[The influence of protein and phosphorous restricted diet supplemented with essential aminoacids (EAA) and their alpha-keto-analogues (KAA) on nutritional status of children with chronic renal failure (CRF)]. / Uticaj normoenergetske, neselekcione niskoproteinske dijete na stanje uhranjenosti dece s hronicnom insuficijencijom bubrega.

The purpose of the study was to establish the influence of protein restricted diet supplemented with EAA/KAA on nutritional status of children with CRF. Seven childredn (four girls and three boys), aged from 7 years and eight months to 14 years and two months, with glomerular filtration rate of 42.6-9.2 ml/min/1.73 m2 and proteinuria of 0.025-1.125 g/24 h, who were on conservative treatment and who lived at home, were observed for six months. In prescribing energy value and protein intake WHO recommendations were used for healthly children (age for height). Through food 80-90% of energy and 80-85% of protein needs were provided. The remaining energy and proteins were provided by glucodextrin and EAA/KAA supplements respectevely. Average daily phosphorous intake amounted to about 550-800 mg. The obtained results showed that stunting and kwashiorkor like aminoacid disbalance were the prominent nutritional problems. This dietary regimen had a beneficial effect on all studied parameters. especially on height standard deviation score which increased from 1.71 +/- 2.6 to 1.5 +/- 4.3 (t = 2.809, p < 0.05); total essential/nonessential aminoacid score increased from 0.38 +/- 0.2 to 0.56 +/- 0.2 (t = 2.763, p < 0.05). The ratio between plasma concentration of four nonessential (glycine+serinet glutamine+taurine) to four essential (leucine+isoleucine+valine+methionine) amino acids decreased from 3.82 +/- 1.2 to 2.7 +/- 0.4 (t = 2.528, p < 0.05). Lymphocyte count increased from 1.809 x 10(9) +/- 0.268 x 10(9)/l to 2.314 x 10(9) +/- 0.922 x 10(9)/l (t = 2.431, p < 0.05). No significant changes were found in the values of relative body weight, arm circumpherence, triceps skinfold thickness, total plasma protein, albumin, transferine, complement C3 and plasma valin/glycin and phenylalanine/thyrosine ratio. It should be noted that the significant changes were not found in the results of these latter anthropometric biochemical parameters in relation to their primary almost insignificant values.

[Levels of immunoreactive atrial natriuretic peptide in the blood of children on hemodialysis therapy]. / Koncentracija imunoreaktivnog atrijumskog natriuretskog peptida u plazmi dece lecene hemodijalizom.

Expansion of extracellular fluid volume,--increasing right atrial pressure,--appears to be a major stimulus for the rise in plasma atrial natriuretic peptide (ANP). End-stage renal disease (ESRD) is associated with significant changes of several hormone systems. Recent studies have shown that plasma ANP concentration is significantly increased in patients with ESRD and that the concentration of the hormone declines following haemodialysis (HD). In patients with ESRD treated by HD "dry weight" for each individual patient is the body weight at which the patients has normal hydration status. The aim of the present study was to determine changes of plasma concentrations of ANP during haemodialysis. We also attempted to check whether the baseline levels of ANP were related to weight loss during dialysis. Eleven children (7 females, 4 males) participated in the study. The patients age related from 8 to 20 years. Plasma concentrations were markedly elevated (p < 0.01) before haemodialysis (251 ae 119) pg/ml) in comparison with control values (61 ae 23 pg/ml), but remained above normal range in all except 4 cases. During HD body weight was reduced in all but one patient. This patient was infused isotonic fluid during HD and did not show weight loss. The four patients who had normal plasma ANP levels at the end of treatment appeared to be in better overall condition than the other patients. In summary, plasma ANP measurements may be of value in establishing the volume status in patients with ESRD. Plasma ANP levels after HD may help to adjust the right dry body weight for each patient.

Medium- and long-term prognosis of patients with acute poststreptococcal glomerulonephritis.

The prognosis of acute poststreptococcal glomerulonephritis (APSGN) is still a matter of considerable debate. In an attempt to elucidate this controversy, the medium-term prognosis was evaluated in 40 patients 5-9 years after the onset of the disease, and the long-term prognosis in 88 patients 10-17 years after the onset of the disease. All were sporadic cases. In the medium-term follow-up study, abnormalities were revealed in 5.0% (2/40) of the patients. Hypertension and proteinuria were the only abnormalities detected. In the long-term follow-up study, abnormalities were revealed in 6.8% (6/88) of the patients. Hypertension was found in 3.4, proteinuria in 2.3, and microhaematuria in 2.3% of the patients. In both studies, all patients had normal creatinine clearance. We conclude that the medium- and long-term outcome of patients with APSGN is excellent.