C H Schröder

Utrecht University, Utrecht, Utrecht, Netherlands

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Publications (138)203.47 Total impact

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    ABSTRACT: Objective. To describe the incidence and causes of terminal renal insufficiency in childhood in the years 1987-2001, to compare these with the published data for 1979-1986, and to determine the differences, if any, between native Dutch and immigrant patients with regard to the underlying renal disease. Design. Retrospective. Method. Data were collected from all children (< 16 years of age) in the Netherlands who either started with haemodialysis (without recovery of renal function in the first 3 months) or underwent kidney transplantation before haemodialysis became necessary in the period from 1 January 1987 to 31 December 2001 because of terminal renal insufficiency. Results. In 1987-2001, 351 children started with treatment designed to replace their renal function: 197 boys and 154 girls. The median incidence of terminal renal insufficiency was 5.8 per million children per year. The prevalence on 31 December 2001 was 38.7 per million children. The most frequent cause of terminal renal insufficiency was urethral valves, which occurred more often than in the period 1979-1986 (50/351 (14%) versus 10/167 (6%)). The percentage contribution of the various underlying diseases was not statistically significantly different for patients of Dutch (n = 271) and non-Dutch origin (n = 80). Focal segmental glomerulosclerosis was seen more often in children from South America than in children from the countries around the Mediterranean (8/28 (29%) versus 1/33 (3%)). In 314 children, the initial treatment was haemodialysis; peritoneal dialysis was given in 196 of these (62%), compared to 43/167 (26%) in 1979-1986. In 37 children, kidney transplantation was performed before the haemodialysis stage was reached. Among the total of 278 initial kidney transplants, 54 (19%) involved a kidney from a living donor. The calculated 5-year survival of the transplants was 76% (living donor: 80%; cadaver graft: 73%). The calculated 10-year survival of the patients was 94%.
    No preview · Article · Jul 2006 · Nederlands tijdschrift voor geneeskunde
  • M.R. Lilien · C H Schröder · H A Koomans
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    ABSTRACT: Cardiovascular complications are emerging as the primary cause of death for patients with childhood end-stage renal disease. Children with end-stage renal failure are subjected to many of the risk factors for cardiovascular disease identified in adult patients. Dysfunction of the endothelium is presently regarded as a first but reversible step in the development of atherosclerosis. Noninvasive techniques to assess endothelial function have been recently developed and have been proven to predict future mortality in adult patients. These techniques are readily applicable to pediatric patients. Endothelial dysfunction has been demonstrated in children in all stages of renal failure. Data on pediatric patients treated with peritoneal dialysis are currently lacking, however. Considering the abundance of cardiovascular risk factors specific to treatment with peritoneal dialysis, such studies should be initiated.
    No preview · Article · Feb 2005 · Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis
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    ABSTRACT: In contrast to the adult population, little is known regarding health-related quality of life and exercise tolerance in children with end-stage renal disease (ESRD) undergoing chronic intermittent hemodialysis. We designed a pilot study to investigate whether research into this area is indicated. The aim of this study was to describe the motor skills, exercise tolerance, and health-related quality of life in children with ESRD. The study population consisted of ten hemodialysis patients (aged 7-16 years). In eight children motor proficiency according to Bruininks-Oseretsky was determined. In all ten children a progressive exercise test on a treadmill was performed. The results were compared with an age-matched healthy reference group. Nine children filled in the TNO-AZL Child Quality of Life (TACQOL) scoring list. One child had a markedly reduced fine motor skills capacity; another five children scored < or = -2 SD compared with healthy children in gross motor skills. Seven children showed a diminished VO(2)max (per kilogram body weight); six of these are physically inactive. Four of these seven children did not sustain the maximum workload. The self-assessed physical and mental health of children on dialysis seems comparable to the general population. We found no correlation between exercise performance or motor skills and hemoglobin levels, Kt/V, and time on dialysis. In conclusion, in this study most children had a reduced exercise tolerance and gross motor skills. There was no difference in fine motor skills. Pediatric dialysis patients report a good health-related quality of life.
    No preview · Article · Nov 2004 · Pediatric Nephrology
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    ABSTRACT: Reduced serum IgG and subclass levels have been demonstrated in children with chronic renal failure. To study possible causes of this reduction, we analysed B cell subset composition, T helper cell frequencies and immunoglobulin (Ig) production capacity in vitro in children with chronic renal failure, with or without dialysis treatment. B cell subsets were characterized by determining CD27, IgM, IgD and CD5 expression within the CD19(+) population. Intracellular expression of interferon (IFN)-gamma, interleukin (IL)-2 and IL-4 in PMA/ionomycin-stimulated peripheral blood mononuclear cells (PBMC) was used to evaluate T helper frequencies. The capacity of B cells to secrete Ig in vitro was determined by measuring IgG(1), IgG(2) and IgM in culture supernatants of anti-CD2/CD28 monoclonal antibody (MoAb)- or SAC/IL-2-stimulated PBMC. Memory B cell numbers (identified as percentage or absolute number of CD19(+) IgM-IgD- or CD19(+)CD27(+) lymphocytes) were lower in children treated with haemodialysis (HD), peritoneal dialysis (PD) and children with chronic renal failure before starting dialysis treatment (CRF) compared to healthy controls (HC) (P < 0.05). Compared with HC, CD5(+) (naive) B cells were reduced in HD-treated patients but not for PD or for children with chronic renal failure before starting dialysis treatment (CRF). No significant differences in CD4(+) T helper cell subsets were found between the groups. However, CRF children had a higher percentage of IFN-gamma producing CD8(+) T lymphocytes compared to HC (P = 0.02). Finally, IgG(1), IgG(2) and IgM production in vitro was similar in the four groups. In conclusion, significantly lower numbers of memory type B cells were found in children with chronic renal failure compared to healthy controls. This reduction may contribute to the low Ig levels found in these children.
    Full-text · Article · Sep 2004 · Clinical & Experimental Immunology
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    ABSTRACT: The present studywas designed to retrospectively evaluate the use of renal biopsies prior to cyclophosphamide therapy. The aim of the study was to determine in how many cases histological outcome of the biopsies had subsequently changed the decision to treat or refrain from treatment. Between January 1980 and September 2001, 85 children with steroid-sensitive nephrotic syndrome (SSNS) underwent a renal biopsy in the University Hospitals of Utrecht and Nijmegen before the start of an 8-week cyclophosphamide treatment. MCNS was suspected in all children because of the following criteria: edema, proteinuria, hypoalbuminemia, absence of macroscopic hematuria and in rare cases microscopic hematuria, no permanent hypertension, normal C3 serum level, a normal glomerular filtration rate as determined by creatinine clearance and age > 1 year. Cyclophosphamide therapy was indicated because of a frequently relapsing (FR) course of illness in 8 children, because of steroid dependence (SD) in 22 children and because of combined FR and SD in 55 children. Steroid-resistant children were excluded from this study. Histology confirmed the diagnosis MCNS in 84 out of 85 children. In addition to MCNS, IgA deposits were observed in renal specimens of 2 children. In 1 SD child, the initial diagnosis MCNS was changed 3 years later when a repeated biopsy showed progression into focal segmental glomerulosclerosis (FSGS). In summary, no renal biopsy is required prior to cytotoxic therapy in children with uncomplicated steroid-sensitive nephrotic syndrome.
    No preview · Article · Nov 2003 · Clinical nephrology

  • No preview · Article · Nov 2003 · Clinical nephrology
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    ABSTRACT: The majority of hemodialysis (HD) treatments incorporate a prescription for fluid removal targeted to a patients “dry” weight. Hypotension, cramps or headache often complicates fluid removal in children. The purpose of this study was to evaluate whether non-invasive blood volume monitoring by hematocrit could be used for the determination of dry weight and prevention of intra-dialytic complaints in children on chronic HD. Patients and methods: 128 dialysis sessions in 16 patients, aged 3–17 years, were evaluated. Non-invasive monitoring of hematocrit (NIMH) (Crit-lineTM, HemaMetrics) was performed during the whole HD session and expressed as % Δ of blood volume (%BVΔ). Results: Changes in blood volume significantly correlated with the changes of patient's weight during hemodialysis treatments (p = 0.001). Thirty HD sessions were complicated by symptomatic hypotension in 12 patients. Conclusion: Changes in blood volume measured by Crit-line correlate with the changes of patient's weight during hemodialysis treatments. Complicated HD sessions were associated with lower halfway %BVΔ. This indicates that NIMH might be useful for the determination of dry weight and for prevention of intra-dialytic morbidity in children by remodeling of the ultrafiltration profile.
    No preview · Article · Feb 2003 · Hemodialysis International
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    C H Schröder · E Rusthoven · L A H Monnens

    Preview · Article · Jan 2002 · Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis
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    ABSTRACT: Hemolytic uremic syndrome (HUS), the leading cause of acute renal failure in childhood, can be caused by different serotypes of vero cytotoxin (VT; i.e., Shiga toxin)–producing Escherichia coli (VTEC). Recently, VT was shown to bind to polymorphonuclear leukocytes (PMNL) in the systemic circulation of patients with HUS. This study investigated whether VT bound to PMNL could be detected in persons in households with patients with HUS. Serum antibodies against E. coli O157 and, when available, fecal samples from patients with HUS and household members were studied for the presence of VTEC infection. The circulating PMNL of 82% of the household members were positive for VT, whereas stool and/or serum examination showed only 21% positivity. Thus, current methods underestimate the number of infected persons in households with patients with HUS
    Preview · Article · Sep 2001 · The Journal of Infectious Diseases
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    E Rusthoven · N C van de Kar · L.A.H. Monnens · C H Schröder

    Full-text · Article · Mar 2001 · Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis
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    E Rusthoven · L.A.H. Monnens · C H Schröder
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    ABSTRACT: To evaluate the use of the combination of cefazolin and ceftazidime for initial treatment of peritoneal dialysis (PD)-related peritonitis in pediatric patients. Retrospective nonrandomized study. Pediatric dialysis units of the University Medical Center of Utrecht and Nijmegen, The Netherlands. 40 children (median age 5.4 years) who were treated with PD during the study period of 4.5 years. All 50 episodes of peritonitis that occurred during the study period were evaluated by review of medical records. Patients were given intraperitoneal ceftazidime 500 mg/L dialysis fluid, and cefazolin 500 mg/L as a loading dose, followed by a maintenance dose of ceftazidime 125 mg/L and cefazolin 100 mg/L, intraperitoneally, 4 times daily. Antibiotics were continued for 14 days. After identification of the causative microorganism, one of the antibiotics was discontinued in 34 cases, and the antibiotic schedule was adapted in 2 cases. All cases were initially cured within 3 days. In 5 cases (10%), there was a peritonitis with the same organism recurring within 2 weeks after completion of treatment. There were 4 cases of PD-related peritonitis caused by pseudomonas, all of which were cured. The antibiotic combination of cefazolin and ceftazidime is effective for the initial therapy of PD-related peritonitis in children. The toxic complications of aminoglycosides are avoided with this combination.
    Preview · Article · Jan 2001 · Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis
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    Preview · Article · Jan 2001 · Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis
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    ABSTRACT: To study the adsorption of erythropoietin and growth hormone to dialysis bags and tubing. In vitro study in which radiolabeled erythropoietin and recombinant human growth hormone were added to small-volume (50- and 250-mL) dialysis bags. Recovery was measured after 15-minute dwells. Experiments were performed in triplicate. University hospital. Adsorption of erythropoietin and growth hormone was less than 7%. Adsorption of erythropoietin and recombinant human growth hormone to dialysis bags and tubing is minimal. This finding provides another argument in favor of intraperitoneal therapy in pediatric peritoneal dialysis.
    Full-text · Article · Jan 2001 · Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis
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    ABSTRACT: To explore further the mechanisms leading to immune deficiency in chronic renal failure and the role of dialysis treatment in these mechanisms. Cross-sectional and longitudinal analysis. We studied 39 children treated with peritoneal dialysis (PD), 23 children treated with hemodialysis (HD), 33 children not yet dialyzed [chronic renal failure (CRF)], and 27 healthy children. Peritoneal cells were also obtained from PD children for analysis. White blood cells (WBCs) were isolated from blood and peritoneal dialysis effluent by centrifugation. The number of CD2+, CD4+, and CD8+ T cells, B cells, and natural killer cells were measured by flow cytometry. The total peripheral blood lymphocyte count was lower in PD children (2.6 x 10(9)/L), HD children (2.1 x 10(9)/L), and CRF children (2.0 x 10(9)/L) compared with healthy children (3.1 x 10(9)/L, p < 0.05). The B lymphocyte count was also lower in PD children (0.34 x 10(9)/L), HD children (0.22 x 10(9)/L), and CRF children (0.33 x 10(9)/L) compared with healthy children (0.52 x 10(9)/L, p < 0.01). Numbers of CD4+ T cells were not different, but numbers of CD8+ T cells were lower in PD children (0.56 x 10(9)/L), HD children (0.63 x 10(9)/L), and CRF children (0.53 x 10(9)/L) compared with healthy children (0.77 x 10(9)/L, p < 0.05). The count of natural killer cells was lower in PD children (0.21 x 10(9)/L), HD children (0.17 x 10(9)/L), and CRF children (0.18 x 10(9)/L) compared with healthy children (0.50 x 10(9)/L, p < 0.0001). The CD4/CD8 ratio of lymphocytes in peritoneal effluent was 0.8 versus 1.9 in peripheral blood (p < 0.001). The CD2/CD19 ratio was not different. The cell subsets remained stable during the first year of PD treatment. The CD2/CD19 ratio in peritoneal effluent was higher in children with a peritonitis incidence > or = 1 per year. The reduced numbers of B lymphocytes, CD8+ T cells, and natural killer cells found in CRF children, dialyzed or not, may favor the frequent occurrence of infections.
    Full-text · Article · Jan 2001 · Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis
  • M R Lilien · M Duran · J. M. E. Quak · J J Frankhuisen · C H Schröder
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    ABSTRACT: The use of recombinant human erythropoietin (rhEPO) has greatly facilitated the treatment of anemia in children with chronic renal failure, but is expensive. Several reports on adult patients have shown that supplementation with L-carnitine can decrease the requirement for rhEPO. The objective of this study was to investigate the effect of oral supplementation with L-carnitine on the rhEPO requirement in children on dialysis. We investigated 16 children on dialysis (11 hemodialysis, 5 peritoneal dialysis) with a median age of 10.2 years. All children were stable on rhEPO treatment at least 3 months before study entrance. After obtaining baseline data, all children were supplemented with L-carnitine 20 mg/kg/day. Data were collected for 26 weeks. Follow-up was completed for 12 patients (8 hemodialysis, 4 peritoneal dialysis). At baseline free carnitine (32+/-18 micromol/l) and total carnitine levels (54+/-37 micromol/l) were normal. At the end of the study free carnitine levels had increased to 97+/-56 micromol/l (P<0.05) and total carnitine levels to 163+/-90 micromol/l (P<0.05). There was no significant change in rhEPO requirement. Hemoglobin level or hematocrit did not change significantly during the study. In conclusion we could not demonstrate a beneficial effect of supplementation with L-carnitine on rhEPO requirement in children on dialysis.
    No preview · Article · Dec 2000 · Pediatric Nephrology
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    ABSTRACT: Icodextrin use in adults provides sustained ultrafiltration (UF) in long-term dwells. No information is available on UF and metabolism in children. In 11 children, a volume of 1,049+/-138 ml/m2 of the study fluid (1.36% glucose, 7.5% icodextrin, 3.86% glucose) was administered for 12 h. Net UF with icodextrin (339+/-147 ml/1.73 m2) did not differ from UF with 3.86% glucose (450+/-306 ml/1.73 m2, P=0.53) and was higher than UF with 1.36% glucose (-87+/-239 ml/1.73 m2, P=0.003). Icodextrin added 0.52+/-0.07 to the weekly Kt/V. Over 6 weeks, icodextrin was used for 12-h daytime dwell. Total icodextrin reached a steady-state level of 2.91+/-1.22 g/l at 2 weeks. The main icodextrin metabolites were maltose, maltotriose, and maltotetraose. After 2 weeks, steady state levels were 2.02+/-0.66 mmol/l, 1.46+/-0.35 mmol/l, and 0.45+/-0.12 mmol/l. No icodextrin or metabolites were detectable 4 weeks after the study. We conclude that 7.5% icodextrin is capable of maintaining UF during 12-h dwell in children and is comparable to UF obtained with 3.86% glucose. Steady-state levels of icodextrin and metabolites were reached at 2 weeks and disappeared after the study.
    No preview · Article · Dec 2000 · Pediatric Nephrology
  • K.J.M. Van Hoeck · M R Lilien · D C Brinkman · C H Schroeder
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    ABSTRACT: The use of the online urea monitor has not been validated in children on hemodialysis. We compared online measured Kt/V(urea) and protein catabolic rate (PCR) with single- and double-pool Daugirdas formula (DF and eDF) based Kt/V(urea) and with protein intake derived from dietary records (DPI). In 8 children aged 8-18 years, 26 measurements were performed with the online urea monitor (UM 1000) with double-needle access. In 7 children, aged 4-14 years, 12 additional measurements were performed using single-needle dialysis. Pre-dialysis serum urea was determined by the monitor in equilibrated ultrafiltrate, obtained with ultrafiltration rates (UF) of 0.5 or 1.0 l/h, in 10 and 23 experiments respectively, and compared with the laboratory results. Urea determination in ultrafiltrate correlated well with blood sample urea: r=0.945 and 0.88 for UF rates of 0.5 l/h and 1.0 l/h, respectively. The correlation of online Kt/V with DF and eDF was 0.79 for double-needle and 0.21 for single-needle access. Bland-Altmann analysis showed a mean bias of 0.02 and 0.001, but levels of agreement of +0.3 and -0.3 for double-needle and +0.77 and -0.77 for single-needle dialysis respectively with DF. Maximum percentage error for double-needle access was 18% and 59% for single-needle access. The correlation of DPI with PCR was 0.5. A Bland-Altmann plot showed a mean bias of =0.22 with upper and lower limits of agreement of +0.55 and -0.1, respectively. Online urea kinetic modelling is feasible in children with double-needle hemodialysis only. Even with small dialyzers, an accurate serum urea measurement is obtained. PCR underestimates dietary protein intake.
    No preview · Article · May 2000 · Pediatric Nephrology
  • C H Schröder · E Rusthoven · L A Monnens

    No preview · Article · Feb 2000 · Pediatric Nephrology

  • No preview · Article · Jan 2000
  • M.R. Lilien · A.J. Rabelink · H A Koomans · C H Schröder

    No preview · Article · Jan 2000

Publication Stats

1k Citations
203.47 Total Impact Points

Institutions

  • 2000-2005
    • Utrecht University
      Utrecht, Utrecht, Netherlands
  • 1999-2004
    • University Medical Center Utrecht
      Utrecht, Utrecht, Netherlands
    • Canisius-Wilhelmina Ziekenhuis
      Nymegen, Gelderland, Netherlands
  • 2000-2002
    • Wilhelmina Hospital,
      Assen, Drenthe, Netherlands
  • 1986-1997
    • Radboud University Nijmegen
      • • Department of Pediatrics
      • • Department of Human Genetics
      • • Department of Biochemistry
      Nymegen, Gelderland, Netherlands