[Show abstract][Hide abstract] ABSTRACT: Purpose:
Despite vast availability of modern methods of treatment of chronic kidney disease and its complications, the short stature still is a major point of concern in adolescents with chronic kidney disease. The aim of the study was to assess changes in growth and nutritional status of Polish children on renal replacement therapy in the decade, 2004-2013.
Material and methods:
The study was designed as a cross-sectional analysis of anthropometric values and selected indices of growth status amongst children receiving dialysis in Poland between the years 2004 and 2013. Data were acquired during two different multicentre studies on hypertension in dialyzed children in Poland. Basic anthropometric parameters (body weight, body height/length, body mass index - BMI), dialysis adequacy and duration of RRT were assessed.
The study showed that anthropometric parameters of children undergoing renal replacement therapy had not significantly changed in the last 10 years of observation. Children on RRT were still of short stature despite availability of modern methods of hormonal therapy and nutrition. Median of height z-score was -2.10 in 2004 and -2.19 in 2013. Expected clinical improvement in these measures was not proven.
The cause of chronic kidney disease, method of dialysis, time on dialysis or dialysis adequacy did not influence the anthropometric parameters significantly in dialyzed children in Poland.
Full-text · Article · Oct 2015 · Advances in Medical Sciences
[Show abstract][Hide abstract] ABSTRACT: Purpose
The mortality of patients with end-stage renal disease (ESRD) is much higher than that of the general population. To date no data has been published on the mortality of children with ESRD in Poland. The aim of this study was to compare the risk of death for pediatric patients on renal replacement therapy (RRT) with that of the general pediatric population and to identify the risk factors of death.
Data of 779 children with ESRD registered in the Polish Registry of Children on RRT was analyzed. The relative risk of death was calculated as the ratio of the mortality rate in ESRD patients to the mortality rate in age-adjusted general population.
The mortality rate of children with ESRD was 74-fold higher than that of the age- and gender-adjusted general pediatric population (4.05 vs. 0.05/100 person-years). The highest mortality rate (4.53/100 patient-years) was found in the youngest age group. Younger age and duration of dialysis therapy were identified as mortality risk factors. The major causes of death in ESRD patients were infections and cardiovascular complications, whereas deaths in general child population were mainly due to accidents or congenital defects.
The mortality in Polish children with ESRD is 74-fold higher than that of the general pediatric population. Infections, followed by cardiovascular complications, constitute the main causes of mortality in children subjected to RRT. The risk of death is the highest among children who started RRT at a younger age and in those subjected to long-term dialysis treatment.
No preview · Article · Jan 2014 · Advances in Medical Sciences
[Show abstract][Hide abstract] ABSTRACT: Abstract Objective.Erythropoiesis-stimulating agents (ESAs) are applied as a standard therapy in children with anaemia in chronic kidney disease. The aim of this study was to describe the efficacy and details of ESA treatment in a population of dialysed children in Poland. Material and methods. The study had a prospective observational design and was performed in 12 dialysis centres. The study group comprised 117 dialysed children with a mean age at enrolment of 165.33 (97.18-196.45) months. Results.Dialysed children were treated mostly with epoietin beta and darbepoietin. The mean dose of ESA was 99 (68-147) U/kg/week with a significant difference between patients on peritoneal dialysis [83 (54-115)] and haemodialysis [134 (103-186)] (p < 0.0001). The mean haemoglobin of all the time-point tests during 6 months was 10.91 ± 1.18 g/dl. The efficacy of anaemia treatment was unsatisfactory in 52% of subjects. In multivariate analysis, initial haemoglobin level <10 g/l, any infection, younger age at first dialysis, malnutrition and inadequate ESA dosage remained significant predictors of anaemia. Conclusions.The study revealed that anaemia treatment in Polish children is unsatisfactory. Late commencement of the treatment, inadequate dosing, malnutrition and infections could constitute risk factors for therapy failure.
No preview · Article · May 2012 · Scandinavian Journal of Urology and Nephrology
[Show abstract][Hide abstract] ABSTRACT: Introduction: The proportion of glomerulopathies as a cause of end-stage renal failure has been increasing in several regions of the world in recent years. Aim of study: An analysis of the contribution of glomerulopathies in 803 children (362 girls and 441 boys) on renal replacement therapy recorded between 2000-2007 in the Polish Renal Replacement Therapy Registry. Results: Among 803 cases, 37.5% were diagnosed as glomerulopathy. The majority were classified as primary glomerulonephritis (22.8%). Secondary glomerulonephritis due to systemic disease was diagnosed in 8.5% of cases and congenital glomerulopathy in 6.2%. The most frequent diagnosis among primary glomerulonephritis was FSGS (35%) and RPGN (13%). There was no differences in sex distribution between glomerulopathy groups. The mean age at start of RRT in glomerulopathy group was 11.4±5 years and did not differ from the whole population (10.4±5.5 years). Patients with congenital nephrotic syndrome started RRT at younger age (7.1±6.4 years, p <0.05). Time to transplant in children with glomerulopathy did not differ significantly compared to the whole population: median observation time was 24.2 months vs 26 months. During 8 years of follow-up 59 deaths were observed: 6 deaths in 181 children with primary glomerulopathies, 4 deaths in 38 children with congenital nephrotic syndrome and 11 deaths in 37 children with secondary glomerulonephrities. Conclusions: Glomerulopathies are the second cause of end-stage renal failure in children after congenital urinary disorders. The worst prognosis and highest case-fatality rate was observed in secondary glomerulopathy group.
No preview · Article · Jan 2012 · Przeglad Pediatryczny
[Show abstract][Hide abstract] ABSTRACT: Introduction: Erythropoiesis-stimulating agents (ESA) are applied as a standard therapy in patients with anaemia in chronic kidney disease in children. There is scarce data on factors influencing ESA treatment efficacy in this population. The aim of our study was to describe the efficacy and details of ESA treatment in population CKD children (3-5) in Poland. Material and methods: The study has a prospective observational design and was performed in 12 dialysis centres for children in Poland. The analysis started on 1 Nov 2008 and lasted for the following 6 months. We analysed basic clinical and anthropometric data, details of renal replacement therapy with its modality, efficacy (KT/V) and duration, ESA (dose, administration), iron (concentration, storage, supplementation). Detailed analysis of anaemia was performed (haemoglobin, transferrin, ferritin concentration) at 1 month interval according to the local requirements. Results: The study group comprised 117 dialysed children and 35 children in predialysis period. The study showed that most of the dialysed children were treated with epoietin beta, despite the treatment modality. The mean dose of EPO was 99 (68-147) IU/kg/week for dialysed and 77 (43-98) for non-dialysed subjects. Mean haemoglobin concentration was 10.9±1.6 g/dl on dialysis and 11.2±1.1 g/dl in predialysis. The efficacy of anaemia treatment was unsatisfactory with 52% of undertreated dialysis subjects, whereas in predialysis 71% children achieved the target level. In multivariate analysis initial haemoglobin level >10 g/l (above median level), any infection, age at first dialysis and erythropoietin dose remained significant (predictors) of anaemia in dialysed children. Conclusion: We revealed that the anaemia treatment in Polish children is unsatisfactory. Late commencing the treatment, dosing based on adult formula (IU/kg/week) and infections could constitute risk factors for therapy failure.
No preview · Article · Jul 2011 · Pediatria i Medycyna Rodzinna
[Show abstract][Hide abstract] ABSTRACT: Peritoneal dialysis (PD) is a preferred method of renal replacement therapy for end-stage renal disease in children. Recent advances have allowed chronic PD to be provided to children of all ages and sizes.
The study was designed as a national (10 dialysis centres), multicentre retrospective analysis of the medical history of 33 children who started chronic peritoneal dialysis in their infancy between 1993 and 2005, with a follow-up period of at least 24 months.
The nutritional status of the infants was unsatisfactory. The mean SDS of body weight at the start was -2.0, at 1 year of age -1.7. Only 40% of infants were adequately nourished at 1 year of age. Long-term follow-up analysis showed that 12 children received a kidney transplant, 13 were still on dialysis (4 changed method) and 6 died (mortality rate in the first year of life of 9%). In 2 children we observed an improvement of renal function. We observed a relatively high (1/8.8 patient-months) peritonitis rate in the analysed children when compared to 1 : 22 patient-months in all children undergoing PD in Poland.
The results of our survey have shown that the management of dialysed infants is still a challenge for the medical team and families, but long-term results of the therapy are encouraging.
[Show abstract][Hide abstract] ABSTRACT: Background. Between Jan. 1, 2000, and Jan. 1, 2003, 203 children with end-stage renal failure were treated with peritoneal dialysis (PD) at the 13 pediatric dialysis centers in Poland. Objectives. The aim of the study was a prospective analysis of peritonitis etiology, incidence rates, and outcome in Polish children treated with peritoneal dialysis. Material and Methods. Of the 203 children, 107 commenced dialysis during the analyzed period. The children were aged 1 week to 18 years. The majority were treated by automated PD (91% APD, 9% CAPD). The total duration of dialysis was 4521 months. The incidence of peritonitis, its relapse rates, causative agents, and complications were analyzed. Results. During the three-year period, 202 primary episodes of peritonitis and 40 relapses were observed (18.9% relapse rate). The overall national incidence of peritonitis in the pediatric centers was 1 episode per 22.39 patient-months or 0.53 episodes per patient-year. Peritonitis-free survival time was 17 months. Gram-positive organisms were the major causative agent, with Staphylococcus aureus and Staphylococcus epidermidis predominating. while Gram-negative rods accounted for 18.6% of episodes, with Pseudomonas species prevailing. Fungal infections were rare. 14.6% of cultures were negative. The highest relapse rates were noted following Acinetobacter, E. coli, and staphylococcal infections. The majority of children recovered and continued peritoneal dialysis, though 5.4% required catheter removal and reinsertion. Four children died and 15 (6.4%) were transferred to hemodialysis. Conclusions. The incidence of peritonitis in children on APD is comparable to the adult population. Contact contamination remains the most common cause of peritonitis in children on APD. Further improvement of outcome should be aimed at decreasing the relatively high relapse rate, the main cause of catheter loss.
No preview · Article · Mar 2008 · Advances in Clinical and Experimental Medicine
[Show abstract][Hide abstract] ABSTRACT: The aim of this nationwide analysis was to assess the incidence and current treatment profile of arterial hypertension in children undergoing chronic haemodialysis or peritoneal dialysis and attitudes of paediatric nephrologists towards the choice of antihypertensive drugs in their patients.
The study group consisted of 134 children (89 males, 45 females, mean age 10.7+/-5 years) from all 13 paediatric dialysis centres in Poland. The data were gathered through a questionnaire for each patient dialysed in November 2004.
The overall incidence of hypertension in the study group was 55% (74 of 134 patients; 47 males, 27 females). The incidence rate was similar in boys and girls (53 vs 60%) and in those on haemodialysis and peritoneal dialysis (56 vs 54%). Chronic glomerulonephritis as an underlying renal disease was significantly more frequent in the hypertensive than in the normotensive subjects (37 vs 10%, P = 0.004). Residual urine output was higher in normotensives (41 vs 10 ml/kg body weight; P < 0.001). Among those treated with antihypertensives: 32% were treated by monotherapy, 36% received two drugs, 22% received three drugs, while 7% received > or = 4 drugs. The therapy was effective in only 57% of subjects. We observed no differences in biochemical and clinical parameters between those who responded to the therapy and those who failed to do so. Calcium channel blockers constituted the most frequently administered class of drugs [73% of children; in 43 out of 48 (90%) combined with other drugs, but in 11 out of 24 (46%) as a monotherapy]. In monotherapy, angiotensin-converting enzyme inhibitors and calcium channel blockers were administered most frequently.
We conclude that the incidence of hypertension in dialysis children in Poland is high (55%). The effectiveness of antihypertensive treatment is rather low (58%) and the choice of drugs is limited.
Full-text · Article · Mar 2006 · Nephrology Dialysis Transplantation
[Show abstract][Hide abstract] ABSTRACT: We retrospectively analysed peritoneal dialysis treatment in 29 infants dialysed in 9 paediatric centres in Poland in the years 1993-2004. The mean age at the start of dialysis was 4.9 +/- 3.5 months (range 2 days to 11 months), mean body mass 5.6 +/- 2.5 kg (range 2.5 to 11 kg). The mean duration of PD was 6.8 +/- 3.9 in the first year of life and total duration of the therapy 34 +/- 27 months. Of the 29 infants 4 died (2 in infancy), 11 underwent renal transplantation, in 2 children PD was stopped (they received a conventional treatment) and 12 were still dialysed at the date of data collection. The peritonitis rate was 1/9.5 patient-month and exit site infection rate 1/16 patient-month up to 1 year of life. 9 children (31%) required hernia repairs and in 9 catheters were replaced. Chronic peritoneal dialysis in infants is associated with high risk of infections and surgical complications and remains a challenge for paediatric nephrologists.
No preview · Article · Feb 2006 · Przegla̧d lekarski
[Show abstract][Hide abstract] ABSTRACT: One of the objectives of Polish Registry of Renal Replacement Therapy in Children established on 31st Dec. 2000 was to collect complete data on etiology of end stage renal disease (ESRD) in polish children.
Data on 469 patients (251 boys, 218 girls) aged 0-22 years treated with renal replacement therapy (RRT) at 13 pediatric dialysis units in Poland from 2000 to 2004 were analyzed. The mean age at start of dialysis was 10 years and 3 months. Renal diseases were defined according to EDTA coding system. Data is presented for the whole group, in 5-year age groups and separately for both sexes.
Congenital and genetic renal diseases were the cause of ESRF in 56% of the polish population of children and adolescents on RRT. 39% of causes were acquired diseases, 5% remained unidentified. Congenital and genetic causes dominated in children < 5 years of age (71%). They accounted for 49%, 61% and 45% of causes in the consecutive 5-year age groups. The most numerous group of congenital diseases leading to ESRF were uropathies 37% and 25% of causes in the consecutive age groups. In boys the most frequent uropathy was obstructive uropathy (25%), the majority caused by posterior urethral valves. In girls the most frequent uropathies were reflux nephropathy (10%) and nephropathy secondary to neurogenic bladder (9%). Uropathies were followed by renal hypo-dysplasia without urinary tract anomalies (11%) and cystic diseases (10%).
Congenital kidney anomalies and genetic diseases are the leading cause of end-stage renal disease in children up to 15 years of age.
No preview · Article · Jan 2006 · Przegla̧d lekarski
[Show abstract][Hide abstract] ABSTRACT: Background: Chronic kidney disease is associated with the development of arterial hypertension in a vast majority of patients. The treatment of hypertension in these subjects is difficult and challenging due to a limited clinical experience with most drugs and no widely recognised recommendations for patients with end-stage renal disease. A choice of antihypertensive drugs is further narrowed by the young age of the patients since almost all drugs are not recommended in children with renal failure. The aim of this nationwide retrospective analysis was to assess the hypertension treatment patterns in the population of children with chronic kidney diseases (CKD) undergoing hemodialysis or peritoneal dialysis in Poland. Material and methods: Among all 134 children dialysed on 30th November 2004 in 13 pediatric dialysis centres in Poland seventy four (55%; 47M, 27F) children were hypertensive. For each patients the treating physicians filled a questionnaire that allowed to collect the following data: the primary kidney disease, chronic dialysis treatment, diagnostic criteria of hypertension and present antihypertensive medication if any. Additionally we asked of the doctors' preference for a therapy for the acute rise in blood pressure and suggestions which drugs, in their opinion, should not be used in dialysed children. Results: In the hypertensive dialysed patients the most frequent causes of chronic kidney disease were chronic glomerulopathies (27/74). Thirty two percent of children were on monotherapy whereas 65% required combined treatment. The therapy was adequate only in 58% of subjects. The lowest rate of efficacy was detected in patients requiring a combined antihypertensive therapy. Among antihypertensive drug classes calcium channel blockers were administered most frequendy (in 73% of children, in 11/ /24 cases in monotherapy and in 43/48 patients in combination). Angiotensin converting enzyme inhibitors were most frequently administered in monotheraphy (50%). Nifedipine was preferred in acute blood pressure rise in children. Conclusion: We conclude that incidence of hypertension in dialysed children in Poland is relatively high. The pattern of the treatment was quite uniform, although the efficacy was relatively low (58%).
No preview · Article · Jan 2005 · Nadcisnienie Tetnicze
[Show abstract][Hide abstract] ABSTRACT: 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).
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+.
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).
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.
[Show abstract][Hide abstract] ABSTRACT: Endogenous creatinine clearance (Ccr) used for glomerular filtration rate assessment often fails in children with nephrotic syndrome. The aim of the study was to evaluate the serum cystatin C concentration in the children with the nephrotic syndrome in comparison with the serum concentration of endogenous creatinine and its clearance in the dynamics of the disease. Material and methods: The investigations were carried out on 2 groups of children: 1-26 children (girls - 10, boys - 16), aged 8.7 ± 2.31 years with the steroid-sensitive nephrotic syndrome, who were examined twice: A - in 2-3 rd day of treatment (proteinuria > 50 mg/kg b.w./24 h, albumin < 25 g/L), B - after 2-3 weeks of prednisone treatment in a dose of 60 mg/m2/24 hours (albumin > 30 g/L), K - 18 healthy children (7.8 ± 2.2 years). The serum cystatin C concentrations were determined by particle-enhanced nephelometric immunoassay using a Dade/Behring cystatin C determination kit and the creatinine concentrations were determined enzymatically using the Jaffe method. Endogenous creatinine clearance was expressed in ml/min/1.73 m 2. Results: In the control group (II) the mean serum cystatin concentration was 0.78 ± 0.04 mg/l, the serum creatinine 0.55 ± 0.12 mg/dl, and the Ccr 101,4 ± 14,2 ml/min. In children with the nephrotic syndrome, in the examination A the serum creatinine concentration was lower and the creatinine clearance higher than in the control group (p < 0.05). Serum cystatin C concentration in this examination did not differ from the healthy controls (p > 0.05). No correlation between the serum cystatin C concentration and serum creatinine and its clearance was observed. In the examination B, after prednisone treatment the serum creatinine concentration and its clearance did not differ from healthy controls (p > 0.05), while the serum concentration of cystatin C was higher (p < 0.01). There was a weak linear correlation between the serum cystatin and creatinine concentration. Conclusions: In the course of steroid-sensitive nephrotic syndrome in children serum cystatin C and creatinine concentration changes in different way in the dynamics of disease. During heavy proteinuria and remission of oedema the decreases creatinine concentration, while after subsidence of proteinuria, during treatment increases cystatin C concentration.
No preview · Article · Jan 2004 · Pediatria polska
[Show abstract][Hide abstract] ABSTRACT: We assessed the excretion of fructose-1,6-bisphosphatase (FBP) and N-acetyl-beta-D-glucosaminidase (NAG) in 52 children (aged 4.1 +/- 2.3): group I--26 children with acute pyelonephritis (APN), in whom the examination were carried out twice: A--before treatment, B--after 14-21 days of antibacterial treatment, group II--21 healthy children. Activity of FBP in urine was found in 80% children from group I and II, and activity of NAG was found in all children from both groups. In examination A mean excretion of FBP and NAG was higher than in healthy children (p < 0.05). After antibacterial treatment excretion of both enzymes decreased to values, which did not differ from control group (p > 0.05). High correlation between FBP and NAG (r = 0.9355; p = 0.00001) was shown only in 14 children, in whom the course of acute pyelonephritis was serious (CRP > 20 mg%, leucocytosis > 10 x 10(9), and renal swelling in ultrasonography). CONCLUSION: Increased excretion of FBP in urine is found mainly in children with severe course of acute pyelonephritis, in whom the correlation between NAG and FBP is observed.
No preview · Article · Jan 2004 · Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego
[Show abstract][Hide abstract] ABSTRACT: The concentration of transforming growth factor-beta 1 (TGF-beta 1) in serum was performed by immunoenzymatic method in serum of children with nephrotic syndrome in following groups: group I--9 children (5-15 years) with focal segmental glomerulosclerosis (FSG), before Cyclosporine A treatment (CyA) (examination A) and after 3-6 months of Cyclosporine A treatment during remission (examination B), group II--13 children (5-14 years) with minimal change nephrotic syndrome (MCNS) during relapse (examination A) and after 7-20 days of prednisone (Encorton) treatment in dose 60 mg/m2, without the proteinuria (examination B), group III--15 healthy children (5-15 years). The aim of the work was to demonstrate any differences in concentration of TGF-beta 1 in serum of examined children and to show the influence of prednisone and Cyclosporine A on the concentration of TGF-beta 1. The results showed that before treatment increased concentration of TGF-beta 1 was shown only in children with MCSN (p < 0.05) and it was reverse proportional to albuminemia. However in children without proteinuria (B), the concentration of cytokines decreased in children with MCSN and increased in children with FSG treated with Cyclosporine A. CONCLUSION: The concentration of TGF-beta 1 in serum increases in children with nephrotic syndrome during gross proteinuria and hypoalbuminemia and after Cyclosporine A treatment.
No preview · Article · Aug 2003 · Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego
[Show abstract][Hide abstract] ABSTRACT: Coulter flow cytometry was used to determine glucocorticoid receptors (GCR) in the peripheral blood cells of patients with nephrotic syndrome. The expression of GCR in the lymphocytes (CD3/GCR) and monocytes (CD14/GCR) of peripheral blood of 23 (age 4.9+/-2.7 years) children with steroid-sensitive nephrotic syndrome was assessed before treatment (proteinuria >50 mg/kg per 24 h), after 4-6 weeks of prednisone treatment, without proteinuria, and in remission, without proteinuria and without any treatment. Before treatment the expression of CD3/GCR was 61.8+/-18.3% and CD14/GCR 43.6.8+/-20.3%; this did not differ from the results of the normal control group ( P>0.05). However, after treatment GCR expression in lymphocytes was 50% ( P<0.001) and in monocytes about 20% lower ( P<0.05). In remission, the GCR expression increased and did not differ from the results before treatment ( P>0.05). A positive correlation between the serum cortisol concentration and the expression of CD3/GCR was found ( r=0.504, P=0.02). In summary, we report that in children with steroid-sensitive nephrotic syndrome, prednisone treatment causes the temporary decrease of the expression of GCR in lymphocytes. A positive correlation between GCR expression and serum cortisol was found. A decrease in GCR expression in monocytes did not correlate with cortisol concentration.
No preview · Article · Aug 2003 · Pediatric Nephrology
[Show abstract][Hide abstract] ABSTRACT: 24-hour blood pressure monitoring has been ever more widely used in children. However, percentile ranks for healthy children have not been prepared yet. The aim of the study was to define percentile ranks of blood pressure measured by ambulatory blood pressure monitoring in healthy children aged 7-17 years depending on sex in children from the Province of Podlasie. The examinations were carried out in a group of 540 children: group I-girls--265, group II boys--275, who were divided into subgroups according to age. Blood pressure was measured by ambulatory blood pressure monitors: BR-102 f. Schiller, Poland LTD and Quiet Tycos, USA according to the principles in force. The results showed that mean systolic blood pressure (RRs) increased with age from 103.2 to 117.7 mm Hg in girls and from 98.8 to 125.6 mm Hg in boys. The differences were statistically significant (p > 0.05). Diastolic blood pressure (RRr) increased less (p > 0.05). Mean systolic blood pressure at night was 9-10% and diastolic pressure 10-11% lower, irrespective of sex. The range of normal blood pressure values (5-95 centile) was established. In group I in the youngest girls the range of RRs was 89-110 mmHg, that of RRr was from 51 to 75 mm Hg while in group II in the youngest boys RRs range was from 95 to 108 mm Hg and RRr--from 52 to 73 mm Hg. In group I and II in the oldest girls and boys the values were higher. The percentile ranks (5-95) were prepared for systolic and diastolic blood pressure based on blood pressure monitoring during 24-hours and separately during activity (day) and resting time (night). CONCLUSIONS: 1. Systolic blood pressure in children aged 7-17 years increases with age more than diastolic blood pressure. 2. Percentile ranks for healthy children aged 7-17 years depending on age, sex and daily time period were established.
No preview · Article · Jul 2003 · Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego
[Show abstract][Hide abstract] ABSTRACT: We report 6-years old boy with Schönlein-Henoch purpura who presented neurologic manifestations: depressed state generalised convulsions, and cortical blindness. Sequential magnetic resonance imaging showed bilateral cerebral ischemic lesions in the cortex and white matter of parieto-occipital lobes caused by vasculitis.
No preview · Article · May 2002 · Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego
[Show abstract][Hide abstract] ABSTRACT: Impairment in the functions of the lower urinary tract can be the cause of recurrent urinary tract infections (UTI) and vesicoureteral reflux (VUR) in children. The purpose of our research was to evaluate the frequency of occurrence of bladder instability in children with UTI.
The research involved 114 children (21 boys, 93 girls), ranging in age from 5 to 16. Group I consisted of 61 children with a history of recurrent UTI, while Group II included 53 children with recurrent UTI and VUR. Urodynamic tests (uroflowmetry and cystometry) were done on all the children, while in selected cases profilometry was also performed, using a Duet apparatus (Dantec Medical A/S).
Abnormal functioning of the lower urinary tract was found in 45 children (74%) from Group I and 44 children (84%) from Group II. The most common dysfunction was instability of the detrusor muscle, which was found in 52 children (45%), including 23 (38%) from Group I and 29 (55%) from Group II. In 19 children detrusor instability was accompanied by reduced bladder volume, and in 8 cases there was a lack of detrusor-sphincter coordination. In both groups ca. 20% of the children did not present with symptoms indicating urination dysfunctions. Ca. 80% reported various symptoms, of which the most common were nocturnal wetting and urinary urgency. In half of the children from Group I and one-fourth of the children from Group II there were several co-occurring symptoms: nocturnal and diurnal wetting, pollakiruria, and urinary urgency, or all three symptoms simultaneously.
The most common disturbance of lower urinary tract functioning in these children with recurrent UTI was instability of the detrusor muscle, which occurred more often in children with VUR.
Full-text · Article · Feb 2002 · Medical science monitor: international medical journal of experimental and clinical research
[Show abstract][Hide abstract] ABSTRACT: The aim of study was to prepare the centile ranks for blood pressure measured by 24-hour blood pressure monitoring in relation to body mass index (BMI) in children aged 7-17 years from our district. The examinations were carried out in group of 525 healthy children aged 7-17 years, in group I - 253 girls), and in group II - 272 boys. Children were subdivided into six subgroups in dependence on the value of BMI (from 13.0 to 24.9) every 2 units. Systolic (RRs) and diastolic (RRd) blood pressure were recorded every 15 minutes during activity and every 60 minutes at rest using Quiet Tycos ABPM f. Welch Allyn Tycos USA and BR-102 monitor f. Schiller. The results showed positive correlation between BMI and systolic blood pressure. Obtained results of RRs during 24 hours, by the lowest value of BMI was from 97 mm Hg (5-th centile) to 109 mm Hg (95-th centile) in girls and 99 to 110 mm Hg in boys respectively. By the highest BMI values RRs were within the range 115-130 mm Hg in group of girls and 121-135 mm Hg in group of boys. Differences in RRr in dependence on BMI values were significantly lower There was no correlation between RRr and BMI. The centile ranks for children of both sexes in dependence on BMI for 24-hour blood pressure and blood pressure during the day and night measured by ambulatory blood pressure monitoring were prepared. Directly proportional correlation between systolic blood pressure measured by a 24-hour blood pressure monitoring and BMI in children aged 7-17 years was found. Prepared centile ranks refer to systolic and diastolic blood pressure measured by ambulatory blood pressure monitoring in dependence on BMI.