[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.

[Acute pyelonephritis--clinical picture and the main diagnostic and therapeutic problems in children]. / Ostre odmiedniczkowe zapalenie nerek--obraz kliniczny oraz glówne problemy diagnostyczne i terapeutyczne u dzieci.

The aim of the study was to determine the main clinical and organising difficulties affecting quality and efficacy of medical care in children with acute pyelonephritis (AP). 41 children aged 3 wk--17 yr 4 mo hospitalized for AP at the Department of Nephrology, District Children's Hospital, Szczecin, Poland in 2000 were investigated. Epidemiologic and demographic data, history, clinical presentation, auxiliary investigations, treatment and ambulatory follow-up were analysed. Instead of typical clinical picture neither diagnostic management nor the therapy fulfilled accepted standards. The main problems found were: delay of referral to hospital by primary care doctor, misdiagnosis or inaccurate primary diagnosis followed by insufficient treatment, difficulties with performing simple ambulatory tests (urinalysis, urine culture, ultrasonography) before hospitalisation and lack of co-operation between parents and nephrological outpatient clinic after discharge. For reflux and obstructive nephropathy, often presenting as urinary tract infection, are still the main cause of chronic renal failure in children in Poland the special attention was paid to necessity of thorough education of family doctors in the subject of management of such cases as well as improvement of accessibility to specialistic care.