Predictors of Progression in IgA Nephropathy in Childhood.

The aim of this retrospective study was to assess the usefulness of potential predictors of poor prognosis in IgA nephropathy in children. The study population consisted of 55 children aged 11 ± 4 years, diagnosed on the basis of the Oxford classification and MEST score of kidney biopsy findings. Proteinuria, glomerular filtration rate (GFR), and the IgA/C3 serum ratio were assessed in all patients twice: at onset and at follow-up. The patients were treated with steroids, immunosuppressive drugs, and/or angiotensin-converting enzyme inhibitors. Follow-up was at 3.9 ± 2.9 (median 2.7) years. The patients were subdivided into two groups: with GFR <90 and ≥90 mL/min at follow-up. ROC AUC curves and logistic regression were used to evaluate the power of prognostic factors. The two groups did not differ regarding the level of proteinuria, MEST score, and the IgA/C3 ratio at onset of disease. There was a significant association between GFR reductions at onset and follow-up (AUC = 0.660; p < 0.05). In patients with nephrotic range proteinuria at onset, proteinuria at follow-up was more frequent compared with other patients (AUC = 0.760; p < 0.05), MEST score ≥3 tended to be associated with reduced GFR (AUC = 0.650; p = 0.07) but not with proteinuria (AUC = 0.608; p = 0.47), and the IgA/C3 ratio was higher (p < 0.05) at follow-up. No significant associations were found between the IgA/C3 ratio at onset and reduced GFR (AUC = 0.565; p = 0.46) or proteinuria at follow-up (AUC = 0.263; p = 0.20). We conclude that predictors of poor outcome in childhood IgAN include the following: GFR reduction, nephrotic range proteinuria at onset of disease, and high MEST score in Oxford classification of kidney biopsy. Despite a higher serum IgA/C3 ratio in children with impaired renal function in long-term follow-up, we failed to demonstrate a significant association between this ratio at onset of disease and reduced GFR or persistent proteinuria at follow-up. Thus, IgA/C3 ratio is not a good foreteller of progression of IgA nephropathy in childhood.

IgA Nephropathy in Children: A Multicenter Study in Poland.

IgA nephropathy (IgAN) is the most common form of glomerulonephritis in pediatric population. The clinical presentation of the disease in children ranges from microscopic hematuria to end-stage kidney disease. The aim of the study was to retrospectively assess clinical and kidney biopsy features in children with IgAN. We assessed a cohort of 140 children, 88 boys, 52 girls with the diagnosis of IgAN in the period of 2000-2015, entered into the national Polish pediatric IgAN registry. The assessment included the following: proteinuria, hematuria, glomerular filtration rate (GFR), arterial blood pressure, and the renal pathological changes according to the Oxford classification and crescents formation, as modifiable and unmodifiable risk factors. The incidence of IgAN in Poland was set at 9.3 new cases per year. The mean age at onset of IgAN was 11.9 ± 4.3 years, and the most common presentation of the disease was the nephritic syndrome, recognized in 52 % of patients. Kidney biopsy was performed, on average, 1.3 ± 2.0 years after onset of disease. Based on the ROC analysis, a cut-off age at onset of disease for GFR <90 mL/min/1.73 m2 (risk factor of progression) was calculated as 13.9 years. Unmodifiable lesions: segmental sclerosis, tubular atrophy/interstitial fibrosis (S1, T1-2) in the Oxford classification and crescents in kidney biopsy were significantly more common in Gr 1 (>13.9 years) compared with Gr 2 (<13.9 years), despite a significantly shorter time to kidney biopsy in the former. We conclude that IgAN in children may be an insidious disease. A regular urine analysis, especially after respiratory tract infections, seems the best way for an early detection of the disease.

Dyslipidaemia in overweight children and adolescents is associated with an increased risk of kidney stones.

AIM: There is conflicting evidence about the role of obesity in paediatric nephrolithiasis. This Polish study explored the influence of nutritional status and lipid disturbances on urinary lithogenic factors and the risk of kidney stone formation in children and adolescents from three to 18 years of age. METHODS: We carried out serum lipid profile evaluations and 24-h urine chemistry analyses on 493 overweight/obese paediatric participants (mean age 13 years) without nephrolithiasis and 492 healthy normal weight sex and age-matched controls. RESULTS: A third (33%) of the study group had blood lipid disturbances, with more acidic urine, lower urinary citrate excretion and a higher fraction of ionised calcium and higher Bonn Risk Index than the controls. The participants' body mass index standard deviation score (BMI Z-score) was positively correlated with urinary oxalate and uric acid and negatively correlated with citrate excretion. Total cholesterol, low-density lipoprotein cholesterol and triglycerides correlated negatively with citraturia, while high-density lipoprotein cholesterol correlated positively. CONCLUSION: The main factor that predisposed overweight and obese children to kidney stones was hypocitraturia. Urinary citrate excretion was related to both BMI Z-scores and all lipid fraction abnormalities. However, hypercholesterolaemia and particularly low-density lipoprotein hypercholesterolaemia seemed to play a major role.

Increased Serum IgA in Children with IgA Nephropathy, Severity of Kidney Biopsy Findings and Long-Term Outcomes.

The aim of the study was to determine whether an elevated IgA level at the time of the diagnosis of IgA nephropathy has an effect on the severity of kidney biopsy findings and long-term outcomes in children. We retrospectively studied 89 children with IgA nephropathy who were stratified into Group 1- elevated serum IgA and Group 2 - normal serum IgA at baseline. The level of IgA, proteinuria, hematuria, glomerular filtration rate (GFR) and hypertension (HTN) were compared at baseline and after the end of the follow-up period of 4.0 ± 3.1 years. Kidney biopsy findings were evaluated using the Oxford classification. The evaluation of treatment included immunosuppressive therapy and renoprotection with angiotensin converting-enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB), or no treatment. The elevated serum IgA was found in 46 (52 %) patients and normal serum IgA level was found in 43 (48 %) patients. No differences were found between the two groups regarding the mean age of patients, proteinuria, and the number of patients with reduced GFR or HTN at baseline. In kidney biopsy, mesangial proliferation and segmental sclerosis were significantly more common in Group 1 compared with Group 2 (p < 0.05). Immunosuppressive therapy was used in 67 % children in Group 1 and 75 % children in Group 2. The Kaplan-Meier survival curves for renal function (with normal GFR) and persistent proteinuria did not differ significantly depending on the serum IgA level at baseline. We conclude that in IgA nephropathy the elevated serum IgA at baseline may be associated with mesangial proliferation and segmental sclerosis contribute to glomerulosclerosis, but has no effect on the presence of proteinuria or on the worsening of kidney function during several years of disease course.

Nanoparticle applications in food - a review.

The use of nanotechnology in the food industry raises uncertainty in many respects. For years, achievements of nanotechnology have been applied mainly in biomedicine and computer science, but recently it has also been used in the food industry. Due to the extremely small (nano) scale, the properties and behavior of nanomaterials may differ from their macroscopic counterparts. They can be used as biosensors to detect reagents or microorganisms, monitor bacterial growth conditions, increase food durability e.g. when placed in food packaging, reducing the amount of certain ingredients without changing the consistency of the product (research on fat substitutes is underway), improve the taste of food, make some nutrients get better absorbed by the body, etc. There are companies on the market that are already introducing nanoparticles into the economy to improve their functionality, e.g. baby feeding bottles. This review focuses on the use of nanoparticles in the food industry, both organic (chitosan, cellulose, proteins) and inorganic (silver, iron, zinc oxide, titanium oxide, etc.). The use of nanomaterials in food production requires compliance with all legal requirements regarding the safety and quantity of nano-processed food products described in this review. In the future, new methods of testing nanoparticles should be developed that would ensure the effectiveness of compounds subjected to, for example, nano-encapsulation, i.e. whether the encapsulation process had a positive impact on the specific properties of these compounds. Nanotechnology has revolutionized our approach towards food engineering (from production to processing), food storage and the creation of new materials and products, and the search for new product applications.

Physico-chemical properties and antimicrobial activity of silver nanoparticles fabricated by green synthesis.

A proper understanding of silver (Ag) nanoparticles properties is fundamental for developing new antimicrobial agents. In this study, Ag nanoparticles were obtained by green synthesis methods using natural reducing agents present in extracts of apples, oranges, potatoes, red pepper, white onion, garlic and radish. The antimicrobial properties of respective nanoparticles, expressed as the minimum inhibitory concentration, were assessed against Staphylococcus aureus, Bacillus cereus, Escherichia coli, and Candida krusei. Characterization of Ag nanoparticles was done with the application of transmission electron microscopy, X-ray diffraction and UV-vis spectroscopy. The obtained results led to the conclusions that in each extract (pH from 2.1 to 6.2) were obtained specific particles (size from 9 to 30 ± 2 nm) with different antimicrobial activity. Our study indicates that plant extracts gives the Ag nanoparticles specific properties, yet the best antimicrobial properties show nanoparticles obtained in the presence of potato extract.

The Outcome of Childhood Immunoglobulin A Nephropathy with Acute Kidney Injury at the Onset of the Disease-National Study.

Introduction: IgA nephropathy (IgAN) is the most common glomerulonephritis worldwide. Decreased glomerular filtration rate is a known risk factor for disease progression. Aim: We aimed to examine factors that may contribute to disease progression in children that present with impaired eGFR at the onset of IgAN. Materials and methods: Of the 175 patients with IgAN from the Polish Registry of Children with IgAN and IgAVN, 54 (31%) patients with IgAN who had an onset of renal function impairment (GFR < 90 mL/min) were eligible for the study. All of them were analyzed for initial symptoms (GFR according to Schwartz formula, creatinine, proteinuria, IgA, C3), renal biopsy result with assessment by Oxford classification, treatment used (R-renoprotection, P-prednisone+R, Aza-azathioprine+P+R, Cyc-cyclophosphamide+P+R, CsA-cyclosporine+P+R, MMF-mycophenolate mofetil+P+R), and distant follow-up. Based on the GFR score obtained at the end, patients were divided into two groups: A-GFR > 90 mL/min and B-GFR < 90 mL/min. Results: In the study group, the mean age of onset was 12.87 ± 3.57 years, GFR was 66.1 ± 17.3 mL/min, and proteinuria was 18.1 (0-967) mg/kg/d. Renal biopsy was performed 0.2 (0-7) years after the onset of the disease, and MESTC score averaged 2.57 ± 1.6. Treatment was R only in 39% of children, P+R in 20%, Aza+P+R in 28%, Cyc+P+R in 9%, CsA+P+R in 7%, and MMF+P+R in 3%. The length of the observation period was 2.16 (0.05-11) years. At the follow-up, Group A had 30 patients (56%) and Group B had 24 patients (44%). There were no significant differences in any of the other biochemical parameters (except creatinine) or proteinuria values between the groups and the frequency of the MESTC score ≥ 2 and <2 was not significantly different between Groups A and B. Patients with normal GFR at the follow-up (Group A) were significantly more likely to have received prednisone and/or immunosuppressive treatment than those in Group B (p < 0.05) Conclusions: In a population of Polish children with IgAN and decreased renal function at the onset of the disease, 56% had normal GFR in remote observation. The use of immunosuppressive/corticosteroids treatment in children with IgAN and impaired glomerular filtration rate at the beginning of the disease may contribute to the normalization of GFR in the outcome, although this requires confirmation in a larger group of pediatric patients.

Serum osteoprotegrin (OPG) and receptor activator of nuclear factor kappaB (RANKL) in healthy children and adolescents.

UNLABELLED: Most metabolic bone diseases are characterized by a disturbance in bone resorption, therefore biochemical markers concerning this process are of special interest. Recent investigations in bone biology identified the RANKL/ RANK/OPG system, the set of cytokines or cytokine receptors belonging to the tumor necrosis factor (TNF) family that are required for control of bone modeling and remodeling. The imbalance between OPG and RANKL was found not only in pathology of bone, but also in the control of the immune and vascular systems. However, clinical application of new bone markers in children may be difficult due to lack of reference data in relation to age, sex and physiological development. AIM: To investigate the relationship of serum concentrations of OPG, RANKL and OPG/RANKL ratio in relation to age, sex and parameters of physical development in healthy children and adolescents. CHILDREN AND METHODS: The study was performed on a group of 70 healthy children and adolescents, divided into subgroups according to sex and age. OPG and sRANKL serum concentrations were determined using ELISA. RESULTS: Serum OPG did not differ between boys and girls or younger and older children. There was no correlation between OPG level and height, weight and BMI percentiles. The level of sRANKL was 3 times higher in males than in females (p < 0.01) and almost 3 times higher in older than younger children (p < 0.01). There was a positive correlation between sRANKL concentration and body weight percentile (r = 0.268, p < 0.05). There was no correlation between serum OPG and sRANKL levels. CONCLUSION: In healthy children and adolescents the serum level of OPG is not influenced by age, sex or parameters of physical development, in contrast to sRANKL and sRANKL/OPG ratio, which are dependent on these factors. Age and sex reference data should be established.

Detection of inflammation from finger temperature profile in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory tissue disease that leads to cartilage, bone, and periarticular tissue damage. This study aimed to investigate whether the use of infrared thermography and measurement of temperature profiles along the hand fingers could detect the inflammation and improve the diagnostic accuracy of the cold provocation test (0 °C for 5 s) and rewarming test (23 °C for180 s) in RA patients. Thirty RA patients (mean age = 49.5 years, standard deviation = 13.0 years) and 22 controls (mean age = 49.8 years, standard deviation = 7.5 years) were studied. Outcomes were the minimal and maximal: baseline temperature (T1), the temperature post-cooling (T2), the temperature post-rewarming (T3), and the Tmax-Tmin along the axis of each finger. The statistical significance was observed for the thumb, index finger, middle finger, and ring finger post-cooling and post-rewarming. Receiver operating characteristics (ROC) analysis to distinguish between the two groups revealed that for the thumb, index finger, middle finger, and ring finger, the area under the ROC curve was statistically significantly (p < 0.05) post-cooling. The cold provocation test used in this study discriminates between RA patients and controls and detects an inflammation in RA patients by the measurement of temperature profiles along the fingers using an infrared camera. Graphical abstract.

Urinary tract infection in children: Diagnosis, treatment, imaging - Comparison of current guidelines.

BACKGROUND AND OBJECTIVE: Urinary tract infection (UTI) is a frequent disorder of childhood, yet the proper approach for a child with UTI is still a matter of controversy. The objective of this study was to critically compare current guidelines for the diagnosis and management of UTI in children, in light of new scientific data. METHODS: An analysis was performed of the guidelines from: American Academy of Pediatrics (AAP), National Institute for Health and Care Excellence (NICE), Italian Society of Pediatric Nephrology, Canadian Paediatric Society (CPS), Polish Society of Pediatric Nephrology, and European Association of Urology (EAU)/European Society for Pediatric Urology (ESPU). Separate aspects of the approach for a child with UTI, including diagnosis, treatment and further imaging studies, were compared, with allowance for recent research in each field. CONCLUSIONS: The analyzed guidelines tried to reconcile recent reports about diagnosis, treatment, and further diagnostics in pediatric UTI with prior practices and opinions, and economic capabilities. There was still a lack of sufficient data to formulate coherent, unequivocal guidelines on UTI management in children, with imaging tests remaining the main area of controversy. As a result, the authors formulated their own proposal for UTI management in children.

Do serum and urinary concentrations of kidney injury molecule-1 in healthy newborns depend on birth weight, gestational age or gender?

OBJECTIVE: The aim of work was to establish the normal levels of serum and urinary kidney injury molecule-1 (sKIM-1 and uKIM-1) in healthy full-term newborns. STUDY DESIGN: The study included 88 healthy full-term neonates from normal, uncomplicated pregnancies. The serum and urinary concentrations of KIM-1 in the material obtained in the first or second day of life were determined with a commercially available enzyme-linked immunosorbent assay kits. In addition, uKIM-1 was normalized for urinary creatinine concentration. RESULTS: Male and female newborns, as well as children in whom the samples were obtained in the first or second day of life, did not differ significantly in terms of their sKIM-1 and uKIM-1 levels. Gestational age correlated inversely with sKIM-1 and positively with uKIM-1, but not with uKIM-1/cr. No correlation was found with birth weight and gender. CONCLUSION: This is the first report of sKIM-1 and uKIM-1 levels in healthy full-term newborns during the first postnatal days. The data from healthy newborns may serve as the reference values for future studies in the youngest children.

Chromosomal aberrations and SCEs as biomarkers of cancer risk.

Previous studies have suggested that the frequency of chromosomal aberrations (CAs), but not of sister chromatid exchanges (SCEs), predicts cancer risk. We have further examined this relationship in European cohorts comprising altogether almost 22,000 subjects, in the framework of a European collaborative project (CancerRiskBiomarkers). The present paper gives an overview of some of the results of the project, especially as regards CAs and SCEs. The results confirm that a high level of CAs is associated with an increased risk of cancer and indicate that this association does not depend on the time between CA analysis and cancer detection, i.e., is obviously not explained by undetected cancer. The present evidence indicates that both chromatid-type and chromosome-type CAs predict cancer, even though some data suggest that chromosome-type CAs may have a more pronounced predictive value than chromatid-type CAs. CA frequency appears to predict cancers at various sites, although there seems to be a particular association with gastrointestinal cancers. SCE frequency does not appear to have cancer predictive value, at least partly due to uncontrollable technical variation. A number of genetic polymorphisms of xenobiotic metabolism, DNA repair, and folate metabolism affect the level of CAs and might collectively contribute to the cancer predictivity of CAs. Other factors that may influence the association between CAs and cancer include, e.g., exposure to genotoxic carcinogens and internal generation of genotoxic species. Although the association between CA level and cancer is seen at the group level, an association probably also exists for the individual, although it is not known if an individual approach could be feasible. However, group level evidence should be enough to support the use of CA analysis as a tool in screening programs and prevention policies in occupational and environmental health.

Occupational exposure to mercury vapour on genotoxicity and DNA repair.

We have conducted a population study to investigate whether current occupational exposure to mercury can cause genotoxicity and can affect DNA repair efficiency. Blood samples from 25 exposed workers and 50 matched controls were investigated for the expression of genotoxicity. The data indicate that mercury exposure did not cause any significant differences between the workers and controls in the baseline levels of DNA strand breaks (as measured by the alkaline version of the single cell gel electrophoresis [SCGE] assay) or sister chromatid exchanges (SCE). However, the exposure produced elevated average DNA tails length in the SCGE assay and frequency of chromosome aberrations. In the studies, isolated lymphocytes were exposed to 6J/m2 UV-C light or 2 Gy dose of X-rays in a challenge assay and repair of the induced DNA damage was evaluated using the SCGE assay. Results from the UV-light challenge assay showed no difference between the workers and controls in the expression of DNA strand breaks after exposure followed by incubation in the absence or presence of the cellular mitogen (phytohemagglutinin, PHA). No difference in DNA strand breaks between the workers and controls was seen immediately after the X-ray challenge, either. However, significant differences were observed in cells that were incubated for 2h with and without phytohemagglutinin. Data from the X-rays challenge assay were further used to calculate indices that indicate DNA repair efficiency. Results show that the repair efficiencies for the workers (69.7% and 83.9% in un-stimulated and stimulated lymphocytes, respectively) were significantly lower than that of matched controls (85.7% and 90.4%, respectively). In addition, the repair efficiency showed a consistent and significant decrease with the duration of occupational exposure to mercury (from 75.7% for <10 years employment, to 65.1% for 11-20 years and to 64.1% for 21-35 years) associated with increase of cytogenetic damage. Our study suggests that the occupational exposure to mercury did not cause a direct genotoxicity but caused significant deficiency in DNA repair. Our observations are consistent with previous studies using the standard chromosome aberration assay to show that exposure to hazardous environmental agents can cause deficiency in DNA repair. Therefore, these affected individuals may have exposure-related increase of health risk from continued exposure and in combination with exposure to other genotoxic agents.

Urinary nerve growth factor in patients with detrusor overactivity.

BACKGROUND: Detrusor overactivity (DO) is one of the most frequent bladder dysfunctions in children up to the age of 18. Nowadays, the only way to confirm DO is by urodynamic investigation, which is an invasive procedure. Among the many mediators influencing bladder function, nerve growth factor (NGF) plays an important role. The present study was designed to measure urinary NGF (uNGF) levels in patients with DO diagnosed by urodynamic study in comparison with healthy controls. METHODS: The investigation was conducted on 44 children, divided into two groups (24 patients with DO, 20 healthy children). Uroflowmetry was performed in all enrolled to the study and cystometry only to patients. uNGF levels were estimated in both studied groups. RESULTS: The median uNGF level in patients with DO before treatment was higher compared with healthy controls. There were no differences between uNGF levels in patients after anticholinergic treatment and the controls. We found differences in uroflowmetry parameters between the reference group and the patients. We found correlations between uroflowmetry parameters and uNGF/cr. level. CONCLUSIONS: 1. The uNGF level could be used for detecting DO in children and adolescents. 2. Measuring uNGF level is a simple, noninvasive procedure and very useful for choosing therapy in patients with DO in various clinical conditions.

Renalase Levels in Children with Solitary Functioning Kidney.

OBJECTIVE: To measure serum and urine renalase levels in children with a single kidney, and to compare with a reference group. METHODS: Participants were: solitary kidney (n=36) and healthy children (n=57). Renalase levels were measured using the immunoenzymatic method. RESULTS: Serum and urine renalase levels were significantly lower in patients with a solitary kidney compared to healthy children. Urine renalase/creatinine values were negatively related to serum creatinine and positively related to glomerular filtration rate. Significant correlations between renalase levels and blood pressure were not found. CONCLUSION: Prognostic importance of reduced renalase levels in children with a single kidney can only be quantified by further longitudinal study.

Blood lipid profile and BMI-Z-score in adolescents with hyperuricemia.

BACKGROUND: Numerous studies have demonstrated that elevated serum uric acid concentration (SUA) is correlated with lipid profile in hypertensive or obese patients. However, the relationship between serum uric acid levels and lipid profile in non-obese late adolescent population was not examined before. AIMS: In this study we decided to assess the potential relationship between SUA and lipid profile, according to gender in adolescents with HU. METHODS: The study group comprises 607 Polish adolescents (474 males, 133 females) with HU. Retrospective analysis included demographic, clinical, and laboratory data. Lipid profile was assessed including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), total cholesterol to HDL-C ratio (TC/HDL-C). RESULTS: In the examined group 187/607 (31%) of teenagers were diagnosed with metabolic syndrome (MetS). Median BMI-Z-score was 1.11 Q1-Q3: (-0.02-2.03) and both females and males in the upper tertile of SUA had statistically significant higher BMI-Z-score. The males in the upper tertile of serum uric acid levels also had higher values of TG and lower of HDL-C. In females, we have not found significant differences in lipid profile. Multiple regression analyses indicated that male gender, BMI-Z-score, and presence of hypertension correlated significantly with serum uric acid concentration. CONCLUSIONS: In summary, the results of our study confirm higher prevalence of hyperuricemia in males when compared to females and a stronger association of HU with BMI-Z-score and lipid profile in male adolescents. Nevertheless, multiple regression does not confirm the independent association of SUA with lipid profile.

Urinary calcium excretion in children with monosymptomatic enuresis.

BACKGROUND: Among many factors predisposing to monosymptomatic enuresis (MNE) disturbances in urinary electrolites excretion play an important role. Because of many controversies in this field there is a need to debate the role of hypercalciuria in MNE. The aim of our study was to determine the urinary calcium in children with MNE. METHODS: The investigation was conducted on 204 children (83 MNE children and 121 reference group). Urinary calcium excretion (in 24-h collection and per kg of body mass), Ca/creatinine ratio, Ca(2+) in urine sample and in 24-h collection of urine were estimated. RESULTS: Hypercalciuria in MNE group was diagnosed in 18/83 (21.69%) patients. We found statistically significant differences between children with MNE in Ca(2+) in urine sample and 24-h collection and Ca/creat. ratio. Median urinary calcium excretion (mg/kg/24-h and mmol/24-h) was significantly higher in hypercalciuric enuretic patients. The urinary total calcium (mmol/24-h), urinary bound calcium and urinary calcium concentration (mmol/L) demonstrated a significant positive correlation with height, weight and age in reference group but not in MNE group. CONCLUSION: Urinary calcium excretion was significantly disturbed and further studies are needed to assess the role of hypercalciuria in the pathogenesis of MNE.

Urine L-carnitine excretion in hypertensive adolescents.

AIM: This study was performed to test the hypothesis that urinary levels of L-carnitine and its derivatives are enhanced in children and adolescents with hypertension and also check if analyzed parameters may serve as early markers of subclinical renal damage. METHODS: The study included 112 children and adolescents (67 males and 45 females) aged median 10-18 years. Participants were divided into two groups: HT-64 subjects with confirmed primary hypertension and R-reference group-48 subjects with white-coat hypertension. Urinary Free and Total L-carnitine were determined by the enzymatic method of Cederblad. The L-carnitine levels were expressed as urinary ratio in micromole per gram creatinine (µmol/g). RESULTS: The urinary excretion of Total and Free L-carnitine was significantly higher in hypertensive adolescents in comparison to reference group-white coat hypertension. Other important findings were positive correlations between Free L-carnitine/cr., Total L-carnitine/cr. ratio and serum uric acid level, serum cholesterol level and systolic blood pressure. CONCLUSION: The results of this study do not explain the increased urine levels of L-carnitine. The most likely reason for excessive urinary loss was disturbed renal tubular reabsorption. It is possible to hypothesize that in hypertensive adolescents subclinical kidney dysfunction occurs. It is proposed that studies examining the concurrent plasma and urine concentration of L-carnitine and correlation with acknowledged proximal tubular markers are needed.

Are oxidized low-density lipoprotein and C-reactive protein markers of atherosclerosis in nephrotic children?

BACKGROUND: Lipid disorders are known to be linked to disturbance in oxidative reactions and play an important role in the progression and complications of idiopathic nephrotic syndrome (INS). AIMS: The aim of this study was to assess oxidized low-density lipoprotein (oxLDL), high-sensitive C-reactive protein (hs-CRP) serum concentrations and other parameters of lipid metabolism in children with INS during relapse and remission of proteinuria. METHODS: The examination was performed on 23 children and adolescents diagnosed with INS. Reference group consisted of 22 participants. The study was carried out twice: in the relapse of INS (A) and in remission of proteinuria during glucocorticoid treatment (B). RESULTS: OxLDL was higher in INS patients, in both examinations when compared with reference participants. hs-CRP showed no differences between nephrotic and healthy children. We found higher concentration of oxLDL in children, who where frequent relapsers. Cholesterol, triglycerides/high density lipoprotein cholesterol and platelets were higher in INS patients (both A and B) in comparison with healthy children. CONCLUSIONS: We observed presence of pro-atherogenic lipid profile in INS. Elevation of oxLDL may reflect increased oxidative stress and higher risk of atherosclerosis in INS, therefore it seems to be relevant to find patients of risk of atherosclerosis to consider lipid lowering treatment with antioxidants.

Interleukin-1 modification of the effects of cyclophosphamide and fractionated irradiation.

Studies were performed to determine whether recombinant human interleukin-1 (IL-1) modifies the tumor cytotoxicity of cyclophosphamide (CY) combined with fractionated X-irradiation. RIF-1 tumors were implanted intradermally in C3H/Km mice and therapeutic effect was evaluated by the regrowth delay method, that is, the time for treated tumors to grow to 3 times their volume at the start of treatment relative to that for untreated tumors. A single intraperitoneal treatment of 15 micrograms/kg IL-1 given 24 hr after 100 or 200 mg/kg CY and immediately before the first of 5 daily fractionated treatments of 1-4 Gy increased tumor growth delay beyond that produced by CY and irradiation without the IL-1. However, the IL-1 given with either CY or fractionated irradiation did not extend the time for tumor regrowth beyond that produced by the agents themselves. Thus, while CY and fractionated irradiation together produce a greater than additive effect, IL-1 seems to extend this phenomenon. From these findings, it appears that IL-1 enhances the cytotoxic effects of CY and X ray against tumors, an effect that would have considerable practical significance in the light of the protective effects shown elsewhere for the same lymphokine on normal tissues.