Elevated brain natriuretic peptide is associated with abnormal heart geometry in children with chronic kidney disease.

AIM: It was to establish whether brain natriuretic peptide (BNP) might predict cardiac dysfunction in children with chronic kidney disease (CKD). METHODS: The relation between BNP, echocardiography and risk factors (hypertension, anemia, lipids, CRP, hyperparathyroidism) was investigated in 46 children (10 pre-dialysis patients, 14 on dialysis, 11 children with kidney transplants, and 11 healthy controls). Data on BNP were transformed into common logarithms (log(10) BNP, log BNP). RESULTS: log BNP was significantly higher in dialysis patients when compared to controls (2.09 +/- 0.78 vs. 1.43 +/- 0.34 pg/ml, p = 0.012) and patients in the pre-dialysis stage (2.09 +/- 0.78 vs. 1.52 +/- 0.42 pg/ml, p = 0.039). log BNP in transplanted children was not significantly different from healthy children (2.09 +/- 0.78 vs. 1.71 +/- 0.46 pg/ml, p = 0.19). Abnormal heart geometry (concentric and eccentric hypertrophy, concentric remodeling) was found in 19 patients (54.28%). A significant correlation was observed between log BNP and ventricular hypertrophy (r = 0.515, p = 0.001). Compared to controls higher log BNP was seen in children with eccentric hypertrophy than in children with concentric hypertrophy (2.178 +/- 0.956 vs. 1.496 +/- 0.395 pg/ml, p = 0.05, or 1.982 +/- 0.618 vs. 1.496 +/- 0.395, p = 0.04). CONCLUSIONS: BNP might predict an abnormal geometry in children with CKD.

[Brain natriuretic peptide might predict the abnormal geometry of heart in children with chronic kidney disease]. / Mozgový natriuretický peptid môze predikovat' zmenu geometrie srdca u detí s chronickou oblickovou chorobou.

BACKGROUND: Cardiovascular diseases are the leading course of morbidity/mortality in children with chronic kidney disease. Recently it has been shown that a brain natriuretic peptide is a sensitive cardiac marker for classification of the cardiovascular risk in adults. Whether it has the same diagnostic value in children with chronic kidney diseases has to be established. The purpose of the study was to evaluate whether the brain natriuretic peptide can predict cardiac dysfunction in children with chronic kidney disease. METHODS AND RESULTS: Relation between serum level of the brain natriuretic peptide, echocardiography and cardiovascular risk factors (hypertension, anaemia, lipids, C-reactive protein, secondary hyperparathyreoidism) has been studied in 46 children (10 patients at predialysis, 14 patients on dialysis, 11 children with kidney transplant and 11 healthy controls). Brain natriuretic peptide was significantly higher in dialysed patients (2.09 +/- 0.78) in comparison with healthy children (1.43 +/- 0.34, p = 0.012) and with both groups of patients at pre-dialysis stage (1.52 +/- 0.42, p = 0.039) and after kidney transplant (1.71 +/- 0.46, p = 0.19). Abnormal heart geometry was found in 19 patients (54.28%). Compared to controls, brain natriuretic peptide was higher in children with eccentric but not in those with concentric hypertrophy (2.178 +/- 0.956 vs. 1.496 +/- 0.395, p = 0.05, resp. 1.982 +/- 0.618 vs. 1.496 +/- 0.395, p = 0.04). Significant correlation was found between levels of brain natriuretic peptide and ventricular hypertrophy (p = 0.001), with the level of parathyroid hormone (p = 0.03) and with the degree of anaemia (p = 0.027). CONCLUSIONS: Brain natriuretic protein can predict an abnormal geometry of heart in children with chronic kidney disease. Our preliminary results suggest that it is a suitable marker of cardiovascular classification in paediatrics.

[Influence of serum levels of luteinizing hormone during controlled ovarian hyperstimulation on the results of IVF cycle]. / Vplyv sérových hladín luteinizacného hormónu pocas kontrolovanej ovariálnej hyperstimulácie na výsledky cyklu IVF.

OBJECTIVE: To evaluate the effect of endogenous luteinizing hormone level in the middle of in vitro fertilization cycle with depot GnRH agonist on the outcomes of assisted reproduction. DESIGN: Prospective clinical trial. SETTING: 2nd Department of Gynecology and Obstetrics of Medical Faculty and L. Pasteur University Hospital Kosice METHODS: In the prospective clinical trial the effect of endogenous LH level during ovarian hyperstimulation with recombinant follicle stimulating hormone on outcomes of IVF was evaluated. The total number of 364 in vitro fertilization cycles in normogonadotrophic women undergoing assisted reproduction with GnRH agonist down-regulation and recombinant FSH controlled ovarian stimulation were included. A part of cycles with low residual LH levels were not included into statistical analysis, because of stimulation protocol adaptation. 315 cycles were taken into final statistical analysis. These cycles were divided into three groups according to middle stimulation LH level: under 0.5 IU/L, 0.5-2.0 IU/L and over 2.0 IU/L. RESULTS: The best results were achieved in the middle group. The differences in most of parameters were statistically significant: FSH dosage, days of stimulation, number of oocytes, estradiol level, number of embryos and fertilization rate. Pregnancy rate and early pregnancy loss differences were not significant. CONCLUSIONS: It was statistically evaluated that the best outcomes of assisted reproduction were in the group with LH level 0.5-2.0 IU/L. Correlation lines proved that the LH level 0.5 IU/L is the point under that the outcomes can worsen. It can be explained that the differences between pregnancy rates were not significant, because of low number of cycles with low residual LH levels included.

[Influence of exogenous supplementation with luteinizing hormone during controlled ovarian hyperstimulation on the results of IVF cycle]. / Vplyv exogénnej suplementácie luteinizacného hormónu pocas kontrolovanej ovariálnej hyperstimulácie na výsledky cyklu IVF.

OBJECTIVE: To evaluate the effect of exogenous luteinizing hormone in in vitro fertilization cycles with depot GnRH agonist and low residual LH levels. DESIGN: Prospective randomized clinical trial. SETTING: 2nd Department of Gynecology and Obstetrics, Medical Faculty and L. Pasteur University Hospital Kosice METHODS: In the prospective randomized clinical trial the effect of exogenous LH on outcomes of assisted reproduction was evaluated. The total number of 68 in vitro fertilization cycles in normogonadotrophic women undergoing assisted reproduction with GnRH agonist down-regulation and recombinant FSH controlled ovarian stimulation were included. In all cycles the low residual LH level in the middle of stimulation was detected. The cycles were randomized into three groups. The first group was stimulated with pure recombinant FSH. In the second group the exogenous LH activity in the form of human menotrophin was added. And in the third group the human recombinant LH was added. RESULTS: Better outcomes of assisted reproduction were detected in both groups with exogenous LH activity. But these results, except the dosage of FSH, were not statistically significant. The increase of pregnancy rate by more than one fifth in these both groups can be considered as clinically relevant. CONCLUSIONS: It can not be positively proved at the base of our results that exogenous LH activity in cycles with low residual LH level can improve outcomes of assisted reproduction. It could be appropriate in the future to select women that can profit from exogenous LH activity according to other parameters not only to the LH serum level.