Disturbed skin barrier in children with chronic kidney disease

BACKGROUND: There are limited data on skin lesions in children with end-stage renal failure. The aim of the study was an evaluation of the skin barrier in children with different stages of chronic kidney disease (CKD). The prevalence of xerosis, its severity, as well as its link selected demographic factors, were examined. METHODS: The study included 103 children: 72 with CKD stages 3–5 (38 on conservative treatment and 34 on dialysis) and 31 patients with primary monosymptomatic nocturnal enuresis as a control group. Initially, the study subjects described the localisation and severity of dry skin by themselves. Next, clinical evaluation of xerosis, non-invasive corneometric assessment of epidermis moisturising and the measurement of transepidermal water loss were performed. RESULTS: Most CKD children reported dry skin. The problem of xerosis was identified more frequently in patients on dialysis (67.6 %) than on conservative treatment (42.1 %) (p = 0.01). CKD patients divided according to skin dryness did not differ with regards to age, sex, initial kidney disease and CKD duration. CONCLUSIONS: Disturbed skin barrier is an important concern of children with CKD, intensifying as the disease progresses. This symptom occurs on early stages of CKD and it should be taken into consideration in the CKD management

Impact of the volume and the profile of volatile fatty acids in the rumen fermentation on cow productivity and milk composition

Cilj ovog rada bio je utvrditi odnose između odabranih produkata fermentacije u buragu i sastava mlijeka muznih krava. Istraživanje je provedeno na 10 krava pasmine holstein-friesian. Životinje su držane u slobodnom stajskom uzgoju i hranjene TMR-om. Produktivnost stada određena je pomoću A4 metode, a podaci o sastavu mlijeka dobiveni su iz centralnog sustava praćenja. Ferment iz buraga izuzet je pomoću želučane pumpe 2 sata nakon jutarnje hranidbe smjesom TMR. Izuzeti uzorci razrijeđeni su puferom i homogenizirani, a dobivena suspenzija je analizirana pomoću plinskog kromatografa opremljenog s FID detektorom kako bi se odredila koncentracija ukupnih, kao i udjeli pojedinačnih hlapivih masnih kiselina (VFA). Sastav mlijeka preuzet je iz zapisa sustava praćenja RW-1, a koeficijent korelacije prema Pearsonu je izračunat iz dobivenih parametara. Utvrđeno je da se odnos propionat/butirat u fermentu buraga povećava s povećanjem udjela proteina i proteinskih frakcija u mlijeku. Koeficijent iskoristivosti hlapivih masnih kiselina u fermentu buraga pokazao je pozitivnu korelaciju s udjelom proteina i negativnu korelaciju s koncentracijom kazeina u mlijeku. Procesi koji se odvijaju u kravljem buragu značajno utječu na sastav i kvalitetu mlijeka. Spoznaje o ukupnom sadržaju kao i sadržaju pojedinih hlapivih masnih kiselina omogućuju podešavanje upravljanja fermentacijom u buragu u svrhu dobivanja boljih tehnoloških svojstava mlijeka.The aim of the research was to establish relations between the selected rumen fermentation products and the milk composition in dairy cows. The experiment was conducted on 10 Polish Holstein-Friesian cows of black and white variety. The animals were kept in the free stall housing system and fed with the total mixed ration (TMR). The herd’s milk production was assessed using the A4 method and the milk analyses were obtained from the milk recordings. The rumen digesta were sampled two hours after the morning delivery of TMR using a stomach pump. The sampled digesta were diluted with buffer, homogenized and the obtained suspension was analysed using gas chromatograph with the FID detector to determine the total concentration of volatile fatty acids (VFA) and the percentage of individual VFAs. Milk composition was obtained from the RW-1 reports, and the Pearson correlation coefficient was calculated for the obtained parameters. It was determined that propionate and the relation of propionate to butyrate in the rumen digesta increased the protein content and its fractions in milk. The volatile fatty acids utilization coefficient in the rumen digesta a positive correlation to protein contents and a negative correlation to the level of caseins in milk were shown. Processes taking place in the cow rumen significantly influence the composition and quality of milk. The knowledge of volatile fatty acids content and the of individual VFAs allows for the management of the rumen fermentation in order to obtain better technological parameters of milk

Filter size not the anticoagulation method is the decisive factor in continuous renal replacement therapy circuit survival

Background/Aim: As continuous renal replacement therapy (CRRT) has emerged as a standard therapy in pediatric intensive care units (PICU), many related issues that may have an impact on circuit survival have gained in importance. Objective of the study was an evaluation of factors associated with circuit survival, including anticoagulation (ACG). Methods: Retrospective study that included 40 patients, who in total received 7636 hours of CRRT during 150 sessions (84 filters, 4260 hours with heparin anticoagulation (Hep-ACG); 66 filters, 3376 hours with regional citrate anticoagulation (RCA)). Results: The Kaplan-Meier analysis of the total circuit survival time depending on the type of ACG did not demonstrate a significant difference between Hep-ACG and RCA. The percentage of clotted filters was significantly higher in case of smaller filters (HF20: 58.8%; ST60: 29.5%; ST100: 15.8%), and their lifetime was significantly lower regardless of ACG (the mean and median lifetime for HF20: 38.7/27.0 h; for ST60: 54.1/72.0 h., for ST100: 62.1/72.0 h, respectively). Conclusions: Irrespectively of filter size, filter clotting occurs within the first 24 hours after the initiation of CRRT. Most commonly, clotting affects small filters, and their lifetime is significantly shorter as compared to larger filters regardless of the type of the ACG

Can we further improve the quality of nephro-urological care in children with myelomeningocele?

Myelomeningocele (MMC) results from a failure of normal neural tube fusion in early fetal development. Retrospective, observational study of medical data of 54 children treated in Pediatric Nephrology and Urology Clinics for five years was performed. The following data were analyzed: serum creatinine, eGFR, urine analysis, renal scintigraphy (RS), renal ultrasound, and urodynamics. Mean age of studied population: 12.3 years, median of eGFR at the beginning and at the end of survey was 110.25 and 116.5 mL/min/1.73 m2 accordingly. Median of frequency of urinary tract infections (fUTI): 1.2 episodes/year. In 24 children: low-pressure, in 30 children: high-pressure bladder was noted. Vesicouretral reflux (VUR) was noted in 23 children (42.6%). fUTI were more common in high-grade VUR group. High-grade VURs were more common in group of patients with severe renal damage. At the end of the survey 11.1% children were qualified to higher stages of chronic kidney disease. Renal parenchyma damage progression in RS was noted in 22.2% children. Positive VUR history, febrile recurrent UTIs, bladder wall trabeculation, and older age of the patients constitute risk factors of abnormal renal scans. More than 2.0 febrile, symptomatic UTIs annually increase by 5.6-fold the risk of severe renal parenchyma damage after five years

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