Jan Scober

226 statements · 4 topics · summaries given as host listed separately

Peritoneal Dialysis Access · guest expert

Featured statements

▶ Ep 1 · 20:42
The GFR criteria in chronic kidney disease guidelines do not apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR.
guideline · Bladder Outlet Obstruction
▶ Ep 3 · 12:48
Lower urinary tract management in infants with obstructive uropathy requires collaboration with pediatric urologists and includes antibiotic prophylaxis, bladder irrigations, and bladder pressure management with anticholinergics and catheterization programs.
clinical · Oligohydramnios
▶ Ep 3 · 18:25
Standard chronic kidney disease staging based on GFR does not apply to children under 2 years of age because normal infants spend their first year developing normal kidney function, with GFR rising from about 50 at one month to about 100 by one year.
clinical · Oligohydramnios
▶ Ep 1 · 13:53
Lower urinary tract management aims to reduce the risk of urinary tract infection through antibiotic prophylaxis and bladder irrigations, and to manage bladder pressure with anticholinergics and catheterization programs guided by urodynamic studies.
clinical · Bladder Outlet Obstruction
▶ Ep 4 · 23:26
When counseling parents about infant dialysis, the focus should be on the length of time it may be needed (until the child reaches transplantable size at 8-10 kg, typically in the second year of life) and the complexity of the therapy package.
opinion · Peritoneal Dialysis Access
▶ Ep 4 · 29:16
Aquaphoresis (ultrafiltration with convective clearance) using slightly smaller catheters than hemodialysis has been successfully used to maintain anuric babies with intraperitoneal problems or those requiring major abdominal surgeries.
clinical · Peritoneal Dialysis Access

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Jan's statements about Bladder Outlet Obstruction 24 statements

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Managing Advanced Chronic Kidney Disease: Cincinnati Fetal Center

▶ Ep 1 · 10:06
quote we really like urine and we're talking about babies who have urine, if we're talking about measuring things in the urine prenatally or shunting things. ↗
▶ Ep 1 · 10:32
clinical Any kind of urine output is much better than no urine output, even if the urine is of poor quality and does not contain cleared metabolites. ↗
▶ Ep 1 · 10:42
quote any kind of urine is much better than no urine ↗
▶ Ep 1 · 11:03
clinical Babies with obstructive uropathy often have a concentrating defect and produce large volumes of urine. ↗
▶ Ep 1 · 13:24
clinical At this center, the size required for safe transplantation is typically between 8 and 10 kg, which usually occurs in the second year of life. ↗
▶ Ep 1 · 13:53
clinical Lower urinary tract management aims to reduce the risk of urinary tract infection through antibiotic prophylaxis and bladder irrigations, and to manage bladder pressure with anticholinergics and catheterization programs guided by urodynamic studies. ↗
▶ Ep 1 · 14:52
clinical Obstructive uropathy bladders can be very high pressure and can change over time, requiring regular follow-up and potentially changing management strategies. ↗
▶ Ep 1 · 15:37
clinical Hypertension is not commonly seen in these babies because they have high urine output and are not volume overloaded, and they tend to lose sodium due to tubular dysfunction. ↗
▶ Ep 1 · 19:48
clinical Normal GFR for a newborn at 1 month of age is about 50, and it takes a whole year to reach what is accepted as normal GFR in older individuals, which is about 100. ↗
▶ Ep 1 · 20:14
clinical Reasonable predictions based on clearance and creatinine cannot be made until a patient has spent the first year of life establishing their kidney function. ↗
▶ Ep 1 · 20:42
guideline The GFR criteria in chronic kidney disease guidelines do not apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR. ↗
▶ Ep 1 · 22:42
clinical Dialysis is indicated when chronic kidney disease management fails, specifically when the baby stops growing (including head circumference) or when hyperkalemia or metabolic acidosis cannot be medically managed. ↗
▶ Ep 1 · 23:27
clinical Peritoneal dialysis is the technically least difficult way to provide dialysis in small children. ↗
▶ Ep 1 · 24:53
quote typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job. ↗
▶ Ep 1 · 25:17
clinical Urine output remains a significant advantage because it is very difficult to manage fluid balance with dialysis alone if there is no residual diuresis. ↗
▶ Ep 1 · 30:04
clinical When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted, though they are challenging due to the need for blood priming and large catheters in small blood vessels. ↗
▶ Ep 1 · 30:22
clinical Aquapheresis (ultrafiltration with convective clearance) using slightly smaller catheters has been successfully used to maintain an anuric baby with intraperitoneal problems. ↗
▶ Ep 1 · 32:34
clinical Nutrition in babies with urine output is easier than in oliguric or anuric babies because the formula does not need to be as concentrated. ↗
▶ Ep 1 · 32:49
clinical High-output babies lose electrolytes and may require supplementation of potassium and phosphorus, which are typically restricted in older chronic kidney disease patients. ↗
▶ Ep 1 · 33:12
clinical The density of formula is essentially an inverse function of urine output. ↗
▶ Ep 1 · 33:50
clinical The need to provide adequate protein intake may necessitate dialysis in some babies because their BUN cannot be managed otherwise. ↗
▶ Ep 1 · 34:15
clinical It is relatively unusual to expect these babies to drink spontaneously in amounts sufficient to supply adequate nutrition. ↗
▶ Ep 1 · 34:31
clinical Breast milk can be incorporated into specialized formulas that meet the baby's specific needs when mothers are motivated to provide it. ↗
▶ Ep 1 · 34:45
clinical The majority of these children have an NG tube or gastrostomy tube, which they keep even around transplant time for medication administration. ↗
Jan's statements about Oligohydramnios 56 statements

Open the Oligohydramnios collection →

Managing Advanced Chronic Kidney Disease: Cincinnati Fetal Center

▶ Ep 1 · 10:06
quote we really like urine and we're talking about babies who have urine, if we're talking about measuring things in the urine prenatally or shunting things. ↗
▶ Ep 1 · 10:32
clinical Any kind of urine output is much better than no urine output, even if the urine is of poor quality and does not contain cleared metabolites. ↗
▶ Ep 1 · 10:42
quote any kind of urine is much better than no urine ↗
▶ Ep 1 · 11:03
clinical Babies with obstructive uropathy often have a concentrating defect and produce large volumes of urine. ↗
▶ Ep 1 · 13:24
clinical At this center, the size required for safe transplantation is typically between 8 and 10 kg, which usually occurs in the second year of life. ↗
▶ Ep 1 · 13:53
clinical Lower urinary tract management aims to reduce the risk of urinary tract infection through antibiotic prophylaxis and bladder irrigations, and to manage bladder pressure with anticholinergics and catheterization programs guided by urodynamic studies. ↗
▶ Ep 1 · 14:52
clinical Obstructive uropathy bladders can be very high pressure and can change over time, requiring regular follow-up and potentially changing management strategies. ↗
▶ Ep 1 · 15:37
clinical Hypertension is not commonly seen in these babies because they have high urine output and are not volume overloaded, and they tend to lose sodium due to tubular dysfunction. ↗
▶ Ep 1 · 19:48
clinical Normal GFR for a newborn at 1 month of age is about 50, and it takes a whole year to reach what is accepted as normal GFR in older individuals, which is about 100. ↗
▶ Ep 1 · 20:14
clinical Reasonable predictions based on clearance and creatinine cannot be made until a patient has spent the first year of life establishing their kidney function. ↗
▶ Ep 1 · 20:42
guideline The GFR criteria in chronic kidney disease guidelines do not apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR. ↗
▶ Ep 1 · 22:42
clinical Dialysis is indicated when chronic kidney disease management fails, specifically when the baby stops growing (including head circumference) or when hyperkalemia or metabolic acidosis cannot be medically managed. ↗
▶ Ep 1 · 23:27
clinical Peritoneal dialysis is the technically least difficult way to provide dialysis in small children. ↗
▶ Ep 1 · 24:53
quote typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job. ↗
▶ Ep 1 · 25:17
clinical Urine output remains a significant advantage because it is very difficult to manage fluid balance with dialysis alone if there is no residual diuresis. ↗
▶ Ep 1 · 30:04
clinical When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted, though they are challenging due to the need for blood priming and large catheters in small blood vessels. ↗
▶ Ep 1 · 30:22
clinical Aquapheresis (ultrafiltration with convective clearance) using slightly smaller catheters has been successfully used to maintain an anuric baby with intraperitoneal problems. ↗
▶ Ep 1 · 32:34
clinical Nutrition in babies with urine output is easier than in oliguric or anuric babies because the formula does not need to be as concentrated. ↗
▶ Ep 1 · 32:49
clinical High-output babies lose electrolytes and may require supplementation of potassium and phosphorus, which are typically restricted in older chronic kidney disease patients. ↗
▶ Ep 1 · 33:12
clinical The density of formula is essentially an inverse function of urine output. ↗
▶ Ep 1 · 33:50
clinical The need to provide adequate protein intake may necessitate dialysis in some babies because their BUN cannot be managed otherwise. ↗
▶ Ep 1 · 34:15
clinical It is relatively unusual to expect these babies to drink spontaneously in amounts sufficient to supply adequate nutrition. ↗
▶ Ep 1 · 34:31
clinical Breast milk can be incorporated into specialized formulas that meet the baby's specific needs when mothers are motivated to provide it. ↗
▶ Ep 1 · 34:45
clinical The majority of these children have an NG tube or gastrostomy tube, which they keep even around transplant time for medication administration. ↗

Fetal management of advanced chronic kidney disease: Fetal Genitourinary...

▶ Ep 3 · 9:01
quote we really like urine and we're talking about babies who have urine, if we're talking about measuring things in the urine prenatally or shunting things. ↗
▶ Ep 3 · 9:26
clinical Any kind of urine output, even poor-quality urine that is mostly water without cleared metabolites, is much better than no urine for both prenatal and postnatal management. ↗
▶ Ep 3 · 9:26
quote any kind of urine is much better than no urine ↗
▶ Ep 3 · 9:46
clinical Infants with obstructive uropathy often have a concentrating defect and produce large volumes of urine, which may be poor quality but is still beneficial as fluid. ↗
▶ Ep 3 · 9:58
quote It may again be bad urine, but at least it's fluid. ↗
▶ Ep 3 · 12:29
clinical At this center, infants are typically transplantable at a size between 8 and 10 kg, which usually occurs in the second year of life. ↗
▶ Ep 3 · 12:48
clinical Lower urinary tract management in infants with obstructive uropathy requires collaboration with pediatric urologists and includes antibiotic prophylaxis, bladder irrigations, and bladder pressure management with anticholinergics and catheterization programs. ↗
▶ Ep 3 · 13:40
clinical Obstructive uropathy bladders can have very high pressure and can change over time, requiring regular urodynamic studies and potentially changing management strategies. ↗
▶ Ep 3 · 14:33
clinical Infants with chronic kidney disease from obstructive uropathy typically do not have significant hypertension because they have high urine output and are not volume overloaded, and they lose sodium due to tubular dysfunction. ↗
▶ Ep 3 · 15:13
clinical Chronic kidney disease management in infants requires supplementation of erythropoietin and iron to prevent anemia, which has negative cognitive, energy, and quality-of-life effects. ↗
▶ Ep 3 · 15:47
clinical Untreated secondary hyperparathyroidism from advanced CKD impairs bone and skeletal health, which is especially problematic in growing children. ↗
▶ Ep 3 · 16:03
clinical Advanced chronic kidney disease not requiring dialysis often causes metabolic acidosis, which is harmful to growth and well-being and requires buffering with citrate supplementation. ↗
▶ Ep 3 · 16:20
clinical Specialized nutrition management in infant CKD includes formula modification and pre-treatment with potassium-binding resins to prevent hyperkalemia. ↗
▶ Ep 3 · 16:44
clinical Infants with advanced CKD have feeding and swallowing difficulties and require occupational therapy, physical therapy, and feeding team involvement for developmental support. ↗
▶ Ep 3 · 18:25
clinical Standard chronic kidney disease staging based on GFR does not apply to children under 2 years of age because normal infants spend their first year developing normal kidney function, with GFR rising from about 50 at one month to about 100 by one year. ↗
▶ Ep 3 · 21:39
clinical The decision to initiate dialysis is based on failed chronic kidney disease management—inability to support growth (including head circumference) or medically manage hyperkalemia or metabolic acidosis—not on creatinine level alone. ↗
▶ Ep 3 · 22:22
clinical Peritoneal dialysis is the modality of choice for infant dialysis because it is the technically least difficult approach in small children. ↗
▶ Ep 3 · 23:04
clinical Peritoneal dialysis introduces a major additional layer of complexity and quality-of-life burden for parents, who are typically taught to perform dialysis at home. ↗
▶ Ep 3 · 23:26
opinion When counseling parents about infant dialysis, the focus should be on the length of time it may be needed (until the child reaches transplantable size at 8-10 kg, typically in the second year of life) and the complexity of the therapy package. ↗
▶ Ep 3 · 23:47
quote typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job. ↗
▶ Ep 3 · 23:47
clinical Parents typically report that when their baby requires complex care including dialysis, one parent usually stops working and caring for the baby becomes their full-time job. ↗
▶ Ep 3 · 24:11
clinical Residual urine output is a major advantage in managing fluid balance during dialysis; it is very difficult to manage fluid balance with dialysis alone without some residual diuresis. ↗
▶ Ep 3 · 24:26
opinion It is difficult to justify placing a patient on chronic dialysis without some prospect of transplantation, as this creates a never-ending one-way street that becomes very challenging. ↗
▶ Ep 3 · 28:58
clinical When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted but are challenging because they require blood priming of circuits and very large catheters in small blood vessels. ↗
▶ Ep 3 · 29:16
clinical Aquaphoresis (ultrafiltration with convective clearance) using slightly smaller catheters than hemodialysis has been successfully used to maintain anuric babies with intraperitoneal problems or those requiring major abdominal surgeries. ↗
▶ Ep 3 · 31:28
clinical Nutrition management is easier in infants with urine output compared to oliguric or anuric infants because formula does not need to be as concentrated. ↗
▶ Ep 3 · 31:43
clinical High-output infants with CKD lose electrolytes including potassium and phosphorus, requiring supplementation of electrolytes that are typically restricted in older CKD patients. ↗
▶ Ep 3 · 32:06
clinical Formula density for infants with CKD is inversely related to urine output volume. ↗
▶ Ep 3 · 32:18
clinical Dietitians calculate required calories for growth and required protein intake while ensuring BUN does not reach dangerously high levels; the inability to provide adequate protein without excessive BUN may necessitate dialysis. ↗
▶ Ep 3 · 32:45
clinical It is relatively unusual to expect infants with advanced CKD to drink spontaneously in amounts sufficient to supply required nutrition. ↗
▶ Ep 3 · 33:03
clinical Breast milk from motivated mothers can be incorporated into specialized formulas that meet the infant's specific nutritional needs; this is typically pumped breast milk. ↗
▶ Ep 3 · 33:39
clinical The majority of infants with advanced CKD have either an NG tube or gastrostomy tube for feeding, which is maintained even around transplant time for medication administration. ↗
Jan's statements about Peritoneal Dialysis Access 114 statements

Open the Peritoneal Dialysis Access collection →

Managing Advanced Chronic Kidney Disease: Cincinnati Fetal Center

▶ Ep 1 · 10:06
quote we really like urine and we're talking about babies who have urine, if we're talking about measuring things in the urine prenatally or shunting things. ↗
▶ Ep 1 · 10:06
quote we really like urine and we're talking about babies who have urine, if we're talking about measuring things in the urine prenatally or shunting things. ↗
▶ Ep 1 · 10:32
clinical Any kind of urine output is much better than no urine output, even if the urine is of poor quality and does not contain cleared metabolites. ↗
▶ Ep 1 · 10:32
clinical Any kind of urine output is much better than no urine output, even if the urine is of poor quality and does not contain cleared metabolites. ↗
▶ Ep 1 · 10:42
quote any kind of urine is much better than no urine ↗
▶ Ep 1 · 10:42
quote any kind of urine is much better than no urine ↗
▶ Ep 1 · 11:03
clinical Babies with obstructive uropathy often have a concentrating defect and produce large volumes of urine. ↗
▶ Ep 1 · 11:03
clinical Babies with obstructive uropathy often have a concentrating defect and produce large volumes of urine. ↗
▶ Ep 1 · 13:24
clinical At this center, the size required for safe transplantation is typically between 8 and 10 kg, which usually occurs in the second year of life. ↗
▶ Ep 1 · 13:24
clinical At this center, the size required for safe transplantation is typically between 8 and 10 kg, which usually occurs in the second year of life. ↗
▶ Ep 1 · 13:53
clinical Lower urinary tract management aims to reduce the risk of urinary tract infection through antibiotic prophylaxis and bladder irrigations, and to manage bladder pressure with anticholinergics and catheterization programs guided by urodynamic studies. ↗
▶ Ep 1 · 13:53
clinical Lower urinary tract management aims to reduce the risk of urinary tract infection through antibiotic prophylaxis and bladder irrigations, and to manage bladder pressure with anticholinergics and catheterization programs guided by urodynamic studies. ↗
▶ Ep 1 · 14:52
clinical Obstructive uropathy bladders can be very high pressure and can change over time, requiring regular follow-up and potentially changing management strategies. ↗
▶ Ep 1 · 14:52
clinical Obstructive uropathy bladders can be very high pressure and can change over time, requiring regular follow-up and potentially changing management strategies. ↗
▶ Ep 1 · 15:37
clinical Hypertension is not commonly seen in these babies because they have high urine output and are not volume overloaded, and they tend to lose sodium due to tubular dysfunction. ↗
▶ Ep 1 · 15:37
clinical Hypertension is not commonly seen in these babies because they have high urine output and are not volume overloaded, and they tend to lose sodium due to tubular dysfunction. ↗
▶ Ep 1 · 19:48
clinical Normal GFR for a newborn at 1 month of age is about 50, and it takes a whole year to reach what is accepted as normal GFR in older individuals, which is about 100. ↗
▶ Ep 1 · 19:48
clinical Normal GFR for a newborn at 1 month of age is about 50, and it takes a whole year to reach what is accepted as normal GFR in older individuals, which is about 100. ↗
▶ Ep 1 · 20:14
clinical Reasonable predictions based on clearance and creatinine cannot be made until a patient has spent the first year of life establishing their kidney function. ↗
▶ Ep 1 · 20:14
clinical Reasonable predictions based on clearance and creatinine cannot be made until a patient has spent the first year of life establishing their kidney function. ↗
▶ Ep 1 · 20:42
guideline The GFR criteria in chronic kidney disease guidelines do not apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR. ↗
▶ Ep 1 · 20:42
guideline The GFR criteria in chronic kidney disease guidelines do not apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR. ↗
▶ Ep 1 · 22:42
clinical Dialysis is indicated when chronic kidney disease management fails, specifically when the baby stops growing (including head circumference) or when hyperkalemia or metabolic acidosis cannot be medically managed. ↗
▶ Ep 1 · 22:42
clinical Dialysis is indicated when chronic kidney disease management fails, specifically when the baby stops growing (including head circumference) or when hyperkalemia or metabolic acidosis cannot be medically managed. ↗
▶ Ep 1 · 23:27
clinical Peritoneal dialysis is the technically least difficult way to provide dialysis in small children. ↗
▶ Ep 1 · 23:27
clinical Peritoneal dialysis is the technically least difficult way to provide dialysis in small children. ↗
▶ Ep 1 · 24:53
quote typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job. ↗
▶ Ep 1 · 24:53
quote typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job. ↗
▶ Ep 1 · 25:17
clinical Urine output remains a significant advantage because it is very difficult to manage fluid balance with dialysis alone if there is no residual diuresis. ↗
▶ Ep 1 · 25:17
clinical Urine output remains a significant advantage because it is very difficult to manage fluid balance with dialysis alone if there is no residual diuresis. ↗
▶ Ep 1 · 30:04
clinical When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted, though they are challenging due to the need for blood priming and large catheters in small blood vessels. ↗
▶ Ep 1 · 30:04
clinical When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted, though they are challenging due to the need for blood priming and large catheters in small blood vessels. ↗
▶ Ep 1 · 30:22
clinical Aquapheresis (ultrafiltration with convective clearance) using slightly smaller catheters has been successfully used to maintain an anuric baby with intraperitoneal problems. ↗
▶ Ep 1 · 30:22
clinical Aquapheresis (ultrafiltration with convective clearance) using slightly smaller catheters has been successfully used to maintain an anuric baby with intraperitoneal problems. ↗
▶ Ep 1 · 32:34
clinical Nutrition in babies with urine output is easier than in oliguric or anuric babies because the formula does not need to be as concentrated. ↗
▶ Ep 1 · 32:34
clinical Nutrition in babies with urine output is easier than in oliguric or anuric babies because the formula does not need to be as concentrated. ↗
▶ Ep 1 · 32:49
clinical High-output babies lose electrolytes and may require supplementation of potassium and phosphorus, which are typically restricted in older chronic kidney disease patients. ↗
▶ Ep 1 · 32:49
clinical High-output babies lose electrolytes and may require supplementation of potassium and phosphorus, which are typically restricted in older chronic kidney disease patients. ↗
▶ Ep 1 · 33:12
clinical The density of formula is essentially an inverse function of urine output. ↗
▶ Ep 1 · 33:12
clinical The density of formula is essentially an inverse function of urine output. ↗
▶ Ep 1 · 33:50
clinical The need to provide adequate protein intake may necessitate dialysis in some babies because their BUN cannot be managed otherwise. ↗
▶ Ep 1 · 33:50
clinical The need to provide adequate protein intake may necessitate dialysis in some babies because their BUN cannot be managed otherwise. ↗
▶ Ep 1 · 34:15
clinical It is relatively unusual to expect these babies to drink spontaneously in amounts sufficient to supply adequate nutrition. ↗
▶ Ep 1 · 34:15
clinical It is relatively unusual to expect these babies to drink spontaneously in amounts sufficient to supply adequate nutrition. ↗
▶ Ep 1 · 34:31
clinical Breast milk can be incorporated into specialized formulas that meet the baby's specific needs when mothers are motivated to provide it. ↗
▶ Ep 1 · 34:31
clinical Breast milk can be incorporated into specialized formulas that meet the baby's specific needs when mothers are motivated to provide it. ↗
▶ Ep 1 · 34:45
clinical The majority of these children have an NG tube or gastrostomy tube, which they keep even around transplant time for medication administration. ↗
▶ Ep 1 · 34:45
clinical The majority of these children have an NG tube or gastrostomy tube, which they keep even around transplant time for medication administration. ↗

Fetal management of advanced chronic kidney disease: Fetal Genitourinary...

▶ Ep 4 · 9:01
quote we really like urine and we're talking about babies who have urine, if we're talking about measuring things in the urine prenatally or shunting things. ↗
▶ Ep 4 · 9:01
quote we really like urine and we're talking about babies who have urine, if we're talking about measuring things in the urine prenatally or shunting things. ↗
▶ Ep 4 · 9:26
quote any kind of urine is much better than no urine ↗
▶ Ep 4 · 9:26
quote any kind of urine is much better than no urine ↗
▶ Ep 4 · 9:26
clinical Any kind of urine output, even poor-quality urine that is mostly water without cleared metabolites, is much better than no urine for both prenatal and postnatal management. ↗
▶ Ep 4 · 9:26
clinical Any kind of urine output, even poor-quality urine that is mostly water without cleared metabolites, is much better than no urine for both prenatal and postnatal management. ↗
▶ Ep 4 · 9:46
clinical Infants with obstructive uropathy often have a concentrating defect and produce large volumes of urine, which may be poor quality but is still beneficial as fluid. ↗
▶ Ep 4 · 9:46
clinical Infants with obstructive uropathy often have a concentrating defect and produce large volumes of urine, which may be poor quality but is still beneficial as fluid. ↗
▶ Ep 4 · 9:58
quote It may again be bad urine, but at least it's fluid. ↗
▶ Ep 4 · 9:58
quote It may again be bad urine, but at least it's fluid. ↗
▶ Ep 4 · 12:29
clinical At this center, infants are typically transplantable at a size between 8 and 10 kg, which usually occurs in the second year of life. ↗
▶ Ep 4 · 12:29
clinical At this center, infants are typically transplantable at a size between 8 and 10 kg, which usually occurs in the second year of life. ↗
▶ Ep 4 · 12:48
clinical Lower urinary tract management in infants with obstructive uropathy requires collaboration with pediatric urologists and includes antibiotic prophylaxis, bladder irrigations, and bladder pressure management with anticholinergics and catheterization programs. ↗
▶ Ep 4 · 12:48
clinical Lower urinary tract management in infants with obstructive uropathy requires collaboration with pediatric urologists and includes antibiotic prophylaxis, bladder irrigations, and bladder pressure management with anticholinergics and catheterization programs. ↗
▶ Ep 4 · 13:40
clinical Obstructive uropathy bladders can have very high pressure and can change over time, requiring regular urodynamic studies and potentially changing management strategies. ↗
▶ Ep 4 · 13:40
clinical Obstructive uropathy bladders can have very high pressure and can change over time, requiring regular urodynamic studies and potentially changing management strategies. ↗
▶ Ep 4 · 14:33
clinical Infants with chronic kidney disease from obstructive uropathy typically do not have significant hypertension because they have high urine output and are not volume overloaded, and they lose sodium due to tubular dysfunction. ↗
▶ Ep 4 · 14:33
clinical Infants with chronic kidney disease from obstructive uropathy typically do not have significant hypertension because they have high urine output and are not volume overloaded, and they lose sodium due to tubular dysfunction. ↗
▶ Ep 4 · 15:13
clinical Chronic kidney disease management in infants requires supplementation of erythropoietin and iron to prevent anemia, which has negative cognitive, energy, and quality-of-life effects. ↗
▶ Ep 4 · 15:13
clinical Chronic kidney disease management in infants requires supplementation of erythropoietin and iron to prevent anemia, which has negative cognitive, energy, and quality-of-life effects. ↗
▶ Ep 4 · 15:47
clinical Untreated secondary hyperparathyroidism from advanced CKD impairs bone and skeletal health, which is especially problematic in growing children. ↗
▶ Ep 4 · 15:47
clinical Untreated secondary hyperparathyroidism from advanced CKD impairs bone and skeletal health, which is especially problematic in growing children. ↗
▶ Ep 4 · 16:03
clinical Advanced chronic kidney disease not requiring dialysis often causes metabolic acidosis, which is harmful to growth and well-being and requires buffering with citrate supplementation. ↗
▶ Ep 4 · 16:03
clinical Advanced chronic kidney disease not requiring dialysis often causes metabolic acidosis, which is harmful to growth and well-being and requires buffering with citrate supplementation. ↗
▶ Ep 4 · 16:20
clinical Specialized nutrition management in infant CKD includes formula modification and pre-treatment with potassium-binding resins to prevent hyperkalemia. ↗
▶ Ep 4 · 16:20
clinical Specialized nutrition management in infant CKD includes formula modification and pre-treatment with potassium-binding resins to prevent hyperkalemia. ↗
▶ Ep 4 · 16:44
clinical Infants with advanced CKD have feeding and swallowing difficulties and require occupational therapy, physical therapy, and feeding team involvement for developmental support. ↗
▶ Ep 4 · 16:44
clinical Infants with advanced CKD have feeding and swallowing difficulties and require occupational therapy, physical therapy, and feeding team involvement for developmental support. ↗
▶ Ep 4 · 18:25
clinical Standard chronic kidney disease staging based on GFR does not apply to children under 2 years of age because normal infants spend their first year developing normal kidney function, with GFR rising from about 50 at one month to about 100 by one year. ↗
▶ Ep 4 · 18:25
clinical Standard chronic kidney disease staging based on GFR does not apply to children under 2 years of age because normal infants spend their first year developing normal kidney function, with GFR rising from about 50 at one month to about 100 by one year. ↗
▶ Ep 4 · 19:36
guideline Guideline writers accept that GFR criteria for CKD staging don't apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR. ↗
▶ Ep 4 · 20:37
opinion Dialysis for small children remains challenging but has improved in outcomes and feasibility and should be discussed with families on an individualized basis. ↗
▶ Ep 4 · 21:39
clinical The decision to initiate dialysis is based on failed chronic kidney disease management—inability to support growth (including head circumference) or medically manage hyperkalemia or metabolic acidosis—not on creatinine level alone. ↗
▶ Ep 4 · 21:39
clinical The decision to initiate dialysis is based on failed chronic kidney disease management—inability to support growth (including head circumference) or medically manage hyperkalemia or metabolic acidosis—not on creatinine level alone. ↗
▶ Ep 4 · 22:22
clinical Peritoneal dialysis is the modality of choice for infant dialysis because it is the technically least difficult approach in small children. ↗
▶ Ep 4 · 22:22
clinical Peritoneal dialysis is the modality of choice for infant dialysis because it is the technically least difficult approach in small children. ↗
▶ Ep 4 · 23:04
clinical Peritoneal dialysis introduces a major additional layer of complexity and quality-of-life burden for parents, who are typically taught to perform dialysis at home. ↗
▶ Ep 4 · 23:04
clinical Peritoneal dialysis introduces a major additional layer of complexity and quality-of-life burden for parents, who are typically taught to perform dialysis at home. ↗
▶ Ep 4 · 23:26
opinion When counseling parents about infant dialysis, the focus should be on the length of time it may be needed (until the child reaches transplantable size at 8-10 kg, typically in the second year of life) and the complexity of the therapy package. ↗
▶ Ep 4 · 23:26
opinion When counseling parents about infant dialysis, the focus should be on the length of time it may be needed (until the child reaches transplantable size at 8-10 kg, typically in the second year of life) and the complexity of the therapy package. ↗
▶ Ep 4 · 23:47
quote typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job. ↗
▶ Ep 4 · 23:47
quote typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job. ↗
▶ Ep 4 · 23:47
clinical Parents typically report that when their baby requires complex care including dialysis, one parent usually stops working and caring for the baby becomes their full-time job. ↗
▶ Ep 4 · 23:47
clinical Parents typically report that when their baby requires complex care including dialysis, one parent usually stops working and caring for the baby becomes their full-time job. ↗
▶ Ep 4 · 24:11
clinical Residual urine output is a major advantage in managing fluid balance during dialysis; it is very difficult to manage fluid balance with dialysis alone without some residual diuresis. ↗
▶ Ep 4 · 24:11
clinical Residual urine output is a major advantage in managing fluid balance during dialysis; it is very difficult to manage fluid balance with dialysis alone without some residual diuresis. ↗
▶ Ep 4 · 24:26
opinion It is difficult to justify placing a patient on chronic dialysis without some prospect of transplantation, as this creates a never-ending one-way street that becomes very challenging. ↗
▶ Ep 4 · 24:26
opinion It is difficult to justify placing a patient on chronic dialysis without some prospect of transplantation, as this creates a never-ending one-way street that becomes very challenging. ↗
▶ Ep 4 · 28:58
clinical When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted but are challenging because they require blood priming of circuits and very large catheters in small blood vessels. ↗
▶ Ep 4 · 28:58
clinical When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted but are challenging because they require blood priming of circuits and very large catheters in small blood vessels. ↗
▶ Ep 4 · 29:16
clinical Aquaphoresis (ultrafiltration with convective clearance) using slightly smaller catheters than hemodialysis has been successfully used to maintain anuric babies with intraperitoneal problems or those requiring major abdominal surgeries. ↗
▶ Ep 4 · 29:16
clinical Aquaphoresis (ultrafiltration with convective clearance) using slightly smaller catheters than hemodialysis has been successfully used to maintain anuric babies with intraperitoneal problems or those requiring major abdominal surgeries. ↗
▶ Ep 4 · 31:28
clinical Nutrition management is easier in infants with urine output compared to oliguric or anuric infants because formula does not need to be as concentrated. ↗
▶ Ep 4 · 31:28
clinical Nutrition management is easier in infants with urine output compared to oliguric or anuric infants because formula does not need to be as concentrated. ↗
▶ Ep 4 · 31:43
clinical High-output infants with CKD lose electrolytes including potassium and phosphorus, requiring supplementation of electrolytes that are typically restricted in older CKD patients. ↗
▶ Ep 4 · 31:43
clinical High-output infants with CKD lose electrolytes including potassium and phosphorus, requiring supplementation of electrolytes that are typically restricted in older CKD patients. ↗
▶ Ep 4 · 32:06
clinical Formula density for infants with CKD is inversely related to urine output volume. ↗
▶ Ep 4 · 32:06
clinical Formula density for infants with CKD is inversely related to urine output volume. ↗
▶ Ep 4 · 32:18
clinical Dietitians calculate required calories for growth and required protein intake while ensuring BUN does not reach dangerously high levels; the inability to provide adequate protein without excessive BUN may necessitate dialysis. ↗
▶ Ep 4 · 32:18
clinical Dietitians calculate required calories for growth and required protein intake while ensuring BUN does not reach dangerously high levels; the inability to provide adequate protein without excessive BUN may necessitate dialysis. ↗
▶ Ep 4 · 32:45
clinical It is relatively unusual to expect infants with advanced CKD to drink spontaneously in amounts sufficient to supply required nutrition. ↗
▶ Ep 4 · 32:45
clinical It is relatively unusual to expect infants with advanced CKD to drink spontaneously in amounts sufficient to supply required nutrition. ↗
▶ Ep 4 · 33:03
clinical Breast milk from motivated mothers can be incorporated into specialized formulas that meet the infant's specific nutritional needs; this is typically pumped breast milk. ↗
▶ Ep 4 · 33:03
clinical Breast milk from motivated mothers can be incorporated into specialized formulas that meet the infant's specific nutritional needs; this is typically pumped breast milk. ↗
▶ Ep 4 · 33:39
clinical The majority of infants with advanced CKD have either an NG tube or gastrostomy tube for feeding, which is maintained even around transplant time for medication administration. ↗
▶ Ep 4 · 33:39
clinical The majority of infants with advanced CKD have either an NG tube or gastrostomy tube for feeding, which is maintained even around transplant time for medication administration. ↗
Jan's statements about Posterior Urethral Valves 32 statements

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Fetal management of advanced chronic kidney disease: Fetal Genitourinary...

▶ Ep 4 · 9:01
quote we really like urine and we're talking about babies who have urine, if we're talking about measuring things in the urine prenatally or shunting things. ↗
▶ Ep 4 · 9:26
clinical Any kind of urine output, even poor-quality urine that is mostly water without cleared metabolites, is much better than no urine for both prenatal and postnatal management. ↗
▶ Ep 4 · 9:26
quote any kind of urine is much better than no urine ↗
▶ Ep 4 · 9:46
clinical Infants with obstructive uropathy often have a concentrating defect and produce large volumes of urine, which may be poor quality but is still beneficial as fluid. ↗
▶ Ep 4 · 9:58
quote It may again be bad urine, but at least it's fluid. ↗
▶ Ep 4 · 12:29
clinical At this center, infants are typically transplantable at a size between 8 and 10 kg, which usually occurs in the second year of life. ↗
▶ Ep 4 · 12:48
clinical Lower urinary tract management in infants with obstructive uropathy requires collaboration with pediatric urologists and includes antibiotic prophylaxis, bladder irrigations, and bladder pressure management with anticholinergics and catheterization programs. ↗
▶ Ep 4 · 13:40
clinical Obstructive uropathy bladders can have very high pressure and can change over time, requiring regular urodynamic studies and potentially changing management strategies. ↗
▶ Ep 4 · 14:33
clinical Infants with chronic kidney disease from obstructive uropathy typically do not have significant hypertension because they have high urine output and are not volume overloaded, and they lose sodium due to tubular dysfunction. ↗
▶ Ep 4 · 15:13
clinical Chronic kidney disease management in infants requires supplementation of erythropoietin and iron to prevent anemia, which has negative cognitive, energy, and quality-of-life effects. ↗
▶ Ep 4 · 15:47
clinical Untreated secondary hyperparathyroidism from advanced CKD impairs bone and skeletal health, which is especially problematic in growing children. ↗
▶ Ep 4 · 16:03
clinical Advanced chronic kidney disease not requiring dialysis often causes metabolic acidosis, which is harmful to growth and well-being and requires buffering with citrate supplementation. ↗
▶ Ep 4 · 16:20
clinical Specialized nutrition management in infant CKD includes formula modification and pre-treatment with potassium-binding resins to prevent hyperkalemia. ↗
▶ Ep 4 · 16:44
clinical Infants with advanced CKD have feeding and swallowing difficulties and require occupational therapy, physical therapy, and feeding team involvement for developmental support. ↗
▶ Ep 4 · 18:25
clinical Standard chronic kidney disease staging based on GFR does not apply to children under 2 years of age because normal infants spend their first year developing normal kidney function, with GFR rising from about 50 at one month to about 100 by one year. ↗
▶ Ep 4 · 21:39
clinical The decision to initiate dialysis is based on failed chronic kidney disease management—inability to support growth (including head circumference) or medically manage hyperkalemia or metabolic acidosis—not on creatinine level alone. ↗
▶ Ep 4 · 22:22
clinical Peritoneal dialysis is the modality of choice for infant dialysis because it is the technically least difficult approach in small children. ↗
▶ Ep 4 · 23:04
clinical Peritoneal dialysis introduces a major additional layer of complexity and quality-of-life burden for parents, who are typically taught to perform dialysis at home. ↗
▶ Ep 4 · 23:26
opinion When counseling parents about infant dialysis, the focus should be on the length of time it may be needed (until the child reaches transplantable size at 8-10 kg, typically in the second year of life) and the complexity of the therapy package. ↗
▶ Ep 4 · 23:47
quote typically our parents will tell us that if they both held jobs prior to having to take care of a complicated, complicated, challenging baby like this, uh, when that started, one of them usually stopped working and, and the baby became his or her job. ↗
▶ Ep 4 · 23:47
clinical Parents typically report that when their baby requires complex care including dialysis, one parent usually stops working and caring for the baby becomes their full-time job. ↗
▶ Ep 4 · 24:11
clinical Residual urine output is a major advantage in managing fluid balance during dialysis; it is very difficult to manage fluid balance with dialysis alone without some residual diuresis. ↗
▶ Ep 4 · 24:26
opinion It is difficult to justify placing a patient on chronic dialysis without some prospect of transplantation, as this creates a never-ending one-way street that becomes very challenging. ↗
▶ Ep 4 · 28:58
clinical When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted but are challenging because they require blood priming of circuits and very large catheters in small blood vessels. ↗
▶ Ep 4 · 29:16
clinical Aquaphoresis (ultrafiltration with convective clearance) using slightly smaller catheters than hemodialysis has been successfully used to maintain anuric babies with intraperitoneal problems or those requiring major abdominal surgeries. ↗
▶ Ep 4 · 31:28
clinical Nutrition management is easier in infants with urine output compared to oliguric or anuric infants because formula does not need to be as concentrated. ↗
▶ Ep 4 · 31:43
clinical High-output infants with CKD lose electrolytes including potassium and phosphorus, requiring supplementation of electrolytes that are typically restricted in older CKD patients. ↗
▶ Ep 4 · 32:06
clinical Formula density for infants with CKD is inversely related to urine output volume. ↗
▶ Ep 4 · 32:18
clinical Dietitians calculate required calories for growth and required protein intake while ensuring BUN does not reach dangerously high levels; the inability to provide adequate protein without excessive BUN may necessitate dialysis. ↗
▶ Ep 4 · 32:45
clinical It is relatively unusual to expect infants with advanced CKD to drink spontaneously in amounts sufficient to supply required nutrition. ↗
▶ Ep 4 · 33:03
clinical Breast milk from motivated mothers can be incorporated into specialized formulas that meet the infant's specific nutritional needs; this is typically pumped breast milk. ↗
▶ Ep 4 · 33:39
clinical The majority of infants with advanced CKD have either an NG tube or gastrostomy tube for feeding, which is maintained even around transplant time for medication administration. ↗

Summaries Jan gave as host · 6 summaries

Recaps of other experts' statements, not Jan's own clinical position.

Summaries Jan gave as host · Oligohydramnios 2 summaries

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Fetal management of advanced chronic kidney disease: Fetal Genitourinary...

▶ Ep 3 · 19:36
host summary Jan Scober summarizing the discussion: Guideline writers accept that GFR criteria for CKD staging don't apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR. ↗
▶ Ep 3 · 20:37
host summary Jan Scober summarizing the discussion: Dialysis for small children remains challenging but has improved in outcomes and feasibility and should be discussed with families on an individualized basis. ↗
Summaries Jan gave as host · Peritoneal Dialysis Access 2 summaries

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Fetal management of advanced chronic kidney disease: Fetal Genitourinary...

▶ Ep 4 · 19:36
host summary Jan Scober summarizing the discussion: Guideline writers accept that GFR criteria for CKD staging don't apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR. ↗
▶ Ep 4 · 20:37
host summary Jan Scober summarizing the discussion: Dialysis for small children remains challenging but has improved in outcomes and feasibility and should be discussed with families on an individualized basis. ↗
Summaries Jan gave as host · Posterior Urethral Valves 2 summaries

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Fetal management of advanced chronic kidney disease: Fetal Genitourinary...

▶ Ep 4 · 19:36
host summary Jan Scober summarizing the discussion: Guideline writers accept that GFR criteria for CKD staging don't apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR. ↗
▶ Ep 4 · 20:37
host summary Jan Scober summarizing the discussion: Dialysis for small children remains challenging but has improved in outcomes and feasibility and should be discussed with families on an individualized basis. ↗