Initial Changes in the Heart Conduction System Illustrated by Difference Map Patterns in Adolescent Patients After Kidney Transplantation: A Pilot Study.

BACKGROUND: Cardiovascular complications (CVCs) in patients with end-stage renal disease (ESRD) often require hospitalization and are associated with an increased risk of fatality. Although kidney transplantation (KTx) improves a patient's status, CVCs are still a serious risk factor, so early identification is very important for final therapeutic outcome. METHODS: This study included 5 post-KTx patients (age, 20.8 ± 1.16 years), dialyzed before KTx, and followed up for 6.7 ± 1.71 years. Body surface potential mapping (BSPM) was performed 4 times: twice before and twice after KTx. Electrocardiographic data were processed into map plotting to illustrate differences in ventricular activation times (VATs). RESULTS: A comparative analysis of difference maps, both of dialyzed patients and normal subjects, highlighted certain specificities in the distribution of VAT changes for the left anterior fascicle block (LAFB). The maps clearly showed a significant correlation between the intensity of changes and duration of dialysis before KTx. After KTx, VATs seemed to be similar to those in normal subjects; however, this was true only for patients dialyzed for <1 year. The patients dialyzed for >1 year showed persistent conduction abnormalities on their VAT maps. CONCLUSION: Summary differences in VAT maps can enable diagnostics of initial activation propagation abnormalities in the heart. Short-term dialysis therapy before KTx imposes positive effects with regression of heart conduction changes. These observations need to be verified in a larger study population.

Dynamics of changes in heart conduction system in dialyzed young adults after kidney transplantation--pilot study.

BACKGROUND: Cardiovascular complications are the main clinical problem in patients with end-stage renal failure (ESRF). After successful kidney transplantation, this situation improves, although cardiovascular complications remain a risk factor for increased mortality in these patients; therefore, their early identification is of key therapeutic and prognostic significance. This study was designed to determine a dynamics of changes in the heart conduction system in hemodialyzed young adult patients after kidney transplantation in a long-term follow-up, based on the body surface potential mapping (BSPM) method. METHODS: The study comprised 5 patients (mean age, 20.8 ± 1.16 years) after kidney transplantation (KT) who had been chronically dialyzed before. The mean observation period was 6.7 ± 1.71 years. All of the patients were submitted to the following examinations before and after KT: 12-lead electrocardiography (ECG), echocardiography, standard biochemistry, and BSPM (isochronous maps). The mean creatinine concentration was 1.38 ± 0.05 mg/dL. The control group comprised 30 healthy persons. RESULTS: BSPM maps taken from the dialyzed patients demonstrated disturbed spreading of electric impulses within the heart ventricles in a type of left bundle branch block, despite normal 12-lead ECG and echocardiography results. A relationship was demonstrated between the BSPM changes and dialysis duration. After KT, the abnormal distribution of isochrones and ventricular activation times (VAT) presented some significant and specific regression. CONCLUSIONS: 1) In dialyzed patients, BSPM is a more sensitive method than ECG and enables early identification of changes in the heart conduction system presented as left bundle branch block. 2) Dialysotherapy duration before and after KT determines the extent of the BSPM changes. 3) Successful effects of KT bring about regression of intraventricular conduction disorders. 4) The observations need verification in a larger patient group.

Erythrocyte caspase-3 levels in children with chronic kidney disease.

OBJECTIVES: In chronic kidney disease (CKD), a number of intra- and extracellular factors, e.g., uremic toxins, mechanic, oxidative or osmotic stress - induce changes (rearrangements) in the structure of cytoplasmatic membrane, while also simultaneously deregulating blood cell metabolism and, in consequence, contributing to preliminary ageing and suicidal death of red blood cells (RBCs).The aim of the reported study was an evaluation of caspase-3 and lactate dehydrogenase activities and of ATP concentrations in erythrocytes as cellular responses to CKD progress. DESIGN AND METHODS: Conservatively treated sixty (60) CKD children were enrolled into the study and divided, according to CKD progression (stage I-IV). The control group consisted of twenty-five (25) healthy children. The activity of caspase-3 (Casp-3) and lactate dehydrogenase (LDH) were spectrophotometrically assayed in haemolysed erythrocytes. Adenosine triphosphate (ATP(e)) concentrations were measured by means of a luciferin-luciferase kit. RESULTS: A gradual increase of LDH and ATP levels was observed in transition from CKD stage I to stage III. In Group IV, the levels of those parameters were statistically significantly lower than in the control group. The activity of Casp-3 in Group I was comparable to that in healthy children. The highest activity of Casp-3 was observed in Group III. CONCLUSIONS: 1. The activity of caspase-3 in RBCs of CKD children grows with progression of the disease. 2. The lower LDH activities and the ATP concentration drop below the values characteristic for the control group, as observed in stage IV of CKD, indicate a compromised energy balance.

[Nutritional status of children treated with continuous ambulatory peritoneal dialysis and ambulatory peritoneal dialysis]. / Stan odzywienia dzieci leczonych ciagla ambulatoryjna dializa otrzewnowa i automatyczna dializa otrzewnowa.

Malnutrition is a very important problem in children with ESRD on peritoneal dialysis. Examinations were conducted on 20 children (9 girls, 11 boys), 10 children were treated continuous ambulatory peritoneal dialysis (CAPD) and 10 automated peritoneal dialysis (APD). Anthropometric and serum biochemical parameters were examined. Dialysis adequacy by KT/V, SCCr, PCR were described. The most significant malnutrition was observed in youngest children with lowest BMI values and significant muscle and fat mass deficiency. Increased protein catabolic rate (PCR) in children under 6 years old was an important factor leading to malnutrition.

[Results of treatment with recombinant human growth hormone in children with growth retardation in end-stage renal disease]. / Wyniki leczenia rekombinowanym ludzkim hormonem wzrostu niskoroslosci dzieci ze schylkowa niewydolnoscia nerek.

The aim of the study was to estimate the results of recombinant human growth hormone (rhGH) treatment in children with end-stage renal disease (ESRD). 60 growth retarded children with ESRD (mean age 11.2 +/- 7.2 years) were treated with rhGH at a dose of 1-1.1 IU/kg/week. The time of observation was 24 months. Thirty children completed first year, 18--second year of treatment. The mean growth velocity prior to the treatment was 3.03 +/- 1.9, during first year of the study--7.52 +/- 2.42, during second year 6.68 +/- 2.87 cm/year. The negative correlation between growth velocity and patient's age (r = -0.39; p < 0.05) suggest the better growth results in younger children during rhGH treatment. The rhGH therapy is effective method of treatment in growth retarded children with ESRD. Side effects are rare.

[Epidemiology of HBV infections and possibilities for therapeutic actions in children and adolescents with end-stage renal failure treated with dialysis]. / Epidemiologia zakazen HBV i mozliwosci dzialan terapeutycznych u dzieci i mlodziezy ze schylkowa niewydolnoscia nerek leczonych nerkozastepczo.

Wide spreading of prophylaxis principles of HBV infections in dialysis centers decreased the HBV infection rate in general population of dialyzed patients in Poland last years. There is neither data concerned with HBV infection epidemiology in children and adolescents, nor data about anti-viral treatment possibilities and effects in this group of dialyzed patients. The aim of the study was evaluating of HBV infection rate in patients of pediatric dialysis centers and analysis of causes of infection and efficacy of treatment. Study was based on data sent in a query-answer by 8 biggest pediatric dialysis centers, all of them treating 210 patients. HBV infection was found much more often (16.6%) than in population of all hemodialyzed patients in Poland. More than 75% non-vaccinated patients was infected before dialysis therapy, remaining were infected during vaccination, before the protecting level of antibodies was gained. Big differences in HBV infection rate among centers are observed. Nowadays HCV infections (more than 40% patients infected) are a bigger issue. Only 10 patients in 5 centers had anti-viral treatment (5 with isolated HBV infection, 5 with mixed HBV/HCV infection). In 9 patients interferon-alpha and in 1 patient lamivudine was administered. Efficacy of interferon-alpha treatment was similar to the population of non-uremic children (33.3% vs. 50% of HBeAg elimination). Majority of patients quite well tolerated the drug. Only in 1 case interferon-alpha treatment had to be ceased because of side effects. In a boy treated with lamivudine, after 3 months elimination of viremia and decrease of ALAT activity was observed. HBV infection in patients of pediatric dialysis centers is still a serious matter. More strict applying of vaccination against hepatitis B before dialysis treatment is needed. The possibility of HBV infections therapy is limited, mostly for economical reasons.

[The condition of circulatory system in children and adolescents with ESRD treated by continuous ambulatory peritoneal dialysis and hemodialysis]. / Stan ukladu krazenia u dzieci i mlodziezy ze schylkowa niewydolnoscia nerek leczonych CADO i HD.

Cardio-vascular abnormalities appear very often in end-stage renal failure patients. Because of this we have examined 54 patients, children and adolescents, 35 patients underwent haemodialysis (HD) and 19 continuous ambulatory peritoneal dialysis (CAPD). We can observe that the anatomical status of the heart was dependent upon the time of the treatment. The function of the heart was normal much longer. Structural heart's abnormalities were observed earlier in patients on HD than on CAPD.

[Evaluation of serum sialic acid concentration in chronic renal failure children on continuous ambulatory peritoneal dialysis and hemodialysis]. / Ocena stezenia kwasu sialowego w surowicy u dzieci z przewlekla niewydolnoscia nerek leczonych CADO oraz HD.

In various pathological conditions elevated serum sialic acid level, as the result of increased metabolism of glycoproteins and glycolipids, is observed. The study aimed at the evaluation of sialic acid concentration in serum of children on continuous ambulatory peritoneal dialysis (CAPD) and maintenance haemodialysis (HD). Examination was performed in 27 end-stage renal disease (ESRD) children including 11 on CAPD, 16 on HD treatment. Ten healthy children served as the control group (K). In CAPD group assessment was carried out during the routine monthly check up, in HD group--before (HD-1) and after (HD-2) dialysis session. Sialic acid concentration was determined using method of Shamberger. In CAPD children we obtained significantly increased serum sialic acid concentration comparing to controls and HD children. Increased serum sialic acid concentration was also found in HD children comparing to controls. There was no significant difference between the sialic acid concentrations before and after dialysis session. Analysis of correlation revealed positive correlation of sialic acid concentration with haemoglobin concentration and hematocrit in CAPD group. In children on HD treatment we showed positive correlation of sialic acid level with renal replacement therapy duration and creatinine concentration after HD. Elevated serum sialic acid concentration in dialysed children could be the result of non-specific organism response, characterised by tissue and organ damage, towards the materials of extracorporeal circulation (HD) or the presence of dialysis solution in peritoneal cavity (CAPD).

[Diagnostic difficulties and unfavorable course Wegener's granulomatosis in 1-year-old girl]. / Trudnosci diagnostyczne i niekorzystny przebieg ziarniniaka Wegenera u 11-letniej dziewczynki.

We described an 11 year old girl who presented and unusual clinical course of Wegener's granulomatosis (WG). The rapidly progressive glomerulonephritis was the onset of the illness. The characteristic manifestation of WG from the respiratory tract was observed after 1.5 year from the beginning of the disease. Inspite of intensive treatment the end-stage renal failure developed and progress of the disease was observed. These complications caused patient's death.

[Prevalence of Helicobacter pylori-specific IGG and IGA in children and adolescents with chronic renal failure]. / Wystepowanie przeciwcial przeciwko Helicobacter pylori u dzieci i mlodziezy z przewlekla niewydolnoscia nerek.

Helicobacter pylori, a bacteria first described in 1984, since that time is linked with chronic gastritis and duodenitis. Dyspeptic symptoms and chronic gastritis are common in patients with chronic renal failure (CRF). The aim of the study was to evaluate of Helicobacter pylori-specific IgG and IgA prevalence in 73 CRF children and possible link of H. pylori infection and dyspeptic symptoms. Anti-H. pylori IgG antibodies were present in 20.5% CRF children (treated conservatively--21%; on CAPD--9%; chronically hemodialysed--29.6%), IgA antibodies was present only in 3 dialysed children (4.1%). Comparing to adult CRF patient, a lower rate of H. pylori infection was observed. No correlation between H. pylori seropositivity and a presence of dyspeptic symptoms was observed. Prevalence of H. pylori antibodies was higher in older CRF children and adolescents.

[Evaluation of the urinary tract in children with renal agenesis]. / Ocena stanu ukladu moczowego u dzieci z agenezja nerki.

The condition of urinary tract in 24 children with kidney agenesia was estimated. 14 out of 24 children had additionally renal abnormalities or different renal diseases. It was detected that more than 50% of patients developed chronic failure of this single kidney, but renal function of normal single kidney remains many years correct.

[Hydronephrosis in the course of primary psoas abscess]. / Wodonercze w przebiegu pierwontego ropnia miesnia biodrowo-ledzwiowego.

Primary psoas abscess is rare and presents a difficult diagnostic challenge. We present an unusual case of primary psoas abscess causing hydronephrosis in a 11-year-old boy. The presence of hydronephrosis complicated diagnosis, that was definitely confirmed by computerized tomography. Percutaneous drainage of the abscess under ultrasonography guidance combined with antibiotic therapy provided an effective treatment. Culture of the pus showed Staphylococcus aureus. The subject is discussed noting incidence, etiology and methods of treatment of primary and secondary psoas abscesses.

[Concentration of selected trace elements in serum and erythrocytes of children with chronic renal failure and am attempt at deficiency correction with animal blood preparation]. / Stezenie wybranych pierwiastków sladowych w surowicy krwi i krwinkach czerwonych u dzieci z przewlekla niewydolnoscia nerek oraz próba korygowania niedoborów preparatem krwi zwierzecej "Livex".

The results are presented of studies in 32 children with chronic renal failure treated conservatively in whom the value was evaluated of serum Mg, Zn, and Se concentration, and erythrocyte Mg, and Zn concentration. Among the patients a group of 15 children was isolated whose diet was enriched with the animal blood preparation brown Livex containing among others the studied trace elements. Significant Zn and Mg deficiency was demonstrated in the serum and Mg deficiency in the erythrocytes of the ill children which were effectively corrected after three months of supplementation with the preparation Livex.

[Histocompatibility antigens (HLA) in children with lipoid nephrosis]. / Antygeny zgodnosci tkankowej (HLA) w nerczycy lipidowej u dzieci.

Actual knowledge on the HLA relationship with the primary glomerulopathies, with particular reference to steroid - sensitive nephrosis of childhood, is surveyed. Occurrence of HLA B-8 and B-35 in this nephropathy has been investigated. The studies involved 47 patients aged between 3 and 15 years and 117 healthy children from Lower Silesian region. It has been showed, that HLA B-8 is present more frequently in sick children, than in healthy controls. The situation is reverse in case of HLA B-35 antigen. However, the difference is statistically insignificant. A probability of the lipid nephrosis sensitivity to corticosteroids can not be predicted on the base of the presence of these HLA antigens.

[Polycystic renal disease in infants]. / Torbielowatosc nerek u niemowlat.

In the light of the observation of 4 infants with polycystic renal disease the clinical manifestation, diagnosis (with stress laid on USG) and therapeutic management are discussed. Attention is called to the possibility of adult-type polycystic renal disease in neonatal period and infancy. This type of nephropathy is supposed by the authors to be in 2 living children.