C1q assay, are associated with greater risk of acute rejection and allograft loss.

    View details for DOI 10.1111/j.1399-3046.2011.01599.x

    View details for Web of Science ID 000299154200010

    View details for PubMedID 22093755

  • End-Stage Renal Disease and Cardiomyopathy in Children: Cardiac Effects of Renal Transplantation TRANSPLANTATION Lal, A. K., de Biasi, A. R., Alexander, S., Rosenthal, D. N., Sutherland, S. M. 2012; 93 (2): 182-187

    Abstract

    The occurrence and progression of cardiomyopathy is well known in patients with end-stage renal disease (ESRD). However, the feasibility of renal transplantation in the setting of cardiac dysfunction and the effect of renal transplantation on this progression remain poorly studied in pediatric patients.A single-center, retrospective review of pediatric renal transplants between January 1, 2001, and December 31, 2010, was conducted. Six children with ESRD and severe systolic dysfunction underwent renal transplantation. Clinical data were collected and compared for the pretransplant, peritransplant, and posttransplant periods.Nutritional support, dialysis, and chronic kidney disease and heart failure therapy led to improved cardiac function before transplantation (ejection fraction 28.8%±9.6% vs. 44.4%±11.5%; fractional shortening 12.7%±5.1% vs. 23.6%±6.2%); however, normal systolic function was not achieved before transplantation in any patient. After transplantation, two patients had normalization of systolic function by hospital discharge, while the systolic function of the remaining four patients normalized during the first posttransplant year. Mean ejection fraction 1 year posttransplant was 22 units greater than before transplant. All patients experienced excellent allograft function in the peritransplant period. Mean estimated creatinine clearance 1 year posttransplant was 93.2±33.3 mL/min/1.73 m(2).Renal transplantation can be performed safely in children with ESRD and severe systolic dysfunction. After transplantation, systolic function continues to improve and may reach normal levels during the first posttransplant year. The presence of severe systolic dysfunction in pediatric dialysis patients should not deter referral for renal transplantation.

    View details for DOI 10.1097/TP.0b013e31823be7f8

    View details for Web of Science ID 000299164000013

    View details for PubMedID 22146314

  • Disseminated Intravascular Coagulation Due to IgM-Mediated Autoimmune Hemolytic Anemia PEDIATRIC BLOOD & CANCER Bleakly, N. T., Fontaine, M. J., Pate, L. L., Sutherland, S. M., Jeng, M. 2011; 57 (2): 329-331

    Abstract

    Disseminated intravascular coagulation (DIC) due to red cell hemolysis has been previously attributed to transfusion-related hemolytic reactions, but not to autoimmune hemolytic anemia. We report a case of DIC in a child with complement-fixing IgM-mediated cold-agglutinin autoimmune hemolysis, which resulted in arterial thrombosis and gangrene of the upper and lower extremities.

    View details for DOI 10.1002/pbc.23024

    View details for Web of Science ID 000292301400028

    View details for PubMedID 21671368

  • Role of Twenty-Four-Hour Ambulatory Blood Pressure Monitoring in Children on Dialysis CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY Chaudhuri, A., Sutherland, S. M., Begin, B., Salsbery, K., McCabe, L., Potter, D., Alexander, S. R., Wong, C. J. 2011; 6 (4): 870-876

    Abstract

    Pre- or postdialysis BP recordings are imprecise, can be biased, and have poor test-retest reliability in children on dialysis. We aimed to examine the possible differences between pre- and postdialysis BP levels and 24-hour ambulatory BP monitoring (ABPM) in diagnosis of hypertension (HTN).Twenty-four children on dialysis had 24-hour ABPM in the interdialytic period, and values were compared with average pre- and postdialysis systolic BP (SBP) and diastolic BP (DBP) recordings that week. Each patient had an echocardiogram to determine presence of left ventricular hypertrophy (LVH).By ABPM, 8% of patients had white coat HTN and 12% had masked HTN. There was no significant difference in diagnosis of systolic HTN based on ABPM daytime SBP mean or load and postdialysis SBP. However, only 15% of patients had diastolic HTN based on postdialysis measures, whereas 46% of patients had significantly elevated daytime DBP loads and 71% had high nighttime DBP loads on ABPM. Forty-eight percent of patients were SBP nondippers. Children with LVH had higher daytime and nighttime SBP loads, significantly higher daytime and nighttime DBP loads, and lesser degree of nocturnal dipping of SBP compared with those who did not.ABPM is more informative than pre- and postdialysis BPs and improves the predictability of BP as a risk factor for target organ damage. Diagnosis and treatment monitoring of HTN among pediatric dialysis patients is enhanced with addition of ABPM.

    View details for DOI 10.2215/CJN.07960910

    View details for Web of Science ID 000289223600026

    View details for PubMedID 21273374

  • Enterococcal peritonitis in children receiving chronic peritoneal dialysis NEPHROLOGY DIALYSIS TRANSPLANTATION Sutherland, S. M., Alexander, S. R., Feneberg, R., Schaefer, F., Warady, B. A. 2010; 25 (12): 4048-4054

    Abstract

    Peritonitis is a common complication of chronic peritoneal dialysis (CPD) and can be associated with technique failure. Enterococcus is an uncommon peritoneal pathogen in children receiving CPD but represents a potential therapeutic challenge due to its innate resistance to cephalosporins and emerging resistance to glycopeptides.The International Pediatric Peritonitis Registry is a global consortium of 47 paediatric dialysis centres designed to address validation of the International Society for Peritoneal Dialysis paediatric peritonitis treatment guidelines. Between 2001 and 2004, peritonitis episodes were assessed in 392 participating children receiving CPD.Among the 392 patients, 340 episodes of culture-positive peritonitis were evaluated. Twenty of these episodes were due to Enterococcus species (5.9%). There were no clinical characteristics uniquely associated with enterococcal peritonitis at presentation. After 3 days of therapy, 75% of patients were pain free, 95% had decreased effluent cloudiness and 90% were afebrile. Only one patient required a catheter exchange, and all patients experienced full functional recovery. Despite broad in vitro resistance to cephalosporins and 21% resistance to glycopeptides, neither in vitro resistance pattern nor choice of empiric antibiotic regimen affected short- or long-term outcomes.Enterococci are likely responsible for ?6% of culture-positive peritonitis episodes in children receiving CPD. Although it was not possible to identify patients with enterococcal peritonitis based on presentation, clinical response was not associated with in vitro resistance patterns, and patients who initially received a cephalosporin-based empiric regimen until culture results are available are likely to respond quickly and have full functional recovery.

    View details for DOI 10.1093/ndt/gfq295

    View details for Web of Science ID 000284640400038

    View details for PubMedID 20501457

  • Protein microarrays identify antibodies to protein kinase C zeta that are associated with a greater risk of allograft loss in pediatric renal transplant recipients KIDNEY INTERNATIONAL Sutherland, S. M., Li, L., Sigdel, T. K., Wadia, P. P., Miklos, D. B., Butte, A. J., Sarwal, M. M. 2009; 76 (12): 1277-1283

    Abstract

    Antibodies to human leukocyte antigens (HLAs) are a risk factor for acute renal allograft rejection and loss. The role of non-HLAs and their significance to allograft rejection have gained recent attention. Here, we applied protein microarray technology, with the capacity to simultaneously identify 5056 potential antigen targets, to assess non-HLA antibody formation in 15 pediatric renal transplant recipients during allograft rejection. Comparison of the pre- and post-transplant serum identified de novo antibodies to 229 non-HLA targets, 36 of which were present in multiple patients at allograft rejection. On the basis of its reactivity, protein kinase Czeta (PKCzeta) was selected for confirmatory testing and clinical study. Immunohistochemical analysis found PKCzeta both within the renal tissue and infiltrating lymphocytes at rejection. Patients who had an elevated anti-PKCzeta titer developed rejection, which was significantly more likely to result in graft loss. The absence of C4d deposition in patients with high anti-PKCzeta titers suggests that it is a marker of severe allograft injury rather than itself being pathogenic. Presumably, critical renal injury and inflammation associated with this rejection subtype lead to the immunological exposure of PKCzeta with resultant antibody formation. Prospective assessment of serum anti-PKCzeta levels at allograft rejection will be needed to confirm these results.

    View details for DOI 10.1038/ki.2009.384

    View details for Web of Science ID 000272230400009

    View details for PubMedID 19812540

  • Steroid-Free Immunosuppression in Pediatric Renal Transplantation: Rationale Outcomes Following Conversion to Steroid Based Therapy TRANSPLANTATION Sutherland, S., Li, L., Concepcion, W., Salvatierra, O., Sarwal, M. M. 2009; 87 (11): 1744-1748

    Abstract

    Short-term outcomes using steroid-free immunosuppression after renal transplantation have been promising. No studies have examined the incidence of and reasons for steroid-avoidance protocol failures.We present a single-center analysis of steroid-free immunosuppression failures among 129 pediatric renal transplant recipients with mean follow-up of 5 years. We analyzed causes for failure and examined reasons for conversion to steroid-based therapy. We compared actual patient and allograft survival and allograft function in the cohort of patients who required conversion to steroid-based immunosuppression with that of the cohort maintaining steroid-free immunosuppression.A total of 13.2% (17/129) of patients failed steroid-free immunosuppression. Actual patient survival was equivalent in the two cohorts, 96.4% for the cohort maintaining steroid-free immunosuppression and 94.1% for those requiring conversion. Actual allograft survival was lower in patients requiring conversion to a steroid-based protocol, 76.5% vs. 95.5% (P=0.004). Estimated glomerular filtration rates 12-months and 24-months posttransplant were greater in patients maintaining steroid-free immunosuppression (P=0.003). Most patients (52.9%, 9/17) who broke the steroid-free protocol did so because of refractory acute rejection. The second most common reason was recurrence of glomerulonephritis (GN; 35.3%, 6/17).The failure rate of steroid-free immunosuppression among selective pediatric patients undergoing renal transplantation is low. Patients maintaining steroid-free immunosuppression have better allograft survival and function than those requiring conversion to steroid-based therapy. The most common reasons for failure of steroid-free immunosuppression are recalcitrant or recurrent allograft rejection and recurrent GN; the role of conversion to steroid-based immunosuppression after episodes of acute rejection and recurrent GN requires additional analysis.

    View details for DOI 10.1097/TP.0b013e3181a5df60

    View details for Web of Science ID 000266889900022

    View details for PubMedID 19502970

  • The challenge for the caregiver of the patient with chronic kidney disease NEPHROLOGY DIALYSIS TRANSPLANTATION Gayomali, C., Sutherland, S., Finkelstein, F. O. 2008; 23 (12): 3749-3751

    View details for DOI 10.1093/ndt/gfn577

    View details for Web of Science ID 000261170100005

    View details for PubMedID 19028759

  • Combined liver-kidney transplantation in children: Indications and outcome PEDIATRIC TRANSPLANTATION Sutherland, S. M., Alexander, S. R., Sarwal, M. M., Berquist, W. E., Concepcion, W. 2008; 12 (8): 835-846

    Abstract

    Although it remains a relatively infrequent procedure in children, CLKT has become a viable option for a select group of pediatric patients with severe liver and kidney disease. Most are performed for rare primary diseases such as PH1, but a selected few are performed in the setting of concomitant hepatic and renal failure of uncertain etiology and prognosis. This article reviews the indications for and outcomes following CLKT in children. While it focuses on the specific primary diseases which impact liver and kidney function simultaneously, it addresses the indications based on concomitant hepatic and renal failure, such as seen in the hepatorenal syndrome, as well.

    View details for DOI 10.1111/j.1399-3046.2008.01041.x

    View details for Web of Science ID 000260341600004

    View details for PubMedID 19000066

  • Liposomal amphotericin B associated with severe hyperphosphatemia PEDIATRIC INFECTIOUS DISEASE JOURNAL Sutherland, S. M., Hong, D. K., Balagtas, J., Gutierrez, K., Dvorak, C. C., Sarwal, M. 2008; 27 (1): 77-79

    Abstract

    We report 4 patients who developed hyperphosphatemia while receiving liposomal amphotericin B to treat an invasive fungal infection. Resolution of the hyperphosphatemia occurred after transition to amphotericin B lipid complex. This phenomenon may occur more commonly in patients with mild to moderate renal insufficiency.

    View details for DOI 10.1097/INF.0b013e31815922a3

    View details for Web of Science ID 000252076200019

    View details for PubMedID 18162947

  • Three cases of suspected antibody-mediated rejection. Clinical transplants Sutherland, S. M., Sarwal, M. 2006: 473-478

    View details for PubMedID 18365406

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