Endothelin-1 (ET-1), N-terminal fragment of pro-atrial natriuretic peptide (NTpro-ANP), and tumour necrosis factor alpha (TNF-α) in children with primary hypertension and hypertension of renal origin

Introduction: Hypertension is regarded as a condition of mild inflammation and endothelial imbalance. The aim of the study was to evaluate serum concentrations of biomarkers of inflammation and endothelial function: tumour necrosis factor alpha (TNF-α), endothelin-1 (ET-1), and N-terminal fragment of pro-atrial natriuretic peptide (NTpro-ANP) in hypertensive and normotensive children.Material and methods: We studied 63 children aged 13.56 ± 3.73 years, divided into two groups: a group with primary hypertension (n = 50) and a group with renal hypertension (n = 13). The control group consisted of 34 normotensive children aged 12.76 ± 3.96 years. Biomarkers were measured with ELISA tests.Results: ET-1 levels were significantly higher in primary hypertension (9.93 ± 1.73 pg/ml) and renal hypertension (10.77 ± 1.50 pg/ml) in comparison to controls (4.03 ± 0.97 pg/ml), (p < 0.001, p < 0.001, respectively). NT-pro ANP concentrations in primary hypertension (71.03 ± 10.02 pg/ml), and renal hypertension (84.78 ± 6.44 pg/ml) were significantly higher than in the control group (29.62 ± 5.56 pg/ml) (p < 0.001, p < 0.001, respectively). TNF-α concentrations in primary hypertension (8.36 ± 1.60 pg/ml) and renal hypertension (7.35 ± 0.93 pg/ml) significantly exceeded concentrations in controls (4.49 ± 0.93 pg/ml), (p < 0.001, p < 0.001, respectively). ET-1 and NT-pro ANP concentrations in renal hypertension significantly exceeded those in primary hypertension (p = 0.049, p < 0.001, respectively) while TNF-α levels in renal hypertension were significantly lower than in primary hypertension (p = 0.046).Conclusions: The results of our study show that ET-1, NT-pro ANP, and TNF-a concentrations are increased in hypertension in children.Our investigation indicates significant importance of inflammation and endothelial involvement in hypertension in youth

Utility of the dobutamine stress echocardiography in the evaluation of the effects of a surgical repair of aortic coarctation in children

Background: Exercise-induced hypertension following repair of the coarctation of the aorta (CoA) is a well known phenomenon. The most important functional parameters in the assessment of the effects of a surgical repair of CoA are the maximal pressure gradient in the descending aorta (GRAD) and systolic blood pressure (SBP). Results of treadmill exercise test using the Bruce protocol (treadmill test) and dobutamine stress echocardiography (DSE) were compared to determine utility of the DSE in the evaluation of the effects of surgical treatment of CoA in children. Methods: The study population comprised of 29 patients, including 20 males and 9 females (mean age 12 years) who underwent a surgical repair of CoA. Changes of the cardiovascular parameters including SBP, GRAD and heart rate (HR) during the treadmill test and DSE were compared. Results: During the treadmill test, SBP at peak exercise ranged from 120 to 230 (mean 163.7) mm Hg, GRAD ranged from 29 to 109 (mean 59.8) mm Hg, and HR ranged from 140 to 188 (mean 169) bpm. At the end of DSE, SBP ranged from 123 to 215 (mean 164.7) mm Hg, GRAD ranged from 29 to 113 (mean 55.4) mm Hg, and HR ranged from 76 to 155 (mean 111) bpm. We found positive correlations of SBP (r = 0.68, p < 0.001) and GRAD (r = 0.82, p < 0.001) values during both tests but no significant correlation for HR (r = 0.42, p = NS). Conclusions: Dobutamine stress echocardiography is useful in the evaluation of the effects of surgical repair of CoA in children

Changes in the coronary arteries during early and long-term follow-up of Kawasaki syndrome: a single centre experience

Background: Kawasaki syndrome is a disease of unknown etiology manifested by fever and the so-called mucocutaneous lymph node syndrome. In some cases aneurysms of the coronary arteries may develop, which may result in myocardial infarction. Methods: Four children treated for Kawasaki disease were followed up. Echocardiography was performed in the early period of the disease and during the follow-up. Results: Changes in the coronary arteries were diagnosed in 3 patients in early period of the disease with one coronary aneurysm persisting in 1 patient over the entire follow-up. Conclusions: Transthoracic echocardiography is usually sufficient to diagnose and monitor coronary artery changes in the course of Kawasaki disease. Despite late initiation of treatment in Kawasaki disease regression of changes in the coronaries is possible

Zmiany w tętnicach wieńcowych w przebiegu choroby Kawasaki w okresie wczesnym i odległym - doświadczenia własne

Wstęp: Zespół Kawasaki jest chorobą o nieznanej jak dotąd etiologii, w przebiegu której występuje gorączka i tzw. zespół skórno-węzłowo-śluzówkowy. U części pacjentów dochodzi do tworzenia się tętniaków naczyń wieńcowych, co może prowadzić do zawału serca. Metody: Obserwacją objęto 4 dzieci leczonych z powodu choroby Kawasaki, u których wykonywano badania echokardiograficzne we wczesnym i odległym okresie od ustalenia rozpoznania. Wyniki: Zmiany w tętnicach wieńcowych rozpoznano u 3 pacjentów we wczesnym okresie choroby, u 1 dziecka tętniak tętnicy wieńcowej utrzymywał się w obserwacji odległej. Wnioski: Transtorakalne badanie echokardiograficzne najczęściej wystarcza, by rozpoznać i monitorować zmiany w tętnicach wieńcowych w przebiegu choroby Kawasaki. Ocena dystalnych części tętnic wieńcowych wymaga zastosowania innych metod obrazowania, np. koronarografii. Mimo późnego wdrożenia leczenia w chorobie Kawasaki jest możliwa regresja zmian w naczyniach wieńcowych

Odległe obserwacje po zabiegu przezskórnego zamknięcia dużej przetoki wątrobowej u dziecka po operacji Fontana

W niniejszej pracy przedstawiono przypadek dziecka z izomeryzmem prawostronnym, złożoną siniczą wadą serca, po operacji Fontany, u którego w trybie pilnym zamknięto w wieku 5 lat ogromną przetokę wątrobową za pomocą implantu Amplatzer Septal Occluder. (Folia Cardiol. 2004; 11: 961&#8211;965

Odległe obserwacje po zabiegu przezskórnego zamknięcia dużej przetoki wątrobowej u dziecka po operacji Fontana

W niniejszej pracy przedstawiono przypadek dziecka z izomeryzmem prawostronnym, złożoną siniczą wadą serca, po operacji Fontany, u którego w trybie pilnym zamknięto w wieku 5 lat ogromną przetokę wątrobową za pomocą implantu Amplatzer Septal Occluder. (Folia Cardiol. 2004; 11: 961&#8211;965

Arterial hypertension in children and adolescents – optimisation of the diagnostic andtherapeutic process

Arterial hypertension constitutes a significant clinical problem in everyday medical practice. It mainly concerns adult patients, but can also develop in childhood and adolescence. The diagnosis of hypertension in children and adolescents is possible by the systematic measurement of blood pressure levels during routine visits (observing the principles concerning the adequacy of measurements) and by referring the values to biological norms (blood pressure percentile tables) and applying proper definitions. Arterial hypertension in children and adolescents can be essential (primary), but much more frequently (compared with adults), it is secondary to a disease of other organs and systems. The predominant secondary causes of hypertension in children and adolescents are renal parenchymal and vascular pathologies, which must be considered in the diagnostic process. Additional examinations conducted in a patient with arterial hypertension depend on the child’s age, severity of hypertension, history and physical findings. Examinations to evaluate the advancement of target organ complications should be conducted simultaneously with the diagnostic process conducted to determine the aetiology of hypertension. A diagnosis of arterial hypertension in the developmental age makes it possible to implement an adequate therapy by treating the underlying condition, modifying patient’s lifestyle or prescribing pharmaceutical agents. The goal of an effective therapy is to prevent early and late complications of hypertension and reduce the risk of hypertensive emergencies

Nephritic syndrome in adolescence – similar symptoms, different diagnosis and treatment. Two case reports

The occurrence of symptoms of nephritic syndrome in the form of oliguria, arterial hypertension, proteinuria and haematuria is routinely interpreted as acute post-infectious glomerulonephritis. The two clinically similar cases of nephritic syndrome indicate the need for a differential diagnosis in order to identify the correct condition and establish appropriate therapy. In the first case, the development of nephritic syndrome was preceded by pharyngitis that had occurred 2 weeks before. A decrease in a concentration of complement components was accompanied by an increased antistreptolysin O titre. A diagnosis of acute post-streptococcal glomerulonephritis enabled the implementation of  symptomatic treatment involving diuretics and hypotensive agents. Clinical improvement was seen in the second week of treatment. In the second case, there was no correlation with an infectious episode. A decrease in a concentration of complement components was accompanied by thrombocytopenia and the presence of antinuclear antibodies. This configuration of signs necessitated renal biopsy, the results of which enabled correct diagnosis of lupus nephritis and implementation of combined immunosuppressive treatment that gave a chance for preserving renal function