RESUMO
The aim of research was to compare the frequencies of HLA class-II antigens between children with minimal change nephrotic syndrome (MCNS) and focal segmental glomerulosclerosis (FSGS). The two morphological courses of glomerulosclerosis were considered: FSGS as a progressive state of minimal lesions (shown by renal rebiopsy results in a given patient), and primary (idiopathic) FSGS. The study group consisted of 38 children observed at least for four years. 15 patients were diagnosed as MCNS, 17 children had minimal lesions shown in the initial biopsy findings, but later progressed to glomerulosclerosis and 6 children had idiopathic FSGS. The control group consisted of 51 healthy unrelated individuals. HLA class II antigens were typed with the microlymphocytotoxicity test and with the method of sequence specific oligonucleotide DNA probes hybridisation (PCR-SSO). In minimal change nephrotic syndrome and glomerulosclerosis which followed the formerly found minimal lesions, the significant associations with HLA-DR3, DR7, and HLA-DQ2 were found. HLA-DQ1 was significantly rare in these groups. Differently idiopathic focal segmental glomerulosclerosis associates with the presence of HLA-DR4.
Assuntos
Glomerulosclerose Segmentar e Focal/imunologia , Antígenos HLA-D/imunologia , Antígenos de Histocompatibilidade Classe II/imunologia , Nefrose Lipoide/imunologia , Biópsia , Criança , Pré-Escolar , Feminino , Antígenos HLA-DQ/análise , Antígeno HLA-DR4/imunologia , Antígeno HLA-DR7/análise , Humanos , Lactente , Rim/patologia , MasculinoRESUMO
The authors present potentially nephrotoxic medications most often employed in clinical practice, along with chemical substances and foods that may result in kidney damage. The possible nephrotoxic effect of certain plant and venom of certain animals is emphasized.
Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Nefropatias/induzido quimicamente , Peçonhas/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Animais , Antibacterianos/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Meios de Contraste/efeitos adversos , Humanos , Imunossupressores/efeitos adversos , Nefropatias/etiologia , Metais Pesados/efeitos adversos , Plantas/efeitos adversosRESUMO
The study aims at assessing the value of bioelectrical impedance analysis in estimation of fluid compartments in children with nephrotic syndrome. The study included 23 children aged, 2 and 20.5 y. In 9 children in remission measured parametres were normal. In the group of 14 children with relapses and oedemas, significantly higher TBW and ECM/BCM were observed. These parameters decreased during the course of disease with clinical improvement, but did not reach normal levels at the disappearance of oedemas. BIA is a simple, non-invasive and valuable method for assessment of total body water and fluid compartments.
Assuntos
Composição Corporal/fisiologia , Água Corporal/fisiologia , Síndrome Nefrótica/complicações , Adolescente , Adulto , Criança , Pré-Escolar , Impedância Elétrica , Feminino , Humanos , Masculino , Índice de Gravidade de DoençaRESUMO
The study aims at assessing the results of treating lupus nephritis in 31 children, aged 4-16 years at the diagnosis of the disease. Renal biopsy was performed in 29 patients. Patients were divided into 2 groups. Group 1 included 15 children treated in 1980-92 and group 2 included 16 children treated in 1993-98. The average age, sex and follow-up were similar in both groups. All children were treated with corticosteroids. Alkylating agents were administered to 12 patients in group 1 and in 14 in group 2. Group 2 patients were given cyclophosphamide in monthly intravenous pulses, and methylprednisolone according to the Mendoza regime. In Group 1, 8 remissions (53%) were observed. Better results with more aggressive treatment were obtained in group 2--13 remissions (81%).
Assuntos
Anti-Inflamatórios/uso terapêutico , Antineoplásicos Alquilantes/uso terapêutico , Ciclofosfamida/uso terapêutico , Nefrite Lúpica/tratamento farmacológico , Metilprednisolona/uso terapêutico , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Indução de Remissão , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The aim of the present study has been to assess the concordance in severity grading when using the Poisoning Severity Score (PSS), proposed by IPCS/EC/EAPCCT vs. some specific grading scales. Cases of acute poisoning admitted to the Department of Clinical Toxicology in Kraków during months January, March, May, July, August and October 1998 (n = 820) were evaluated. Severity grading was performed in all cases using both the PSS and special grading scales developed by the poisons centre in Kraków. The PSS is assessing severity on the basis of observed clinical signs and symptoms (at their maximum), but does not take into account potential risks or plasma/serum concentrations. The Kraków scales include both clinical symptoms on admission and results of toxicological analyses. Ethanol (39.4%), drugs (36.2%) and carbon monoxide (7.9%) were the most commonly involved toxic agents. Overall concordance between the PSS and the Kraków scales was at hand in 596 cases (72.7%). The lack of concordance was most evident for ethanol and carbon monoxide cases--the PSS generally giving a lower grade. The discordance was less pronounced for grade 3 (life-threatening) poisonings. Significant number of ethanol poisoning in Kraków centre require medicolegal certification thus ethanol concentration (blood or expired air) is considered while evaluating the poisoning severity. Moreover majority (more than 70%) of acutely ethanol poisoned patients treated at the Department are chronic alcoholics so clinical evidence of intoxication may be minimal at blood ethanol levels higher than 3.0 g/L. For ethanol intoxication the blood ethanol concentration was considered in the Kraków scale but not in the PSS, and when the blood concentrations were disregarded and clinical symptoms only were evaluated the concordance improved between the different systems from 72.7% to 92.3%. Thereby also the overall concordance in the study increased to 82.9%. The less satisfying concordance for carbon monoxide cases was mainly caused by discrepancies in the evaluation of neurological symptoms. Also the blood lactate concentration, COHb level, duration of exposure and patient's age are considered in the Kraków scale but not in PSS. The PSS is intended as a general scheme for grading severity of acute poisoning. In this study an acceptable concordance between the PSS and some locally developed grading scales was at hand in the majority of cases, but it seems that for specific poisons, like carbon monoxide, some modifications and additional criteria may be justified. Further studies to test the reliability of the PSS are encouraged.
Assuntos
Intoxicação/classificação , Índice de Gravidade de Doença , Adulto , Fatores Etários , Alcoolismo/classificação , Alcoolismo/diagnóstico , Etanol/sangue , Etanol/intoxicação , Feminino , Humanos , Lactatos/sangue , Masculino , Pessoa de Meia-Idade , Intoxicação/sangue , Polônia , Reprodutibilidade dos Testes , Toxicologia/legislação & jurisprudência , Toxicologia/normasRESUMO
The pattern of adolescent and adult poisonings in Kraków is presented on the basis of the data collected by the Poison Information Centre of the Department of Clinical Toxicology Collegium Medicum of the Jagiellonian University in 1997. This analysis includes 3472 people treated at the Department of Clinical Toxicology and 118 poisoned people who were not given any treatment and died at the scene of the accident. The group of hospitalised persons consisted of 2359 (67.9%) men and 1113 (32.1%) women, and the group of people who died at the scene of the accident consisted of 97 (82.2%) men and of 21 (17.8%) women. The overall coefficient of poisonings in 1997 was 46.9; for men--67.8 and 28.3 for women. Ethanol (39.7%) followed by drugs (20.2%), drugs + ethanol (6.7%), carbon monoxide (6.2%) and drugs of abuse (4.4%) were the most common cause of acute poisonings. The mortality rate of the cases treated was low (0.43%), but while including those people who were not given any treatment and died at the scene of the accident, mostly due to ethanol, carbon monoxide, and drugs poisoning the fatality index rose up to 3.7%.
Assuntos
Intoxicação/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Demografia , Etanol/toxicidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Drogas Ilícitas/intoxicação , Masculino , Pessoa de Meia-Idade , Intoxicação/mortalidade , Polônia/epidemiologia , Estações do Ano , Distribuição por Sexo , Suicídio/estatística & dados numéricos , Taxa de Sobrevida , Desemprego/estatística & dados numéricosRESUMO
The aim of the paper is to present a case of self-poisoning with paracetamol, overdosed just before a delivery. A 21-year-old woman was admitted to Obstetric and Gynecology Ward of local hospital in the second stage of physiological delivery, more than 6 hours after she had ingested 19 g of acetaminophen for self-poisoning. She delivered a normal infant weighing 3520 g who had Apgar scores of 10, and then both infant and mother were sent in an emergency ambulance to the nearest poison centre. Blood samples for toxicological examination were taken on admission to toxicological intensive care unit i.e. 11 hours post maternal ingestion. Acetaminophen levels of both patients were above the acetaminophen overdose nomogram line and the antidote treatment, i.v. N-acetylcysteine was administered according to the protocol: the mother within 11 hours post-ingestion and approximately 4 hours after a delivery; the neonate within 11 hours post maternal ingestion and 4 hours of life. Higher paracetamol concentration in the blood of infant compared to the mother's was noted in the first and then control toxicological examination performed within 35 hours post maternal ingestion. Peak maternal aspartate aminotransferase (AST) activity was 326 U/L within 35 hours and alanine aminotransferase (ALT) activity was 262 U/L within 56 hours post-ingestion. The highest neonatal enzyme activity was noted within 11 hours post maternal ingestion of paracetamol, and the elevation was not high. Except moderate anaemia in the mother, no clinical or biochemical symptoms of renal, cardiovascular or CNS injury were stated in the mother or infant. Normalisation in the maternal enzymes activity was stated within 226 hours, while in the neonatal within 58 hours post maternal ingestion. The woman recovered without sequelae and was discharged from hospital on the 11th day following paracetamol overdosing. No evidence of the liver injury was found in the infant either.
Assuntos
Acetaminofen/intoxicação , Doenças do Recém-Nascido/terapia , Complicações na Gravidez/terapia , Efeitos Tardios da Exposição Pré-Natal , Acetaminofen/sangue , Adulto , Aspartato Aminotransferases/sangue , Overdose de Drogas , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/sangue , Doenças do Recém-Nascido/diagnóstico , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Terceiro Trimestre da Gravidez , Tentativa de SuicídioRESUMO
The aim of the study was to evaluate the number and the course of acute pesticides poisoning treated in the Department of Clinical Toxicology in 1986-1995. During that period 264 cases (189 men and 75 women) of acute pesticides poisoning were treated. Suicidal oral ingestion followed by inhalation and dermal exposure was the most common cause of acute intoxication. Organophosphates and carbamates were the most common cause of acute intoxication. Poisonings with dipyridyls and sulfonylurea derivatives are relatively rare. The highest number of poisonings was noted in age group 30-39 years. In 37% of the total analysed cases the co-ingestion of ethanol was noted. As organophosphorous compounds were the most common cause of acute pesticides poisoning, the gastric lavage + intensive care treatment + specific and non-specific antidotes were the most common therapeutic management. Duration of hospitalisation was dependent on the kind of pesticide. The longest hospitalisation required the patients poisoned with organophosphates. A full recovery was noted in 57.6% of poisoned patients. 34.1% of patients suffered different organ injury mostly from respiratory and central nervous system. 22 (8.3%) the fatal cases were noted in analysed period.
Assuntos
Praguicidas/intoxicação , Intoxicação/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Intoxicação/terapia , Polônia/epidemiologia , Distribuição por Sexo , Tentativa de Suicídio/estatística & dados numéricos , Resultado do TratamentoRESUMO
44 pregnant women were treated at the Department of Clinical Toxicology in years 1986-1996 as a result of acute poisonings with different xenobiotics. Acute pesticide poisoning that involved 4 cases were always severe and had dramatic clinical course. Carbofuran intoxication stated in a 17-year-old woman (18 weeks of pregnancy) resulted in fetus death. Toxicological findings revealed that the level of the poison in the mothers blood was comparable to that in the fetus. Carbofuran evidently passed the placental barrier in concentration which was sufficient to cause the fetus death. In the second woman (20-year-old, 12 weeks pregnant) who was classified as severely poisoned on admission to the clinic a spontaneous abortion was stated on 27th day after poisoning. The highest level of carbofuran in the blood of the mother was 9.71 micrograms/g. A 30-year-old woman, 10 weeks pregnant took formothion (50 ml) per vaginam in order to provoke abortion. She was classified as moderately poisoned. Gynecological examination and ultrasonography confirmed the pregnancy. The fetus heart tones were audible. The patient was discharged from hospital after 3 days at her own request in a good general condition. The concentration of formothion in washings from vagina was similar to the levels observed in blood serum on the patient admission to the Clinic, and 24 hour later. A 21-year-old woman, 5 month pregnant ingested an unknown amount of endosulfan to provoke abortion. Gynecological examination and abdominal ultrasonography revealed longitudinal pelvic presentation of fetus. Neither fetal movement nor heart tones were audible as early as four hours after the clinical symptoms occurred. Such low concentration of endosulfan in the blood of the mother as 0.47 microgram/g of the poison caused relatively quick fetus death. The highest levels of endosulfan were found in the liver and in the fetus kidneys.
Assuntos
Carbofurano/intoxicação , Endossulfano/intoxicação , Morte Fetal/induzido quimicamente , Inseticidas/intoxicação , Compostos Organotiofosforados/intoxicação , Aborto Induzido , Adolescente , Adulto , Química Encefálica , Carbofurano/análise , Endossulfano/análise , Feminino , Feto/química , Feto/efeitos dos fármacos , Humanos , Inseticidas/análise , Rim/química , Fígado/química , Troca Materno-Fetal , Compostos Organotiofosforados/análise , Gravidez , Ultrassonografia Pré-Natal , Xenobióticos/análise , Xenobióticos/intoxicaçãoRESUMO
The study aimed at the evaluation of metabolic effect of recombinant human erythropoietin (EPO) in children treated with repeated hemodialyses. The research included 16 patients aged 7-17 years of life. The observations were carried out for 6 months prior to and during EPO administration programme. In that time there were monitored changes in peripheral blood count, lean body mass, protein catabolic rate- pcr, urea time averaged concentration TAC and dialysis index KT/V. The results obtained in both phases of the investigation revealed that correction of anemia by means of EPO evokes in children a significant increase of lean body mass, while TAC decreases. The two factors combined speak for anabolic effect of EPO in these patients. The results of peripheral blood count obtained in the groups with high and acceptable exposure to uremic toxemia did not differ significantly, this proves that uremic toxemia does not exert inhibitory effect on erythropoiesis stimulated by EPO administration.
Assuntos
Anemia/terapia , Eritropoetina/administração & dosagem , Diálise Renal , Adolescente , Anemia/etiologia , Proteínas Sanguíneas/metabolismo , Criança , Contagem de Eritrócitos/efeitos dos fármacos , Estudos de Avaliação como Assunto , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Monitorização Fisiológica , Proteínas Recombinantes , Albumina Sérica/metabolismoRESUMO
Distilled spirits are the major source of ethanol consumption in Poland. Such concentrated alcohol is drunk quickly, especially in teenager groups who consider consumption of 250 or 500 ml of vodka during one hour or one hour and half as quite normal. For two years the New Years Eve party has been celebrated in the Main Market Square in Kraków. In 1995 unfavourable weather conditions had been observed for at least 14 days before the New Year's Eve night. During that night only 15 people-participants of the party were admitted to the Department of Toxicology. The aim of this study is to present the cases of poisoned people with ethanol during the last night of the year 1995. All the patients were young (10 poisoned patients were below 17 years of age), considerably low body temperature, and relatively low coma grade. 80% of the patients were admitted between 0:00 and 5:00 a.m. after 200 minutes since the moment they started to drink alcohol. Blood ethanol concentration ranged from 1.2 to 4.23 g/L and serum osmolality from 338 to 440 mOsm/kg H2O. Both ethanol concentration and serum osmolality progressively rose reaching the highest values in the group of patient with III coma degree (p < 0.001). All the cases of acute ethanol poisoning presented in the study had a good outcome, as patient were admitted at the Clinic in relatively short time after symptoms of poisoning have occurred.
Assuntos
Coma/induzido quimicamente , Etanol/intoxicação , Hipotermia/etiologia , Adolescente , Adulto , Pressão Sanguínea/efeitos dos fármacos , Temperatura Baixa , Eletrocardiografia , Etanol/sangue , Feminino , Humanos , Masculino , Isquemia Miocárdica/induzido quimicamente , Isquemia Miocárdica/diagnóstico , Polônia , Estações do AnoRESUMO
The aim of the paper was to evaluate Cyclosporine A (CsA) treatment in children with steroid resistant nephrotic syndrome (diagnosed according to criteria established by ISKDC), in whom numerous attempts at other types of therapy had failed. CsA was used in 23 children aged 2-16 years. Renal biopsies revealed minimal changes (MCD) in 7 children, focal segmental glomerulosclerosis (FGS) in 11, mesangial glomerulonephritis (MES) in 4, and membrano-proliferative glomerulonephritis (MPGN) in 1. CsA was administered for a period of 6-41 months at a daily dose of 6 mg/kg, gradually decreased to 2.5 mg/kg. Blood CsA level was 40-200 ng/ml. In the course of the treatment, proteinuria disappeared or diminished and clinical improvement was seen in 21 patients. 13 children had relapses of nephrotic syndrome, showing very low blood CsA levels. Complete remissions were achieved in 16 children, partial remissions in 5, no remission in 2. Throughout the treatment and after its cessation 22 patients manifested no deterioration of renal function. In 1 child, repeated renal biopsies revealed some lesions that could suggest a nephrotoxic effect of CsA. Secondary steroid sensitivity observed in 3 children should be emphasized. Concluding, CsA is an effective and well tolerated agent in children with steroid resistant nephrotic syndrome, and the improvement noted in patients with FGS may reduce the risk of early terminal failure. The treatment requires monitoring blood CsA levels.
Assuntos
Ciclosporina/uso terapêutico , Imunossupressores/uso terapêutico , Síndrome Nefrótica/tratamento farmacológico , Adolescente , Biópsia , Criança , Pré-Escolar , Resistência a Medicamentos , Feminino , Seguimentos , Humanos , Lactente , Masculino , Síndrome Nefrótica/patologia , Proteinúria/tratamento farmacológico , Recidiva , Indução de Remissão , Esteroides/farmacologiaRESUMO
A 10-year old boy with steroid resistant nephrotic syndrome developed neurological symptoms during the combined therapy with Cyclosporine A, prednisone and ketonazole. These symptoms might be caused by Cyclosporine because the clinical course and laboratory data revealed neither inflammatory nor other causative factors.
Assuntos
Encefalopatias/induzido quimicamente , Ciclosporina/efeitos adversos , Síndrome Nefrótica/tratamento farmacológico , Encefalopatias/diagnóstico por imagem , Criança , Clorambucila/administração & dosagem , Ciclofosfamida/administração & dosagem , Ciclosporina/administração & dosagem , Resistência a Medicamentos , Quimioterapia Combinada , Humanos , Masculino , Metilprednisolona/administração & dosagem , Prednisona/administração & dosagem , Indução de Remissão , Esteroides/farmacologia , Tomografia Computadorizada por Raios XRESUMO
The aim of the paper was to compare the efficacy of two therapeutical protocols employed in children with steroidresistant nephrotic syndrome. Group 1 consisted of 10 children treated with methylprednisolone (Met P). In six of them morphologic studies revealed glomerulosclerosis, and in four--submicroscopic glomerulonephritis. Group 2 included 7 children treated with cyclosporin A (CsA). In six of them morphological studies showed glomerulosclerosis, and in one--mesangial glomerulonephritis. There were no significant differences between the groups with respect to age and biochemical parameters. In Group 1, improvement was achieved in six children (3 cases of glomerulosclerosis and 3 cases of submicroscopic glomerulonephritis), and partial improvement in two patients. Two cases of glomerulosclerosis yielded no improvement at all. In Group 2 improvement was seen in five children, partial improvement in one, and no improvement in another patient with mesangial glomerulonephritis. The efficacy of treatment employing Met P and CsA is comparable. No firm conclusions can be formulated due to a shorter time of CsA treatment. CsA seems to be justified in patients who showed no improvement following the MetP therapy.
Assuntos
Ciclosporina/uso terapêutico , Metilprednisolona/uso terapêutico , Síndrome Nefrótica/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Resistência a Medicamentos , Feminino , Humanos , Masculino , Resultado do TratamentoRESUMO
None of the clinical symptoms of the nephrotic syndrome including the age and sex of the sick child as the presence or absence of immunologic markers, and even kidney morphology results explains the fact why in similar situation the course of the nephrotic syndrome in some children is of poor prognosis whereas in others of a good one. The objective of the present study has been to prove that there are additional factors accounting for the course of the obtained remission. The author has had in mind mutagenic factors active during pregnancy in mothers of the children with the primary nephrotic syndrome. An attempt has been made to determine the relationship between the single or multiple occurrence of mutagenic factors and the remission type. The analysis included 250 children with the nephrotic syndrome treated in the years 1965-1985, their age being from 10 months up to 14 years. In the majority of the patients the diagnosis was made on the basis of the clinical picture and laboratory determinations. In 86 cases a renal biopsy was performed. Out of 250 children a complete remission was obtained in 125 cases (50%), and a partial one included 81 patients (32.4%). No remission was observed in 44 children (17.6%). Thirteen patients died (5.2%). The results of the studies have revealed that the presence of selected mutagenic factors e.g. the mother's age over 30 years, maternal diseases and "exposures" noted during pregnancy is closely related to the obtained remission type in the children with the nephrotic syndrome. In the group wherein single factors occurred 48.4% of mothers were over 30 years of age. In the group with two mutagenic factors a combination of maternal diseases and "exposures" was most frequent (52.7%). The mother's age, maternal diseases and "exposures" were the most common combination (73.9%) in the group with three mutagenic factors. The author has noted a positive correlation between the number of mutagenic factors occurring in mothers of the children with the nephrotic syndrome and the obtained degree of improvement. The theoretical likelihood of the lack of remission was increasing with the number of mutagenic factors. The above hypothesis has been confirmed by the relationship between the remission type and the frequency of mutagenic factors incidence in 86 children in whom a renal biopsy was performed. Regardless of the morphologic findings the likelihood of the lack of remission in the children with the nephrotic syndrome increases along with the number of simultaneously acting mutagenic factors.(ABSTRACT TRUNCATED AT 400 WORDS)
Assuntos
Síndrome Nefrótica/terapia , Complicações na Gravidez , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Idade Materna , Gravidez , Prognóstico , Indução de Remissão , Fatores de RiscoAssuntos
Síndrome Hemolítico-Urêmica/patologia , Adolescente , Humanos , Rim/patologia , Masculino , RecidivaRESUMO
The relative number of T/B lymphocytes and the response of peripheral blood mononuclear cells to PHA in the migration inhibition test was studied in a group of patients with idiopathic nephrotic syndrome. It has been found that the level of T lymphocytes and the response to PHA was decreased in patients in particular those with frequent relapses. The possible implications of these finding for pathogenesis of idiopathic nephrotic syndrome is briefly discussed.