Hanna Szymanik-Grzelak - Academia.edu (original) (raw)
Papers by Hanna Szymanik-Grzelak
Nephrology Dialysis Transplantation, 2012
Introduction and Aims: Congenital obstructive nephropathy is the primary cause of chronic renal f... more Introduction and Aims: Congenital obstructive nephropathy is the primary cause of chronic renal failure in children. Rapid diagnosis and initiation of the treatment are vital to preserve function and/or to slow down renal injury. In oxidative stress, heme oxygenase-1 (HO-1) plays a pivotal role in maintaining renal function and protecting renal structure, especially in renal tubular epithelial cells. The aim of our study was to determine whether urinary (u) HO-1 may be a useful biomarker in children with congenital hydronephrosis (HN) caused by ureteropelvic junction obstruction. Methods: The study consisted of 25 children with severe HN who required pyeloplasty (average age: 2.37 ± 0.66 years), 25 children with mild, non-obstructive HN (average age: 7.13 ± 0.65 years) and 30 healthy children (control group, average age: 5.95 ± 0.70 years). Immunoenzymatic ELISA commercial kits were used to measure uHO-1 concentration. Results: The uHO-1 and uHO-1/creatinine (cr) levels before surgery and during surgery were significantly greater in children with severe HN than in both children with mild, non-obstructive HN and control group (P < 0.01). Three months after surgery, uHO-1/cr decreased significantly in children with severe HN compared with that before surgery (1.73 ± 0.25 ng/mg vs. 4.23 ± 0.53 ng/mg; P < 0.01), but was still higher than that in children with mild, non-obstructive HN (1.73 ± 0.25 ng/mg vs. 1.04 ± 0.21 ng/mg; P < 0.05). The uHO-1 and uHO-1/creatinine (cr) levels were markedly lower in control group than that in children with mild, non-obstructive HN (uHO-1: 0.36 ± 0.06 ng/mg vs. 0.84 ± 0.11 ng/mg, P < 0.01; uHO-1/cr: 0.56 ± 0.10 ng/mg vs. 1.04 ± 0.21 ng/mg, P < 0.05). Moreover, a negative correlation between uHO-1/cr ratio and split renal function was found before surgery (r = −0.593, P = 0.002) and during pyeloplasty (r = −0.452, P = 0.023) in children with severe HN. Receiver operator characteristic analysis revealed that a good diagnostic profile for uHO-1 in terms of identifying a split renal function of < 40% in HN patients (area under the curve (AUC) 0.767) and < 45% in all examined children (AUC 0.812). Conclusions: These results indicate that increasing uHO-1 level is associated with worsening obstruction and uHO-1 is a potential useful, novel, and noninvasive biomarker for evaluating the progression of obstructive nephropathy.
Journal of Personalized Medicine, Jan 10, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Clinical Nephrology, Jul 1, 2023
PubMed, Apr 1, 1996
Skin biopsy was performed in 17 of 27 children with IgA nephropathy (IgAN) and 45 of 62 children ... more Skin biopsy was performed in 17 of 27 children with IgA nephropathy (IgAN) and 45 of 62 children with Schönlein-Henoch purpura (SHP). Renal biopsy was done in all patients with IgAN and in 51 of 62 with SHP. There was no correlation between presentation of immunological deposits in skin and renal biopsy. Deposits of IgA with or without other deposits or other deposits without IgA were observed in different pathomorphological states. Correlation between IgA serum concentration and presentation of deposits in skin was not observed. Attention was drawn to the high proportion of negative results in skin biopsy.
PubMed, Apr 1, 1996
The clinical course as well as the effects of the treatment in 27 children suffering from IgA nep... more The clinical course as well as the effects of the treatment in 27 children suffering from IgA nephropathy were followed in this study. The observation period lasted from 1.5 to 15.5 years, mean 9.1. The clinical picture according to changes in urine was the criterion of classification into 4 groups, and was related to the WHO classification of pathomorphological types. Hypertension as well as acute renal failure were observed in each clinical group except the group of children with erythrocyturia and/or haematuria. Depending on the pathomorphological changes in kidneys, different groups of drugs were used, e.g. anticoagulants, corticosteroids and also alkylating agents. In 9 children no treatment was prescribed. Only 6 children showed regression of urine changes: 2 of them with steroid-sensitive nephrotic syndrome and 1 with steroid-resistant nephrotic syndrome. In 12 children, erythrocyturia and proteinuria decreased and the intervals between successive seizures of haematuria became longer. In 3 of 8 children with nephrotic syndrome, chronic renal failure as well as end-stage renal disease were observed. In 2 of them hypertension was present during the entire observation period and it was difficult to achieve control using hypotensive drugs. In the remaining 2 children, regression of nephrotic syndrome was found, but slight proteinuria and hypertension are observed.
Pediatria i Medycyna Rodzinna, Dec 30, 2022
Normal sodium levels in the extracellular fluid are in the range of 135-145 mmol/L. Low serum sod... more Normal sodium levels in the extracellular fluid are in the range of 135-145 mmol/L. Low serum sodium (hyponatraemia) is a common water and electrolyte balance disorder. Dehydration and overhydration are the most common causes of hyponatraemia in children. This paper describes a case of a 2.5-year-old boy admitted to the paediatric ward due to pneumonia. The child showed reluctance to fluid intake, hypoosmolar hyponatraemia with hypouricaemia, and increased urinary sodium excretion in the absence of abnormalities in hydration status. He had a family history of persistent hyponatraemia and hypertension in his grandfather. After excluding pituitary, thyroid, adrenal cortex pathologies, kidney disfunction, and proliferative processes in the differential diagnosis, cerebral salt wasting syndrome, the syndrome of inappropriate secretion of antidiuretic hormone and the renal-related syndrome of inappropriate antidiuresis were taken into account. The aim of the study was to discuss the differential diagnosis of chronic euvolemic hyponatraemia and to draw attention to the need for genetic testing for the nephrogenic syndrome of inappropriate antidiuretic hormone secretion caused by activating point mutations of the vasopressin 2 receptor gene (V2R). Keywords: hyponatraemia, nephrogenic syndrome of inappropriate antidiuresis (NSIAD), syndrome of inappropriate antidiuretic hormone secretion (SIADH), cerebral salt wasting syndrome (CSWS), children Prawidłowe stężenie sodu w płynie pozakomórkowym wynosi 135-145 mmol/l. Niskie stężenie sodu w surowicy (hiponatremia) jest jednym z częstych zaburzeń gospodarki wodno-elektrolitowej. U dzieci najczęstszą przyczyną hiponatremii jest odwodnienie lub przewodnienie. W niniejszej pracy opisano przypadek 2,5-letniego chłopca, który został przyjęty na oddział pediatryczny z powodu zapalenia płuc. U dziecka stwierdzono niechęć do przyjmowania płynów, hiponatremię hipoosmolalną z hipourykemią, zwiększone wydalanie sodu z moczem, bez zaburzeń w stanie nawodnienia. W wywiadzie rodzinnym odnotowano utrzymującą się hiponatremię i nadciśnienie tętnicze u dziadka chłopca. W diagnostyce różnicowej, po wykluczeniu chorób przysadki mózgowej, tarczycy, kory nadnerczy, zaburzeń funkcji nerek, procesów rozrostowych, pod uwagę brano zespół utraty soli pochodzenia mózgowego, zespół nieadekwatnego wydzielania wazopresyny oraz nerkopochodny zespół nieadekwatnej antydiurezy. Cele pracy obejmują przedstawienie diagnostyki różnicowej przewlekłej hiponatremii euwolemicznej oraz zwrócenie uwagi na potrzebę wykonywania badań genetycznych w kierunku nerkopochodnego zespołu nieadekwatnego wydzielania wazopresyny, spowodowanego aktywującymi mutacjami punktowymi genu receptora wazopresyny 2 (V2R). Słowa kluczowe: hiponatremia, nerkopochodny zespół nieadekwatnej antydiurezy (NSIAD), zespół nieadekwatnego wydzielania wazopresyny (SIADH), zespół utraty soli pochodzenia mózgowego (CSWS), dzieci
Acta Paediatrica, Dec 1, 1992
The role of cow's milk protein intolerance in steroid-resistant nephrotic syndrome was ev... more The role of cow's milk protein intolerance in steroid-resistant nephrotic syndrome was evaluated in 17 children. Cow's milk was excluded from the diet for at least 14 days without changing previously ineffective prednisone dosage. Six patients with minimal change or mesangial proliferation went into remission 3 to 8 days after elimination of cow's milk. After a period of 2-3 weeks of remission, cow's milk challenge was positive in three patients. After one year on a cow's milk-free diet, two of six patients became milk tolerant and are in remission of NS, one of six became steroid-dependent, two of six are still unable to tolerate cow's milk and are in remission on a cow's milk-free diet and one of six children was lost from observation. The role of cellular mechanisms in steroid-resistant nephrotic syndrome is suggested.
PubMed, Oct 1, 1998
The aim of the study was to evaluate the influence of prednisone therapy on selected parameters o... more The aim of the study was to evaluate the influence of prednisone therapy on selected parameters of bone metabolism [carboxyterminal propeptide of type I procollagen (PICP), carboxyterminal pyridinoline crosslinked telopeptide of type I collagen (ICTP), alkaline phosphatase (AP), parathormone (PTH), and calciuria (Cau) in children with nephrotic syndrome. Twenty patients (aged 4-15 years, mean: 9.2 years) were treated with prednisone. Blood and urine samples were taken: T0--before prednisone treatment; T1--after two weeks of treatment with prednisone 1-2 mg/kg/24 h; T2--after two weeks of treatment with prednisone 1-2 mg/kg/48 h; T3--after 3 months of treatment with prednisone; T6--in 6th month of treatment with prednisone, at dose 0.2-0.4 mg/kg/48 h. Mean values of PICP, ICTP, AP concentration, and PICP/ICTP ratio found in the T1 period were significantly lower, and mean Cau value was higher in comparison to means of these parameters observed before steroid treatment. After two weeks of prednisone administered every 48 hours mean values of PICP, ICTP concentrations and PICP/ICTP ratio were significantly higher than in the T1 period of treatment. There were no significant differences in mean concentrations of PTH before and during everyday doses of prednisone therapy. Mean value of PTH concentration decreased significantly during T2 in comparison with T1 period of prednisone treatment. Our data demonstrate that short-term treatment with high daily doses of prednisone in children with nephrotic syndrome is associated with increase of calciuria and suppression of serum markers of type I collagen's turnover. Changes of PICP, ICTP, and PICP/ICTP ratio depend on a method of steroid administration. Decreased PICP/ICTP ratio during daily steroid treatment may indicate stronger inhibition of bone formation than bone resorption, but significance of PICP/ICTP ratio in later phases of treatment needs further studies. Present study suggests that prednisone influences bone metabolism directly rather than by stimulating the parathyroids.
Pediatria i Medycyna Rodzinna
Normal sodium levels in the extracellular fluid are in the range of 135–145 mmol/L. Low serum sod... more Normal sodium levels in the extracellular fluid are in the range of 135–145 mmol/L. Low serum sodium (hyponatraemia) is a common water and electrolyte balance disorder. Dehydration and overhydration are the most common causes of hyponatraemia in children. This paper describes a case of a 2.5-year-old boy admitted to the paediatric ward due to pneumonia. The child showed reluctance to fluid intake, hypoosmolar hyponatraemia with hypouricaemia, and increased urinary sodium excretion in the absence of abnormalities in hydration status. He had a family history of persistent hyponatraemia and hypertension in his grandfather. After excluding pituitary, thyroid, adrenal cortex pathologies, kidney disfunction, and proliferative processes in the differential diagnosis, cerebral salt wasting syndrome, the syndrome of inappropriate secretion of antidiuretic hormone and the renal-related syndrome of inappropriate antidiuresis were taken into account. The aim of the study was to discuss the diff...
Journal of Personalized Medicine
Urinary tract infections (UTIs) are one of childhood’s most common bacterial infections. The stud... more Urinary tract infections (UTIs) are one of childhood’s most common bacterial infections. The study aimed to determine the clinical symptoms, laboratory tests, risk factors, and etiology of different UTIs in children admitted to pediatric hospitals for three years. Methods: Patients with positive urine cultures diagnosed with acute pyelonephritis (APN) or cystitis (CYS) were analyzed for clinical symptoms, laboratory tests, risk factors, and etiology, depending on their age and sex. Results: We studied 948 children with UTIs (531 girls and 417 boys), with a median age of 12 (IQR 5–48 months). A total of 789 children had clinical symptoms; the main symptom was fever (63.4% of patients). Specific symptoms of UTIs were presented only in 16.3% of patients. Children with APN had shown significantly more frequent loss of appetite, vomiting, lethargy, seizures, and less frequent dysuria and haematuria than children with CYS. We found significantly higher median WBC, CRP, and leukocyturia in...
Pediatria polska, 1996
The clinical course as well as the effects of the treatment in 27 children suffering from IgA nep... more The clinical course as well as the effects of the treatment in 27 children suffering from IgA nephropathy were followed in this study. The observation period lasted from 1.5 to 15.5 years, mean 9.1. The clinical picture according to changes in urine was the criterion of classification into 4 groups, and was related to the WHO classification of pathomorphological types. Hypertension as well as acute renal failure were observed in each clinical group except the group of children with erythrocyturia and/or haematuria. Depending on the pathomorphological changes in kidneys, different groups of drugs were used, e.g. anticoagulants, corticosteroids and also alkylating agents. In 9 children no treatment was prescribed. Only 6 children showed regression of urine changes: 2 of them with steroid-sensitive nephrotic syndrome and 1 with steroid-resistant nephrotic syndrome. In 12 children, erythrocyturia and proteinuria decreased and the intervals between successive seizures of haematuria becam...
Acta Paediatrica, 1992
The role of cow's milk protein intolerance in steroid-resistant nephrotic syndrome was ev... more The role of cow's milk protein intolerance in steroid-resistant nephrotic syndrome was evaluated in 17 children. Cow's milk was excluded from the diet for at least 14 days without changing previously ineffective prednisone dosage. Six patients with minimal change or mesangial proliferation went into remission 3 to 8 days after elimination of cow's milk. After a period of 2-3 weeks of remission, cow's milk challenge was positive in three patients. After one year on a cow's milk-free diet, two of six patients became milk tolerant and are in remission of NS, one of six became steroid-dependent, two of six are still unable to tolerate cow's milk and are in remission on a cow's milk-free diet and one of six children was lost from observation. The role of cellular mechanisms in steroid-resistant nephrotic syndrome is suggested.
PubMed, Mar 1, 1992
The sensitivity to Cefobid was evaluated in vitro in 37 bacterial strains obtained from 37 patien... more The sensitivity to Cefobid was evaluated in vitro in 37 bacterial strains obtained from 37 patients. Good effectiveness of the drug against the strains was found in 78.3%, moderate in 13.5%, none in 8.2%. The clinical examinations were carried out in 16 children and again a high clinical effectiveness of Cefobid was found, with cure in 14 cases (87.5%). Cefobid was ineffective in 2 children with infection of Tenckhoff catheter, which required finally exchange of the catheter. No side effects of Cefobid were noted. Cefobid is a safe and effective antibiotic which may be given to small children and patients with renal failure. The broad spectrum and the possibility of drug use without dosage modification facilitate the treatment of patients with various grades of renal failure.
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2001
The aim of the study was to analyse effectiveness of long term alternate-day prednisone treatment... more The aim of the study was to analyse effectiveness of long term alternate-day prednisone treatment according the protocol of Waldo (Pediatr. Nephrol. 1993, 7, 529) in children with IgA nephropathy (IgAN) and Schönlein-Henoch nephritis (HSN). Eight pts: 6 with IgAN, mean age 10.1 yrs and 2 with HSN aged 10.3 and 14.3 yrs were treated with use of alternate-day prednisone for 2.3 to 3.92 (mean 2.90 yrs). Renal biopsies were performed in all patients 2 to 72 (mean 16 mths) after onset and were graded according the classification of WHO. All pts had normal serum creatinine concentrations at presentation. 3 pts had proteinuria > 1 g/1.73 m2 per day at onset and 5 pts had macroscopic or microscopic haematuria and/or increased proteinuria and/or III grade WHO in renal biopsy. After treatment haematuria and proteinuria disappeared in 2 pts and decreased in 6 pts. Hypertension (2/8), hypercalciuria (2/8), mild weight gain (6/8) and low bone density in lumbar region (5/8) were observed durin...
Background and objectives Steroid-resistant nephrotic syndrome is a rare kidney disease involving... more Background and objectives Steroid-resistant nephrotic syndrome is a rare kidney disease involving either immune-mediated or genetic alterations of podocyte structure and function. The rare nature, heterogeneity, and slow evolution of the disorder are major obstacles to systematic genotype-phenotype, intervention, and outcome studies, hampering the development of evidence-based diagnostic and therapeutic concepts. To overcome these limitations, the PodoNet Consortium has created an international registry for congenital nephrotic syndrome and childhood-onset steroid-resistant nephrotic syndrome. Design, setting, participants, & measurements Since August of 2009, clinical, biochemical, genetic, and histopathologic information was collected both retrospectively and prospectively from 1655 patients with childhood-onset steroid-resistant nephrotic syndrome, congenital nephrotic syndrome, or persistent subneph-rotic proteinuria of likely genetic origin at 67 centers in 21 countries through...
Introduction: Every year about 2.4 million people in USA are exposed to toxic substances. Many of... more Introduction: Every year about 2.4 million people in USA are exposed to toxic substances. Many of them are children below 6 years of age. Majority of poisonings in children are incidental and related to household products including for example drugs, cleaning products or antifreeze products. Antifreeze solutions contain ethylene glycol and methanol. Treatment of these toxic substances involves ethanol administration, fomepizole, hemodialysis and correction of metabolic acidosis. Purpose: The aim of the study was to check the eecacy of continuous venovenous hemodiagiltration in intoxication with ethylene glycol and methanol. Material and methods: One year and 7 months old girl after intoxication with ethylene glycol and methanol was treated with continuous venovenous hemodialtration instead of hemodialysis because of technical problems (circulatory instability). Results: Intravenous ethanol infusion with hemodialtration resulted in rapid elimination of methanol from the body and sign...
Advances in Medical Sciences, 2021
PURPOSE The aim of the study was to evaluate the clinical course and pathomorphological correlati... more PURPOSE The aim of the study was to evaluate the clinical course and pathomorphological correlations in Polish children with the diagnosis of lupus nephritis (LN). METHODS We retrospectively analyzed the medical records of 39 children hospitalized due to LN in 7 pediatric nephrology units in Poland between 2010 and 2019. Demographic data, clinical symptoms at the onset of LN and laboratory parameters were reviewed. We analyzed Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), histological LN findings with the activity (IA) and chronicity index (IC). RESULTS We examined 32 girls and 7 boys, median age at LN onset was 14.75 (IQR 13.0-16.0) years, SLEDAI of 22.0 (IQR 18.0-27.0) points; LN histological class: IV (59.4%), III (18.9%), III/V (10.8%), IV/V (8.1%), VI (2.7%); IA 8.0 (IQR 6.0-11.0) points, IC 1.05 (IQR 0-2.0) points. Children with nephrotic (n = 22) and non-nephrotic (n = 17) proteinuria differed in median Hb level (9.55, IQR 8.3-11.2 vs 10.9, IQR 10.1-11.6 g/L; P < 0.05), albumin level (2.5, IQR 2.1-3.19 vs 3.6, IQR 3.4-4.1 g/dL; P < 0.001), proteinuria (5.76, IQR 3.0-7.5 vs 1.08, IQR 0.53-1.50 g/day; P < 0.0001), eGFR (53.9, IQR 27.0-68.8 vs 96.7, IQR 73.8-106.2 mL/min/1.73 m2; P < 0.01) and occurrence of hypertension (77% vs 23%; P < 0.01). In multivariate analysis Hb level (β = 8.0; 95%CI, 1.90-14.11) was the significant predictor of eGFR<90 mL/min/1.73 m2. CONCLUSIONS Proliferative forms of LN in children may have a varying clinical presentation. Children with LN with nephrotic range proteinuria have lower Hb level, lower eGFR and higher occurrence of hypertension. Hb level is the significant predictor of eGFR<90 mL/min/1.73 m2 in children with LN.
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2008
AIM OF THE STUDY To estimate the results of treatment of vesicoureteral refluxes (VUR) in childre... more AIM OF THE STUDY To estimate the results of treatment of vesicoureteral refluxes (VUR) in children. 156 children were involved into the study. 68 children aged 10 years and above (mean age 13.1 +/- 2.4 years) were analysed in detail. The patients were divided into groups depending on method of treatment: surgical (26 children), transurethral injection of teflon/collagen (11 children), conservative (31 children). The results of treatment were evaluated on basis of subsidence of VUR, kidney function, renal scarring on DMSA scan and arterial hypertension. RESULTS Persistence of VUR was observed in 6 patients treated conservatively (19.4%), 5 of them had voiding disturbances, in 1 patient treated with injections (9.1%) and in no operated patients. There was no significant difference between groups in kidney function and in presence of hypertension. Operated patients had significantly higher grade of VUR and grade of renal scarring on DMSA scan. CONCLUSION Method of treatment of vesicour...
Nephrology Dialysis Transplantation, 2012
Introduction and Aims: Congenital obstructive nephropathy is the primary cause of chronic renal f... more Introduction and Aims: Congenital obstructive nephropathy is the primary cause of chronic renal failure in children. Rapid diagnosis and initiation of the treatment are vital to preserve function and/or to slow down renal injury. In oxidative stress, heme oxygenase-1 (HO-1) plays a pivotal role in maintaining renal function and protecting renal structure, especially in renal tubular epithelial cells. The aim of our study was to determine whether urinary (u) HO-1 may be a useful biomarker in children with congenital hydronephrosis (HN) caused by ureteropelvic junction obstruction. Methods: The study consisted of 25 children with severe HN who required pyeloplasty (average age: 2.37 ± 0.66 years), 25 children with mild, non-obstructive HN (average age: 7.13 ± 0.65 years) and 30 healthy children (control group, average age: 5.95 ± 0.70 years). Immunoenzymatic ELISA commercial kits were used to measure uHO-1 concentration. Results: The uHO-1 and uHO-1/creatinine (cr) levels before surgery and during surgery were significantly greater in children with severe HN than in both children with mild, non-obstructive HN and control group (P < 0.01). Three months after surgery, uHO-1/cr decreased significantly in children with severe HN compared with that before surgery (1.73 ± 0.25 ng/mg vs. 4.23 ± 0.53 ng/mg; P < 0.01), but was still higher than that in children with mild, non-obstructive HN (1.73 ± 0.25 ng/mg vs. 1.04 ± 0.21 ng/mg; P < 0.05). The uHO-1 and uHO-1/creatinine (cr) levels were markedly lower in control group than that in children with mild, non-obstructive HN (uHO-1: 0.36 ± 0.06 ng/mg vs. 0.84 ± 0.11 ng/mg, P < 0.01; uHO-1/cr: 0.56 ± 0.10 ng/mg vs. 1.04 ± 0.21 ng/mg, P < 0.05). Moreover, a negative correlation between uHO-1/cr ratio and split renal function was found before surgery (r = −0.593, P = 0.002) and during pyeloplasty (r = −0.452, P = 0.023) in children with severe HN. Receiver operator characteristic analysis revealed that a good diagnostic profile for uHO-1 in terms of identifying a split renal function of < 40% in HN patients (area under the curve (AUC) 0.767) and < 45% in all examined children (AUC 0.812). Conclusions: These results indicate that increasing uHO-1 level is associated with worsening obstruction and uHO-1 is a potential useful, novel, and noninvasive biomarker for evaluating the progression of obstructive nephropathy.
Journal of Personalized Medicine, Jan 10, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Clinical Nephrology, Jul 1, 2023
PubMed, Apr 1, 1996
Skin biopsy was performed in 17 of 27 children with IgA nephropathy (IgAN) and 45 of 62 children ... more Skin biopsy was performed in 17 of 27 children with IgA nephropathy (IgAN) and 45 of 62 children with Schönlein-Henoch purpura (SHP). Renal biopsy was done in all patients with IgAN and in 51 of 62 with SHP. There was no correlation between presentation of immunological deposits in skin and renal biopsy. Deposits of IgA with or without other deposits or other deposits without IgA were observed in different pathomorphological states. Correlation between IgA serum concentration and presentation of deposits in skin was not observed. Attention was drawn to the high proportion of negative results in skin biopsy.
PubMed, Apr 1, 1996
The clinical course as well as the effects of the treatment in 27 children suffering from IgA nep... more The clinical course as well as the effects of the treatment in 27 children suffering from IgA nephropathy were followed in this study. The observation period lasted from 1.5 to 15.5 years, mean 9.1. The clinical picture according to changes in urine was the criterion of classification into 4 groups, and was related to the WHO classification of pathomorphological types. Hypertension as well as acute renal failure were observed in each clinical group except the group of children with erythrocyturia and/or haematuria. Depending on the pathomorphological changes in kidneys, different groups of drugs were used, e.g. anticoagulants, corticosteroids and also alkylating agents. In 9 children no treatment was prescribed. Only 6 children showed regression of urine changes: 2 of them with steroid-sensitive nephrotic syndrome and 1 with steroid-resistant nephrotic syndrome. In 12 children, erythrocyturia and proteinuria decreased and the intervals between successive seizures of haematuria became longer. In 3 of 8 children with nephrotic syndrome, chronic renal failure as well as end-stage renal disease were observed. In 2 of them hypertension was present during the entire observation period and it was difficult to achieve control using hypotensive drugs. In the remaining 2 children, regression of nephrotic syndrome was found, but slight proteinuria and hypertension are observed.
Pediatria i Medycyna Rodzinna, Dec 30, 2022
Normal sodium levels in the extracellular fluid are in the range of 135-145 mmol/L. Low serum sod... more Normal sodium levels in the extracellular fluid are in the range of 135-145 mmol/L. Low serum sodium (hyponatraemia) is a common water and electrolyte balance disorder. Dehydration and overhydration are the most common causes of hyponatraemia in children. This paper describes a case of a 2.5-year-old boy admitted to the paediatric ward due to pneumonia. The child showed reluctance to fluid intake, hypoosmolar hyponatraemia with hypouricaemia, and increased urinary sodium excretion in the absence of abnormalities in hydration status. He had a family history of persistent hyponatraemia and hypertension in his grandfather. After excluding pituitary, thyroid, adrenal cortex pathologies, kidney disfunction, and proliferative processes in the differential diagnosis, cerebral salt wasting syndrome, the syndrome of inappropriate secretion of antidiuretic hormone and the renal-related syndrome of inappropriate antidiuresis were taken into account. The aim of the study was to discuss the differential diagnosis of chronic euvolemic hyponatraemia and to draw attention to the need for genetic testing for the nephrogenic syndrome of inappropriate antidiuretic hormone secretion caused by activating point mutations of the vasopressin 2 receptor gene (V2R). Keywords: hyponatraemia, nephrogenic syndrome of inappropriate antidiuresis (NSIAD), syndrome of inappropriate antidiuretic hormone secretion (SIADH), cerebral salt wasting syndrome (CSWS), children Prawidłowe stężenie sodu w płynie pozakomórkowym wynosi 135-145 mmol/l. Niskie stężenie sodu w surowicy (hiponatremia) jest jednym z częstych zaburzeń gospodarki wodno-elektrolitowej. U dzieci najczęstszą przyczyną hiponatremii jest odwodnienie lub przewodnienie. W niniejszej pracy opisano przypadek 2,5-letniego chłopca, który został przyjęty na oddział pediatryczny z powodu zapalenia płuc. U dziecka stwierdzono niechęć do przyjmowania płynów, hiponatremię hipoosmolalną z hipourykemią, zwiększone wydalanie sodu z moczem, bez zaburzeń w stanie nawodnienia. W wywiadzie rodzinnym odnotowano utrzymującą się hiponatremię i nadciśnienie tętnicze u dziadka chłopca. W diagnostyce różnicowej, po wykluczeniu chorób przysadki mózgowej, tarczycy, kory nadnerczy, zaburzeń funkcji nerek, procesów rozrostowych, pod uwagę brano zespół utraty soli pochodzenia mózgowego, zespół nieadekwatnego wydzielania wazopresyny oraz nerkopochodny zespół nieadekwatnej antydiurezy. Cele pracy obejmują przedstawienie diagnostyki różnicowej przewlekłej hiponatremii euwolemicznej oraz zwrócenie uwagi na potrzebę wykonywania badań genetycznych w kierunku nerkopochodnego zespołu nieadekwatnego wydzielania wazopresyny, spowodowanego aktywującymi mutacjami punktowymi genu receptora wazopresyny 2 (V2R). Słowa kluczowe: hiponatremia, nerkopochodny zespół nieadekwatnej antydiurezy (NSIAD), zespół nieadekwatnego wydzielania wazopresyny (SIADH), zespół utraty soli pochodzenia mózgowego (CSWS), dzieci
Acta Paediatrica, Dec 1, 1992
The role of cow's milk protein intolerance in steroid-resistant nephrotic syndrome was ev... more The role of cow's milk protein intolerance in steroid-resistant nephrotic syndrome was evaluated in 17 children. Cow's milk was excluded from the diet for at least 14 days without changing previously ineffective prednisone dosage. Six patients with minimal change or mesangial proliferation went into remission 3 to 8 days after elimination of cow's milk. After a period of 2-3 weeks of remission, cow's milk challenge was positive in three patients. After one year on a cow's milk-free diet, two of six patients became milk tolerant and are in remission of NS, one of six became steroid-dependent, two of six are still unable to tolerate cow's milk and are in remission on a cow's milk-free diet and one of six children was lost from observation. The role of cellular mechanisms in steroid-resistant nephrotic syndrome is suggested.
PubMed, Oct 1, 1998
The aim of the study was to evaluate the influence of prednisone therapy on selected parameters o... more The aim of the study was to evaluate the influence of prednisone therapy on selected parameters of bone metabolism [carboxyterminal propeptide of type I procollagen (PICP), carboxyterminal pyridinoline crosslinked telopeptide of type I collagen (ICTP), alkaline phosphatase (AP), parathormone (PTH), and calciuria (Cau) in children with nephrotic syndrome. Twenty patients (aged 4-15 years, mean: 9.2 years) were treated with prednisone. Blood and urine samples were taken: T0--before prednisone treatment; T1--after two weeks of treatment with prednisone 1-2 mg/kg/24 h; T2--after two weeks of treatment with prednisone 1-2 mg/kg/48 h; T3--after 3 months of treatment with prednisone; T6--in 6th month of treatment with prednisone, at dose 0.2-0.4 mg/kg/48 h. Mean values of PICP, ICTP, AP concentration, and PICP/ICTP ratio found in the T1 period were significantly lower, and mean Cau value was higher in comparison to means of these parameters observed before steroid treatment. After two weeks of prednisone administered every 48 hours mean values of PICP, ICTP concentrations and PICP/ICTP ratio were significantly higher than in the T1 period of treatment. There were no significant differences in mean concentrations of PTH before and during everyday doses of prednisone therapy. Mean value of PTH concentration decreased significantly during T2 in comparison with T1 period of prednisone treatment. Our data demonstrate that short-term treatment with high daily doses of prednisone in children with nephrotic syndrome is associated with increase of calciuria and suppression of serum markers of type I collagen's turnover. Changes of PICP, ICTP, and PICP/ICTP ratio depend on a method of steroid administration. Decreased PICP/ICTP ratio during daily steroid treatment may indicate stronger inhibition of bone formation than bone resorption, but significance of PICP/ICTP ratio in later phases of treatment needs further studies. Present study suggests that prednisone influences bone metabolism directly rather than by stimulating the parathyroids.
Pediatria i Medycyna Rodzinna
Normal sodium levels in the extracellular fluid are in the range of 135–145 mmol/L. Low serum sod... more Normal sodium levels in the extracellular fluid are in the range of 135–145 mmol/L. Low serum sodium (hyponatraemia) is a common water and electrolyte balance disorder. Dehydration and overhydration are the most common causes of hyponatraemia in children. This paper describes a case of a 2.5-year-old boy admitted to the paediatric ward due to pneumonia. The child showed reluctance to fluid intake, hypoosmolar hyponatraemia with hypouricaemia, and increased urinary sodium excretion in the absence of abnormalities in hydration status. He had a family history of persistent hyponatraemia and hypertension in his grandfather. After excluding pituitary, thyroid, adrenal cortex pathologies, kidney disfunction, and proliferative processes in the differential diagnosis, cerebral salt wasting syndrome, the syndrome of inappropriate secretion of antidiuretic hormone and the renal-related syndrome of inappropriate antidiuresis were taken into account. The aim of the study was to discuss the diff...
Journal of Personalized Medicine
Urinary tract infections (UTIs) are one of childhood’s most common bacterial infections. The stud... more Urinary tract infections (UTIs) are one of childhood’s most common bacterial infections. The study aimed to determine the clinical symptoms, laboratory tests, risk factors, and etiology of different UTIs in children admitted to pediatric hospitals for three years. Methods: Patients with positive urine cultures diagnosed with acute pyelonephritis (APN) or cystitis (CYS) were analyzed for clinical symptoms, laboratory tests, risk factors, and etiology, depending on their age and sex. Results: We studied 948 children with UTIs (531 girls and 417 boys), with a median age of 12 (IQR 5–48 months). A total of 789 children had clinical symptoms; the main symptom was fever (63.4% of patients). Specific symptoms of UTIs were presented only in 16.3% of patients. Children with APN had shown significantly more frequent loss of appetite, vomiting, lethargy, seizures, and less frequent dysuria and haematuria than children with CYS. We found significantly higher median WBC, CRP, and leukocyturia in...
Pediatria polska, 1996
The clinical course as well as the effects of the treatment in 27 children suffering from IgA nep... more The clinical course as well as the effects of the treatment in 27 children suffering from IgA nephropathy were followed in this study. The observation period lasted from 1.5 to 15.5 years, mean 9.1. The clinical picture according to changes in urine was the criterion of classification into 4 groups, and was related to the WHO classification of pathomorphological types. Hypertension as well as acute renal failure were observed in each clinical group except the group of children with erythrocyturia and/or haematuria. Depending on the pathomorphological changes in kidneys, different groups of drugs were used, e.g. anticoagulants, corticosteroids and also alkylating agents. In 9 children no treatment was prescribed. Only 6 children showed regression of urine changes: 2 of them with steroid-sensitive nephrotic syndrome and 1 with steroid-resistant nephrotic syndrome. In 12 children, erythrocyturia and proteinuria decreased and the intervals between successive seizures of haematuria becam...
Acta Paediatrica, 1992
The role of cow's milk protein intolerance in steroid-resistant nephrotic syndrome was ev... more The role of cow's milk protein intolerance in steroid-resistant nephrotic syndrome was evaluated in 17 children. Cow's milk was excluded from the diet for at least 14 days without changing previously ineffective prednisone dosage. Six patients with minimal change or mesangial proliferation went into remission 3 to 8 days after elimination of cow's milk. After a period of 2-3 weeks of remission, cow's milk challenge was positive in three patients. After one year on a cow's milk-free diet, two of six patients became milk tolerant and are in remission of NS, one of six became steroid-dependent, two of six are still unable to tolerate cow's milk and are in remission on a cow's milk-free diet and one of six children was lost from observation. The role of cellular mechanisms in steroid-resistant nephrotic syndrome is suggested.
PubMed, Mar 1, 1992
The sensitivity to Cefobid was evaluated in vitro in 37 bacterial strains obtained from 37 patien... more The sensitivity to Cefobid was evaluated in vitro in 37 bacterial strains obtained from 37 patients. Good effectiveness of the drug against the strains was found in 78.3%, moderate in 13.5%, none in 8.2%. The clinical examinations were carried out in 16 children and again a high clinical effectiveness of Cefobid was found, with cure in 14 cases (87.5%). Cefobid was ineffective in 2 children with infection of Tenckhoff catheter, which required finally exchange of the catheter. No side effects of Cefobid were noted. Cefobid is a safe and effective antibiotic which may be given to small children and patients with renal failure. The broad spectrum and the possibility of drug use without dosage modification facilitate the treatment of patients with various grades of renal failure.
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2001
The aim of the study was to analyse effectiveness of long term alternate-day prednisone treatment... more The aim of the study was to analyse effectiveness of long term alternate-day prednisone treatment according the protocol of Waldo (Pediatr. Nephrol. 1993, 7, 529) in children with IgA nephropathy (IgAN) and Schönlein-Henoch nephritis (HSN). Eight pts: 6 with IgAN, mean age 10.1 yrs and 2 with HSN aged 10.3 and 14.3 yrs were treated with use of alternate-day prednisone for 2.3 to 3.92 (mean 2.90 yrs). Renal biopsies were performed in all patients 2 to 72 (mean 16 mths) after onset and were graded according the classification of WHO. All pts had normal serum creatinine concentrations at presentation. 3 pts had proteinuria > 1 g/1.73 m2 per day at onset and 5 pts had macroscopic or microscopic haematuria and/or increased proteinuria and/or III grade WHO in renal biopsy. After treatment haematuria and proteinuria disappeared in 2 pts and decreased in 6 pts. Hypertension (2/8), hypercalciuria (2/8), mild weight gain (6/8) and low bone density in lumbar region (5/8) were observed durin...
Background and objectives Steroid-resistant nephrotic syndrome is a rare kidney disease involving... more Background and objectives Steroid-resistant nephrotic syndrome is a rare kidney disease involving either immune-mediated or genetic alterations of podocyte structure and function. The rare nature, heterogeneity, and slow evolution of the disorder are major obstacles to systematic genotype-phenotype, intervention, and outcome studies, hampering the development of evidence-based diagnostic and therapeutic concepts. To overcome these limitations, the PodoNet Consortium has created an international registry for congenital nephrotic syndrome and childhood-onset steroid-resistant nephrotic syndrome. Design, setting, participants, & measurements Since August of 2009, clinical, biochemical, genetic, and histopathologic information was collected both retrospectively and prospectively from 1655 patients with childhood-onset steroid-resistant nephrotic syndrome, congenital nephrotic syndrome, or persistent subneph-rotic proteinuria of likely genetic origin at 67 centers in 21 countries through...
Introduction: Every year about 2.4 million people in USA are exposed to toxic substances. Many of... more Introduction: Every year about 2.4 million people in USA are exposed to toxic substances. Many of them are children below 6 years of age. Majority of poisonings in children are incidental and related to household products including for example drugs, cleaning products or antifreeze products. Antifreeze solutions contain ethylene glycol and methanol. Treatment of these toxic substances involves ethanol administration, fomepizole, hemodialysis and correction of metabolic acidosis. Purpose: The aim of the study was to check the eecacy of continuous venovenous hemodiagiltration in intoxication with ethylene glycol and methanol. Material and methods: One year and 7 months old girl after intoxication with ethylene glycol and methanol was treated with continuous venovenous hemodialtration instead of hemodialysis because of technical problems (circulatory instability). Results: Intravenous ethanol infusion with hemodialtration resulted in rapid elimination of methanol from the body and sign...
Advances in Medical Sciences, 2021
PURPOSE The aim of the study was to evaluate the clinical course and pathomorphological correlati... more PURPOSE The aim of the study was to evaluate the clinical course and pathomorphological correlations in Polish children with the diagnosis of lupus nephritis (LN). METHODS We retrospectively analyzed the medical records of 39 children hospitalized due to LN in 7 pediatric nephrology units in Poland between 2010 and 2019. Demographic data, clinical symptoms at the onset of LN and laboratory parameters were reviewed. We analyzed Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), histological LN findings with the activity (IA) and chronicity index (IC). RESULTS We examined 32 girls and 7 boys, median age at LN onset was 14.75 (IQR 13.0-16.0) years, SLEDAI of 22.0 (IQR 18.0-27.0) points; LN histological class: IV (59.4%), III (18.9%), III/V (10.8%), IV/V (8.1%), VI (2.7%); IA 8.0 (IQR 6.0-11.0) points, IC 1.05 (IQR 0-2.0) points. Children with nephrotic (n = 22) and non-nephrotic (n = 17) proteinuria differed in median Hb level (9.55, IQR 8.3-11.2 vs 10.9, IQR 10.1-11.6 g/L; P < 0.05), albumin level (2.5, IQR 2.1-3.19 vs 3.6, IQR 3.4-4.1 g/dL; P < 0.001), proteinuria (5.76, IQR 3.0-7.5 vs 1.08, IQR 0.53-1.50 g/day; P < 0.0001), eGFR (53.9, IQR 27.0-68.8 vs 96.7, IQR 73.8-106.2 mL/min/1.73 m2; P < 0.01) and occurrence of hypertension (77% vs 23%; P < 0.01). In multivariate analysis Hb level (β = 8.0; 95%CI, 1.90-14.11) was the significant predictor of eGFR<90 mL/min/1.73 m2. CONCLUSIONS Proliferative forms of LN in children may have a varying clinical presentation. Children with LN with nephrotic range proteinuria have lower Hb level, lower eGFR and higher occurrence of hypertension. Hb level is the significant predictor of eGFR<90 mL/min/1.73 m2 in children with LN.
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego, 2008
AIM OF THE STUDY To estimate the results of treatment of vesicoureteral refluxes (VUR) in childre... more AIM OF THE STUDY To estimate the results of treatment of vesicoureteral refluxes (VUR) in children. 156 children were involved into the study. 68 children aged 10 years and above (mean age 13.1 +/- 2.4 years) were analysed in detail. The patients were divided into groups depending on method of treatment: surgical (26 children), transurethral injection of teflon/collagen (11 children), conservative (31 children). The results of treatment were evaluated on basis of subsidence of VUR, kidney function, renal scarring on DMSA scan and arterial hypertension. RESULTS Persistence of VUR was observed in 6 patients treated conservatively (19.4%), 5 of them had voiding disturbances, in 1 patient treated with injections (9.1%) and in no operated patients. There was no significant difference between groups in kidney function and in presence of hypertension. Operated patients had significantly higher grade of VUR and grade of renal scarring on DMSA scan. CONCLUSION Method of treatment of vesicour...