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1.
Pediatr Nephrol ; 33(7): 1251-1256, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29476242

RESUMO

BACKGROUND: The incidence of acute kidney injury (AKI) among the neonates treated at the Neonatal Intensive Care Unit is high with high mortality rates. Glutathione S-transferase (GST) class Pi plays an important role in the protection of cells from cytotoxic and oncogenic agents. The aim of the study was to examine whether the levels of serum glutathione S-transferase Pi (GST Pi) determined after birth have any predictive value for the outcome and development of AKI in premature neonates. METHODS: The prospective study included 36 premature neonates. The data about morbidity was gathered for all the neonates included in the study. The blood samples were taken in the first 6 h of life and GST Pi levels were measured. RESULTS: The mean values and standard deviations of GST Pi among the neonates who died and who survived were 1.904 ± 0.4535 vs 1.434 ± 0.444 ng/ml (p = 0.0128). Logistic regression revealed a statistically significant, positive correlation between GST Pi levels and death (p = 0.0180, OR7.5954; CI 1.4148-40.7748).The mean value of GST Pi levels in the neonates with AKI was higher than in neonates without AKI (p = 0.011). CONCLUSIONS: The conclusion of our study is that high levels of serum GST Pi in the first 6 h after birth are associated with an increased mortality and development of AKI in prematurely born neonates.


Assuntos
Injúria Renal Aguda/diagnóstico , Glutationa S-Transferase pi/sangue , Lactente Extremamente Prematuro/sangue , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Testes de Função Renal/métodos , Injúria Renal Aguda/sangue , Injúria Renal Aguda/epidemiologia , Índice de Apgar , Biomarcadores/sangue , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Recém-Nascido de Peso Extremamente Baixo ao Nascer/sangue , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Análise de Sobrevida , Taxa de Sobrevida
2.
Pediatr Res ; 78(4): 430-5, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26107391

RESUMO

BACKGROUND: The new urinary and serum biomarkers are discovered and are being investigated. With them we can diagnose acute kidney injury (AKI) faster and more precisely and they also have a significant role in the outcome prediction. METHODS: The study included 22 extremely low-birth-weight neonates who were hospitalized in the neonatal intensive care units. They were divided into two groups based on serum creatinine (SCr) level-with and without AKI. Detection and quantification of urinary kidney injury molecule-1 (uKIM-1) was done on the third day of life, using commercially available KIM-1 rapid test. Subsequently, measurements were repeated only in subjects who were diagnosed with AKI, at different values of SCr. RESULTS: Logistic regression analysis showed that AKI is an independent risk factor for mortality. In a group of neonates with AKI, 50% of neonates administered the KIM-1 rapid test showed positive findings. KIM-1 rapid test was positive in patients with a wide range of SCr levels (range of 78.73-385 µmol/l), but all subjects had oliguria and died in the next 24 h. CONCLUSION: KIM-1 is a significant predictor of death. On the other hand, our study failed to prove that KIM-1 rapid test has any significance for early prediction of AKI.


Assuntos
Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/urina , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Glicoproteínas de Membrana/urina , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/mortalidade , Biomarcadores/sangue , Biomarcadores/urina , Peso ao Nascer , Creatinina/sangue , Feminino , Idade Gestacional , Receptor Celular 1 do Vírus da Hepatite A , Mortalidade Hospitalar , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Modelos Lineares , Modelos Logísticos , Razão de Chances , Mortalidade Perinatal , Valor Preditivo dos Testes , Gravidez , Prognóstico , Estudos Prospectivos , Receptores Virais , Fatores de Risco , Urinálise
3.
Pediatr Res ; 76(1): 11-6, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24713815

RESUMO

BACKGROUND: The aims of this study were to determine which of the two biomarkers of renal injury, kidney injury molecule-1 or cystatin C, is more sensitive and to evaluate whether erythropoietin protects kidneys injured by perinatal asphyxia. METHODS: Animals were split into three groups designated as follows: AE, pups that survived perinatal asphyxia and subsequently received 2.5 µg (0.1 ml) of darbepoetin-α (i.p.); A, the pups that survived perinatal asphyxia and received 0.1 ml of 0.9% NaCl; and C, control group. The pups were killed at different ages of life (6 h, 24 h, 48 h, 7 d, and 14 d of age; 10 rats in each subgroup). Immunohistopathological evaluation of kidneys was performed. RESULTS: At 48 h and on days 7 and 14, absolute injury scores were significantly lower in group AE as measured by both biomarkers. Cystatin C expression was the most intensive 6 h after the hypoxic event (average value of absolute injury score was 2.82) and declined over time. Expression of kidney injury molecule-1 was less intensive, with the average value of absolute injury score being 2.02 at 6 h and 2.105 at 24 h; the peak value (2.155) was recorded 48 h after the hypoxic event. CONCLUSION: Erythropoietin has a protective effect on hypoxic kidneys. Cystatin C is more sensitive as an early biomarker of acute kidney injury in comparison with kidney injury molecule-1.


Assuntos
Asfixia Neonatal/tratamento farmacológico , Asfixia Neonatal/prevenção & controle , Moléculas de Adesão Celular/metabolismo , Cistatina C/metabolismo , Eritropoetina/farmacologia , Rim/efeitos dos fármacos , Rim/patologia , Animais , Animais Recém-Nascidos , Asfixia Neonatal/metabolismo , Biomarcadores/metabolismo , Darbepoetina alfa , Eritropoetina/análogos & derivados , Eritropoetina/uso terapêutico , Feminino , Hipóxia , Masculino , Ratos , Ratos Wistar , Fatores de Tempo , Resultado do Tratamento
4.
Ann Indian Acad Neurol ; 23(2): 228-232, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32189869

RESUMO

We report a case of a 7-year-old boy with Kawasaki disease (KD) complicated with cerebral vasculitis and encephalitis. The patient was admitted with signs of encephalopathy, seizures, and coma. The diagnosis of KD was made on the 2nd day of hospitalization based on the clinical features (fever >5 days, maculopapular rash, nonpurulent conjunctivitis, fissured lips, and cervical adenopathy). Brain magnetic resonance imaging findings suggested cerebral vasculitis. Treatment with intravenous immunoglobulin was followed by mild improvement. After a single dose of immunoglobulin, pulse methylprednisolone therapy was started resulting in gradual improvement of consciousness and eventual complete motor and cognitive function recovery with regression of brain magnetic resonance lesions. KD can present with marked neurological symptomatology. Therefore, it should be considered in the differential diagnosis of encephalitis and encephalopathy etiologies in children.

5.
Perit Dial Int ; 37(4): 389-396, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28676510

RESUMO

BACKGROUND: The aim of this retrospective study is to evaluate clinical characteristics and outcomes of very low birth weight (VLBW) neonates with acute kidney injury (AKI) treated with peritoneal dialysis (PD). METHODS: This retrospective study included 10 VLBW neonates treated with PD. Intravenous (IV) cannula and umbilical venous catheter were used for the peritoneal access. RESULTS: Mean age at the moment of starting PD was 14.9 ± 9.3 days. Mean body weight (BW) was 825 ± 215 g. The average gestational age was 26.3 ± 1.1 weeks. The average duration of dialysis was 20.5 ± 14.7 h. The average ultrafiltration was 7.7 ± 4.2 mL/kg/h. At the moment of starting PD, the average BW was 302 ± 317g (22 ± 13%), higher than at birth (in patients who had PD started in first 2 weeks of their lives) or higher than the BW before AKI was diagnosed (patients who had PD started when they were older than 2 weeks). The main cause of AKI was sepsis (n = 8/10). Dialysate leak was registered in 2 patients, 1 patient had peritonitis and the other had a blocked PD catheter. Six patients died during PD (severe sepsis), 1 died due to hypoxic encephalopathy and coma, and 2 patients survived. One patient (with hypoxic encephalopathy and coma) died 10 days after PD was stopped due to sepsis. The overall mortality was 80%. CONCLUSION: Acute PD is still an appropriate treatment choice for VLBW neonates with AKI. In VLBW neonates, PD can be performed with an improvised PD system and catheters.


Assuntos
Injúria Renal Aguda/terapia , Doenças do Prematuro/terapia , Diálise Peritoneal , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/mortalidade , Cateterismo , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/etiologia , Doenças do Prematuro/mortalidade , Recém-Nascido de muito Baixo Peso , Masculino , Estudos Retrospectivos , Resultado do Tratamento
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