Agnieszka Jędzura

Evaluation of adipocytokines in children with chronic kidney disease

INTRODUCTION Adipose tissue through the many secreted adipocytokines creates a highly active metabolic and endocrine organ. The evaluation of serum adipocytokine concentration in children with chronic kidney disease (CKD) could serve as a marker of cardio-vascular complication progression and an index of outcome in adulthood and after kidney transplantation. MATERIAL AND METHODS The aim of the study was to evaluate simultaneously the serum concentrations of six different adipocytokines: adiponectin, apelin, chemerin, omentin, resistin, and vaspin, in 28 children with CKD stage 5 on haemodialysis and peritoneal dialysis. RESULTS The concentration of apelin, omentin, and resistin in children with CKD was significantly higher and the concentration of vaspin, adiponectin, and chemerin was significantly lower than in the control group. After adjusting to body mass index (BMI), the same results were obtained. After adjusting to body surface area (BSA), the concentration of vaspin, adiponectin, and chemerin did not differ between children with CKD and the control group. In analysis of the correlation between serum total adipocytokine levels in children with CKD we found a negative relationship in pairs: omentin-apelin and omentin-vaspin, and positive in pairs: adiponectin-chemerin and adiponectin-resistin. CONCLUSIONS Our results show that changes in serum adipocytokines concentration are associated with the kidney dysfunction in CKD in children. Longitudinal studies on larger groups of paediatric cohorts would be helpful in investigating whether adipocytokines play a harmful role in the development of CKD and would enable further understanding of the risk factors for CKD progression.

Non-dipping status and selected adipokines concentration in children with primary arterial hypertension

ABSTRACT High blood pressure (BP) in children and adolescents is associated with increased risk of persistent hypertension (HT) in adulthood and, consequently, cardiovascular disease and target organ damage. Aim: The values of selected anthropometric parameters and laboratory test results including leptin and apelin concentration were evaluated with regard to averaged values of office BP measurements and 24-hour ABPM. Material and methods: The study included 55 children: 23-with primary HT and coexisting overweight or obese (HT-OB), 16-with primary HT and normal weight (HT-NW), and 16 healthy children (C). Results: The concentration of leptin and apelin in HT-OB children was significantly higher than in the C and HT-NW group. A similar finding for leptin level was demonstrated in comparison of HT-NW with C group. In children with HT-OB, the lack of decline in nocturnal DBP was associated with significantly higher BMI and the Cole’s Index value. Children with HT-OB and lack of decline in nocturnal SBP showed lower leptin and insulin concentrations, and lower values of HOMA-IR as compared with dipping children. Positive correlation in the whole study group was found between adipokines levels and BP measurements. In conclusion, children with primary HT show higher concentration of adipokines compared with their healthy peers. The data on relationship of serum adipokines levels with anthropometric and BP parameters in children may be helpful to clarify the sequence of disturbances in the cardiovascular system in adults, which requires further examination.

Rare case of nephrocalcinosis in a 14-year-old girl: Questions

A 14-year-old Caucasian girl with a history of primary hypoparathyroidism and unstable calcium and phosphorus levels and on ongoing treatment was admitted to the Department of Pediatric Nephrology because of the onset of nephrocalcinosis and difficulties achieving normocalcemia. Coexistence of hypoparathyroidism, oral candidiasis, dental enamel hypoplasia, and subclinical Hashimoto’s disease was strongly suggestive for autoimmune polyglandular syndrome (APS) type I. One of the clinical implications of this diagnosis is the high probability of future occurrence of adrenal insufficiency and hence the importance of maintaining a high level of suspicion in case of the onset of symptoms like weakness, fainting, hypotonia, or hyperkaliemia. Addison’s disease would, in fact, be quite challenging for the future management of this patient.This clinical quiz highlighted the importance of careful evaluation of all multiorgan symptoms occurring in a patient to prevent further complications.

Rare case of nephrocalcinosis in a 14-year-old girl: Answers

Hypoparathyroidism in childhood is predominantly due to congenital parathyroid agenesis or hypoplasia, associatedwith numerous conditions, the most common one being the Di George syndrome (approximately 70 % of children with isolated hypoparathyroidism) [1]. Rare conditions may include specific renal disturbances, such as steroid-resistant nephrotic syndrome, kidney dysplasia, hypoplasia or aplasia in Barakat syndrome [2]. From a nephrologist perspective, it is also worth noting that hypomagnesemia (e.g. during chronic cyclosporine or diuretic treatment) inhibits parathyroid hormone secretion and can mimic hypoparathyroidism. In the presented case, however, the coexistence of hypoparathyroidism, oral candidiasis, dental enamel hypoplasia and subclinical Hashimotos disease is strongly suggestive of autoimmune polyglandular syndrome (APS) type 1. One of the clinical implications of this diagnosis is the high probability of future occurrence of adrenal insufficiency, emphasizing the importance of maintaining a high level of suspicion with the onset of symptoms such as weakness, fainting, hypotonia or hyperkalemia. Addison’s disease would in fact represent quite a challenge in terms of the future management of this patient.