Evaluation of left ventricular function provides early evidence of target-organ damage in children with primary hypertension. We performed a systematic review and meta-analysis of left ventricular ...systolic and diastolic function in children and adolescents with primary hypertension.
Literature search was performed in PubMed database and out of 718 articles (published between 2000 and 2021) 22 studies providing comparison of left ventricular function parameters between children with primary hypertension and normotensive controls were selected.
Overall, 3460 children (5-21 years) with primary hypertension were analyzed. Meta-analysis showed that hypertensive patients when compared with normotensives, had an increased heart rate (mean difference MD 5.59; 95% confidence interval CI 3.28, 7.89; 10 studies) and increased fractional shortening (MD 1.04; 95% CI 0.48, 1.60; 9 studies) but did not differ in ejection fraction (MD -0.03; 95% CI -1.07, 1.02; 12 studies). Stroke volume was higher in one out of three studies, whereas no differences in cardiac output were found in two studies with available data. Hypertensive children had also lower E/A values (MD -0.21; -0.33, -0.09; 14 studies), greater values of E/e' (MD 0.59; 0.36, 0.82; 8 studies) and greater global longitudinal stress (MD 2.50; 2.03, 2.96; 4 studies) when compared to those with normotension.
Our results indicate that hypertensive children and adolescents present with signs of hyperkinetic function of the left ventricle, demonstrate evidence of increased left ventricular strain and impaired diastolic function compared to normotensive controls.
Background
For a definitive diagnosis of congenital solitary kidney, renal scintigraphy is suggested as being the gold standard of ruling out ectopic functioning renal tissue, possibly missed by ...ultrasound. The aim of our study was to test ultrasonography precision in comparison with renal scintigraphy on a larger cohort of congenital solitary kidneys.
Methods
We performed a retrospective unicenter study of children with congenital solitary kidney with no contralateral tissue, who were treated in the period from 1980 to 2017. The findings in children who underwent both abdominopelvic ultrasound and nuclear renal scintigraphy were compared and the accuracy of ultrasound was assessed.
Results
99 children met the inclusion criteria of congenital solitary kidney confirmed with abdominopelvic ultrasound and nuclear renal scintigraphy. The children were predominantly male (61.6%), and the congenital solitary kidney was largely right-sided (55.5%). In 97 cases (98%), ultrasound correctly predicted the absence of functional renal tissue on one side in the renal fossa or in an ectopic location (pelvis or ipsilateral side). The calculated accuracy of abdominopelvic ultrasound in diagnosing congenital solitary kidney was therefore 98%.
Conclusions
Our findings confirm that abdominopelvic ultrasound alone is accurate enough to diagnose congenital solitary kidney. It gives enough information for consideration if further radiological evaluation is still needed.
Arterijska hipertenzija se pri otrocih redkeje pojavlja kot pri odraslih, vendar pa je pomemben dejavnik tveganja za zgodnejši pojav srčno-žilnih bolezni v odrasli dobi. Namen prispevka je ...predstaviti zadnje ameriške in evropske smernice za obravnavo in zdravljenje arterijske hipertenzije pri otrocih in jih smiselno prenesti na slovenska tla.
Izhodišča: Čeprav so srčne kateterizacije v primerjavi s kardiokirurškimi posegi manj invazivne, imajo manj zapletov, bolniki pa po njih hitreje okrevajo, te niso brez zapletov. Z raziskavo smo ...želeli ugotoviti značilnosti populacije, najpogostejše patologije, vrste kateterizacij, zaplete pri kateterizacijah v našem centru ter opredeliti morebitne dejavnike tveganja.
Metode: Zbrali smo podatke o vseh pediatričnih srčnih kateterizacijah, opravljenih med junijem 2018 in avgustom 2021. Opredelili smo jih glede na vrsto kateterizacije (diagnostične in terapevtske), težo, starost, spol bolnikov in kompleksnost patologije. Zaplete smo ločili na lažje in težje ter z uporabo Pearsonovega testa hi-kvadrat in testa Mann-Whitney U ugotavljali njihovo povezanost s morebitnimi dejavniki tveganja.
Rezultati: V tem obdobju je bilo opravljenih 191 srčnih kateterizacij (54 diagnostičnih in 137 terapevtskih) pri 175 otrocih, od tega pri 95 dečkih in 80 deklicah. Otroci so bili stari od nekaj ur do 18 let, tehtali so od 2,6 kg do 85,5 kg. Zabeležili smo 9 zapletov, od tega 5 težjih in 4 lažje. Z našo raziskavo nismo dokazali statistično pomembne povezave med dejavniki tveganja (telesna teža, spol, vrsta kateterizacije, starost, kompleksnost patologije) in pojavom zapletov.
Zaključek: Največ kateterizacij je bilo opravljenih pri otrocih, starih med 1 letom in 10 let in tistih, ki so tehtali med 10 in 40 kg. Nekoliko več kateterizacij je bilo opravljenih pri dečkih. Najpogostejše so bile terapevtske kateterizacije. Pojavnost zapletov v našem centru je primerljiva z drugimi centri. Telesna teža, spol, starost otroka, vrsta kateterizacije in kompleksnost patologije v našem centru niso bili statistično značilno povezani s pojavom zapletov ob katerizaciji.
BackgroundAcute tubulointerstitial nephritis (TIN) is a significant cause of acute renal failure in paediatric and adult patients. There are no large paediatric series focusing on the aetiology, ...treatment and courses of acute TIN.Patients, design and settingWe collected retrospective clinical data from paediatric patients with acute biopsy-proven TIN by means of an online survey. Members of four professional societies were invited to participate.ResultsThirty-nine physicians from 18 countries responded. 171 patients with acute TIN were included (54% female, median age 12 years). The most frequent causes were tubulointerstitial nephritis and uveitis syndrome in 31% and drug-induced TIN in 30% (the majority of these caused by non-steroidal anti-inflammatory drugs). In 28% of patients, no initiating noxae were identified (idiopathic TIN). Median estimated glomerular filtration rate (eGFR) rose significantly from 31 at time of renal biopsy to 86 mL/min/1.73 m2 3–6 months later (p<0.001). After 3–6 months, eGFR normalised in 41% of patients (eGFR ≥90 mL/min/1.73 m2), with only 3% having severe or end-stage impairment of renal function (<30 mL/min/1.73 m2). 80% of patients received corticosteroid therapy. Median eGFR after 3–6 months did not differ between steroid-treated and steroid-untreated patients. Other immunosuppressants were used in 18% (n=31) of patients, 21 of whom received mycophenolate mofetil.ConclusionsDespite different aetiologies, acute paediatric TIN had a favourable outcome overall with 88% of patients showing no or mild impairment of eGFR after 3–6 months. Prospective randomised controlled trials are needed to evaluate the efficacy of glucocorticoid treatment in paediatric patients with acute TIN.
A central venous catheter (CVC) can either be inserted “de novo” or placed by guidewire exchange (GWE). From September 1998 to September 2015, 32 children (19 boys, 13 girls) were hemodialyzed in our ...unit by using a CVC. The mean age at CVC insertion was 12.6 ± 0.5 years. A total of 121 uncuffed catheters were placed, either “de novo” or by GWE in 64 (52.9%) and 57 (47.1%) cases, respectively. The most frequent cause for line revision was catheter dysfunction in 40/121 (33.1%) patients. The overall incidence of bacteremia was 1.5/1000 catheter‐days. The incidence in newly inserted and GWE catheters was 1.4 and 1.7/1000 catheter‐days, respectively. The difference did not reach statistical significance (P = 0.939). The infection rate correlated with patient age, and was higher in younger children (P = 0.006). GWE is an effective option of line revision, and did not influence the infection rate in our study.
Chronic Hemodialysis in Small Children Novljan, Gregor; Rus, Rina R; Premru, Vladimir ...
Therapeutic apheresis and dialysis,
06/2016, Letnik:
20, Številka:
3
Journal Article
Recenzirano
When peritoneal dialysis is inapplicable, chronic hemodialysis (HD) becomes the only available treatment option in small children. Due to small patient size, central venous catheters (CVC) are mainly ...used for vascular access. Over the past 4 years, four children weighing less than 15 kg received chronic HD in our unit. A total of 848 dialysis sessions were performed. Altogether, 21 catheters were inserted. In all but one occasion, uncuffed catheters were used. Catheter revision was performed 15 times during the study period, either due to infection or catheter malfunction. The median number of catheter revisions and the median line survival was 3.0/patient‐year and 53 days (range; 6–373 days), respectively. There were 14 episodes of catheter related infections requiring 11 CVC revisions (78.6%). The median rate of line infections was 2.8/patient‐year. Chronic HD in small children is demanding and labor intensive. Issues pertain mainly to CVCs and limit its long‐term use.
Focal segmental glomerulosclerosis is sometimes associated with a circulating permeability factor. It was proposed that this factor interacts with the sugars of the glycocalyx, and its high affinity ...for galactose was shown on the basis of chromatographic studies. Galactose inactivates it and seems to lead to its clearance from plasma. A toddler with a nephrotic syndrome resistant to corticosteroids was admitted. A renal biopsy revealed minimal change disease with deposition of immunoglobulin M. Immunosuppressive therapy with pulses of cyclophosphamide, low‐dose combination immunosuppressive therapy, and later with mycophenolate mofetil failed to induce remission. A renal biopsy six years later showed transformation to FSGS. After unsuccessful treatment with monthly pulses of cyclophosphamide, we began therapy with tacrolimus, which showed no effect. After two months, we added oral galactose to tacrolimus for one month, after which proteinuria decreased by 50%. Seven months later, galactose was again added for six months, after which proteinuria remained below 2 g/24 h and the plasma albumin and cholesterol concentrations normalized. An adolescent girl with a nephrotic syndrome resistant to corticosteroids was admitted. A renal biopsy revealed mesangioproliferative glomerulonephritis with C1q nephropathy. Therapy with tacrolimus failed to induce remission. After six months, we added galactose for three months, which reduced proteinuria to 0.76 g/24 h. After the discontinuation of galactose therapy, proteinuria increased to 2.48 g/24 h, despite further treatment with tacrolimus. It seems that oral galactose at a dose of 0.2 g/kg twice a day could be a promising new and nontoxic therapy for the treatment of resistant nephrotic syndrome.
There are only a few reports of the co-occurrence of acute poststreptococcal glomerulonephritis (APGN) and acute rheumatic fever. We report an unusual case of a 3-year-old boy with nephrotic syndrome ...and acute renal failure with the transitional need for peritoneal dialysis, biopsy-proven atypical IgA-dominant APGN, and concomitant acute rheumatic fever, successfully treated by steroids. Aggressive treatment with pulses of methylprednisolone proved to be successful and we recommend its use in this type of cases.
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