Urinary OPN excretion in children with glomerular proteinuria.

PURPOSE: The aim of the study was to investigate urinary levels and clinical significance of osteopontin (uOPN) in children with different glomerular diseases according to histological diagnosis and degree of proteinuria. MATERIALS AND METHODS: The examinations were conducted in 3 groups of children: I - 20 children with minimal change disease (MCD) examined twice: A - in relapse; B - in remission, group II - 17 children with focal segmental glomerulosclerosis (FSGS), III - 12 children with IgA nephropathy (IgAN). The control group (C) contained 20 healthy children. OPN was measured in the urine using ELISA commercial available kit (R&D Quantikine) and was expressed in ng/ mg cr. RESULTS: The median uOPN/ cr. in MCD children in relapse (IA) was median 134.98 ng/ mg cr. and was higher when compared to controls (p< 0.01). In exam IB, when proteinuria subsided, OPN/ cr. increased to median 172.96 ng/ mg cr. and was higher in comparison to healthy subjects (p< 0.01) and MCD children in relapse (p<0.05). Children from group II revealed higher uOPN/ cr. levels when compared to groups I, III and C (p< 0.01). UOPN/ cr. positively correlated with protein/ creatinine ratio in all examined groups of children (p< 0.01). CONCLUSION: We found significantly higher uOPN/ cr. in all the groups of children with glomerulonephritis. The highest uOPN/ cr. levels were found in patients with FSGS and correlated significantly with both interstitial changes and mesangial expansion found in kidney biopsy.

Bonn Risk Index based micromethod for assessing risk of urinary calcium oxalate stone formation.

PURPOSE: The Bonn Risk Index has been used to evaluate the risk of urinary calcium oxalate stone formation. According to the original method, risk should be determined based on a 200 ml urine sample taken from a 24-hour collection. We evaluated whether the Bonn Risk Index can also be effectively determined in small urine samples. MATERIALS AND METHODS: We studied 190 children and adolescents with nocturia and calcium oxalate urolithiasis. Initially Bonn Risk Index was determined according to the original method of Laube. Subsequently Bonn Risk Index was calculated using a computer program controlling a specially designed system to define the time point of induced crystallization based on consecutive urine samples of 1.5, 2.0 and 3.0 ml. RESULTS: No significant differences were found in Bonn Risk Index between values obtained from 200 ml samples and those based on the micromethod with urine samples of 2 and 3 ml. CONCLUSIONS: Assessment of risk of urinary calcium oxalate stone formation with Bonn Risk Index in small urine volumes, based on prototype equipment controlled by specialized computer software, is comparable to the original method. This finding facilitates the procedure and improves Bonn Risk Index determination in children.

Serum osteoprotegrin (OPG) and receptor activator of nuclear factor kappaB (RANKL) in healthy children and adolescents.

UNLABELLED: Most metabolic bone diseases are characterized by a disturbance in bone resorption, therefore biochemical markers concerning this process are of special interest. Recent investigations in bone biology identified the RANKL/ RANK/OPG system, the set of cytokines or cytokine receptors belonging to the tumor necrosis factor (TNF) family that are required for control of bone modeling and remodeling. The imbalance between OPG and RANKL was found not only in pathology of bone, but also in the control of the immune and vascular systems. However, clinical application of new bone markers in children may be difficult due to lack of reference data in relation to age, sex and physiological development. AIM: To investigate the relationship of serum concentrations of OPG, RANKL and OPG/RANKL ratio in relation to age, sex and parameters of physical development in healthy children and adolescents. CHILDREN AND METHODS: The study was performed on a group of 70 healthy children and adolescents, divided into subgroups according to sex and age. OPG and sRANKL serum concentrations were determined using ELISA. RESULTS: Serum OPG did not differ between boys and girls or younger and older children. There was no correlation between OPG level and height, weight and BMI percentiles. The level of sRANKL was 3 times higher in males than in females (p < 0.01) and almost 3 times higher in older than younger children (p < 0.01). There was a positive correlation between sRANKL concentration and body weight percentile (r = 0.268, p < 0.05). There was no correlation between serum OPG and sRANKL levels. CONCLUSION: In healthy children and adolescents the serum level of OPG is not influenced by age, sex or parameters of physical development, in contrast to sRANKL and sRANKL/OPG ratio, which are dependent on these factors. Age and sex reference data should be established.

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.

Assessment of selected adhesion molecules and lymphocyte subpopulations in children with IgA nephropathy.

PURPOSE: The aim of the study was to assess the expression of selected adhesion molecules on mononuclear cells of peripheral blood and lymphocyte subpopulations in children with IgA nephropathy (IgAN). MATERIAL AND METHODS: 14 children with IgAN and 20 healthy controls were included in the study. Flow cytometry was used to determine the expression of such adhesion molecules as L selectin (CD62L), VLA-4 integrin (CD49d), intracellular molecule ICAM-1 (CD54) and cytotoxic lymphocyte molecule CTLA-4 (CD152), as well as the lymphocyte antigens: CD3, CD4, CD8, CD19, CD1656 (NK), CD4 and CD8 RO+ and RA+. RESULTS: The findings revealed that the expression of the adhesion molecules VLA-4 and CTLA-4 did not differ from that of the healthy controls (p > 0.05). However, the expression of CD62L (L-selectin) was increased (p < 0.05). The expression of ICAM-1 was reduced, but not significantly, compared to the control group (p > 0.05). We found a decrease in the expression of NK cells (CD1656) and CD4/CD8 ratio, and an increase in CD8 cells (p < 0.05). In the group of 9/14 children, with proteinuria over 1.0 g/24 hours, a decreased expression of CD4 was additionally found (p < 0.05). CONCLUSIONS: The children with IgAN show: 1. Changes in peripheral lymphocyte subpopulations involving an increase in CD8 cells and a decrease in CD1656(NK) cells, a reduction in the CD4/CD8 ratio, and additionally in cases with proteinuria a reduction in CD4 cell count, 2. Increased expression of L-selectin (CD62L) on peripheral blood mononuclear cells.

[Lymphocyte subpopulations of peripheral blood in children with Schönlein-Henoch purpura and IgA nephropathy]. / Subpopulacje limfocytów krwi obwodowej u dzieci z choroba Schönleina-Henocha i nefropatia IgA.

The main lymphocytes' subpopulations of peripheral blood in 21 children (mean age--9.8 +/- 3.3 y) with permanent proteinuria and haematuria, 11 with IgA nephropathy (IgA) and 10 with nephropathy in course of Schonlein-Henoch purpura (Sch-H) during intensification of symptoms were assessed on flow cytometer f. Coultier, using monoclonal antibodies. The control group consisted of 21 healthy children at the same age. The results showed decreased percentage of CD4 and increased percentage of CD8 with decreased CD4/CD8 ratio in both groups of examined children. In most cases also increased percentage of B lymphocytes (CD19) were noticed and especially in children from N IgA group increased concentration of immunoglobulin A in serum. Only in some patients increased percentage of natural cytotoxic cells NK were noticed. The results were similar either in N IgA or Sch-H groups.

[Sacral bone dysgenesis in a child whose mother has diabetes]. / Niedorozwój kosci krzyzowej u dziecka matki chorej na cukrzyce.

We introduced 2.5-year old girl with gait and miction disturbances as a result of sacral bone dysgenesis (only S1 existed) and abnormal position of nerve roots of medulla. The 28-year old mother of the child has been treated for diabetes mellitus type I since she was 15.

[The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection]. / Przebieg popaciorkowcowego klebuszkowego zapalenia nerek w zaleznosci od sposobu leczenia poprzedzajacego zapalenia dróg oddechowych.

UNLABELLED: The aim of our work was to assess the course of post-streptococcal glomerulonephritis (APSGN) in children according to the way of preceding respiratory tract infection treatment. The examinations were carried out in a group of 26 children aged 5-15 years, who were divided into two subgroups: I--12 children, who did not receive antibacterial treatment, and II--14 children who were shortly treated with different antibiotics (3-5 days). All the children had full symptomatic picture of post-streptococcal glomerulonephritis with haematuria, oedemas, hypertension and hypocomplementemia. The etiology was diagnosed retrospectively during observation of ASO titer dynamics and additionally in 18 after finding pathogenic Streptococcus strains in pharyngeal swab. The differences in the course of illness was shown only during first weeks. In children from the group I the course of acute APSGN was a little more serious, because haematuria, proteinuria and hypertension were observed longer. Symptoms of nephrotic syndrome were observed in two children, acute renal insufficiency in two children, and one with hypertensive encephalopathy. After 3 and 12 months no children had pathological signs. Erythrocyturia was observed in 19 of 26 children after 3 months and in 10 of 26 children after 12 months after illness with similar frequency in both groups. In 5 children with proteinuria renal biopsy showed mesangialis proliferative glomerulonephritis--1st degree. CONCLUSION: All observed children with APSGN were not cured properly during the respiratory tract infection preceding the disease, however even short antibacterial treatment caused the moderation of symptoms.

[Urinary calcium/creatinine excretion in children with isolated hematuria]. / Wydalanie szczawianów w moczu dzieci z izolowanym krwikomoczem.

The aim of this study was to assess the oxalate excretion (Ox) in 23 children aged 3-17 years with haematuria (I), using the enzymatic method. Control group (II) consisted of 21 healthy children. The results showed out that in children with haematuria both mean oxalate excretion (Ox/ker) and mean calcium excretion (Ca) and calcium/creatinine ratio (Ca/ker) were higher than in control group. However, the differences were not significant important (p > 0.05). Significantly higher oxalate and calcium excretion was diagnosed in 5 children with renal stone disease and 8 children without stones but with paroxysmal abdominal pain and positive family history.

[Ultrasound-guided renal biopsy with automatic needle with a leader]. / Biopsja nerki pod kontrola obrazu ultrasonograficznego z uzyciem automatycznej igly z prowadnica.

UNLABELLED: The aim of this work was to discuss the results of percutaneous renal biopsy under control of ultrasound, using automated needle. 110 specimen in 55 children aged 3-18 years were obtained. Adequate biopsy was obtained in 53 children. Only in 26% of children the number of glomeruli in each specimen was below 8. The most frequent complication was microscopic haematuria, lasted 1-3 days, which was shown in 70.9% of children. Perirenal haematoma smaller than 2 cm was observed in about 12% of children and pain during the first day after biopsy in 20% of examined children. CONCLUSION: Percutaneous renal biopsy using automated biopsy needle under control of ultrasound is safe and efficient method, which is used for definitive diagnosis.

[Immunoglobulin E and eosinophils in urine of children with bronchial asthma]. / Immunoglobulina E oraz eozynofile w moczu dzieci chorych na dychawice oskrzelowa.

Excretion IgE and eosinophils was assayed in the urine of 25 children with bronchial asthma during attack (I) after regression of symptoms (II) and in a group of healthy children aged 4-15 years. Three healthy children (12%) excreted trace amounts of IgE and single eosinophils to urine. In the group of sick children during attack (I), 20 children (80%) excreted IgE in urine, 10 children (40%) excreted eosinophils. Thirteen children (52%) had nocturia, dysuria or erythrocyturia of unknown cause. After regression of acute symptoms of asthma (II) IgE in urine was excreted in smaller amounts than in (I) by 60% of the children, while eosinophils by 24% children. In the II investigation, 8 children (32%) still had nocturia. It was found that IgE and eosinophils are present in the urine of children with bronchial asthma, regardless if symptoms from the urinary tract are present or not.

[Nephrotoxicity evaluation of cytostatic agents in children with acute lymphoblastic leukemia]. / Ocena nefrotoksycznosci cytostatyków u dzieci z ostra bialaczka limfoblastyczna.

Urinary excretion of the markers of tubular nephrotoxicity, total NAG and isoenzymes A and B and B-2-M, were evaluated in urine of 21 children with acute lymphoblastic leukaemia after the first injection of cytostatic administrated according to the BFM scheme: VCR + Rub, L-aspa, CY, Ara-C. Every administrated drug caused temporary elevation in urinary excretion of total NAG and isoenzyme B and B-2-M. GFR was unchanged. These results point to nephrotoxicity of cytostatics. Peak total NAG, isoenzyme B and B-2-M excretion was observed on the third day after L-aspa and Ara-C injection.

[Use of salazopyrin in Schonlein-Henoch disease]. / Zastosowanie salazopiryny w chorobie Schonleina-Henocha.

A favourable effect was achieved of treatment with salazopyrin of severe abdominal of Schoenlein-Henoch disease (SH). Salazopyrin was used in two children with generalized form of SH, with paroxysmal abdominal pain and bleeding from the gastrointestinal tract.

[Anomalies of the cervical spine in children]. / Anomalie w zakresie kregoslupa szyjnego u dzieci.

Two children are presented with congenital anomalies of the cervical spine and associated malformations of the nervous and urinary systems. The attention is paid to the usefulness of the cervical spine assessment in children in cases of recurrent cerebellar manifestations of unclear aetiology or combined malformations of the urinary system.

[Evaluation of N-acetyl-beta-D-glucosaminidase (NAG) and its isoenzyme activities in the urine of children with primary and secondary hypertension]. / Ocena aktywnosci N-acetylo-beta-D-glukozaminidazy (NAG) i jej izoenzymów w moczu dzieci z nadcisnieniem pierwotnym i wtórnym.

The total activity of N-acetyl-beta-D-glucosaminidase (NAG) and its isoenzymes A and B was determined in the urine of 18 children aged 9-18 years with essential hypertension and 21 with nephrogenic hypertension. The results were compared with those in a control group of 30 healthy children. The obtained results show that in children with stabilized hypertension (above the 95 centile) of essential type the proportion (above the 95 centile) of essential type the proportion of urinary isoenzymes are changes, with higher activity of the B isoenzyme. On the other hand, in children with nephrogenic hypertension the total activity and the activity of the B isoenzyme are increased. After reduction of blood pressure following hypotensive treatment (below the 90th centile) the activity of NAG and its isoenzymes was again normal in essential hypertension and was much reduced in nephrogenic hypertension. The study demonstrated that hypertension leads to transient damage to the proximal tubules which is reversed by effective hypotensive treatment.