[Evaluation of the efficacy of cyclosporine A treatment in idiopathic nephrotic syndrome in children]. / Ocena skutecznosci cyklosporyny A w idiopatycznym zespole nerczycowym u dzieci.

This study reports the results of cyclosporine A (CsA) treatment in 106 children with idiopathic nephrotic syndrome. All of them had normal renal function. In 66 CsA was added to prednisone because of primary steroid-resistancy. Remission was obtained in 31 (47%) and improvement in 23 (35%). In 12 patients (18%) CsA was ineffective. Best results were obtained in youngest children (< 2 years of age) and those with minimal change disease (78% of remission). Renal function remained normal in all children in remission, while in 30% of those with improvement GFR decreased. In all children with persistent nephrotic syndrome chronic or end stage renal failure developed. 40 children were treated with CsA because of long-lasting steroid-dependency, the lack of effect of alkylating agents and steroid toxicity. In 16 of them prednisone was discontinued and in the rest given in very low doses. The steroid-toxicity effects disappeared or became less prominent in all of them. Appearance of albuminuria with decrease of the CsA dose and/or relapses of nephrotic syndrome during or after discontinuation of CsA treatment were quite frequent. For this reason the treatment course was prolonged, in some patients up to 55 months. This may result in chronic CsA nephrotoxicity. We performed second renal biopsy during remission in 28 children. The morphological signs of nephrotoxicity (grade I according to Habib and Niaudet) were considered in 5 (18%) of them.

[Vasoactive peptides, endothelin 1 and neuropeptide Y, and total peripheral vascular resistance in children with essential hypertension]. / Stezenie wazoaktywnych peptydów endoteliny 1 i neuropeptydu Y a calkowity obwodowy opór naczyniowy u dzieci z samoistnym nadcisnieniem tetniczym.

Cardiac function was evaluated in rest and after exercise on a cycloergometer in 20 patients with essential hypertension (EH) aged 14 to 19 years and 12 age-matched healthy volunteers. Selected parameters of ECHO examination and mitral flow were assessed, including SV, CO, CI, %SF, EF, LIVDd, IVSd, LVPWd, LVMI, total peripheral vascular resistance, ESS, velocity of wave E. A and E/A index. In all cases, serum ET1 and NPY levels were measured in rest and after exercise, before and after 6-month enalapril therapy. The ETI serum level in hypertensive patients did not differ from controls, while the NPY level was significantly higher in hypertensives. Exercise did not affect the ETI serum concentration, however, it did increase the NPY level. Enalapril therapy had no effect on serum peptide concentrations. Correlation of the ETI serum level with ECHO parameters, including CO, Cl, SV, LIVDd, LVPWd, %SF, TPRI and wave E velocity, as well as correlation of NPY concentration with LIVDd, LVPWd, LVMI, ESS and wave E and A velocity may suggest that these peptides influence left ventricle function and structure disturbances in children with EH.

[Evaluation of treatment of uric acid urolithiasis and prevention of stone formation in children]. / Ocena skutecznosci leczenia zachowawczego kamicy moczanowej u dzieci i zapobiegania nawrotom.

The objective of this study was to evaluate treatment of uric acid urolithiasis and prevention of uric acid stone formation in children. We treated 18 children (11 boys and 7 girls) with uric acid urolithiasis. Complete dissolution of stones was achieved in 16 children (89%). During a two year follow-up period, 14 children (78%) were recurrence free.