Chronic Kidney Disease In Children Research Articles

The association of alcohol, cigarette, e-cigarette, and marijuana use with disease severity in adolescents and young adults with pediatric chronic kidney disease.

We investigated the putative associations of alcohol, cigarette, e-cigarette, and marijuana use with kidney function and proteinuria among adolescents and young adults (AYA) with pediatric-onset chronic kidney disease (CKD) enrolled in the Chronic Kidney Disease in Children (CKiD) study. Participants responded to questions about past year and 30-day substance use. Associations between each substance and kidney function, proteinuria, nephrotic range proteinuria, and high blood pressure were separately estimated using repeated measures regression models, adjusting for sociodemographic characteristics. Models controlled for covariates at the present visit (contemporaneous) and additionally controlled for disease severity at the year prior to reporting substance use (lagged). A total of 441 participants ≥16 years contributed 1,245 person-visits with 39% reporting alcohol and 16%, 17%, and 15% reporting cigarette, e-cigarette, and marijuana use, respectively, over the previous year. In adjusted lagged models, past year and 30-day cigarette use were significantly associated with higher levels of proteinuria (+18.6%, 95%CI: +2.8%, +36.9%; and +20.0%, 95%CI: +0.7%, +43.1%, respectively). Inferences were similar when controlling for secondhand smoke exposure. In a cohort of AYA with pediatric kidney diseases, substance use was non-trivial, and cigarette use was associated with higher proteinuria, although the prevalenceof use was low. Occasional alcohol, e-cigarette, and marijuana use were not associated with proteinuria, disease progression, or elevated blood pressure. Pediatric nephrologists as specialty care providers are well-positioned to discuss substance use and should encourage tobacco prevention/treatment efforts among AYA at high risk for use in order to preserve kidney function and promote well-being.

Comparison of Efficacy of First Haemodialysis Session for Correction of Metabolic Disturbances in Acute Kidney Injury and Chronic Kidney Disease in Children


 
 
 
 Introduction: Acute kidney injury and chronic kidney disease present with various complications like electrolyte disturbances, metabolic acidosis and fluid overload in children. The objective of the study was to compare the efficacy of the first session of haemodialysis in children with acute kidney injury stage 3 and chronic kidney disease G5 treated by dialysis for immediate recovery of renal functions in terms of reduction in the level of azotemia, correction of fluid and electrolyte imbalances, metabolic acidosis, and improvement in clinical status.
 Methods: This was a cross-sectional comparative observational study conducted on 13 patients of acute kidney injury stage 3 and 46 patients with chronic kidney disease G5, who required haemodialysis. Their clinical assessment, fluid status, renal function tests, electrolyte, bicarbonate were done at admission and completion of the first session of heamodialysis.
 Results: The age group of children was six to 16 years (median 11.4 years). There were six males (46%) and seven females (54%) in the acute kidney injury group and 29 (63%) males and 17 (37%) females in chronic kidney disease G5 groups. Sepsis (31%) and glomerulonephritis (31%) were common etiologies detected for acute kidney injury while in chronic kidney disease G5, congenital anomalies of the kidney and the urinary tract were the commonest (50%). There were significant reductions in the levels of serum urea and creatinine and a rise in blood pH, bicarbonate level, and base excess following the first session of haemodialysis in comparison to pre-dialysis values in both AKI and CKD.
 Conclusions: The study demonstrated improvement in the clinical parameters and biochemical parameters equally after the first dialysis sessions in both groups. This is one of the effective renal replacement therapy and should be instituted wherever indicated to improve the immediate outcome of the patients.
 
 
 

NAFLD and renal function in children: is there a genetic link?

ABSTRACT Introduction: Over the past decades, a large amount of both adult and pediatric data has shown relationship between Nonalcoholic Fatty Liver Disease (NAFLD) and chronic kidney disease (CKD), resulting in an overall increased cardiometabolic burden. In view of the remarkable role of the genetic background in the NAFLD pathophysiology, a potential influence of the major NAFLD polymorphisms (e.g. the I148M variant of the Patatin-like phospholipase containing domain 3 (PNPLA3) gene, the E167K allele of the Transmembrane 6 superfamily member 2 (TM6SF2), the hydroxysteroid 17-beta dehydrogenase 13 (HSD17B13), and the Membrane bound O-acyltransferase domain containing 7-transmembrane channel-like 4 (MBOAT7-TMC4) genes) on renal function has been supposed. A shared metabolic and proinflammatory pathogenesis has been hypothesized, but the exact mechanism is still unknown. Areas covered: We provide a comprehensive review of the potential genetic link between NAFLD and CKD in children. Convincing both adult and pediatric evidence supports this association, but there is some dispute especially in childhood. Expert opinion: Evidence supporting a potential genetic link between NAFLD and CKD represents an intriguing aspect with a major clinical implication because of its putative role in improving strategy programs to counteract the higher cardiometabolic risk of these patients.

Biochemical predictors of chronic kidney disease in children recovering from acute kidney injury

The pressing question today is to find early informative markers for kidney interstitial injury in reconvalescents of acute kidney injury (AKI). The aim of the study was to determine the informativeness of transferrin (TF), ceruloplasmin (CP) presence and activity level of lysosomal enzymes in urine as predictors of chronic kidney disease. Materials and methods. The contents of TF, CP and N-acetyl-β-Dgluosaminindase (NAG) and β-galactosidase (ß-GAL) in the urine of 41 children after AKI were determined. All patients were divided into 2 groups depending on the disease duration – group 1 included 22 patients with 12 months’ duration, group 2 – 19 children with the disease duration of 2 years and more. The control group consisted of 28 conditionally healthy children. Results. The levels of NAG and ß-GAL were 8 and 3 times increased, respectively, in the patients from group 1 in comparison with the control group (P < 0.001). In the group 2 children, the enzyme levels were 4 times higher than the control, and albuminuria was observed at normal GFR (P < 0.001). An inverse correlation was established between GFR indices and activity levels of NAG (r = -0.473) and ß-GAL (r = -0.333), and a direct correlation between activity indices of GAG and ß-GAL (r = 0.845). The presence and high levels of TF in 18.8 % of children in group 1 and in 21.0 % in group 2, as well as urine CP in 72.7 % of patients in group 1 and in 78.9 % in group 2, is indicative of a progressive damage to the kidney glomerular apparatus. Conclusions. The presence and increased quantitative parameters of TF and CP in the urine of children after AKI are early signs of damage to the kidney glomerular apparatus. Four times increased levels of the enzyme activity and albuminuria at unchanged GFR indicate an interstitial kidney injury (P < 0.001). The examinations conducted are non-invasive, relatively low cost and easy to use for children of all ages.

Assessment of urinary podocalyxin as a marker of glomerular injury in obesity-related kidney disease in children and adolescents with obesity compared to urinary albumin creatinine ratio.

Obesity increases the risk of chronic kidney disease in children. Our aim was to assess urinary podocalyxin (PCX) in children and adolescents with obesity as a potential marker of obesity-related kidney disease (ORKD). The current case-control study included 128 children with obesity compared to 60 non-obese age and sex matched controls. Study population were subjected to full history taking as well as thorough physical examination. Urine samples for albumin creatinine ratio (uACR) and PCX were collected from the study population as well as blood samples for assessment of serum creatinine and fasting lipid profile. A statistically significant difference was found between cases and controls regarding urinary PCX (P < .001) and uACR (P=.021). A statistically significant positive correlation was found between uACR and weight SD score (SDS), body mass index SDS, waist circumference, estimated glomerular filtration rate, triglycerides (TG) as well as urinary PCX, whilst urinary PCX correlated significantly with obesity duration and uACR. Cases with microalbuminuria had a statistically significant higher waist circumference, waist-hip ratio, fat percentage, TG and urinary PCX compared to those with normal uACR (P=.042, .034, .05, .018 and .036 respectively). Urinary PCX showed 83.3% sensitivity and 74% specificity in detection of albuminuria. Urinary PCX was increased significantly in children with obesity making it a potential sensitive marker of ORKD in children.

Steroid Sensitive Nephrotic Syndrome: Revised Guidelines

JustificationSteroid sensitive nephrotic syndrome (SSNS) is one of the most common chronic kidney diseases in children. These guidelines update the existing Indian Society of Pediatric Nephrology recommendations on its management.ObjectiveTo frame revised guidelines on diagnosis, evaluation, management and supportive care of patients with the illness.ProcessThe guidelines combine evidence-based recommendations and expert opinion. Formulation of key questions was followed by review of literature and evaluation of evidence by experts in two face-to-face meetings.RecommendationsThe initial statements provide advice for evaluation at onset and follow up and indications for kidney biopsy. Subsequent statements provide recommendations for management of the first episode of illness and of disease relapses. Recommendations on the use of immunosuppressive strategies in patients with frequent relapses and steroid dependence are accompanied by suggestions for step-wise approach and plan of monitoring. Guidance is also provided regarding the management of common complications including edema, hypovolemia and serious infections. Advice on immunization and transition of care is given. The revised guideline is intended to improve the management and outcomes of patients with SSNS, and provide directions for future research.

Dietary Fibre Intake Is Associated with Serum Levels of Uraemic Toxins in Children with Chronic Kidney Disease.

Imbalanced colonic microbial metabolism plays a pivotal role in generating protein-bound uraemic toxins (PBUTs), which accumulate with deteriorating kidney function and contribute to the uraemic burden of children with chronic kidney disease (CKD). Dietary choices impact the gut microbiome and metabolism. The aim of this study was to investigate the relation between dietary fibre and gut-derived PBUTs in paediatric CKD. Sixty-one (44 male) CKD children (9 ± 5 years) were prospectively followed for two years. Dietary fibre intake was evaluated by either 24-h recalls (73%) or 3-day food records (27%) at the same time of blood sampling for assessment of total and free serum levels of different PBUTs using liquid chromatography. We used linear mixed models to assess associations between fibre intake and PBUT levels. We found an inverse association between increase in fibre consumption (g/day) and serum concentrations of free indoxyl sulfate (−3.1% (−5.9%; −0.3%) (p = 0.035)), free p-cresyl sulfate (−2.5% (−4.7%; −0.3%) (p = 0.034)), total indole acetic acid (IAA) (−1.6% (−3.0%; −0.3%) (p = 0.020)), free IAA (−6.6% (−9.3%; −3.7%) (p < 0.001)), total serum p-cresyl glucuronide (pCG) (−3.0% (−5.6%; −0.5%) (p = 0.021)) and free pCG levels (−3.3% (−5.8%; −0.8%) (p = 0.010)). The observed associations between dietary fibre intake and the investigated PBUTs highlight potential benefits of fibre intake for the paediatric CKD population. The present observational findings should inform and guide adaptations of dietary prescriptions in children with CKD.

Perspective on New Equations for Estimating Glomerular Filtration Rate.

The Kidney Disease Improving Global Outcomes 2012 Clinical Practice Guideline on Chronic Kidney Disease (1) recommends calculating estimated glomerular filtration rate (eGFR) using equations developed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) for adults ≥18 years (2) and by the Chronic Kidney Disease in Children (CKiD) for ages <18 years (3). These equations were recommended because they used readily available information, serum/plasma/blood creatinine, plus age, sex, and race for adults, and height for children; and have been validated in large and diverse cohorts of people who had measured glomerular filtration rate (mGFR) as a basis for establishing accuracy.

L-type calcium channel blocker use and proteinuria among children with chronic kidney diseases.

Hypertension is common among children with chronic kidney disease (CKD), and dihydropyridine calcium channel blockers (dhCCBs) are frequently used as treatment. The impact of dhCCBs on proteinuria in children with CKD is unclear. Data from 722 participants in the Chronic Kidney Disease in Children (CKiD) longitudinal cohort with a median age of 12 years were used to assess the association between dhCCBs and log transformed urine protein/creatinine levels as well as blood pressure control measured at annual visits. Angiotensin-converting enzyme inhibitor (ACEi) and angiotensin receptor blocker (ARB) use was evaluated as an effect measure modifier. Individuals using dhCCBs had 18.8% higher urine protein/creatinine levels compared to those with no history of dhCCB or ACEi and ARB use. Among individuals using ACEi and ARB therapy concomitantly, dhCCB use was not associated with an increase in proteinuria. Those using dhCCBs had higher systolic and diastolic blood pressures. Use of dhCCBs in children with CKD and hypertension is associated with higher levels of proteinuria and was not found to be associated with improved blood pressure control.

Health-related quality of life in children with chronic kidney disease is affected by the number of medications.

The number of medications could serve as a surrogate for burden of care at home and may affect health-related quality of life (HRQoL) in children with chronic kidney disease (CKD). Using baseline data from the Chronic Kidney Disease in Children (CKiD) Study, we modeled HRQoL scores, self-reported by the child (if ≥ 8years old) and/or caregiver (all children) on unique counts and administrations of CKD- and non-CKD-related medications, using multivariate linear regression. Heterogeneity of associations between HRQoL and medication burden by age group (≥ 8 vs. < 8years old) were explored. 734 participants median age 11years, disease duration 8years, median eGFR 53mL/min/1.73m2, 61% male, 22% African-American, 31% glomerular disease were prescribed median 3 unique CKD-related medications. Regarding HRQoL assessment, 201 children were < 8years old and had only parent-proxy HRQoL score; 533 children ≥ 8years of age had both child and parent-proxy scores. Overall, parents of children < 8years old reported higher HRQoL scores than parents of older children: 84 vs. 76. However, in a unified multivariate regression model, HRQoL scores of children < 8years showed greater decreases as the number of CKD-related medications increased compared to scores for children ≥ 8years old. Average HRQoL scores reported by parents of younger CKD children were higher than those of older CKD children but decreased more with increased CKD medication counts than scores of older children. Considerations of HRQoL may be of particular importance for clinicians and caregivers when managing chronic disease comorbidities in younger children.

Epidemiology of Chronic Kidney Disease in Children: A Report from Lithuania.

Background and Objectives: The data on the prevalence of chronic kidney disease (CKD) in the pediatric population are limited. The prevalence of CKD ranges from 56 to 74.7 cases per million of the age-related population (pmarp). The most common cause of CKD among children is congenital anomalies of the kidney and urinary tract (CAKUT). With progressing CKD, various complications occur, and end-stage renal disease (ESRD) can develop. The aim of the study was to determine the causes, stage, prevalence, and clinical signs of CKD and demand for RRT (renal replacement therapy) among Lithuanian children in 2017 and to compare the epidemiological data of CKD with the data of 1997 and 2006. Materials and Methods: The data of 172 Lithuanian children who had a diagnosis of CKD (stage 2–5) in 1997 (n = 41), in 2006 (n = 65), and in 2017 (n = 66) were retrospectively analyzed. Physical development and clinical signs of children who had CKD (stage 2–5) in 2017 were assessed. Results: The prevalence of CKD stages 2–5 was 48.0 pmarp in 1997; 88.7 in 2006; and 132.1 in 2017 (p < 0.01). Congenital and hereditary diseases of the kidney in 1997 accounted for 66% of all CKD causes; in 2006, for 70%; and in 2017, for 79%. In 2017, children with CKD stages 4 or 5 (except transplanted children) had hypertension (87.5%) and anemia (50%) (p < 0.01). Children under ≤2 years with CKD were at a 3-fold greater risk of having elevated blood pressure (OR = 3.375, 95% CI: 1.186–9.904). Conclusions: There was no change in the number of children with CKD in Lithuania; however, the prevalence of CKD increased due to reduced pediatric population. CAKUT remains the main cause of CKD at all time periods. Among children with CKD stages 4 or 5, there were more children with hypertension and anemia. In children who were diagnosed with CKD at an early age hypertension developed at a younger age.

Bone Disease in CKD in Children.

This manuscript discusses mineral and bone disorders of chronic kidney disease (MBD-CKD) in pediatric patients with special emphasis on the underlying pathophysiology, the causes and clinical profile of growth retardation, the alterations in the growth plate, the strategies to optimize growth and the medical recommendations for prevention and treatment.

Social Support and Loneliness Among Chinese Caregivers of Children With Chronic Kidney Disease During the COVID-19 Pandemic: A Propensity Score Matching Analysis.

To evaluate social support and loneliness as well as their association among caregivers of children with chronic kidney disease (CKD) from China during the coronavirus disease 2019 (COVID-19) pandemic. We collected data for caregivers of children with CKD and caregivers of healthy children and matched the two groups using propensity score matching (PSM). We compared the differences in social support and loneliness between the two groups after matching and analyzed the relationship between social support and loneliness in the observation group. Before PSM, we analyzed the data for 247 caregivers of children with CKD and 315 caregivers of healthy children from 13 provinces. After PSM, the two groups each included 202 caregivers. The social support score of caregivers of children with CKD was lower than that of caregivers of healthy children (P < 0.002), while the loneliness score was higher for caregivers of children with CKD than for caregivers of healthy children (P < 0.008). The social support score was negatively correlated with the loneliness score (r = −0.598, P < 0.001). Caregivers of children with CKD experienced less social support and greater loneliness than caregivers of healthy children during the COVID-19 pandemic. Therefore, greater attention should be paid to providing social support for caregivers of CKD children and to improving the ability of these caregivers to cope with loneliness.

Chronic kidney disease in children in Ukraine

The study aimed to summarize data of Chronic Kidney Disease (CKD) in children and adolescents in Ukraine.&#x0D; Methods. There were performed a qualitative study based on published documents and registers, and a cohort observational study included 3528 depersonalized patients with CKD diagnosed before the age of 18. That was used cross-sectional and longitudinal design for the structure, etiology, and outcomes analysis, period comparison (years 2014 and 2019), quantitative analyzes depending on patients age and nosology, risk measurements and survival function.&#x0D; Results. There was found the tendency to reduce the incidence of the genitourinary system diseases in childhood, and the predominance of these classes of diseases in adolescents. The main causes of CKD were congenital structural or histological abnormalities and glomerulonephritis. Prolonged kidney function preservation at the initial level was confirmed in many patients (CKD1 was maintained in 33.0% and CKD5 - in 56.6% causes after 5 years period) with the partial function improvement in CKD1-3. CKD1-4 probability at the 1st year of observation was 91.7±0.47%, at the 5th year - 84.2±0.82%. The structural CKD5 specialties in patients receiving Kidney Replacement Therapy have been established. There was a significantly higher risk of CKD5 during 5 years period after Acute Kidney Injury (OR 2.81-2.10), and a lower probability of CKD5 in patients with glomerulonephritis (OR 0.66-0.54) compared to other nosology. CKD pathomorphosis was found in the year 2019 compared to the year 2014: the kidney dysplasia as an etiological factor was increased (from 19.3% to 22.0%, р=0.040); the immediate outcome at the 1st year of observation was improved with the lower risk of declaring of Glomerular Filtration Rate (GFR) to CKD5 level (93.6% vs. 90.0%), but the late follow-up prognosis became worse (the cumulative probability of CKD1-4 at the 5th year of observation decreased from 85.5 to 73.9%, p=0.016); the structure of Kidney Replacement Therapy changed with the increasing part of transplanted patients (from 30.5% to 48.9%, p&lt;0.001), especially as a first choice (pre-dialysis); the tendency to decrease the proportion of polycystic kidney disease in CKD and to increase it in CKD5 was revealed with risk raising of GFR loss &lt;15 ml/min in the year 2019 compared to other nosology (OR 1.69, p=0.027).&#x0D; Conclusions. The established epidemiological and clinical realities are important for determining the kidney disease outcome in children and adolescents, assessing the medical management of these patients, sharpening the priorities of pediatric nephrology, and emphasizing the significance of further studies with appropriate regulations.

Social Determinants of Cardiovascular Health in African American Children With CKD: An Analysis of the Chronic Kidney Disease in Children (CKiD) Study

To identify differences in socioeconomic factors (SES) and subclinical cardiovascular disease (CVD) markers by race among Chronic Kidney Disease in Children (CKiD) participants and determine whether differences in CVD markers persist after adjusting for SES. Analysis of 3,103 visits with repeated measures from 628 children (497 White participants; 131 African American participants) enrolled in the CKiD study. Children with mild-moderate CKD with at least 1 cardiovascular (CV) parameter (ambulatory blood pressure, left ventricular mass index [LVMI], or lipid profile) measured. African American race. Ambulatory hypertension, LVMI, triglycerides, high-density lipoprotein cholesterol. Due to increased CV risks of glomerular disease, the analysis was stratified by CKD cause. Inverse probability weighting was used to adjust for SES (health insurance, household income, maternal education, food insecurity, abnormal birth history). Linear and logistic regression were used to evaluate association of race with CV markers. African American children were disproportionately affected by adverse SES. African Americans with nonglomerular CKD had more instances of ambulatory hypertension and higher LVMI but more favorable lipid profiles. After adjustment for SES, age, and sex, the magnitude of differences in these CV markers was attenuated but remained statistically significant. Only LVMI differed by race in the glomerular CKD group, despite adjustment for SES. Study design limits causal inference. African American children with CKD are disproportionately affected by socioeconomic disadvantages compared with White children. The degree to which CV markers differ by race is influenced by disease etiology. African Americans with nonglomerular CKD have increased LVMI, more ambulatory hypertension, and favorable lipid profile, but attenuation in magnitude after adjustment for SES was observed. African Americans with glomerular CKD had increased LVMI, which persisted after SES adjustment. As many social determinants of health were not captured, future research should examine effects of systemic racism on CV health in this population.

FOLLOW UP OF CHILDREN WITH KIDNEY INJURY IN NEONATAL AGE

Long-term follow-up of patients with acute kidney injury (AKI) has shown that glomerular filtration and tubular function are still normal. Renal blood flow remains permanently impaired, suggesting that there is still some irreversible loss of nephrons and that glomerular filtration is maintained by hypertrophy of the remaining nephrons. The aim of the study was to identify signs of&nbsp; chronic kidney diseases in children with kidney injury in neonatal age. The study was designed as a prospective investigation conducted in the period of two years, which included 50 neonates with kidney injury hospitalized in NICU, University Clinic for Pediatric Diseases in Skopje. Due to the potential risk of developing chronic renal failure by the end of the first year of life, in 26 children with kidney injury in neonatal age were evaluated growth and development, arterial tension, and renal function. The material was statistically analyzed using methods of descriptive statistics. Of the total of 50 neonates with documented AKI, we followed 26 neonates because of the risk of disease progression to chronic renal failure. According to the results from the percentage growth curves, 85% of children had a normal finding, while 15% were obese children, with weighing between 85 and 95 percentiles. 96% of children had arterial tension with reference values ​​according to age group, and only one child had prehypertension. We registered microproteinuria in 7.6% of children, and there were no hematuria findings. Most of the monitored children had proper renal function, which was probably due to the predominance of prerenal AKI, associated with a better prognosis. The follow-up period of one year was short and in order to obtain more reliable results, long-term controlled monitoring is required, which would last several years. Keywords:&nbsp; neonates, acute kidney injury, follow-up &nbsp;

Therapeutic plasma exchange as a promising therapeutic modality in the management of acute cytokine storms and secondary prevention of chronic kidney disease in children during pandemic

Persistent proteinuria in children is a silent killer as it potentially of being progressive severity of chronic kidney disease (CKD). Monoclonal antibodies are currently recommended for the treatment of this disease. In some developing and low socioeconomic countries, the aforementioned agents are nearly impossible to be given. Also, the COVID-19 disease has a huge impact in all countries in the world, including in nephrology and other immunocompromized patients in children. The problems caused by this disease are also exacerbated by the economic conditions of poor and developing countries. It is challenging for clinicians in poor and developing countries to take advantage of alternative modalities for the management of the disease. Therapeutic plasma exchange (TPE) is a very useful modality for the management of diseases that require clearance of proteins with a certain molecular weight. Diseases that require TPE in pediatric nephrology field is glomerular disease either related to autoimmune diseases or not. Evidence about the success of COVID-19 treatment with TPE has also been widely reported by researchers in various parts of the world. This article aims to analyze in detail the benefits of TPE in overcoming this pandemic, as well as knowing the very appropriate timing for plasmapheresis in this disease.

The Assessment of the Usefulness of Selected Markers in the Diagnosis of Chronic Kidney Disease in Children.

Introduction:The kidney deterioration, which starts in childhood often leads to end-stage renal failure in the future. Therefore, searching for an early, sensitive, and specific biomarkers became a paramount for chronic kidney disease diagnosis. The aim of this study was the assessment of markers: KIM-1, FGF-23, NAG, NGAL, and uromodulin for diagnosis of preclinical phase of the disease in children.Patients and methods:59 children (15 boys, 44 girls from 6 months to 17 years old) with kidney disorders, which had clinical indications for renoscintigraphy, were included in the study. All patients were divided depending on the result of renoscintigraphy (renal scarring vs normal kidney picture) and depending on the level of estimated glomerular filtration rate (glomerular hyperfiltration vs normal filtration rate). The concentration of uromoduline, KIM-1, FGF-23, NAG, and NGAL in serum and of NGAL and uromoduline in urine were measured in all studied groups.Results:The children with glomerular hyperfiltration had a statistically significantly higher serum values of FGF-23 and NGAL than the children with normal filtration rate (P < .05). There were no statistically significant differences in serum concentrations of tested markers in children with renal scars in comparison to children with normal renal image. There was no statistically significant difference in the concentration of tested markers in urine.Conclusions:The study confirmed the possible usefulness of FGF-23 and NGAL in detecting the preclinical-stage of renal disease associated with glomerular hyperfiltration in children. The study do not allow to indicate markers, which could be useful in the early diagnosis of kidney damage visible in the scintigraphic examination.

Steroid sensitive nephrotic syndrome: Revised guidelines

Justification: Steroid-sensitive nephrotic syndrome (SSNS) is one of the most common chronic kidney diseases in children. These guidelines update the existing Indian Society of Pediatric Nephrology recommendations on its management. Objective: To frame revised guidelines on diagnosis, evaluation, management, and supportive care of patients with the illness. Process: The guidelines combine evidence-based recommendations and expert opinion. Formulation of key questions was followed by review of literature and evaluation of evidence by experts in two face-to-face meetings. Recommendations: The initial statements provide advice for evaluation at onset and follow-up and indications for kidney biopsy. Subsequent statements provide recommendations for the management of the first episode of illness and of disease relapses. Recommendations on the use of immunosuppressive strategies in patients with frequent relapses and steroid dependence are accompanied by suggestions for step-wise approach and plan of monitoring. Guidance is also provided regarding the management of common complications including edema, hypovolemia, and serious infections. Advice on immunization and transition of care is given. The revised guideline is intended to improve the management and outcomes of patients with SSNS and provide directions for future research.

Interleukin-8 is increased in chronic kidney disease in children, but not related to cardiovascular disease.

Introduction:In this study, we aimed to detect the cytokine that is involved in the early stage of chronic kidney disease and associated with cardiovascular disease.Methods:We included 50 patients who were diagnosed with predialytic chronic kidney disease and 30 healthy pediatric patients in Ege University Medical Faculty Pediatric Clinic, İzmir/Turkey. Interleukin-8 (IL-8), interleukin-10 (IL-10), interleukin-13 (IL-13), and transforming grow factor-β1 (TGF-β1) levels (pg/mL) were measured by ELISA. Carotid-femoral pulse wave velocity (PWV), augmentation index (Aix), carotid intima media thickness (cIMT), and left ventricular mass index (LVMI) were evaluated as markers of cardiovascular disease. The presence of a cardiovascular disease marker was defined as an abnormality in any of the parameters (cIMT, PWV, Aix, and left ventricular mass index (SVKI)). The patient group was divided into two groups as with and without cardiovascular disease.Results: Mean Aix and PWV values were higher in CKD patients than controls (Aix: CKD 32.8±11.11%, healthy subjects: 6.74±6.58%, PWV CKD: 7.31±4.34m/s, healthy subjects: 3.42±3.01m/s, respectively; p=0.02, p=0.03). The serum IL-8 levels of CKD were significantly higher than of healthy subjects 568.48±487.35pg/mL, 33.67±47.47pg/mL, respectively (p<0.001). There was no statistically significant difference between IL-8, IL-10, IL-13, TGF-1, in CKD patients with and without cardiovascular disease (p> 0.05).Discussion:IL-8 is the sole cytokine that increases in pediatric patients with chronic kidney disease among other cytokines (IL-10, IL-13 and TGF-β1). However, we did not show that IL-8 is related to the presence of cardiovascular disease.