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

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

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

Breast milk jaundice

Jaundice is the most common clinical symptom in the neonatal period. Free serum bilirubin levels during the first days after birth are higher than at any point later in life. Breastfeeding is associated with both increased risk and severity of jaundice. Early-onset breastfeeding jaundice is primarily a result of insufficient caloric supply and resolves gradually with the normalisation of lactation. Late-onset type, i.e. breast milk jaundice, develops after 4–7 days of life in otherwise healthy neonates and is mainly associated with the presence of an unknown factor in breast milk, which increases the enterohepatic reabsorption of bilirubin. Breast milk (late-onset) jaundice is the most common cause of persistent jaundice due to increased unconjugated bilirubin. Elevated conjugated bilirubin always indicates a pathological process and requires urgent diagnosis extension. It was believed until recently that breast milk jaundice is a mild condition, which never leads to central nervous system damage. This, however, is not entirely certain in the light of currently available scientific research; therefore it is necessary to monitor bilirubin levels. Since breast milk jaundice is a diagnosis of exclusion, it is usually preceded by differential diagnosis. In the case of breast milk jaundice, serum bilirubin levels will return to normal by 12–14 weeks of life. In the case of newborns/infants in good condition, who develop properly and gain weight systematically, supporting parents in effective breastfeeding, monitoring and regular check-ups of the child are recommended. Breast milk jaundice is not a contraindication to prophylactic vaccination

Assessment of changes in leptin and ghrelin levels, anthropometric and laboratory parameters before and after implantation of the gastric balloon

Introduction: Obesity is a syndrome characterized by weight gain over optimal weight which affects both adults and children. The aim of the study was to search for the relation between anthropometric parameters, lipid parameters, glucose, leptin and ghrelin concentrations in patients before and after the implantation of balloon–type gastric BIB (ORBERA). Material and methods: The material for the study was the whole blood derived from 45 people, including 35 women and 10 men voluntarily undergoing gastric balloon implantation. The concentration of glucose, total cholesterol, HDL and LDL, triglycerides, glucose, leptin and ghrelin were measured both before the implantation of the gastric balloon and after its removal. Simultaneously, the evaluation of anthropometric parameters such as body mass index (BMI), body fat distribution (WHR),% body fat and the excess weight loss/weight loss ratio EWL/WL) was done. Results: The statistical analysis showed a significant change of all measured parameters after gastric balloon implantation. There was a statistically significant decrease in variables such as body mass index (BMI), waist–to–hip ratio (WHR), % of body fat, excess weight loss/weight loss (ELW/WL), blood the concentration of glucose, cholesterol (total and LDL), triglycerides and leptin. Concentrations of HDL cholesterol and ghrelin increased significantly. Conclusion: The implantation of a balloon–type gastric BIB (ORBERA) has a beneficial effect on lipid parameters, glucose, leptin and ghrelin concentration. Moreover, it is connected with an the improvement of studied anthropometric parameters.Wstęp: Otyłość jest zespołem chorobowym cechującym się m.in. zwiększeniem masy ciała powyżej wartości optymalnej i dotyczy zarówno osób dorosłych, jak i dzieci. Celem pracy było poszukiwanie zależności między wskaźnikami antropometrycznymi, parametrami lipidogramu, stężeniami glukozy, leptyny oraz greliny u osób przed i po implantacji balonu żołądkowego typu BIB (ORBERA). Materiały i metody: Materiał do badania stanowiła krew pełna pochodząca od 45 osób, w tym 35 kobiet i 10 mężczyzn, dobrowolnie poddających się implantacji balonu żołądkowego. Zbadano stężenie glukozy, cholesterolu całkowitego, frakcji HDL i LDL, triglicerydów oraz stężenie leptyny i greliny oraz dokonano oceny parametrów antropometrycznych: wskaźnika masy ciała (BMI), wskaźnika dystrybucji tkanki tłuszczowej (WHR), % tkanki tłuszczowej oraz wskaźnika EWL/WL (ang. excess weight loss/weight loss) zarówno przed implantacją balonu żołądkowego, jak i po jego usunięciu. Wyniki: Analiza statystyczna wykazała istotną zmianę wszystkich mierzonych parametrów po implantacji balonu żołądkowego. Stwierdzono statystycznie istotny spadek wartości takich zmiennych, jak: BMI, WHR, % tkanki tłuszczowej, ELW/WL, stężenie glukozy, cholesterolu, triglicerydów, cholesterolu frakcji LDL i leptyny. Wartości stężenia cholesterolu frakcji HDL i greliny istotnie wzrosły. Wnioski: Zabieg implantacji balonu żołądkowego typu BIB (ORBERA) wpływa korzystnie na parametry gospodarki lipidowej, stężenia glukozy, greliny i leptyny, jak również wiąże się z poprawą badanych parametrów antropometrycznych

SARS-CoV-2 Infection as a Possible Trigger for IgA-Associated Vasculitis: A Case Report

Background: IgA-associated vasculitis (IgAV), formerly known as Henoch–Schönlein purpura (HSP) disease, is the most common type of systemic vasculitis observed during developmental age. Available published studies associate the outbreak of the disease with streptococci, adenovirus, parvovirus, mycoplasma, respiratory syncytial virus (RSV), and influenza infection in approximately 50% of patients with HSP, while some emerging reports have described a few cases of COVID-19 infection being associated with HSP in both adults and children. Case presentation: a 7-year-old girl was diagnosed with HSP, fulfilling the four required clinical criteria (palpable purpura and abdominal pain, arthralgia and edema, and periodic renal involvement). Infection with SARS-CoV-2 was confirmed via the presence of IgM and IgG antibodies. The disclosure of the Henoch–Schönlein purpura (HSP) disease was preceded by a mild, symptomatically treated infection of the upper respiratory tract. High levels of inflammatory markers were observed during hospitalization, including leukocytosis, an increased neutrophil count and a high neutrophil-to-lymphocyte ratio (NLR). All of these markers are associated with IgAV gastrointestinal bleeding, which was also associated with rotavirus diarrhea observed in the patient. Conclusions: This case presented by us and similar cases presented by other authors indicate the possible role of SARS-CoV-2 in the development of HSP, but this assumption requires further research and evidence-based verification