Correlation of Salusin Beta with hs-CRP and ADMA in Hypertensive Children and Adolescents.

PURPOSE: The emerging evidence has recently shown an evident dependence between recently identified salusin peptides and atherosclerosis, and their important roles as endogenous modulators of atherogenesis. It was reported that the development of atherosclerosis could also be affected by endogenous salusin- ß overproduction in vascular lesions. MATERIALS/METHODS: This prospective cohort study was conducted in two groups of children: HT - 58 patients with essential hypertension (HT); R - 30 participants with white-coat HT (R). We analysed the relationship between serum salusin- α and salusin- ß levels and ADMA, SDMA and hs- CRP in children and adolescents with essential hypertension. RESULTS: Serum level of salusin- ɑ in each sample was under the sensitivity of method. Serum level of salusin-ß was statistically significantly higher in hypertension group when compared to the reference group (p<0.05) and correlated positively with serum hs-CRP [rho=0.47; p<0.01] and asymmetric dimethylarginine (ADMA) [rho=0.32; p<0.05]. There was no significant association between salusin-ß and symmetric dimethylarginine (SDMA) [rho=0.27; p>0.05]. CONCLUSION: This preliminary study showed that the concentration of salusin-ß is associated with circulating level of hs-CRP and ADMA in teenagers with hypertension. Further studies are needed to find out if salusin-ß levels may indicate for endothelial dysfunction and form the basis for the development of new therapeutic agent.

Does obesity or hyperuricemia influence lithogenic risk profile in children with urolithiasis?

BACKGROUND: There are indications that obesity and hyperuricemia may influence the formation and composition of urinary stones. The aim of our study was to determine the effect of obesity and hyperuricemia on the urinary lithogenic risk profile in a large cohort of pediatric patients. METHODS: The study population comprised 478 children with urolithiasis and 517 healthy children (reference group). We studied the effects of obesity on the lithogenic profile by dividing the patients with urolithiasis into two groups based on body mass index Z-score (patients who were overweight/obese vs. those with normal weight for age) and comparing the two groups. To study the effect of hyperuricemia on the lithogenic profile, we divided the patients with urolithiasis into two groups based on the presence or not of hyperuricemia (110 patients with urolithiasis accompanied by hyperuricemia vs. 368 patients with urolithiasis and normal serum uric acid levels) and compared the groups. RESULTS: Among the children and adolescents with urolithiasis and hyperuricemia, there was a significantly lower excretion of crystallization inhibitors (citrates, magnesium). We also found significantly negative correlations between serum uric acid levels and the urine citrate/creatinine ratio (citrate/cr.; r = -0.30, p < 0.01), as well as the magnesium/cr. ratio (Mg/cr.; r = -0.33, p < 0.01). There was no statistically significant differences in the urinary excretion of oxalates, citrates, calcium, phosphorus, magnesium and uric acid between children with urolithiasis who were either overweight or obese and children with urolithiasis who had a normal body weight. CONCLUSIONS: In our pediatric patient cohort, hyperuricemia was associated with a decrease in the excretion of crystallization inhibitors in the urine, but the clinical relevance of this observation needs to be confirmed in future studies. Obesity and overweight had no direct influence on the lithogenic risk profile in the urinary stone formers in our study, but there was an indication that higher serum uric acid may be associated with impairment in renal function, which in turn could influence the excretion of lithogenic parameters.

Is the serum level of salusin-ß associated with hypertension and atherosclerosis in the pediatric population?

BACKGROUND: Salusins are recently identified endogenous bioactive peptides that have hypotensive and bradycardiac effects. Salusin-ß is involved in the pathogenesis of human atherosclerosis. METHODS: This was a prospective cohort study of a young patient population with hypertension (HTN). Based on ambulatory blood pressure monitoring (ABPM), the adolescents were categorized into two groups, namely, a hypertensive group consisting of patients with essential (primary) HTN (HTN group) and a group consisting of patients with white-coat HTN [reference (R) group]. Correlations between serum salusin-ß level and clinical, laboratory and ambulatory blood pressure (BP) variables were assessed. RESULTS: The median salusin-ß concentration was significantly higher in patients with essential HTN than in those with white-coat HTN (R group). Salusin-ß was positively correlated with the body mass index Z-score, systolic and diastolic blood pressure (BP) from three independent measurements, mean systolic BP during the daytime, triglyceride (TG) level, and atherogenic index (TG/high-density lipoprotein-cholesterol ratio). CONCLUSIONS: The results of this preliminary study suggest that salusin-ß may play an important role in the pathogenesis of HTN in a young population. Further research should focus on the role of salusin-ß in the mechanism of essential HTN and the assessment of possible correlations between salusin-ß and other well-known markers of atherosclerosis in both teenagers and adults. This research should serve as a base for future studies in this field.

Urinary angiotensinogen as a marker of intrarenal angiotensin II activity in adolescents with primary hypertension.

BACKGROUND: Experimental and epidemiological studies have demonstrated that urinary angiotensinogen (AGT) is a novel biomarker for the intrarenal activity of the renin-angiotensin system in hypertension (HT). Several large-scale epidemiological studies have shown that an elevated serum uric acid (SUA) level is associated with HT. The aim of our study was to assess urinary AGT excretion and its correlation with SUA level, the lipid profile, and the body mass index (BMI) Z-score in hypertensive adolescents. METHODS: Participants were divided into two groups: (1) the group with confirmed HT consisting of 55 subjects with primary HT and (2) the reference (R) group consisting of 33 subjects with white-coat HT. A commercial enzyme-linked immunosorbent assay (ELISA) kit was used to determine urinary AGT concentration. RESULTS: The urinary AGT/creatinine (cr.) ratio in subjects in the HT group was significantly higher than that in the reference group (p < 0.01) and showed a strong positive correlation with SUA (r = 0.47, p < 0.01). The relationship between the AGT/cr. ratio and SUA levels after controlling for age, gender and BMI Z-score continued to show a significant association. CONCLUSIONS: The most obvious finding to emerge from this study is that in adolescents with primary HT, the increased urinary excretion of AGT correlated with hyperuricemia, although large, multicenter studies are needed to confirm this observation.

KIM-1 and NGAL: new markers of obstructive nephropathy.

Congenital obstructive nephropathy is the primary cause of chronic renal failure in children. Rapid diagnosis and initiation of the treatment are vital to preserve function and/or to slow down renal injury. The aim of our study was to determine whether urinary (u) kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) may be useful non-invasive biomarkers in children with congenital hydronephrosis (HN) caused by ureteropelvic junction obstruction. The study cohort consisted of 20 children with severe HN who required surgery (median age 2.16 years) and two control groups (control group 1: 20 patients with mild, non-obstructive HN; control group 2: 25 healthy children). All of the children had normal renal function. Immunoenzymatic ELISA commercial kits were used to measure uKIM-1 and uNGAL concentrations. The preoperative median uKIM-1/creatinine (cr.) and uNGAL levels were significantly greater in the children with severe HN than in both control groups. Three months after surgery, uNGAL had decreased significantly (p<0.05) in the children with severe HN, but was still higher than that in control group 2 children (p<0.05). Receiver operator characteristic analyses revealed a good diagnostic profile for uKIM-1 and uNGAL in terms of identifying a differential renal function of <40% in HN patients (area under the curve (AUC) 0.8 and 0.814, respectively) and <45% in all examined children (AUC 0.779 and 0.868, respectively). Based on these results, we suggest that increasing uNGAL and uKIM-1 levels are associated with worsening obstruction. Further studies are required to confirm a potential application of uKIM-1 and uNGAL as useful biomarkers for the diagnosis and progression of chronic kidney disease.

Effect of cyclosporin A on proteinuria in the course of glomerulopathy associated with WT1 mutations.

Denys-Drash syndrome (DDS) is characterized by progressive glomerulopathy caused by diffuse mesangial sclerosis (DMS), genitourinary defects, and a higher risk of developing Wilms' tumor. It is commonly assumed that the DMS is unresponsive to any medications. In this report, we present a patient with Denys-Drash syndrome, in whom the cyclosporine A (CsA) was found to induce total remission. This observation and observations of other authors confirm that in genetic forms of nephrotic syndrome, the proteinuric effect of CsA may be due to a non-immunologic mechanism. We confirm the beneficial effect of CsA treatment in DDS; however, the potential nephrotoxicity of this drug will probably not allow long-term use.