[The use of sevelamer in the treatment of resistant hyperphosphataemia in children with chronic renal disease]. / Zastosowanie sewelameru w leczeniu opornej hiperfosfatemii u dzieci z przewlekla niewydolnoscia nerek.

UNLABELLED: The aim of study was the estimation of efficacy and safety of sevelamer treatment in children with chronic kidney disease with resistant hyperphsphatemia. MATERIAL AND METHODS: The study group was 7 patients (hemodialysed--2 boys, mean age 7, 7+/-0.1; peritoneal dialysis--5: 3 boys and 2 girls, mean age 5, 6+/-5.0). Sevelamer (Renagel, 800 mg, Genzyme) was used in all patients in mean dosis of 117 mg/kgm.c./d due to lack of effect of the typical treatment (vitamin D, diet, calcium carbonate). Results of treatment by sevelamer were estimated by measuring of calcium, phosphates, albumins, parathormone and alkalic phosphate concentration in the serum and blood gases after 6 and 12 month. RESULTS: There were found that sevelamer treatment significantly decrease the phosphates concentration and CaxP product in the serum without influence on concentration of PTH or calcium. Any adverse events were observed during the study and any drug intolerance. CONCLUSION: Sevelamer treatment may be usefulness in children with resistant hyperphosphatemia.

[Cinacalcet in the treatment of secondary hyperparathyreoidism in a child with chronic kidney disease--case report]. / Zastosowanie cinakalcetu w leczeniu wtónej nadczynnosci przytarczyc u dziecka z przewlekla niewydoinoscia nerek--opis przypadku.

UNLABELLED: The medical history and treatment of 2.5 years old girl with chronic kidney disease and heavy hyperparathyreoidism was presented in this case report. This girl was treated by peritoneal dialysis (APD) due to chronic kidney disease and congenital nephrotic syndrome. The secondary paraidothyreoidism was a reason of the epiphysial of the upper end of the femur, which appeared despite of the treatment by the Vitamin D3 (Calciphediol and Alphacalcidol) and phosphate binding drugs like Calcium Carbonate and Sevelamer. The primary laboratory tests were: Ca 9.32 mg/dl, Ca jon. 1.21 mmol/l, PO4 7.29 mg/dl, BE +4.9 mmol/l, ALP 1425 U/l, PTH 3774 pg/ml, Albumins 3.23 g/l, Hgb 8.2 g/l. The treatment of cinacalcet (Mimpara, 30 mg, Amgen) in dose of 15 mg was started because of lack of the standard therapy results. The laboratory tests were controlled after 2 weeks and then every week to 5th and every 2 weeks to the end. This therapy was finished after 30 weeks and only the standard therapy of hyperphosphatemia was continued. The laboratory tests 3 month after stopped the treatment were: Ca 10.5 mg/dl, Ca jon. 1.36 mmol/l, PO4 4.0 mg/dl, BE +4.9 mmol/l, ALP 312 U/l, PTH 134 pg/ml, Albumins 3.23 g/l, Hgb 9.9 g/l. There were any adverse events observed during the treatment. CONCLUSION: It seems, the cinacalcet may be an alternate treatment to paraidectomy in children with chronic kidney disease and heavy secondary hyperparathyreoidism.

[A child with myelomeningocele as a dialytic patient]. / Dziecko z przepuklina oponowo-rdzeniowa jako pacjent dializacyjny.

The aim of the study was to present difficulties and problems of dialytic treatment in children with spina bifida (SB). Between 2000 and 2005 five girls with SB and neurogenic bladder were treated with renal replacement therapy (15% of all children with end stage kidney disease dialyzed at our centre). Four patients (pts) had hydrocephalus requiring ventriculoperitoneal shunt, they were wheelchair-bound due to lower limbs paralysis and mentally retarded. Only 1 girl had been supervised by nephrologist from the very beginning. Dialysis was started at the age of 3-17 yr and the first mode was automatic peritoneal dialysis (ADO) in 3 and hemodialysis (HD) in 2. During the treatment ADO was switched onto HD in 2 pts for sclerosing encapsulating peritonitis (1) and tunnel infection with spontaneous Tenckhoff catheter evacuation (1). Permanent central venous catheters served as vascular access in 3 cases, in 2 there were difficulties with creation of arteriovenous fistula. No neurological complications were noticed in pts with ventriculo-peritoneal shunt and ADO. Total period of renal replacement therapy was 9-99 mo. Only 2 pts were qualified to transplantation. Two pts died after 16 mo of dialysis, 2 were transplanted and 1 is still being treated with HD. All families were dysfunctional. In 4 cases insufficient parental support caused many disturbances during predialytic and dialytic period. We concluded that in Poland pediatric pts with SB create specific group with the number of problems and complications higher than in other children on dialysis.