Aetiology, course and treatment of acute tubulointerstitial nephritis in paediatric patients: a cross-sectional web-based survey.

BACKGROUND: Acute tubulointerstitial nephritis (TIN) is a significant cause of acute renal failure in paediatric and adult patients. There are no large paediatric series focusing on the aetiology, treatment and courses of acute TIN. PATIENTS, DESIGN AND SETTING: We collected retrospective clinical data from paediatric patients with acute biopsy-proven TIN by means of an online survey. Members of four professional societies were invited to participate. RESULTS: Thirty-nine physicians from 18 countries responded. 171 patients with acute TIN were included (54% female, median age 12 years). The most frequent causes were tubulointerstitial nephritis and uveitis syndrome in 31% and drug-induced TIN in 30% (the majority of these caused by non-steroidal anti-inflammatory drugs). In 28% of patients, no initiating noxae were identified (idiopathic TIN). Median estimated glomerular filtration rate (eGFR) rose significantly from 31 at time of renal biopsy to 86 mL/min/1.73 m2 3-6 months later (p<0.001). After 3-6 months, eGFR normalised in 41% of patients (eGFR ≥90 mL/min/1.73 m2), with only 3% having severe or end-stage impairment of renal function (<30 mL/min/1.73 m2). 80% of patients received corticosteroid therapy. Median eGFR after 3-6 months did not differ between steroid-treated and steroid-untreated patients. Other immunosuppressants were used in 18% (n=31) of patients, 21 of whom received mycophenolate mofetil. CONCLUSIONS: Despite different aetiologies, acute paediatric TIN had a favourable outcome overall with 88% of patients showing no or mild impairment of eGFR after 3-6 months. Prospective randomised controlled trials are needed to evaluate the efficacy of glucocorticoid treatment in paediatric patients with acute TIN.

[Systemic lupus erythematosus and pregnancy]. / Tocze'n rumieniowaty ukladowy a ciaza.

Systemic lupus erythematosus (SLE) is an autoimmune chronic disease, which involves multiple organs, particularly joints, skin, heart, lungs, nervous system and kidneys. Systemic lupus erythematosus has the predilection to women in their reproductive years and causes numerous health complications during the pregnancy and labour. Lupus flares occur during each trimester of pregnancy and also at postpartum period. Complications are usually mild and appear as the skin and joint involvement. The main challenge are flares in women with severe renal form of SLE. Such exacerbations often need the intensive treatment measures for the mother. The presence of lupus nephritis during conception may aggravate current arterial hypertension in the mother and lead to chronic renal failure progression. In the study authors report the risk factors for spontaneous abortions and premature births in women with SLE particularly in the group with the presence of antiphospholipid syndrome. The features and course of neonatal SLE was also discussed. The goals of medication of women with SLE and lupus nephritis during pregnancy and the treatment during postpartum period and lactation were described.

[Characteristics of metabolic syndrome in children and adolescents with arterial hypertension]. / Cechy zespolu metabolicznego u dzieci i mlodziezy z nadcisnieniem tetniczym.

UNLABELLED: Among the components of metabolic syndrome (MS) obesity, arterial hypertension, insulin resistance, abnormal plasma lipoproteins balance: decreased HDL concentration and increased level of triglycerides are mentioned. In diagnosis of MS the coexistence of three of these criteria is obligatory. MS is frequently diagnosed in adult patients. The aim of the study was the evaluation of MS components in the group of 118 children with arterial hypertension (HT) who were hospitalized in Pediatric Department of Silesian Medical University in Bytom. The criterium of qualification to HT group was: blood pressure higher than 97 percentile in at least 20% of ABPM measurements. BMI, glucose blood concentration, HDL levels, triglycerides (TG) levels, uric acid concentration were also analyzed. Thirty children (25%) presented at least three of MS components: 16 (53%) - three of them, 12 (40%) - four of them and 2 (6,7%) all of them. Mean age of children with MS was 13,5 years, the youngest was 6 years old. BMI of 83% children with metabolic syndrome was considerably above 97 percentile. 53% had low HDL levels and 80% high TG levels. TG levels highly increased above normal values for sex and age. Mean TG concentration was 2,26 mmol/l. 83% of our patients with MS had primary (idiopathic) arterial hypertension, at 13,3% arterial hypertension of renal cause. CONCLUSIONS: The study revealed that all children with arterial hypertension especially those with primary HT should be evaluated for MS in order to start the early prevention of cardiovascular disease.