[Epidemiology of HBV infections and possibilities for therapeutic actions in children and adolescents with end-stage renal failure treated with dialysis]. / Epidemiologia zakazen HBV i mozliwosci dzialan terapeutycznych u dzieci i mlodziezy ze schylkowa niewydolnoscia nerek leczonych nerkozastepczo.

Wide spreading of prophylaxis principles of HBV infections in dialysis centers decreased the HBV infection rate in general population of dialyzed patients in Poland last years. There is neither data concerned with HBV infection epidemiology in children and adolescents, nor data about anti-viral treatment possibilities and effects in this group of dialyzed patients. The aim of the study was evaluating of HBV infection rate in patients of pediatric dialysis centers and analysis of causes of infection and efficacy of treatment. Study was based on data sent in a query-answer by 8 biggest pediatric dialysis centers, all of them treating 210 patients. HBV infection was found much more often (16.6%) than in population of all hemodialyzed patients in Poland. More than 75% non-vaccinated patients was infected before dialysis therapy, remaining were infected during vaccination, before the protecting level of antibodies was gained. Big differences in HBV infection rate among centers are observed. Nowadays HCV infections (more than 40% patients infected) are a bigger issue. Only 10 patients in 5 centers had anti-viral treatment (5 with isolated HBV infection, 5 with mixed HBV/HCV infection). In 9 patients interferon-alpha and in 1 patient lamivudine was administered. Efficacy of interferon-alpha treatment was similar to the population of non-uremic children (33.3% vs. 50% of HBeAg elimination). Majority of patients quite well tolerated the drug. Only in 1 case interferon-alpha treatment had to be ceased because of side effects. In a boy treated with lamivudine, after 3 months elimination of viremia and decrease of ALAT activity was observed. HBV infection in patients of pediatric dialysis centers is still a serious matter. More strict applying of vaccination against hepatitis B before dialysis treatment is needed. The possibility of HBV infections therapy is limited, mostly for economical reasons.

[Metabolic disorders in children with urolithiasis]. / Zaburzenia metaboliczne u dzieci ze skapoobjawowa postacia kamicy dróg moczowych.

Nephrolithiasis is a common disease of multifactorial ethiopatogenesis. The majority of stone formers has disturbances in the metabolism and excretion of stone constituents, promotors or inhibitors of crystallization. The aim of our study was to evaluate metabolic disturbances in children with nephrolithiasis in the early stages of the disease. Cases with severe urinary obstruction, infection and glomerular filtration decrease were excluded. Daily calcium, uric acid, oxalate, phosphate, sodium, potassium, chloride, citrate, and magnesium excretion was examined in 27 children (12 M, 15 F, mean age--10.4 +/- 3.9 y). Hypercalciuria (10 cases) and hiperurykosuria (8 cases) were most often found in the studied group. We concluded that early diagnosis of metabolic background of stone formation (promotors and inhibitors) enables to apply proper preventive measures.

[An incidence and etiology of Tenckhoff catheter in patients treated with CAPD]. / Czestosc wystepowania i etiologia zapalen ujscia zewnetrznego cewnika Tenckhoffa u chorych leczonych metoda dializy otrzewnowej.

Continuous ambulatory peritoneal dialysis (CAPD) is a renal replacement therapy of choice in small children, the elderly, diabetics, subjects with cardiovascular disease and with difficulties in vascular access. Frequent complication of this method is the infection of the Tenckhoff catheter exit site, definition of which has not been firmly established yet. The aim of this study was to assess the frequency of catheter exit infections, its bacterial etiology and the efficacy of antibiotic treatment. The study material consisted of 21 subjects (11 female, 10 male) treated with CAPD in 1992-99 at our department, mean age 19.8 +/- 11.8 yrs, with mean CAPD treatment time 33 +/- 27 months. They were divided into two groups: group I--patients aged > or = 5 yrs, and group II--patients aged 15 yrs. Mean catheter usage time was 15.8 +/- 14.9 months. 43 cases of catheter exit site infection was diagnosed (0.7 case of infection per patient per year). Infection frequency was found to be 1 case in 9.4 months and 1 in 26.5 months, in group I and II, respectively (p < 0.001). Catheter usage in two groups was 10.4 +/- 8.2 and 21.4 +/- 15.4 months, respectively (p < 0.01). The most frequent pathogen was S. aureus (31 cases), with 5 cases of MRSA strains found. Antibiotic treatment was applied according to Keane's recommendations and it lasted 13.2% of CAPD treatment duration. In conclusion, catheter exit site infection occurred more often in children under the age of 5 yrs, and the catheter usage time was significantly shorter in this group of patients.

[A role of hemodialysis in the treatment of acute renal failure in children less than 5 years of age]. / Rola hemodializy w leczeniu ostrej niewydolnosci nerek u dzieci ponizej 5 roku zycia.

Mortality in acute renal failure (ARF) still exceeds 50%. However, while the outcome data for ARF in adults are readily available, similar data for pediatric population are scarce. Children survival rate varies between centres, particularly in regard to age and size of a child, and cause of ARF. Dialysis continues to be a major supportive intervention in severe acute renal failure. There are few data available that address treatment modality impact on ARF outcome. The youngest patients are usually treated with peritoneal dialysis, though sometimes hemodialysis is used even in children with very low birth body weight. We reviewed a 9-year experience with hemodialysis in children under 5 years of age. 33 children (13 boys, 10 girls) were treated with hemodialysis in the analysed period. Their mean age was 26.8 +/- 23.0 years, mean body weight 10.6 +/- 4.6 kg. Cardiac surgery and haemolytic-uremic syndrome were the major causes of ARF in the studied group. Dialysis duration, ultrafiltration rate, maximum blood flow, mortality and its risk factors were analysed. 232 dialyses were conducted in the studied group, mean 6 dialyses per patient. Mean dialysis time was 85 +/- 42 min for the first and 135 +/- 38 min for consecutive procedures. Urea reduction rates in the first and following dialyses were 50% and 58% respectively. Maximum blood flow was 7.4 ml/kg/min, i.e. higher than recommended. However, no adverse events were caused by that. Mortality rate was 38%. Hemodialysis may be used in small children, when indicated, with no higher death rate than standard peritoneal dialysis.