Ambulatory blood pressure parameters and their association with albuminuria in adolescents with type 1 diabetes mellitus.

BACKGROUND: This study aimed to evaluate the blood pressure (BP) status, including arterial stiffness parameters, hemodynamic indicators, circadian profile, and its association with albuminuria in adolescents with type 1 diabetes mellitus (DM1). METHODS: The analysis included 46 patients, with diabetes duration of 7.38 ± 3.48 years. Ambulatory blood pressure monitoring (ABPM) was conducted using an oscillometric device, the Mobil-O-Graph, which is a Pulse Wave Analysis Monitor. RESULTS: Hypertension (HT) was diagnosed in 31 adolescents (67% of patients), primarily due to isolated nocturnal BP (21 cases, 68% of HT cases). The HT group exhibited significantly increased diastolic load (DL). Pulse wave velocity (PWV, a measure of arterial stiffness) values showed a strong correlation with both peripheral systolic BP (r = 0.954) and central systolic BP (r = 0.838). Additionally, non-dipping status was found in 61% of the HT group. Urinary albumin excretion (UAE) was positively correlated with diastolic BP (particularly nocturnal) peripheral and central BP, DL, heart rate, augmentation index (AIx@75), and nocturnal total vascular resistance (TVR). Diastolic non-dippers exhibited a significant increase in UAE. CONCLUSIONS: Hypertension is a common complication in adolescents with type 1 diabetes mellitus, primarily caused by elevated nocturnal diastolic BP. Albuminuria is mainly associated with diastolic BP, especially during the nocturnal period and in cases of diastolic non-dipping status. The association of UAE with AIx@75 and nocturnal TVR suggests the presence of early-stage vascular disease in diabetic adolescents.

Hypertensive nephropathy in children - do we diagnose early enough?

BACKGROUND/AIMS: The aim was to evaluate the level of neutrophil gelatinase-associated lipocalin (NGAL), interleukin 18 (IL-18) and retinol binding protein (RBP) in children with primary hypertension and no features of hypertensive nephropathy. METHODS: The study group consisted of 19 children (15 males) aged 14.8 ± 2.18 years with primary hypertension. Estimated glomerular filtration rate (eGFR) and albumin/creatinine ratio (ACR) were within the normal range. Mean blood pressure (BP) was 141/79 mmHg (mean systolic BP percentile was 98, mean diastolic BP percentile was 80). Ambulatory BP measurement (ABPM), blood and urine biochemical measurements and features of end organ damage were assessed. The control group consisted of 20 healthy children. RESULTS: Hypertensive children showed significantly increased serum and urine NGAL concentration vs controls. Urine RBP was significantly higher in the study group vs controls. A positive correlation was found between urine NGAL and the index of mean systolic BP measured in ABPM, between urine IL-18 and the index of office diastolic BP, between serum NGAL and ACR, and between urine NGAL concentration and serum HDL. CONCLUSION: In children with primary hypertension, increased serum and urine NGAL may reflect kidney injury earlier than typical markers of hypertensive nephropathy.

Efficacy and safety of rituximab treatment in children with primary glomerulonephritis.

BACKGROUND: The aim of our study was to analyze the efficacy and safety of rituximab, a chimeric monoclonal antibody against CD20 lymphocytes, as a nonstandard immunosuppressive therapy in children with different types of primary glomerulonephritis who were not eligible for routine treatment. METHODS: The study group was composed of 16 children with proteinuric glomerulopathies, not responding to standard immunosuppressive therapy. The indications included steroid-resistant nephrotic syndrome (n=14) and steroid-dependent nephrotic syndrome (n=2). The dose of rituximab was established as 375 mg/m2 of body surface area, administered by intravenous infusion once weekly for 1 to 4 weeks, depending on the CD19 lymphocyte count. We evaluated proteinuria and plasma concentration of CD19 lymphocytes at intervals of 1, 3 and 6 months, after which patients received a single repeat dose. RESULTS: Remission, defined as proteinuria less than 150 mg per 24 hours, was observed in 7 of the 16 children. There were no statistically significant differences in leukocyte counts between single and multiple rituximab doses. We also did not observe any clinical or biochemical side effects. CONCLUSIONS: In conclusion, we postulate that alternative rituximab therapy should be taken into consideration in nephrotic patients not responding to standard therapy.

[24-hour pulse pressure in children with chronic kidney disease]. / Calodobowe cisnienie tetna u dziecl z przewlekla choroba nerek.

The aim of the study was to assess 24-h pulse pressure (PP) and to determine relationships between PP and echocardiographic parameters of left ventricle in children with chronic kidney disease (CKD). The study population included 47 children (mean age: 13.11 yrs) with CKD treated conservatively (n=14), with hemodialysis (HD) (n=13) and automated peritoneal dialysis (APD) (n=20). Retrospectively, antropometrical data, office blood pressure, ambulatory blood pressure monitoring (ABPM) variables and LV parameters in echocardiogaphy were analyzed. In study subjects, hypertension (HTN) was present in 25 (53.19%) and in 29 (61.7%) when based on office blood pressure and ABPM respectively. The prevalence of HTN was the highest in predialysis patients. 21 (44.6%) of children had left ventricular hypertrophy (LVH), which was the most frequently found in HD group. The mean PP value was 45.26 +/- 7.56 mmHg and was similar in all groups. Positive correlations were found between PP and weight (p < 0.001), height (p < 0.05), body surface area (p < 0.01) and LV measures (LV mass, LV posterior wall thickness and diastolic diameter of LV, all p < 0.05). Children with PP above median had tendency for greater LV mass (p = 0.06). There was no difference in severity of blood pressure and PP in children with/without LVH. However, in 45% of patients LVH was noted in whom the value of PP was greater than calculated normative value of PP (95 centile). HTN and LVH is common in children with CKD. A mean PP in children with CKD is lower when compared to adult population with CKD. The results confirm that PP increases with the age and an increasing PP has an influence on the changes of LV geometry. Assessment of PP in ABPM might help in identifying those with abnormal LV geometry.

[New, successful treatment of urinary tract infection caused by Pseudomonas aeruginosa]. / Nowy, skuteczny model leczenia zakazenia ukladu moczowego spowodowanego Pseudomonas aeruginosa.

Urinary tract infection (UTI) is common in pediatric practice and an important cause of morbidity and mortality in children. Escherichia coli remains the predominant uropathogen (80%) isolated in acute community-acquired uncomplicated infections, followed by Staphylococcus saprophyticus (10% to 15%) and Pseudomonas aeruginosa (9%) The pathogens traditionally associated with UTI are changing many of their features, particularly because of antimicrobial resistance. Reinfections and relapses of urinary tract infections caused by PA are very frequent. The aim of the study was to evaluate the efficacy of combined clarithromycine and ceftazidime in terms of eradication of PA infection. We analyzed 20 out of 264 children with UTI where PA infection was confirmed with urine culture. Those children were treated for at least 14 days with the protocol used for PA infection in patients with mucoviscidosis. Short-term eradication was achieved in all patients. Long-term study revealed relapse in 25% of children, all with serious congenital malformations. 75% of children were treated with success. No side effects were observed. Conclusion. We conclude that an empirical combination treatment of clarithromycine and ceftazidime is appropriate and effective in children with UTI caused by PA. This therapy was clinically efficacious, well tolerated, and cost effective, and should prevent unnecessary development of antimicrobial resistance.