[Value of bioelectrical impedance analysis in the assessment of body water in children with nephrotic syndrome: initial results]. / Zastosowanie bioimpedancji do oceny przestrzeni plynowych u dzieci z zespolem nerczycowym--wyniki wstepne.

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.

Long-term Cyclosporine A (Sandimmun) therapy for steroid resistant nephrotic syndrome in children.

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.

[A comparison of the efficacy of cyclosporine and methylprednisolone in treatment of steroid-resistant nephrotic syndrome in children]. / Porównanie skutecznosci cyklosporyny i metylprednisolonu w leczeniu sterydoopornego zespolu nerczycowego u dzieci.

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.