Top

Published in:

01-06-2014 | Original Article

Electrolyte abnormalities in cystic fibrosis: systematic review of the literature

Authors: Elisabetta Scurati-Manzoni, Emilio F. Fossali, Carlo Agostoni, Enrica Riva, Giacomo D. Simonetti, Maura Zanolari-Calderari, Mario G. Bianchetti, Sebastiano A. G. Lava

Published in: Pediatric Nephrology | Issue 6/2014

Abstract

Background

Cystic fibrosis per se can sometimes lead to hyponatremia, hypokalemia, hypochloremia or hyperbicarbonatemia. This tendency was first documented 60 years ago and has subsequently been confirmed in single case reports or small case series, most of which were retrospective. However, this issue has not been addressed analytically. We have therefore systematically reviewed and analyzed the available literature on this subject.

Methods

This was a systematic review of the literature.

Results

The reports included in this review cover 172 subacute and 90 chronic cases of electrolyte imbalances in patients with cystic fibrosis. The male:female ratio was 1.57. Electrolyte abnormalities were mostly associated with clinically inapparent fluid volume depletion, mainly affected patients aged ≤2.5 years, frequently tended to recur and often were found before the diagnosis of cystic fibrosis was established. Subacute presentation often included an history of heat exposure, vomiting, excessive sweating and pulmonary infection. History of chronic presentation, in contrast, was often inconspicuous. The tendency to hypochloremia, hypokalemia and metabolic alkalosis was similar between subacute and chronic patients, with hyponatremia being more pronounced (P < 0.02) in subacute compared to chronic presentations. Subacute cases were treated parenterally; chronic ones were usually managed with oral salt supplementation. Retention of urea and creatinine was documented in 38 % of subacute cases.

Conclusions

The findings of our review suggest that physicians should be aware that electrolyte abnormalities can occur both as a presenting and a recurring feature of cystic fibrosis.

Liamis G, Milionis H, Elisaf M (2008) A review of drug-induced hyponatremia. Am J Kidney Dis 52:144–153PubMed

Greenlee M, Wingo CS, McDonough AA, Youn JH, Kone BC (2009) Narrative review: evolving concepts in potassium homeostasis and hypokalemia. Ann Intern Med 150:619–625PubMed

Kerem E (2006) Atypical CF and CF related diseases. Paediatr Respir Rev 7[Suppl 1]:S144–S146PubMed

Kessler WR, Andersen DH (1951) Heat prostration in fibrocystic disease of the pancreas and other conditions. Pediatrics 8:648–656PubMed

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269PubMed

Anonymous (1964) Convulsions after therapy for alveolar hypoventilation. JAMA 189:1023

Sojo A, Rodríguez-Soriano J, Vitoria JC, Vazquez C, Ariceta G, Villate A (1994) Chloride deficiency as a presentation or complication of cystic fibrosis. Eur J Pediatr 153:825–828PubMed

Beckerman RC, Taussig LM (1979) Hypoelectrolytemia and metabolic alkalosis in infants with cystic fibrosis. Pediatrics 63:580–583PubMed

O'Sullivan BP, Freedman SD (2009) Cystic fibrosis. Lancet 373:1891–1904PubMed

10.

Akgün C, Başaranoğlu M, Yuca SA, Akbayram S, Arslan Ş, Kirimi E (2009) Pseudo–Bartter’s syndrome associated with cystic fibrosis. Nobel Med 5:43–45

11.

Al-Ghimlas F, Faughnan ME, Tullis E (2012) Metabolic alkalosis in adults with stable cystic fibrosis. Open Respir Med J 6:59–62PubMedCentralPubMed

12.

Arvanitakis SN, Lobeck CC (1973) Metabolic alkalosis and salt depletion in cystic fibrosis. J Pediatr 82:535–545PubMed

13.

Augusto JF, Sayegh J, Malinge MC, Illouz F, Subra JF, Ducluzeau PH (2008) Severe episodes of extra cellular dehydration: an atypical adult presentation of cystic fibrosis. Clin Nephrol 69:302–305PubMed

14.

Baird JS, Walker P, Urban A, Berdella M (2002) Metabolic alkalosis and cystic fibrosis. Chest 122:755–756PubMed

15.

Ballestero Y, Hernandez MI, Rojo P, Manzanares J, Nebreda V, Carbajosa H, Infante E, Baro M (2006) Hyponatremic dehydration as a presentation of cystic fibrosis. Pediatr Emerg Care 22:725–727PubMed

16.

Bar-Or O, Blimkie CJ, Hay JA, MacDougall JD, Ward DS, Wilson WM (1992) Voluntary dehydration and heat intolerance in cystic fibrosis. Lancet 339:696–699PubMed

17.

Bates CM, Baum M, Quigley R (1997) Cystic fibrosis presenting with hypokalemia and metabolic alkalosis in a previously healthy adolescent. J Am Soc Nephrol 8:352–355PubMed

18.

Beckerman RC (1979) Metabolic alkalosis in infants with cystic fibrosis. Pediatrics 64:389PubMed

19.

Berezin S, Ruddy RM, Dozor AJ, Newman L (1989) Hypoelectrolytemia, hypovolemia, and alkalosis in cystic fibrosis with wood-burning stove in winter. Pediatr Emerg Care 5:189–190PubMed

20.

Bianchetti MG, Mauri S (1996) Hypotonic dehydration in cystic fibrosis: mild or severe disease phenotype? J Pediatr 128:723PubMed

21.

Bijman J (1987) Transport processes in the eccrine sweat gland. Kidney Int Suppl 21:S109–S112PubMed

22.

Carlile JR, Pafford DM, Waring WW (1983) Severe hypernatremia in cystic fibrosis. Am J Dis Child 137:702–703PubMed

23.

Chan LL, Osmond DH, Balfe JW, Halperin ML (1981) Plasma "prorenin"-renin in Bartter's syndrome, cystic fibrosis, and chloride deficiency, and the effect of prostaglandin synthetase inhibition. J Lab Clin Med 97:785–790PubMed

24.

Coates AJ, Crofton PM, Marshall T (2009) Evaluation of salt supplementation in CF infants. J Cyst Fibros 8:382–385PubMed

25.

Cohen LF, di Sant'Agnese PA, Taylor A, Gill JR Jr (1977) The syndrome of inappropriate antidiuretic hormone secretion as a cause of hyponatremia in cystic fibrosis. J Pediatr 90:574–578PubMed

26.

Corbeel L, Proesmans W (1994) Dehydration associated with hypochloraemic alkalosis and cystic fibrosis. Eur J Pediatr 153:792

27.

Davé S, Honney S, Raymond J, Flume PA (2005) An unusual presentation of cystic fibrosis in an adult. Am J Kidney Dis 45:e41–e44PubMed

28.

Davison AG, Snodgrass GJ (1983) Cystic fibrosis mimicking Bartter's syndrome. Acta Paediatr Scand 72:781–783PubMed

29.

Devlin J, Beckett NS, David TJ (1989) Elevated sweat potassium, hyperaldosteronism and pseudo-Bartter's syndrome: a spectrum of disorders associated with cystic fibrosis. J R Soc Med 82:38–43PubMedCentralPubMed

30.

Di Sant'Agnese PA, Darling RC, Perera GA, Shea E (1953) Abnormal electrolyte composition of sweat in cystic fibrosis of the pancreas. Pediatrics 12:549–563

31.

Di Sant'Agnese PA (1960) Salt depletion in cold weather in infants with cystic fibrosis of the pancreas. JAMA 172:2014–2021

32.

Eigenmann P, Délèze G, Kuchler H (1991) Chronic metabolic alkalosis in an infant with cystic fibrosis. Eur J Pediatr 150:669–670PubMed

33.

English MC (1993) Clinical quiz. Pediatr Nephrol 7:119–120PubMed

34.

Epaud R, Girodon E, Corvol H, Niel F, Guigonis V, Clement A, Feldmann D, Bensman A, Ulinski T (2005) Mild cystic fibrosis revealed by persistent hyponatremia during the French 2003 heat wave, associated with the S1455X C-terminus CFTR mutation. Clin Genet 68:552–553PubMed

35.

Escobar Castro H, Medina E, Kirchschläger E, Camarero C, Suarez L (1995) Metabolic alkalosis with hypo-electrolytaemia or pseudo-Bartter syndrome as a presentation of cystic fibrosis in infancy. Description of three cases. Eur J Pediatr 154:868–869PubMed

36.

Forsyth JS, Gillies DR, Wilson SG (1982) Cystic fibrosis presenting with chronic electrolyte depletion, metabolic alkalosis and hyperaldosteronism. Scott Med J 27:333–335PubMed

37.

Fustik S, Pop-Jordanova N, Slaveska N, Koceva S, Efremov G (2002) Metabolic alkalosis with hypoelectrolytemia in infants with cystic fibrosis. Pediatr Int 44:289–292PubMed

38.

Geara AS, Parikh A, Rekhtman Y, Rao MK (2012) The Case - Metabolic alkalosis in a patient with cystic fibrosis. Kidney Int 81:421–422PubMed

39.

Gökçe S, Süoğlu OD, Celtik C, Aydoğan A, Sökücü S (2007) Cystic fibrosis and hypoelectrolytemia. Pediatr Emerg Care 23:760PubMed

40.

Gottlieb RP (1971) Metabolic alkalosis in cystic fibrosis. J Pediatr 79:930–936PubMed

41.

Greig F, Schoeneman MJ, Kandall SR, Bonforte RJ (1993) Neonatal hyponatremic dehydration as an initial presentation of cystic fibrosis. Clin Pediatr (Phila) 32:548–551

42.

Guimarães EV, Schettino GC, Camargos PA, Penna FJ (2012) Prevalence of hyponatremia at diagnosis and factors associated with the longitudinal variation in serum sodium levels in infants with cystic fibrosis. J Pediatr 161:285–289PubMed

43.

Hochman HI, Feins NR, Rubin R, Gould J (1976) Chloride losing diarrhoea and metabolic alkalosis in an infant with cystic fibrosis. Arch Dis Child 51:390–391PubMedCentralPubMed

44.

Holland AE, Wilson JW, Kotsimbos TC, Naughton MT (2003) Metabolic alkalosis contributes to acute hypercapnic respiratory failure in adult cystic fibrosis. Chest 124:490–493PubMed

45.

Holland AE, Wilson JW, Kotsimbos TC, Naughton MT (2004) Metabolic alkalosis and cystic fibrosis. Chest 125:1169–1170

46.

Hooman N, Jafari D, Jalali-Farahani S, Lahouti Harahdashti A (2012) An infant with alternating metabolic acidosis and alkalosis. Pediatr Nephrol 27:51–54PubMed

47.

Issa ARA, Teebi AS, Issa MA, Shaabani IS, Ramadan DJ (1988) Metabolic alkalosis in cystic fibrosis: atypical presentation in Kuwait. Ann Trop Paediatr 8:271–272PubMed

48.

Kabra SK, Kabra M, Lodha R, Shastri S, Ghosh M, Pandey RM, Kapil A, Aggarwal G, Kapoor V (2003) Clinical profile and frequency of delta f508 mutation in Indian children with cystic fibrosis. Indian Pediatr 40:612–619PubMed

49.

Kaskavage J, Sklansky D (2012) Hyponatremia-associated rhabdomyolysis following exercise in an adolescent with cystic fibrosis. Pediatrics 130:e220–e223PubMed

50.

Kennedy JD, Dinwiddie R, Daman-Willems C, Dillon MJ, Matthew DJ (1990) Pseudo-Bartter's syndrome in cystic fibrosis. Arch Dis Child 65:786–787PubMedCentralPubMed

51.

Khorasani E (2011) Case of Pseudo-Bartter’s Syndrome: an atypical presentation of cystic fibrosis. J Nepal Paediatr Soc 31:121–123

52.

Kleta R, Brune T, Harms E (1999) Cystic fibrosis and metabolic alkalosis in children—revisited. Miner Electrolyte Metab 25:210PubMed

53.

Kose M, Pekcan S, Ozcelik U, Cobanoglu N, Yalcin E, Dogru D, Kiper N (2008) An epidemic of pseudo-Bartter syndrome in cystic fibrosis patients. Eur J Pediatr 167:115–116PubMed

54.

Kriemler S, Wilk B, Schurer W, Wilson WM, Bar-Or O (1999) Preventing dehydration in children with cystic fibrosis who exercise in the heat. Med Sci Sports Exerc 31:774–779PubMed

55.

Kurlandsky LE (2002) Failure to recognize the association of cystic fibrosis and metabolic alkalosis. Clin Pediatr (Phila) 41:715–719

56.

Laughlin JL, Brady MS, Eigen H (1981) Changing feeding trends as a cause of electrolyte depletion in infants with cystic fibrosis. Pediatrics 68:203–207PubMed

57.

Legris GJ, Dearborn D, Stern RC, Geiss CL, Hopfer U, Douglas JG, Doershuk CF (1998) Sodium space and intravascular volume: dietary sodium effects in cystic fibrosis and healthy adolescent subjects. Pediatrics 101:48–56PubMed

58.

Leoni GB, Pitzalis S, Podda R, Zanda M, Silvetti M, Caocci L, Cao A, Rosatelli MC (1995) A specific cystic fibrosis mutation (T3381) associated with the phenotype of isolated hypotonic dehydration. J Pediatr 127:281–283PubMed

59.

Lumpaopong A, Thirakhupt P, Srisuwan K, Chulamokha Y (2009) Rare F311L CFTR gene mutation in a child presented with recurrent electrolyte abnormalities and metabolic alkalosis: case report. J Med Assoc Thail 92:694–698

60.

Marah MA (2010) Pseudo-Bartter as an initial presentation of cystic fibrosis. A case report and review of the literature. East Mediterr Health J 16:699–701PubMed

61.

Mathew PM, Hamdan JA, Nazer H (1991) Cystic fibrosis presenting with recurrent vomiting and metabolic alkalosis. Eur J Pediatr 150:264–266PubMed

62.

Mauri S, Pedroli G, Rüdeberg A, Laux-End R, Monotti R, Bianchetti MG (1997) Acute metabolic alkalosis in cystic fibrosis: prospective study and review of the literature. Miner Electrolyte Metab 23:33–37PubMed

63.

Muñoz AI, Rodríguez A, Jiménez JF (1983) Cystic fibrosis of the pancreas presenting as metabolic alkalosis. Bol Asoc Med P R 75:230–231PubMed

64.

Nahida e-R, Mohammed H, Guy L (2011) Pseudo-Bartter's syndrome revealing cystic fibrosis in an infant caused by 3849 + 1G>A and 4382delA compound heterozygosity. Acta Paediatr 100:e234–e235

65.

Nussbaum E, Boat TF, Wood RE, Doershuk CF (1979) Cystic fibrosis with acute hypoelectrolytemia and metabolic alkalosis in infancy. Am J Dis Child 133:965–966PubMed

66.

Omron EM (2004) Metabolic alkalosis and cystic fibrosis. Chest 125:1169PubMed

67.

Özçelik U, Göçmen A, Kiper N, Coşkun T, Yilmaz E, Özgüç M (1994) Sodium chloride deficiency in cystic fibrosis patients. Eur J Pediatr 153:829–831PubMed

68.

Öztürk Y, Soylu OB, Arslan N (2006) Prevalence and clinical features of cystic fibrosis with pseudo-Bartter syndrome. Ann Trop Paediatr 26:155PubMed

69.

Pavone MA, Solís Padrones A, Muratore DG, Saiz M, Puig C (2010) Hyponatraemia, hypopotassaemia and pre-renal acute renal failure as a presentation of cystic fibrosis. Nefrologia 30:481–482PubMed

70.

Pedroli G, Liechti-Gallati S, Mauri S, Birrer P, Kraemer R, Foletti-Jäggi C, Bianchetti MG (1995) Chronic metabolic alkalosis: not uncommon in young children with severe cystic fibrosis. Am J Nephrol 15:245–250PubMed

71.

Priou-Guesdon M, Malinge MC, Augusto JF, Rodien P, Subra JF, Bonneau D, Rohmer V (2010) Hypochloremia and hyponatremia as the initial presentation of cystic fibrosis in three adults. Ann Endocrinol (Paris) 71:46–50

72.

Rapaport R, Levine LS, Petrovic M, Wilson T, Draznin M, Bejar RL, Johanson A, New MI (1981) The renin–aldosterone system in cystic fibrosis. J Pediatr 98:768–771PubMed

73.

Rendle-Short J (1956) Fibrocystic disease of the pancreas presenting with acute salt depletion. Arch Dis Child 31:28–30PubMedCentralPubMed

74.

Rodríguez Portales JA, Delea CS (1986) Renal tubular reabsorption of chloride in Bartter's syndrome and other conditions with hypokalemia. Clin Nephrol 26:269–272PubMed

75.

Ruddy R, Anolik R, Scanlin TF (1981) Hypoelectrolytemia as a presentation and complication of cystic fibrosis. Clin Pediatr (Phila) 21:367–369

76.

Salvatore D, Tomaiuolo R, Abate R, Vanacore B, Manieri S, Mirauda MP, Scavone A, Schiavo MV, Castaldo G, Salvatore F (2004) Cystic fibrosis presenting as metabolic alkalosis in a boy with the rare D579G mutation. J Cyst Fibros 3:135–136PubMed

77.

Schiffer M, Lynch R (1977) Inappropriate secretion of ADH as a cause of hyponatremia in cystic fibrosis. J Pediatr 91:850–851PubMed

78.

Sheth KJ, Heimler R (1977) Cystic fibrosis in an infant presenting with metabolic alkalosis. Wis Med J 76[Suppl]:47–49

79.

Smith HR, Dhatt GS, Melia WM, Dickinson JG (1995) Cystic fibrosis presenting as hyponatraemic heat exhaustion. BMJ 310:579–580PubMedCentralPubMed

80.

Sovtić A, Minić P, Bogdanović R, Stajić N, Rodić M, Marković-Sovtić G (2012) Atypical presentation of cystic fibrosis—obese adolescent with hypertension and pseudo-Bartter's syndrome. Vojnosanit Pregl 69:367–369PubMed

81.

Stenvinkel P, Hjelte L, Alván G, Hedman A, Hultman E, Strandvik B (1991) Decreased renal clearance of sodium in cystic fibrosis. Acta Paediatr Scand 80:194–198PubMed

82.

Sweetser LJ, Douglas JA, Riha RL, Bell SC (2005) Clinical presentation of metabolic alkalosis in an adult patient with cystic fibrosis. Respirology 10:254–256PubMed

83.

Teeratakulpisarn J, Kosuwon P, Srinakarin J, Panthongviriyakul C, Sutra S (2006) Cystic fibrosis in three northeast Thai infants is CF really a rare disease in the Thai population? J Med Assoc Thail 89:1756–1761

84.

Trauer JM, Wrobel JP, Young AC (2008) The syndrome of inappropriate anti-diuretic hormone secretion concurrent with an acute exacerbation of cystic fibrosis. J Cyst Fibros 7:573–575PubMed

85.

vande Velde S, Verloo P, Van Biervliet S, Robberecht E (2007) Heroin withdrawal leads to metabolic alkalosis in an infant with cystic fibrosis. Eur J Pediatr 166:75–76

86.

Vertolli U, Ruffatti AM, De Giorgi ML, Scapin V, Naso A, Calò LA (2013) A very unusual case of hypokalaemia. Clin Kidney J 6:87–89

87.

Wahab AA, Janahi IA, Marafia MM (2004) Pseudo-Bartter's syndrome in an Egyptian infant with cystic fibrosis mutation N1303K. J Trop Pediatr 50:242–244PubMed

88.

Wang MC, Shu SG, Chang SM, Ho WL, Chi CS (1993) Cystic fibrosis in two Chinese infants in Taiwan. Acta Paediatr Sin 34:314–321PubMed

89.

Williams AJ, McKiernan J, Harris F (1976) Heat prostration in children with cystic fibrosis. BMJ 273:297

90.

Yalçin E, Kiper N, Doğru D, Ozçelik U, Aslan AT (2005) Clinical features and treatment approaches in cystic fibrosis with pseudo-Bartter syndrome. Ann Trop Paediatr 25:119–124PubMed

91.

Yalçın SS, Akça T, Genç Ö, Çelik M, Doğru D, Özçelik U (2007) Modified oral rehydration therapy in a case with cystic fibrosis. Turk J Pediatr 49:102–104PubMed

92.

Yiallouros PK, Neocleous V, Zeniou M, Adamidou T, Costi C, Christophi C, Tzetis M, Kanavakis E, Deltas C (2007) Cystic fibrosis mutational spectrum and genotypic/phenotypic features in Greek-Cypriots, with emphasis on dehydration as presenting symptom. Clin Genet 71:290–292PubMed

93.

Živanović S, Šaranac L, Kostić G (2008) The case of Pseudo-Bartter’s syndrome: an atypical presentation of cystic fibrosis. Med Biol 15:33–36

94.

Dahabreh MM, Najada AS (2013) Pseudo-Bartter syndrome, pattern and correlation with other cystic fibrosis features. Saudi J Kidney Dis Transpl 24:292–296PubMed

95.

Aguirre I (2010) Fibrosis quística en el Perú. Neumol Pediatr 20:52

96.

Aranzamendi RJ, Breitman F, Asciutto C, Delgado N, Castaños C (2008) Deshidratación con alcalosis hipoclorémica: presentación inusual de fibrosis quística en un lactante. Arch Argent Pediatr 106:443–446PubMed

97.

Campaňá-Cobas NG, Razón Behar R, Álvarez SD, Mañalich Coma R, Valdés Mesa M, Hernández Hernández JS (2008) Fibrosis quística que simula un síndrome de Bartter. Rev Cubana Pediatr 80. Available at: www.scielo.sld.cu/scielo.php

98.

Frontera Izquierdo P, Cabezuelo Huerta G (1980) Alcalosis metabólica en un lactante come primera manfestación clínica de mucoviscidosis. An Esp Pediatr 13:731–732PubMed

99.

Param T, Aldunate D (1988) Alcalosis metabólica en fibrosis quística del páncreas. Rev Chil Pediatr 59:322–325PubMed

100.

Saieh CA, Rodríguez JA, Paris EM, Fuentes AG, Letelier GG (1982) Alcalosis metabólica hipokalémica: importancia del cloro. Rev Chil Pediatr 53:233–236PubMed

101.

Götz M, Parth K, Singer P, Weissenbacher G (1976) Hypochlorämische Alkalose und sekundärer Hyperaldosteronismus bei Mukoviszidose. Pädiatr Pädol 11:275–282PubMed

102.

Sauter R, Will M, Helwig H (1997) Schwere Hyponatriämie als diagnoseweisendes Symptom der cystischen Fibrose. Klin Padiatr 209:361–363PubMed

103.

Weller F, Wiebicke W, Tümmler B (2000) Türkischer Säugling mit Hypoelektrolytämie und metabolischer Alkalose als alleinige Manifestation einer milden Form einer zystischen Fibrose (Mutation D110H). Klin Padiatr 212:41–43PubMed

104.

Bérard E, Maillotte AM, Albertini M, Delalandre E, Boutté P, Mariani R (1994) Mucoviscidose révélée par une déshydratation avec alcalose hypochloronatrémique chez trois nourrissons et un nouveau-né. Arch Pediatr 1:42–45PubMed

105.

Desmazes-Dufeu N, Hubert D, Burgel PR, Kanaan R, Vélea V, Dusser D (2005) Déshydratation sévère, consequence de la canicule d’août 2003 sur une cohorte d’adultes atteints de mucoviscidose. Presse Med 34:647–648PubMed

106.

Sanfelice NFT, Zucchi L (1998) Síndrome de Bartter: relato de dois casos em crianças. J Pediatr (Rio J) 74:473–478

107.

Santos GPC, Cecon MR, Riedi CA, Dias LM, Braga MC, Rosário NA (2007) Alcalose hipoclorêmica em pacientes com fibrose cística—relato de 6 casos. J Paran Pediatr 8:43–44

108.

Luke RG, Galla JH (2012) It is chloride depletion alkalosis, not contraction alkalosis. J Am Soc Nephrol 23:204–207PubMedCentralPubMed

109.

Peruzzo M, Milani GP, Garzoni L, Longoni L, Simonetti GD, Bettinelli A, Fossali EF, Bianchetti MG (2010) Body fluids and salt metabolism—part II. Ital J Pediatr 36:78PubMedCentralPubMed

110.

Royer P (1975) Métabolisme du sodium et développement prénatal et postnatal. Arch Fr Pediatr 32:497–502PubMed

111.

Miozzari HH, Tönz M, von Vigier RO, Bianchetti MG (2001) Fluid resuscitation in infantile hypertrophic pyloric stenosis. Acta Paediatr 90:511–514PubMed

Title: Electrolyte abnormalities in cystic fibrosis: systematic review of the literature
Authors: Elisabetta Scurati-Manzoni
Emilio F. Fossali
Carlo Agostoni
Enrica Riva
Giacomo D. Simonetti
Maura Zanolari-Calderari
Mario G. Bianchetti
Sebastiano A. G. Lava
Publication date: 01-06-2014
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 6/2014
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-013-2712-4

At a glance: The STEP trials

Springer Medicine

Electrolyte abnormalities in cystic fibrosis: systematic review of the literature

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2014

Calcium and vitamin D for osteoprotection in children with new-onset nephrotic syndrome treated with steroids: a prospective, randomized, controlled, interventional study

Eculizumab in atypical haemolytic uraemic syndrome with severe cardiac and neurological involvement

Extrarenal sequential organ failure assessment score as an outcome predictor of critically ill children on continuous renal replacement therapy

Rituximab fails where eculizumab restores renal function in C3nef-related DDD

Conversion from twice- to once-daily tacrolimus in pediatric kidney recipients: a pharmacokinetic and bioequivalence study

Is the renin–angiotensin system actually hypertensive?