[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.

[Bone metabolism markers and bone histomorphometry in children with chronic renal failure in predialysis period during growth hormone treatment]. / Markery metabolizmu kostnego u dzieci z przewlekla niewydolnoscia nerek leczonych hormonem wzrostu w okresie przeddializacyjnym.

The aim of the study was to estimate biochemical bone metabolism markers and bone histomorphometric parameters in children with chronic renal failure (CRF) treated with recombinant human growth hormone (rhGH). Twelve children with CRF aged 2-13.4 years were treated with rhGH 1-1.1 IU/kg per week and alfacalcidol. Bone biopsies were performed before and after 12 months of therapy. An increase in the biochemical markers of bone formation and bone resorption were noted. A statistically significant increase in mineral apposition rate (MAR) was observed in bone histomorphometry. The administration of active vitamin D metabolites enable proper bone mineralization in fast growing children with CRF during rhGH treatment.

Accuracy of hemodialysis modeling.

BACKGROUND: One- and two-compartmental models of hemodialysis (HD) are well known. These models make it possible to analyze the course of treatment and to predict the effect of dialysis procedures. Mathematical modeling helps physicians to match dialysis therapy to the individual needs of the patient; however, the efficiency of the models depends on the accuracy of the coefficients. How to select coefficients in the case of one-compartmental models is known for urea and creatinine. Less information is available for two-compartmental models. Results on modeling of uric acid concentrations have not been published. METHODS: The identification of the mathematical model coefficients was based on the concentration measurements of three markers of uremic toxicity (urea, creatinine, and uric acid) in both patients' blood and dialysate. Blood samples were taken from the arterial line several times throughout the dialysis period. Simultaneously, dialysate samples were taken from a test port in the dialyzer outflow line. The mathematical model parameters were determined so as to minimize the deviations between the measured points and the calculated curves. In this way, distribution volumes, cellular clearances, and dialyzer mass transfer coefficients were estimated. RESULTS: For a one-compartmental model, the median value of distribution volume V = 0.56 DW was obtained, where DW is the patient's dry weight. For a two-compartmental model, intercompartment volume Vi = 0.36 DW and extracompartment volume Ve = 0.21 DW. The following median values for cellular clearances were established: urea 415 (mL/min), creatinine 207 (mL/min), and uric acid 257 (mL/min). CONCLUSIONS: One- and two-compartmental models describe the concentration of the urea, creatinine, and uric acid very effectively, in contrast with phosphorus, in which modeling results are not satisfactory. Although two-compartmental models are more effective, they are much more complicated than one-compartmental models, which justifies using the one-compartmental model for hemodialysis modeling. A two-compartmental model must be used in the case of rebound phenomenon modeling. The total body water values we have obtained are similar to the anthropometrically based values for urea and creatinine and to a lesser degree for uric acid. Distribution volumes for one- and two-compartmental models obtained from patient weight are the simplest coefficients for mathematical models and have sufficient precision as well. The global value of both compartments is slightly greater than the corresponding value for a one-compartmental model. The effectiveness of dialyzers is in practice lower than might be expected on the basis of the data provided by their manufacturers. Urea cellular clearance is two times greater than creatinine and uric acid cellular clearances. The clearance differences are more prominent for the cellular membrane than for artificial semipermeable membranes.

[Use of modern microscopic techniques for examining dialysis membrane properties]. / Zastosowanie nowoczesnych technik mikroskopowych w badaniach wlasnosci kapilar dializatorów.

The aim of the study was the microscopic evaluation of internal structure of cuprophane and polysulfone membrane and their surface analysis before and after reprocessing. The investigations were performed using an optical measurement system (Digital Instruments), a scanning electron microscope (SEM) and an atomic force microscope (AFM). We confirmed by SEM that reprocessing completely removed biofilm from both membranes surface. The analysis based on AFM visualized channels in the examined membrane. The diameter of the channels varied from 150 nm for cuprophane to 380 nm for polysulfone. The roughness expressed as root mean square (RMS) was higher for cuprophane than for polysulfone membrane. The physical differences between nanostrucure of the examined membranes might be responsible for lower biocompatibility of cuprophane.

Severe polyneuropathy in a 3-year-old child after dichlorophenoxyacetic herbicide--chwastox intoxication, treated successfully with plasmapheresis (PF).

The clinical picture of intoxication with dichlorophenoxy acetic herbicides is well recognised in adults and some treatment recommendations are established. To the best of our knowledge there is scarcity of well documented cases of intoxication with this substance in children. Our report describes the clinical picture of Chwastox intoxication in a 3-year-old child. Some similarities and differences between adults and children are discussed, as well as the indications for plasmapheresis, which could be a valuable mode of treatment in such cases.

[Clinical and metabolic effects of erythropoietin administration in hemodialyzed children]. / Kliniczne i metaboliczne efekty podazy erytropoetyny u dzieci hemodializowanych.

The study aimed at the evaluation of metabolic effect of recombinant human erythropoietin (EPO) in children treated with repeated hemodialyses. The research included 16 patients aged 7-17 years of life. The observations were carried out for 6 months prior to and during EPO administration programme. In that time there were monitored changes in peripheral blood count, lean body mass, protein catabolic rate- pcr, urea time averaged concentration TAC and dialysis index KT/V. The results obtained in both phases of the investigation revealed that correction of anemia by means of EPO evokes in children a significant increase of lean body mass, while TAC decreases. The two factors combined speak for anabolic effect of EPO in these patients. The results of peripheral blood count obtained in the groups with high and acceptable exposure to uremic toxemia did not differ significantly, this proves that uremic toxemia does not exert inhibitory effect on erythropoiesis stimulated by EPO administration.

[Use of urea kinetic modeling in patients on maintenance hemodialysis]. / Zastosowanie modelowania kinetycznego mocznika u chorych leczonych powtarzanymi hemodializami.

The effect of urea kinetic modeling (u.k.m.) application on dialysis efficiency and metabolic status was evaluated in 50 maintenance dialyzed patients. U.k.m. sessions were performed once a month based on the self-developed computer program to control dialysis. The dialysis index (Kt/V), the time averaged concentration (TAC), protein catabolic rate (pcr) and dialysis effectiveness (Ct/Co) were evaluated and the results obtained at the beginning and after 2, 4, and 8 months of the study were compared. Kt/V had risen significantly in the modeled patients from 1.04 to 1.24 and was accompanied by 12% Ct/Co increase of urea removal after 8 months. The tendency of the moderate (non significant) decrease of TAC from 54.57 to 52.48 mg% BUN was observed during the study. According to the NCDS criteria the percentage of adequately dialyzed patients increased from 42% at the beginning to 64% after 80 months; underdialyzed patients decreased from 16% to 6% and malnourished also from 16% to 6%, respectively, after u.k.m. application. Dialysis effectiveness for creatinine and uric acid described by Ct/Co for the above after 4 and 8 months was significantly increased when compared with the results obtained at the beginning of the study. These results indicate that u.k.m. application allowed to take control over uremic toxemia and improved dialysis adequacy in patients on maintenance dialysis. Protein catabolic rate in studied patients increased from 1.18 to 1.24 g/kg/per day during the study and it was accompanied by a total blood protein and serum albumin increase. This could indicate improvement of the nutritional status of dialyzed subjects.

[Estimation of the dialysis time based on a simplified algorithm for urea kinetics]. / Obliczanie czasu dializy w oparciu o uproszczone algorytmy modelowania kinetycznego mocznika.

A simplified method of calculating the dialysis time based upon urea kinetic modeling equation: Ct = C0 e exp - (Kt/V) is presented together with a table of urea clearance values for most commonly used dialyzers. The method is handy and helpful to prescribe dialysis time either in chronic uraemics or in patients with acute renal failure on hemodialysis. Estimation of a patient's urea distribution volume equal to the total body water and blood flow through the dialyzer are the key points in the described calculations.

[Effect of using recombinant human erythropoietin on the effectiveness of hemodialysis in children with terminal renal failure]. / Wplyw stosowania rekombinowanej ludzkiej erytropoetyny na skutecznosc dializy u dzieci ze schylkowa niewydolnoscia nerek.

Recombinant human erythropoietin (EPO) was administered to 12 children aged 8-17 years subjected to hemodialysis for a mean period of 16 (S.D. 19.7) months prior to EPO treatment. The hormone was administered thrice weekly at an intravenous dose of 25-75 u/kg until hemoglobin value of 100 g/l was obtained, and subsequently at maintenance doses for mean period of 7 (S.D. 4.0) months. The urea kinetic modeling (UKM) algorithms allowed to compute dialysis index KT/V for each patient in modeling sessions performed once a month. The analysis included the effect of EPO upon: peripheral whole blood count; individual UKM parameters; selected laboratory data (predialysis potassium, phosphorus, creatinine, total blood protein and albumin levels) in three randomized groups according to the value of KT/V: I. KT/V less than or equal to 1.0--underdialyzed, II. KT/V (1.0-1.4)--adequately dialyzed, III. KT/V greater than 1.4--overdialyzed. The results from 188 pre-EPO modeling sessions and 78 sessions in the course of EPO treatment were compared. All the three groups revealed increased Hb, Ht and erythrocyte count in cu mm, statistically significant in Groups II and III. EPO administration resulted in an improvement of dialysis adequacy, increasing the number of adequate modeling sessions from 66 up to 90% and simultaneously reducing the number of sessions in Groups I and III from 9.5 to 2.5% and from 24.5 to 7.5%, respectively. The 2.4% decrease of dialysis index observed after EPO administration was due to increased urea distribution volume.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of recombinant human erythropoietin--rHu-EPO on the metabolism of children treated by long-term hemodialysis]. / Wplyw rekombinowanej ludzkiej erytropoetyny--rHu-EPO na metabolizm dzieci leczonych powtarzanymi hemodializami.

Recombinant human erythropoietin (EPO) was administered to 12 children with terminal renal failure aged 8-17 years subjected to hemodialysis for a mean period of 16 (S.D. = 19.7) month prior to EPO utilisation. The hormone was administered thrice weekly at an intravenous dose of 25-75 u/kg until Hb value of 100 g/l was obtained, and subsequently at maintenance doses for mean period of 7 (S.D. = 4.0) month. The urea kinetic modeling (UKM) algorithms allowed to compute protein catabolic rate (pcr) for each patient in modeling sessions performed once a month. The analysis included the effect of EPO upon: 1. peripheral whole blood count; 2. individual UKM parameters; 3. selected lab data describing the metabolic status of the patient (predialysis potassium, phosphorus, creatinine, total blood protein and albumin--and iron levels), in three randomized groups according to the value of pcr. Group I presented pcr less than 1.0 g protein/kg/day typical for malnutrition; group II--pcr = 1.0-1.4 g protein/kg/day--with appropriate protein catabolism; group III--pcr greater than 1.4 g protein/kg/day--hypercatabolic. The results from 188 pre-EPO modeling sessions and 78 sessions in the course of EPO treatment were compared. All the three groups revealed statistically significant increased Hb, Ht and erythrocyte count after EPO administration, which also resulted an increase of protein catabolism what is manifested in a decrease in the number of sessions by 26.1% in Group I and a corresponding increase by 13.5% and 12.6% in Groups II and III, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Mastoiditis--a forgotten disease?]. / Antritis--choroba zapomniana?

The symptoms and clinical course of latent mastoiditis in 18. children treated in Polish-American Children's Hospital in Cracow were presented. The ultimate diagnosis of mastoiditis was based on typical findings on antrotomy and the presence of granulation on histology of the tissue obtained during the operation. The main symptoms of latent mastoiditis were: a lack of appetite, chronic or recurrent fever and failure to thrive. 11 children (61%) had experienced more than 3 episodes of acute otitis media before the diagnosis of mastoiditis was established. Bacteria most commonly isolated from the middle ear were those of Staphylococcus, Streptococcus and Proteus species. Radiograms of mastoid processes were negative in up to 45% of those children. The mean duration of antibiotic therapy was 10.7 weeks. After antrotomy complete dissolution of symptoms were observed in 14 patients (78%). It is concluded, that in the presence of symptoms suggesting latent mastoiditis, the possibility of antrotomy, which may shorten the period of ineffective antibiotic therapy, should be considered earlier.