Characteristics of adverse side effects of corticosteroid therapy in children with nephrotic syndrome and methods of pharmacological correction

The article discusses the issues of the long-term glucocorticosteroid therapy in children with nephrotic syndrome that results in severe adverse side effect

БЕЗОПАСНОСТЬ ДЛИТЕЛЬНОЙ ГЛЮКОКОРТИКОСТЕРОИДНОЙ ТЕРАПИИ У ДЕТЕЙ С НЕФРОТИЧЕСКИМ СИНДРОМОМ

Background: Long-term corticosteroid therapy in children leads to plenty of adverse effects with negative influence on health. Objective: analysis of adverse effects of corticosteroids in children with steroid-sensitive  nephrotic syndrome and development of recommendations of their early detection.Methods: A retrospective study is conducted on children with this syndrome aged 3–18 who applied to Voronezh Regional Children’s Clinical Hospital № 1 in 2011–2014.  Complications  of corticosteroid  therapy revealed during clinical examination of children were taken into account. Data on 118 healthy children examined in 2012–2014 were used to calculate integral index.Results: The study analyses treatment results of 18 children who received glucocorticosteroids  during 6 months before hospitalization and 13 children who were withdrawn from glucocorticosteroids  for 6 months or more before hospitalization. Among adverse reactions in group 1 there prevailed overweight/obesity  (78%), reactive pancreatitis (72%), leukemoid reactions (67%), liver damage (61%), Cushingoid syndrome (44%), chronic gastroduodenitis  (33%). Hyperglycemia (11%), hypertension (6%) and infection (6%) were less common. In group 2 only 2 (15%) patients had chronic gastroduodenitis,  other complications were not documented. Indices that change in children with nephrotic syndrome during corticosteroid treatment (body mass index, blood serum glucose and amylase) were measured by a single scale using modifications coefficients. Average value of the coefficients is suggested to be a new diagnostic criterion (metabolic reaction index) which allows to reveal corticosteroid adverse effects before any clinical manifestations.Conclusion: Most adverse reactions of glucocorticosteroids are short-term and continue after 6 months in a small number of patients.Длительная  глюкокортикостероидная терапия у детей с нефротическим синдромом является причиной развития многочисленных побочных реакций, негативно влияющих на здоровье ребенка.Цель исследования — изучить нежелательные побочные реакции  глюкокортикостероидной терапии  у детей  со стероидчувствительным  нефротическим  синдромом и разработать  рекомендации по их раннему выявлению.Методы.  В ретроспективном  исследовании  изучали результаты лечения детей в возрасте 3–18 лет со стероидчувствительным  нефротическим синдромом, госпитализированных  в стационар в 2011–2014  гг. Учитывали  осложнения  терапии, выявленные при клинико-лабораторном и инструментальном обследовании.  Для расчета интегрального  индекса метаболических реакций использовали данные 118 здоровых детей,        165 обследованных  в 2012–2014 гг.Результаты. Проанализированы  данные 18 детей, получавших глюкокортикостероиды в течение 6 мес до госпитализации,  и 13 детей, завершивших лечение  глюкокортикостероидами за 6 мес и более  до госпитализации.  У больных первой группы в числе побочных реакций чаще всего определяли избыточную массу тела или ожирение  (78%), реактивный панкреатит (72%), лейкемоидные  реакции (67%), поражение  печени (50%), кушингоидный синдром (44%) и хронический гастродуоденит (33%). Относительно редко встречались гипергликемия (11%), артериальная гипертензия (6%), инфекционное  заболевание  (6%). У больных второй группы только  у 2 (15%) сохранялись проявления хронического гастродуоденита. На основании значений индекса массы тела, уровня глюкозы и амилазы сыворотки крови рассчитывали  индекс метаболических  реакций — интегральный  показатель  риска возникновения  побочных эффектов глюкокортикостероидой терапии.Заключение. Большинство побочных реакций глюкокортикостероидной терапии являются краткосрочными и сохраняются по прошествии 6 мес у небольшого числа больных

Markers of Chronic Kidney Disease in Children with Obstructive Uropathy or Vesicoureteral Reflux

Background. Identification of markers of chronic kidney disease and its progression in the early stages of the disease is important, however, the most of research concerns late (3–5) stages of the disease.Objective. Identification of the markers of chronic kidney disease (CKD) and its progression in the early stages of the disease in children with obstructive uropathy and vesicoureteral reflux.Methods. Prospective follow-up (for 5 years) of 92 children with obstructive and reflux uropathies (1st to 4th stages of CKD). All patients had episodes of urinary tract infections, mostly pyelonephritis, minimum once a year.Results. High prevalence of proteinuria (60.9%), reduced renal functional reserve (88.7%) and disorders of cortical renal blood flow (by Doppler Color Flow Imaging) (69.6%) were found in children with 1st stage of CKD. Groups of children with proteinuria and a reduced renal functional reserve had a higher level of systolic and diastolic blood pressure in comparison with the patients without proteinuria and the reduced renal functional reserve (p < 0.05). In patients with 2–4 stages of CKD the glomerular filtration rate (GFR) correlated with atypical flora in the etiology of urinary tract infections (rpb = 0.66; n = 23; p = 0.0006), sex (boys had lower levels of GFR, rpb = 0.61; n = 23; p = 0.001), bilateral renal abnormalities (rpb = -0.53; n = 23; p = 0.009) the level of hemoglobin (r = 0.45; n = 23; p = 0.02). Conclusion. Markers of CKD of children with obstructive and reflux uropathies are: proteinuria, arterial hypertension, reduction of renal functional reserve and the impaired cortical renal blood flow (by Doppler Color Flow Imaging). The importance of arterial hypertension and proteinuria as markers of the progression of CKD of children with urinary tract obstruction and vesicoureteral reflux was confirmed. Additional markers for the progression of CKD in children with obstructive and reflux uropaties might be: male sex, bilateral renal abnormalities, anemia and atypical bacteriuria during relapses of urinary tract infections

ADVERSE EFFECTS OF LONG-TERM CORTICOSTEROID THERAPY OF NEPHROTIC SYNDROME IN CHILDREN

Background: Long-term corticosteroid therapy in children leads to plenty of adverse effects with negative influence on health. Objective: analysis of adverse effects of corticosteroids in children with steroid-sensitive  nephrotic syndrome and development of recommendations of their early detection.Methods: A retrospective study is conducted on children with this syndrome aged 3–18 who applied to Voronezh Regional Children’s Clinical Hospital № 1 in 2011–2014.  Complications  of corticosteroid  therapy revealed during clinical examination of children were taken into account. Data on 118 healthy children examined in 2012–2014 were used to calculate integral index.Results: The study analyses treatment results of 18 children who received glucocorticosteroids  during 6 months before hospitalization and 13 children who were withdrawn from glucocorticosteroids  for 6 months or more before hospitalization. Among adverse reactions in group 1 there prevailed overweight/obesity  (78%), reactive pancreatitis (72%), leukemoid reactions (67%), liver damage (61%), Cushingoid syndrome (44%), chronic gastroduodenitis  (33%). Hyperglycemia (11%), hypertension (6%) and infection (6%) were less common. In group 2 only 2 (15%) patients had chronic gastroduodenitis,  other complications were not documented. Indices that change in children with nephrotic syndrome during corticosteroid treatment (body mass index, blood serum glucose and amylase) were measured by a single scale using modifications coefficients. Average value of the coefficients is suggested to be a new diagnostic criterion (metabolic reaction index) which allows to reveal corticosteroid adverse effects before any clinical manifestations.Conclusion: Most adverse reactions of glucocorticosteroids are short-term and continue after 6 months in a small number of patients

Psychological features of mothers who have given birth to premature infants

Psychological features of mothers who have given birth to premature babies present one of the most complex and insufficiently explored areas of modern perinatal psychology. The progressive increase of the children born before the term as well as the insufficient development of psychological care programs for mothers at the women's consultation and nursing departments of newborns dictate the urgency and necessity of this problem. Using psychological techniques, the authors comprehensively assessed the personality characteristics, motives for the pregnancy preservation, personal and situational anxiety of mothers of premature babies at Perinatal Center №.1. The assessment revealed that the mothers with premature low-birth-weight babies experienced a sharp increase in situational anxiety compared to personal anxiety, while the mothers of full-term babies with a normal weight tended to decrease the level ofsituational anxiety. In addition, the mothers of premature babiessufferfrom expressed and severe depression more often than the mothers of full-term babies(p<0.05)

Diastolicheskaya funktsiya miokarda i avtonomnaya kardial'naya neyropatiya u detey pri sakharnom diabete tipa 1

Цель: изучение характера взаимосвязи изменений ДФ сердца и начальных стадий АКН , а также уточнение сроков их проявлений у детей с СД Материалы и методы: Обследован 61 ребенок (30 мальчиков и 31 девочка) в возрасте от 10 до 16 лет (средний возраст 13 ?1,2 лет) ?со стажем? СД от впервые выявленного заболевания до 12 лет. Все дети находились в состоянии декомпенсации без кетоацидоза: уровень гликозилированного гемоглобина составил 8-21%, уровень глюкозы крови ? 6-15 мМ/л, глюкозурии - 0-2%. Все больные были нормотензивными, имели нормальные показатели ЭКГ без признаков миокардиодистрофии и не предъявляли жалоб со стороны сердечно-сосудистой системы. Ни у кого из детей не было тахикардии покоя. В качестве контрольной группы обследованы 11 здоровых детей аналогичного возраста. Для оценки зависимости выявленных изменений от длительности заболевания дети были разделены на группы с впервые выявленным диабетом с давностью СД 1 год, 2-3 года и т.д., с интервалом в 2 года. Результаты: При оценке параметров Д Ф Л Ж в группах детей с давностью СД более 5 лет выявлено значимое увеличение показателей ТМП в фазу систолы предсердий (А), увеличение ФП Н и снижение соотношений Е/А и Ei/Ai по сравнению с контрольной группой и детьми с СД и давностью болезни 1 год (ФПН после 7 лет диабета был значимо выше , чем у детей с длительностью заболевания 2-3 года). В группе детей с длительностью СД 10 лет показатель А был значимо выше, чем в группах больных с продолжительностью диабета до 5 лет. Значения Ai повышались после 7 лет от начала заболевания

Trends in the physical development indicators of 14-year-old adolescents in the Voronezh Region

The paper presents the results of statistical (sigma and percentile) analysis of height and weight in 434 boys and girls aged 14 years from the Voronezh Region in 2011 —2012. The girls' height was comparable with the regional indicators of physical development in the children of the Voronezh Region (1997—1999). The boys' height was characterized by a wide scatter of the obtained values; but there was an increase in the mean values as compared to the 1997—1999 data. Examinations of the boys and girls revealed a wide scatter in their weight with its increasing tendency. The performed examinations indicate the need for revision of the regional height and weight values for teenagers every ten years