Left ventricular geometry in children with chronic renal failure.

The aim of the study was to assess left ventricular (LV) geometry in children with chronic renal insufficiency (CRI), and its relationship with glomerular filtration rate (GFR) and preexisting renal disease. Echocardiography was performed on 56 non-dialysed CRI patients and 56 controls. CRI patients had bigger interventricular septum thickness (0.77+/-0.17 vs. 0.67+/-0.12 cm, p=0.002), LV posterior wall thickness (0.79+/-0.14 vs. 0.71+/-0.14 cm, p<0.006), LV mass index (LVMI) (40.7+/-12.2 vs. 31.7+/-6.3 g/m2.7, p<0.0001; 86.4+/-24.1 vs. 69.1+/-13.9 g/m2, p<0.0001), and relative wall thickness (0.38+/-0.05 vs. 0.34+/-0.04, p<0.0001) in comparison with controls. Twenty (36%) of CRI patients had LV hypertrophy (LVH). Thirteen patients (23%) had eccentric LVH, 7 (13%)-concentric LVH), and 9 (16%) of patients-concentric LV remodeling. No significant difference was found between LV parameters in patient groups with different GFR. Patients with acquired renal diseases and hereditary nephropathies had significantly higher LVMI than patients with congenital renal abnormalities. Our results indicate that changes of LV geometry are present in children with mild, moderate and predialysis CRI. These findings support the concept of cardiovascular disease risk for patients with different stages of CRI.

Enalapril influence on blood pressure and echocardiographic parameters in children with acute postinfectious glomerulonephritis.

UNLABELLED: The aim of the study was to evaluate the effects of early treatment with the angiotensin-converting enzyme inhibitor, enalapril, on the blood pressure and left ventricular diameters and function in children suffering from acute postinfectious glomerulonephritis. PATIENTS AND METHODS: A total of 51 children with acute postinfectious glomerulonephritis were involved in the study. Out of them, 26 patients were treated with enalapril for 6 weeks, 25 patients served as their controls. Their blood pressure was measured every other day in the early course of the disease, after 6-8 weeks, and after 6 months. 2D, M-mode, pulsed-wave Doppler echocardiography were performed on 18 enalapril treated patients and 14 controls on admission to the hospital and after 6-8 weeks. RESULTS: An earlier decline in blood pressure was found in the enalapril treated patients, with no difference between the groups at 6 months after onset of acute postinfectious glomerulonephritis. Comparison of the echocardiographic findings at the onset of acute postinfectious glomerulonephritis and after 6-8 weeks of enalapril treatment showed a significant decrease of left ventricular end-diastolic diameter (4.42+/-0.71 cm before treatment vs. 4.19+/-0.69 after treatment, p<0.001), left ventricular end-systolic diameter (2.81+/-0.59 cm vs. 2.64+/-0.48 cm, respectively, p=0.04), left ventricular mass (102.56+/-51.86 g vs. 86.77+/-43.54 g, p<0.001), and mitral peak flow velocity of late filling (0.54+/-0.11 m/s vs. 0.49+/-0.09 m/s, p=0.02). Other parameters, although statistically nonsignificant, showed better improvement in the enalapril treated patients than in those untreated. In the enalapril untreated group, echocardiographic parameters did not change significantly. CONCLUSION: A better antihypertensive effect was found in the enalapril treated patients, as well as better improvement of echocardiographic parameters, early in the disease. Whether these effects of enalapril have some influence on the outcome of acute postinfectious glomerulonephritis requires further study.

[Poststreptococcal reactive arthritis]. / Postreptokokinis reaktyvusis artritas.

Arthritis, following infection caused by group A beta-hemolytic streptococcus, is classically attributed to acute rheumatic fever. However, a new clinical syndrome, called poststreptococcal reactive arthritis, as a distinct entity from acute rheumatic fever, was described recently. The purpose of this paper is to provide a summary of published information on poststreptococcal reactive arthritis. The paper outlines its clinical description and proposed diagnostic criteria. Similarities and differences between poststreptococcal reactive arthritis and acute rheumatic fever are discussed. Information regarding long-term risk of carditis following poststreptococcal reactive arthritis is provided, and therapeutic recommendations are outlined.

Echocardiographic findings in children ill with acute postinfectious glomerulonephritis.

There are many studies about heart dysfunction and its significance in chronic renal diseases, but only few data regards cardiac involvement in acute glomerular diseases. The aim of this study was to assess echocardiographic changes in children with acute postinfectious glomerulonephritis (APGN), and the relationship of those changes to blood pressure (BP), edema and glomerular filtration rate (GFR). Echocardiography was performed on 127 patients on admission to the hospital, on a random sample consisting of 51 patients after 6-8 weeks, and 124 controls. In the acute phase, APGN patients had a greater left ventricular (LV) internal end-diastolic diameter (LVIDd) (P=0.022), interventricular septum thickness (IVSd) (P=0.038), LV mass (LVM) (P=0.0001), longer early diastolic flow deceleration time (DT) (P=0.0001), and higher numbers of cases with mitral regurgitation (MR) (P=0.0001) and pericardial effusion (P=0.0001) in comparison with the controls. Changes were more evident in the youngest patients. At follow-up after 6-8 weeks, echocardiographic parameters significantly improved, but LV posterior wall thickness, IVSd, LV end-diastolic volume, LVM and DT remained greater than in the controls. GFR and edema influenced echocardiographic parameters. In conclusion, in a group of children ill with APGN, increases in left ventricular dimensions, wall thickness, LVM and changes in the left ventricular diastolic function related to edema and GFR were found. Whether different treatment regimens effect these changes requires further study.