[Clinical and histopathological characteristics of biopsy-proven renal diseases in Croatia]. / Klinicke i patohistoloske karakteristike biopsijom dokazanih bubreznih bolesti djece u Hrvatskoj.

There is little data on the spectrum of renal diseases in children in Croatia. The Croatian Society for Pediatric Nephrology has established the Registry of Biopsy-Proven Renal Diseases in an attempt to address this issue nationwide. Here we report preliminary results of a retrospective analysis of clinical and histopathological data of 565 children aged < or =17 years presenting to 9 hospitals in Croatia from 1991 to 2004, in whom kidney biopsy was performed. The most common indication for renal biopsy was nephrotic syndrome (39.1%), followed by asymptomatic proteinuria/hematuria (22.0%) and acute nephritic syndrome (17.0%). All biopsies were analysed by light-, immunofluorescent and electron microscopy. The majority of children, 552 out of 565 (92.4%), had glomerulonephritis (GN). Tubulointerstitial nephritis was found in 16 (2.8%), congenital renal parenchyma anomalies in 14 (2.5%) and vascular disease in 11 (1.9%) cases. One (0.2%) child had sarcoidosis with nephrocalcinosis. The sample was non-diagnostic in 1 (0.2%) case. Among children with GN, primary GN accounted for 70.9%, secondary GN for 16.1% and hereditary GN for 13.0% cases. The most frequent primary GN forms were focal segmental glomerulosclerosis (FSGS) (24.6%), mesangial proliferative glomerulonephritis (MEPGN) (19.2%) and IgA nephropathy (18.1%). Acute GN in resolution was found in 11.1% and minimal changes GN in 6.8% of cases. Most children with secondary GN had nephritis of Henoch-Schönlein purpura (HSP) (54.7%) and nephritis of systemic lupus erythematosus (SLE) (40.5%), while among hereditary GN Alport syndrome was most common (80.9%). In the group of children with primary GN who presented with nephrotic syndrome, most common forms were FSGS (38.5%) and MEPGN (24.0%). Minimal changes GN accounted for only 10.9% of cases. IgA nephropathy, primary or related to HSP (20.0%), FSGS (16.1%), MEPGN (12.6%) and Alport syndrome (9.7%) were the most common biopsy-proven renal diseases in Croatian children. The analysis provided data on the frequency of histological renal lesions in children in Croatia. The higher frequency of FSGS and MEPGN among Croatian children in comparison with other countries deserves further evaluation.

Long-term treatment with vaginal estradiol tablets--an impact on uterine artery blood flow.

OBJECTIVE: We investigated, using color Doppler ultrasound, possible detectable blood changes of prolonged treatment with 17-beta-estradiol tablets on uterine artery blood flow, in a cohort of low risk postmenopausal women. METHODS: 39 postmenopausal women, who were taking local estrogen therapy for at least 6 months, were examined in the study group. Forty-two women who never used hormone replacement therapy consisted a control group. They were examined with color Doppler ultrasound and the pulsatility index of the uterine artery was measured. The groups were divided into three subgroups (the age, the duration of the postmenopause, and the duration of the treatment) and the data were compared among groups and within subgroups. RESULTS: The overall mean age of the patients was 66 years, the mean duration of the postmenopause was 15 years, the overall mean PI was 1.96 +/- 0.90, and the mean duration of taking vaginal estradiol tablets was 1.97 years for the study group; and 64 years, 13 years and 2.88 +/- 0.96 for the control group, respectively. There was a difference in the mean PI among groups. No significant differences in pulsatility index values in the subgroups were found. CONCLUSION: Long-term treatments with vaginal estradiol tablets in low risk women causes lowering of the uterine artery PI values compared to the women who are not receiving hormone replacement therapy.

Severity of symptoms in primary dysmenorrhea--a Doppler study.

OBJECTIVE: Doppler findings in women with severe symptoms of primary dysmenorrhea include high impedance to blood flow in uterine arteries with a preserved cyclic pattern throughout the whole cycle. Doppler findings in women who present with mild symptoms of primary dysmenorrhea are not yet documented. The aim of this study was to investigate possible differences in Doppler findings among women with mild and severe primary dysmenorrhea. STUDY DESIGN: One hundred and fifty four women were examined with color Doppler ultrasound: 50 in the control group, 60 in the mild and 44 in the severe primary dysmenorrhea subgroup. We calculated resistance index in uterine arteries in these women on the first day of the cycle, in the follicular (days 9-12) and the luteal (days 20-23) phase of the cycle and used analysis of variance for comparing results. RESULTS: The rate of visualization was 100% for uterine and arcuate arteries, 44-76% for the radial and 32-62% for spiral arteries, respectively. A significant difference in Doppler index values among the mild and severe dysmenorrheic group was observed in the luteal phase for the arcuate artery and in all the three measurement periods for the radial and spiral arteries. CONCLUSION: There is a difference in Doppler findings between women with mild and severe symptoms of primary dysmenorrhea.

Ultrasound assessment of detrusor muscle thickness in children with non-neuropathic bladder/sphincter dysfunction.

OBJECTIVE: To measure detrusor muscle thickness in children with non-neuropathic bladder/sphincter dysfunction (NNBSD), and to evaluate the difference between children with various bladder dysfunctions and those with normal urodynamics. MATERIALS AND METHODS: In 139 children the urodynamic study was performed, and the detrusor of the anterior bladder wall was measured using high-frequency ultrasonography (US). Children were categorized into five groups, according to urodynamic findings. Differences in detrusor thickness between groups were tested by one-way ANOVA with post hoc Scheffé test. RESULTS: Forty-six children (33.1%) had normal urodynamics, and mean (+/-S.D.) detrusor thickness 1.3 +/- 0.5 mm (range 0.5-3.0). Fifty-two (37.4%) had urge syndrome, with detrusor thickness of 2 +/- 0.7 mm (1.0-3.6). Thirty-three (23.7%) had dysfunctional voiding, with detrusor thickness of 2.6 +/- 0.5 mm (1.5-3.6). Four (2.9%) had lazy bladder, with detrusor thickness of 0.9 +/- 0.1 mm (0.8-1.0), and four had anatomical infravesical obstruction, with detrusor thickness of 4.4 +/- 0.3 mm (4-4.6). The mean detrusor thickness in all children with NNBSD was 2.2 +/- 0.7 mm (range 0.8-3.6). Multiple comparisons showed significant difference between all groups, except between children with normal urodynamics and children with lazy bladder. CONCLUSION: There is statistically significant difference in mean detrusor thickness between children with normal urodynamics and children with NNBSD. However, due to the overlap of measured values, it is not possible to determine the cut-off value that could be used to distinguish children with and without NNBSD.