No 4 (2011)

Peculiarities of pathogenesis of renal disease in children, connected with the renal postnatal ontogenesis, are discussed

Problems of treatment of urinary tract infections in children and opportunities of Canephron N are discussed

Aim. Assessment of role of adipokines (leptin, adiponectin) in kidney damage in steroid-resistant nephrotic syndrome (SRNS) in children. Methods. 16 and 18 girls (mean age 12,69±4,21 years) with SRNS were included into the study. Longevity of the disease was 4,61±4,61 years in the study group, 4,04±3,04 years in the control group. Groups of patients did not differ significantly according to the main clinical and laboratory parameters. In all patients plasma concentrations of leptin and adiponectin were determined. Results. In active SRNS elevation of plasma adiponectin level was found in comparison with children, who had remission of nephrotic syndrome (median 22,1 mg/ml and 14,7 mg/ml, p=0,01). Positive correlation between adiponectinemia and total cholesterol (r =0,601 , p<0,05), low density lipoprotein cholesterol (r = 0,855, p<0,05) were found. Adiponectinemia negatively correlated with serum protein level (r=- 0,689 , p<0,05), serum albumin level (r=- 0, 642, p<0,05) and age (r =-0,666, p<0,05). Leptin/adiponectin ratio in children with SRNS was sighnificantly higher, than in SRNS remission (0,64 vs 0,35, p<0,05). Conclusion. In children with SRNS production of adipokines increases in active renal disease.

Aim. Assessment of clinical significance of serum and urinary levels of interleukin -8 (IL-8) and -18 (IL-18) in children with primary glomerulonephritis with nephrotic syndrome. Methods. 55 children age 2 -17 years (42 boys and 13 girls) with nephrotic syndrome (NS) were included into the study: 13 - with debut of glomerulonephritis with NS, 10 - with recurrent NS, 32 - with steroid-dependent NS. All patients were divided into 3 groups according to NS activity; 1st - maximal activity of NS, 2nd - minimal activity of NS, 3rd - with remission of NS for >4 months. 9 healthy children served as control group. Results. No correlation was found between serum levels of IL-8 and IL-18 and activity of NS. In highest activity of NS urinary concentration of IL-8 and IL-18 was significantly higher, than in other groups of children with NS and healthy controls. In patients with NS debut sensitivity to glucocorticosteroids was associated with decrease of urinary levels of IL-8 and IL-18 in 3-4 weeks. Conclusion. Urinary levels of IL-8 and IL-18 can detect activity of glomerulonephritis in children and can be used for prediction of response to glucocorticosteroids.

Цель исследования. Определение эффективности цинакальцета у детей с V стадией хронической болезни почек (ХБП). Материал и методы. Эффективность цинакальцета определялась по динамике изменений основных биохимических маркеров кальций-фосфорного обмена: паратгормон (ПТГ), кальций (Са), фосфор (Р), кальций-фосфорное произведение (СахР), щелочная фосфатаза (ЩФ) у 13 пациентов в возрасте 11,84 ± 5,83лет (от 10 месяцев до 16 лет, 7 мальчиков и 6 девочек). Длительность лечения составляла от 2 месяцев 11 дней до 1 года. Средняя доза цинакальцета составляла 0,77 ± 0,27мг/кг. Результаты. Медиана концентрации ПТГ достоверно снижалась уже к 1 месяцу от начала лечения (Z = 2,43, p = 0,015), далее тенденция к снижению сохранялась к 3 и 6 месяцам (Z = 2,1, p = 0,04, и Z = 2,0, p = 0,041 соответственно). Детальное изучение динамики концентрации ПТГ у каждого пациента показало, что доля пациентов со значимым уменьшением концентрации ПТГ спустя 1 месяц от начала лечения составляла 38 %, к 3 месяцам снижение наблюдалось уже у 75 % пациентов и у всех 5 (100 %) пациентов, продолжающих получать цинакальцет, достоверно снизился ПТГ к 6 месяцам. Сывороточная концентрация кальция и активность щелочной фосфатазы на фоне лечения цинакальцетом не изменялась. Сывороточная концентрация фосфора резко снижалась спустя 1 месяц от начала лечения (Z = 2,35, p = 0,02) у 53 % детей, в последующем вновь отмечалось ее повышение, но к 4 и 5 месяцам лечения у 85 % и 83 % больных отмечалось достоверное снижение сывороточной концентрации фосфора (Z = 2,03, p = 0,04 и Z = 2,2, p = 0,03 соответственно). Динамика уровня фосфора в крови имела свое отражение в СахР произведении, которое достоверно уменьшалось к 1 и 4 месяцам от начала лечения у 38 % и 57 % детей (Z = 2,3, p = 0,019 и Z = 2,2, p = 0,028 соответственно). Заключение. Цинакальцет позволяет добиться достоверного снижения сывороточного уровня паратиреоидного гормона у детей с хронической болезнью почек V стадии и неконтролируемым вторичным гиперпаратиреозом.

Aim. Analysis of clinical course and outcomes of obstructive uropathy in children and determination of multidisciplinary approach to prevention of chronic kidney disease in this patients. Methods. 265 children with obstructive uropathies (hydronephrosis, megaurether) in age 1 month - 17 years were analyzed during period years 1999 - 2010. In 145 children with megaurether outcomes of kidney disease were retrospectively assessed; prospectively 120 children with hydronephrosis or megaurether were followed prospectively. Results. In retrospective part of the study 36,8% children recovered completely, 14,5% developed terminal rebal failure, chronic kidney disease stage II - IV - in 46,9%. Decrease in estimated glomerular filtration rate detected in 30% of children during 3 years of follow-up. Conclusion. Children with obstructive uropathy require early diagnosing and follow-up by nephrologists and urologists.

Clinical evolution, prognosis and treatment options of primary hyperoxaluria with case report description are discussed.

Cardio-renal syndrome in anemia is discussed with special emphasis of iron sucrose therapy.