The edition · Nephrology
A permissive blood pressure target cut vasopressor use in sick children without harming kidneys, and what older donor kidneys cost
PRESSURE randomised 1,900 ventilated children on vasoactive drugs; a MAP above the 5th centile meant 37.5% less noradrenaline with no difference in death, ventilation or kidney replacement therapy. Kidneys from donors over 60 were linked to more graft loss.
The edition in brief
The PRESSURE trial in 23 paediatric intensive care units randomised 1,900 ventilated children receiving vasoactive drugs to a permissive mean arterial pressure target (above the 5th centile for age) or usual care. The permissive arm received 37.5% less noradrenaline-equivalent drug, with no difference in the composite of 30-day mortality and ventilation duration, and no difference in kidney replacement therapy or adverse events. A meta-analysis of seven observational studies (19,210 recipients) linked older donor age, particularly over 60, with more death-censored graft loss (HR 1.73) and higher recipient mortality (HR 1.42), but not more acute rejection. Six small trials of paricalcitol after kidney transplantation (482 recipients) showed lower PTH but nearly four times the risk of hypercalcaemia and no clear effect on proteinuria or rejection. A Kidney International commentary highlights evidence that fetal growth restriction raises acute kidney injury risk from infancy to early adulthood. The pearl covers PLA2R antibodies in membranous nephropathy.
Kidneys from donors over 60 were linked to more graft loss and recipient deaths
Kidneys from older donors, especially over 60, are linked to poorer graft survival; use them with careful recipient matching rather than rejecting them outright.
Paricalcitol after kidney transplant lowered PTH but nearly quadrupled hypercalcaemia
After kidney transplant, paricalcitol lowers PTH but raises hypercalcaemia risk; monitor calcium and do not use it for proteinuria.
Fetal growth restriction carries acute kidney injury risk into early adulthood
Count fetal growth restriction as a lifelong risk factor for acute kidney injury, and protect these kidneys during acute illness.
Use anti-PLA2R antibodies to diagnose and follow membranous nephropathy
Measure anti-PLA2R in adult nephrotic syndrome; it supports the diagnosis of membranous nephropathy and helps track response.
A permissive blood pressure target in sick children cut vasopressor use with no harm to outcomes or kidneys
In ventilated children on vasoactive drugs, a permissive MAP target above the 5th centile reduced vasopressor exposure without worse survival, ventilation or kidney outcomes.
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