Buchanec J

Incidence of renal complications in Schönlein—Henoch purpura syndrome in dependence of an early administration of steriods

Between 1976 and 1986, the authors treated 33 children with Schönlein-Henoch purpura (S-H purpura), with physiological urinary finding on admission. Twentythree of them received prednisone already at the beginning of hospitalization, 10 were not given any prednisone at all. In patients with prednisone, nephropathy occurred only once (4.3%), in those without prednisone it occurred 5 times (50%), the incidence being thus significantly higher. Prednisone was administered in doses ranging between 1.0 and 2.5 mg/kg body mass/day, on an average for 21 days (first 10 days in the same dose, later in reduced doses). Since there is a general lack of data on the positive effect of steroids upon the prevention of nephropathies in S-H purpura, the authors recommend more thorough studies in the initial stage of the disease (before the development of nephropathies).

Heart rate variability and cardiovascular tests in young patients with diabetes mellitus type 1.

The aim of this study was to obtain information about parameters of heart rate variability (HRV) in three frequency bands (high frequency - HF, low frequency - LF and very low frequency - VLF), the sensitivity of cardiovascular tests, and subjective feelings depending on autonomic nervous system balance in a group of young patients with diabetes mellitus type 1 (IDDM). Sixty-four subjects were examined: 32 patients with diabetes with a mean age of 16.1 +/- 0.7 years and a mean duration of IDDM of 6.3 +/- 0.8 years, and 32 healthy controls matched for age, sex and BMI. Shorter R-R intervals and abnormal values reflecting HRV were found in the diabetic group. In particular, parameters of total power, and HF and LF bands were reduced. The ratio VLF/HF power revealed predominance of sympathetic tone in the diabetic subjects. Although relative power VLF was increased in the supine position, the reactive rise of the VLF band activity in orthostasis was lower in the IDDM group. Using cardiovascular tests (deep breathing, Valsalva, orthostasis), significant differences in reactions were found only in the deep breathing test. Evaluation of sympathetic:parasympathetic:indifferent subjective feelings by questionnaire did not reveal any differences between the diabetic and healthy groups.

Heart Rate and its Variability in Juvenile Hypertonics During Respiratory Maneuvers

In 27 children (14 juvenile hypertonics and 13 healthy control children, with the mean age 14.7 +/- 0.4 y. or 15.2 +/- 0.5 y., respectively, P greater than 0.05) the changes of heart rate (HR), its variability (HRV) during deep inspiration and subsequent expiration, Valsalvas maneuver, doubled breathing frequency and the deepening of breathing were studied. The resting supine mean HR was significantly higher (P less than 0.001) in hypertonics than in controls. Deep inspiration was in both groups accompanied with the HR increase. However, the percentage increase in hypertonics was significantly lower than in normals (P less than 0.02). With subsequent expiration, the HR fell in both groups. There was no significant difference between the percentage decreases in both groups (P greater than 0.05). During the Valsalvas maneuver, in the first phase the tachycardic response occurred, which was in hypertonics significantly less pronounced. After the recovery of breathing a bradycardic reaction occurred which was equal in both groups (P greater than 0.05). Both, in juvenile hypertonics and in controls the doubled frequency of breathing increased the mean HR and decreased the HRV. During the deepened breathing there was an increase in mean HR in both groups, and only in the controls there was an increase in HRV. Heart rate variability in hypertonics was lower than in the controls under all the conditions.

X-ray changes in the kidneys of children wit orthostatic proteinuria

In 38 patients with orthostatic proteinuria (O. P.) and in 31 children of the control group (C) roentgenograms of excretory urography have bee compared, made in the standing erect and in the lying down posture. In childre with O. P. significantly more frequent and more expressive ptosis of the kidneys during orthostasis was found than in the controls. In children with O. P. disturbed urine outflow was found in 36.8%, while in children of the control group only in 3.2%.On the basis of the results obtained relations between haemodynamic changes in ptosis of the kidneys, disturbed urine outflow and the origin of O. P. are analysed.

Contribution to the etiopathogenesis of orthostatic proteinuria in children

The results of sequential scintigraphy of the kidneys of 22 children with orthostatic proteinuria and of 25 patients with nephritis or nephrotic syndrome, respectively, have been evaluated. At particular time intervals significant differences have been found between the two groups. On the basis of the visual method of evaluation of scintiscans and by bilateral comparison the authors conclude that in children with orthostatic proteinuria the frequency of asymmetry of the kidneys was significantly higher. These changes were most likely due to spasms or other disturbances of the function of excretory urinary passages in the calyx-pelvis system as responses to unfavourable emotional impulses (intravenous application of the substance, etc.) and to the sitting position during the examination.

Renal Doppler ultrasonography in infants with hydronephrosis

The objective was to evaluate the importance of obstruction in unilateral hydronephrosis by using renal Doppler ultrasonography. A total of 19 infants were examined. It was revealed that patients of group withobstruction have in the affected kidney a higher mean resistive index [RI= 0.77 ± 0.04] than in the healthy kidney [RI = 0.69 ± 0.02] [p < 0.001]. In patients of group with nonobstructive dilatation this difference was not observed. In infants it is not possible to evaluate only absolute changes of the resistive index. It is much more useful to compare values of RI of both kidneys using the above indices. The determination of RI, RIR and delta RI can be helpful in distinguishing obstructed from non-obstructed hydronephrosis.

Heart rate variability and physical fitness in children and adolescents with diabetes mellitus type 1

The primary aim of the study was to compare heart rate variability (HRV) in children and adolescents with diabetes mellitus type 1 (DM 1) regularly engaged in sports (trained T) and those not engaged in physical activities (non-trained NT). The study evaluated the effect of a short-term stay in a reconditioning summer camp on HRV, and assessed the importance of physical exercise in young diabetics. The patients included twenty diabetics with DM 1 (mean age 15.5 years range 827) with an average duration of DM 1 of 6.0 (0.5 15) years examined by system VariaPulse TF3 on the second and the last day (9 day) of their stay in camp. The mean value of glycosylated hemoglobin (HbA l c ) of the trained subgroup was significantly lower (8.8 ± 0.7 %) in comparison to the NT subgroup (11.6 ± 0.9%). Trained diabetics had significantly longer RR intervals (slower heart rate), higher values of MSSD, spectral total power and powers in three studied frequency bands (very low -VLF, low-LF, high-HF) of the HRV. In active orthostasis, trained subjects had higher reactive changes of spectral powers in the VLF and HF band. Trained subjects had a significantly lower occurence of abnormal values of individual measures of HRV (T = 14 ± 6%, NT = 54 ± 9 %). In the whole group (T+NT) at the end of the stay, as compared with starting values, there were significantly longer RR intervals and higher values of HRV parameters. The increase of the whole spectral power was mainly due to an increased power in HF parasympathetic band. The results indicate the importance of physical activity and sports in the maintenance and improvement of physiological regulation of cardiac activity in diabetic children and adolescents.

A comparison of the results of sequential scintigraphy and roentgenography in 50 children with urinary tract infection

The asymmetry of renal and urinary tract lesions in 50 children with urinary tract infection have been evaluated on the basis of scintiscans, taken by gammacamera and the results of X-ray examination, and also using a comparison of different number of impulses, taken from both right and left sides. A significant asymmetry increasing with the time has been found. The evaluation of scintiscans allowed results to be judged qualitatively and quantitatively. The parenchyma lesions and asymmetry in accordance with sides have been detected almost with the same frequency, using comparison of the sequential scintigraphy with excretory urography. The X-ray examination has presented the ureteric atony or dilatation more frequently. The gamma camera examination intercepted the asymmetry of particular parts of renal tissue substantially more frequently and has warned at urine stasis in the efferent urinary tract still before the morphological X-ray changes had been developed.

Contribution to the aetiopathogenesis of orthostatic proteinuria in children: Relation to the upper calyx syndrome

The authors discuss the correlations between the upper calyx syndrome and proteinuria. The syndrome was demonstrated in 33.6 per cent of all children with orthostatic proteinuria hospitalized at the Paediatric Clinic, Martin (Czechoslovakia) during 1978–1985. They consider the possible relations between these conditions that could be mediated by the activation of the renin/angiotensin II system. The direct stimulus of this system could rest in local ischaemization of parenchyma in the region of the proximal pole of the kidney or its partial passive congestion. They assume that these changes become more marked in the standing position and may cause proteinuria of orthostatic character. The inhibition of the renin/angiotensin II system may obviously lead to decreased proteinuria.

Some indication fields of radioisotope examination of the kidneys and ureteral urine passage in infants

This study presents a review of the knowledge the authors have gathered during 11 years of work with radioisotope examinations of the kidneys and ureteral urine passage performed in 34 children. As an important indication field they consider the conditions where excretory urography or separate functional examination, respectively, was impossible to perform or was otherwise contraindicated (anuria, uremia, coma, poor general condition, allergy to X-ray contrast substances, etc.). Scintigraphic examination is indicated even in cases where excretory urography fails to demonstrate filling of the kidneys and, on the basis of X-ray picture, it cannot be concluded whether it is a case of monolateral afunction, marked hypofunction or complete agenesis of the kidney. As the ost suitable methods they consider phase scintigraphy of the kidneys together with simultaneous examination of the functional curves from both kidneys, or separate functional examinations of particular parts of the kidneys and urinary passage by means of an analyser device for evaluation.