Introduction: IgA nephropathy (IgAN) is the most common glomerulonephritis worldwide. Decreased glomerular filtration rate is a known risk factor for disease progression. Aim: We aimed to examine ...factors that may contribute to disease progression in children that present with impaired eGFR at the onset of IgAN. Materials and methods: Of the 175 patients with IgAN from the Polish Registry of Children with IgAN and IgAVN, 54 (31%) patients with IgAN who had an onset of renal function impairment (GFR < 90 mL/min) were eligible for the study. All of them were analyzed for initial symptoms (GFR according to Schwartz formula, creatinine, proteinuria, IgA, C3), renal biopsy result with assessment by Oxford classification, treatment used (R—renoprotection, P—prednisone+R, Aza—azathioprine+P+R, Cyc—cyclophosphamide+P+R, CsA—cyclosporine+P+R, MMF—mycophenolate mofetil+P+R), and distant follow-up. Based on the GFR score obtained at the end, patients were divided into two groups: A—GFR > 90 mL/min and B—GFR < 90 mL/min. Results: In the study group, the mean age of onset was 12.87 ± 3.57 years, GFR was 66.1 ± 17.3 mL/min, and proteinuria was 18.1 (0–967) mg/kg/d. Renal biopsy was performed 0.2 (0–7) years after the onset of the disease, and MESTC score averaged 2.57 ± 1.6. Treatment was R only in 39% of children, P+R in 20%, Aza+P+R in 28%, Cyc+P+R in 9%, CsA+P+R in 7%, and MMF+P+R in 3%. The length of the observation period was 2.16 (0.05–11) years. At the follow-up, Group A had 30 patients (56%) and Group B had 24 patients (44%). There were no significant differences in any of the other biochemical parameters (except creatinine) or proteinuria values between the groups and the frequency of the MESTC score ≥ 2 and <2 was not significantly different between Groups A and B. Patients with normal GFR at the follow-up (Group A) were significantly more likely to have received prednisone and/or immunosuppressive treatment than those in Group B (p < 0.05) Conclusions: In a population of Polish children with IgAN and decreased renal function at the onset of the disease, 56% had normal GFR in remote observation. The use of immunosuppressive/corticosteroids treatment in children with IgAN and impaired glomerular filtration rate at the beginning of the disease may contribute to the normalization of GFR in the outcome, although this requires confirmation in a larger group of pediatric patients.
Background. It is estimated that 20–50% of adult patients start chronic dialysis therapy without prior contact with a nephrologist. The aim of this nationwide study was to assess clinical and ...metabolic status of children at the start of chronic dialysis in Poland with regard to the timing of the referral to a nephrologist. Methods. We studied data of 180 children (mean age 14±6 years) undergoing chronic dialysis in 13 (out of 14) dialysis pediatric centres in Poland. Patients were classified as early referrals (ERs) when they entered the dialysis programme at least 1 month after the first referral to a nephrologist or late referrals (LRs) when the dialysis was introduced within 1 month from the first visit. Results. Seventy-nine percent of pediatric patients were referred early (ER) to the dialysis centre and 21% were referred late (LR) and had to start dialysis within a month. When starting dialysis, LR patients had significantly higher levels of urea and phosphate as well as lower calcium and haemoglobin in comparison with ERs. Hypertension, pulmonary oedema, fluid overload, treatment in the intensive care unit (ICU) and body mass index (BMI) below 10th percentile turned out to be more frequent in the LR group. Peritoneal dialysis (PD) was used as the first method of dialysis in 59% of ERs and 46% of LRs. The majority of ER patients was treated in the predialysis period with calcitriol, phosphate binders and low protein diet (84%, 89%, 92% of all children, respectively), and 20% of them received epoetin. In the up to 3 years observation of our initial cohort, we also found that the patients who were referred late were less likely to receive kidney transplant (P = 0.02). Conclusion. The results of the study indicate that the LR to a pediatric nephrologist was associated with poorer clinical and metabolic status of children entering chronic dialysis programmes.
Cardiovascular complications (CVCs) in patients with end-stage renal disease (ESRD) often require hospitalization and are associated with an increased risk of fatality. Although kidney ...transplantation (KTx) improves a patient's status, CVCs are still a serious risk factor, so early identification is very important for final therapeutic outcome.
This study included 5 post-KTx patients (age, 20.8 ± 1.16 years), dialyzed before KTx, and followed up for 6.7 ± 1.71 years. Body surface potential mapping (BSPM) was performed 4 times: twice before and twice after KTx. Electrocardiographic data were processed into map plotting to illustrate differences in ventricular activation times (VATs).
A comparative analysis of difference maps, both of dialyzed patients and normal subjects, highlighted certain specificities in the distribution of VAT changes for the left anterior fascicle block (LAFB). The maps clearly showed a significant correlation between the intensity of changes and duration of dialysis before KTx. After KTx, VATs seemed to be similar to those in normal subjects; however, this was true only for patients dialyzed for <1 year. The patients dialyzed for >1 year showed persistent conduction abnormalities on their VAT maps.
Summary differences in VAT maps can enable diagnostics of initial activation propagation abnormalities in the heart. Short-term dialysis therapy before KTx imposes positive effects with regression of heart conduction changes. These observations need to be verified in a larger study population.
•There were differences in the distribution of ventricular activation time maps in hemodialysis patients.•The changes for the left anterior fascicle block of the His bundle.•There were significant correlation between the intensity of changes and the duration of dialysis before kidney transplant.
IgA nephropathy (IgAN) is the most common form of glomerulonephritis in pediatric population. The clinical presentation of the disease in children ranges from microscopic hematuria to end-stage ...kidney disease. The aim of the study was to retrospectively assess clinical and kidney biopsy features in children with IgAN. We assessed a cohort of 140 children, 88 boys, 52 girls with the diagnosis of IgAN in the period of 2000-2015, entered into the national Polish pediatric IgAN registry. The assessment included the following: proteinuria, hematuria, glomerular filtration rate (GFR), arterial blood pressure, and the renal pathological changes according to the Oxford classification and crescents formation, as modifiable and unmodifiable risk factors. The incidence of IgAN in Poland was set at 9.3 new cases per year. The mean age at onset of IgAN was 11.9 ± 4.3 years, and the most common presentation of the disease was the nephritic syndrome, recognized in 52 % of patients. Kidney biopsy was performed, on average, 1.3 ± 2.0 years after onset of disease. Based on the ROC analysis, a cut-off age at onset of disease for GFR <90 mL/min/1.73 m
(risk factor of progression) was calculated as 13.9 years. Unmodifiable lesions: segmental sclerosis, tubular atrophy/interstitial fibrosis (S1, T1-2) in the Oxford classification and crescents in kidney biopsy were significantly more common in Gr 1 (>13.9 years) compared with Gr 2 (<13.9 years), despite a significantly shorter time to kidney biopsy in the former. We conclude that IgAN in children may be an insidious disease. A regular urine analysis, especially after respiratory tract infections, seems the best way for an early detection of the disease.
The aim of the study was to determine whether an elevated IgA level at the time of the diagnosis of IgA nephropathy has an effect on the severity of kidney biopsy findings and long-term outcomes in ...children. We retrospectively studied 89 children with IgA nephropathy who were stratified into Group 1- elevated serum IgA and Group 2 - normal serum IgA at baseline. The level of IgA, proteinuria, hematuria, glomerular filtration rate (GFR) and hypertension (HTN) were compared at baseline and after the end of the follow-up period of 4.0 ± 3.1 years. Kidney biopsy findings were evaluated using the Oxford classification. The evaluation of treatment included immunosuppressive therapy and renoprotection with angiotensin converting-enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB), or no treatment. The elevated serum IgA was found in 46 (52 %) patients and normal serum IgA level was found in 43 (48 %) patients. No differences were found between the two groups regarding the mean age of patients, proteinuria, and the number of patients with reduced GFR or HTN at baseline. In kidney biopsy, mesangial proliferation and segmental sclerosis were significantly more common in Group 1 compared with Group 2 (p < 0.05). Immunosuppressive therapy was used in 67 % children in Group 1 and 75 % children in Group 2. The Kaplan-Meier survival curves for renal function (with normal GFR) and persistent proteinuria did not differ significantly depending on the serum IgA level at baseline. We conclude that in IgA nephropathy the elevated serum IgA at baseline may be associated with mesangial proliferation and segmental sclerosis contribute to glomerulosclerosis, but has no effect on the presence of proteinuria or on the worsening of kidney function during several years of disease course.
The purpose of this study is to offer an interpretation of the relationship between accidents and employee absenteeism in terms of quantitative (statistical data on accidents and absenteeism) and ...qualitative (study of employee attitudes) evaluation. It has been assumed that the description using the results obtained from one group only is incomplete, because the rate of accidents is affected by the attitude of the staff, and in describing the behaviour of employees, the indicators of quality play an important role. The growing popularity of studies on employee behaviour results from the growing importance of human resources in companies. A metallurgical enterprise was selected for the case study.
Abstract Background Cardiovascular complications are the main clinical problem in patients with end-stage renal failure (ESRF). After successful kidney transplantation, this situation improves, ...although cardiovascular complications remain a risk factor for increased mortality in these patients; therefore, their early identification is of key therapeutic and prognostic significance. This study was designed to determine a dynamics of changes in the heart conduction system in hemodialyzed young adult patients after kidney transplantation in a long-term follow-up, based on the body surface potential mapping (BSPM) method. Methods The study comprised 5 patients (mean age, 20.8 ± 1.16 years) after kidney transplantation (KT) who had been chronically dialyzed before. The mean observation period was 6.7 ± 1.71 years. All of the patients were submitted to the following examinations before and after KT: 12-lead electrocardiography (ECG), echocardiography, standard biochemistry, and BSPM (isochronous maps). The mean creatinine concentration was 1.38 ± 0.05 mg/dL. The control group comprised 30 healthy persons. Results BSPM maps taken from the dialyzed patients demonstrated disturbed spreading of electric impulses within the heart ventricles in a type of left bundle branch block, despite normal 12-lead ECG and echocardiography results. A relationship was demonstrated between the BSPM changes and dialysis duration. After KT, the abnormal distribution of isochrones and ventricular activation times (VAT) presented some significant and specific regression. Conclusions 1) In dialyzed patients, BSPM is a more sensitive method than ECG and enables early identification of changes in the heart conduction system presented as left bundle branch block. 2) Dialysotherapy duration before and after KT determines the extent of the BSPM changes. 3) Successful effects of KT bring about regression of intraventricular conduction disorders. 4) The observations need verification in a larger patient group.
The aim of the study was to investigate whether rs1800471 polymorphism in TGFB1 gene is associated with the development and progression of non-diabetic chronic kidney disease. Moreover, we examined ...the serum TGF-beta1 concentration and its association with that polymorphism and progression of the disease. We applied two different methodological approaches. Firstly, a family based study was carried out, comprised of 109 patients with non-diabetic chronic kidney disease and their 218 healthy parents, using the transmission/disequilibrium test. The rs1800471 polymorphism and serum TGF-beta1 level were determined in all subjects. Serum TGF-beta1 concentration was also measured in 40 healthy controls. Secondly, we performed a case-control orientated study to determine whether rs1800471 polymorphism and other factors influence the progression of renal impairment. We found no relationships between rs1800471 polymorphism allele transfer and the incidence or progression of non-diabetic chronic kidney disease. We found, however, that the serum TGF-beta1 was significantly higher in patients than in controls. In conclusion, rs1800471 polymorphism in TGFB1 gene does not have an impact on the development and progression of non-diabetic chronic kidney disease caused by primary glomerulopathy and chronic interstitial nephritis. The increased serum TGF-beta1 concentration in such patients suggests its role in the pathomechanism of the disease. Circulating TGF-beta1 level is determined in a multifactorial way, not by rs1800471 polymorphism in TGFB1 gene.
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