Disease-related social situation in family of children with chronic kidney disease - parents' assessment : a multicentre study

Introduction and Objective. Chronic kidney disease (CKD) in children burdens life of patients and their families. Little is known about parents` assessment of families’ social situation. However, the knowledge of the details of a patient’s and his family’s life standards might influence modification and optimization of applied therapy. Therefore, the main goal of the present study was to explore the selected elements of life situation of patients suffering with CKD as well as their parents, depending on the CKD stage and appropriate treatment. Materials and Methods. Cross-sectional national study was conducted. A total of 203 children with CKD and 388 their parent-proxies (196 women and 192 men) were enrolled into this study. Patient data and questionnaires filled by both parents, concerning social-demographic parameters and assessment of changes in families after CKD diagnosis in the child, were analysed. Results. CKD children are being brought up in proper families whose financial situation is not good. Children need help in process of education. Perception of current situation differed between both parents in the change of the income source, taking care of CKD child, change in social relations and evaluating relations with medical staff. Parents do not obtain proper support from social workers. Conclusion. Families of CKD children require support in area of financial and educational help for school children. The discrepancies in evaluation of family situation between mothers and fathers of ill children might be the source of conflicts possibly resulting in worsening the outcome for CKD children

Anxiety in children and adolescents with chronic kidney disease - multicenter national study results

Background/Aims: Chronic medical illness is a significant risk factor for the development of psychiatric disorders. The aims of the study were: to investigate the level of anxiety in children with chronic kidney disease (CKD) and to identify factors associated with the presence of that emotional problem. Methods: CKD children on hemodialysis (HD, n=22), peritoneal dialysis (PD, n=20,) and on conservative treatment (CT, n=95) were enrolled in the study. We used State-Trait Anxiety Inventory (STAI) for adolescents and STAI-C for children. Socio-demographic and physical factors were assessed. Results: There was a significantly higher level of anxiety-state among HD children (8-12 years) compared with other groups of participants of the same age and Polish population norms. The level of anxiety among adolescents (13-18 years), both anxiety-state and anxiety-trait, was significantly higher in the HD group compared with other groups, which did not differ among themselves. In the HD adolescents, there was a correlation between the anxiety-state and the duration of the disease as well as with the number of hospitalizations. PD adolescents in the mainstream education had higher levels of anxiety-state and anxiety-trait compared with home schooled patients. Conclusions: Even though children and adolescents with CKD are at risk of developing a variety of emotional disorders, the level of anxiety among the researched group, with the exception of HD patients, was not significantly different than the level of anxiety among healthy subjects. Adolescents on HD who present a high level of anxiety should undergo long-term psychological treatment

What has changed in the prevalence of hypertension in dialyzed children during the last decade?

Background: Hypertension very often accompanies progression of chronic kidney disease (CKD) in children. A cross-sectional analysis of hypertension prevalence in dialyzed children in Poland was designed with a comparison with the data previously recorded 10 years earlier. Methods: Two cohorts of children were analyzed: 59 subjects dialyzed in 2013, and 134 children from the previous study performed in 2003 that were reevaluated according to the current methodology. The incidence of hypertension (defined by SDS of sBP or dBP >1.64), clinical data, medical history, dialysis modalities and selected biochemical parameters of dialysis adequacy were analyzed. Results: The prevalence of hypertension increased from 64% in 2003 to 78% in 2013. The efficacy of antihypertensive treatment remained unsatisfactory (61% proper BP control). Preservation of residual urine output and strict fluid balance may prevent development of hypertension in children on dialysis. Conclusions: Despite the higher awareness of hypertension and its complications in dialyzed children, the incidence of this entity has increased during the last decade, with the percentage of undertreated patients comparable to that observed 10 years ago. Thus, more attention should be paid to therapy efficacy in this population to prevent further damage to the cardiovascular system and to decrease morbidity

Perception of health-related quality of life in children with chronic kidney disease by the patients and their caregivers : multicentre national study results

Objective The aim of the study was to analyse the healthrelated quality of life (HRQoL) in Polish children with chronic kidney disease (CKD) dependant on the CKD stage, treatment modality and selected social life elements in families of the patients. Furthermore, potential differences between self-report and parent/proxy reports and the factors influencing them were assessed. Methods A total of 203 CKD children (on haemodialysis (HD), peritoneal dialysis (PD) and conservative treatment (CT)) and their 388 parent/proxies were enrolled into a cross-sectional national study. The demographic and social data were evaluated. We used the Paediatric Quality of Life Inventory 4.0 Generic Core Scales to assess the HRQoL in children. Results Health-related quality of life scores for all CKD groups were significantly lower in all domains compared with population norms, the lowest one being in the HD group. In CT children, HRQoL did not depend on the CKD stage. Both parents assessed the HRQoL of their children differently depending on their involvement in the care. There are differences between the HRQoL scores of the children and their parents

Microplastic Pollution in EU Farmland Soils: Preliminary Findings from Agricultural Soils (Southwestern Poland)

Agricultural soils are considered as “hot-spots” of plastic particles; however, due to a lack of standardized method of microplastic determination in soils, as well as no legal regulations requiring the monitoring of the soil environment in the context of microplastic contamination, the data on MP abundance and occurrence in European soils are very limited. In this first study of MPs pollution in agricultural soils in Poland, we developed a method of microplastic extraction from soil samples with different properties (particle size distribution, clay and organic matter content) and used optical microscopy for MP determination and quantification. In this study, we analyzed 44 soil samples from five sampling site locations with differing soil type, agricultural activity, including farmland soils on floodplains and past records of sewage sludge and compost applications. We found evidence that 93% of cultivated soils in the SW part of Poland contained MPs. The content of MP varied between soil types and present/former use of the land. Loamy and clay soils contained more MPs, 1540 ± 912 particles per kg soil and 933 ± 682 particles per kg, respectively, compared with sandy soils at 383 ± 188 particles per kg of soil. The highest MP concentrations were determined in soils amended with sewage sludge, wastewaters and green-waste composts (up to 4050 ± 2831 particles per kg of soil). The wide distribution of MPs with a dominance of plastic fibers (up to 60% of determined MP types) can be associated with agricultural sources such as soil mulching, the use of organic fertilizers, seed coating or unintentional waste dumping and air deposition

End-stage renal disease inthe course ofurinary tract defects inWolf–Hirschhorn syndrome – case report

Wolf–Hirschhorn syndrome is a complex development disorder containing facial dysmorphy, development retardation, growth impairment, muscular hypotonia and occurrence of paroxysmal disorders. Characteristic dysmorphic features are hypertelorism, oblique eyelids, prominent high forehead, wide nose, short philtrum, micrognathia, low set dysplastic ears and gothic palate, in some cases cleft palate. Those features are described as “Greek warrior helmet”. Dysmorphia can be accompanied by various congenital defects, such as growth impairment, heart defects, coloboma, urogenital and skeletal abnormalities, deafness, and in 20% of patients kidney defects, which could lead in some cases to end of stage renal disease. Observed disorders are resulting from deletion of short arm of 4th chromosome and their severity, clinical outcome and intensity of  development retardation depend on deletion size. In our article we present a  boy with severe case of Wolf–Hirschhorn syndrome accompanied by renal dysplasia of his only kidney, which lead to end of stage renal disease during his infancy. He has been treated with peritoneal dialysis since then. In our patient’s case variety of congenital defects and severe development retardation cause bad clinical outcome and serious prognosis. Patient like that requires multidisciplinary medical care. Decision about initiation of renal replacement therapy in such a patient is still an important ethical dilemma

The relevance of dry weight estimation by electrical bioimpedance in dialysed children and adolescents

WSTĘP: Do określenia tzw. suchej masy ciała zastosowano metodę bioimpedancji elektrycznej (BIA). Głównym celem pracy była ocena przydatności oznaczania suchej masy ciała za pomocą bioimpedancji elektrycznej u przewlekle dializowanych dzieci i młodych dorosłych, w tym w szczególności w odniesieniu do wybranych wykładników biochemicznych i parametrów układu sercowo-naczyniowego. Dodatkowo w tej grupie pacjentów, przy użyciu BIA, analizowano stan odżywienia. MATERIAŁ I METODY: Badaniem objęto 17 dzieci i młodych dorosłych w wieku od 6 do 24 lat (średnio 15 ± 3,5 roku), leczonych przewlekle hemodializą lub dializą otrzewnową. Oceniono wartości ciśnienia tętniczego, badania biochemiczne, parametry sercowe i wyniki z bioimpedancji w badaniu wyjściowym i po 2 miesiącach, po modyfikacji leczenia dializacyjnego w oparciu o parametry BIA. WYNIKI: Badane parametry ciśnienia tętniczego (skurczowe, rozkurczowe, średnie, tętna) było istotnie niższe podczas drugiego badania w porównaniu z wartościami wyjściowymi. Stężenie hemoglobiny było istotnie wyższe po 2 miesiącach obserwacji. W badaniu echokardiograficznym wykazano istotny wzrost frakcji wyrzutowej lewej komory, przy niezmienionych parametrach anatomicznych serca. Oceniane wskaźniki odżywienia – tkanki beztłuszczowej (LTI) i tłuszczowej (FTI) – nie uległy zmianie. Wykazano dodatnią korelację LTI z ciśnieniem tętniczym i niektórymi para-metrami z badania echokardiograficznego. WNIOSKI: Bioimpedancja elektryczna, jako prosta do przeprowadzenia i nieinwazyjna metoda, może być przydatna do precyzyjnego wyznaczania tzw. suchej masy ciała u dializowanych dzieci i młodych dorosłych. Adekwatne odwodnienie pacjentów pozwala na normalizację ciśnienia tętniczego krwi, co wiąże się z poprawą funkcji i prawdopodobnie stanu anatomicznego mięśnia sercowego. BIA pozwala także na dokładniejszą ocenę stanu odżywienia dializowanych chorych i wcześniejsze wykrycie niedożywienia, co w przypadku populacji pediatrycznej ma znaczenie rokownicze.INTRODUCTION: Electrical bioimpedance (BIA) is used to estimate a patient's dry weight. The main goal of the study was to assess the usefulness of BIA in evaluating dry weight in children and young adults on chronic dialysis, with relation to selected biochemical and cardiovascular parameters. An additional goal was to analyze the state of nutrition by means of BIA. MATERIAL AND METHODS: 17 children and young adults, aged from 6 to 24 years (mean 15 ± 3.5 years) on hemodialysis or peritoneal dialysis, were examined. We estimated the arterial blood pressure, biochemical results, echocardiographic and bioimpedance parameters during the initial examination. Based on these results, modifications in the dialysis treatment were introduced. The follow-up examination was performed after 2 months. RESULTS: Arterial blood pressure values were significantly lower at the time of the second examination compared to the first one. The hemoglobin levels were higher after 2 months of observation. In the echocardiographic results, only the EF% improved. The Lin Tissue Indexes (LTI) and the Fat Tissue Indexes (FTI) were similar in both examinations. We observed positive correlations between LTI and arterial blood pressure and some echocardiographic parameters. CONCLUSION: The arterial blood pressure values were significantly lower at the time of the second examination compared to the first one. The hemoglobin levels were higher after 2 months of observation. In the echocardiographic results, only the EF% improved. The Lin Tissue Indexes (LTI) and the Fat Tissue Indexes (FTI) were similar in both examinations. We observed positive correlations between LTI and arterial blood pressure and some echocardiographic parameters

Oxidative stress in children and adolescents with primary hypertensi

Introduction: Primary or essential hypertension is diagnosed more often in children and adolescents. Studies carried out in recent years indicate a complex part of oxidative stress and endothelial dysfunction in the pathogenesis of primary hypertension. Studies on disorders of oxidative metabolism in children with primary hypertension are few. The aim of the study was to assess oxidative stress in children and adolescents with primary hypertension, based on the concentration of malonyldialdehyde (MDA) as a marker of lipid peroxidation and the activity of selected enzymes of the antioxidant system (superoxide dismutase – SOD and glutatione peroxidase – GSH-Px) in erythrocytes. Material and methods: The study included 24 children with newly diagnosed primary hypertension at the age of 5-18 years. The control group comprised 24 healthy children respectively matched according to age and gender. The concentration of MDA and the activity of GSH-Px and SOD were tested in erythrocytes and additionally a full blood count was examined. Results: MDA concentration in erythrocytes was significantly higher in the group of sick children compared to the healthy group (p<0.001). GSH-Px activity in children with primary hypertension was significantly lower than in the control group (p<0.001), SOD activity did not differ between the groups examined. No correlation was found between the values of MDA and SOD and between MDA and GSH-Px in the group of sick patients. Conclusions: Studies reveal intensification of lipid peroxidation and disturbance in functioning of the antioxidant enzyme system in erythrocytes of children with primary hypertension.Wstęp: Nadciśnienie tętnicze pierwotne (NTP) coraz częściej rozpoznawane jest u dzieci i młodzieży. Przeprowadzone w ostatnich latach badania wskazują na złożony udział stresu oksydacyjnego i dysfunkcji śródbłonka naczyń w patogenezie NTP. Prace dotyczące zaburzeń metabolizmu tlenowego u dzieci z NTP są nieliczne. Celem pracy była ocena stresu oksydacyjnego u dzieci i młodzieży z NTP na podstawie stężenia dialdehydu malonylowego (MDA) jako markera peroksydacji lipidów i aktywności wybranych enzymów układu antyoksydacyjnego (dysmutazy ponadtlenkowej – SOD, peroksydazy glutationu – GSH-Px) w erytrocytach. Materiał i metody: Badaniami objęto 24 osoby ze świeżo rozpoznanym NTP w wieku 5-18 lat. Grupę kontrolną stanowiło 24 dzieci zdrowych, odpowiednio dobranych pod względem płci i wieku. W erytrocytach oznaczono: stężenie MDA oraz aktywność GSH-Px i SOD, ponadto zbadano morfologię krwi. Wyniki: Stężenie MDA w erytrocytach było istotnie wyższe w grupie chorych w porównaniu ze zdrowymi (p<0,001). Aktywność GSH-Px w grupie dzieci z NTP była znamiennie niższa aniżeli w grupie kontrolnej (p<0,001), aktywność SOD nie różniła się w badanych grupach. Nie wykazano korelacji pomiędzy wartościami MDA i SOD oraz MDA i GSH-Px w grupie chorych. Wnioski: Przeprowadzone badania wskazują na wzmożenie peroksydacji lipidów oraz zaburzenia w funkcjonowaniu enzymatycznego układu antyoksydacyjnego w erytrocytach dzieci z NTP