ABSTRACT
INTRODUCTION: Adalimumab (ADM) is a recombinant human monoclonal antibody (anti-TNFα) used to treat inflammatory bowel diseases. It can cause kidney injury (KI). CASE DIAGNOSIS/TREATMENT: We describe two pediatric patients with Crohn's disease (CD) in whom ADM therapy was associated with kidney injury (KI). The drug was discontinued in both cases. For the first patient, changes were irreversible despite intensive glucocorticosteroid (GCS) therapy. For the second patient, discontinuation of ADM led to an improvement in kidney function. CONCLUSIONS: Due to the risk of KI in patients undergoing ADM therapy, careful assessment of kidney function and early specialist referral are required. Timely withdrawal of ADM can significantly reduce kidney damage, but in some cases, the kidney damage can be irreversible.
Subject(s)
Acute Kidney Injury , Adalimumab , Crohn Disease , Humans , Crohn Disease/drug therapy , Crohn Disease/complications , Adalimumab/adverse effects , Adalimumab/therapeutic use , Adolescent , Male , Acute Kidney Injury/chemically induced , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Female , Anti-Inflammatory Agents/therapeutic use , Anti-Inflammatory Agents/adverse effects , ChildABSTRACT
BACKGROUND AND OBJECITVES: The currently available kidney volume normative values in children are restricted to small populations from single-centre studies not assessing kidney function and including none or only a small number of adolescents. This study aimed to obtain ultrasound-based kidney volume normative values derived from a large European White/Caucasian paediatric population with normal kidney function. METHODS: After recruitment of 1427 children aged 0-19 years, 1396 individuals with no history of kidney disease and normal estimated glomerular filtration rate were selected for the sonographic evaluation of kidney volume. Kidney volume was correlated with age, height, weight, body surface area and body mass index. Kidney volume curves and tables related to anthropometric parameters were generated using the LMS method. Kidney volume predictors were evaluated using multivariate regression analysis with collinearity checks. RESULTS: No clinically significant differences in kidney volume in relation to height were found between males and females, between supine and prone position and between left and right kidneys. Males had, however, larger age-related kidney volumes than females in most age categories. For the prediction of kidney volume, the highest coefficient correlation was observed for body surface area (r = 0.94), followed by weight (r = 0.92), height (r = 0.91), age (r = 0.91), and body mass index (r = 0.67; p < 0.001 for all). CONCLUSIONS: This study presents LMS-percentile curves and tables for kidney volume which can be used as reference values for children aged 0-19 years.
Subject(s)
Kidney , Ultrasonography , Humans , Adolescent , Child , Male , Female , Infant , Child, Preschool , Kidney/diagnostic imaging , Kidney/anatomy & histology , Reference Values , Organ Size , Infant, Newborn , Young Adult , Body Mass Index , Glomerular Filtration Rate , Age Factors , Europe , Body WeightABSTRACT
Purpose: Arterial hypertension (HT) is a main, potentially reversible cardiovascular risk factor. Long lasting HT leads to hypertension mediated organ damage (HMOD) of heart, vascular bed, and kidneys. Assessment of HMOD is a standard diagnostic procedure in hypertensive adults and presence of HMOD is associated with increased cardiovascular risk. The assessment of main HMOD markers includes the assessment of left ventricular mass, carotid intima-media thickness, arterial stiffness expressed as pulse wave velocity, and assessment of microcirculation. In contrast to adults, proper interpretation of obtained results of HMOD must be adjusted to age and sex referential values. In the last two decades, numerous studies describing HMOD in children with hypertension have been published, including meta-analyses evaluating various methods of HMOD assessment. Here, we present current state of the art and discuss recommendations on HMOD evaluation in hypertensive children.
Arterial hypertension is a serious condition that without treatment leads to increased cardiovascular risk and hypertension mediated organ damage (HMOD).HMOD includes damage of heart, vascular bed, kidneys, and central nervous system (CNS).Currently used methods of HMOD assessment include estimation of left ventricular mass index (LVMi) in echocardiography, electrocardiography, eye fundus examination, evaluation of kidney function and microalbuminuria. Other recommended, but not obligatory HMOD assessment methods include measurement of cIMT by ultrasonography and PWV. Recent studies indicate also cognitive impairment in hypertensive children measured in neurocognition tests and questionnaires.HMOD assessment in children and adolescents with arterial hypertension can support decision-making process concerning anti-HT treatment and monitoring of the long-term clinical outcomes.Effective antihypertensive treatment can lead to the regression of HMOD.
