RESUMEN
UNLABELLED: Endothelial dysfunction was observed in patients with chronic renal failure (CRF). Endothelial cells produce a lot of factors among them endothelin and nitric oxide. The aim of this study was to evaluate the plasma/serum and urine levels of edothelin 1 (ET 1) and nitric oxide (NO) in children with CRF treated conservatively. 52 children (23 girls and 29 boys) aged 2-20 years (mean 13.19 years) were enrolled into the study. Patients were divided into 2 groups according to the creatinine level: group I--children with CRF and creatinine level below 265.2 micromol/l, group II CRF children with creatinine level above 265.2 micromol/l. We evaluated serum and urine metabolites of NO (nitrates + nitrites). IN CONCLUSION: in children with chronic renal failure elevated level of ET1 and enhanced excretion of ET1 were observed. Decreased plasma and urine NOx levels were found in CRF children. The disorders are connected with progression of renal failure.
Asunto(s)
Endotelina-1/sangre , Endotelina-1/orina , Fallo Renal Crónico/sangre , Fallo Renal Crónico/orina , Óxido Nítrico/sangre , Óxido Nítrico/orina , Adolescente , Adulto , Niño , Preescolar , Endotelio Vascular/metabolismo , Femenino , Humanos , Fallo Renal Crónico/terapia , Pruebas de Función Renal/clasificación , Masculino , Diálisis RenalRESUMEN
PURPOSE: Chronic renal failure (CRF) patients present with signs of immunodeficiency, such as increased incidence of infections. Cell adhesion molecules, determining leukocyte migration, may be responsible for the impaired immune response. The aim of the study was to measure soluble (s) vascular cell adhesion molecule-1 (VCAM-1), intercellular cell adhesion molecule-1 (ICAM-1), P-selectin and L-selectin levels in sera of CRF children and young adults. MATERIAL AND METHODS: The evaluation of adhesion molecule concentrations by ELISA was performed on 15 patients with serum creatinine levels below 265.2 micromol/l (gr. I), 15 patients with serum creatinine levels above 265.2 micromol/l (gr. II) and 15 controls. RESULTS: sVCAM-1, sICAM-1 and sP-selectin concentrations were elevated in both groups vs controls, whereas sL-selectin levels were decreased in all CRF patients. Mean sVCAM-1 and sICAM-1 values in gr. I and gr. II were comparable. sL-selectin and sP-selectin mean values in gr. II were lower than in gr. I. sICAM-1 correlated with haemoglobin and erythrocyte count in both groups and with haematocrit and serum urea--in gr. I. CONCLUSIONS: Enhanced (sVCAM-1, sICAM-1, sP-selectin) and diminished (sL-selectin) adhesion molecule concentrations in both groups show a state of immunologic imbalance, already present in early stages of CRF. Differences in sL-selectin concentrations between gr. I and II imply a progressive character of CRF-related leukocyte dysfunction. sICAM-1 correlation with anaemia markers may suggest the connection between this molecule and the CRF-related disorders.
Asunto(s)
Molécula 1 de Adhesión Intercelular/sangre , Fallo Renal Crónico/inmunología , Fallo Renal Crónico/terapia , Selectina L/sangre , Selectina-P/sangre , Molécula 1 de Adhesión Celular Vascular/sangre , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Preescolar , Creatinina/sangre , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Lactante , MasculinoRESUMEN
Bone status was assessed in 15 children and adolescents with predialysis chronic renal failure (CRF) and in 25 subjects with end-stage renal failure (ESRF). The mean age in the whole group was 14.6+/-3.2 years and CRF had been recognized 5.8+/-4.0 years earlier. The mean age, body size, duration of the disease and Tanner stages did not differ significantly between patients with predialysis CRF and ESRF. The control group consisted of 890 healthy subjects matched with patients for age. Bone mineral density (BMD) was measured by DPX-L (Lunar, Madison, WI) at the spine (s-BMD) and total body (TB-BMD); quantitative ultrasound (QUS) was performed by DBM 1200 (IGEA, Italy) at the hand phalanges (Ad-SoS). Laboratory investigations included the evaluation of intact parathyroid hormone (i-PTH), total and ionized serum calcium, and serum phosphate. In the whole group of patients the following mean values were obtained: Ad-SoS 1952+/-79 m/s (significantly lower than in controls, who had Ad-SoS 2022+/-85 m/s, p<0.05; the difference remained significant after adjusting for body mass index), s-BMD 0.87+/-0.22 g/cm2 ( Z-score -1.6), TB-BMD 0.92+/-0.12 g/cm2 ( Z-score -1.44), i-PTH 276+/-300 pg/ml, total calcium 2.46+/-0.19 mmol/l, ionized calcium 1.14+/-0.08 mmol/l, phosphate 1.68+/-0.61 mmol/l. Skeletal measurements correlated significantly with age, body size and Tanner stages (also after adjusting for age), while significant correlations of these parameters with the duration of CRF and laboratory investigations (except of correlations of i-PTH with Ad-SoS and with TB-BMD in predialysis patients) were not observed. None of the studied variables differed significantly between predialysis and dialysis patients. In conclusion, both predialysis and dialysis children and adolescents showed a decrease in BMD and quantitative ultrasound measurements. The severity of skeletal alterations was similar in the early phase (predialysis patients) and end stage (dialysis patients) of the disease and did not show a tendency to progress with CRF duration.
Asunto(s)
Densidad Ósea/fisiología , Fallo Renal Crónico/fisiopatología , Absorciometría de Fotón , Adolescente , Biomarcadores/sangre , Calcio/sangre , Estudios de Casos y Controles , Niño , Femenino , Humanos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/terapia , Masculino , Hormona Paratiroidea/sangre , Fosfatos/sangre , Diálisis Renal , Columna Vertebral/diagnóstico por imagen , UltrasonografíaRESUMEN
The skeletal status in 30 children, adolescents and young adults (18 females, 12 males) with end-stage renal failure (ESRF) aged 9-23 years (mean 15.8 +/- 3.6 years) was evaluated using measurements of bone mineral density (BMD, g/cm2) at the spine and total body (TB) (Lunar DPX-L, USA), quantitative ultrasound (QUS) of the hand phalanges (DBM Sonic 1200, IGEA, Italy) and laboratory investigations (parathyroid hormone, serum total and ionized calcium, serum phosphate). Eleven subjects were treated with hemodialysis and 19 with peritoneal dialysis. The mean value of the amplitude-dependent speed of sound (Ad-SoS, m/s) measured by QUS was significantly decreased in comparison with the value obtained in a group of 686 age-matched controls (1942 +/- 74 m/s vs 2050 +/- 77 m/s, p<0.0001). BMD measurements were also decreased in comparison with mean values for the healthy population (Z-scores for spine -1.47, and for TB -1.53). Duration of dialysis correlated significantly with spine-BMD, TB-BMD and Ad-SoS (r = -0.37, r = -0.45, r = -0.55, respectively, p<0.05), while duration of ESRF did not have such an influence. Laboratory investigations did not correlate with skeletal parameters. Ad-SoS correlated significantly with spine-BMD (r = 0.45, p<0.05) and TB-BMD (r = 0.56, p<0.01). Both QUS and BMD values correlated significantly with Tanner stages (r ranged from 0.59 to 0.69, p<0.001) and did not increase with age except for correlation between age and TB-BMD. In conclusion, skeletal status in the population studied is strongly affected by ESRF. Both QUS and BMD measurements show an ability to express skeletal changes in a similar manner, though the QUS parameter seems to be more sensitive at revealing changes due to renal failure.
Asunto(s)
Densidad Ósea/fisiología , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/fisiopatología , Fallo Renal Crónico/fisiopatología , Absorciometría de Fotón/métodos , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/diagnóstico , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/etiología , Femenino , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Masculino , Diálisis Peritoneal/métodos , Diálisis Renal/métodos , Estadísticas no ParamétricasRESUMEN
The aim of the study was to estimate the results of recombinant human growth hormone (rhGH) treatment in children with end-stage renal disease (ESRD). 60 growth retarded children with ESRD (mean age 11.2 +/- 7.2 years) were treated with rhGH at a dose of 1-1.1 IU/kg/week. The time of observation was 24 months. Thirty children completed first year, 18--second year of treatment. The mean growth velocity prior to the treatment was 3.03 +/- 1.9, during first year of the study--7.52 +/- 2.42, during second year 6.68 +/- 2.87 cm/year. The negative correlation between growth velocity and patient's age (r = -0.39; p < 0.05) suggest the better growth results in younger children during rhGH treatment. The rhGH therapy is effective method of treatment in growth retarded children with ESRD. Side effects are rare.
Asunto(s)
Trastornos del Crecimiento/complicaciones , Trastornos del Crecimiento/tratamiento farmacológico , Hormona de Crecimiento Humana/uso terapéutico , Fallo Renal Crónico/complicaciones , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Resultado del TratamientoRESUMEN
Wide spreading of prophylaxis principles of HBV infections in dialysis centers decreased the HBV infection rate in general population of dialyzed patients in Poland last years. There is neither data concerned with HBV infection epidemiology in children and adolescents, nor data about anti-viral treatment possibilities and effects in this group of dialyzed patients. The aim of the study was evaluating of HBV infection rate in patients of pediatric dialysis centers and analysis of causes of infection and efficacy of treatment. Study was based on data sent in a query-answer by 8 biggest pediatric dialysis centers, all of them treating 210 patients. HBV infection was found much more often (16.6%) than in population of all hemodialyzed patients in Poland. More than 75% non-vaccinated patients was infected before dialysis therapy, remaining were infected during vaccination, before the protecting level of antibodies was gained. Big differences in HBV infection rate among centers are observed. Nowadays HCV infections (more than 40% patients infected) are a bigger issue. Only 10 patients in 5 centers had anti-viral treatment (5 with isolated HBV infection, 5 with mixed HBV/HCV infection). In 9 patients interferon-alpha and in 1 patient lamivudine was administered. Efficacy of interferon-alpha treatment was similar to the population of non-uremic children (33.3% vs. 50% of HBeAg elimination). Majority of patients quite well tolerated the drug. Only in 1 case interferon-alpha treatment had to be ceased because of side effects. In a boy treated with lamivudine, after 3 months elimination of viremia and decrease of ALAT activity was observed. HBV infection in patients of pediatric dialysis centers is still a serious matter. More strict applying of vaccination against hepatitis B before dialysis treatment is needed. The possibility of HBV infections therapy is limited, mostly for economical reasons.
Asunto(s)
Hepatitis B/epidemiología , Hepatitis B/terapia , Fallo Renal Crónico/epidemiología , Adolescente , Adulto , Niño , Preescolar , Comorbilidad , Femenino , Vacunas contra Hepatitis B/administración & dosificación , Hepatitis C/epidemiología , Hepatitis C/terapia , Humanos , Incidencia , Interferón-alfa/uso terapéutico , Fallo Renal Crónico/terapia , Lamivudine/uso terapéutico , Masculino , Polonia/epidemiología , Diálisis RenalRESUMEN
In chronic renal failure patients a state of immunodeficiency paradoxically coexists with the activation of immune effector cells, including monocytes and lymphocytes. The activation of these cells leads to the release of cytokines. The aim of this study was to estimate the serum concentrations of IL-2, IL-6, TNF-alpha and their soluble receptors: IL-2 sRalpha, IL-6 sR, sTNF RI in children with chronic renal failure and young adults on maintenance hemodialysis (HD). The study included 16 HD patients (11 females, 5 males) aged 11-22 (mean 16.1 +/- 3.1) years and a control group of 15 age-matched healthy children. Only the mean concentration of IL-6 was similar in HD patients and the control group. The levels of the other cytokines were significantly higher in patients undergoing HD compared to the healthy subjects. No significant differences were observed between the pre- and post-dialysis values or between the values obtained using various dialyzer membranes. These data suggest that immune cells in HD children are in an activated state and that neither a single dialysis session nor the type of dialyzer membrane has an influence on the cytokines examined.
Asunto(s)
Interleucina-2/sangre , Interleucina-6/sangre , Fallo Renal Crónico/sangre , Receptores de Interleucina-2/sangre , Receptores de Interleucina-6/sangre , Receptores del Factor de Necrosis Tumoral/sangre , Diálisis Renal , Factor de Necrosis Tumoral alfa/metabolismo , Adolescente , Adulto , Celulosa/análogos & derivados , Niño , Femenino , Humanos , Masculino , Membranas Artificiales , Polímeros , SulfonasRESUMEN
In various pathological conditions elevated serum sialic acid level, as the result of increased metabolism of glycoproteins and glycolipids, is observed. The study aimed at the evaluation of sialic acid concentration in serum of children on continuous ambulatory peritoneal dialysis (CAPD) and maintenance haemodialysis (HD). Examination was performed in 27 end-stage renal disease (ESRD) children including 11 on CAPD, 16 on HD treatment. Ten healthy children served as the control group (K). In CAPD group assessment was carried out during the routine monthly check up, in HD group--before (HD-1) and after (HD-2) dialysis session. Sialic acid concentration was determined using method of Shamberger. In CAPD children we obtained significantly increased serum sialic acid concentration comparing to controls and HD children. Increased serum sialic acid concentration was also found in HD children comparing to controls. There was no significant difference between the sialic acid concentrations before and after dialysis session. Analysis of correlation revealed positive correlation of sialic acid concentration with haemoglobin concentration and hematocrit in CAPD group. In children on HD treatment we showed positive correlation of sialic acid level with renal replacement therapy duration and creatinine concentration after HD. Elevated serum sialic acid concentration in dialysed children could be the result of non-specific organism response, characterised by tissue and organ damage, towards the materials of extracorporeal circulation (HD) or the presence of dialysis solution in peritoneal cavity (CAPD).
Asunto(s)
Fallo Renal Crónico/sangre , Fallo Renal Crónico/terapia , Ácido N-Acetilneuramínico/sangre , Diálisis Peritoneal Ambulatoria Continua/métodos , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Diálisis Renal , Factores de TiempoRESUMEN
The HCV proliferation occurs in patients with chronic hepatitis type C on hemodialysis treatment after the kidney graft. The replication markers of HBV also occurs in patients after kidney graft. 35 children were examined. Among HBV infected children the replication phase was in 1 child (3%), nonreplication phase in 2 children (6%). 12 children had a signs of chronic hepatitis type C, 4 children (11.4%) of double active infection of HBV and HCV. The aim of this study was a preliminary evaluation of interferon alpha treatment (INF-alpha) of chronic hepatitis in dialysed children. Despite of high costs of treatment, it is necessary to begin an interferon alpha therapy before renal graft.
Asunto(s)
Hepatitis C Crónica/terapia , Interferón-alfa/uso terapéutico , Diálisis Renal , Adolescente , Niño , Preescolar , Femenino , Humanos , Interferón-alfa/economía , Trasplante de Riñón , Pruebas de Función Hepática , Masculino , Carga ViralRESUMEN
The cytokines play a main role as mediators in immunological response. IL-6 with IL-2 and INF-gamma take a part in stimulation and differentiation of cytotoxic lymphocytes T, in stimulation and production of antibodies by lymphocytes B, in stimulation of production of acute phase proteins by hepatocytes and in proliferation of mezenchymal cells. The aim of this study was a comparison of concentrations of IL-6 and sIL-6R in children with chronic renal failure on dialysis treatment (11 children), continuous ambulatory peritoneal dialysis (10 children) and conservative therapy (18 children). They concluded that the concentration of IL-6 in children on hemodialysis therapy comparing with children on conservative therapy was nearly significant.
Asunto(s)
Interleucina-6/sangre , Fallo Renal Crónico/inmunología , Fallo Renal Crónico/terapia , Receptores de Interleucina/sangre , Proteínas Recombinantes de Fusión/sangre , Adolescente , Niño , Diálisis , Femenino , Humanos , Fallo Renal Crónico/sangre , Masculino , Diálisis Peritoneal Ambulatoria Continua , Receptores de Interleucina-6RESUMEN
Developmental disturbances and encephalopathy have been observed in children with chronic renal failure (CRF). The aim of this study was to investigate the efficiency of the cerebral circulation in uremic children. The study group consisted of 10 children with CRF on conservative treatment, 8 children on continuous ambulatory peritoneal dialysis (CAPD), and 8 children on maintenance hemodialysis (HD). Examination was performed using a TC2-64B, EME Doppler flowmeter machine and capnograph Datex, Normocap. Blood flow velocity in both middle cerebral arteries (MCA), at rest and after spontaneous hyperventilation for 30 s, was analyzed. The vascular reactivity coefficient was calculated as the percentage ratio of decline of blood flow velocity in MCA to PCO2 decrease. Baseline mean blood flow velocities of MCA in euvolemic children under conservative treatment and on CAPD were significantly higher than those in children on HD and healthy control children. The highest value of the vascular reactivity coefficient was significantly higher in the group of children with CRF on conservative and CAPD treatment, than in children on HD and healthy controls. We suggest that hyperreactivity of the cerebral circulation could be the result of impaired autoregulation of blood flow. Evaluation of cerebrovascular reactivity in uremic children requires further examination.
Asunto(s)
Circulación Cerebrovascular , Fallo Renal Crónico/fisiopatología , Adolescente , Velocidad del Flujo Sanguíneo , Dióxido de Carbono/sangre , Arterias Cerebrales/diagnóstico por imagen , Arterias Cerebrales/fisiopatología , Niño , Femenino , Humanos , Hiperventilación/fisiopatología , Fallo Renal Crónico/diagnóstico por imagen , Fallo Renal Crónico/terapia , Masculino , Presión Parcial , Diálisis Peritoneal Ambulatoria Continua , Valores de Referencia , Diálisis Renal , UltrasonografíaRESUMEN
HGF--hepatocyte growth factor--belongs to the growth factors family, derivatives of plasminogen. HGF is a potent mitogen for hepatocytes, and has also renotropic properties. The study aimed at analysing HGF serum concentration in 20 children on continuous ambulatory peritoneal dialysis (CAPD) and haemodialysis (HD) treatment. 10 healthy children served as a control group (K). CAPD group has been examined during routine monthly control, whereas HD group before a haemodialysis session. In HD treated children the highest HGF concentration was obtained in comparison to children on CAPD and control group. There was no significant difference HGF levels between children on HD and healthy ones. We found no relationship between the dialysis treatment duration, mean arterial pressure values, serum total cholesterol, triglycerides, ionised calcium concentration, haemoglobin concentration, hematocrit and serum HGF concentration. In examined group of children with chronic renal failure the highest HGF values were noted in children on HD, not strictly observing the dietetic regime and proper daily fluid intake. Diminished HGF concentration in children on CAPD could be explained by the absence of stimulating action of heparin and by transperitoneal removal of substances false by elevating HGF. It is necessary to carry out studies in larger group of children with chronic renal failure on CAPD in order to estimate transperitoneal clearance of HGF and its metabolites.
Asunto(s)
Factor de Crecimiento de Hepatocito/sangre , Fallo Renal Crónico/sangre , Fallo Renal Crónico/terapia , Adolescente , Niño , Femenino , Humanos , Masculino , Diálisis Peritoneal Ambulatoria Continua/métodos , Diálisis Renal/métodosRESUMEN
Helicobacter pylori, a bacteria first described in 1984, since that time is linked with chronic gastritis and duodenitis. Dyspeptic symptoms and chronic gastritis are common in patients with chronic renal failure (CRF). The aim of the study was to evaluate of Helicobacter pylori-specific IgG and IgA prevalence in 73 CRF children and possible link of H. pylori infection and dyspeptic symptoms. Anti-H. pylori IgG antibodies were present in 20.5% CRF children (treated conservatively--21%; on CAPD--9%; chronically hemodialysed--29.6%), IgA antibodies was present only in 3 dialysed children (4.1%). Comparing to adult CRF patient, a lower rate of H. pylori infection was observed. No correlation between H. pylori seropositivity and a presence of dyspeptic symptoms was observed. Prevalence of H. pylori antibodies was higher in older CRF children and adolescents.
Asunto(s)
Anticuerpos Antibacterianos/inmunología , Especificidad de Anticuerpos/inmunología , Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/etiología , Helicobacter pylori/inmunología , Inmunoglobulina A/inmunología , Inmunoglobulina G/inmunología , Fallo Renal Crónico , Adolescente , Adulto , Niño , Preescolar , Femenino , Infecciones por Helicobacter/complicaciones , Helicobacter pylori/aislamiento & purificación , Humanos , Lactante , Fallo Renal Crónico/complicaciones , Masculino , PrevalenciaRESUMEN
Diabetic ketotic acidosis and hyperosmolar hyperglycemic syndrome are regarded as the most serious diabetes complications. Acute renal failure frequently develops simultaneously with the symptoms of multiorgan disfunction and might be a factor indicating the severity of the primary disease. Authors present a case of a 11-year-old boy with acute renal failure due to defective perfusion and disseminated intravascular coagulation as the complications of hyperosmolar hyperglycemic syndrome. This syndrome was the first feature of juvenile diabetes. Intensive treatment of fluid and electrolyte disorders, mechanic ventilation, renal replacement therapy, and close collaboration of trained nephrologist with intensive care unit specialists allowed to cure critical health states and improve the course of diabetes.
Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Hiperglucemia/etiología , Insuficiencia Multiorgánica/etiología , Niño , Cetoacidosis Diabética/complicaciones , Humanos , Fallo Renal Crónico/etiología , Masculino , Concentración Osmolar , SíndromeRESUMEN
HGF--hepatocyte growth factor--belongs to the growth factors family, derivatives of plasminogen. Authors in this study discuss HGF and its receptor structure, physicochemical properties, release of HGF and its action on cellular level, describe also methods of HGF detection. HGF is a potent mitogen for hepatocytes, plays an important role in liver regeneration after inflammation and partial hepatectomy. Elevated levels of serum HGF were detected in liver diseases with co-existing nephromegaly. HGF has also renotropic properties. A role of HGF in kidney development in physiology and pathology conditions, HGF action in acute renal failure, in chronic renal failure and after kidney transplantation was discussed. According to current literature, HGF importance in glomerulonephritis was described. Elevated concentration of this growth factor correlates with kidney destruction and could be connected with glomerulopathy exacerbation. HGF also plays a role in vascular endothelium defence and regeneration. The importance of HGF in arterial hypertension pathomechanism was underlined.
Asunto(s)
Factor de Crecimiento de Hepatocito/metabolismo , Enfermedades Renales/metabolismo , Endotelio Vascular/metabolismo , Humanos , Hipertensión/metabolismo , Trasplante de Riñón/fisiologíaRESUMEN
Transcranial Doppler ultrasonography is a useful method for the estimation and monitoring of cerebral circulation in dialyzed patients. The aim of this study was to evaluate the effect of disease and treatment on cerebral circulation in children on maintenance hemodialysis (HD) and children prior to renal replacement therapy. We demonstrated that in uremic children blood flow velocities of the internal carotid artery (ICA), anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) 120 min and 240 min from the beginning of an HD session were significantly lower than values immediately before HD. Changes in blood flow velocities of MCA and ACA during HD correlated significantly with changes in mean arterial pressure during HD. There was no correlation between changes in blood flow velocities and intradialytic changes in hematocrit values, ultrafiltration, hemoglobin concentration, and blood urea nitrogen values. Mean blood flow velocities of ICA, MCA, and PCA in euvolemic children on conservative treatment were significantly higher than after a HD session in children on maintenance HD. The factors responsible for intradialytic velocity changes of cerebral arteries in uremic children require further examination.
Asunto(s)
Arterias Cerebrales/diagnóstico por imagen , Uremia/diagnóstico por imagen , Adolescente , Presión Sanguínea , Circulación Cerebrovascular , Niño , Femenino , Humanos , Masculino , Diálisis Renal , Ultrasonografía Doppler Transcraneal , Uremia/fisiopatología , Uremia/terapiaRESUMEN
Echocardiography evaluation of heart systolic and diastolic function is applied in monitoring of cardiovascular changes in end-stage renal disease children on maintenance haemodialysis. The aim of the study was the comparison of cardiac cavities diameters and heart walls thickness changes, as well as, indices of left ventricle (LV) function in 12 end-stage renal disease children before and after haemodialysis session, before (initial examination) and after half-year duration of maintenance haemodialysis treatment (control examination). In 5 dialysed children the comparison of above-mentioned parameters was done after 3 years of maintenance haemodialysis duration. In both examinations significant increase of relative wall thickness (RWT) of LV without the features of asymmetric hypertrophy and decrease of left atrium transverse diameter after haemodialysis session was noted. There was no progression of LV hypertrophy during the six months and three years of treatment. After 3 years of maintenance haemodialysis duration significant decrease of LV mass index was revealed in examined children. There was no significant change of cardiac cavity diameters and indices of LV function during the time of observation.
Asunto(s)
Ecocardiografía/métodos , Cardiopatías/diagnóstico , Fallo Renal Crónico/terapia , Diálisis Renal/métodos , Adolescente , Índice de Masa Corporal , Niño , Preescolar , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Estudios ProspectivosRESUMEN
The aim of this study was to evaluate serum lipid abnormalities, particularly lipoprotein (a) [Lp(a)] in children with end-stage renal failure undergoing chronic dialysis and to estimate the influence of treatment method on these disturbances. Studies were performed on 21 children aged +/- 14.8 years (10 girls, 11 boys) on maintenance hemodialysis and 10 children, aged 13.2 years (8 girls, 2 boys) on CAPD. Control group consisted of 27 healthy age-matched subjects. All children were tested for concentration of serum Lp(a), total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C). It was found a significantly increase in Lp(a), TG, TC, LDL-C and significantly decrease in HDL-C in all dialysed children compared to controls. CAPD patients had markedly elevated serum Lp(a) and TG compared to hemodialysed children. These results suggest that CAPD treatment may contribute to the pathogenesis of lipid abnormalities and increased risk of developing coronary heart disease.
Asunto(s)
Fallo Renal Crónico/sangre , Fallo Renal Crónico/terapia , Lipoproteína(a)/sangre , Diálisis Peritoneal Ambulatoria Continua , Diálisis Renal , Adolescente , Niño , Colesterol/sangre , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Enfermedad Coronaria/etiología , Femenino , Humanos , Masculino , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Triglicéridos/sangreRESUMEN
The aim of this study was to evaluate serum lipid abnormalities, particularly lipoprotein (a), [Lp(a)] as an independent risk factor for cardiovascular disease in children with mild and moderate renal failure. Study were performed on 14 children of whom serum creatinine levels were above 265.3 mumol/l and 32 patients with serum creatinine levels below 265.3 mumol/l. Control group consisted of 27 healthy age-matched subjects. All children were tested for concentration of serum Lp(a), total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (C-LDL) and high density lipoprotein cholesterol (C-HDL). It was found a significantly increase in Lp(a), TC, C-LDL and significantly decrease in C-HDL in children with more advanced renal insufficiency compared to the control. In children with mild renal failure concentration of serum Lp(a) also increased but not significantly. Patients in this group had elevated serum TC and decreased C-HDL. These results suggest that even in the early stages of renal insufficiency in children abnormalities of lipoprotein are present. Such abnormalities, particularly Lp(a) might contribute to accelerated atherosclerosis in this patients.
Asunto(s)
Fallo Renal Crónico/sangre , Lipoproteína(a)/sangre , Adolescente , Arteriosclerosis/sangre , Arteriosclerosis/etiología , Niño , Colesterol/sangre , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Creatinina/sangre , Femenino , Humanos , Fallo Renal Crónico/complicaciones , Masculino , Factores de Riesgo , Triglicéridos/sangreRESUMEN
Haemodynamic changes in children examined by reocardiography impedance method were compared for 15 sessions performed with new capillary cuprophan dialysers and 15 sessions performed with reused ones (fourth use). Subsequent parameters of cardiovascular system performance were assessed: CI-cardiac index, SI-stroke index, ACI-acceleration index, SVRI-systemic vascular resistance index, EF-ejection fraction, TFC-thoracic fluid conductivity, MAP-mean arterial pressure. Significant differences in MAP, EF, TFC, ACI values between the sessions with the first and the fourth use of cuprophan dialysers were noted. Marked increase of cardiac output during the acetate haemodialysis was observed as the result of afterload declining by lowering systemic vascular resistance during the session with new and reused cuprophan dialysers. Contractility of myocardium and ejection fraction significantly increased during the session performed on new dialysers. Ejection fraction remained unchanged and myocardial contractility slightly improved during the fourth use of cuprophan dialysers.