No abstract

Background. 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 the 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 and 85 adolescents > 11 years), diagnosed with hypertension in the Department of Pediatric Nephrology, were analyzed. Family history, aetiology 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 of 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 paediatric patients, hypertension secondary to renal diseases is more frequent than 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.

The majority of recently published studies indicate a greater incidence rate and mortality due to Clostridioides difficile infection (CDI) in patients with chronic kidney disease (CKD). The aim of this study was to assess the clinical determinants predicting CDI among hospitalized patients with CKD and refine methods of prevention. We evaluated the medical records of 279 patients treated at a nephrological department with symptoms suggesting CDI, of whom 93 tested positive for CDI. The survey showed that age, poor kidney function, high Padua prediction score (PPS) and patients’ classification of care at admission, treatment with antibiotics, and time of its duration were significantly higher or more frequent among patients who suffered CDI. Whereas BMI, Norton scale (ANSS) and serum albumin concentration were significantly lowered among CDI patients. In a multivariate analysis we proved the stage of CKD and length of antibiotics use increased the risk of CDI, whereas higher serum albumin concentration and ANSS have a protective impact.

Eggs are among the most common and easily obtainable foods in the market. They provide wide and optimally balanced range of nutrients. Eggs cover all protein needs thanks to having all necessary amino acids – both endogenous and exogenous ones. Eggshells, a good source of minerals such as calcium, are used in food industry too. However, eggs used to be limited in every daily diet because they contained significant amounts of cholesterol. Although fatty acids in eggs have good ratio of saturated and unsaturated ones and they enable vitamins A, D, E and K to be easily absorbed by human digestive system, the cholesterol was often accused of increasing risk of cardiovascular diseases. Numerous researches on that topic did not definitely confirmed or disclaimed that. Nevertheless, American Heart Association no longer recommends reducing eating eggs. Eggs having almost perfect composition of nutrients if not eaten too often can for sure be a part of a balanced diet.

Background and Aims Aging, renal pathology (eg SLE, ADPKD), X-ray exposition and pharmacological treatments, especially previous immunosuppressives, may negatively influence the ovarian reserve in childbearing age women. Anti-Müllerian hormone (AMH) is regarded as biomarker for ovarian reserve. The aim was to assess influence of immunosuppressive therapy, X-ray exposition and renal pathology on ovarian in female patients with normal menstrual cycle and chronic kidney disease, including kidney transplant recipients. Method Consecutive premenopausal females visiting renal outpatient setting at university hospital who gave informed consent and met exclusion criteria (past ovarian surgical procedure, PCOS, eGFR &lt;30ml/min, diabetes) were enrolled in cross-sectional study. Clinical (renal pathology, smoking, X-rays exposition, eGFR standardized MDRD4, contraceptives) and demographic characteristics, as well as previous and current therapies were recorded. Serum AMH levels were measured by enzyme-linked immunosorbent assay; AMH levels were classified as low or normal/above age-adjusted reference levels (published norms). Results In cohort of consecutive 153 premenopausal females (mean age 32,2 y.,range 18-45), 83 (54,2%) were treated recently with antiproliferation immunosuppressive regimen (mycophenolate/azathioprine/methotrexate) and 39 (25,5%) had received cyclophosphamide (CYC) in the past. Median eGFR was 68,5 (IQR 54, 82) ml/min/1.73m2 and renal pathology were as follows glomerulonephritis (n=75), lupus nephritis (n=42), ADPKD (n=6), interstitial (n=5), vasculitis (n=7), other/unknown (n=18). 55 patients were kidney transplant recipients. Median AMH concentration was 2,9 ng/ml (IQR 1,0 ; 5,2); AMH levels were classified in 45 females as low (median 0,64 IQR 0,05; 1,84) and in 108 as normal/above age-adjusted reference (median 4 IQR 2,1; 5,9). AMH levels did not differ between patients treated with or without antiproliferation immunosuppressives (2.6 IQR 0,9; 5,0  vs. 3.2  IQR 1,1; 5,2 ng/ml, p=0.33) or as well as between being kidney transplant recipients or not (2.72  IQR 0,8; 4,0 vs. 3,0 IQR 1,15; 5,0 ng/ml, p=0.08). Referring to CYC exposition, AMH levels were lower in females treated with CYC regardless of reason (1.1 ± 1.4 ng/ml vs. 3.2 ± 2 ng/ml, p=0.003). Linking AHA level with renal disease, only lupus patients showed low age-adjusted AMH levels ( 18/42 – 43%), especially with history of CYC exposition (11 of 18 with low level). Significant negative correlation was found between AMH level and age (r -0,45, p&lt; 0,0001), and very weak with eGFR (r 0,2, p=0,005). Conclusion Almost 1/3 of studied childbearing age women with chronic kidney disease (eGFR &gt;30) showed a reduction of the ovarian reserve. It was associated with underlying disease (lupus), cyclophosphamide treatment but not with cumulative X-ray exposition, contraceptives or smoking. Further studies on biomarkers of ovarian reserve in renal patients are still needed for better therapeutic strategy and family planning.