Vaikų steroidams jautraus nefrozinio sindromo gydymo prednizolonu ir prednizolonu kartu su fusido rūgštimi lyginamasis tyrimas

Background. There are several reports in the literature indicating that fusidic acid owns functions similar to those of cyclosporin. As cyclosporin has effectively been used in frequently relpsing steroid-responsive nephrotic syndrome we carried out this study to determine whether fusidic acid used along with prednisolone diminishes rate of steroid-responsive nephrotic syndrome relapses in children. Patients and methods. The patients were randomly allocated to receive either prednisolone alone or prednisolone plus fusidic acid for two months in standard doses..

The impact of IgM deposits on the outcome of Nephrotic syndrome in children

Background: The significance of IgM deposits in glomerular mesangium has been controversial since they were first described due to the variations in the both the definitions used and described impact on clinical outcome. The aim of our study was to evaluate the significance of the IgM deposits in the glomerular mesangium for outcomes of nephrotic syndrome (NS) in children. Methods: Forty-five children with NS who underwent renal biopsy at tertiary pediatric hospital from January 1st, 2000 to December 31st, 2015 and the pathology diagnosis of minimal change disease, focal segmental glomerulosclerosis and mesangial hypercellularity (MH) were retrospectively analyzed. IgM positivity was defined as >= 1+ imunofluorescence with predominantly mesangial distribution. The patients were stratified into IgM-positive (n = 18) and IgM-negative (n = 27). Results: At the end of the median follow-up 4.5 years (range 0.17-13.14), the IgM-positive group was represented by 11 patients (61.1%) in remission, 3 patients (16.7%) with active disease and normal kidney function, 2 (11.1%) patients with active disease and impaired kidney function, 2 (11.1%) patients on renal replacement therapy. Accordingly, the IgM-negative group included 13 patients (48.1%) in remission, 12 (44.4%) with active disease and normal kidney function, 1 (3.7%) with active disease and impaired kidney function, 1 (3.7%) on renal replacement therapy, with no statistical significance between groups (p = 0.186). Conclusions: This study did not reveal significant differences of the disease outcomes between IgM-positive and IgM-negative groups

Factors determining parents' decisions to bring their children to the pediatric emergency department for a minor illness

Background: The number of children visiting Emergency Departments (EDs) is increasing in Lithuania; therefore, the aim of this study was to determine the factors influencing the parental decision to bring their child to the ED for a minor illness that could be managed in a primary healthcare setting, and to compare parents' and medical professionals' attitudes toward a child's health status and need for urgent care. Material/Methods: A prospective observational study was performed at the tertiary-level teaching Children's Hospital in Vilnius. A total of 381 patients' parents were interviewed using an original questionnaire based on Andersen's behavioral model of healthcare utilization; in addition, the medical records of patients were reviewed to identify factors that might have an impact on parental decisions to bring their child to the ED for a minor health problem. The study participants were enrolled from October 1, 2013 to August 31, 2014. The urgency of medical care needed to be provided to the patients was evaluated by a tertiary-level triage system. Results: Based on the assessment of the triage nurses, the need for emergency care to patients was distributed as follows: 298 patients (78.2%) needed non-urgent care and 83 patients (21.8%) needed urgent care. More than one-third (38.8%) of the parents reported that they came to the ED due to their child's urgent care need and worsened child's health; however, the opinion of ED professionals indicated only a fifth of patients required urgent care. Parents who brought their children to the ED without physician referral were five times more likely to visit the ED during evening hours and on weekends (OR= 5.416; 95% CI, 3.259-8.99; p<0.001). The decision to come to the ED without visiting a primary care physician was made more often by parents with a higher income (OR= 2.153; 95% CI, 1.167-3.97) and those who came due to children having rash (OR= 4.303; 95% CI, 1.089-16.995) or fever (OR= 3.463; 95% CI, 1.01-11.876). Older parents were 2.07 (95% CI, 1.1224-3.506) times more likely to evaluate their child's health unfavorably than younger parents. Conclusions: We identified predisposing, enabling, and need factors that influenced the parents' decision to bring their child to the ED for minor health problems that could be managed by a primary care physician. Parents assessed their child's condition more critically and thought that their child required urgent medical aid more frequently than healthcare professionals

Ypač mažo gimimo svorio neišnešioto naujagimio su inkstų akmenlige ūmus inkstų pažeidimas: atvejo pristatymas

Acute kidney injury is associated with mortality of very low birth weight infants and reduces their survival regardless of other factors. The kidneys in the extremely preterm infants are very immature and susceptible to environmental factors. Clinical conditions and medications are risk factors for acute kidney injury in these patients. Nephrolithiasis in preterm infants is an extremely rare phenomenon that usually manifests as a complication of nephrocalcinosis. This is a case report that describes several episodes of acute kidney injury in the first two months of age in an extremely low birth weight infant with kidney stones in the background. The main causes that led to acute kidney injury in this patient were persistent ductus arteriosus, sepsis and captopril. At one month of age, ultrasound detected calcinates in the right kidney. Within two weeks a large number of linear stones formed across the collecting duct system. Small calcinates still remained in the right kidney when the girl was half a year of the corrected age. The evaluation of a neonate who develops acute kidney injury requires a systematic approach. Early identification of the emerging risk factors and prevention of nephrolithiasis along with effective treatment can reduce the risk of developing acute kidney injury in very low birth weight infants

Renal replacement therapy in children in Lithuania: challenges, trends, and outcomes

Background and Objectives: Pediatric renal replacement therapy (RRT) in Lithuania resumed in 1994 after a 12-year pause in renal transplantation. Management of end stage renal disease (ESRD) has changed, and outcomes have improved over decades. Our aim was to evaluate the dynamics of RRT in Lithuania in the period 1994–2015, describe its distinctive features, and compare our results with other countries. Materials and Methods: Data between 1994 and 2015 were collected from patients under the age of 18 years with ESRD receiving RRT. The data included: Hemodialysis (HD), peritoneal dialysis (PD), transplantation incidence and prevalence, transplant waiting time, dialysis modalities before transplantation, causes of ESRD and gender distribution in transplanted patients, and patient and graft survival. Results: RRT incidence and prevalence maintained an increase up until 2009. Sixty-four transplantations were performed. Juvenile nephronophthisis (25.9%) was the primary cause of ESRD in transplanted children. The transplant waiting time median was 8.0 months. The male to female ratio post-transplantation was 1.02. Patient survival after transplantation at 10 years was 90.0%, while graft survival for living (related) was 77.0% and 51.1% for deceased. Twelve patients died while on RRT. Conclusions:RRT numbers are increasing in Lithuania. HD is the primary treatment of choice before transplantation, with continued low numbers of preemptive transplantation. Patient survival post-transplantation is favorable, though graft survival is less satisfactory

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

Population-based screening for selective immunoglobulin A (IgA) deficiency in Lithuanian children using a rapid antibody-based fingertip test

Background: Selective immunoglobulin A (IgA) deficiency is the most common inherited immunodeficiency disorder worldwide. An early diagnosis is advocated because of the increased risk of infections, autoimmune diseases, and allergic reactions. We investigated the usefulness of a rapid point-of-care test in detecting for IgA deficiency in a population with a previously unknown prevalence. Material/Methods: Altogether, 1000 children aged 11–13 years from randomly selected Lithuanian schools were enrolled. A pointof-care test with a fingertip sample was used to screen for the presence of IgA deficiency in children whose parents gave consent. Those with suspected IgA deficiency were referred to hospital for further clinical examination and confirmation of the diagnosis. In addition, their medical histories were compared with those of 30 age- and sex-matched healthy controls. Results: IgA deficiency was suspected in one girl and in three boys on the basis of the rapid test, and the diagnosis was confirmed for all four cases (prevalence 0.4%, 95% confidence interval 0.16–1.02%). There was no difference in disease history or complications between IgA-deficient children and healthy controls. Conclusions: The rapid antibody test is a practical and accurate method to diagnose selective IgA deficiency in children. The prevalence of IgA deficiency among Lithuanian schoolchildren is 1:250

Long-term follow-up of children with typical hemolytic uremic syndrome

Objective: The aim of the study was to determine the associations of the acute period course with late-emerging sequelae in children with typical hemolytic uremic syndrome (HUS). Materials and methods: The data of 62 children with typical HUS during the acute phase were retrospectively analyzed by age, sex, duration of anuria/oliguria, method and duration of renal replacement therapy, proteinuria, hypertension, and renal function. The data of 33 children at 10-year follow-up after the onset of the disease were evaluated for changes in hypertension, proteinuria, and renal function. Results: In the acute phase of the disease (n = 62), hypertension was documented in 75.8% of the children; proteinuria, in 85.5%; and renal dysfunction, in 100%. At 10 years after the onset of the disease (n = 33), hypertension was documented in 12.1%, 6.1%, and 24.2% at 1-, 5-, and ≥10-year follow-ups, respectively, and more often in children aged &lt;1 year at the onset of the disease. Proteinuria was found in 15.2%, 9.1%, and 33.3% of the patients, respectively. After ≥10 years, hypertension developed for the first time in 6.1% of the patients. Renal injury of varying degrees was seen in 15.2% of the children at the 1-year follow-up, and after ≥10 years the proportion increased to 33.3%. Conclusions: At 10 years after the acute phase of typical HUS in children, the prevalence of hypertension and proteinuria at 1- and 5-year follow-ups decreased, but after 10 years it started to increase. As much as 6.1% of the children developed hypertension or proteinuria for the first time at 10 years. Hypertension was documented more frequently in children who were younger than &lt;1 year at the onset of the disease. Renal dysfunction after 5 and 10 years remained in more than one-third of cases, and it was observed more often if hypertension was documented at the acute period

Etiology, prevalence of chronic renal failure and growth retardation in Lithuanian children

The aim of the study was to evaluate the causes, prevalence, and grades of chronic renal failure in Lithuanian children and to assess its influence on children's growth. The study was performed in Vilnius University Children's Hospital and Clinic of Children's Diseases, Kaunas University of Medicine. By March 31, 2006, 65 children with chronic renal failure had been registered. The prevalence was 88.3 cases per million children. The mean age was [email protected] years. The leading causes of chronic renal failure were congenital diseases (37) and obstruction with interstitial nephritis (33.8). At presentation, 23 (35.40) children had mild, 17 (26.15) had moderate, 9 (23.85) had severe renal failure, and 16 (24.6) had end-stage renal disease. Fourteen (21.54) children were below the third percentile in height for their age. Growth failure was observed in one (4.35) child with Grade 1 renal failure. The deterioration of renal function had a significant influence on growth impairment, and 13 (30.95) children with glomerular filtration rate of less than 60 mL/min/1.73 nrand 7 (43.75) with end-stage renal disease had a height below the third percentile. Growth retardation as one of the symptoms of impairment of children's physical development depends on the severity of renal function

Unscheduled return visits to a pediatric emergency department

Background and objective: Return visits (RVs) to a pediatric emergency department (ED) within a short period after discharge have an influence on overcrowding of the ED and reveal some weaknesses of the health care system. The aim of this study was to determine the rate of RVs and factors related to RVs to the pediatric ED in Lithuania. Materials and methods: A retrospective study in an urban, tertiary-level teaching hospital was carried out. Electronic medical records of all patients (n = 44 097) visiting the ED of this hospital between 1 January and 31 December 2013 were analyzed. Demographic and clinical characteristics of patients who return to the ED within 72 h and those who had not visited the ED were compared. Factors associated with RVs were determined by multivariable logistic regression. Results: Of the overall ED population, 33 889 patients were discharged home after the initial assessment. A total of 1015 patients returned to the ED within 72 h, giving a RV rate of 3.0%. Being a 0–7-year old, visiting the ED during weekdays, having a GP referral, receiving of laboratory tests and ultrasound on the initial visit were associated with greater likelihoods of returning to the ED. Patients who arrived to the ED from 8:01 a.m. to 4:00 p.m. and underwent radiological test were less likely to return to the ED within 72 h. Diseases such as gastrointestinal disorders or respiratory tract/earth–nose–throat (ENT) diseases and symptoms such as fever or pain were significantly associated with returning to the ED. The initial diagnosis corresponded to the diagnosis made on the second visit for only 44.1% of the patients, and the highest rate of the congruity in diagnosis was for injuries/poisoning, surgical pathologies (77.2%) and respiratory tract diseases (76.9%). Conclusions: RVs accounted for only a small proportion of visits to the ED. RVs were more prevalent among younger patients and patients with a GP referral as well as performed more often after discharging from the ED in the evening and at night