Expression of chemokine receptors on peripheral blood T cells in children with chronic kidney disease.

Chemokine receptors play a role in leukocyte recruitment, activation, and maintaining effector functions and regulate adaptive immune response and angiogenesis. The study aimed at flow cytometric analysis of T cell subsets with selected surface chemokine receptors (CCR4, CCR5, CCR7, CXCR3, and CXCR4) or receptor combination in peripheral blood of children with chronic kidney disease (CKD) on hemodialysis (HD). The percentage of T lymphocytes with CD8 and combined CD28,CCR7 expression was higher in HD children. The percentage of T lymphocytes expressing CCR7, CD28,CCR7, and CXCR4,CD8 was increased in children on conservative treatment. Total number (tn) of CXCR4+ cells was reduced in children on hemodialysis. The tn of T CXCR3+ cells was lower in children on conservative treatment. During HD the percentage of T CD4+ cells was higher and of T CXCR3+ lymphocytes was lower after HD session as compared to 15 min of session duration. During HD tn of T cells with expression of CCR4, CCR5, CCR7, CXCR3, and CXCR4 was constant. The alteration of chemokine receptors expression in children with CKD occurs early in the development. Diminished expression of CXCR3, CXCR4 on T cells in patients with CKD on HD might result in impaired inflammatory response. Increased CCR7+ T cell percentage could be responsible for the alteration of migration of cells into secondary lymphatic organs.

Percutaneous endoscopic gastrostomy as a method of nutrition support in children with chronic kidney disease.

Chronic kidney disease (CKD) exerts a significant impact on children's growth and development. In infants and children with CKD, feeding-related problems are not infrequent, leading to protein-energy malnutrition and resulting in retarded physical development. Because spontaneous energy intake is usually inadequate in children with CKD, special dietary counseling with supportive procedures are often required. Placement of a percutaneous endoscopic gastrostomy (PEG) tube is one practical way to allow home tube feeding. Such nutrition support is valuable in children with CKD, and although it is not free from complications and technical problems, it seems to be helpful in providing required nutrition intake. In this report, the authors describe their own experience with PEG implantation and use in 3 children with CKD.

The heat shock protein profile in children with chronic kidney disease.

OBJECTIVES: Chronic kidney disease (CKD) due to inflammation, lipid disorders, and endothelial dysfunction predisposes to accelerated atherosclerosis. Elevated levels of heat shock proteins (HSPs) and antibodies against them have been described in adults with atherosclerotic lesions and cardiovascular events. However, there are no investigations of these variables in children with CKD treated conservatively or on peritoneal dialysis. Therefore, we decided to evaluate the profile of HSPs and their potential role as markers of atherosclerosis in these groups of patients. METHODS: The study group consisted of 37 children with CKD treated conservatively and 19 children and young adults on automated peritoneal dialysis (APD). The control group comprised 15 age-matched subjects with normal kidney function. HSP-60, HSP-70, HSP-90alpha, anti-HSP-60, anti-HSP-70, sE-selectin, and interleukin (IL)-4 serum concentrations were assessed by ELISA; high-sensitivity C-reactive protein (hs-CRP) serum levels were assessed by nephelometry. Serum lipid profiles (total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglycerides) were also estimated. RESULTS: HSP-90alpha, anti-HSP-60, and sE-selectin concentrations in the CKD and APD patients were higher than in the controls and were lower in the predialysis subjects than in the children on dialysis. Median values of anti-HSP-70 were higher in the CKD patients than in the control group. Levels of IL-4 were increased in all patients versus controls. Median values of HSP-60 were decreased in the CKD and APD children versus controls. HSP-70 and hs-CRP concentrations were comparable in all groups. CONCLUSIONS: The altered HSP and anti-HSP concentrations may imply that the response to stress conditions in the course of CKD is disturbed in children; APD does not aggravate that dysfunction in a significant way. Relationships between HSPs, lipid profile, and markers of inflammation suggest a possible role of the selected HSPs as markers of atherosclerosis in children with CKD.

The impact of dialysis modality on serum heat shock proteins in children and young adults with chronic kidney disease.

BACKGROUND/AIMS: The acceleration of atherosclerosis by dialysis is not completely understood. The elevated levels of heat shock proteins (HSP) and antibodies against them were described in adults with atherosclerotic lesions, but there are no investigations on them in dialyzed patients. The aim of the study was to evaluate the serum HSP, their connections with dialysis modality and their possible role as markers of atherosclerosis. METHODS: Hsp60, Hsp90-alpha, anti-Hsp60 and anti-Hsp70 concentrations were assessed by ELISA in 19 children on automated peritoneal dialysis (APD) and 17 patients on hemodialysis (HD). hsCRP, sE-selectin, IL-4, IL-12 and the lipid profile were also estimated. RESULTS: Hsp60 values were lower, whereas Hsp90-alpha was higher in the dialyzed children than in the controls, without any difference between the dialysis modalities. The anti-Hsp60 concentrations were increased in all patients and higher in HD patients than in APD patients. The anti-Hsp70 levels in the APD children were decreased versus controls. Anti-Hsp60 correlated with HDL-cholesterol in APD children, and with total cholesterol and LDL-cholesterol in HD patients. Anti-Hsp70 correlated with sE-selectin in HD subjects. CONCLUSIONS: The levels of antibodies against HSP seem to distinguish between the dialysis modalities and the correlations with the lipid profile and sE-selectin, suggesting their potential role as markers of atherosclerosis.

Heat shock proteins in children and young adults on chronic hemodialysis.

Chronic inflammation, lipid and autoimmune disorders are hallmarks of atherogenesis, and hemodialysis per se may be an additional factor predisposing to accelerated atherosclerosis. Elevated levels of heat shock proteins (HSP) and antibodies against these HSP have been described in adults with atherosclerotic lesions and cardiovascular events, but to date there has been a scarcity of investigations on these parameters in adult and pediatric patients on hemodialysis (HD). We have investigated the HSP profile in hemodialyzed children and the impact of a single HD session on those proteins and their correlations with known risk factors for atherosclerosis. The study group consisted of 17 children and young adults undergoing HD with polysulfone membranes. The control group comprised 15 age-matched subjects with normal kidney function. The serum concentrations of Hsp60, Hsp90alpha, anti-Hsp60, anti-Hsp70, and sE-selectin were assessed by an enzyme-linked immunosorbent assay, and serum concentration of high-sensitivity-C-reactive protein was assayed by nephelometry. The serum lipid profile [total cholesterol (CHOL), high-density lipoprotein-CHOL, low-density lipoprotein-CHOL, triglycerides] was also estimated. Compared to the control values, the median values of Hsp60 before the HD session were lower, whereas those of Hsp90alpha and anti-Hsp60 were higher. A single HD session raised the median values of Hsp60 and Hsp90alpha and decreased the concentrations of anti-Hsp60 and anti-Hsp70. In addition, the concentrations of HSPs and the antibodies against them correlated with the lipid markers both before and after HD. The altered HSP and anti-HSP concentrations in HD children, which correlated with the lipid profile and the endothelial markers, suggest a dysfunctional HSP system in this population and the possibility of HSPs being classified as new markers of atherosclerosis.

Oxidative stress in children on peritoneal dialysis.

OBJECTIVES: Enhanced oxidative stress has been observed in dialysis and predialysis adult patients with chronic kidney disease (CKD), which resulted in increased mortality and morbidity within this population. Not much attention in the literature has been paid to nonenzymatic antioxidant defense in children with CKD on peritoneal dialysis (PD). The aim of the present study was to describe the plasma, erythrocyte, and dialysate concentrations of oxidized (GSSG) and reduced glutathione (GSH) and vitamins A, E, and C in a pediatric PD population. PATIENTS: 10 children on PD and 27 age-matched healthy subjects were enrolled in the study. RESULTS: Erythrocyte and plasma GSH concentrations were lower in PD patients, erythrocyte concentration of GSSG remained unchanged, and plasma GSSG was significantly higher in children on PD. Children on PD exhibited decreased plasma concentrations of antioxidant vitamins compared to healthy subjects. Moreover, we documented loss of vitamins A, E, and C into ultrafiltrate. CONCLUSION: Such low plasma levels of vitamins A, E, and C and simultaneously decreased activity of erythrocyte GSH may be responsible for the increased oxidative stress occurring in children with CKD on PD.

[Systemic lupus erythematosus and pregnancy]. / Tocze'n rumieniowaty ukladowy a ciaza.

Systemic lupus erythematosus (SLE) is an autoimmune chronic disease, which involves multiple organs, particularly joints, skin, heart, lungs, nervous system and kidneys. Systemic lupus erythematosus has the predilection to women in their reproductive years and causes numerous health complications during the pregnancy and labour. Lupus flares occur during each trimester of pregnancy and also at postpartum period. Complications are usually mild and appear as the skin and joint involvement. The main challenge are flares in women with severe renal form of SLE. Such exacerbations often need the intensive treatment measures for the mother. The presence of lupus nephritis during conception may aggravate current arterial hypertension in the mother and lead to chronic renal failure progression. In the study authors report the risk factors for spontaneous abortions and premature births in women with SLE particularly in the group with the presence of antiphospholipid syndrome. The features and course of neonatal SLE was also discussed. The goals of medication of women with SLE and lupus nephritis during pregnancy and the treatment during postpartum period and lactation were described.

[Evaluation of growth hormone treatment results in children with chronic renal failure--one center experience]. / Ocena wyników leczenia hormonem wzrostu dzieci z przewlekla niewydoinoscia nerek--doswiadczenia jednego osrodka.

UNLABELLED: The study aimed at the retrospective evaluation of rhGH treatment results in children with chronic renal failure CRF and short stature treated at Dpt. and Clinic of Pediatrics, Dialysis Unit and Ambulatory in Zabrze, Medical University of Silesia in Katowice. Medical records of 21 children at mean age of 11.0 years (7 girls and 14 boys) were analysed. Eleven children remained on renal replacement therapy. The mean dose of rhGH was 1.1 UI/kg/week). Five children are still on rhGH treatment. RESULTS: Mean growth velocity during rhGH treatment was 15.2 cm/ total period of treatment, 6.98 cm/year. Mean SDS of growth at the beginning of treatment was: -3.25, at the end of treatment: -2.76 (p < 0.02). PTH value 123.6 pg/ml, at the end of treatment 241.29 pg/mL (p < 0.05). CONCLUSION: RhGH treatment in children with CRF gives the opportunity to gain the final height compared to healthy children.

[Diagnostic value and safety of percutaneous kidney biopsy in experience of one clinical center]. / Wartosc diagnostyczna i bezpieczenstwo przeskórnej biopsji nerki w doswiadczeniach jednegos osrodka.

UNLABELLED: Percutaneous kidney biopsy is a widely applied diagnostic procedure providing with kidney tissue for microscopy. AIM OF THE STUDY: The assessment of diagnostic value of kidney tissue specimens gained by percutaneous biopsy and the assessment of that method's safety. MATERIAL: 119 percutaneous kidney biopsies performed on patients of Pediatric Clinic in Zabrze from 1998 through 2007 were analysed. RESULTS: Histopathological diagnosis was assessed in 107 cases (90%). The other 12 specimens (10%) were described by the pathomorphologist as non-diagnostic. In analysed group of patients serious complications were noted in 5 cases (4.2%): massive haematuria (in 2 cases), massive bleeding in perirenal space (in 3 cases including 1 resulting in nephrectomy). CONCLUSIONS: Percutaneous kidney biopsy is a valuable diagnostic procedure. Because of possible complications it is very important to comply with indications and contraindications established for that procedure.

Plasma ghrelin levels in children with chronic renal failure on peritoneal dialysis.

OBJECTIVES: Malnutrition and loss of appetite represent a serious problem in children with chronic renal failure. Ghrelin is a newly described hormone involved in control of growth hormone secretion, stimulation of food intake, and regulation of energy balance. METHODS: Plasma ghrelin levels were compared between 12 children on automated peritoneal dialysis (APD) and 9 children on conservative treatment of chronic renal failure. Eight healthy children matched for age and body mass index (BMI) served as a control group. RESULTS: Plasma ghrelin levels were similar in children on APD (698.3 +/- 59.7 pg/mL) and children on conservative treatment (675.4 +/- 41.9 pg/mL) compared to healthy controls (700.1 +/- 24.7 pg/mL). There was no difference in plasma ghrelin levels in children with chronic renal failure regardless of the method of treatment (peritoneal dialysis vs conservative treatment). The plasma ghrelin index was similar in all three investigated groups: APD 40.2 +/- 8.7 vs conservative treatment 39.1 +/- 5.6 vs controls 41.0 +/- 7.8 (pg/mL)/BMI (kg/m2). Plasma ghrelin levels did not correlate with age, duration of dialysis treatment, height, weight, BMI, creatinine and urea levels, adequacy parameters, or nightly glucose load. CONCLUSION: Plasma ghrelin levels in children on APD were not different from levels in children on conservative treatment or healthy controls with comparable BMI. The persistent state of toxic influence of uremic end-products could be responsible for such a lack of correlation with anthropometrical parameters. Further studies on a larger group of children on APD are needed to clarify the effect of ghrelin on nutritional status in children with chronic renal failure.

[Renal complication in tuberous sclerosis complex]. / Powiklania nefrologiczne w zespole stwardnienia guzowatego.

Authors present the review of current literature on the subject of nephrological complications in tuberous sclerosis complex (TSC) on the basis of two ease reports of children with familial TSC. In 18-years-old girl the features of polycystic kidney disease with end-stage renal failure, epilepsy, mental retardation, calcifications of structures in central nervous system and skin abnormalities coexist. In 10.5-years-old boy morphological changes in both kidneys revealed hyperechoic renal cortex (renal function - creatinine clearance within normal ranges), other features are similar as compared to sister. In the girl during the one month of observation asymptomatic acute bleeding to a cyst and under the renal capsule occurred. It was necessary to perform bilateral nephrectomy because of these life threatening events.

Methimazole-induced toxic epidermal necrolysis in a 12-year-old girl.

We report a 12-year-old girl with hyperthyreosis who presented methamazole-induced toxic epidermal necrolysis (TEN). The patient's past history suggests a presence of autoimmune disease. To our knowledge it is the first report describing such an adverse effect of methimazole.

[Hearing evaluation in chronic renal failure children]. / Ocena narzadu sluchu u dzieci z przewlekla niewydolnoscia nerek.

UNLABELLED: Chronic renal failure (CRF) causes a lot of systemic side-effects, among them: neurological and otological complications. In present study hearing evaluation was made in young patients, using distortion product otoacoustic emissions (DPOAEs) and auditory brainstem responses (ABR). THE AIM OF STUDY: (1) objective assessment of hearing organ activity in CRF children, (2) localization of hearing organ part involved in CRF, (3) establishing best parameters of ipsilateral stimulation in DPOAEs for clinical use. MATERIALS AND METHODS: Hearing acuity was assessed in 22 CRF children ranging in age from 9 to 17 years and 18 healthy children ranging in age from 10 to 18 years. At first pure tone audiometry and tympanometry were evaluate. Only patients with normal middle ear condition and hearing threshold better than 30 dB HL were put forward further investigations. Objective assessment of hearing condition included: (1) DPOAEs using DP-gram format. Two simultaneous pure-tone signals (primaries) were presented to the ear at two different frequencies (f1 and f2, where f2 > f1) and the 2f1-f2 were analyzed. Five pairs of non equal level and L2 were used L1 and L2: panel A1: L1 = 65 and L2 = 60 dB SPL, panel A2: L1 = 63 and L2 = 55 dB SPL, panel A3: L1 = 59 and L2 = 45 dB SPL, panel A4: L1 = 55 and L2 = 35 dB SPL, panel A5: L1 = 51 and L2 = 25 dB SPL; (2) ABR investigation using click stimulus, at 90 dB nHL level. Wave I, III, V latencies and intervals I-III, III-V, I-V were evaluated. Our results reviled significantly lower mean DPOAEs amplitudes in CRF children when compare to healthy children, at all frequencies measured. No differences in ABR evaluation were observed. Most optimal DPOAEs parameters in clinical use seem to be panel A1, A2 and A3 of level L1 and L2.

Lipid peroxidation and antioxidant enzymes in children on maintenance dialysis.

End-stage renal disease (ESRD) is associated with numerous complications, which may partly result from excessive amounts of reactive oxygen species and/or decreased antioxidant activity. The aim of the study was to evaluate lipid peroxidation (LP) in plasma and erythrocytes, erythrocyte antioxidant enzyme activity (superoxide dismutase, SOD; catalase, CAT; glutathione peroxidase, GSH-Px), and concentrations of Cu and Zn as cofactors of SOD and Se as a cofactor of GSH-Px in erythrocytes, plasma and in dialysis fluid in children with ESRD. In particular, we analyzed whether the modality of dialysis could modify oxidative stress parameters in children. To determine the influence of hemodialysis (HD) on oxidative stress, the measurements were also performed on HD children 20 min after the beginning of the dialysis session. Thirty-one patients participated in the study: group I with 10 children on continuous ambulatory peritoneal dialysis (CAPD), and group II with 21 on HD. The erythrocyte malondialdehyde concentrations (E-MDA), plasma MDA (P-MDA) and plasma organic hydroperoxide (OHP) in children from both groups were higher than in controls. E-MDA and P-MDA in HD before the session was lower compared to the values after 20 min of HD session (time T20). The activity of SOD, GSH-Px, CAT, concentrations of erythrocyte and plasma Se, Cu, Zn were lower in children with ESRD than in controls. In the HD group, the activity of GSH-Px, CAT, and levels of trace elements in erythrocytes and in plasma were diminished at time T20. In conclusion, increased oxidative stress occurs in children on maintenance dialysis, independent of dialysis modality. The activity of the enzymatic antioxidant defence system is highly reduced in red blood cells of pediatric dialysis patients. Children with ESRD exhibit lower trace element (Se, Cu, Zn) levels in plasma and erythrocytes as compared to healthy subjects. Oxidative stress is aggravated during every single HD session in children.

Vitamins A, E and C as non-enzymatic antioxidants and their relation to lipid peroxidation in children with chronic renal failure.

BACKGROUND: Increased lipid peroxidation (LP) and reduced enzymatic antioxidant defense have been observed in predialysis patients with advanced chronic renal failure (CRF) and in patients on maintenance hemodialysis (HD). To extend these observations, we evaluated the plasma, erythrocyte and dialysate levels of vitamins A and E and the plasma and dialysate levels of vitamin C as exogenous non-enzymatic antioxidants in children with CRF treated conservatively and on HD. The data obtained were related to LP monitored by erythrocyte malonyldialdehyde (E-MDA) and plasma organic hydroperoxide (OHP) concentrations. PATIENTS: Forty-six predialysis children were enrolled in the study and divided into 2 groups: group I = moderate CRF (plasma creatinine < 265.3 micromol/l), and group II = plasma creatinine > or = 265.3 micromol/l. Group III consisted of 21 HD children. 27 age-matched healthy subjects served as a control group. RESULTS: The plasma levels of vitamin A and vitamin C were significantly reduced in all CRF patients when compared to the controls, with the lowest values observed in children on maintenance HD (group III). Significant differences were also noted between the moderate CRF (group I) and HD (group III). Plasma levels of vitamin E were significantly decreased in moderate CRF (group I) and HD (group III) as compared to controls. In contrast, the erythrocyte vitamin A and vitamin E levels of predialysis children and HD patients were not different from the controls. The E-MDA and OHP concentrations in the 3 groups of CRF children were significantly higher than in healthy subjects. The concentration of plasma vitamin C was significantly inversely correlated with E-MDA, plasma OHP and creatinine in group I. In group II we found a significant correlation of plasma vitamin E levels with creatinine and E-MDA and a correlation of the plasma vitamin C concentration with E-MDA. CONCLUSION: CRF in children is associated with decreased concentrations of plasma antioxidant vitamins. This reduction is most expressed in children on maintenance HD and particularly concerns plasma vitamin C and erythrocyte vitamin E concentrations. The low levels of plasma vitamin A, E and C might result in reduced activity of the non-enzymatic antioxidant defense system and might be responsible for increased oxidative stress occurring in children with CRF.

Does a late referral to a nephrologist constitute a problem in children starting renal replacement therapy in Poland?--a nationwide study.

BACKGROUND: It is estimated that 20-50% of adult patients start chronic dialysis therapy without prior contact with a nephrologist. The aim of this nationwide study was to assess clinical and metabolic status of children at the start of chronic dialysis in Poland with regard to the timing of the referral to a nephrologist. METHODS: We studied data of 180 children (mean age 14+/-6 years) undergoing chronic dialysis in 13 (out of 14) dialysis pediatric centres in Poland. Patients were classified as early referrals (ERs) when they entered the dialysis programme at least 1 month after the first referral to a nephrologist or late referrals (LRs) when the dialysis was introduced within 1 month from the first visit. RESULTS: Seventy-nine percent of pediatric patients were referred early (ER) to the dialysis centre and 21% were referred late (LR) and had to start dialysis within a month. When starting dialysis, LR patients had significantly higher levels of urea and phosphate as well as lower calcium and haemoglobin in comparison with ERs. Hypertension, pulmonary oedema, fluid overload, treatment in the intensive care unit (ICU) and body mass index (BMI) below 10th percentile turned out to be more frequent in the LR group. Peritoneal dialysis (PD) was used as the first method of dialysis in 59% of ERs and 46% of LRs. The majority of ER patients was treated in the predialysis period with calcitriol, phosphate binders and low protein diet (84%, 89%, 92% of all children, respectively), and 20% of them received epoetin. In the up to 3 years observation of our initial cohort, we also found that the patients who were referred late were less likely to receive kidney transplant (P = 0.02). CONCLUSION: The results of the study indicate that the LR to a pediatric nephrologist was associated with poorer clinical and metabolic status of children entering chronic dialysis programmes.

Hypertension in dialysed children: the prevalence and therapeutic approach in Poland--a nationwide survey.

BACKGROUND: The aim of this nationwide analysis was to assess the incidence and current treatment profile of arterial hypertension in children undergoing chronic haemodialysis or peritoneal dialysis and attitudes of paediatric nephrologists towards the choice of antihypertensive drugs in their patients. METHODS: The study group consisted of 134 children (89 males, 45 females, mean age 10.7+/-5 years) from all 13 paediatric dialysis centres in Poland. The data were gathered through a questionnaire for each patient dialysed in November 2004. RESULTS: The overall incidence of hypertension in the study group was 55% (74 of 134 patients; 47 males, 27 females). The incidence rate was similar in boys and girls (53 vs 60%) and in those on haemodialysis and peritoneal dialysis (56 vs 54%). Chronic glomerulonephritis as an underlying renal disease was significantly more frequent in the hypertensive than in the normotensive subjects (37 vs 10%, P = 0.004). Residual urine output was higher in normotensives (41 vs 10 ml/kg body weight; P < 0.001). Among those treated with antihypertensives: 32% were treated by monotherapy, 36% received two drugs, 22% received three drugs, while 7% received > or = 4 drugs. The therapy was effective in only 57% of subjects. We observed no differences in biochemical and clinical parameters between those who responded to the therapy and those who failed to do so. Calcium channel blockers constituted the most frequently administered class of drugs [73% of children; in 43 out of 48 (90%) combined with other drugs, but in 11 out of 24 (46%) as a monotherapy]. In monotherapy, angiotensin-converting enzyme inhibitors and calcium channel blockers were administered most frequently. CONCLUSION: We conclude that the incidence of hypertension in dialysis children in Poland is high (55%). The effectiveness of antihypertensive treatment is rather low (58%) and the choice of drugs is limited.

[Port device central venous access in children with chronic renal disease--personal experience]. / Zastosowanie centralnych dostepów zylnych typu "port" u dzieci z przewleklymi chorobami nerek--doswiadczenia wllsne.

UNLABELLED: The application of central venous lines in children has been widely accepted in the case of pediatric cancer treatment. This is of particular importance when the treatment must be continued during the long period of time. The indication to long-term application of central venous lines became significantly frequent within last years. They are necessary in the treatment of chronic pediatric patients, in whom the central venous line allows continuous access for medication, parenteral rehydration, nutrition and frequent blood sampling. MATERIAL AND METHODS: In the current study authors present their experience in subcutaneous port devices application in children with kidney disease. The case history data obtained from 8 children were retrospectively analysed. In these children subcutaneous port devices were applied for mean 26.7 months (totally 9 port devices). The mean age at the time of implantation was 2.2 years, and the mean body weight--10.6 kg. RESULTS: Peripheral venous access in all children was bad. In one child during the time of implantation the hematoma of coli and chest was present. Infectious complications connected with implanted port device were not detected. Thrombotic complications were present in 6 children with chronic renal failure--in 5 the lumen of port device has been successfully recanalysed, in 3 cases even several times. In 1 child the thrombus on the tip of central venous line was detected. In 2 children the removal of port device was necessary because of breakage of venous line and in the second case because of port device thrombosis. Two children died with functioning port device. The cause of death was not connected with implanted port device. CONCLUSIONS: The application of subcutaneous port devices definitely improved the comfort of treatment but was significantly associated with thrombotic complications. Infectious complications were not detected as compared to hematological group of patients.

[Evaluation of cochlear function in children with chronic renal failure]. / Ocena funkcji slimaka u dzieci z przewlekla niewydolnoscia nerek.

UNLABELLED: In present study cochlear function was evaluate in young chronic renal failure (CRF) patients using distortion product otoacoustic emissions (DPOAEs). THE AIM OF STUDY: (a) objective assessment of cochlear function in CRF children, (b) establishing best parameters of ipsilateral stimulation in DPOAEs (DP-gram format) for clinical use. Hearing acuity was assessed in 19 CRF children and 18 healthy children. At first pure tone audiometry and tympanometry were evaluate. Only patients with normal middle ear condition and hearing threshold better than 30 dB HL were put forward further investigations. Objective assessment of cochlear function included DPOAEs using DP-gram format. Our results reviled significantly lower mean DPOAE amplitudes in CRF children when compare to healthy children, at all frequencies measured. Most optimal DP-gram parameters in clinical use seems to be level L1 and L2 equal respectively: 65 and 60 dB SPL; 63 and 55 dB SPL; 59 and 45 dB SPL.

[Serum leptin levels in children with chronic renal failure on continuous ambulatory peritoneal dialysis and on hemodialysis treatment]. / Ocena stezenia leptyny w surowicy krwi u dzieci z przewlekla niewydolnoscia nerek, leczonych za pomoca ciaglej ambulatoryjnej dializy otrzewnowej oraz hemodializ.

UNLABELLED: Malnutrition and loss of appetite remain a frequent problem in children with chronic renal failure (CRF). Recent studies in human gave much attention for leptin, polypeptide produced by adipocytes, and its influence on appetite and energetic balance regulation. The study aimed at evaluation of serum leptin levels (SLL) in children with CRF with regard to applied method of treatment. Study included 29 children, mean age 13.9 +/- 4.2 years. Among them 10 on peritoneal dialysis (PD, mean age 11.9 +/- 4.3 years), 10 - on maintenance hemodialysis (HD, mean age 16.3 +/- 2.4 years), 9 - on conservative treatment of CRF (CT, 13.0 +/- 4.3 years). SLL was evaluated by RIA. In all groups of children with CRF SLL was high: group I (PD): 34.3 +/- 44.0, group II (HD): 31.5 +/- 57.4, group III (CT): 16.5 +/- 21.1 ng/ml. There was no difference of SLL in children with CRF regarding to method of treatment. Evaluated SLL/BMI index (body mass index) showed no difference in comparison of examined groups of children with CRF (values respectively: PD: 1.5 +/- 1.8; HD: 1.3 +/- 2.1; CT: 0.8 +/- 1.9 ng/ml +/- kg/m2). Also SLL/creatinine index did not differ between examined groups (values respectively: PD: 5.2 +/- 8.2; HD: 4.4+/-8.4; CT: 4.0 +/- 4.6 ng/mg). In both subgroups on dialysis treatment SLL correlated with BMI, additionally in HD SLL correlated with body weight, in PD - with serum ionised calcium. No correlation with age, dialysis treatment duration, creatinine and urea levels was found. CONCLUSIONS: In children on maintenance dialysis high SLL were observed. The highest SLL in PD patients, when considering CRF group could be related to high dialysate glucose concentration and probably decreased clearance through the peritoneal membrane. The correlation between SLL and BMI was preserved in all groups of children with CRF, irrespective of applied method of treatment.