[Continuous ambulatory measurement of blood pressure in children--personal experience]. / Kontinuisano ambulatorno merenje krvnog pritiska kod dece--nasa iskustva.

UNLABELLED: Ambulatory blood pressure monitoring (ABPM) during normal daily activities and during night, when the patient is asleep, is a new method of measuring blood pressure (BP) in children, used for better diagnosis and treatment of hypertension. Compared to casual BP measurements, it documents normal daily BP variations, BP during sleep, the influence of emotional and physical stress on BP and is a better predictor of hypertension associated with end-organ damage. However, the experience in ABPM in children is still limited. In our country ABPM has been used since recently, and first results are referred to children with end-stage renal failure. SUBJECTS AND METHODS: ABPM was performed in two groups of children: group A consisted of 61 children, aged 14.3 +/- 2.9 (mean +/- SD) yrs in whom intermittent outpatient BP measurements (for at least 3 months) suggested the diagnosis of hypertension (according to the data of Second Task Force); group B consisted of 52 patients (pts), aged 12.8 +/- 4.6 yr with renal disease. Four pts from group A (6.6%) and 20 pts from group B (38.5%) received antihypertensive therapy (captopril, nifedipine, furosemide and propranolol ). All children from group A and half of the children from group B had normal renal function. Eighteen pts from group B were on chronic haemodialysis (34.6%). Blood pressure was recorded during a 24-hour period except in haemodialyzed pts (48 h) (Table 1). Results of BP measurements are presented as the mean values of BP during a 24-hour period, during normal daily activities and during sleep. We used the age- and gender-appropriate 95th percentile from the Task Force Study as the daytime upper-limit of normal and 10% lower for the upper-limit at night. According to BP load (the percentage of BPs exceeding the upper limits of normal for age), children were assumed to have mild-to-moderate hypertension (BP load between 20% and 40%) or severe hypertension (BP load more than 40%). The success of antihypertensive therapy was evaluated after 1-3 months in 11 pts (twice in 10 pts and three times in one pt). RESULTS: In group A 39.4% of pts were normotensive and 36.1% were without antihypertensive therapy, 58.4% of normotensive and 40.5% of hypertensive pts had blunted circadian BP rhythm (nocturnal BP reduction of less than 10% of diurnal values) (Graph. 1). In group B 38.5% of pts were normotensive and 27% were without antihypertensive therapy. In the group of normotensive pts alteration of circadian BP rhythm was found in 40% of pts with normal renal function, 80% of pts with chronic renal failure and in 100% of pts with terminal renal failure, while in the hypertensive group, altered circadian BP rhythm had 68%, 100% and 92% of pts, respectively (Graph 2). Mild-to-moderate hypertension had 54% of hypertensive pts from group A and 37.5% of hypertensive pts from group B. Severe hypertension was more frequent in group B (62.5%) comparing to group A (46%). The effectiveness of antihypertensive therapy was assessed in 11 pts. In 69.2% of pts BP became normal or was significantly decreased, in 23.1% of pts BP was not changed and 7.7% of pts had higher values of BP. DISCUSSION: ABPM is very useful for diagnosing white coat hypertension. Like other authors, we have pointed out that more than one third of pts who were hypertensive according to usual BP measurements had normal 24-hour BP and we classified them as white coat hypertensives. More than a half of the pts had blunted circadian BP rhythm, and as it is not certain whether they will become hypertensive in adulthood they should be periodically controlled. There are several proofs that results of ABPM have a better correlation with hypertensive end-organ damage; therefore ABPM is used for assessing the severity of hypertension. In our former work, we showed excellent correlation of BP with left ventricular mass index in children with end-stage renal failure. (ABSTRACT TRUNCATED)

[Serum osteocalcin in children with chronic renal insufficiency]. / Osteokalcin u serumu kod dece s hronicnom insuficijencijom bubrega.

UNLABELLED: The research of the bone metabolism has undergone a long evolution which began with the use of radioisotopes in calcium kinetic studies and went through the determination of several humoral parameters like alkaline phosphatase (ALP), hydroxyproline and intact immunoreactive parathyroid hormone (iPTH) and finally to the assay of a new serum and urinary parameters of bone metabolism, like osteocalcine (OC) and procollagen and collagen metabolites. The X-ray study of the skeleton, densitometric techniques, computerized tomography, scintigraphy and NMR are used for visualization of bone changes, but bone biopsy and histomorphometry provide the most precise evaluation [1]. Disorders of bone and mineral metabolism in children with chronic renal failure (CRF) are an almost regular occurrence; so early discovery and treatment of these changes are very important [2]. The aim of this study was to measure the serum OC level in children with CRF and terminal renal failure (TRF), treated with chronic haemodialysis, and to evaluate the significance of OC compared to other humoral parameters of renal osteodistrophy, such as ALP and iPTH. MATERIALS AND METHODS: We studied the fasting levels of OC in three different groups of children: group A consisted of 18 patients with TRF; group B consisted of 12 patients at different stages of CRF, and group C consisted of 32 healthy children, all of the approximately same age. Clinical characteristics of the examinded children are presented in Table 1. Of 30 patients, 26 were treated with calcium carbonate and 21 with vitamin D analogues. None were treated with aluminium hydroxide. Additional parameters included serum calcium, phosphate, ALP and body height, while serum concentrations of iPTH and ionized serum calcium were measured only in group A. Serum OC was measured by radioimmunoassay using OSTK PR RIA (CIS), while ELISA-PTH (CIS) radioimmunoassay was used to determine iPTH plasma levels. Statistical analyses were performed using Kolmogorov-Smirnov test to confirm normal distribution, the Pearson and Spearman rank sum test for correlation between variables of interest, while analysis of variance was used to compare the findings. RESULTS: Serum OC levels were significantly different in all groups (p < 0.01); they were three times higher in group A than in group C. Similar increase was noticed in plasma iPTH, assuming that "normal" uremic iPTH was raised up to threefold above normal range (between 10 and 60 pg/ml) [2]. However, the total serum ALP activity was not sensitive as OC and iPTH, since ALP increases were less as compared to them. OC was age related only in group A (p < 0.01), with a positive correlation between OC and duration of haemodialysis (p < 0.05), as well as between OC and serum phosphate (p < 0.05), but there was no correlation between OC and growth retardation (expressed by SDS), bone age and current therapy for renal osteodistrophy. A direct correlation between OC and ALP was found only in healthy children (p < 0.01), while in groups A and B it was remarkable, although not statistically significant (p = 0.08) (Graphs 1, 2, 3). In group A, ALP and iPTH were directly correlated (p < 0.001), but the correlation of OC with iPTH was less significant (p = 0.06). In patients with CRF no correlation was found between glomerular filtration rate and OC. DISCUSSION: OC is a bone-derived noncollagenous protein of low molecular weight (about 5800 D), containing residues of the vitamin K dependent amino acid gamma-carboxyglutamic acid and is synthesized by osteoblasts and odontoblasts. Calcitriol is a potent stimulator of OC synthesis, acting at the transcriptional level and increasing mRNA severalfold. OC is found mainly in bone, but nanomolar concentrations circulate in the blood. Its serum levels are an expression of the bone formation process and are age related (higher in the neonatal and adolescent period). ABSTRACT TRUNCATED.

[Determination of the level of urinary tract infection in children by antibodies coating bacteria from urinary sediment]. / Otkrivanje mesta infekcije u urinarnom sistemu kod dece pomocu oblazucih antitela na bakterijama u sedimentu urina.

The article deals with the evaluation of the significance of surface antibodies in urinary sediment bacteria by direct immunofluorescence in children with urinary tract infection caused by Escherichia coli (E. coli), so as of determination of location of the infection. Sixty five children were studied, aged from 1 to 16.5 years. Based on the recognized criteria in literature, all patients were classified into three groups: chronic pyelonephritis (CP)--10 patients, acute pyelonephritis (AP)--34 patients, and lower urinary tract infections (LUTI)--21 patients. On the basis of the analysis of the relationship among the three groups of patients in relation to the absence or various presence rates (up to 5%, 6-10% and 11-15% respectively) of fluorescent antibodies in urine sediment, and using the Fischer's test of absolute probability, we obtained a highly significant difference (p = 0.00006) only between the groups AP and LUTI. This difference caused the presence of fluorescence in the AP group and its absence in the LUTI group. By adding the positive fluorescence findings we found that it was present in 80% of CP patients, in 91.17% of AP patients, and in 14.28% of LUTI patients. chi2 test showed a highly significant difference (chi2 = 34.79; p < 0.01), which confirmed that bacterial fluorescence was most often present in the urine of AP patients and absent in LUTI patients. Bacterial fluorescence was significantly more frequent in CP patients in relation to LUTI patients. These results indicate that the method for detecting surface antibodies in urine bacteria, aimed at determinig the location of infection, is more reliable and noninvasive as compared to other methods.

[Clinical significance of serotypization of Escherichia coli isolated in children urinary tract]. / Klinicki znacaj serotipizacije bakterija Escherichia coli izolovanih kod dece s infekcijom urinarnog sistema.

The paper deals with the study of 65 children, aged from 1 to 16,5 years (7 years and 5 months +/- 2 years and 7 months), with urinary tract infection caused by Escherichia coli (E. coli). All patients were classified into three groups according to accepted criteria from literature (clinical features, urographic characteristics, immunological analyses and laboratory signs of inflammatory reaction: (1) 10 patients with chronic pyelonephritis (CP); (2) 34 patients with acute pyelonephritis (AP), and (3) 21 patients with lower urinary tract infection (LUTI). Using 7 antisera antigen preparations O1, O2, 04, O7, O11, O15 and O18, 46 (70.8%) isolated strains were serotyped, while 19 (29.2%) isolated strains of E. coli remained unserotyped. None of the patients showed the presence of more than one serotype in urine. Due to the small number of cases in some groups and low number of serotype strains within the groups, break-down of serotype by patient groups was not done. The prevalent serogroup was O7 found in 22 (47.8%) patients, then O11 in 9 (19.6%), O1 in 4 (8.7%), O15 in 4 (8.7%), O4 in 3 (6.5%), O2 in 2 (4.3%) and O18 in 2 (4.3%) patients. Serogroup O7 was present in all three groups of patients. Statistical analysis showed that the incidence of serogroup O7 was not significantly different (p > 0.05); this suggests that a specific serogroup does not cause only one type of infection. Having in mind that all existing antisera were not used, the possibility of intra-hospital infection provoked by O7 serogroup should be taken into consideration.