An overview of rickets in children
prevention; vitamin D; mutations; animal-model; phosphate; chronic kidney disease; phosphorus; d-receptor; d-resistant rickets; hereditary hypophosphatemic rickets; hypocalcemia; hypophosphatemia; targeted ablation; vitamin-d-deficiency; x-linked hypophosphatemia
Rickets is a common bone disease worldwide that is associated with disturbances in calcium and phos- phate homeostasis and can lead to short stature and joint deformities. Rickets can be diagnosed based on history and physical examination, radiological features, and biochemical tests. It can be classified into 2 major groups based on phosphate or calcium levels: phosphopenic and calcipenic. Knowledge of cate- gorization of the type of rickets is essential for prompt diagnosis and proper management. Nutritional rickets is a preventable disease through adequate intake of vitamin D through both dietary and sunlight exposure. There are other subtypes of rickets, such as vitamin D-dependent type 1 rickets and vitamin D- dependent type 2 rickets (due to defects in vitamin D metabolism), renal rickets (due to poor kidney function), and hypophosphatemic rickets (vitamin D-resistant rickets secondary to renal phosphate wasting wherein fibroblast growth factor -23 (FGF-23) often plays a major role), which requires closer monitoring and supplementation with activated vitamin D with or without phosphate supplements. An important development has been the introduction of burosumab, a human monoclonal antibody to FGF- 23, which is approved for the treatment of X -linked hypophosphatemia among children 1 year and older.
Chanchlani R; Nemer P; Sinha R; Nemer L; Krishnappa V; Sochett E; Safadi F; Raina R
Kidney International Reports
2020
2020-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.ekir.2020.03.025" target="_blank" rel="noreferrer noopener">10.1016/j.ekir.2020.03.025</a>
ASPEN Consensus Recommendations for Refeeding Syndrome.
magnesium; potassium; consensus; phosphorus; nutrition assessment; nutrition support; refeeding syndrome
INTRODUCTION: In the spring of 2017, the American Society for Parenteral and Enteral Nutrition (ASPEN) Parenteral Nutrition Safety Committee and the Clinical Practice Committee convened an interprofessional task force to develop consensus recommendations for identifying patients with or at risk for refeeding syndrome (RS) and for avoiding and managing the condition. This report provides narrative review and consensus recommendations in hospitalized adult and pediatric populations. METHODS: Because of the variation in definitions and methods reported in the literature, a consensus process was developed. Subgroups of authors investigated specific issues through literature review. Summaries were presented to the entire group for discussion via email and teleconferences. Each section was then compiled into a master document, several revisions of which were reviewed by the committee. FINDINGS/RECOMMENDATIONS: This group proposes a new clinical definition, and criteria for stratifying risk with treatment and screening strategies. The authors propose that RS diagnostic criteria be stratified as follows: a decrease in any 1, 2, or 3 of serum phosphorus, potassium, and/or magnesium levels by 10%-20% (mild), 20%-30% (moderate), or >30% and/or organ dysfunction resulting from a decrease in any of these and/or due to thiamin deficiency (severe), occurring within 5 days of reintroduction of calories. CONCLUSIONS: These consensus recommendations are intended to provide guidance regarding recognizing risk and identifying, stratifying, avoiding and managing RS. This consensus definition is additionally intended to be used as a basis for further research into the incidence, consequences, pathophysiology, avoidance, and treatment of RS.
da Silva Joshua S V; Seres David S; Sabino Kim; Adams Stephen C; Berdahl Gideon J; Citty Sandra Wolfe; Cober M Petrea; Evans David C; Greaves June R; Gura Kathleen M; Michalski Austin; Plogsted Stephen; Sacks Gordon S; Tucker Anne M; Worthington Patricia; Walker Renee N; Ayers Phil
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
2020
2020-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1002/ncp.10474" target="_blank" rel="noreferrer noopener">10.1002/ncp.10474</a>