Antibody response to chlamydiae in children with asthma and respiratory illness.

No relation between the occurrence of antibodies to chlamydial agents and asthma in children was found. In asthmatic children, the antibodies to Chlamydia trachomatis occurred in 3.1% and to Chlamydophila pneumoniae in 22.7%, whereas in a control group of children without asthma or other allergic disease in 2.3% and 24.0%, respectively. The occurrence of antibodies of IgA and IgG classes to C. pneumoniae was also very similar; its rise was age-dependent. On the other hand, in the group of children in a pre-school age with respiratory tract infection, anti-chlamydial antibodies were demonstrated significantly more often (18.5% of IgG antibodies to C. trachomatis, 20.0% of IgM antibodies to both C. trachomatis and C. pneumoniae) than in those suffering from other, non-respiratory illness (3.9% of the former and 5.9% of the latter antibodies). However, in these children, we did not succeed in detection of C. trachomatis in conjunctival and nasopharyngeal smears by PCR. Nevertheless, chlamydial agents (C. trachomatis in infants, C. pneumoniae in pre-school children) should be taken into consideration in a differential diagnosis of respiratory tract inflammation.

[Diagnosis of renal tumors with percutaneous biopsy]. / Diagnostika nádorov obliciek pomocou punkcnej biopsie.

The authors describe four, out of 506 cases of renal biopsies in which this diagnostic procedure enabled to reveal a tumour. Two cases of tumours which were intentionally subdued to renal biopsy justified an angiomyolipoma and a focus (metastasis) of tubulopapillomatous carcinoma) in the kidney. In one case the renal biopsy revealed renal infiltration thus enabling to state the diagnosis of chronic lymphatic leukaemia subsequently, and in the last case where the diagnosis of chronic lymphatic leukaemia had been stated in advance, the renal biopsy was performed due to suspective glomerulonephritis. In these cases the unexpected results of renal biopsy were of great diagnostic value. Such intentional use of biopsy is rare. (Fig. 3, Ref. 6.)

[Growth hormone therapy in prepubertal children with chronic renal insufficiency]. / Liecba rastovým hormónom u prepubertálnych detí v chronickej renálnej insuficiencii.

BACKGROUND: Growth retardation is a serious problem in children with chronic renal failure (CRF) despite normal endogenous growth hormone (GH) secretion. Intensive medical care and dialysis do not improve height velocity. The aim of the study was to evaluate the efficacy of GH therapy in children with growth retardation secondary to CRF. METHODS AND RESULTS: Biosynthetic growth hormone was given to 7 prepubertal children (five boys and 2 girls, age with a range 3.5-14.5 years) with severe growth retardation and CRF during 1 year. The dosage of GH was 1 IU/kg/per week. GH was given daily, sc. The patients had a full examination every 3 months. Six children completed the study. Height velocity improved with GH therapy in 5 children. Renal function deterioration was accelerated in 2 children. The serum alkaline phosphatase concentration increased and the serum calcium concentration decreased during GH treatment in all children. Glucose, thyroid gland hormone concentration and lipid concentrations remained constant. CONCLUSIONS: The study showed clearly that treatment with biosynthetic GH gave an impressive improvement of height velocity in growth retarded prepubertal children with CRF.

[Variations in histologic and ultrastructural findings in renal glomerular biopsies]. / Rozdielne histologické a ultrastruktúrne nálezy v glomeruloch renálnej biopsie.

On the basis of 506 renal biopsies performed within a six-year period (237 of which were evaluated electron-microscopically) the authors discovered that in 11 cases the diagnosis based on electron microscopic examination had to be corrected or supplemented by the diagnostic statement of membranous glomerulonephritis. These cases included 1 boy (HBsAg positive), 2 men and 8 women were middle aged. 5 women were treated due to polyarthritis. All cases when examined light-microscopically yielded a pattern evaluated as normal, or as minute abnormalities of glomeruli. Half-thick sections were not sufficient for the diagnosis. 3 cases of biopsies yielded a variously developed chronic tubulointerstitial nephritis, two cases were accompanied with polyarthritis. On the basis of the latter the authors consider the electron microscopic examination as indicated: 1. in cases when the diagnosis statement is not achieved by other examinations, 2. findings are in the range of the so-called variable norm, 3. in all cases of minute abnormalities in glomeruli detected without electron microscopy, 4. the impact of any of effective drugs cannot be excluded, 5. the diagnostic conclusion based on renal biopsy and the clinical-laboratory pattern of the disease are inconsistent. The authors assume that especially the fourth and fifth groups are going to be gradually supplemented and made more precise. (Fig. 1, Ref. 5.).

[Minor glomerular abnormalities in chronic tubulointerstitial nephritis]. / Malé abnormality glomerulov pri chronických tubulointersticiálnych nefritídach.

The authors examined consecutive renal biopsies from 43 patients with minor glomerular abnormalities and from 35 patients with chronic tubulointerstitial nephritis (in the least affected glomeruli). The findings were evaluated according to WHO criteria of minor abnormalities. They found that significantly more frequently lipid drops were found in minor abnormalities (6:0), as well as changes in the capillaries of glomeruli (breakdown 1:7), wrinkling (15:29-highly significant even after correction of p)) in tubulointerstitial nephritis. The incidence in another 15 compared indicators there was not significantly different. With regard to the assembled results the authors consider the morphological finding of minor glomerular abnormalities as non-specific changes, and adaptational glomerular changes in response to various noxious substances. Therefore it is necessary to evaluate purely morphological findings of minor abnormalities carefully and in a differentiated manner, in particular in conjunction with treatment.

[The nephrotic syndrome in renal biopsies]. / Nefrotický syndróm v renálnych biopsiách.

Among 1,499 representative renal biopsies in 278 cases nephrotic syndrome was diagnosed. In the latter only in 201 glomerulonephritis was confirmed by biopsy and in 77 (more than one quarter) the bioptic finding was different. The authors attempt to analyze the essential feature of nephrotic syndrome focused on the glomerular basal membrane and surrounding structures.

[Long-term prognosis in children with minor glomerular abnormalities]. / Dlhodobá prognóza detí s malými abnormalitami glomerulov.

The authors evaluated the course and prognosis of the disease in 109 children with minor glomerular abnormalities manifested clinically in 45.9% as nephrotic syndrome (NS), in 33% as nephritic syndrome (GN), in 11.9% as isolated haematuria (IH) and in 9.2% as Schönlein-Henoch's purpura (PSH). In NS 78% of the children had before biopsy of the kidneys frequent relapses, 22% were resistant to cortisonoids. After biopsy all children were given cortisonoids, 94% immunosuppressive treatment with cytostatics and some of the children additional treatment. The number of resistant cases declined to 10% and the mean number of relapses from four to one in 12 months. Children under five years had more relapses (P less than 0.05) but also more complete remissions (P less than 0.001) than older children. Relapses occurred up to 10.2 years after the onset of the disease (mean = 4 years). With advancing age and duration of the disease their number declined after treatment. An adverse symptom was resistance to cortisonoids and immunosuppressive treatment, major haematuria and persisting hypertension but not immunological activity (elevated level of immune complexes, reduced C3, positive immunohistochemical finding in renal tissue). The morphological finding which at the onset was slightly beyond the range of minor abnormalities had a poorer prognosis when associated with greater clinical activity. The group developed 88% complete remissions and 6% CHRI. After 22 years the probability of survival in complete continual remission is 66%, the probability in CHRI is 10% (with morphological progression). In nephritic syndrome the children were given after biopsy prednisone in 80.6% and cytostatics in 44.4%. In PSH this treatment was given to 100% and 60% of the children, in IH to 61.5% and 7.7%. On evaluation in nephritic syndrome complete remission was recorded in 47.2%, after 0.4-10.5 years since the onset of the disease; 30.6% did not improve and in 2.8% CHRI developed. In PSH remission developed in 60% after 0.8-6.9 years, no improvement was recorded in 20%, incl. 10% where CHRI developed after a resistant course of NS. In IH 84.6% of the patients did not improve, but in none the renal function deteriorated. The course was in all instances milder than in NS, most frequently only with microscopic haematuria and/or slight proteinuria, respectively minor immunological activity. In the entire group of minor glomerular abnormalities complete remission was achieved in two-thirds of the children, in one quarter the disease did not improve, incl. 4.6% where CHRI developed, always associated with progression of morphological changes.(ABSTRACT TRUNCATED AT 400 WORDS)

[Treatment of nephrotic syndrome with cyclosporin A]. / Liecba nefrotického syndrómu cyklosporínom A.

The authors treated eight children with corticoid dependent syndrome caused by minor abnormalities of the glomeruli with Cyclosporin A. They administered Cyclosporin, 5 mg/kg/24 h., for a period of 8-16 weeks. In three patients they used Cyclosporin A alone, 5 children were given in addition 10 mg Prednisone per day. They achieved complete remission in all patients. During treatment they monitored haematological and biochemical parameters as well as Cyclosporin A levels; before treatment and after its termination they examined also immunological indicators. They did not observe any serious side effects of treatment.

[Congenital nephrotic syndrome]. / Kongenitálny nefrotický syndróm.

Only one case of congenital nephrotic syndrome was recorded in a series of 2,500 bioptic examinations of the kidney performed over a period of 20 years. In necroptic material examined over the same period of time congenital nephrotic syndrome was recorded three times. At the first bioptic examination of the kidneys only minimal changes of glomeruli were diagnosed. Rebiopsy exhibited proliferation of mesangial cells, focal segmental glomerular sclerosis, cystically dilated tubules in the juxtamedular region of the cortex, and focal tubulointerstitial reactive changes, which in accordance with the clinical findings were assessed as congenital nephrotic syndrome of the Finnish type. Comparison of the findings observed at the first biopsy and at rebiopsy demonstrates the importance of proper collection of a representative sample for renal biopsy.

[Diagnosis and classification of tubulointerstitial nephritis]. / Problémy diagnostiky a klasifikácie tubulointersticiálnych nefritíd.

To make a correct diagnosis of tubulointerstitial nephritis and to make it in time calls for knowledge of its clinical symptomatology (it is usually very marked in acute forms and in chronic forms it is frequently inapparent) and it is essential to know the main causes which produce this type of renal damage. In some instances the already developed disease is diagnosed and not infrequently even renal failure. Recognition of the aetiological and pathogenetic multiplicity of the disease, as made possible by the submitted classification of the WHO expert commission, is one of the prerequisites of the diagnosis and treatment in time or of prevention by effective provisions.

Treatment of renal hypertension in children by captopril.

Nine children aged 2 months to 13 (mean 6.6) years with renal hypertension were treated with captopril. The treatment lasted for 1.5 to 14 months. Maintenance doses ranged between 1 and 5 mg/kg/day. Good effect was achieved with captopril in children with normal renal function and in mild renal insufficiency. In patients with end-stage renal disease when dialysis failed to maintain normal body water captopril was ineffective.