Although multiple case reports have been published, several obstacles make the diagnosis of serotonin syndrome more difficult in pediatric patients [ 26-29 ]. Children may not be able to communicate vague symptoms; clinicians may not consider the syndrome a pediatric problem; and adolescents may be reluctant to disclose recreational drug use, which may include serotonergic agents, such as methylenedioxymethamphetamine (MDMA; "ecstasy") or dextromethorphan [ 13 ]. (See "MDMA (ecstasy) intoxication" and "Dextromethorphan abuse and poisoning: Clinical features and diagnosis" .)
After surgical excision, up to 30% of patients with localized tumors experience relapse. The lung is the most common site of distant recurrence, seen in 50% to 60% of patients. The median time to relapse after surgery is approximately 2 years, with most relapses occurring within 5 years. Interferon alpha and high-dose interleukin-2 (IL-2) have been tested as adjuvant treatments following resection of stage 1-2 kidney cancer. However, no benefit has been seen in randomized trials. 29,30 Observation remains standard care after nephrectomy, and eligible patients should be offered enrollment in randomized clinical trials.
Chronic kidney failure is measured in five stages, which are calculated using a patient’s GFR, or glomerular filtration rate . Stage 1 CKD is mildly diminished renal function, with few overt symptoms. Stages 2 and 3 need increasing levels of supportive care from their medical providers to slow and treat their renal dysfunction. Patients in stages 4 and 5 usually require preparation of the patient towards active treatment in order to survive. Stage 5 CKD is considered a severe illness and requires some form of renal replacement therapy ( dialysis ) or kidney transplant whenever feasible.