Modification of the Schwartz equations for children increases their accuracy at eGFR > 60 mL/min/1.73 m(2).

AIM: Estimation of eGFR in children with normal kidney function using the Schwartz equations results in underestimating real GFR. MATERIALS AND METHODS: We propose modification of three Schwartz equations - two based on creatinine concentration (eGFRScrBS bedside) and (eGFRScr) and one 3-marker based on creatinine, urea and cystatin C concentrations (eGFRS3M). The iohexol test (reference method) was performed 417 times in 353 children >2 years with mean GFR: 98 ± 31.6 ml/min/1.73m(2). The assessment included also the Filler and Zappitelli equations. The modification was performed using methods: (1) based on equation, eGFRcor = a [eGFR - T] + T, where T = 50, if eGFR > T, and a equals for: eGFRScrBS 1.4043, for eGFRScr 2.0048, for eGFRS3M 1.2951, and (2) based on correction of all coefficients of the original equation. RESULTS: For comparison of all the results and for children with GFR< 60, 60-90, 90-135 and > 135 ml/min/1.73m(2) the correlation coefficient, relative error (RE) and root mean square relative error (RMSRE) was employed and revealed improvement of RE from 25.9 to 6.8 and 3.9% (depending on the correction method) for eGFRScr; from 19 to 8.1 and 3.9% for eGFRScrBS and: from 11.6% to 2.0 and 2.3% for eGFRS3M (respectively). The RMSRE values changed from 30 to 21.3 and 19.8% for eGFRScr, from 25.1 to 21.6 and 19.8% for eGFRScrBS and from 19.1 to 15.8 and 15.3 % for eGFRS3M. CONCLUSIONS: Modifications of Schwartz equations at GFR > 60 ml/min/1.73m(2) significantly improves the accuracy of calculating eGFR. The 3-markers equation is more accurate and should be employed frequently.

[Do we successfully treat anemia and calcium-phosphate disorders in children with chronic kidney disease at the beginning of the twenty-first century?]. / Czy na poczatku XXI wieku skutecznie leczymy niedokrwistosc i zaburzenia wapniowo-fosforanowe u dzieci z przewlekla choroba nerek?

UNLABELLED: In children with chronic kidney disease (CKD) anemia and calcium-phosphate disturbances are already present at early stages of the disease and require a comprehensive treatment. The aim of this study was to evaluate the efficacy of the treatment of biochemical disturbances, depending on the severity of CKD in children. MATERIAL AND METHODS: The study included 71 children (44 boys, 27 girls) with CKD stage 1-5. Mean age was 11 ± 5 years, mean height: 135.7 ± 28 cm and mean eGFR 32 ml/min/1.73 m2. The serum hemoglobin, urea, creatinine, cystatin C, calcium, phosphorus and parathyroid hormone (PTH) levels were measured. eGFR was calculated according to Schwartz and Filler formulas, employing creatinine and cystatin C as markers. Patients were divided into groups depending on the stage of CKD [group 1: CKD stage 1+2 (GFR > 60), group 2: CKD stage 3 (GFR = 30-59) Group 3: CKD stage 4 (GFR = 15-29 ml/min/1.73 m2), group 4 - dialyzed children]. RESULTS: The concentration of he- moglobin depending on the stage of CKD (group 1 vs. group 2 vs. group 3 vs group 4) was 12.95 vs. 12.68 vs. 12.47 vs. 11.3 g/dI, respectively. The concentration of total and ionized calcium was significantly lower in children on dialysis compared to patients treated conservatively. With the progression of CKD the concentration of phosphorus (1.39 vs. 1.4 vs. 1.49 vs. 1.82 mmolI) and PTH (21.7 vs 48.6 vs 99.9 vs. 219 pg/ml) significantly increased. Treatment with erythropoietin was used in 48% of children, calcium carbonate in 55% and alphacalcidol in 56% of patients. CONCLUSIONS: Despite the use of regular treatment, with the progression of CKD a progression of anemia, increased serum phosphate and parathyroid hormone and a decrease in calcium levels in studied children was observed. The severity of metabolic disorders in dialyzed children indicates the need for administration of new and more effective drugs, to prevent early enough complications of CKD in the form of mineral bone disease and cardiovascular complications.

Clinical validity of urinary interleukin 18 and interleukin 6 determinations in preterm newborns.

INTRODUCTION: Preterm newborns are at a particular risk of acute kidney injury (AKI) and sepsis. PURPOSE: Assessment of urinary interleukin 18 (ulL-18) and urinary interleukin 6 (ulL-6) concentrations in association with AKI and sepsis respectively in newborns hospitalized in Neonatal Intensive Care Unit (NICU). MATERIAL AND METHODS: An evaluation was carried out of the dependence of ulL-18 on neonatal birth weight (BW) and AKI as well as ulL6 on sepsis. In prospective study, the evaluation included 58 children with BW up to 2000 g. Clinical observations spanned the period between the 1st and 28th day of life. RESULTS: The mean gestational age was 30.3 Hbd, mean BW was 1361.9 g. AKI was diagnosed in 35 (60.3%), sepsis in 22 (39.7%) neonates. For median values of uIL-18 and ulL-18/mgCr, as well as for mean logarithmically transformed values of ulL-18 and ulL-18/mgCr, negative, statistically significant linear correlations were demonstrated for BW. In population, median value of ulL-18 and ulL-18/mgCr decreased respectively by 8.21 pg/ml and 84.8 pg/mgCr per each 100 g increment of BW. A negative, statistically significant linear correlation with an average strength was noted for the dependency of the duration of AKI and BW. No significant differences were observed in uIL-18 and ulL-181 mgCr values between the investigated days of AKI and reference group. There was noted a significant increase of the values of uIL-6 and uIL-6/ mgCr on day 0 of sepsis confirmed by the ROC analysis with AUROC 78% and 74%, respectively. CONCLUSIONS: ulL-18 and ulL-18/mgCr values might be a reliable marker of renal tubules maturation in newborns; ulL-18 is not a reliable marker in diagnosing AKI in neonatal population; ulL-6 and uIL-6/ mgCr concentration values measured on actual days may be regarded an early marker of sepsis; AKI duration in preterm neonates is negatively correlated with BW.

Acute kidney injury in a single pediatric intensive care unit in Poland: a retrospective study.

BACKGROUND/AIMS: The recent improvements of management of patients in pediatric intensive care units (PICU) are associated with improved outcome. However, this decrease in mortality is associated with an increased number of children with acute kidney injury (AKI), especially in patients with multiorgan failure. METHODS: The report presents a retrospective analysis of 25 cases of AKI (assessed based on the pRIFLE criteria) in PICU within 7 years. RESULTS: AKI was diagnosed in 1.24% of all hospitalized children. AKI percentage duration (as compared to the total hospitalization time) in the children who died vs. the survivors was 79.55% vs. 46.19%, respectively (p<0.05). The mortality rate of AKI patients was 40% which was 4.4-times higher as compared to the total mortality rate in PICU. The final cumulative survival ratio (FCSR) of patients meeting the oliguria criterion (which was met in 48% of AKI patients) was 37% vs. 49% in non-oliguric children. Averaged urine output values in the first week of hospitalization in the deceased vs. survivors were 1.49 vs. 2.57 ml/kg/h, respectively (p<0.05). CONCLUSIONS: Oliguria should not be considered as a sensitive parameter for AKI diagnosing in children below one year of age. A decreased mean urine output in the first week of PICU hospitalization (less than 1.4 ml/kg/h) should be considered as a poor prognostic factor. In many cases AKI was diagnosed too infrequently and too late.

[Familial case of oral-facial-digital syndrome type 1 (OFD 1)]. / Rodzinny przypadek zespolu ustno-twarzowo-palcowego typu 1 (OFD 1).

UNLABELLED: Ciliopathies are phenotypically and genetically heterogeneous disorders that share ciliary dysfunction as a common pathological mechanism. Ciliary dysfunction results in a broad range of malformations including renal, hepatic and pancreatic cysts, visceral abnormalities, retinal degeneration, anosmia, cerebellar or other brain anomalies, polydactyly, bronchiectasis and infertility. The paper presents a familial case of oral-facial-digital syndrome type 1 in 14 year old girl suspected to polycystic kidney disease. CONCLUSIONS: Molecular testing in daughters of known OFD1 mutation carriers and mothers of affected daughters seems to be reasonable. Not each case of policystic kidney disease which looks like autosomal dominant policystic kiedney disease is actually the above disease. The insight into the pathogenesis of ciliopathies is mandatory for understanding these combined congenital anomaly syndromes of seemingly unrelated symptoms of hepatorenal and pancreatic fibrocystic disease. Close interdisciplinary approach is mandatory in terms of efficient and reliable diagnostic and therapeutic interventions in patients presenting with ciliopathies.

Knowledge and Attitudes of Dialysis Patients Toward Kidney Transplantation: Preliminary Report from a Pilot Study Preceding a Cross-Sectional Nationwide Evaluation.

BACKGROUND: The knowledge and attitudes of dialyzed patients toward the best method of renal replacement treatment (ie, kidney transplantation [KTx]) may be the main factor motivating them to apply and be put on the national kidney transplant waiting list, resulting in a better prognosis. OBJECTIVE: Assessment of the knowledge and attitudes of dialyzed patients toward KTx. METHODS: A pilot study is considered an introductory step before the nationwide project, which will cover dialysis centers in Poland from 2023 to 2024. The authorship 4-part questionnaire, including self-assessment knowledge, attitude dimension, pain and mental evaluation section, was made available to 30 patients with hemodialysis aged 30 to 75 years. RESULTS: The median age of the patients was 59 years. The primary cause of end-stage renal disease (ESRD) was glomerulonephritis (33%). Most of the patients stayed on hemodialysis for 2 years or less (57%); 43% of the patients declared insufficient knowledge in the field of KTx, 41% of the patients were not informed at the nephrology clinic that KTx remains one of the methods of renal replacement therapy, and 65% did not receive information about the possibility of preemptive or early transplantation from a relative donor. Only 34% of the patients considered KTx to be a much better treatment option than dialysis, but only 20% of those were on the national waiting list for KTx. CONCLUSIONS: The pilot study showed insufficient knowledge of patients with ESRD regarding kidney transplantation as a method of renal replacement therapy. There is a need to introduce an effective educational program.

[Early markers of acute kidney injury in newborns]. / Wczesne markery ostrego uszkodzenia nerek w okresie noworodkowym.

The incidence of acute kidney injury (AKI) at neonatal intensive care units (NICU) is estimated as 6-24%. Traditional AKI markers i.e. serum creatinine (SCr) concentration, fractional sodium exertion, urine sodium concentration and renal failure index--are low sensitivity and low specificity markers but beside remain very late ones. Serum creatinine concentration arises 48 hours after renal tissue damage. The paper presents contemporary knowledge concerning concentration reference ranges of some early AKI biomarkers (NGAL, hKIM1, OPN, IL18)--either in term or preterm newborns. The most current reports about chosen AKI biomarkers in newborns with uncomplicated clinical course and in children with AKI within the course of sepsis or after cardiopulmonary bypass surgery--were discussed. Disposing of the reliable clinical data referring to early AKI biomarkers constitutes a valuable aid for clinicians who having got to know about the actual risk possess the time for proper clinical interventions.

The effect of peritoneal dialysis method on residual renal function in children.

We set out to assess the effect of continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) on residual renal function (RRF) in children with end-stage renal disease (ESRD). In 101 children (age: 8.84 +/- 5.25 years; 44 on CAPD, 57 on APD) over 36 months, we evaluated RRF [as daily diuresis (DD) in mL/kg/24 h and mL/m2/24 h], glomerular filtration rate [GFR (in mL/min/1.73 m2)], ESRD cause, presence of arterial hypertension (HTN), biochemical parameters, peritoneal equilibration test (PET), adequacy [as total weekly Kt/V (twKt/V) and creatinine clearance (twCCr)], and infectious complications of PD. Initially, the CAPD and APD groups did not differ significantly in DD, but mean GFR was significantly higher in the APD group (p < 0.05). In the CAPD group, the volume of high osmolarity PD fluid was significantly lower (p < 0.05), and the rates of peritonitis and exit-site infection and of aminoglycoside use were higher (p < 0.001, p < 0.05, and p < 0.005 respectively). Over 36 months, the mean twKt/V and twCCr were within norms in both groups, but were higher in APD, significantly so (p < 0.05) for twKt/V at 24 and 36 months and for twCCr initially. In both groups, RRF decreased systematically, with a significantly lower (p < 0.05) rate of DD (mL/m2/24 h) and GFR decline in the first year in CAPD, but without a difference in the next 2 years. The longest RRF preservation was in children with tubulointerstitial nephropathies, particularly hypoplasia and dysplasia (p < 0.05). Children with hemolytic uremic syndrome (HUS) and hereditary nephropathy were at the highest anuria risk. Compared with the 22 children (7 CAPD, 15 APD) who became anuric, the 20 children (10 CAPD, 10 APD) with RRF preserved for 36 months had a higher DD and GFR before dialysis onset; higher hemoglobin and albumin; and lower HTN prevalence, cholesterol, triglycerides, and proteinuria (p < 0.05). Risk of anuria during 36 months did not differ significantly between the CAPD and APD groups. In children on CAPD or APD, risk factors for RRF loss include HUS, hereditary nephropathy, low diuresis and GFR before dialysis onset, HTN, anemia, hypoalbuminemia, hyperlipidemia, and proteinuria. Compared with children on APD, those on CAPD show better preservation of RRF during year 1, although the risk of anuria seems to be the same for both methods. In children with risk factors for rapid diuresis loss, CAPD might be considered the preferred initial dialysis method.

[Does diagnostic and therapeutic management of urinary tract infections remain still controversial in children?]. / Czy diagnostyka i leczenie zakazen ukladu moczowego u dzieci pozostaje nadal przedmiotem kontrowersji?

The paper presents controversial issues in diagnosis and management of urinary tract infections (UTIs) in children, with respect to diagnosis and so called chronic antibiotic prophylaxis in children with UTI and coexisting vesicoureteral reflux. It should be remembered, that there is a risk of development of chronic kidney disease in adulthood in those who suffered UTIs in childhood.

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

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.

[Effectiveness of plasmapheresis in adolescent myasthenia gravis treatment]. / Skutecznosc plazmaferezy w leczeniu lekoopornej miastenia gravis u mlodocianej.

BACKGROUND: Myasthenia gravis (MG) is a disease with autoimmune background. Impaired neuromuscular transmission is caused by blockage of acetylcholine receptors on postsynaptic membrane by circulating specific antibodies. Recognition of myasthenia gravis in children, especially its ocular type, may be difficult due to occurrence of similar clinical symptoms in other diseases like ecephalomyopathies. MG is characterized by variety of clinical symptoms and their alternations during excercise and rest. AIM OF THE STUDY: Case report of nearly 18-year-old girl with generalized type of MG. MATERIAL AND METHODS: Before hospitalization the girl had been treated psychiatrically for 6 months due to suspicion of conversion disorders. After performance of clinical test and electro-neurophysiological examinations mysathenia gravis was diagnosed and conservative treatment was instituted. Additionally, on the ground of low effectiveness of the treatment, sterydotherapy and immunosuppressive treatment were instituted without marked clinical improvement. Thymectomy was also low effective. Thymic inflammation was recognised histopathologically. Only after performance of 5 plasmapheresis was significant clinical improvement achieved. CONCLUSION: Plasmapheresis may be used not only in the treatment of myasthenic crisis but also in the treatment of drug-resistant mysthenia gravis.

[Non-structural abnormalities of CNS function resulting in coincidence of endocrinopathies, epilepsy and psychoneurologic disorders in children and adolescents]. / Niestrukturalne zaburzenia czynnosci OUN odpowiedzialne za wspólwystepowanie endokrynopatii, padaczki i zaburzen psychoneurologicznych u dzieci i mlodziezy.

BACKGROUND: In the population of children and adolescents, epilepsy affects approximately 1% of cases, nonepileptic seizures are seen in approximately 3%, and endocrine disorders are several times more common. For this reason, coincidence of endocrine disorders and epilepsy and psychoneurologic disorders is frequent. Much less common are structural abnormalities (tumors, developmental abnormalities), and especially non-structural CNS abnormalities, resulting in coincidence of both disorders. There are no reports available in the literature that would address the problem. AIM OF THE STUDY: 1) Assessment of the frequency of coincidental epilepsy and endocrine disorders in patients without structural CSN abnormalities treated as outpatients and inpatients of Department of Endocrinology University Children's Hospital of Krakow. 2) Presentation of diagnostic and therapeutic difficulties in these patients, and 3) An attempt at defining the common etiology of both disorders. MATERIAL AND METHODS: On the basis of ICD code patients with coincidance of endocrine disorders, epilepsy and psychoneurologic disorders were selected from several thousands of children treated between 2000 and 2009 in Pediatric Endocrinology Department. The neurologic disorders were diagnosed and treated in Chair and Department of Children's and Adolescents Neurology or in another pediatric neurology center. RESULTS: Various forms of epilepsy (symptomatic or idiopathic) and other psychoneurological disorders (disorders of behavior and emotions, obsession-compulsion syndromes, stereotypias, aggression, autoaggression, or hypothalamic obesity) coincident with one or more endocrine disorders, such as growth disorders, disorders of pubertal development, obesity, thyroid diseases, adrenal diseases, hyperprolactinemia, hypoparathyroidism and ion metabolism disorders were diagnosed in 49 patients. The group included: i) children after cranial irradiation and chemotherapy due to medulloblastoma (3 patients), oligodenroglioma (1 patient), ependymoma (1 patient), optic chiasm glioma (2 patients), suprasellar germinal tumor (1 patient), ii) children with Hashimoto encephalopathy (2 patients), iii) children with Prader-Willi syndrome (20 patients), with Klinefelter syndrome (10 patients), with Albright syndrome (9 patients). Of the 49 patients, a group of 6 children representative for individual disorders was selected. In those patients, the etiology of both endocrine disorders, epilepsy and neuropsychiatric disorders was suspected to be common, and the diagnosis was usually delayed. CONCLUSIONS: 1. Cranial irradiation and chemotherapy, encephalopathy associated with Hashimoto disease and some of the syndromes with the chromosomal and genetic background are the causes of non-structural CNS abnormalities and coincidence of endocrinopathies, epilepsy and psychoneurologic disorders. 2. MR/CT CNS imaging should be performed in any case of central neurological disorders, disorders of behavior, epilepsy or seizures, but also in patients with delayed psycho-motor development, delayed or accelerated growth and pubertal development. All of the above-mentioned manifestations may be symptoms of structural CNS abnormalities and their early treatment determines the child's future. 3. Excluding structural CNS abnormalities allows for forming suspicions associated with diseases resulting in non-structural disorders of the CNS function, predisposing to coincidence of endocrine and neurological disorders. 4. In the diagnosis of Hashimoto's encephalopathy, a decisive factor is exclusion of structural, infectious, traumatic and metabolic causes, intoxications, epilepsy and presence of neuropsychiatric symptoms in patients with high level of against TPO antibodies. In cases of steroids resistance, a good therapeutic effect may be achieved by plasmapheresis, Rituximab therapy and progestagene inhibition of the menstrual cycle.

Correlation between fat mass and blood pressure in healthy children.

Obesity is a well-known risk factor for arterial hypertension. The aim of this study was to analyze which surrogate marker of adiposity, i.e., body mass index (BMI) or fat mass (FM), as measured by bioimpedance analysis (BIA), best correlated with blood pressure in healthy children. Body weight, height, and casual blood pressure (BP) were measured in 193 healthy children (103 boys), aged 8-16 years. Body composition was determined by BIA. The correlation between BMI and age was linear, whereas the correlation between percentage of FM and age was nonlinear and it was different in boys and girls. Blood pressure standard deviation scores (SDS) correlated with FM SDS (BIA) over the entire normal range (systolic: r = 0.26, p = 0.002; diastolic: r = 0.33, p < 0.01). An evaluation of the children based on BP (three groups: BP < 50th percentile, 50th < BP > 95th percentile; BP > 95th percentile) revealed that hypertensive children had a higher BMI (17.6 vs. 19.4 vs. 26.2 kg/m(2), respectively) and a greater FM (14.0 vs. 16.8 vs. 30.2%, respectively). In conclusion, the divergence in FM in healthy boys and girls can be determined by BIA but not by BMI. In healthy children, BP within the entire normal range correlated with FM, children with established hypertension presented with a significantly higher FM. The study points to FM as an important determinant of BP pressure in obese and non-obese children.

Residual renal function in children treated with continuous ambulatory peritoneal dialysis or automated peritoneal dialysis--a preliminary study.

Our study assessed the influence of mode of dialysis [continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD)] on residual renal function (RRF). The study retrospectively examined 30 children [15 on CAPD, mean age: 8.85 +/- 5.15 years; and 15 on APD, mean age: 10.17 +/- 3.63 years (nonsignificant)], followed for at least 12 months, for whom these methods were initial mode of treatment. Arterial hypertension was found in 80% of the children on CAPD and in 67% on APD. Parameters that were analyzed included 24-hour urine output; residual glomerular filtration rate (GFR); adequacy based on total weekly Kt/V urea and creatinine clearance; and hemoglobin, total protein, serum albumin, daily proteinuria, medications used, and causes of end-stage renal disease. After 12 months of decline in urine output, residual GFR was higher in children on APD (p = 0.06, nonsignificant). The difference in adequacy between CAPD and APD was nonsignificant, but a higher volume of dialysate was used in APD (p < 0.01). Proteinuria was present in 9 children on CAPD and in 6 on APD. In CAPD, we observed a negative correlation between the volume of dialysate and duration of treatment (p < 0.01, r = -0.79); in APD, a positive correlation (p < 0.0001, r = 0.89) was observed. In APD, we observed negative correlations between residual diuresis and duration of treatment (p < 0.0001, r = -0.9), serum albumin (p < 0.05, r = -0.6), and volume of dialysate (p < 0.001, r = -0.83). Residual renal function was better preserved in children with a glomerulopathy or a familial or hereditary renal disease than in those with pyelonephritis. Our results suggest that RRF is better preserved in children with a glomerulopathy or a familial or hereditary renal disease, especially in those treated with CAPD. Further studies are needed in larger groups of patients.

[Peritonitis in the course of peritoneal dialisis caused by Haemophilus influenzae with BLNAR phenotype]. / Dializacyjne zapalenie otrzewnej wywolane przez Haemophilus influenzae o fenotypie BLNAR.

Most common bacterial species causing peritonitis in the course of peritoneal dialysis (PDP) are coagulase-negative staphylococci, Staphylococcus aureus and streptococci. Haemophilus influenzae is rarely associated with PDP. Hereby we present the first known case of APD-associated peritonitis caused by non-type able H. influenzae (NTHi) presenting the beta-lactamase negative, ampicillin-resistant (BLNAR) phenotype. An 18 year old boy who had been treated with the APD for 12 months due to SLE was admitted in good general condition with diagnosis of PDP. Standard diagnostic and therapeutical procedures were initiated. Dialysis fluid was turbid with cytosis of 435 WBC/ml. From dialysis fluid pure culture of Gram-negative coccobacillus was isolated. The isolate was identified as a BLNAR phenotype. The same bacterium was isolated from nasal swab. Blood cultures were negative. After evaluation of antimicrobial susceptibility the treatment was changed for the oral ciprofloxacin. The treatment was successful. Control tests 2 days later revealed cytosis of 15 WBC/mm3 and control cultures of peritoneal fluid were negative. After two weeks of treatment the patient was discharged in a good condition. Haemophilus influenzae is a bacterium frequently colonizing the nasopharyngeal cavity. A PCR-based method allowed to classify isolates as NTHi. Infection was probably of the respiratory origin as the isolates (from peritoneal fluid and nasal swab) were undistinguishable. There are only few reports describing this species as an ethiologic agent of peritonitis. This case prove that Haemophilus species should be taken into account as a possible aethiologic agent of PDP, especially in patients on immunosupression with carrier state of H. influenzae in the upper respiratory tract. This kind of microorganism requires specific conditions during its growing in vitro. Identification of its sensitivity to antibiotics is essential in order to detect strains of BLNAR phenotype, as it is a crucial part of an effective antibiotic therapy.

[GFR estimation based upon cystatin C concentration as a substance marker--proposal of a new formula]. / Wyznaczanie GFR na podstawie stezenia cystatyny C jako substancji markerowej--propozycja nowego wzoru.

Glomerular filtration rate (GFR) estimation is very important for evaluation of kidney function. Its calculation is based upon a 24 hour urine collection and serum creatinine concentration values or on the basis of developed for this purpose numerous formulas with special attention dedicated to the abbreviated MDRD formula and Cockcroft-Gault formulas for adults and Schwartz et al. and Counahan et al. formulas for children. Future expectations are related to GFR estimation based on serum cystatin C concentration and formulas specially developed for this cause. The aim of the study was the comparative analysis of GFR results based on Filler's and Lapage's, Grubb's et al. and Schwartz's et al. formulas and reference values obtained in 93 patients after measuring iohexol concentration after its single injection. Significant differences between the results obtained from employed formulas for high, as well as for low values of GFR were shown, respectively. Serial calculations were performed allowing to finding out a new prescription for GFR calculation. A new formula for GFR calculation based on cystatin C concentration: GFR = -7.28+82.29 x C(-1) was proposed.

[Erytrocyte membrane change due to the chemical treatment studied with atomic force microscopy]. / Zastosowanie mikroskopii sil atomowych do badan zmian w blonie erytrocytów wywolanych czynnikami chemicznymi.

The influence of some selected pharmacological compounds on the structure of human erythrocytes (red blood cells, RBCs) has been studied by means of an atomic force microscopy (AFM). The imaging has been done both in the air environment on the fixed cells, and in the liquid (physiological conditions). It was shown that RBCs are very sensitive to osmotic changes in the solution. Increased NaCl concentration in the solution to a value higher than 0.9% leads to the characteristic changes of the erythrocyte from a discoid-like shape to a very irregular one, the so-called "echinocyte", with a lot of ledges. After exposition on nifedipin the modification of the erythrocyte surface morphology was observed. Based on the contact and non-contact AFMs study the consecutive stages of RBCs surface modification were observed. Scanning electron microscopy pictures of erythrocytes were presented for comparison.

[The assessment of heart function in children with chronic kidney disease (CKD)]. / Ocena funkcji serca u dzieci z przewlekla choroba nerek (PChN).

THE AIM OF THE STUDY: The echocardiography evaluation of cardiac function in children with CKD. PATIENTS AND METHODS: 30 children (17 males, 13 females), aged 2-20 yrs with CKD 2-5. Left ventricular (LV) dimensions, LV ejection fraction (EF) and LV mass index (LVMI), as well mitral inflow velocity (E/A waves) and isovolumetric relaxation time (IRT) were evaluated. RESULTS: Impaired diastolic heart function were ascertained in 12 patients (in 2 from 5 with CKD 3, in 3 from 10 with 4 and 7 from 14 with 5). Left ventricular hypertrophy was observed in 13 children with CDD 3-5 (4, 4, 5), and decreased ejection fraction in 2. CONCLUSIONS: The vast majority of children with chronic kidney disease demonstrate an impairment of diastolic cardiac function.

[24-hour pulse pressure in children with chronic kidney disease]. / Calodobowe cisnienie tetna u dziecl z przewlekla choroba nerek.

The aim of the study was to assess 24-h pulse pressure (PP) and to determine relationships between PP and echocardiographic parameters of left ventricle in children with chronic kidney disease (CKD). The study population included 47 children (mean age: 13.11 yrs) with CKD treated conservatively (n=14), with hemodialysis (HD) (n=13) and automated peritoneal dialysis (APD) (n=20). Retrospectively, antropometrical data, office blood pressure, ambulatory blood pressure monitoring (ABPM) variables and LV parameters in echocardiogaphy were analyzed. In study subjects, hypertension (HTN) was present in 25 (53.19%) and in 29 (61.7%) when based on office blood pressure and ABPM respectively. The prevalence of HTN was the highest in predialysis patients. 21 (44.6%) of children had left ventricular hypertrophy (LVH), which was the most frequently found in HD group. The mean PP value was 45.26 +/- 7.56 mmHg and was similar in all groups. Positive correlations were found between PP and weight (p < 0.001), height (p < 0.05), body surface area (p < 0.01) and LV measures (LV mass, LV posterior wall thickness and diastolic diameter of LV, all p < 0.05). Children with PP above median had tendency for greater LV mass (p = 0.06). There was no difference in severity of blood pressure and PP in children with/without LVH. However, in 45% of patients LVH was noted in whom the value of PP was greater than calculated normative value of PP (95 centile). HTN and LVH is common in children with CKD. A mean PP in children with CKD is lower when compared to adult population with CKD. The results confirm that PP increases with the age and an increasing PP has an influence on the changes of LV geometry. Assessment of PP in ABPM might help in identifying those with abnormal LV geometry.

[Shall we recognize chronic renal insufficiency as a pediatric controversy?]. / Czy przewlekla chorobe nerek mozna uznac za jedna z kontrowersji w pediatrii?

Introduction in 2002 the new, 5 - degree classification of chronic renal disease which has been based upon calculation of glomerularfiltration rate (eGFR)--on the one hand took note of the problem of kidney injury and decrease of active nephrons' number which may accompany various renal diseases--on the other--allowed to define the risk factors, which include first of all--hypertension and persistent proteinuria. Chronic renal disease is diagnosed in each clinical case, where a decrease of glomerular filtration rate below 90 ml/min/1.73m2 had occurred with or without kidney injury or when a decrease of glomerular filtration rate maintains for at least 3 months on the level < 60 ml/min/1.73 m2. Delayed diagnosis of chronic kidney disease leads to manifestation of chronic renal failure symptoms and excludes an effective nephroprotective treatment. In the face of a large number of potential causes of chronic renal disease which may be encountered by a pediatrician, all children which are numbered among the high risk group--should have eGFR calculated--initially according to the simplest Schwartz formula. Setting of a diagnosis of chronic renal failure only on the basis of serum creatinine concentration doesn't allow to notice hyper-filtration phenomenon and should not be a daily clinical practice. Fundamental approach of therapeutical management in in children with chronic renal disease is slowing down the disease progression and/or elimination or modification of some risk factors. Each child with diagnosed chronic renal disease should be referred to specialist outpatient pediatric nephrology clinic.