Wysoko czułe białko C-reaktywne w moczu pacjentów z pęcherzem neurogennym po operacji przepukliny oponowo-rdzeniowej

Introduction. Neurogenic bladder (NB) is specific condition caused by disturbed bladder innervation and the most often complication of meningomyelocele (MMC). It is known that incorrect bladder function causes renal damage. Condition of  NB is worsened by urinary tract infections, detrusor overactivity, dysfunctional voiding and/or irregular catheterization. hs-CRP plays an important role in inflammatory process and can predict kidney function. The aim of this study was the estimation of urinary hs-CRP level in association with neurogenic bladder function based on urodynamics and renal function based on eGFR in MMC patients with various activity states and with different levels of lesion.Material and methods. 33 children and adolescents with urodynamically  confirmed neurogenic bladder and 20 healthy individuals were enrolled into the study. Patients were divided according to Hoffer’s scale and level of lesion. Urinary hs-CRP were evaluated in all individuals using ELISA methods. Urinary hs-CRP results were adjusted to the creatinine and expressed as hs-CRP/creatinine ratio. Nonparametric tests were used for statistical analysis.Results. When compared to the reference group, MMC patients showed increased urinary hs-CRP. There were no differences in the studied parameter between boys and girls, non- and catheterized, and with different urodynamic diagnosed children. We found positive correlations between Hoffer’s scale assessing physical activity and level of lesion and between GFR and urinary hs-CRP/crea.Conclusion. Urinary hs-CRP level is elevated in MMC patients compared to reference group and could be considered as a very early marker of glomerular hyperfiltration.Wstęp. Pęcherz neurogenny jest to specyficzny stan spowodowany zaburzonym unerwieniem pęcherza i jest jednym z najczęstszych powikłań przepukliny oponowo rdzeniowej. Znany jest fakt uszkodzenia funkcji nerek w następstwie pęcherza neurogennego. Czynność pęcherza neurogennego pogarszana jest poprzez zakażenia układu moczowego, nadczynność wypieracza, dysfunkcyjną mikcję i/lub nieregularne cewnikowanie. Wysoko czułe białko C-reaktywne (hs-CRP) odgrywa istotną rolę w procesach zapalnych, jak również może być czynnikiem predykcyjnym funkcji nerek. Celem pracy była ocena hsCRP w moczu w powiązaniu z czynnością pęcherza neurogennego ocenianą w badaniu urodynamicznym oraz funkcją nerek w oparciu o GFR u pacjentów z przepuklina oponowo-rdzeniową w zależności  od aktywności fizycznej i poziomu uszkodzenia.Materiał i metody. Do badania włączono 33 dzieci z potwierdzonym pęcherzem neurogennym i 20 zdrowych  jako grupę referencyjną. Pacjenci zostali podzieleni zgodnie z poziomem uszkodzenia i ze skalą aktywności fizycznej Hoffera. Stężenie hs-CRP w moczu oceniono metodą ELISA u wszystkich uczestników badania. Stężenie hs-CRP odniesiono do stężenia kreatyniny i przestawiono jako wskaźnik hs-CRP/kreatynina. Do analizy statystycznej użyto testów nieparametrycznych.Wyniki. U pacjentów z przepukliną oponowo-rdze-niową wykazano podwyższony hs-CRP w moczu w porów-naniu do grupy kontrolnej. Nie było różnic w badanych parametrach pomiędzy chłopcami i dziewczynkami, pacjentami cewnikowanymi i nie cewnikowanymi, i po-między pacjentami z różnymi rozpoznaniami urody-namicznymi. Wykazano pozytywne korelacje pomiędzy GFR i wskaźnikiem hsCRP/kreatynina a skalą Hoffera oceniającą aktywność fizyczną i poziomem uszkodzenia.Wniosek. Stężenie hs-CRP w moczu jest pod-wyższone u pacjentów z pęcherzem neurogennym po przepuklinie oponowo rdzeniowej w porównaniu do dzieci zdrowych i może być rozważany jako wczesny marker hyperfiltracji

Clinical characteristics of patients with neurogenic bladder due to myelomeningocele – Eighteen-year retrospective study; University Children's Hospital, Bialystok, Poland

AbstractIntroductionMyelomeningocele (MMC) is congenital nervous system malformation caused by neurulation process failure during pregnancy. The prevalence varies by the continent, region, race, ethnicity and the time when assessed and patients present abnormalities of different organs. One of the most severe complications is renal failure.AimClinical evaluation of patients with MMC in North-East Poland and answering the question whether our treatment methods lead to renal function preservation.Material and methodsMedical records of 112 patients in the period 1995–2013 were evaluated retrospectively.The data included: age, sex, BMI Z-score WHO, place of residence, perinatal history, social situation, physical activity, urodynamic diagnosis, renal function, hydrocephalus diagnosis, and functioning of shunting procedures.ResultsThey were no statistically significant differences in most studied parameters between boys and girls. We observed statistically significant differences among MMC patients divided into 4 groups according to the physical activity. They differed in birth weight and length, Apgar scale, hydrocephalus diagnosed and the need for ventriculoperitoneal shunt. We did not find differences in urodynamic diagnosis among 4 studied groups.Conclusions1.Data of MMC children from Poland are similar to the other countries.2.In our opinion, early diagnostic and treatment procedure especially with early catheterization of MMC children prevent renal failure development.3.Assessment of very early markers in renal function deterioration in neurogenic bladder patients from widespread multicenters’ research is indicated

An Examination of the Relationship between Urinary Neurotrophin Concentrations and Transcutaneous Electrical Nerve Stimulation (TENS) Used in Pediatric Overactive Bladder Therapy

This article aims to explore changes in urinary concentrations of selected neurotrophins in the course of TENS therapy in children with overactive bladder (OAB). A two-group open-label prospective study was conducted. The intervention group comprised 30 children aged between 5 and 12 years old with OAB refractory to conservative therapy. They received 12 weeks of TENS therapy in a home setting. The urinary neurotrophins, NGF, BDNF, NT3, NT4, were measured by ELISA at baseline and at the end of the TENS therapy. Total urinary neurotrophins levels were standardized to mg of creatinine (Cr). We compared the results with the reference group of 30 participants with no symptoms of bladder overactivity. The results revealed that children with OAB both before and after TENS therapy had higher NGF, BDNF, and NT4 concentrations in total and after normalization to Cr than the reference group in contrast to NT3. The response to the therapy expressed as a decrease of urinary neurotrophins after TENS depended on the age and the presenting symptoms. In conclusion, children older than 8 years of age with complaints of daytime incontinence responded better to TENS

The role of selected parental and perinatal factors in the future mobility of children with myelomeningocele

Background. Myelomenigocele (MMC) is the most severe form of spina bifida, caused by genetic and environmental components; it has many serious complications in a patient’s future life, where dysfunctional mobility is one of the most troublesome. Objectives. The aim of our study was to explore the role of selected factors: parental and perinatal in children with myelomenigocele and correlate them with their future motor function. Material and methods. This retrospective analysis was based on 95 births that occurred from 1985 to 2013. Clinical data were collected using medical records and supplemented by a questionnaire for parents. Standard deviation of WHO scores (Z-scores) for weight, length, and body mass index (BMI) at birth were calculated. Hoffer’s scale was used to assess MMC children’s motor function. Results . There were no statistically significant differences between 53 girls and 42 boys who were enrolled in the study, excluding the month of conception. The tested parameters did not vary substantially according to maternal age. Maternal age correlated positively with paternal age at conception, birth order, and stillbirth rate. Mode of delivery was strongly associated with Apgar scale and birth weight. Apgar score, birth length, and thus WHO Z-score for length-for-age had positive correlations with future mobility of MMC children. Conclusions . 1. Perinatal factors have a significant effect on children’s physical activity. 2. There is no clinical evidence that cesarean section improves early neurological outcome of MMC infants. 3. Parental factors, particularly maternal age, do not determine the future mobility of children with myelomeningocele

The role of selected parental and perinatal factors in the future mobility of children with myelomeningocele

Background. Myelomenigocele (MMC) is the most severe form of spina bifida, caused by genetic and environmental components; it has many serious complications in a patient’s future life, where dysfunctional mobility is one of the most troublesome. Objectives. The aim of our study was to explore the role of selected factors: parental and perinatal in children with myelomenigocele and correlate them with their future motor function. Material and methods. This retrospective analysis was based on 95 births that occurred from 1985 to 2013. Clinical data were collected using medical records and supplemented by a questionnaire for parents. Standard deviation of WHO scores (Z-scores) for weight, length, and body mass index (BMI) at birth were calculated. Hoffer’s scale was used to assess MMC children’s motor function. Results . There were no statistically significant differences between 53 girls and 42 boys who were enrolled in the study, excluding the month of conception. The tested parameters did not vary substantially according to maternal age. Maternal age correlated positively with paternal age at conception, birth order, and stillbirth rate. Mode of delivery was strongly associated with Apgar scale and birth weight. Apgar score, birth length, and thus WHO Z-score for length-for-age had positive correlations with future mobility of MMC children. Conclusions . 1. Perinatal factors have a significant effect on children’s physical activity. 2. There is no clinical evidence that cesarean section improves early neurological outcome of MMC infants. 3. Parental factors, particularly maternal age, do not determine the future mobility of children with myelomeningocele

Ocena stężenia leptyny, białka ostrej fazy i lipidów u dzieci i młodzieży z przepukliną oponowo-rdzeniową

Introduction. Development of obesity and atherosclerosis can begin at a young age, particularly in patients with limited mobility as a result of myelomeningocele (MMC). In diagnostics, in addition to lipidogram, glucose and C-reactive protein (CRP) levels, the concentration of leptin in blood serum has practical importance. The aim of the study was to assess the above indicators in children and adolescents with MMC depending on Hoffer’s scale. Method. We studied 84 patients with MMC aged 7–17 years. The following were measured: weight, height, leptin levels, lipid metabolism, glycemia, CRP, vitamin D3, total protein and albumin. BMI was calculated. In the assessed group of patients 29 patients moved independently (IV on Hoffer’s scale) and 34 patients used a wheelchair (I on Hoffer’s scale) with a mean value of 2.45 on Hoffer’s scale. Results. Mean leptin level in the study group was 9.45 ng/mL and was higher compared with the control group (5.85 ng/mL). Leptin levels statistically significantly depended on age (p = 0,000); height (p = 0.000); level of physical activity according to Hoffer’s classification (p = 0.0017); BMI (p = 0.000); total protein (p = 0.0306). Conclusion: High leptin levels in children with MMC with excess body mass can be an indicator of metabolic syndrome development.Wstęp. Rozwój otyłości oraz miażdżycy może rozpocząć się już w wieku dziecięcym szczególnie u pacjentów z ograniczoną aktywnością ruchową w przebiegu przepukliny oponowo-rdzeniowej (MMC). W diagnostyce, oprócz oznaczenia lipidogramu, stężenia glukozy, białka ostrej fazy (CRP), praktyczne znaczenie ma ocena oznaczonego stężenia leptyny w surowicy krwi. Celem pracy była ocena powyższych wskaźników u dzieci i młodzieży z MMC w zależności od skali Hoffera. Metoda. Badaniami objęto 84 pacjentów z MMC w wieku od 7 do 17 lat. Wykonano pomiary masy i wysokości ciała, oznaczono stężenia: leptyny, oceniono stan gospodarki lipidowej oraz glikemię i CRP, witaminy D3, białka całkowitego i albumin. Wyliczono wskaźniki: BMI. Wyniki. W ocenianej grupie pacjentów 29 pacjentów poruszało się samodzielnie (IV wg skali Hoffera), a 34 osoby poruszały się na wózkach (I wg skali Hoffera) przy średniej wartości skali Hoffera 2,45. Średnie stężenie leptyny w grupie badanej wynosiło 9,45 ng/ml i było wyższe niż w grupie kontrolnej 5,85 ng/ ml. Stężenia leptyny zależały istotnie statystycznie od wieku (p = 0,000); wzrostu (p = 0.000); poziomu aktywności ruchowej wg klasyfikacji Hoffera (p = 0.0017); BMI (p = 0.000); białka całkowitego (p = 0,0306). Wnioski. Wysokie stężenia leptyny u dzieci z przepukliną oponowo-rdzeniową z nadmiarem masy ciała mogą być wskaźnikiem rozwoju zespołu metabolicznego. Dzieci z otyłością oraz współistniejącymi zaburzeniami metabolicznymi powinny być objęte szczególną opieką ze względu na możliwość wystąpienia wczesnych zmian miażdżycowych

Urinary MMP-9/NGAL Ratio as a Potential Marker of FSGS in Nephrotic Children

BACKGROUND: The study was undertaken to develop a potential new markers for distinguishing minimal change nephrotic syndrome (MCNS) and focal segmental glomerulosclerosis (FSGS) in children. We hypothesized that matrix metalloproteinase-9/neutrophil gelatinase-associated lipocalin (MMP-9/NGAL) is a better marker of focal sclerosis in the glomerulus then matrix metalloproteinase-9/tissue inhibitor of metalloproteinase-1 (MMP-9/TIMP-1) and matrix metalloproteinase-2/tissue inhibitor of metalloproteinase-2 MMP2/TIMP-2

Urinary risk factors for calcium oxalate urolithiasis in children with monosymptomatic enuresis

Introduction: A disturbed calcium-phosphate balance is an important issue for kidney stone formation in nephrolithiasis. Hypercalciuria (HC) has been proposed as an essential etiology of monosymptomatic nocturnal enuresis (MNE). Objectives: We may suspect that patients with MNE may be at risk of stone formation hence the objective of this paper was to assess the risk in MNE children using Bonn Risk Index (BRI). Patients and Methods: The urinary work-up of 204 children (83 with MNE and 121 controls) included urinary calcium (Ca), magnesium (Mg) and sodium (Na) excretion, Ca/creatinine ratio, BRI, ionized calcium (Ca2+), Mg/creatinine and Ca/citrate ratios, urinary citrates and oxalates (Ox). Results: Ca/creatinine and Mg/creat ratios were higher in the MNE group. There were no differences in Mg and Ca amount in urine and Mg/Ca ratio between MNE and the reference group. Both groups differed in Mg and Ca excretion per kg of body mass. MNE children differed from controls regarding BRI, Ox and urinary Ca2+. No differences in urinary citrate excretion nor Ca/citrate ratio between MNE and the controls were found. Correlations between factors important in the crystallization process in MNE children were recorded. Conclusion: MNE patients may be at risk of oxalate nephrolithiasis. Further studies to assess the role of the BRI and Ca/citrate ratio in predicting stone formation in MNE children are needed