[The ability to produce nitric oxide by leukocytes in whole blood of children with recurrent urinary tract infections]. / Zdolnosc do produkcji tlenku azotu przez leukocyty pelnej krwi u dzieci chorych na nawracajace zakazenia ukladu moczowego.

We examined 20 children in age from 6 till 18 years old with recurrent urinary tract infection (rUTI). The control group were 15 healthy volunteers in age from 19 till 23 years old. In all cases nitrogen oxide concentration was designated in supernatant of 48 hours leukocytes culture with using colorimetric method with Griess reagent described by Ding. The spontaneous and LPS stimulated ability to nitrogen oxide production in full blood was estimated. The nitrogen oxide index was counted from the difference of concentration of inducated and stimulated nitrogen oxide. The defective response of the leukocytes of full blood to LPS-stimulation for nitrogen oxide productionin aggravation also in remission in children with rUTI and with rUTI in age till 5 years old and above 5 years old comparing to healthy ones.

[Levels of selected soluble adhesion molecules in blood serum of children with chronic glomerulonephritis]. / Stezenie wybranych rozpuszczalnych czasteczek adhezyjnych w surowicy krwi dzieci chorych na przewlekle klebuszkowe zapalenie nerek.

Increased concentrations of circulating soluble adhesion molecules have been reported in a variety of disorders. The aim of this study was to evaluate serum sICAM-1, sVCAM-1, sE-selectin, sP-selectin concentrations in 60 children with chronic glomerulonephritis GN (49 patients with GN and syndrome nephroticum, 11--with GN only), aged 3-17 years (mean 9 years) and in 15 healthy children (control group). The histopathological diagnoses of the 27 patients were: minimal change GN--10 cases, lupus nephritis--3, mesangiocapillary GN--4, mesangial GN--4, membranous GN--1, focal glomerulosclerosis--5. It was found a significant increase of tested soluble adhesion molecules in all children with GN compared to the control, independent on the histopathological type of GN. Serum sVCAM-1 and sP-selectin concentrations were higher in children with GN and syndrome nephroticum compared with patients with GN only. The results indicate activation of platelets, leucocytes, endothelium and its damage in GN. It seems, that more advanced vascular endothelium changes and platelets activation occur in children with GN and syndrome nephroticum.

Serum concentration of IL-2, IL-6, TNF-alpha and their soluble receptors in children on maintenance hemodialysis.

In chronic renal failure patients a state of immunodeficiency paradoxically coexists with the activation of immune effector cells, including monocytes and lymphocytes. The activation of these cells leads to the release of cytokines. The aim of this study was to estimate the serum concentrations of IL-2, IL-6, TNF-alpha and their soluble receptors: IL-2 sRalpha, IL-6 sR, sTNF RI in children with chronic renal failure and young adults on maintenance hemodialysis (HD). The study included 16 HD patients (11 females, 5 males) aged 11-22 (mean 16.1 +/- 3.1) years and a control group of 15 age-matched healthy children. Only the mean concentration of IL-6 was similar in HD patients and the control group. The levels of the other cytokines were significantly higher in patients undergoing HD compared to the healthy subjects. No significant differences were observed between the pre- and post-dialysis values or between the values obtained using various dialyzer membranes. These data suggest that immune cells in HD children are in an activated state and that neither a single dialysis session nor the type of dialyzer membrane has an influence on the cytokines examined.

[Lupus nephritis in children]. / Toczniowe zapalenie nerek u dzieci.

UNLABELLED: Systemic lupus erythematosus is a very variable and pleomorphic disease. Lupus nephritis with clinical manifestation appears in 65-70% of patients, kidney morphological changes are observed in 80-100%. In this study we analysed clinical course of lupus nephritis in 15 children treated between 1989-1998 (10 girls, 5 boys, aged 9.5-16 years). The following data were considered: inherited susceptibility to the disease, the first symptoms, primary diagnosis, the symptoms at admission to clinical hospital, the time from first symptoms to diagnosis of lupus, laboratory results, clinical course, treatment, outcome of disease. All children underwent percutaneous renal biopsy. 2 patients had class II, 7 patients--class III, 5--class IV and 1 class V of lupus nephritis. In the treatment were used: oral prednisone, intravenous methylprednisolone, methylprednisolone pulse, cyclophosphamide (oral and i.v.), sandimmum. Total or partial remission with normal renal function was observed in 11 children, 1 had stable renal insufficiency, 1 with terminal renal insufficiency started regular HD treatment, 2 patients died. CONCLUSIONS: Lupus nephritis appears the main in young girls aged 12-15 years; the children with renal symptoms need of early renal biopsy and individual treatment; the prognosis of children with IV class lupus nephritis, severe anaemia, low complement, active urinary sediment and quick progress of renal insufficiency is poor.

Purtscher-like retinopathy in nephrotic syndrome associated with mild chronic renal failure.

A sudden loss of vision attributable to Purtscher-like retinopathy occurred in a 4-year-old boy with focal segmental glomerulosclerosis and nephrotic syndrome as well as mild chronic renal failure. This retinopathy was bilateral. After treatment with intravenous methylprednisolone, infusion of 20% albumin, and low molecular weight heparin (nadroparin calcium), his visual acuity improved within 3 days. Ischemic retinal blanching and hemorrhages gradually disappeared. The pathogenesis of this disorder is unknown.

[Hyperuricosuria in children]. / Hiperurykozuria u dzieci.

Hyperuricosuria (HU), defined as an increased urinary acid excretion, seems to be responsible for the of kidney stone formation. Hyperuricosuria was identified as a potential etiology of hematuria in children and adult patients too. The aim of the study was to analyze clinical course of hyperuricosuria in 77 children (43 girls and 33 boys) treated in 1995-1999. We analyzed familial history of urolithiasis, reasons of hospital admissions, laboratory findings and treatment. HU has been suspected to cause hematuria in patients. Children with higher urinary acid excretion are in increased risk of stone formation.

[Urolithiasis in children less than 4 years of age]. / Kamica ukladu moczowego u dzieci do 4 roku zycia.

The aim of the study was to analyse the cases of nephrolithiasis in the youngest children from 2 months and 4 years. 30 children treated between 1955 and 1999 were included in to the study. Nephrolithiasis causes, clinical course of the disease and risk factors for the urinary stone formation were taken under consideration.

[Resistance to therapy in primary nephrotic syndrome: effect of MDR1 gene activity]. / Odpornosc na leczenie w przebiegu pierwotnego zespolu nerczycowego: wplyw aktywnosci genu MDR1.

MDR1 gene encodes for a transmembranous glycoprotein, gp-170, which acts as a drug export pump and is also a cyclosporine(CsA)-binding protein. This study aimed at evaluating MDR1 expression in NS sensitive(S) and resistant(R) to therapy (steroids/S/, cyclophosphamide/C/, CsA) patients. Twenty six boys, 13 girls aged 3-8 years were included to the study. MDR1 was analysed using: 1) evaluation of gp-170 activity according to DiC2/3/ [3,3-Diethyloxa-carbocyanine Iodide] by means of flow cytometry and as 2) mRNA expression of MDR1 determined by RT-PCR. The analysis was performed in the lymphocyte subset CD4/CD45RA presenting suppressor-inducer activity. Negative control, Jurkat-T-cell line, not expressing the MDR1 phenotype, was transfected with viral expression vector containing a full-length cDNA for the human MDR1 gene. We found that: in SR-NS the high expression of MDR1 was associated mainly with the suppressor-inducer T-cells (CD45RA+CD4+) and was subsequently enhanced during an ineffective treatment with C and/or CsA. C-R-NS and CsA-R-NS were partially reversible by S- and R-Verapamil; this was in vitro confirmed by inhibition of export pump activity, gp-170. SS-NS, C-S-NS and CsA-S-NS presented the low expression and activity of MDR1 comparing to R-children (p < 0.001) and healthy controls (p < 0.00001). Resistance to therapy in NS patients seems to be resulted from the enhanced expression of MDR1 gene and subsequent high activity of export pump P-gp-170. Calcium channel blockers may reverse the MRD1-related resistance in the therapy of NS. Analysis of MDR1 may help to detect of suspected therapy resistance in NS.

[Cytokines in patients with chronic renal failure during non-invasive therapy]. / Cytokiny u chorych z przewlekla niewydolnoscia nerek leczonych zachowawczo.

Patients with chronic renal failure (CRF) present an immunodeficient state manifested by an abnormally high incidence of malignant tumors, enhanced susceptibility to certain infections diseases, poor responses to influenza and hepatitis B vaccines. This state coexists paradoxically with activation of most immunocompetent cells, mostly monocytes and lymphocytes. A complexed net of reciprocally acting reasons of immunological processes in patients with CRF remains still unclear. Immunological response is bounded with release and functioning of cytokines. Plasma levels of many cytokines in patients with CRF are higher than in healthy control. The main role in this process plays the state of activation of monocytes provoked by the circulating endotoxins, which has been confirmed in those patients. Moreover, chronic renal failure itself and reactive oxygen species can cause a disregulation of production and elimination of these cytokines. The decreased clearance of cytokines due to renal failure can cause an accumulation of those proteins in blood. The origin, physiological role and disordered production of cytokines needs still further investigations in order to get a better understanding of a nature of dysfunction immune system in CRF patients.