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This paper presents a case of urosepsis caused by Escherichia coli in an 11-year-old girl with a neurogenic bladder. The patient had not previously been supervised by a nephrologist or urologist. On admission, significantly elevated serum markers of inflammation (C-reactive protein 32.4 mg/dl, procalcitonin 64.2 ng/ml), kidney failure (creatinine 6.9 mg/dl, pH 7.22, HCO3 6.3 mmol/l), and increased serum urea (399 mg/dl) were detected. Antibiotic therapy with rehydration was started and improved renal function without dialysis. However, a 9-cm-long perirenal abscess site was diagnosed. It required surgical treatment, which was complicated by an anaphylactic reaction to latex. Colitis caused by Clostridium difficile was also diagnosed. Hospital treatment lasted 38 days. After 4 months the patient's glomerular filtration rate was 66 ml/min/1.73 m² and indicated stage 2 chronic kidney disease. Because early diagnosis of urinary tract infection is crucial for preventing complications in children with neurogenic bladder, they should undergo regular nephro-urological care. [ABSTRACT FROM AUTHOR]

Background/Aims. The aim was to evaluate the level of neutrophil gelatinase-associated lipocalin (NGAL), interleukin 18 (IL-18) and retinol binding protein (RBP) in children with primary hypertension and no features of hypertensive nephropathy. Methods. The study group consisted of 19 children (15 males) aged 14.8 ± 2.18 years with primary hypertension. Estimated glomerular filtration rate (eGFR) and albumin/creatinine ratio (ACR) were within the normal range. Mean blood pressure (BP) was 141/79 mmHg (mean systolic BP percentile was 98, mean diastolic BP percentile was 80). Ambulatory BP measurement (ABPM), blood and urine biochemical measurements and features of end organ damage were assessed. The control group consisted of 20 healthy children. Results. Hypertensive children showed significantly increased serum and urine NGAL concentration vs controls. Urine RBP was significantly higher in the study group vs controls. A positive correlation was found between urine NGAL and the index of mean systolic BP measured in ABPM, between urine IL-18 and the index of office diastolic BP, between serum NGAL and ACR, and between urine NGAL concentration and serum HDL. Conclusion. In children with primary hypertension, increased serum and urine NGAL may reflect kidney injury earlier than typical markers of hypertensive nephropathy. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic kidney disease (CChN) is one of the most important complications of diabetes. The risk of kidney damage in type 1 diabetes mellitus (DM1) increases during adolescence, especially in female patients. Aim of the study: Assessment of the kidney damage and glycemic control according to gender in normoalbuminuric adolescents with DM1. Materials and method: The study included 63 children suffering from DM1 (35 girls and 28 boys, mean age 13.46±2.75 years). All children were in the IInd and IIIrd stage of puberty according to Tanner and Marshall scale. All patients presented normal albumin/creatinine ratio (ACR) and glomerular filtration rate above 90 ml/min/1.73 m2. GFR was estimated using modified Schwartz et al. formula (GFRSch) as well as Filler formula (GFRF). Results: Female patients compared to males showed a significantly higher level of ACR, GFRF, glycated hemoglobin (HbA1c) and C-reactive protein (CRP). GFRSch values were similar in both groups. Among girls the negative correlation was found between duration of diabetes and GFRF and positive correlation between GFRF and GFRSch. In the male group the positive correlation between ACR and HbA1c values as well as GFRF and GFRSch was found. Conclusions: During puberty female gender is a group at risk of poor control of glycaemia and subsequent kidney damage. This damage as opposed to the boys seems to be independent of glycemic control. Glomerular filtration rate based on Filler formula may identify diabetic patients with the risk of glomerular hyperfiltration. Mild inflammation assessed by CRP may be involved in kidney damage in diabetic subjects. [ABSTRACT FROM AUTHOR]

Introduction: Systemic lupus erythematosus (TRU) is an autoimmune connective tissue disease that occurs much less frequently in children than in adults. Lupus nephritis (NT) is a major determinant of the prognosis. It occurs in 60-80% of cases and in most children it is very severe, requiring long-term therapy. Until now there are no treatment standards in children. The aim of the study: The aim of the study was to evaluate the results of the NT treatment in children receiving immunosuppressants, including mycophenolate mofetil (MMF). Material and methods: The study group consisted of 8 children (6 girls and 2 boys) hospitalized in the Department of Pediatric Cardiology and Nephrology, Poznań Medical University. The average age at onset was 13 years and 3 months. We analyzed clinical, laboratory and medical treatment. Results: 6/8 patients presented class IV, according to WHO classification. In 5/8 children lupus nephropathy occurred in the form of nephrotic and nephritic syndrome and 7/8 patients suffered from acute renal injury. The patients were treated with steroids, cyclophosphamide (CF), cyclosporine (C5A), plasmapheresis (PF), and mycophenolate mofetil (MMF, 5/8). After 6 months complete remission occurred in 6/8 patients. The best results were obtained after the application of intensive immunosuppressive therapy (CF+MMF). Conclusions: The use of MMF in NT may accelerate the achievement of remission, lead to a reduction CF pulses and prolong remission. [ABSTRACT FROM AUTHOR]

Background: The increase of circulating urokinase plasminogen activator receptor (suPAR) was demonstrated in various diseases showing its prognostic value as well as the link to the inflammatory reaction. In glomerular diseases, suPAR was considered a causative factor of proteinuria. In the present study we aimed to evaluate serum concentration of suPAR in children with primary and secondary glomerulonephritis (GN) and its association with disease severity., Methods: The study involved 22 children with minimal change disease (MCD), nine with primary focal segmental glomerulosclerosis (FSGS), seven with Henoch-Schönlein nephritis, seven with lupus nephritis (LN) and 16 controls., Results: Serum suPAR was significantly higher in children with FSGS and LN than controls (4.47±1.39 ng/mL vs. 3.23±0.76 ng/mL; P=0.011 and 6.17±1.12 ng/mL vs. 3.23±0.76 ng/mL, respectively; P<0.0001). Further, suPAR was increased in LN when compared to FSGS (P=0.031). In the total group suPAR showed negative correlation with eGFR, serum complement C3 and positive with left ventricular mass index. In children with MCD and FSGS the inverse association of suPAR with eGFR was also shown., Conclusions: In children with primary and secondary glomerulonephritis suPAR levels are not associated with proteinuria. In primary GN elevated suPAR levels may result from reduced eGFR reflecting renal damage. In LN circulating suPAR can be increased further indicating both multi-organ involvement and systemic inflammation reflecting disease severity.

Introduction: The aim of this study was to evaluate serum levels and urinary excretion of neutrophil-gelatinase associated lipocalin (respectively sNGAL and uNGAL) and urinary excretion of Cathepsin L (uCathL) in children with type 1 diabetes mellitus (DM1) who presented normoalbuminuria and the estimated glomerular filtration rate (eGFR) above 90 mL/min/1.73 m2., Material and Methods: The study group consisted of 63 children with a diabetes duration of 5.16 ± 3.39 years. The degree of albuminuria was based on urine albumin-to-creatinine ratio (ACR), while eGFR was based on serum cystatin C. Glomerular hyperfiltration (GH) was defined as an eGFR value above 135 mL/min/1.73 m2., Results: Children with DM1 showed significantly higher concentrations of uNGAL, and lower sNGAL and uCathL. Significant changes of uNGAL and uCathL levels were even found in children without GH and with optimal glycaemic control (HbA1c < 7.5%). Positive correlations between uNGAL, ACR and eGFR were shown, as well as between uCathL and eGFR., Conclusions: Significant changes in the concentration of markers of early kidney injury: sNGAL, uNGAL, and uCathL, can occur in children with DM1 and normoalbuminuria. The changes of uNGAL and uCathL can be even found in children without GH and with optimal glycaemic control. The earliest signs of diabetic kidney dysfunction seem to result from tubular damage.