Neutrophil gelatinase-associated lipocalin (NGAL) and matrix metalloproteinases as novel stress markers in children and young adults on chronic dialysis

Phenomena related to chronic kidney disease, such as atherosclerosis, aggravate with the introduction of dialysis. Matrix metalloproteinases (MMP) and factors modifying their activity, such as their tissue inhibitors (TIMP) or neutrophil gelatinase-associated lipocalin (NGAL), take part in the matrix turnover and the endothelial damage characteristic for atherogenesis. However, there are no data on the associations between these parameters and other known pro-atherogenic factors, or on the impact of various dialysis modalities on them. The aim of our study was to assess the serum concentrations of NGAL, MMP-7, MMP-9, and TIMP-1, as well as their correlations with human heat shock proteins (Hsp90α, anti-Hsp60), endothelial dysfunction (sE-selectin), and inflammation (hsCRP) in pediatric patients chronically dialyzed. Twenty-two children on automated peritoneal dialysis (APD), 17 patients on hemodialysis (HD) and 24 controls were examined. The serum concentrations of NGAL, MMP-7, MMP-9, TIMP-1, Hsp90α, anti-Hsp60, and sE-selectin were assessed by enzyme-linked immunosorbent assay (ELISA). The median values of NGAL, MMP-7, MMP-9, TIMP-1, and MMP-9/NGAL ratio were significantly elevated in all dialyzed children vs. controls and were higher in HD than in APD. The values of MMP-9/TIMP-1 and MMP-7/TIMP-1 ratios in the HD subjects were lower than those in the APD children. Hsp90α and anti-Hsp60 predicted the values of NGAL, MMPs, and TIMP-1. Additionally, sE-selectin was a predictor of NGAL levels, whereas NGAL predicted the MMP and TIMP-1 concentrations. The increased concentrations of examined parameters indicate the dysfunction of MMP/TIMP/NGAL system in the dialyzed children, more pronounced on hemodialysis. The discrepancies between dialysis modalities and correlations with heat shock proteins (HSPs) suggest that NGAL may be considered a novel stress protein, whereas MMP-7, MMP-9, and TIMP-1 may be regarded as indicators of stress response in the pediatric population on chronic dialysis

New markers of inflammation and tubular damage in children with chronic kidney disease

Introduction and Aims. Monocyte chemoattractant protein- (MCP-) 1, macrophage colony-stimulating factor (MCSF), and neopterin are connected with monocyte migration and transition into macrophages, leading to fibrosis and tubular damage in the course of CKD. The aim of the study was to analyze the applicability of urinary fractional excretion (FE) of MCP1, MCSF, and neopterin, as markers of inflammation and tubular damage, in children with CKD. Methods. The study group consisted of 61 children with CKD stages 1-5 and 23 age-matched controls. The serum and urine concentrations of MCP1, MCSF, and neopterin were assessed by ELISA and then the fractional excretion (FE) was calculated. Results. FE MCSF and neopterin values exceeded 1% already in controls. FE MCSF rose significantly since CKD stages 1-2, FE neopterin since CKD stages 3-5. FE MCP1 was below 1% in healthy controls and in CKD stages 1-2, then increased significantly in CKD stages 3-5. Conclusions. The FE MCP-1 values show that inflammation precedes the tubular dysfunction. FE MCSF and FE neopterin may be considered new markers of the renal parenchyma progressive damage. Fractional excretion may become a useful tool in the assessment of inflammation and tubular damage in children with CKD

Hypertension in children from a nephrological perspective - are there any differences between younger children and adolescents ?

Background. Hypertension (HTN) affects about 5% of children. Renal diseases are the major cause of HTN inpediatric patients, but the incidence of primary HTN is increasing. The aim of the study was to analyze the potentialdifferences between etiology of HTN, type of renal disease leading to HTN, clinical picture, laboratory test resultsor family history, with reference to patients’ age. Material and methods. Medical records of 112 patients (27 children < 11 years and 85 adolescents > 11 years),diagnosed with hypertension in the Department of Pediatric Nephrology, were analyzed. Family history, aetiologyof HTN, clinical course and laboratory results were compared, regarding the patients’ age. Results. HTN secondary to renal disease prevailed over the primary one in younger children. Major causes of renalHTN differed with age. In children under 11 anomalies in the urinary tract were dominant, in teenagers — glomerulopathies. In adolescents, the incidence of primary HTN was higher than in the younger patients and becamecomparable to that of secondary HTN. Patients with primary HTN, irrespective of their age, had higher BMI andmore frequent positive family history of HTN. Clinical symptoms, except for headaches prevalent in adolescents,did not depend on age. Conclusions. In paediatric patients, hypertension secondary to renal diseases is more frequent than the primaryone. The incidence of primary HTN is increasing with age and occurs in adolescents more often than in youngerchildren. The clinical course is usually asymptomatic and may delay the diagnosis, especially in the youngest patients.Introduction: Hypertension (HTN) affects about 5% of children. Renal diseases are the major cause of HTN in pediatric patients, but the incidence of primary HTN is increasing. The aim of study was to analyze the potential differences between etiology of HTN, type of renal disease leading to HTN, clinical picture, laboratory test results or family history, with reference to patients’ age. Material and methods: Medical records of 112 patients (27 children 11 years), diagnosed for hypertension in the Department of Pediatric Nephrology, were analyzed. Family history, etiology of HTN, clinical course and laboratory results were compared, regarding the patients’ age. Results: HTN secondary to renal disease prevailed over the primary one in younger children. Major causes for renal HTN differed with age. In children under 11 anomalies in the urinary tract were dominant, in teenagers – glomerulopathies. In adolescents, the incidence of primary HTN was higher than in the younger patients and became comparable to that of secondary HTN. Patients with primary HTN, irrespective of their age, had higher BMI and more frequent positive family history of HTN. Clinical symptoms, except for headaches prevalent in adolescents, did not depend on age. Conclusions: In pediatric patients, hypertension secondary to renal diseases is more frequent that the primary one. The incidence of primary HTN is increasing with age and occurs in adolescents more often than in younger children. The clinical course is usually asymptomatic and may delay the diagnosis, especially in the youngest patients

Aggression against medical personnel in perception of nursery students : tool suggestion

Agresja pacjentów i ich rodzin stanowi poważny problem w pracy personelu medycznego. Agresja powoduje wiele psychologicznych reakcji: od poczucia winy przez lęk do złości i wściekłości. Efekt długofalowy stanowi pogorszenie jakości opieki zdrowotnej powiązane z wypaleniem zawodowym personelu. Celem pracy była adaptacja skali IMPACS, służącej do oceny konsekwencji agresji wobec pielęgniarek. Badaniem objęto 102 studentki III roku pielęgniarstwa. Narzędzie badawcze stanowiła adaptacja skali IMPACS. W celu uzyskania polskiej wersji narzędzia zastosowano metodę eksploracyjnej analizy czynnikowej. Przedstawiono dwa warianty analizy - trzy- i dwuczynnikowe. W badaniu wykazano różnice w rozbieżnościach pomiędzy oryginalną wersją skali i uzyskaną w badaniach. Wskazuje to na różnice w postrzeganiu agresji i jej konsekwencji w zależności od wpływu kultury i miejsca pracy.Aggression of patients and their families poses a serious problem in the work of medical personnel. Violence in relationships causes a number of psychological reactions of carers: from a sense of guilt through fear to anger and rage. A long-term effect is a decline in health care quality connected with occupational burnout of the personnel. The aim of the research was adaptation of the IMPACS scale: a tool for evaluation of the consequences of aggression towards nurses. The research covered 102 students of nursery. The research tool used in the research was adaptation of IMPACS scale. In order to obtain the scales of the Polish version of the tool, the exploratory factor analysis method was used. Two variants of the analysis results were demonstrated, i.e. with three and two factors. The study demonstrates the divergence between the original version and the one developed as a result of the present research. It means that the perception and consequences of aggression depend on the influence of culture and workplace

Recommendations of Polish Society Paediatric Nephrology for the management of the child with nephrotic syndrome

Polskie Towarzystwo Nefrologii Dziecięcej opracowało pierwsze zalecenia dotyczące postępowania z dzieckiem z zespołem nerczycowym. Wytyczne, przygotowane przez doświadczonych nefrologów dziecięcych z różnych polskich ośrodków specjalistycznych, powstały na podstawie dostępnych zaleceń europejskich oraz amerykańskich oraz wyników badań i metaanaliz o wysokim stopniu wiarygodności. Wytyczne nie powinny być odczytane jako nakaz postępowania. Ich celem jest wsparcie dla lekarzy zajmujących się dziećmi z chorobami nerek w ich wyborze najlepszej dla danego dziecka opcji diagnostycznej oraz terapeutycznej. Zalecenia będą w najbliższych latach regularnie aktualizowane, aby przybliżyć lekarzom informacje wynikające z postępu dokonującego się w dziedzinie glomerulopatii.The Polish Society for Paediatric Nephrology has prepared the society’s first recommendations on the management of the child with a nephrotic syndrome. The recommendations have been put together by a representative group of experienced pediatric nephrologists. They are based on existing European and American guidelines and the results of reliable published trials and meta-analyses. Their aim is to aid the physician in their independent choice of the best strategy available for the diagnosis and treatment of an individual child with NS. Due to the rapid progress in the field of glomerulonephritis the recommendations will be regularly updated by the Society in the coming years

Novel Venetin-1 nanoparticle from earthworm coelomic fluid as a promising agent for the treatment of non-small cell lung cancer

The present research shows the antitumor activity of a protein-polysaccharide complex Venetin-1 obtained from the coelomic fluid of Dendrobaena veneta earthworms against A549 cancer cells. The investigations are a continuation of experiments on the antitumor activity of coelomic fluid obtained from this species. The Venetin-1 nanoparticle was obtained after thermal treatment of the coelomic fluid, separation from coelomocytes, filtration, and lyophilization. The preparation showed a selective effect on cancer cells, whereas normal cells were unaffected. Venetin-1 was effective against the lung cancer cells at doses of 31.3 and 62.5 µg/ml, and the results were imaged using light microscopy and scanning electron microscopy (SEM). The cells died mainly via the apoptosis pathway. Necrotic cells appeared sporadically in the microscopic view. SEM imaging revealed complete destruction of the A549 cells after the incubation with Venetin-1. The atomic force microscopy (AFM) analyses showed changes in the topography, peak force error images, and Young’s modulus (elasticity) of the A549 cells after the incubation with Venetin-1. The transmission electron cryomicroscopy (Cryo-TEM) analysis indicated a polymeric nature of the analyzed preparation. The samples of Venetin-1 showed a very homogeneous size profile with the microparticle size of approximately 58.23 nm. A significant decrease in Venetin-1 binding to sphingomyelin was observed. Venetin-1 lost its pore-forming activity or deactivation of the pore-forming activity occurred. This confirms the absence of hemolytic capacity of Venetin-1 towards red blood cells. The conducted analyses show the suitability of the obtained complex for biomedical research. The next step will consist in analyses of the effect of Venetin-1 on the immune system in mice

Heat shock proteins in chronic kidney disease

Heat shock proteins (HSP) form a heterogenous, evolutionarily conserved group of molecules with high sequence homology. They mainly act as intracellular chaperones, protecting the protein structure and folding under stress conditions. The extracellular HSP, released in the course of damage or necrosis, play a pivotal role in the innate and adaptive immune responses. They also take part in many pathological processes. The aim of this review is to update the recent developments in the field of HSP in chronic kidney disease (CKD), in regard to three different aspects. The first is the assessment of the role of HSP, either positive or deleterious, in the pathogenesis of CKD and the possibilities to influence its progression. The second is the impact of dialysis, being a potentially modifiable stressor, on HSP and the attempt to assess the value of these proteins as the biocompatibility markers. The last area is that of kidney transplantation and the potential role of HSP in the induction of the immune tolerance in kidney recipients