Carotid intima-media thickness in children with idiopathic nephrotic syndrome: A single center cross-sectional study
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AIM: Our aim was to assess common carotid artery intima-media thickness (cIMT) in children with idiopathic nephrotic syndrome (INS) and to find relation between cIMT and clinical and biochemical parameters in these patients. MATERIALS AND METHODS: In 50 children with INS we retrospectively evaluated: cIMT ((mm) and Z-score) and selected clinical and biochemical parameters. The control group consisted of 20 healthy children aged 9.46 ± 2.29 years. RESULTS: Children with INS had higher cIMT (0.45 ± 0.05 vs. 0.40 ± 0.05 (mm), p = 0.0002) and cIMT Z-score (1.72 ± 1.01 vs. 0.43 ± 1.01, p < 0.0001) than the control group. In the INS group, children with arterial hypertension had significantly higher cIMT (p = 0.0148) than normotensive children. In 50 children, with INS we found correlations between cIMT and disease duration (r = 0.40, p = 0.0040), number of INS relapses (r = 0.51, p< 0.0001), cumulative prednisone dose (r = 0.45, p = 0.0010), and BMI (r = 0.35, p = 0.0120); whereas, cIMT Z-score correlated only with the number of INS relapses (r = 0.41, p = 0.0160) and cumulative prednisone dose (r = 0.36, p = 0.0362). We found no relation between cIMT and response to corticosteroids, treatment used, and biochemical parameters. CONCLUSION: 1. Idiopathic nephrotic syndrome predisposes to atherosclerotic lesions in affected children. 2. The severity of atherosclerotic lesions is dependent mainly on the number of INS relapses, but disease vintage, cumulative steroid dose, body mass index, and presence of arterial hypertension may also be predisposing factors.
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[Pulmonary embolism in a girl with nephrotic syndrome and factor V Leiden - case report]. / Zatorowosc plucna u dziewczynki z zespolem nerczycowym i czynnikiem V Leiden ­ opis przypadku.

Thromboembolic complications are found in 2-3% of children with nephrotic syndrome (NS); this increased risk is caused by hypovolemia, hemoconcentration, increased number and activity of platelets, hyperfibrinogenemia and loss of coagulation inhibitors. Risk is even higher in case of additional factors e.g. congenital thrombophilia. CASE REPORT: Girl with NS aged 17 11/12 years was admitted to hospital due to respiratory tract infection with cough and back pain. NS started 9 months earlier and she had two bouts of disease, and was treated only with prednisone (current dose - 60 mg/48h). On admission she was without any abnormalities on auscultation, with BP 111/65 mmHg, HR 80 bpm, satO2 99%. Lab results showed the increase of WBC 18.3×103/µL, D-dimers 23038 µg/L and proteinuria 900 mg/dL. Other values of examined parameters were in normal limits. Chest X-ray and ECG were also normal. Presumptive diagnosis of pulmonary embolism was made and the patient was given 1000IU of antithrombin III and nadroparine (2x90IU/kg/24h s.c.). In ECHO the occlusion of left pulmonary artery and preserved blood flow in right were revealed. In angioCT clot nearly filling lumen of left pulmonary artery, clot in intermediate part of right pulmonary artery, and focus of pulmonary infarction in 10th segment of left lung were found. Doppler USG of lower limb veins did not reveal thrombi or perforator vein incompetence. Treatment with nadroparine was continued, and rapid improvement of clinical condition and disappearance of pain and cough were observed. Mycophenolate mofetil was added, which resulted in subsidence of proteinuria. Rivaroxaban was used in prophylaxis of recurrences of thromboembolism. Tests for thrombophilia revealed factor V Leiden in patient.

Fluoroscopic-Guided vs. Multislice Computed Tomography (CT) Biopsy Mode-Guided Percutaneous Radiologic Gastrostomy (PRG)-Comparison of Interventional Parameters and Billing.

BACKGROUND: This study investigated and compared the efficacy, safety, radiation exposure, and financial compensation of two modalities for percutaneous radiologic gastrostomy (PRG): multislice computed tomography biopsy mode (MS-CT BM)-guided and fluoroscopy-guided (FPRG). The aim was to provide insights into optimizing radiologically assisted gastrostomy procedures. METHODS: We conducted a retrospective analysis of PRG procedures performed at a single center from January 2018 to January 2024. The procedures were divided into two groups based on the imaging modality used. We compared patient demographics, intervention parameters, complication rates, and procedural times. Financial compensation was evaluated based on the tariff structure for outpatient medical services in Switzerland (TARMED). Statistical differences were determined using Fisher's exact test and the Mann-Whitney U test. RESULTS: The study cohort included 133 patients: 55 with MS-CT BM-PRG and 78 with FPRG. The cohort comprised 35 women and 98 men, with a mean age of 64.59 years (±11.91). Significant differences were observed between the modalities in effective dose (MS-CT BM-PRG: 10.95 mSv ± 11.43 vs. FPRG: 0.169 mSv ± 0.21, p < 0.001) and procedural times (MS-CT BM-PRG: 41.15 min ± 16.14 vs. FPRG: 28.71 min ± 16.03, p < 0.001). Major complications were significantly more frequent with FPRG (10% vs. 0% in MS-CT BM-PRG, p = 0.039, φ = 0.214). A higher single-digit number of MS-CT BM-guided PRG was required initially to reduce procedure duration by 10 min. Financial comparison revealed that only 4% of MS-CT BM-guided PRGs achieved reimbursement equivalent to the most frequent comparable examination, according to TARMED. CONCLUSIONS: Based on our experience from a retrospective, single-center study, the execution of a PRG using MS-CT BM, as opposed to FPRG, is currently justified in challenging cases despite a lower incidence of major complications. However, further well-designed prospective multicenter studies are needed to determine the efficacy, safety, and cost-effectiveness of these two modalities.