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UNLABELLED: The aim of the study was to analyse effectiveness of long term alternate-day prednisone treatment according the protocol of Waldo (Pediatr. Nephrol. 1993, 7, 529) in children with IgA nephropathy (IgAN) and Schönlein-Henoch nephritis (HSN). Eight pts: 6 with IgAN, mean age 10.1 yrs and 2 with HSN aged 10.3 and 14.3 yrs were treated with use of alternate-day prednisone for 2.3 to 3.92 (mean 2.90 yrs). Renal biopsies were performed in all patients 2 to 72 (mean 16 mths) after onset and were graded according the classification of WHO. All pts had normal serum creatinine concentrations at presentation. 3 pts had proteinuria > 1 g/1.73 m2 per day at onset and 5 pts had macroscopic or microscopic haematuria and/or increased proteinuria and/or III grade WHO in renal biopsy. After treatment haematuria and proteinuria disappeared in 2 pts and decreased in 6 pts. Hypertension (2/8), hypercalciuria (2/8), mild weight gain (6/8) and low bone density in lumbar region (5/8) were observed during the treatment. CONCLUSIONS: 1. Long term alternate-day prednisone treatment according the protocol of Waldo allows to decrease haematuria and proteinuria in children with IgAN and HSN 2. Side effects of therapy were observed in 62.5% pts.

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The aim of the study was to evaluate the influence of prednisone therapy on selected parameters of bone metabolism [carboxyterminal propeptide of type I procollagen (PICP), carboxyterminal pyridinoline crosslinked telopeptide of type I collagen (ICTP), alkaline phosphatase (AP), parathormone (PTH), and calciuria (Cau) in children with nephrotic syndrome. Twenty patients (aged 4-15 years, mean: 9.2 years) were treated with prednisone. Blood and urine samples were taken: T0--before prednisone treatment; T1--after two weeks of treatment with prednisone 1-2 mg/kg/24 h; T2--after two weeks of treatment with prednisone 1-2 mg/kg/48 h; T3--after 3 months of treatment with prednisone; T6--in 6th month of treatment with prednisone, at dose 0.2-0.4 mg/kg/48 h. Mean values of PICP, ICTP, AP concentration, and PICP/ICTP ratio found in the T1 period were significantly lower, and mean Cau value was higher in comparison to means of these parameters observed before steroid treatment. After two weeks of prednisone administered every 48 hours mean values of PICP, ICTP concentrations and PICP/ICTP ratio were significantly higher than in the T1 period of treatment. There were no significant differences in mean concentrations of PTH before and during everyday doses of prednisone therapy. Mean value of PTH concentration decreased significantly during T2 in comparison with T1 period of prednisone treatment. Our data demonstrate that short-term treatment with high daily doses of prednisone in children with nephrotic syndrome is associated with increase of calciuria and suppression of serum markers of type I collagen's turnover. Changes of PICP, ICTP, and PICP/ICTP ratio depend on a method of steroid administration. Decreased PICP/ICTP ratio during daily steroid treatment may indicate stronger inhibition of bone formation than bone resorption, but significance of PICP/ICTP ratio in later phases of treatment needs further studies. Present study suggests that prednisone influences bone metabolism directly rather than by stimulating the parathyroids.

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The clinical course as well as the effects of the treatment in 27 children suffering from IgA nephropathy were followed in this study. The observation period lasted from 1.5 to 15.5 years, mean 9.1. The clinical picture according to changes in urine was the criterion of classification into 4 groups, and was related to the WHO classification of pathomorphological types. Hypertension as well as acute renal failure were observed in each clinical group except the group of children with erythrocyturia and/or haematuria. Depending on the pathomorphological changes in kidneys, different groups of drugs were used, e.g. anticoagulants, corticosteroids and also alkylating agents. In 9 children no treatment was prescribed. Only 6 children showed regression of urine changes: 2 of them with steroid-sensitive nephrotic syndrome and 1 with steroid-resistant nephrotic syndrome. In 12 children, erythrocyturia and proteinuria decreased and the intervals between successive seizures of haematuria became longer. In 3 of 8 children with nephrotic syndrome, chronic renal failure as well as end-stage renal disease were observed. In 2 of them hypertension was present during the entire observation period and it was difficult to achieve control using hypotensive drugs. In the remaining 2 children, regression of nephrotic syndrome was found, but slight proteinuria and hypertension are observed.

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Skin biopsy was performed in 17 of 27 children with IgA nephropathy (IgAN) and 45 of 62 children with Schönlein-Henoch purpura (SHP). Renal biopsy was done in all patients with IgAN and in 51 of 62 with SHP. There was no correlation between presentation of immunological deposits in skin and renal biopsy. Deposits of IgA with or without other deposits or other deposits without IgA were observed in different pathomorphological states. Correlation between IgA serum concentration and presentation of deposits in skin was not observed. Attention was drawn to the high proportion of negative results in skin biopsy.

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The effect of epidoxorubicin (epiDX) on contractility of left ventricle was followed up in patients treated according to protocols containing the drug. The examined group comprised 30 pts with Hodgkin's disease. 16 women and 14 men, aged 17-70 years, and 9 pts with high grade malignant lymphoma, 3 females and 6 males in the age of 21-64 years. Using Hewlett-Packard echocardiograph diastolic and systolic diameter of left ventricle in typical place was evaluated, 24 hrs before and after 40 mg of epiDX application as well as after completing therapy (total dose epiDX 80-480m mg). The percentages of fractional shortening of the left ventricle dimension (FS%) and ejection fraction (EF%) were calculated from the above parameters. There were no changes in measurements of cardiac function after the first dose of the drug. The fractional shortening of left ventricle dimension and EF in patients who have completed therapy were statistically significantly lower in comparison with those before therapy and control group. Heart failure was not observed. Decreased indices of heart muscle contractility and ejection fraction found in our patients may be connected with the epiDX therapy, though in dosis lower than 50% of the cumulative one, and may express the late toxicity of the drug.

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The role of cow's milk protein intolerance in steroid-resistant nephrotic syndrome was evaluated in 17 children. Cow's milk was excluded from the diet for at least 14 days without changing previously ineffective prednisone dosage. Six patients with minimal change or mesangial proliferation went into remission 3 to 8 days after elimination of cow's milk. After a period of 2-3 weeks of remission, cow's milk challenge was positive in three patients. After one year on a cow's milk-free diet, two of six patients became milk tolerant and are in remission of NS, one of six became steroid-dependent, two of six are still unable to tolerate cow's milk and are in remission on a cow's milk-free diet and one of six children was lost from observation. The role of cellular mechanisms in steroid-resistant nephrotic syndrome is suggested.

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The sensitivity to Cefobid was evaluated in vitro in 37 bacterial strains obtained from 37 patients. Good effectiveness of the drug against the strains was found in 78.3%, moderate in 13.5%, none in 8.2%. The clinical examinations were carried out in 16 children and again a high clinical effectiveness of Cefobid was found, with cure in 14 cases (87.5%). Cefobid was ineffective in 2 children with infection of Tenckhoff catheter, which required finally exchange of the catheter. No side effects of Cefobid were noted. Cefobid is a safe and effective antibiotic which may be given to small children and patients with renal failure. The broad spectrum and the possibility of drug use without dosage modification facilitate the treatment of patients with various grades of renal failure.

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24 patients (12 women and 12 men) aged 17 to 70 years with Hodgkin's disease in the clinical stages IIA-IVB were treated according to the polychemotherapeutic schemes containing epirubicin (epiDX). Using the 24-hour ambulatory ECC on the day before and the day of drug application as well as after completion of the therapy, heart rate, arrhythmias and conduction abnormalities were estimated. There was statistically insignificant decrease in heart rate (mean, minimal and maximal) on the day of epiDX administration and after therapy completion. Arrhythmias in form of supraventricular and ventricular extrasystoles including bigeminy and couplets of VES in one patient and two episodes of atrial tachycardia in another one on the day of drug injection were noticed. In 2 young women occurred interruption of sinus rhythm lasting longer than 3 sec., due to sinus arrest in one and due to 2:1 sinus exit block in the second one. The above mentioned disturbances were in majority of patients not associated with clinical symptoms. The authors conclude that the reduction in heart rate and SVES formation might be in the majority of patients neurogenic but in some of them as well as VES generation result from epiDX action.

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