Hanna Szymanik-Grzelak’s research while affiliated with Medical University of Warsaw and other places

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Publications (29)


Figure 1. The study period was divided into 3-month interventions and 6 months of follow-up.
Figure 2. A flowchart of the recruiting process.
Figure 4. Median of UTI episodes before and during the study.
Figure 5. Median of days antibiotic therapy due to UTIs before and during the study.
Characteristics of the study group.
Lactobacillus rhamnosus PL1 and Lactobacillus plantarum PM1 Versus Placebo as Prophylaxis for Recurrence of Urinary Tract Infections in Children
  • Article
  • Full-text available

May 2024

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18 Reads

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1 Citation

Microorganisms

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Hanna Szymanik-Grzelak

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Janusz Sierdziński

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Urinary tract infections (UTIs) rank among the most prevalent bacterial infections in children. Probiotics appear to reduce the risk of recurrence of UTIs. This study aimed to evaluate whether probiotics containing Lactobacillus rhamnosus PL1 and Lactobacillus plantarum PM1 therapy prevent UTIs in the pediatric population compared to a placebo. A superiority, double-blind, randomized, controlled trial was conducted. In total, 54 children aged 3–18 years with recurrent UTIs or ≥one acute pyelonephritis and ≥one risk factor of recurrence of UTIs were randomly assigned (27 patients in each arm) to a 90-day probiotic or placebo arm. The age, sex, diagnosis, renal function, risk factors, and etiology of UTIs did not vary between the groups. During the intervention, 26% of children taking the probiotic had episodes of UTI, and it was not significantly less than in the placebo group. The number of UTI episodes during the intervention and the follow-up period decreased significantly in both groups, but the difference between them was insignificant. We observed a decrease in UTIs during the study of almost 50% in the probiotic group compared to the placebo group. Probiotics can be used as natural, safe prophylaxis for children with risk factors for UTIs in whom antibiotic prevention is not indicated.

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Thrombotic complications in children with first-episode steroid-sensitive nephrotic syndrome: A single-center experience

April 2023

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9 Reads

Clinical Nephrology

Objective: The aim of the study was to evaluate the clinical course and risk factors of venous thromboembolic complications (VTEC) in children with a first episode of steroid-sensitive nephrotic syndrome (SSNS). Materials and methods: We retrospectively analyzed the medical records of children hospitalized due to SSNS in one pediatric nephrology unit between 2012 and 2019. Demographic data, clinical symptoms at the onset of NS, and laboratory parameters were compared between patients with and without VTEC. Results: Among 106 children (4.7 ± 3.06 years of age) with a first episode of SSNS, 5 VTEC were diagnosed during 2 - 60 days after onset of NS, on the basis of clinical symptoms and/or results of imaging studies. These were thromboses of femoral vein, central part of the kidney, dorsal veins of the hand, venous sinuses of the brain, and superficial vein in the popliteal fossa region. We found significant higher serum fibrinogen level (p = 0.022) and D-dimers (p = 0.0001) in children with VTEC vs. those without VTEC, but AUC analysis showed that only D-dimers significantly differentiate thrombosis. The clinical risk factors of VTEC were vascular cannulation (100%), infections (80%), and diuretics (80%). In children with VTEC, low molecular weight heparin was used. The outcome was a full recovery in all patients. Conclusion: VTEC occurs in 4.72% of children with a first episode of SSNS. The course of VTEC in children with SSNS may be asymptomatic. The clinical risk factors of VTEC in children with SSNS are vascular cannulation, infections, and diuretics. High D-dimer levels are a sensitive indicator of thrombosis.


Hyponatraemia – diagnostic difficulties in 2.5-year-old boy with nephrogenic syndrome of inappropriate antidiuresis. Case report

February 2023

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6 Reads

Pediatria i Medycyna Rodzinna

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).


Figure 3. Distribution of E. coli strains according to sex, age, and type of UTI. APN; acute pyelonephritis, CYS; cystitis.
Figure 5. Etiology of UTIs in children with and without risk factors.
Demographic data, clinical presentations, and laboratory data in children with UTIs.
Risk factors of UTIs in children, according to their clinical presentations (APN and CYS) and age groups.
Epidemiology and Risk Factors of UTIs in Children—A Single-Center Observation

January 2023

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129 Reads

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26 Citations

Journal of Personalized Medicine

Unlabelled: 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 children with APN than with CYS. The risk factors of UTIs were presented in 46.6% of patients, of which 35.6% were children with APN and 61.7% with CYS. The main risk factor was CAKUT, more frequently diagnosed in children with CYS than APN, mainly in children <2 years. The most commonly isolated bacteria were Escherichia coli (74%). There was a higher percentage of urine samples with E. coli in girls than in boys. Other bacteria found were Klebsiella species, Pseudomonas aeruginosa, Proteus mirabilis, and Enterococcus species. Conclusions: Patients with APN were younger and had higher inflammatory markers. Often, fever is the only symptom of UTI in children, and other clinical signs are usually non-specific. The most common UTI etiology is E. coli, regardless of the clinical presentation and risk factors.


Figure 1. Case 1 (male): A) Ultrasonography of the left kidney above the spleen (spleen between the calipers); B) Posterior-anterior (PA) chest radiograph shows a mass above the left hemidiaphragm; C) Coronal CT scan shows the left kidney in the left posterior-interior thorax; D) 99mTc-ethylene-dicysteine ( 99m Tc-EC) renal scintigraphy (PA).
Figure 3. Case 3 (female): A) Ultrasonography imaging (the left kidney above the left hemidiaphragm); B) Sagittal CT scan shows the left kidney in the left posterior-interior thorax; C) 99mTc-ethylene-dicysteine ( 99m Tc-EC) renal scintigraphy (PA).
Radiation Doses of Radiopharmaceuticals
Clinical Presentations and Usefulness of 99mTchnetium-Ethylene-Dicysteine (99mTc-EC) Renal Scintigraphy in Estimation of Thoracic Kidney Function in Children

May 2021

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59 Reads

Iranian Journal of Radiology

: Thoracic kidney is a rare congenital abnormality with the lowest frequency of all renal ectopias. Most cases are discovered incidentally via routine imaging and have a benign clinical course. Here, we report three pediatric cases of thoracic kidney among 156 children with renal ectopy (1.9%). Thoracic kidney was asymptomatic in two children; in one child, it was associated with a recurrent diaphragmatic hernia. All diagnoses were made by chest ultrasonography (USG) and/or radiography in children and confirmed by computed tomography (CT) scan. Moreover, 99mtechnetium-ethylene-dicysteine (99mTc-EC) renal scintigraphy was carried out to visualize and assess the function of ectopic kidneys. All thoracic kidneys were left-sided, and their functions were comparable to their normally located counterparts. During an observation period of 5 - 10 years, two children with thoracic kidneys presented with unstable proteinuria/microalbuminuria and hypertension, respectively. The 99mTc-EC renal scintigraphy is an uncomplicated and safe method for imaging the thoracic kidneys and can be used for detecting the thoracic kidney function in children. Thoracic ectopic kidneys are associated with complications, such as hypertension and proteinuria. Children with thoracic kidneys need long-term follow-ups.


Retrospective analysis of clinical and pathomorphological features of lupus nephritis in children

March 2021

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30 Reads

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4 Citations

Advances in Medical Sciences

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.


Health-related quality of life in children with immunoglobulin A nephropathy – results of a multicentre national study

January 2021

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55 Reads

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8 Citations

Introduction Immunoglobulin A nephropathy (IgAN) may lead to end stage renal disease and severely affect patient functioning and wellbeing. The aim of the study was to evaluate health-related quality of life (HRQoL) in children and adolescents with IgAN, and compare HRQoL in relation to the disease course, social status and psychological factors, such as expressing anger and perceived personal competence. Material and methods The multicentre cross-sectional study included 51 patients ≥ 8 years from 7 paediatric nephrology centres in Poland. Psychometric analysis was performed using the Kidscreen-52 questionnaire to evaluate HRQoL, the Anger Expression Scale to evaluate the severity of anger and the Personal Competence Scale to measure general perception of personal competence. Results Mean age of patients was 14.54 ±3.69 years; duration since the dia­gnosis of IgAN was 4.98 ±3.9 years. Patients with IgAN rated their psychological wellbeing as significantly worse compared to healthy peers (p < 0.05). The presence of proteinuria was associated with significantly worse physical wellbeing (58.72 ±18.45 vs. 74.44 ±22.97; p < 0.05). Current therapy (steroids/immunosuppressive drugs) had no effect on HRQoL in the study group. Perceived personal competence was rated high by 49% of children in the study group. Children with IgAN were characterized by lower intensity of expressed anger (p < 0.001) and significantly higher intensity of suppressed anger (p < 0.01) compared to reference ranges. Severity of expressed anger correlated positively with the parent relations and school environment dimensions of HRQoL. Conclusions We found lower HRQoL in regard to physical and psychological wellbeing in a group of Polish children with IgAN compared to healthy peers. HRQoL should be monitored in this patient group.


Citations (15)


... Daniel и соавт. показали, что у детей с пиелонефритом уровень С-реактивного белка был значительно выше (в среднем 69,5 мг/л), чем у детей с циститами (8,5 мг/л) [5,23]. ...

Reference:

Diagnosis, course, and prognostic outcomes of pyelonephritis in children
Lactobacillus rhamnosus PL1 and Lactobacillus plantarum PM1 Versus Placebo as Prophylaxis for Recurrence of Urinary Tract Infections in Children

Microorganisms

... Urinary tract infections (UTIs) are a significant health challenge, affecting approximately 8% of children at some point in their lives [1]. These infections, characterized by non-specific symptoms, pose a significant burden on healthcare systems and increase the risk of long-term complications if not detected and managed promptly. ...

Epidemiology and Risk Factors of UTIs in Children—A Single-Center Observation

Journal of Personalized Medicine

... The evaluation of LN was extended with a histologic type of nephropathy, classified according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) system (if kidney biopsy was performed) and numbers of LN exacerbations [18,19]. Renal biopsies were performed in 9 cases, representing 56.3% of LN patients. ...

Retrospective analysis of clinical and pathomorphological features of lupus nephritis in children
  • Citing Article
  • March 2021

Advances in Medical Sciences

... Only a few generic questionnaires designed for children and written in Polish exist that have been validated for the assessment of HRQoL. European Kidscreen-52 is one of the tools used to evaluate HRQoL among the Polish population [5], but it can also be used for specific diseases [6]. Other disease-centered tools, such as EA-QOL [7] for esophageal atresia or PAQLQ for asthma [8], are available in Polish. ...

Health-related quality of life in children with immunoglobulin A nephropathy – results of a multicentre national study

... Probiotics offer a promising avenue for restoring UT microbial balance and work in concert with the host immune system to produce compounds like vitamins and immunomodulators, acidify the mucosal surface and inhibit pathogen attachment [150,151]. Clinical studies have shown promising results, demonstrating the efficacy of probiotics in preventing and treating UTIs (Table 2) [152][153][154][155][156]. 13 If specific bacterial components are found to trigger autoimmune responses, research could focus on developing therapies that target these specific immune cells or pathways to prevent them from attacking healthy tissues. ...

Lactobacillus rhamnosus PL1 and Lactobacillus plantarum PM1 versus placebo as a prophylaxis for recurrence urinary tract infections in children: a study protocol for a randomised controlled trial

BMC Urology

... The evaluation of the active metabolite 1,25(OH) 2 D showed that more than 54% of the estimated population had a concentration above 80 pg/mL; in clinical practice this is considered suitable for further detailed analysis [45,54,55]. ...

Hypercalciuria caused by CYP24A1 mutation as the cause of recurrent urinary tract infections – a case report

Pediatria i Medycyna Rodzinna

... Of these, inadequate salt intake can be diagnosed with reasonable certainty if the urine spot sodium is low (below 20 -40mEq/L) and hypopituitarism can be diagnosed by biochemical evaluation of pituitary hormones. After ruling out these two entities, the clinician is left with cerebral salt waste and syndrome of inappropriate antidiuretic hormone, both of which manifest as hyponatremia with natriuresis (urine spot sodium more than 40mEq/L) 6,15 . CSW is a less common etiology of hyponatremia, occurring in 12% of cases. ...

Cerebral salt wasting syndrome as a complication of subarachnoid hemorrhage in a girl with nephrotic syndrome - a case report
  • Citing Article
  • August 2019

Polski Merkuriusz Lekarski

... AQP2 is involved in the urinary concentration in collecting ducts. It mediates transmembrane water transport in the collecting ducts [12,13]. It is consistently important to evaluate urine AQP-2 rhythm, as a useful noninvasive biomarker of vasopressin function in children with PMNE. ...

Is copeptin a reliable biomarker of primary monosymptomatic nocturnal enuresis?

... AKI in PCH is a rarity. [5,6,7] Das et al., in their report, have described a two-year-old boy who developed AKI secondary to PCH. The boy required peritoneal dialysis and plasma exchange. ...

Diagnostic difficulties in a patient with paroxysmal cold haemoglobinuria and acute kidney injury

... However, in Europe, the proportion of propacetamol-related injection site reaction Table 2. Regional differences of propacetamol-related adverse events according to system organ class terms. . Moreover, we found zero reports of propacetamol-associated thrombosis or contact dermatitis/eczema in Asia, which is line with previous studies as case reports were available only for thrombosis associated with non-selective NSAIDs [20][21][22][23][24] , and for contact dermatitis with NSAIDs (e.g., diclofenac, indomethacin, ibuprofen, and ketoprofen) [25][26][27] . Data on propacetamol or intravenous paracetamol were inconclusive to deduce any meaningful relations, although one study reported a relatively lower incidence of thrombosis among Asian and Pacific populations over other regions [28][29][30] . ...

Thrombotic thrombocytopenic purpura in the course of systemic lupus erythematosus in a 15-year-old girl