Kidney volume normative values in Central European children aged 0-19 years: a multicenter study.

BACKGROUND AND OBJECITVES: The currently available kidney volume normative values in children are restricted to small populations from single-centre studies not assessing kidney function and including none or only a small number of adolescents. This study aimed to obtain ultrasound-based kidney volume normative values derived from a large European White/Caucasian paediatric population with normal kidney function. METHODS: After recruitment of 1427 children aged 0-19 years, 1396 individuals with no history of kidney disease and normal estimated glomerular filtration rate were selected for the sonographic evaluation of kidney volume. Kidney volume was correlated with age, height, weight, body surface area and body mass index. Kidney volume curves and tables related to anthropometric parameters were generated using the LMS method. Kidney volume predictors were evaluated using multivariate regression analysis with collinearity checks. RESULTS: No clinically significant differences in kidney volume in relation to height were found between males and females, between supine and prone position and between left and right kidneys. Males had, however, larger age-related kidney volumes than females in most age categories. For the prediction of kidney volume, the highest coefficient correlation was observed for body surface area (r = 0.94), followed by weight (r = 0.92), height (r = 0.91), age (r = 0.91), and body mass index (r = 0.67; p < 0.001 for all). CONCLUSIONS: This study presents LMS-percentile curves and tables for kidney volume which can be used as reference values for children aged 0-19 years.

Kidney length normative values - new percentiles by age and body surface area in Central European children and adolescents.

BACKGROUND: Kidney size evaluation is an essential examination in pediatric nephrology. While body length/height is the best predictor of kidney length, age-based and body surface area (BSA)-based normative values may be useful in clinical practice or research. This study aimed to establish ultrasound-based kidney length lambda-mu-sigma (LMS) percentiles by age and BSA in healthy children. METHODS: In 1758 Polish and Lithuanian children (868 boys, 49%) aged 0-19 years, kidney length was measured using ultrasonography. In all participants, anthropometric measurements were taken and kidney function was evaluated based on serum creatinine concentration. Participants with chronic or kidney diseases, abnormal kidney function, or pathologies in sonographic examination were excluded from the analysis. RESULTS: Kidney length (median kidney length) increased progressively from infancy to the age of 18 years, from 60.1 to 114.2 mm in males, and from 57.3 to 105.2 mm in females. A gradual increase of kidney length (50th percentile) in relation to BSA (from 46.1 mm in infants with a BSA of 0-1.2 m2 to 118.3 mm in adolescents with a BSA of 2.6-2.8 m2) was also observed. LMS percentiles by age (stratified by sex) and BSA were determined and presented as graphs and tables of percentiles and LMS parameters by 1-year age intervals and 0.2 m2 of BSA, respectively. CONCLUSIONS: We present the first age- and BSA-based kidney length LMS normative values based on the largest pediatric cohort to date, which can be used in both clinical practice and research studies. A higher resolution version of the Graphical abstract is available as Supplementary information.

Kidney length normative values in children aged 0-19 years - a multicenter study.

BACKGROUND: Currently used pediatric kidney length normative values are based on small single-center studies, do not include kidney function assessment, and focus mostly on newborns and infants. We aimed to develop ultrasound-based kidney length normative values derived from a large group of European Caucasian children with normal kidney function. METHODS: Out of 1,782 children aged 0-19 years, 1,758 individuals with no present or past kidney disease and normal estimated glomerular filtration rate had sonographic assessment of kidney length. The results were correlated with anthropometric parameters and estimated glomerular filtration rate. Kidney length was correlated with age, height, body surface area, and body mass index. Height-related kidney length curves and table were generated using the LMS method. Multivariate regression analysis with collinearity checks was used to evaluate kidney length predictors. RESULTS: There was no significant difference in kidney size in relation to height between boys and girls. We found significant (p < 0.001), but clinically unimportant (Cohen's D effect size = 0.04 and 0.06) differences between prone vs. supine position (mean paired difference = 0.64 mm, 95% CI = 0.49-0.77) and left vs. right kidneys (mean paired difference = 1.03 mm, 95% CI = 0.83-1.21), respectively. For kidney length prediction, the highest coefficient correlation was observed with height (adjusted R2 = 0.87, p < 0.0001). CONCLUSIONS: We present height-related LMS-percentile curves and tables of kidney length which may serve as normative values for kidney length in children from birth to 19 years of age. The most significant predictor of kidney length was statural height.

Effects of vitamin D on macrophages and myeloid-derived suppressor cells (MDSCs) hyperinflammatory response in the lungs of COVID-19 patients.

Vitamin D regulates homeostasis, anti-microbial response, and inflammation. The vitamin D receptors are expressed in the macrophages and other immune cells, regulating the transcription of many different genes, including those coding the anti-microbial peptides. One of the most severe complications of the SARS-CoV-2 infection is the acute respiratory distress syndrome (ARDS) caused by the hyperinflammatory response (commonly called cytokine storm) of the lung macrophages. Studies showed that Vitamin D deficiency increases the severity of the ARDS in COVID-19 infection. We discuss here how the vitamin D supplementation may influence macrophage and myeloid-derived suppressor cells (MDSCs) inflammatory response, subdue the hyperinflammatory response, and lessen the ARDS in COVID-19 patients.

The Effect of Passive Exposure to Tobacco Smoke on the Immune Response in Children with Asthma.

Introduction: There are a few publications about the impact of tobacco smoke on the children's immune system. Material and Methods: The study group consisted of 43 children with asthma. The control group consisted of 37 healthy children. The exposure to tobacco smoke was assessed by the presence of the cotinine in the urine (metabolit of nicotine). Results: The group of children with asthma exposed to tobacco smoke had significantly higher levels of the IL-1 and lower levels IL-4 than children not exposed to the passive smoking. The children from the control group exposed to tobacco smoke had a significantly higher concentration of IL-4 than unexposed children. In the whole analyzed population, there was a significant positive correlation between cotinine-IL1 and cotinine-CRP. Conclusion: In this study we found that the passive exposure to tobacco smoke has the immunomodulatory effects on the immune system.

Excessive Body Weight and Immunological Response in Children with Allergic Diseases.

The prevalence of allergy and obesity is sharply on the rise in children. However, the nature of a mutual relation of the two conditions remains unclear. The aim of the study was to assess the impact of excessive body weight on the immune response in children with allergies. There were 56 children with allergies, aged 4-15 years, included into the study (41 with asthma and 15 with atopic dermatitis). Based on the body mass index, children were divided into two groups: normal weight (body mass index (BMI) <85th percentile) and excessive weight (BMI ≥ 85th percentile). The immunological parameters were evaluated by flow cytometry. We found that children with excessive body weight had a significantly lower percentage of CD4+ lymphocytes and a higher percentage of natural killer T cells (NKT) and CD16/56+ lymphocytes than those with normal weight. In the group with allergy, a significant positive association was noticed between BMI and the percentage of human leukocyte antigen (HLA)-DR-specific CD3. Further analysis was done after dividing the allergy group into the children with normal and excessive weight. There were an adverse association between BMI and the percentage of CD8+ lymphocytes in those with normal weight and a positive one between BMI and the percentage of CD4+ in those with excessive weight. We conclude that excessive body weight plays a major role in mediating the immunological response in children with allergy.

The role of progranulin (PGRN) in the modulation of anti-inflammatory response in asthma.

Asthma is one of the most common chronic diseases. Epidemiological studies show that asthma will develop among around 40% of children under six years old with symptoms of bronchial obstruction. Diagnosis of asthma is complicated, especially in the paediatric population. As a result, a lot of research is being carried out to establish the pathophysiology and to find new biomarkers of this disease. Progranulin (PGRN) is a recently discovered growth factor with many biological functions. PGRN has anti-inflammatory properties because it inhibits neutrophil degranulation and blocks tumor necrosis factor α (TNF-α) transmission. The underlying mechanisms are still being researched, but TNF-α is considered to be a cytokine responsible for neutrophilic inflammation in the airways and bronchial hyperresponsiveness. Therefore, PGRN, by lowering TNF-α concentration and stimulating regulatory T-cell (Treg) proliferation, relieves symptoms of bronchial inflammatory diseases. This article attempts to verify the current knowledge about basic pathophysiological mechanisms in asthma. We also summarise the most recent research advances in the role of PGRN in the respiratory system.

Vitamin B6 improves blood parameters in rats fed a protein-deficient diet and subjected to moderate, long-term exercise.

Vitamin B6 is necessary for many enzymatic pathways (glucose and lipid metabolism, DNA/RNA synthesis, or modulation of gene expression) and affects immune cell function and blood-forming processes. We hypothesised that supplementing a protein-deficient diet with vitamin B6 may reduce the negative impact of protein malnutrition. Here, we evaluated the effect of moderate, long-term exercise (ninety days) on selected blood parameters in rats fed a normal diet, a protein-deficient diet, or a protein-deficient diet supplemented with vitamin B6. Selected haematological, immunological, and biochemical parameters were examined. A protein-deficient diet lasting 90 days caused significant reduction in body mass, increased activity of aminotransferases (asparagine and alanine), an increased percentage of innate cells in the blood, and decreased haemoglobin concentration in the blood. Adding vitamin B6 significantly increased body and muscle mass, decreased liver parameters, and caused normalisation of haemoglobin concentration and the proportion of white blood cells in the blood. These results indicate that vitamin B6 supplementation significantly improves the health of protein-malnourished rats and paves the way for the development of novel anti-malnutrition therapies.

Serum Diamine Oxidase in Pseudoallergy in the Pediatric Population.

Histamine intolerance (pseudoallergy) is a poorly investigated type of food hypersensitivity. The main enzyme responsible for histamine degradation in the extracellular matrix is diamine oxidase (DAO). Disturbances in the concentration or activity of DAO may lead to the development of clinical signs of allergy. The aim of the present work was to assess the DAO concentration, peripheral blood morphology, lymphocytes phenotyping (CD3+, CD4+, CD8+, CD19+, NK cells, NKT cells, and activated T-cells), and natural regulatory Treg (nTregs) cell population (CD4+, CD25+, CD127low, and FoxP3) in 34 pediatric patients with histamine-dependent syndromes. Patients were divided into two groups: classical allergy and pseudoallergy on the basis of IgE concentration. The investigation was based on the analysis of peripheral blood samples. A significantly lower serum DAO, both total and specific IgE, concentration was found in the pseudoallergy group compared with the allergy group. There were no significant differences in blood morphology or lymphocyte populations. A similar level of nTreg lymphocytes was also found in both groups, although it was lower than that present in healthy individuals. The findings suggest that the serum DAO is responsible for the symptoms of histamine intolerance. Moreover, a general decrease in nTreg cells in comparison with healthy individuals may lead to symptom aggravation.

Pathophysiology and symptoms of renal colic in children - a case report.

Urolithiasis is a disease characterized by the presence of stones in the kidney or urinary tract. It is often detected accidentally during an ultrasound or an abdominal x-ray performed for other reasons. However, the first symptom of kidney stone disease can be severe pain called renal colic. Pain caused by a colic attack is characterized by sudden onset. In half of the cases it is associated with nausea or vomiting and can lead to hypotension and fainting. The exact location and radiation of the pain depends on the location of the stone in the urinary tract. The first most commonly performed study is abdominal ultrasound with estimation of the deposit size and evaluation of urinary tract obstruction. Alternative or complementary studies are: an abdominal x-ray where radiopaque deposits can be shown, or unenhanced helical computed tomography of the abdomen. The severity of pain depends on the individual pain threshold and on the change in hydrostatic pressure in the part of the urinary system above the obstruction. Prolonged deposition of the stone in one place causes the activation of autoregulatory mechanisms to lower the pressure of the upper urinary tract, which limits the pain. The basic treatment for renal colic is analgetic therapy. The most commonly used drugs are NSAIDs and opiates. Another important component of renal colic treatment are medications that facilitate urinary stone passage by reducing oedema or limiting urethral contractions, such as: calcium channel blockers, alpha blockers, phosphodiesterase inhibitors. Intensive hydration is not currently recommended. Patients who are unlikely to spontaneously excrete the stone are eligible for minimally invasive treatment. The risk of urolithiasis recurring is high, reaching up to 40% in 5 years and up to 50% in 10 years. However, it can be reduced by proper prevention. The paper describes the pathophysiology of pain in renal colic, the treatment methods, and the case of a boy with recurrent renal colic.

The impact of vitamin D supplementation on vitamin D level, urinary calcium excretion and bone density in patients with hypercalciuria and vitamin D deficiency - preliminary report.

AIM: To study the impact of vitamin D supplementation on vitamin D concentration in plasma, calcium urinary excretion and bone density in patients with urolithiasis in the course of idiopathic hypercalciuria and with a low vitamin D level. MATERIALS AND METHOD: Prospective analysis concerning 28 patients (16 boys, 12 girls) aged 6-14 years (average 10.4) in terms of urinary calcium excretion (mg/kg/day and Ca/Creatinine ratio in morning urine sample), 25OHD blood level after 3, 6, 9 and 12 months of individually recommended doses of vitamin D supplementation (400 IU or 800 IU). The doses were determined on the basis of 25 (OH) D deficiency. The children were on a normocalcemic diet. The bone mineral density of the patients was assessed before and after 12 months of vitamin D use at the aforementioned doses. RESULTS: There was no statistically significant correlation between 25 (OH) D plasma concentration and urinary calcium excretion measured on Ca /Creatinine ratio in daily urine collection and Ca/Creatinine ratio in the morning urine sample. No statistically significant change in calcium excretion was noted (measured by calciuria in daily urine collection and the calcium to creatinine ratio in the morning urine sample). A statistically significant increase in vitamin D plasma concentration was observed. Improvement in bone mineral density was not statistically significant. CONCLUSIONS: Supplementation of vitamin D in the children with idiopathic hypercalciuria and urolithiasis who were examined seems to be safe. The decision to start treatment and the selection of the vitamin D dose should be considered individually. Patients with urolithiasis should be carefully monitored for calcium/phosphate metabolism parameters and the activity of the disease. Supplementation of low doses vitamin D in the children examined did not improve bone mineral density.

Early complications of extracorporeal shockwave lithotripsy in the records of the Department of Paediatrics, Nephrology and Allergology of the Military Institute of Medicine - preliminary results.

The aim of the study was to analyse the frequency and type of early complications of extracorporeal shock wave lithotripsy (ESWL) and to assess the safety of the procedure among paediatric patients. The study is a retrospective analysis of all ESWL procedures carried out due to urolithiasis in 2009-2015 in the Department of Paediatrics, Nephrology and Allergology of the Military Institute of Medicine. Medical records of 170 children were analysed: 94 girls (55.3%) and 76 boys (44.7%) aged 1 to 18 years. Out of the 272 procedures performed, 247 were included in the study. Among 233 effective ESWL treatments, complications were noted in 35 (15.02%) procedures: among 10 girls (40%) and 15 boys (60%). In 25 cases (10.73%) surgical intervention was necessary due to urinary obstruction caused by a fragment of a disintegrated stone. Urinary tract infection was present among 3 patients (1.29%) who required surgical treatment. Nonsurgical complications included 7 urinary tract infections (3%) and 3 cases of severe abdominal pain (1.29%). Complications such as perirenal haematoma, subcapsular haematoma or ureteral perforation were not observed. The vast majority of complications observed in the study were associated with urinary obstruction caused by partial blockage of the ureter with kidney stone fragments ("steinstrasse"). Despite the complications that were documented, ESWL should be considered a safe procedure.

Evaluation of Immune Indices and Serum Vitamin D Content in Children with Atopic Dermatitis.

The influence of vitamin D on allergic diseases, including atopic dermatitis, is linked to the presence of vitamin D nuclear receptors in immune cells. The present study seeks to determine the possible relationship between serum vitamin D content and immune indices in children with atopic dermatitis. The study was conducted in 19 children with atopic dermatitis. The control consisted of 17 age-matched healthy children. A single significant finding was a distinctly lower number of serum regulatory T cells in atopic dermatitis compared with controls (p < 0.00001). There were no appreciable differences between the two groups concerning the immunological indices such as the phenotypes: CD3, CD4, CD8, CD4/CD8, CD19, CD16/56, natural killer T cells, and anti-CD3 human leukocyte antigen - antigen D related cell surface receptor (HLA-DR3), or the percentage of lymphocytes, eosinophils, and the IgE level. We also revealed an inverse association between the serum vitamin D and the percentage of CD8+ cells (p < 0.05; r = 0.62) in atopic dermatitis. In conclusion, the results point to a regulatory role of T cells in the pathogenesis of atopic dermatitis, but fail to substantiate the influence of vitamin D on the course of the disease.

Influence of Vitamin D and Cotinine on T-Regulatory Cells and Asthma Severity in Children.

Asthma is a common chronic respiratory diseases in children. Understanding the immune mechanisms of epigenetic factors may contribute to a better control of asthma. This study seeks to determine the effects of serum vitamin D and urine cotinine on asthma severity and on T regulatory cells (Tregs) and other immune-related factors such as CD3, CD4, CD8, CD19, CD16/56, and anti-CD3 HLA-DR3. The study involved 34 children with asthma. Disease severity was assessed with the Asthma Control Test, spirometry, and the fractional exhaled nitric oxide (FeNO). The control group consisted of 18 healthy children. We found a significantly lower proportion of Tregs in the serum of asthmatic children compared with the control group (p < 0.002). There were no significant differences in the other immunological factors investigated. Nor was there any appreciable association between vitamin D or cotinine and the course of asthma, FeNO, Tregs, and the other immune factors. However, the percentage of Tregs was positively associated with the level of FeNO (p < 0.02). In conclusion, the study shows a role of T regulatory cells in the pathogenesis of asthma in children, but fails to show any influence of serum vitamin D or urine cotinine on disease course.

Evaluation of selected immunological parameters and the concentration of vitamin D in children with asthma. Case-control study.

Due to the increased incidence of allergic diseases and emerging effects of unsatisfactory control of asthma, new mechanisms for supervising the immune system should be searched. The aim of the study was to analyze the percentage of CD3, CD4, CD8, CD19, CD16/56, NKT, CD3 anti-HLADR3 and Foxp3 regulatory lymphocytes in patients with asthma. Additionally the correlation between immune parameters, severity of asthma and serum concentration of vitamin D was performed. 25 children diagnosed with asthma were enrolled. Disease severity was assessed with the Asthma Control Test (ACT) and spirometry. The control group consisted of 15 healthy children. Venous blood from each patient was collected on EDTA or on "clott". Phenotypes of lymphocytes were evaluated by flow cytometry. Vitamin D concentration was assessed by chemiluminescent immunoassay (CLIA) technology. There was a significant decrease in the percentage of T regulatory cells (p < 0.006) in children with asthma compared to the control group. There were no significant differences in the other investigated immunological parameters. In addition, in asthma group statistically significant decreased of vitamin D concentration (p < 0.04) was observed. There were also no significant correlations between vitamin D3 concentration and the course of asthma or percentage of regulatory cells. The results confirmed the role of regulatory T cells in the pathogenesis of asthma. Effects of vitamin D on the severity of the disease has not been proven.

Absence of inferior vena cava in 14-year old boy associated with deep venous thrombosis and positive Mycoplasma pneumoniae serum antibodies--a case report.

BACKGROUND: Absence of the inferior vena cava is a rare vascular anomaly, which usually remains asymptomatic in childhood. It is recognized as the risk factor for deep venous thrombosis, since the collateral circulation does not provide adequate drainage of the lower limbs. Mycoplasma pneumoniae is a common cause of community-acquired pneumonia in school-aged children and adolescents. Mycoplasma pneumoniae infection might be associated with deep venous thrombosis but its pathophysiology remains unknown. According to previous reports, deep venous thrombosis due to Mycoplasma pneumoniae infection is associated with positive serum anticardiolipin antibodies. To our knowledge, we describe the first case of deep venous thrombosis associated with Mycoplasma pneumoniae serum antibodies indicating early stage of infection with negative anticardiolipin serum antibodies in adolescent with absence of inferior vena cava. CASE PRESENTATION: 14-year old boy was admitted to the pediatric unit few days after the appendectomy complaining with pain of the left hip that caused him unable to walk. The pain was accompanied with subfebrile temperature. After clinical examination and additional tests, the boy was diagnosed with a deep venous thrombosis. Computed tomography revealed absence of the vena cava inferior distally to the hepatic veins and varices of the collateral circulation in the pelvis. Anticardiolipin IgM and IgG antibodies and antinuclear antibodies were not detected. Additionally, the Mycoplasma pneumoniae antibodies in classes IgM, IgA and IgG were detected in serum as another risk factor of thrombosis. After the initial treatment with low-molecular-weight heparin in combination with clarithromycin the clinical condition of the patient improved. The patient became a candidate for life-long anticoagulation therapy. CONCLUSIONS: In this case Mycoplasma pneumoniae antibodies were associated with deep venous thrombosis in child with congenital absence of inferior vena cava. Uncommonly for deep venous thrombosis due to Mycoplasma pneumoniae infection, anticardiolipin antibodies were not detected in serum. It is important to remember in clinical practice that Mycoplasma pneumoniae affects coagulability and may trigger thrombosis, especially in the presence of other risk factors. The pathophysiology of this process remains unknown.

Thermal imaging evaluation of paravertebral block for mastectomy in high risk patient: case report.

Thoracic paravertebral block is the technique of injecting local anesthetic adjacent to the thoracic vertebra close to where the spinal nerves emerge from the intervertebral foramina. It is effective in treating acute and chronic pain of unilateral origin from the chest and abdomen. This technique causes pain relief with pulmonary function preservation and great hemodynamic stability. 66 year old woman (156 cm, 80 kg, BMI 32) with chronic right heart failure, hypertension and obesity, on chronic oxygen therapy was presented for elective mastectomy due to breast cancer. She suffered from severe COPD and also bullous emphysema. FVC 1.59 l; FEV1 0.55 l; FEV1%FVC 34.6. The paravertebral block was performed using the multi-shot percutaneous technique with additional light general anesthesia. For confirmation, of proper analgesia range, control of temperature changes, using FLIR i7 infrared camera, was performed. Control photos were made 20 min after the blockade and then 10 min later. Infrared photo showed rise of temperature reading in every marked region. There were no hemodynamic and pulmonary complications postoperatively. Paravertebral block in combination with sedation creates excellent conditions for breast surgery procedures. Additional temperature changes monitoring performed with infrared camera may confirm proper range of analgesia needed to perform surgery. Great cardiovascular stability and very good pulmonary function preservation make this method excellent for high risk patients. Low complication rate is additional advantage. In our opinion this method is recommendable.

Interleukin 18 and neutrophil-gelatinase associated lipocalin in assessment of the risk of contrast-induced nephropathy in children.

The aim of the study was to determine the usefulness of interleukin 18 (IL-18) and neutrophil-gelatinase associated lipocalin (NGAL) in the risk assessment of contrast nephropathy in children. The study included patients among whom radiological examinations were performed using intravascular contrast agent. The material consisted of 33 children (19 girls, 14 boys) aged 6.37 ±5.41 years. 20/33 (61%) of patients had hydronephrosis, 9/33 (27%) had other urinary tract defects referred as "no hydronephrosis" and 4/33 (12%) had urolithiasis. NGAL determination was performed with the use of Human Lipocalin-2 / NGAL Immunoassay. To determine the concentration of human IL-18 an ELISA Kit (MBL International Corporation) was used. There were no statistically significant differences in the concentrations of NGAL and IL-18 in serum determined before the procedure, and after the administration of contrast agent. Concentrations of NGAL and IL-18 were determined in urine three times: before the procedure, 2-4 hours after administration of the contrast agent, and 48 hours after the performed procedure. The analysis showed that the concentration of IL-18 and NGAL in urine did not differ significantly in three consecutive preformed measurements. The study has also found no statistically significant differences between serum creatinine before and 48 hours after injection of contrast. Implementation of new biomarkers such as NGAL and IL-18 expands the possibilities of renal function assessment in children undergoing radiological procedures using contrast agents. In examined children with normal or slightly impaired renal function they did not demonstrate the risk of contrast nephropathy.

The influence of vitamin B12 supplementation on the level of white blood cells and lymphocytes phenotype in rats fed a low-protein diet.

Protein malnutrition has a negative effect on body composition and some blood parameters, especially in the young growing organism. One of nutritional factors which could protect against negative consequences of protein deficiency may be B group vitamins. The aim of the study was to investigate the effect of vitamin B12 supplementation on the immune system in rats fed a standard and a low-protein diet. Rats were fed a control (20% of energy from protein) or a protein-deficient diet (4.5% of energy from protein). Half of animals in each group were additionally supplemented with vitamin B12 (300% of the daily intake). The white blood cells analysis and lymphocytes immunophenotyping (number and percentage) were performed. Low-protein diets caused disturbances in WBC and lymphocyte subpopulations in both short- (30-day) as well as long-term periods (90-day). Vitamin B12 supplementation significantly reduced the negative impact of protein malnutrition after 30 days, however had no effect on long-term malnutrition. Furthermore, vitamin B12 addition in rats fed a control diet did not affect the studied parameters. This observation opens the promise of use of vitamin B12 supplementation to improve immune system parameters in protein malnourished organisms.

Interleukin-18 and NGAL in assessment of ESWL treatment safety in children with urolithiasis.

Urolithiasis is recurrent chronic disease and a complex nephro-urological problem. Currently it is diagnosed in very young children, even infants in the first quarter of life. Until recently the main method of treatment for stones, which for various reasons did not pass spontaneously, was open surgery. At present, the main method replacing open surgery is extracorporeal shock wave lithotripsy (ESWL). Usefulness of common known indicators of the renal function to assess the safety of ESWL procedure is evaluated and verified. The basic markers are serum creatinine, cystatin C, urea, glomerular filtration rate and albuminuria assessment. Unfortunately all these methods show little sensitivity in the case of acute injury processes. There are efforts to use new biomarkers of renal tubular activity, which include among others interleukin 18 (IL-18) and neutrophil gelatinase-associated lipocalin (NGAL). The aim of the study was to assess the safety of ESWL by means of albumin to creatinine ratio, serum cystatin C levels and concentration of two new markers: IL -18 and NGAL. Albumin to creatinine ratio (p = 0.28) and serum cystatin C (p = 0.63) collected before and 48 hours after ESWL did not show statistically significant differences. Similarly, both new markers (IL -18 and NGAL) showed no significant differences (urine IL -18 p = 0.31; serum NGAL p = 0.11; urine NGAL p = 0.29). In conclusion, serum cystatin C tests, urine albumin to creatinine ratio and new early markers of renal tubular injury confirmed the safety of the extracorporeal shock wave lithotripsy (ESWL) and show that the procedure does not cause any episode of acute renal injury.