Jacek A. Pietrzyk

Oxidative Stress Biomarkers and Left Ventricular Hypertrophy in Children with Chronic Kidney Disease

Cardiovascular diseases remain the most frequent cause of morbidity and mortality in patients with chronic kidney disease (CKD). The aim of the study was to assess the association between oxidative stress biomarkers and cardiovascular risk factors and left ventricular hypertrophy in children with CKD. Material and Methods. The studied group consisted of 65 patients aged 1.4–18.6 (mean 11.2) years with stages 1 to 5 CKD. Serum oxidized low-density lipoprotein (oxLDL), protein carbonyl group, creatinine, cystatin C, albumin, lipids, high-sensitivity C-reactive protein, intercellular adhesion molecule-1, insulin, plasma renin activity, and aldosterone levels were measured. Patients were divided into groups depending on CKD stage. Anthropometric measurements, ambulatory blood pressure (BP) measurements, and echocardiography with left ventricular mass (LVM) calculation were performed. Results. Serum oxLDL strongly correlated with creatinine (R = 0.246; p = 0.048), cystatin C (R = 0.346; p = 0.006), total cholesterol (R = 0.500; p < 0.001), triglycerides (R = 0.524; p < 0.001), low-density lipoprotein concentrations (R = 0.456; p < 0.001), and 24 hour BP values of systolic (R = 0.492; p = 0.002), diastolic (R = 0.515; p < 0.001), and mean arterial pressure (R = 0.537; p < 0.001). A significant correlation between oxLDL levels and LVM z-scores (R = 0.299; p = 0.016) was found. Conclusions. Hypertension and dyslipidemia correlated with lipid oxidation in children with CKD. oxLDLs seem to be valuable markers of oxidative stress in CKD patients, correlating with left ventricular hypertrophy.

Acute kidney injury in a single pediatric intensive care unit in Poland: a retrospective study.

Background/Aims: The recent improvements of management of patients in pediatric intensive care units (PICU) are associated with improved outcome. However, this decrease in mortality is associated with an increased number of children with acute kidney injury (AKI), especially in patients with multiorgan failure. Methods: The report presents a retrospective analysis of 25 cases of AKI (assessed based on the pRIFLE criteria) in PICU within 7 years. Results: AKI was diagnosed in 1.24% of all hospitalized children. AKI percentage duration (as compared to the total hospitalization time) in the children who died vs. the survivors was 79.55% vs. 46.19%, respectively (p<0.05). The mortality rate of AKI patients was 40% which was 4.4-times higher as compared to the total mortality rate in PICU. The final cumulative survival ratio (FCSR) of patients meeting the oliguria criterion (which was met in 48% of AKI patients) was 37% vs. 49% in non-oliguric children. Averaged urine output values in the first week of hospitalization in the deceased vs. survivors were 1.49 vs. 2.57 ml/kg/h, respectively (p<0.05). Conclusions: Oliguria should not be considered as a sensitive parameter for AKI diagnosing in children below one year of age. A decreased mean urine output in the first week of PICU hospitalization (less than 1.4 ml/kg/h) should be considered as a poor prognostic factor. In many cases AKI was diagnosed too infrequently and too late.

Looking for new diagnostic tools and biomarkers of hypertension in obese pediatric patients

Introduction Development of obesity in childhood may be linked to an increased risk of hypertension. Objectives This study aimed (a) to analyze the expression of genes associated with blood pressure (BP) in obese children, (b) to evaluate ambulatory blood pressure monitoring (ABPM) as a diagnostic tool in hypertension in children, and (c) to assess the prevalence of metabolic syndrome in children with obesity. Patients and methods Office BP measurements and ABPM were performed in 49 children with obesity and 25 age-matched healthy children. Expressions of 12 monogenic hypertension genes and 45 genes variants associated with BP were assessed using the microarray technique. Results No significant differences in gene expression levels were found. Children with obesity had significantly higher (P<0.001) mean office systolic and diastolic BPs compared with the controls. The diagnosis of high normal BP and hypertension with ABPM was established in 27 and 33% of children, respectively. Nocturnal BP decrease less than 10% was found in 27% of children, whereas nocturnal BP decrease more than 20% was found in 13% of children. Nocturnal BP increase was found in 13% of patients. The diagnosis of metabolic syndrome was established in 29% of obese patients. Conclusion The following can be concluded: (a) the prevalence of metabolic syndrome was found in nearly one-third of children with obesity. (b) ABPM is a useful and reliable tool in the diagnostics of pediatric hypertension. Abnormal BP can be observed in ∼50% of obese children. (c) The lack of significant differences in gene expression levels is consistent with the concept of ‘missing heritability’ in pediatric hypertension.

Can We Further Improve the Quality of Nephro-Urological Care in Children with Myelomeningocele?

Myelomeningocele (MMC) results from a failure of normal neural tube fusion in early fetal development. Retrospective, observational study of medical data of 54 children treated in Pediatric Nephrology and Urology Clinics for five years was performed. The following data were analyzed: serum creatinine, eGFR, urine analysis, renal scintigraphy (RS), renal ultrasound, and urodynamics. Mean age of studied population: 12.3 years, median of eGFR at the beginning and at the end of survey was 110.25 and 116.5 mL/min/1.73 m2 accordingly. Median of frequency of urinary tract infections (fUTI): 1.2 episodes/year. In 24 children: low-pressure, in 30 children: high-pressure bladder was noted. Vesicouretral reflux (VUR) was noted in 23 children (42.6%). fUTI were more common in high-grade VUR group. High-grade VURs were more common in group of patients with severe renal damage. At the end of the survey 11.1% children were qualified to higher stages of chronic kidney disease. Renal parenchyma damage progression in RS was noted in 22.2% children. Positive VUR history, febrile recurrent UTIs, bladder wall trabeculation, and older age of the patients constitute risk factors of abnormal renal scans. More than 2.0 febrile, symptomatic UTIs annually increase by 5.6-fold the risk of severe renal parenchyma damage after five years.

Should the Lopot-Plot Be Used in Daily Practice to Optimise Hemodialysis Treatment?

ABSTRACT The paper presents an application of the Lopot-plot, which compares the timeaveraged concentration (TAC) and the time-averaged deviation (TAD) of the weekly dialysis cycle, to comprise the results of intensive computational study. The presented case is based on 420 one-week-cycle simulations to verify the consequences implied by the change of the treatments schedule from nonuniformly to uniformly distributed over the week. The concept of steady state is explained and utilized to obtain periodical runs of the urea concentration. The presented graphs encouragingly indicate the potential of such plots in presenting results of multivariable intensive computations that should be advisably performed during the planning process of hemodialysis treatment.

Video processing for modelling of temperature changes in the initially cooled forearm of the hemodialyzed person

In the paper a problem of precise compensation of the original object motion in front of the infrared camera is discussed. The block matching techniques from stereovision and video coding have been adopted to this peculiar task after top-hat preprocessing of the sequence. The pixels are described with the original temperature values instead of colour parameters. The motion detection and compensation processes have been followed carefully with help of adequate images and graphs. It has been proved that proper video processing may compensate for lack of strong restrictions during thermogram sequence acquisition.