Publications (29)52.77 Total impact
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Article: Pediatric normative data for urine NGAL/creatinine ratio.
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ABSTRACT: AIM: The objective of this study was to establish age-dependent urine NGAL (neutrophil gelatinase associated lipocalin) /creatinine ratio values in healthy children and adolescents. METHODS: The study was performed using a random sample of 172 healthy children and adolescents (M - 88, F - 84), aged median 9.75 (0.2 - 17.9) years. Urine NGAL concentration was measured using a commercially available ELISA kit (R&D Systems, USA). RESULTS: Median concentrations of urine NGAL/creatinine in particular age groups were analyzed using ANOVA. The differences between the youngest group of children, under the age of 6 years and the rest of examined population was statistically significant. There were no differences in urine NGAL/creatinine between other age groups. Statistically significant negative correlation between urine NGAL/creatinine and age of subjects was found (r= -0.29, p<0.05). CONCLUSION: In the study, normative values of urine NGAL/creatinine for subjects aged 0.2 to 17.9 years have been established. These data may help clinicians and researchers to improve the interpretation of urine NGAL/creatinine ratio in children and adolescents. However further studies using numerous data should be conducted to add reference values for urine NGAL partitioned by age and gender. ©2013 The Author(s)/Acta Paediatrica ©2013 Foundation Acta Paediatrica.Acta Paediatrica 02/2013; · 2.07 Impact Factor -
Article: Polish 2012 growth references for preschool children.
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ABSTRACT: Growth references are useful in monitoring a child's growth, which is an essential part of child care. The aim of this paper is to provide updated growth references for Polish preschool children and to assess how well children in Poland match or diverge from the World Health Organization (WHO) growth standards/references and recent German height-for-age references. The height-, weight-, body mass index-for-age, and weight-for-height references were constructed with the LMS method using data from a recent, large, population-representative sample of 4,941 preschool children aged 3 to 6 years (the OLA study). In the case of boys, the third, 50th, and 97th height percentiles of new Polish and German references overlap almost completely, whereas the WHO growth standards/references percentiles are systematically lower. In the case of girls, comparison between the new Polish and German height references showed conformity on the third and 50th percentile, whereas body height values of the WHO standards/references are shorter. Polish children aged 3 to 6 years from for the nation representative sample, had significantly greater than zero mean z scores of height-, weight-, and BMI-for-age and weight-for-height, relative to the WHO growth standards/references. The number of children in the sample with height-for-age below -2 SD was significantly lower than expected and number of children with height-for-age above +2 SD was significantly higher than expected. Conclusion: The OLA study growth references can be recommended as national references for preschool children in Poland.European Journal of Pediatrics 02/2013; · 1.88 Impact Factor -
Article: Oscillometric blood pressure percentiles for Polish normal-weight school-aged children and adolescents.
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ABSTRACT: OBJECTIVE:: The objective of this study was to construct blood pressure (BP) references with the use of a validated oscillometric device for normal-weight, school-aged children and adolescents and to study BP predictors. METHODS:: BP was measured in 14 266 randomly selected, normal-weight Polish children and adolescents aged 7-18 years, who were free of chronic disease, using a validated oscillometric device (Datascope Accutor Plus). Height, weight and waist circumference were measured. BP percentiles were constructed for age and height simultaneously with the use of a polynomial regression model. The normative values of BP were compared with the US normal-weight reference, German oscillometric reference, and Polish auscultatory reference. RESULTS:: Reference BP percentiles by sex, age and height are presented. At median height, the age-specific differences in the 90th BP percentiles compared with German oscillometric reference ranged in the case of boys from -3 to 2 mmHg and from -5 to -1 mmHg, SBP and DBP, respectively, and in the case of girls from 0 to 3 mmHg and from -5 to -1 mmHg, SBP and DBP, respectively. As compared to weight, waist circumference was stronger SBP predictor in low birth weight boys. CONCLUSION:: The study provides BP references for oscillmetric device, based on a current, nationally representative sample of normal-weight Polish children and adolescents. The normative values of BP were compared taking into consideration the height and BMI differences, the pubertal spurt, the methods of BP measurement and percentile construction.Journal of hypertension 07/2012; 30(10):1942-1954. · 4.02 Impact Factor -
Article: Oxidative stress in hypertensive children before and after 1 year of antihypertensive therapy.
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ABSTRACT: The relation between primary hypertension (PH), target organ damage (TOD) and oxidative stress (SOX) is not known. We assessed SOX in 86 children with PH before and after 12 months of standard non-pharmacological and pharmacological therapy based on renin-angiotensin system blockade. Patients with left ventricular hypertrophy (LVH) and with carotid intima-media thickness (cIMT) >2SDS had higher thiobarbituric acid reactive substances (TBARS) concentrations in comparison to patients without LVH or with normal cIMT. Patients with metabolic syndrome (MS) had lower activity of gluthatione peroxidase, higher asymmetric dimethyloarginine (ADMA) and oxidized LDL cholesterol (oxyLDL) in comparison to patients without MS. TBARS correlated with left ventricular concentric hypertrophy, cIMT, albuminuria and SBP/24 h. ADMA and oxyLDL correlated with CRP and TG/HDL ratio. After 1 year of antihypertensive treatment blood pressure, TOD and prevalence of MS decreased. TBARS decreased and glutathione concentrations increased. The decrease of TBARS concentration correlated with the decrease of body mass index (BMI). Decrease of oxyLDL and ADMA correlated with increased insulin sensitivity, however markers of SOX did not correlate with BP decrease. SOX in children with PH correlates with TOD, metabolic abnormalities, changes in fat amount and improvement of insulin sensitivity, but not with BP decrease.Pediatric Nephrology 06/2012; 27(10):1943-51. · 2.52 Impact Factor -
Article: Add-on therapy with angiotensin II receptor 1 blocker in children with chronic kidney disease already treated with angiotensin-converting enzyme inhibitors
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ABSTRACT: The standard renoprotection is based on the inhibition of the renin-angiotensin system (RAS) by angiotensin convertase inhibitors (ACEi) or angiotensin II receptor 1 blockers (AT1B). The aim of our study was to analyze the effects of the addition of AT1B to ACEi-based renoprotection in children with chronic kidney disease. We examined 11 children with a mean age of 10.5years (range, 0.5–18years) with a mean glomerular filtration rate (GFR) of 61±61ml/min/1.73m2. In four patients, the primary renal disease was hemolytic uremic syndrome, in three congenital nephrotic syndrome (CNS), in two reflux nephropathy, prune-belly syndrome in one and acute cortical necrosis in one. All patients were treated with complex hypotensive ACEi-based therapy. AT1B losartan was added in a mean dose of 0.9mg/kg/day. The change in GFR, proteinuria and blood pressure at two 12-month intervals before and after adding AT1B was compared. The results showed that during the 12 months preceding AT1B therapy, there was no change in blood pressure and proteinuria, but the GFR declined in 7 of 11 patients. After the 12th month of add-on therapy with AT1B, there was a significant decrease in both absolute and indexed blood pressure values. Proteinuria decreased in eight patients, did not change in one and increased in two, including one with CNS. The GFR stabilized or increased in eight patients and decreased in three patients with CNS. In 7 of 11 patients, there was a significant, but not threatening increase in serum potassium. In conclusion, add-on renoprotection with AT1B added to ACEi is safe and significantly improves the renoprotective effects of ACEi treatment in children with progressive nephropathies, including patients with advanced CKD.Pediatric Nephrology 04/2012; 21(11):1716-1722. · 2.52 Impact Factor -
Article: Left ventricular hypertrophy and arterial wall thickening in children with essential hypertension
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ABSTRACT: ObjectiveOur aim was to determine the prevalence of left ventricular hypertrophy (LVH) and increased intima-media thickness (IMT) in Caucasian children with newly diagnosed, untreated essential hypertension (EH).ParticipantsOur study cohort consisted of 72 children with EH (mean age: 14.5years; range: 5–18years). The control groups consisted of 103 age-matched, healthy children.MethodsWe evaluated the left ventricular mass (LVM), intima-media thickness in the carotid (cIMT) and superficial femoral (fIMT) arteries, 24-h ambulatory blood pressure, and biochemical cardiovascular risk factors.ResultsOf the hypertensive children examined, 41.6% had LVM above the 95th percentile, and 13.2% had LVM above 51g/m2.7. Of the hypertensive subjects, the cIMT was above 2SDS of normal values in 38.8%, and the flMT was above 2SDS of normal values in 17.5%. Patients with LVM above 51g/m2.7 had a higher birth weight than other patients. LVM, cIMT, and fIMT correlated with 24-h SBP and pulse pressure; LVM also correlated with homocysteine and serum uric acid concentrations. fIMT correlated with low AproteinA1 (ApoA1), higher ApoB and Creactive protein, and daily sodium excretion. Step-wise regression analysis revealed that serum uric acid and higher birth weight were predictors for LVM, pulse pressure was a predictor for cIMT, and ApoB was a predictor for fIMT.ConclusionsA significant number of adolescents with EH already had cardiovascular damage at diagnosis. LVM and markers of arterial injury correlate with SBP, biochemical, and perinatal cardiovascular risk factors. Serum uric acid and higher birth weight are predictors of LVM.Pediatric Nephrology 04/2012; 21(6):811-819. · 2.52 Impact Factor -
Article: Different BMI cardiovascular risk thresholds as markers of organ damage and metabolic syndrome in primary hypertension
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ABSTRACT: Obesity is the main intermediate phenotype of primary hypertension (PH), and increased fat mass is directly related to target organ damage (TOD) and metabolic syndrome (MS). The aim of the study was to assess the sensitivity and specificity of body mass index (BMI), percentile-based, definitions of obesity [BMI > 95th percentile (pc)], and overweight (BMI > 85th pc), and BMI thresholds for cardiovascular (cv) complications (BMIcv) described by Katzmarzyk et al. (Pediatrics 114:198–205, 2004) in predicting risk of TOD and MS in 122 adolescents with PH. Our results indicated that the prevalence of left ventricular hypertrophy (LVH) and carotid intima-media thickness (cIMT) above 2 standard deviations (SDS) was the same, irrespective of the criteria used. BMIcv was more sensitive as a marker of LVH than were the cut-off values of the 85th pc and 95th pc of BMI (87.5%, 75%, 62.5%, respectively; P < 0.0001). BMIcv thresholds and cut-off values of the 85th pc of BMI were of the same sensitivity in predicting the presence of MS (95.8% and 95.8%, respectively) and were more sensitive than the cut-off values of the BMI 95th pc (87.5%; P = 0.02). Metabolic abnormalities, including insulin resistance, were more marked in patients with greater BMI, irrespective of cut-off value. However, only when a stratification system using the 85th pc of BMI was used, were the differences significant for a homoeostasis model assessment for insulin resistance (HOMA-IR) and for serum concentrations of high-density lipoprotein (HDL)-cholesterol, triglycerides and adiponectin. We concluded that BMIcv is more sensitive for diagnosing the presence of LVH and that the cut-off value of the 85th pc of BMI is more sensitive for predicting presence of MS in children with PH.Pediatric Nephrology 04/2012; 23(5):787-796. · 2.52 Impact Factor -
Article: Population-based centile curves for triceps, subscapular, and abdominal skinfold thicknesses in Polish children and adolescents--the OLAF study.
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ABSTRACT: Skinfold thicknesses are used as valid anthropometric indicators of regional body fatness. Actual population-based values for skinfold thicknesses for Polish children are not available. The purpose of this study was to provide population-based values for triceps, subscapular, and abdominal skinfold thicknesses in healthy children and adolescents. A total number of 17,416 boys and girls aged 6.5-18.5 years, randomly selected from whole Polish population of children and adolescents, were enrolled in the study. Skinfold thicknesses (triceps, subscapular, and abdominal) were measured using Harpenden skinfold caliper. All measurements were taken after the training of participating investigators. The LMS method was used to fit percentile curves across age for each skinfold. Q tests for fit were used to assess the global goodness of fit of our final models. The study shows for the first time smoothed population-based values of body fat distribution indices for Polish children and adolescents 7-18 years of age. Reported skinfold centiles are higher compared to previously established for Warsaw children and very close to the actual US data. CONCLUSION: Our study provided for the first time population-based values for skinfold thicknesses evaluation in a way allowing to calculate reliable Z scores. The early detection of abnormal fat stores, using our population-based values and respective Z scores, may be now implemented for practice.European Journal of Pediatrics 03/2012; 171(8):1215-21. · 1.88 Impact Factor -
Article: Change in left ventricular geometry during antihypertensive treatment in children with primary hypertension.
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ABSTRACT: The pattern of the left ventricle (LV) has important significance in adults with hypertension. The aim of the present study was to analyze changes and determinants of LV geometry after 1 year of antihypertensive treatment in children with primary hypertension (PH) in relation to metabolic abnormalities and anthropometrical parameters. In 86 children (14.1 ± 2.4 years) with newly diagnosed PH, LV geometry and biochemical parameters before and after 12 months of standard antihypertensive therapy were assessed. At baseline, normal LV geometry (NG) was found in 42 (48.9%), concentric remodeling (CR) in 4 (4.6%), concentric hypertrophy (CH) in 8 (9.3%), and eccentric hypertrophy (EH) in 32 (37.2%) patients. The prevalence of NG in patients with severe hypertension was significantly lower than in patients with ambulatory hypertension. There were no differences in dipping status in relation to LV geometry. Patients with CH and EH were more viscerally obese than patients with NG. Patients with CH had higher diastolic blood pressure in comparison with EH patients (p < 0.05). The main predictor of relative wall thickness (RWT) was the triglycerides to high density lipoprotein cholesterol (TG/HDL) ratio (R(2 ) = 0.319, β = 0.246, p = 0.004). Patients received 12 months of antihypertensive treatment, either lifestyle modification only (n = 37) or lifestyle modification plus antihypertensive medications (n = 49) if severe ambulatory hypertension or target organ damage were present. After 12 months of treatment the prevalence of EH (37.2% vs 18.6%, p = 0.003) decreased but prevalence of CH did not change. Patients in whom RWT decreased also decreased waist circumference and TG/HDL; the main predictor of RWT decrease was a decrease of the TG/HDL ratio (β = 0.496, R (2) = 0.329, p = 0.002). In adolescents with PH, LV geometry is related to central obesity and insulin resistance. Decrease of abdominal obesity and insulin resistance are the most important predictors of normalization of LV geometry, however CH has lower potential to normalize LV geometry.Pediatric Nephrology 05/2011; 26(12):2201-9. · 2.52 Impact Factor -
Article: Polish 2010 growth references for school-aged children and adolescents.
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ABSTRACT: Growth references are useful in monitoring a child's growth, which is an essential part of child care. The aim of this paper was to provide updated growth references for Polish school-aged children and adolescents and show the prevalence of overweight and obesity among them. Growth references for height, weight, and body mass index (BMI) were constructed with the lambda, mu, sigma (LMS) method using data from a recent, large, population-representative sample of school-aged children and adolescents in Poland (n = 17,573). The prevalence of overweight and obesity according to the International Obesity Taskforce definition was determined with the use of LMSGrowth software. Updated growth references for Polish school-aged children and adolescents were compared with Polish growth references from the 1980s, the Warsaw 1996-1999 reference, German, and 2000 CDC references. A positive secular trend in height was observed in children and adolescents from 7 to 15 years of age. A significant shift of the upper tail of the BMI distribution occurred, especially in Polish boys at younger ages. The prevalence of overweight or obesity was 18.7% and 14.1% in school-aged boys and girls, respectively. The presented height, weight, and BMI references are based on a current, nationally representative sample of Polish children and adolescents without known disorders affecting growth. Changes in the body size of children and adolescents over the last three decades suggest an influence of the changing economical situation on anthropometric indices.European Journal of Pediatrics 10/2010; 170(5):599-609. · 1.88 Impact Factor -
Article: Altered cardiovascular rhythmicity in children with white coat and ambulatory hypertension.
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ABSTRACT: Adults with ambulatory hypertension or white coat hypertension (WCH) display abnormal cardiovascular rhythms. We studied cardiovascular rhythms by Fourier analysis of 24-h ambulatory blood pressure (BP) measurement profiles in 129 hypertensive children, 54 children with WCH, and 146 age-, height-, and gender-matched healthy subjects. The day/night mean arterial pressure ratio was lower in hypertensive and patients with WCH compared with controls (1.13 versus 1.16 versus 1.21, respectively; p < 0.0001). Eighty-five percent of controls were dippers compared with 74% of WCH (n.s.) and 64% of patients with ambulatory hypertension (p < 0.0001). The prevalence of 24-h rhythms was similar among the groups, but prevalence of 12-h BP rhythms was increased in hypertensive (67%) and WCH (72%) compared with controls (51%, p < 0.0001). The amplitudes of the 24-, 8-, and 6-h BP rhythms were reduced in hypertensive and WCH compared with controls (p < 0.05). Hypertensive and patients with WCH displayed delayed 24-, 12-, 8-, 6-h acrophases in comparison with controls (p < 0.05). In conclusion, hypertensive children exhibit abnormal cardiovascular rhythmicity compared with controls, especially a higher prevalence of nondipping compared with normotensive children. Abnormalities in patients with WCH are intermediate between healthy children and patients with ambulatory hypertension.Pediatric Research 04/2010; 67(4):419-23. · 2.70 Impact Factor -
Article: The height-, weight-, and BMI-for-age of Polish school-aged children and adolescents relative to international and local growth references.
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ABSTRACT: The growth of children is an indicator of health and society's wellbeing. Growth references are useful in monitoring a child's growth, which is a very important part of child care. Poland's growth references are not updated regularly. Although several growth reference ranges have been developed in Poland over recent years, sampling was restricted to urban populations of major cities. The aim of this study was to assess how well Polish children match with, or diverge from, regional charts and to compare them with international growth references. Four Polish and two international (WHO 2007 and USCDC2000) growth references were used to calculate the height, weight and BMI z-scores in a recent, large, population-representative sample of school-aged children and adolescents in Poland. The distributions of z-scores were analysed with descriptive and inferential statistical methods. Mean height z-scores calculated with the use of the WHO 2007 and USCDC2000 references were positive and significantly different from zero over the entire age range. The mean height z-score was closest to zero in the Poznan reference for boys (0.05) and Warszawa reference for girls (0.01). Median weight z-scores were positive under all weight references over the entire age range with only the exception of 18-year-old girls' weight z-score calculated relative to USCDC2000. Median BMI z-scores were positive in males in early childhood, decreasing with age. In the case of girls, the median BMI z-score calculated using WHO 2007 and USCDC2000 was close to zero in early childhood, decreased in adolescents and reached minimum values at age 18 years. Median BMI z-scores calculated with the use of the Lodz reference fluctuated between 0.05 and 0.2 over the studied age range. In this contemporary sample of Polish school-aged children, distributions of height, weight and BMI differed from those of children from the international growth references. These differences should be considered when using the references. There exist certain limitations to the analysis of height, weight, and BMI z-scores when Polish regional references are used.BMC Public Health 03/2010; 10:109. · 2.00 Impact Factor -
Article: The height-, weight-, and BMI-for-age of Polish school-aged children and adolescents relative to international and local growth references
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ABSTRACT: Abstract Background The growth of children is an indicator of health and society's wellbeing. Growth references are useful in monitoring a child's growth, which is a very important part of child care. Poland's growth references are not updated regularly. Although several growth reference ranges have been developed in Poland over recent years, sampling was restricted to urban populations of major cities. The aim of this study was to assess how well Polish children match with, or diverge from, regional charts and to compare them with international growth references. Methods Four Polish and two international (WHO 2007 and USCDC2000) growth references were used to calculate the height, weight and BMI z-scores in a recent, large, population-representative sample of school-aged children and adolescents in Poland. The distributions of z-scores were analysed with descriptive and inferential statistical methods. Results Mean height z-scores calculated with the use of the WHO 2007 and USCDC2000 references were positive and significantly different from zero over the entire age range. The mean height z-score was closest to zero in the Poznan reference for boys (0.05) and Warszawa reference for girls (0.01). Median weight z-scores were positive under all weight references over the entire age range with only the exception of 18-year-old girls' weight z-score calculated relative to USCDC2000. Median BMI z-scores were positive in males in early childhood, decreasing with age. In the case of girls, the median BMI z-score calculated using WHO 2007 and USCDC2000 was close to zero in early childhood, decreased in adolescents and reached minimum values at age 18 years. Median BMI z-scores calculated with the use of the Lodz reference fluctuated between 0.05 and 0.2 over the studied age range. Conclusions In this contemporary sample of Polish school-aged children, distributions of height, weight and BMI differed from those of children from the international growth references. These differences should be considered when using the references. There exist certain limitations to the analysis of height, weight, and BMI z-scores when Polish regional references are used.BMC Public Health. 01/2010; -
Article: Intima-media thickness measurements in children with cardiovascular risk factors.
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ABSTRACT: Measuring intima-media thickness (IMT) is now a standard diagnostic procedure in assessing cardiovascular risk and hypertensive target-organ damage (TOD) in adults. There is also an increasing number of pediatric publications evaluating IMT in children from high-risk groups, such as those with arterial hypertension, diabetes, chronic kidney disease, obesity, dyslipidemia, and homocystinurias. It has been shown that carotid IMT is strongly related with other markers of TOD in children with arterial hypertension and with metabolic cardiovascular risk factors. In children with coarctation of the aorta, carotid IMT correlated both with blood pressure and even with mild residual aortic gradient. On the other hand, studies in children with high cardiovascular risk have shown that normalization of blood pressure and metabolic abnormalities led to regression of arterial changes and decrease of IMT. Although not yet accepted as standard pediatric procedure, IMT measurement is emerging as a promising method of assessing TOD and cardiovascular risk and monitoring treatment efficacy. From a practical point of view, clinical utility of IMT measurements seems to be similar to use of echocardiography in assessing left ventricular mass. However, IMT measurements in children and adolescents should be standardized to avoid bias caused by the use of different measurement methods.Pediatric Nephrology 10/2008; 24(4):707-19. · 2.52 Impact Factor -
Article: Different BMI cardiovascular risk thresholds as markers of organ damage and metabolic syndrome in primary hypertension.
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ABSTRACT: Obesity is the main intermediate phenotype of primary hypertension (PH), and increased fat mass is directly related to target organ damage (TOD) and metabolic syndrome (MS). The aim of the study was to assess the sensitivity and specificity of body mass index (BMI), percentile-based, definitions of obesity [BMI > 95th percentile (pc)], and overweight (BMI > 85th pc), and BMI thresholds for cardiovascular (cv) complications (BMIcv) described by Katzmarzyk et al. (Pediatrics 114:198-205, 2004) in predicting risk of TOD and MS in 122 adolescents with PH. Our results indicated that the prevalence of left ventricular hypertrophy (LVH) and carotid intima-media thickness (cIMT) above 2 standard deviations (SDS) was the same, irrespective of the criteria used. BMIcv was more sensitive as a marker of LVH than were the cut-off values of the 85th pc and 95th pc of BMI (87.5%, 75%, 62.5%, respectively; P < 0.0001). BMIcv thresholds and cut-off values of the 85th pc of BMI were of the same sensitivity in predicting the presence of MS (95.8% and 95.8%, respectively) and were more sensitive than the cut-off values of the BMI 95th pc (87.5%; P = 0.02). Metabolic abnormalities, including insulin resistance, were more marked in patients with greater BMI, irrespective of cut-off value. However, only when a stratification system using the 85th pc of BMI was used, were the differences significant for a homoeostasis model assessment for insulin resistance (HOMA-IR) and for serum concentrations of high-density lipoprotein (HDL)-cholesterol, triglycerides and adiponectin. We concluded that BMIcv is more sensitive for diagnosing the presence of LVH and that the cut-off value of the 85th pc of BMI is more sensitive for predicting presence of MS in children with PH.Pediatric Nephrology 05/2008; 23(5):787-96. · 2.52 Impact Factor -
Article: Metabolic abnormalities, insulin resistance, and metabolic syndrome in children with primary hypertension.
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ABSTRACT: We sought to describe the prevalence of metabolic abnormalities and of metabolic syndrome (MS) and its relationship to target-organ damage in children with primary hypertension (PH). Patients included 113 children with untreated PH at a mean age of 14.6 years (range, 5 to 18 years). The control group consisted of 134 healthy children at a mean age of 13.5 years (range, 5 to 20 years). We performed a cross-sectional assessment of anthropometric and biochemical cardiovascular risk factors, homeostatic metabolic assessment (HOMA-IR), the insulin sensitivity index (ISI[0,120]), and adiponectin. Metabolic syndrome, as defined by classic criteria, was present in 4 of 134 (3%) of controls versus 23 of 113 (20.4%) patients (P=.0001), but when PH was not taken as a criterion of MS, MS was diagnosed in 6.2% of patients (no significance). Left-ventricular hypertrophy (LVH) was found in 46 of 113 patients (40.7%), and severe LVH was found in 14 of 113 patients (12.5%). Patients with LVH had a greater body mass index, greater waist-to-hip-ratio, and greater number of parameters of metabolic syndrome (overall P<.05). Carotid (cIMT) and femoral superficial artery intima-media thicknesses correlated positively with HOMA-IR and negatively with ISI[0.120] and serum adiponectin (P<.05). The main predictor for cIMT was adiponectin (R2=0.178, beta=-0.466, P=.002). Left-ventricular hypertrophy was predicted (R2=0.332) by body mass index-standard deviation score (beta=0.551, P=.005) and HOMA-IR (beta=0.380, P=.04). Metabolic syndrome, as defined by classic criteria, was diagnosed in 20% of children with PH, but when PH was not a criterion, MS was present in 6.2% of patients. Irrespective of the definition of MS, the applied markers of MS and insulin resistance were the main predictors of target-organ damage.American Journal of Hypertension 08/2007; 20(8):875-82. · 3.18 Impact Factor -
Article: Add-on therapy with angiotensin II receptor 1 blocker in children with chronic kidney disease already treated with angiotensin-converting enzyme inhibitors.
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ABSTRACT: The standard renoprotection is based on the inhibition of the renin-angiotensin system (RAS) by angiotensin convertase inhibitors (ACEi) or angiotensin II receptor 1 blockers (AT1B). The aim of our study was to analyze the effects of the addition of AT1B to ACEi-based renoprotection in children with chronic kidney disease. We examined 11 children with a mean age of 10.5 years (range, 0.5-18 years) with a mean glomerular filtration rate (GFR) of 61+/-61 ml/min/1.73 m(2). In four patients, the primary renal disease was hemolytic uremic syndrome, in three congenital nephrotic syndrome (CNS), in two reflux nephropathy, prune-belly syndrome in one and acute cortical necrosis in one. All patients were treated with complex hypotensive ACEi-based therapy. AT1B losartan was added in a mean dose of 0.9 mg/kg/day. The change in GFR, proteinuria and blood pressure at two 12-month intervals before and after adding AT1B was compared. The results showed that during the 12 months preceding AT1B therapy, there was no change in blood pressure and proteinuria, but the GFR declined in 7 of 11 patients. After the 12th month of add-on therapy with AT1B, there was a significant decrease in both absolute and indexed blood pressure values. Proteinuria decreased in eight patients, did not change in one and increased in two, including one with CNS. The GFR stabilized or increased in eight patients and decreased in three patients with CNS. In 7 of 11 patients, there was a significant, but not threatening increase in serum potassium. In conclusion, add-on renoprotection with AT1B added to ACEi is safe and significantly improves the renoprotective effects of ACEi treatment in children with progressive nephropathies, including patients with advanced CKD.Pediatric Nephrology 12/2006; 21(11):1716-22. · 2.52 Impact Factor -
Article: Left ventricular hypertrophy and arterial wall thickening in children with essential hypertension.
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ABSTRACT: Our aim was to determine the prevalence of left ventricular hypertrophy (LVH) and increased intima-media thickness (IMT) in Caucasian children with newly diagnosed, untreated essential hypertension (EH). Our study cohort consisted of 72 children with EH (mean age: 14.5 years; range: 5-18 years). The control groups consisted of 103 age-matched, healthy children. We evaluated the left ventricular mass (LVM), intima-media thickness in the carotid (cIMT) and superficial femoral (fIMT) arteries, 24-h ambulatory blood pressure, and biochemical cardiovascular risk factors. Of the hypertensive children examined, 41.6% had LVM above the 95th percentile, and 13.2% had LVM above 51 g/m2.7. Of the hypertensive subjects, the cIMT was above 2 SDS of normal values in 38.8%, and the flMT was above 2 SDS of normal values in 17.5%. Patients with LVM above 51 g/m2.7 had a higher birth weight than other patients. LVM, cIMT, and fIMT correlated with 24-h SBP and pulse pressure; LVM also correlated with homocysteine and serum uric acid concentrations. fIMT correlated with low Aprotein A1 (ApoA1), higher ApoB and C reactive protein, and daily sodium excretion. Step-wise regression analysis revealed that serum uric acid and higher birth weight were predictors for LVM, pulse pressure was a predictor for cIMT, and ApoB was a predictor for fIMT. A significant number of adolescents with EH already had cardiovascular damage at diagnosis. LVM and markers of arterial injury correlate with SBP, biochemical, and perinatal cardiovascular risk factors. Serum uric acid and higher birth weight are predictors of LVM.Pediatric Nephrology 07/2006; 21(6):811-9. · 2.52 Impact Factor -
Article: [Fat tissue distribution and metabolic alterations in boys with primary hypertension].
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ABSTRACT: Metabolic alterations related to obesity are regarded as significant risk factor for target organ damage in hypertensive patients. Fat tissue distribution seems to play significant role in metabolic alterations related to cardiovascular damage. The aim of the study was to test hypothesis that fat tissue distribution and excess of visceral fat is related to cardiovascular damage and metabolic cardiovascular risk factors in obese boys with yet untreated, primary hypertension. 40 boys (14.8 +/- 3.0 yrs) with untreated essential hypertensions. amount of visceral (VAT), intraperitoneal visceral (ipVAT), extraperitoneal visceral (epVAT) and subcutaneous fat (SAT) was measured by nuclear magnetic imaging (NMR). Carotic intima media thickness (cIMT), fenoral intima media thickness (fIMT) and left ventricular mass index (LVMi) were evaluated by sonography. Oral glucose loading test was done, lipids, homocysteine, CRP, uric acid, microalbuminuria, adipocytokines, IGF-1 and IGF binding proteins (IGFBP) were determined. The ratio of VAT to epVAT (V/Ve) correlated with carotid IMT (p=0.0001; r=0.561), standard deviation from median of the norm of cIMT (cIMT-SDS) (p=0.0001; r=0.681), femoral IMT (p=0.015; r=0.480) and fIMT-SDS (p=0.002; r=0.579). SAT correlated negatively with cIMT (p=0.0016; r=-0.355) and cIMT-SDS (p=0.01; r=-0.391). Waist to hip ratio (WHR) correlated with cIMT-SDS (p=0.03; r=0.401). VAT correlated positively and SAT negatively with HDL, apoA1, uric acid concentration and HOMA-IR value. VAT/epVAT correlated with HOMA-IR (p=0.02; r=0.402), free IGF-1 (p=0.001; r=0.478). epVAT also correlated with free IGF-1 (p=0.006; r=-0.494) and IGFBP3 (p=0.02; r=-0.471). Step-wise regression analysis revealed that relative excess of intraperitoneal visceral fat (VAT/epVAT) and WHR were independent predictors of cIMT-SDS(p=0.022, R2=0.755). Fat tissue distribution correlates with early vascular injury and metabolic alterations in boys with primary hypertension. Relative excess of visceral fat assessed by NMR and truncal obesity expressed as WHR are independent risk factors for early vascular damage in overweight boys with primary hypertension.Przegla̧d lekarski 02/2006; 63 Suppl 3:49-53. -
Article: [Target organ damage in children with newly diagnosed and untreated essential hypertension].
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ABSTRACT: Target organ damage in the course of essential hypertension (EH) may develop already in childhood. The aim of the study was to determine the prevalence of left ventricular hypertrophy (LVH) and arterial damage and its main determinants in children with newly diagnosed, untreated EH. PATIENTS (pts): 87 children (22 girls and 65 boys) with EH, age 14.4 +/- 3 (5-18) yrs. 104 healthy children (51 girls and 53 boys) aged 13.3 +/- 3.3 (5-20) yrs. cross-sectional, controlled study. evaluation of anthropometrical data, birth weight, family history towards cardiovascular diseases, serum biochemical cardiovascular risk factors (lipids, sCRP, homocysteine, uric acid), carotid (cIMT) and superficial femoral artery intima-media thickness (fIMT). In EH children ambulatory blood pressure monitoring (ABPM), echocardiography, ophthalmoscopy, microalbuminuria were evaluated. EH pts were significantly higher, heavier and had greater body mass index (BMI) (p<0.05). 59% of pts were overweight compared to 19% in control group (p<0.05). Carotid (cIMT) and superficial femoral artery intima-media thickness (fIMT) was greater in children with EH (0.47 +/- 0,05 v 0.43 +/- 0.04 and 0.36 +/- 0.04 v 0.33 +/- 0.04) (p<0.05) respectively. 41% and 19% of pts had cIMT and fIMT above 2 SDS of normal values respectively. The prevalence of LVH was 45%, and in 12% of pts severe (left ventricular mass index--LVMi > 51 g/m2.7) LVH was diagnosed. Pts with LVH had higher birth weight than other pts 3525 < or = 598 v 3136 +/- 635 g (p=0.04) and LVMi correlated with higher birth weight (p=0.0001; r=0.358), 24-hour heart rate (p=0.01; r= -0.361), serum uric acid (p=0.01; r=0.286), homocysteine (p=0.01; r=0.309) and apolipoprotein B (p=0.0001; r=0.258). LVMi correlated with fIMT (p=0.02; r=0.292), but not with cIMT. cIMT correlated with 24-hour systolic blood pressure (SBP)(p=0.01; r=0.305), SBP load (p=0.01; r=0.377), puls pressure (PP) (p=0.01; r=0.292), and heart rate (HR) (p=0.01; r=-0.285). 46% of pts had primary retinopathy, and 1 boy had secondary retinopathy. All pts had normal renal function, and mean microalbuminuria was 29.3+/-11.4 mg/d. Positive family history towards EH was confirmed in 80% of pts vs 29% in controls (p<0.05). 1. Target organ damage is present already at the time of diagnosis in significant number of children with EH. 2. Overweight was 59% of pts and only 19% of healthy children. 3. LVMi and markers of arterial injury correlate with SBP, PP and HR, fIMT, uric acid, homocysteine, apolipoprotein B and birth weight.Przegla̧d lekarski 01/2006; 63 Suppl 3:101-6.
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2002–2013
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Children's Memorial Health Institute
Warsaw, Masovian Voivodeship, Poland
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