[Effect of diet and salt intake on the development of hypertension in children and adolescents]. / Povezanost prehrane i unosa soli s razvojem hipertenzije u djece i adolescenata.

Arterial hypertension is a major risk factor for cardiovascular, cerebrovascular and renal diseases. A common opinion, even among physicians, is that arterial hypertension is rare in children and that it is mainly caused by renal disease. It only holds true for infants and small children. Essential hypertension is not so rare in school children and adolescents. The prevalence of essential hypertension in adolescents, particularly those near their twenties, is very close to that in adults. According to its prevalence, essential hypertension is the second most common chronic disease of childhood following asthma. Results of the EH-UH study on arterial hypertension in Croatia showed the prevalence of hypertension to be 37.5% in adults. It is logical to presume that hypertension does not begin at the age of 18, and that its onset should be sought in younger age. We witness a global epidemic of overweight/obesity. According to the WHO 2003 report, the prevalence of overweight/obesity in Croatia was 61.4% in the 18-100 age groups. There is a direct relationship between overweight/obesity and essential hypertension of childhood. Body mass index is greater in children with essential hypertension than in those with secondary hypertension. The risk of hypertension is three- to fivefold in children with overweight/obesity. According to a British study, the increase in salt intake by 1 g in children is associated with 0.4 mm Hg rise in systolic blood pressure and 0.6 mm Hg rise in pulse pressure. Prevention of cardiovascular disease begins in early childhood, through education of the population on healthy lifestyle which includes prevention of overweight/obesity, lower salt intake and regular physical activity.

[Clinical and histopathological characteristics of biopsy-proven renal diseases in Croatia]. / Klinicke i patohistoloske karakteristike biopsijom dokazanih bubreznih bolesti djece u Hrvatskoj.

There is little data on the spectrum of renal diseases in children in Croatia. The Croatian Society for Pediatric Nephrology has established the Registry of Biopsy-Proven Renal Diseases in an attempt to address this issue nationwide. Here we report preliminary results of a retrospective analysis of clinical and histopathological data of 565 children aged < or =17 years presenting to 9 hospitals in Croatia from 1991 to 2004, in whom kidney biopsy was performed. The most common indication for renal biopsy was nephrotic syndrome (39.1%), followed by asymptomatic proteinuria/hematuria (22.0%) and acute nephritic syndrome (17.0%). All biopsies were analysed by light-, immunofluorescent and electron microscopy. The majority of children, 552 out of 565 (92.4%), had glomerulonephritis (GN). Tubulointerstitial nephritis was found in 16 (2.8%), congenital renal parenchyma anomalies in 14 (2.5%) and vascular disease in 11 (1.9%) cases. One (0.2%) child had sarcoidosis with nephrocalcinosis. The sample was non-diagnostic in 1 (0.2%) case. Among children with GN, primary GN accounted for 70.9%, secondary GN for 16.1% and hereditary GN for 13.0% cases. The most frequent primary GN forms were focal segmental glomerulosclerosis (FSGS) (24.6%), mesangial proliferative glomerulonephritis (MEPGN) (19.2%) and IgA nephropathy (18.1%). Acute GN in resolution was found in 11.1% and minimal changes GN in 6.8% of cases. Most children with secondary GN had nephritis of Henoch-Schönlein purpura (HSP) (54.7%) and nephritis of systemic lupus erythematosus (SLE) (40.5%), while among hereditary GN Alport syndrome was most common (80.9%). In the group of children with primary GN who presented with nephrotic syndrome, most common forms were FSGS (38.5%) and MEPGN (24.0%). Minimal changes GN accounted for only 10.9% of cases. IgA nephropathy, primary or related to HSP (20.0%), FSGS (16.1%), MEPGN (12.6%) and Alport syndrome (9.7%) were the most common biopsy-proven renal diseases in Croatian children. The analysis provided data on the frequency of histological renal lesions in children in Croatia. The higher frequency of FSGS and MEPGN among Croatian children in comparison with other countries deserves further evaluation.

[Pregnancy in patients treated with hemodialysis and peritoneal dialysis: review of the literature and management guidelines]. / Trudnoca u bolesnica lijecenih hemodijalizom i peritonejskom dijalizom: pregled literature za vodenje trudnoce i poroda.

Pregnancy in patients suffering from chronic renal disease is still a rare phenomenon due to a number of factors that impair fertility in such patients, in spite of a number of new treatment techniques that have been introduced recently, e.g. renal replacement therapy with biocompatible dialysis membranes, highflux dialyzers, erythropoietins, and new types of peritoneal dialysis and higher level of care for such patients. Yet, when pregnancy occurs, it is possible to provide a safe outcome for both the mother and fetus. However, optimal conditions for hemodialysis and peritoneal dialysis should be provided. The data on pregnancy in patients suffereing from chronic renal disease are rather scarce, and have been derived from registers of dialyzed patients from few countries. Unfortunately, no such data are known for the patients in Croatia. This review deals with the specific approach to hemodialysis and peritoneal dialysis in patients with pregnancy and end-stage renal disease. Particular attention is paid to specific problems associated with gestation, delivery and care for patients, with special reference to prenatal and neonatal care.