Assessment of Clinical Indicators Registered on Admission to the Hospital Related to Mortality Risk in Cancer Patients with COVID-19.

BACKGROUND: Oncology patients are a particularly vulnerable group to the severe course of COVID-19 due to, e.g., the suppression of the immune system. The study aimed to find links between parameters registered on admission to the hospital and the risk of later death in cancer patients with COVID-19. METHODS: The study included patients with a reported history of malignant tumor (n = 151) and a control group with no history of cancer (n = 151) hospitalized due to COVID-19 between March 2020 and August 2021. The variables registered on admission were divided into categories for which we calculated the multivariate Cox proportional hazards models. RESULTS: Multivariate Cox proportional hazards models were successfully obtained for the following categories: Patient data, Comorbidities, Signs recorded on admission, Medications used before hospitalization and Laboratory results recorded on admission. With the models developed for oncology patients, we identified the following variables that registered on patients' admission were linked to significantly increased risk of death. They are: male sex, presence of metastases in neoplastic disease, impaired consciousness (somnolence or confusion), wheezes/rhonchi, the levels of white blood cells and neutrophils. CONCLUSION: Early identification of the indicators of a poorer prognosis may serve clinicians in better tailoring surveillance or treatment among cancer patients with COVID-19.

The Usefulness of the COVID-GRAM Score in Predicting the Outcomes of Study Population with COVID-19.

BACKGROUND: The COVID-GRAM is a clinical risk rating score for predicting the prognosis of hospitalized COVID-19 infected patients. AIM: Our study aimed to evaluate the use of the COVID-GRAM score in patients with COVID-19 based on the data from the COronavirus in the LOwer Silesia (COLOS) registry. MATERIAL AND METHODS: The study group (834 patients of Caucasian patients) was retrospectively divided into three arms according to the risk achieved on the COVID-GRAM score calculated at the time of hospital admission (between February 2020 and July 2021): low, medium, and high risk. The Omnibus chi-square test, Fisher test, and Welch ANOVA were used in the statistical analysis. Post-hoc analysis for continuous variables was performed using Tukey's correction with the Games-Howell test. Additionally, the ROC analysis was performed over time using inverse probability of censorship (IPCW) estimation. The GRAM-COVID score was estimated from the time-dependent area under the curve (AUC). RESULTS: Most patients (65%) had a low risk of complications on the COVID-GRAM scale. There were 113 patients in the high-risk group (13%). In the medium- and high-risk groups, comorbidities occurred statistically significantly more often, e.g., hypertension, diabetes, atrial fibrillation and flutter, heart failure, valvular disease, chronic kidney disease, and obstructive pulmonary disease (COPD), compared to low-risk tier subjects. These individuals were also patients with a higher incidence of neurological and cardiac complications in the past. Low saturation of oxygen values on admission, changes in C-reactive protein, leukocytosis, hyperglycemia, and procalcitonin level were associated with an increased risk of death during hospitalization. The troponin level was an independent mortality factor. A change from low to medium category reduced the overall survival probability by more than 8 times and from low to high by 25 times. The factor with the strongest impact on survival was the absence of other diseases. The medium-risk patient group was more likely to require dialysis during hospitalization. The need for antibiotics was more significant in the high-risk group on the GRAM score. CONCLUSION: The COVID-GRAM score corresponds well with total mortality. The factor with the strongest impact on survival was the absence of other diseases. The worst prognosis was for patients who were unconscious during admission. Patients with higher COVID-GRAM score were significantly less likely to return to full health during follow-up. There is a continuing need to develop reliable, easy-to-adopt tools for stratifying the course of SARS-CoV-2 infection.

The Usefulness of the C2HEST Risk Score in Predicting Clinical Outcomes among Hospitalized Subjects with COVID-19 and Coronary Artery Disease.

BACKGROUND: Even though coronary artery disease (CAD) is considered an independent risk factor of an unfavorable outcome of SARS-CoV-2-infection, the clinical course of COVID-19 in subjects with CAD is heterogeneous, ranging from clinically asymptomatic to fatal cases. Since the individual C2HEST components are similar to the COVID-19 risk factors, we evaluated its predictive value in CAD subjects. MATERIALS AND METHODS: In total, 2183 patients hospitalized due to confirmed COVID-19 were enrolled onto this study consecutively. Based on past medical history, subjects were assigned to one of two of the study arms (CAD vs. non-CAD) and allocated to different risk strata, based on the C2HEST score. RESULTS: The CAD cohort included 228 subjects, while the non-CAD cohort consisted of 1956 patients. In-hospital, 3-month and 6-month mortality was highest in the high-risk C2HEST stratum in the CAD cohort, reaching 43.06%, 56.25% and 65.89%, respectively, whereas in the non-CAD cohort in the high-risk stratum, it reached: 26.92%, 50.77% and 64.55%. Significant differences in mortality between the C2HEST stratum in the CAD arm were observed in post hoc analysis only for medium- vs. high-risk strata. The C2HEST score in the CAD cohort could predict hypovolemic shock, pneumonia and acute heart failure during hospitalization, whereas in the non-CAD cohort, it could predict cardiovascular events (myocardial injury, acute heart failure, myocardial infract, carcinogenic shock), pneumonia, acute liver dysfunction and renal injury as well as bleedings. CONCLUSIONS: The C2HEST score is a simple, easy-to-apply tool which might be useful in risk stratification, preferably in non-CAD subjects admitted to hospital due to COVID-19.

Dent disease in Poland: what we have learned so far?

PURPOSE: Dent disease (DD) is a rare tubulopathy characterized by proximal tubular dysfunction leading to chronic kidney disease (CKD). The aim of the study was to characterize patients with DD in Poland. METHODS: A retrospective analysis of a national cohort with genetically confirmed diagnosis. RESULTS: Of 24 males, all patients except one carried mutations in the CLCN5 gene; in one patient a mutation in the OCRL gene was disclosed. Molecular diagnosis was delayed 1 year on average (range 0-21 years). The most common features were tubular proteinuria (100%), hypercalciuria (87%), and nephrocalcinosis (56%). CKD (≤stage II) and growth deficiency were found in 45 and 22% of patients, respectively. Over time, a progression of CKD and persistence of growth impairment was noted. Subnephrotic and nephrotic proteinuria (20%) was found in most patients, but tubular proteinuria was assessed in only 67% of patients. In one family steroid-resistant nephrotic syndrome prompted a genetic testing, and reverse phenotyping. Five children (20%) underwent kidney biopsy, and two of them were treated with immunosuppressants. Hydrochlorothiazide and angiotensin-converting enzyme inhibitors were prescribed for a significant proportion of patients (42 and 37.5%, respectively), while supplemental therapy with phosphate, potassium, vitamin D (12.5% each), and alkali (4.2%) was insufficient, when compared to the percentages of patients requiring repletion. CONCLUSIONS: We found CLCN5 mutations in the vast majority of Polish patients with DD. Proteinuria was the most constant finding; however, tubular proteins were not assessed commonly, likely leading to delayed molecular diagnosis and misdiagnosis in some patients. More consideration should be given to optimize the therapy.

[Importance of annexin V in kidney diseases]. / Znaczenie aneksyny V w chorobach nerek

Annexin V (AnV) belongs to a cytoplasmic calcium binding protein family found in many body tissues, including distal tubule cells and glomerular epithelial cells. The biological role of this protein discovered so far is connected with apoptosis. AnV is considered as an early marker of that process and is used in one of the most frequently applied apoptosis detection methods, consisting in the detection of biochemical and morphological changes in cells. Measuring the AnV level may help understand many renal processes. Elevated AnV levels have been found in both acute and chronic renal conditions. Applying AnV to identify cells in the early phase of apoptosis in acute pyelonephritis caused by Escherichia coli showed that hemolysins of pathogenic bacteria stimulate the death of tubular cells and that the intensification of the process depends on the level of the toxin and its activity time. Studies on the mechanisms of reperfusion injury in acute renal injury have revealed protective activity of a synthetic AnV homodimer with regard to tubular cells. AnV was also used in diabetic nephropathy to study the influence of metabolic disorders on the intensification of apoptosis in renal tubular cells. Additionally, the suitability of AnV measurement as a biochemical marker of atherosclerosis in patients with a chronic renal condition was evaluated. It was also used to study the causes of immunodeficiency in patients diagnosed with the above-mentioned condition. There have been few papers published so far on the significance of AnV in children with renal conditions. The prognostic value of AnV and T cell apoptosis was evaluated in children with nephrotic syndrome.

Long-term outcomes in idiopathic nephrotic syndrome: from childhood to adulthood.

BACKGROUND: The aim of the study was to assess idiopathic nephrotic syndrome (INS) relapse rate, co-morbidities, and social status of adults diagnosed with INS in childhood. MATERIAL AND METHODS: A written questionnaire was sent to 118 adults treated for INS in childhood. In 61 (51.7%) responders (aged 26.0 ± 6.2 years, range 18 - 51.5 years), we used available medical records to evaluate age at the onset of INS, number of INS relapses below 18 years of age, response to corticosteroids (CS), renal biopsy findings, and immunosuppressive treatment as well as questionnaire to evaluate the number and treatment of INS relapses above 18 years of age, co-morbidities, age at menarche, marital status, offspring, educational status, and occupation. RESULTS: In the group of 61 responders, median age at the onset of INS was 3 (range 1.3 - 14.0) years, median number of INS relapses at < 18 years of age was 5 (1 - 20). Steroid-sensitive nephrotic syndrome (SSNS) was diagnosed in 37 (60.7%) patients, steroid-dependent nephrotic syndrome SDNS in 18 (29.5%) patients, and steroid-resistant nephrotic syndrome (SRNS) in 6 (9.8%) patients. Mesangial proliferation was the most common pattern in renal biopsy (35.7%). All patients received CS, 15 were treated with methylprednisolone pulses, 13 with cyclophosphamide, 11 with chlorambucil, 2 with cyclosporine, and 21 with levamisole. All patients achieved remission and had normal renal function at the age of 18. In adulthood, INS relapsed in 10 (16.4%) patients, including 5 (13.5%) patients with SSNS, 4 (22.2%) with SDNS, and 1 (16.7%) with SRNS (p = 0.72). Median number of relapses was 2 (range 1 - 11). Patients with relapses at > 18 years of age had more (p < 0.005) relapses at < 18 years of age. Hypertension was diagnosed in 8 (16.1%), overweight in 14 (23.0%), obesity in 3 (4.9%), and bone fractures in 12 (19.7%) patients. Five patients had height < 3rd percentile, including 4 with INS onset at < 3 years of age. One patient had growth retardation before the treatment. No myocardial infarctions, strokes, severe infections, or malignancies were reported. Mean age at menarche was 12.9 ± 1.4 years, 37 (60.7%) patients were in a steady relationship/ married, 1/18 (5.6%) patients treated with cytostatic agents and 12/43 (24/7%) patients not treated with cytostatic agents had offspring (p < 0.05). Elementary education was reported by 4 (6.6%), secondary education by 32 (52.5%), and higher education by 25 (40.9%) patients, and 34 (55.7%) patients were professionally active. None of the 6 patients with SRNS developed end-stage renal disease. CONCLUSIONS: 1. High number of INS relapses in childhood is a risk factor for recurrences in adulthood. 2. INS relapses in childhood do not preclude active professional life in adulthood.

Unspecific increase of tumor markers in a girl with nephrotic syndrome and ovarian teratoma.

Coexistence of nephrotic syndrome and neoplasm is rarely observed in children. We report the diagnostic and therapeutic problems of a 16-year-old female with nephrotic syndrome, ovarian tumor, and increased levels of tumor markers. She was suspected to have paraneoplastic nephrotic syndrome. After ovarian tumor resection, the nephrotic syndrome remission was not observed, while increased tumor marker levels were noted. The patient's final diagnosis was nephrotic syndrome in the course of primary mesangial proliferative glomerulonephritis. In conclusion, nephrotic syndrome in a patient with neoplasia might occur in the course of the primary and nonparaneoplastic glomerulopathy. Elevated serum tumor markers in patients with nephrotic syndrome might be nonspecific because of the stimulation of their production by peritoneal mesothelium, due to transudation to body cavities, that is, ascites.

[Serum adiponectin and resistin level in children with idiopathic nephrotic syndrome]. / Stezenie adiponektyny i rezystyny we krwi u dzieci ze steroidowrazliwym idiopatycznym zespolem nerczycowym.

UNLABELLED: The adipose tissue was recognized as an active endocrine organ. The adipopkines seem to play an important role in the modulation of inflammatory response and have a pleiotropic function. The aim of this study was to evaluate serum resistin and adiponectin level in children with idiopathic nephrotic syndrome (INS). MATERIALS AND METHODS: 39 children with INS aged 2.5-17 year (mean 9.35 +/- 5.6), 15 children in relapse, 24 in remission and 8 healthy were included into the study. Serum total protein, albumin, cholesterol, daily proteinuria and BMI were measured in children with INS. Serum resistin and adiponectin levels were determined by ELISA. RESULTS: Increased resistin and adiponectin levels were observed during relapse and remission of INS, compared to controls. No significant difference between adipocytokines in relapse and remission INS was found. Serum resistin level decreased in remission of INS, compared to relapse, but the value did not reach statistical significance. Between resistin and cholesterol, resistin and proteinuria positive correlation was found. Negative correlation between resistin and serum albumin was observed. CONCLUSION: Increased serum level of resistin and adiponectin was observed in children with relapse of INS or in early phase of remission. These finding suggests that they may play a role in the pathogenesis of INS in children. It requires further investigation based on a broad study.

Oxidative stress in children on peritoneal dialysis.

OBJECTIVES: Enhanced oxidative stress has been observed in dialysis and predialysis adult patients with chronic kidney disease (CKD), which resulted in increased mortality and morbidity within this population. Not much attention in the literature has been paid to nonenzymatic antioxidant defense in children with CKD on peritoneal dialysis (PD). The aim of the present study was to describe the plasma, erythrocyte, and dialysate concentrations of oxidized (GSSG) and reduced glutathione (GSH) and vitamins A, E, and C in a pediatric PD population. PATIENTS: 10 children on PD and 27 age-matched healthy subjects were enrolled in the study. RESULTS: Erythrocyte and plasma GSH concentrations were lower in PD patients, erythrocyte concentration of GSSG remained unchanged, and plasma GSSG was significantly higher in children on PD. Children on PD exhibited decreased plasma concentrations of antioxidant vitamins compared to healthy subjects. Moreover, we documented loss of vitamins A, E, and C into ultrafiltrate. CONCLUSION: Such low plasma levels of vitamins A, E, and C and simultaneously decreased activity of erythrocyte GSH may be responsible for the increased oxidative stress occurring in children with CKD on PD.

Lymphoepithelioma-like thymic carcinoma in a 16-year-old boy with nephrotic syndrome--a case report.

Nephrotic syndrome can occur as a consequence of, among others, malignancy. In this report we describe a 16-year-old boy with secondary nephrotic syndrome associated with lymphoepithelioma-like thymic carcinoma, an extremely rare subtype ofthymic carcinoma with poor prognosis.

Plasma ghrelin levels in children with chronic renal failure on peritoneal dialysis.

OBJECTIVES: Malnutrition and loss of appetite represent a serious problem in children with chronic renal failure. Ghrelin is a newly described hormone involved in control of growth hormone secretion, stimulation of food intake, and regulation of energy balance. METHODS: Plasma ghrelin levels were compared between 12 children on automated peritoneal dialysis (APD) and 9 children on conservative treatment of chronic renal failure. Eight healthy children matched for age and body mass index (BMI) served as a control group. RESULTS: Plasma ghrelin levels were similar in children on APD (698.3 +/- 59.7 pg/mL) and children on conservative treatment (675.4 +/- 41.9 pg/mL) compared to healthy controls (700.1 +/- 24.7 pg/mL). There was no difference in plasma ghrelin levels in children with chronic renal failure regardless of the method of treatment (peritoneal dialysis vs conservative treatment). The plasma ghrelin index was similar in all three investigated groups: APD 40.2 +/- 8.7 vs conservative treatment 39.1 +/- 5.6 vs controls 41.0 +/- 7.8 (pg/mL)/BMI (kg/m2). Plasma ghrelin levels did not correlate with age, duration of dialysis treatment, height, weight, BMI, creatinine and urea levels, adequacy parameters, or nightly glucose load. CONCLUSION: Plasma ghrelin levels in children on APD were not different from levels in children on conservative treatment or healthy controls with comparable BMI. The persistent state of toxic influence of uremic end-products could be responsible for such a lack of correlation with anthropometrical parameters. Further studies on a larger group of children on APD are needed to clarify the effect of ghrelin on nutritional status in children with chronic renal failure.

[Evaluation of renal function in children undergoing surgery under general anaesthesia]. / Ocena funkcji nerek u dzieci poddawanych zabiegom chirurgicznym w znieczuleniu ogólnym.

UNLABELLED: 47 children (29 boys and 18 girls) aged from 3 to 13 years were examined. The children were operated under general anaesthesia. All children were in good general condition, belonged to anaesthesia risk groups ASA 1 and ASA 2, had no metabolic, endocrinological, haematological diseases nor had renal or hepatic dysfunction. The examined children were divided into two groups with regard to anaesthesia method. 24 healthy children aged 2-16 years were included into control group. Urinary excretion of N-acetyl-beta-D-glucosaminidase (U-NAG), Tamm-Horsfall protein (U-THP), beta 2-microglobulin (U-beta 2-m) and albumins (U-Alb) as indicators of functions of the following nephron structures: glomerular, proximal and distal tubular were assessed. The studies were carried out directly before and on the first day after surgery. RESULTS: Statistically significant differences between values of examined indicators before and after surgery have not been observed. CONCLUSION: The administered methods of anaesthesia have not negatively influenced renal function in children.

Analysis of collagen IV and fibronectin in blood and urine in evaluation of nephrotic fibrosis in children with chronic glomerulonephritis.

BACKGROUND: Changes in the concentration of extracellular matrix components in body fluids may reflect the degree of kidney fibrosis. The aim of our study was to evaluate fibronectin (FN) and type IV collagen (COL IV) concentrations in blood serum and urine, and to refer these values to immunoreactivity in renal biopsy material. MATERIAL/METHODS: Our research involved 37 children with glomerulonephritis (GN) aged 4-15 and 18 healthy children. The patients were divided into 3 groups according to the histopathological diagnosis of GN: I - minimal change GN (MCGN, n=17), II - lupus nephritis (LN, n=7), III - other types of GN (n=13). RESULTS: Significantly higher COL IV concentrations in serum and urine were noted in the patient group in comparison to the controls, but no differences in FN concentrations. The highest values of serum and urine COL IV were observed in the LN patients. Positive correlation was found between serum and urine COL IV and its renal content in the LN group. CONCLUSIONS: The results indicate that serum and urine COL IV rises in children with GN, above all in the course of LN. This also reflects changes in renal COL IV content.