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Introduction: Acute kidney injury biomarkers are opening a new era in diagnosing kidney failure. The requirement for a specific and sensitive marker of kidney function is highly desirable in neonates because the diagnostic possibilities in this age group are not sufficient. Recent research show that neutrophil gelatinase-associated lipocalin (NGAL) can have a great potential but there is a wide range of medical conditions, that may influence their expression. The aim of the study was to evaluate the impact of perinatal risk factors on NGAL level in neonates. Material and methods : NGAL was measured in umbilical cord blood and peripheral blood in full term neonates with perinatal risk factors during the first days of life. Results : We found significantly higher umbilical cord blood NGAL levels in neonates with perinatal risk factors (117.69 ng/ml) compared to the control group (64.37 ng/ml). No significant difference in peripheral blood NGAL level was shown between the two groups. Umbilical cord blood NGAL level correlated positively with peripheral blood NGAL level (r = 0.36, p < 0.01). Umbilical cord blood NGAL level was significantly higher in neonates with fetal distress and infection compared to neonates with other perinatal risk factors. Peripheral blood NGAL level was significantly higher in neonates with infection compared to neonates with other perinatal risk factors. Significantly higher umbilical cord blood NGAL levels were seen in neonates born by operative delivery compared to born by natural delivery.

Background Advances in the treatment of chronic kidney disease (CKD) resulted in expanding therapy goals from simple prolongation of life to a return to normal social functioning and having an active and satisfactory life after reaching adulthood. Objectives The aim of the study was to evaluate life activity, disease acceptance (DA) and quality of life (QOL) in patients with end-stage renal disease (ESRD) treated with renal replacement therapy (RRT) since childhood. Material and methods We surveyed 117 patients aged .16 years on RRT since childhood. The control group included 25 healthy subjects. We used questionnaires that included a sociodemographic questionnaire (questions regarding education, work, family, and offspring), Acceptance of Illness Scale (AIS), Satisfaction With Life Scale, and Kidney Disease Quality of Life (KDQOL). Results A completed survey was returned by 45 respondents aged 27.16 }6.78 years, among whom 82.2% had a transplanted kidney and 17.8% were on hemodialysis (HD). Higher education was reported by 18.18% of respondents, secondary and primary by 63.64% and 18.18%, respectively. Employment was reported by 46.67% of the respondents. A family was started by 35% of women and 4% of men. Good DA was found in 28.9% of the respondents. Satisfaction with life was lower in the study group compared to the control group. We found statistically significant correlations between the age when the kidney disease was diagnosed and satisfaction with life (r = 0.33), and between the time since the last change of RRT modality and emotional well-being (r = 0.34). The number of kidney transplantations correlated negatively with emotional component of QOL (r = .0.66) and emotional well-being (r = .0.73). Conclusions Patients treated with RRT were quite well adapted to their chronic disease but showed less ability to live independently. Young age at the diagnosis of kidney disease, loss of kidney transplant and living on social security benefit had a negative effect on their emotional well-being.

Mycoplasma pneumoniae is one of the most common causes of respiratory tract infections in children. Extrapulmonary manifestations are seen in up to 25% of infected patients. Extrapulmonary complications are associated with the central nervous system, gastrointestinal tract, skin changes, myocarditis, pericarditis, hemolytic anemia, thrombocytopenia and thrombosis. The majority of extrapulmonary symptoms are associated with skin changes such as exanthematous skin eruptions, erythema nodosum, urticaria, Stevens-Jonson syndrome. M. pneumoniae stimulates production of the interleukins and tumor necrosis factor (TNF) α and can cause vasculitis. Henoch-Schonlein purpura (HSP) is a leucoclastic vasculitis that affects small vessels. Clinical manifestations of HSP include typical rash, arthritis, gastrointestinal and sometimes renal involvement. The main feature in HSP is abnormal IgA deposits in vessel walls. Circulating abnormal glycosylated IgA 1 and IgG antibodies form immune complexes: IgA1-IgG and anti-IgA 1. Immune complexes activate cytokines, parts of complement and influence directly the endothelium. We report cases of three children with Henoch-Schonlein purpura with prolonged and recurrent skin and joint changes. The serological analysis (positive serum IgM) confirmed Mycoplasma pneumoniae infection. Treatment with clarithromycin caused complete regression of disease. We suggest that in the case of prolonged symptoms of vasculitis due to Henoch-Schonlein purpura, Mycoplasma pneumonia infection may be a potential cause of exacerbation of the disease.

StreszczenieNieprawidłowości dróg moczowych u płodu są jednym z najczęściej stwierdzanych odchyleń podczas wykonywanych prenatalnie badań ultrasonografi cznych. Bardzo istotne jest takie zaplanowanie postępowania u noworodka i niemowlęcia, aby odpowiednio szybko wyłonić i objąć właściwą opieką grupę dzieci wysokiego ryzyka zakażeń i postępu choroby nerek. Takie działanie wymaga współpracy wielospecjalistycznej i wspólnych dla pediatrów, neonatologów i lekarzy rodzinnych schematów postępowania. Niniejszy artykuł powstał na podstawie opracowanych przez Polskie Towarzystwo Nefrologii Dziecięcej i dotyczy działań, jakie należy podjąć u dziecka z prenatalnie wykrytym poszerzeniem dróg wyprowadzających mocz.AbstractMalformations of urinary tract in fetus are one of the most often abnormalities detected by prenatal ultrasound screening. It is of great importance to establish adequate diagnostic plan of postnatal evaluation and selection of patients at high risk of complications, urinary tract infections or kidney failure progression. Adequate diagnosis requires strict cooperation of specialists: paediatrician, neonatologist and family doctors with common guidelines. The paper is based on Guidelines of Polish Society for Paediatric Nephrology and concerns postnatal evaluation of dilatation of the urinary tract in fetus and newborn.

BACKGROUND Diarrhea-associated hemolytic uremic syndrome (HUS D+) caused by verotoxigenic E. coli strains (VTEC) is a major cause of acute kidney injury in children between 1 and 5 years of age. Because of the short presence of VTEC in the gastrointestinal tract as well as difficulties with the detection of the verotoxigenic strain, identification of HUS etiology might be challenging. OBJECTIVES The aim of the study was to assess the clinical and diagnostic value of serological tests for specific antibodies against verotoxigenic strains of E. coli in patients with HUS. MATERIAL AND METHODS Eight children aged 8 months - 7.1 years (mean 40 ± 29 months) with symptoms of acute kidney injury, hemolytic anemia and thrombocytopenia observed after hemorrhagic diarrhea were included to the study. VTEC presence was detected in a stool culture with subsequent analysis of the ability to produce verotoxin and the presence of VT1 and VT2 as well as intimin and enterohemolysin genes. In addition, the presence of specific IgA, IgM and IgG antibodies against E. coli serogroups O26, O103, O104, O111, O121, O145 and O157 was measured using ELISA. RESULTS In 3 subjects, VTEC O26, O157 and O104 serogroups were cultured in the stool and the specific IgA, IgM and IgG antibodies were detected. In 4 subjects, no VTEC strains were cultured, however, high titers of IgA, IgM and IgG antibodies against E. coli O26, O157 and O111 were detected. In a single patient, the negative results of bacteriological and serological analyses excluded VTEC etiology of HUS. CONCLUSIONS A serological analysis of VTEC can confirm the result of stool culture for verotoxigenic E. coli strains and help to find the cause of HUS in case of negative results of a stool culture.

BackgroundThe aim of the study was to assess risk factors for residual renal function (RRF) decline in children during the first/second year of chronic peritoneal dialysis (PD).MethodsThe study group included 56 children with end-stage renal disease (ESRD) (age 10.13 ± 4.86 years), including 18 on continuous ambulatory PD (CAPD) and 38 on automated PD (APD), in whom we evaluated RRF (daily diuresis [mL/m2/24 h], residual glomerular filtration rate (rGFR) [mL/min/1.73 m2]), etiology of ESRD, PD fluid volume (mL/m2/24 h), glucose load (g/m2/24 h), ultrafiltration (mL/m2/24 h), peritoneal permeability (D/PCrea4h, D/D0Glu4h), dialysis adequacy (twKt/V, twCCr [L/week/1.73 m2]), blood pressure (BP), biochemical parameters, and medications used. Duration of follow-up was 24 months.ResultsMean diuresis before initiation of PD was 1,394.93 ± 698.37 (mL/m2/24 h), and mean rGFR was 7.41 ± 3.96 (mL/min/1.73 m2). The rate of daily diuresis decline was -529.34 ± 546.28 in the first year and -107.10 ± 291.54 (mL/m2/24 h) in the second year ( p = 0.005), and the rate of rGFR decline was -3.35 ± 3.73 in the first year and -1.63 ± 1.85 (mL/min/1.73 m2) in the second year ( p = 0.118). Eleven (19.64%) patients became anuric. In univariate analysis, the rate of daily diuresis decline in the first year was related to baseline diuresis ( r = -0.29, p = 0.031), proteinuria ( r = -0.43, p = 0.001), and systolic BP ( r = -0.31, p = 0.020); 12-month changes (Δ0 - 12) in PD fluid volume ( r = -0.37, p = 0.004), glucose load ( r = -0.28, p = 0.035), and ultrafiltration ( r = -0.38, p = 0.004); serum calcium-phosphorus product ( r = -0.41, p = 0.002); and Δ0 - 12 body mass index (BMI) Z-score ( r = 0.30, p = 0.024); while the rate of rGFR decline in the first year was related only to baseline rGFR ( r = -0.57, p < 0.001). In multivariate analysis, significant predictors of the rate of daily diuresis decline in the first year were baseline diuresis (P = -0.386, p < 0.001) and proteinuria (p = -0.278, p = 0.017), mean systolic BP Z-score (P = -0.237, p = 0.027), and age at the onset of PD (P = -0.224, p = 0.037), while predictors of the rate of rGFR decline were baseline rGFR (P = -0.607, p < 0.001) and baseline proteinuria (P = -0.225, p = 0.046). In the second year, the only predictors of the rate of rGFR decline were D/D0Glu4h( r = 0.44, p = 0.033, univariate analysis) and rGFR at 12 months (P = -0.499, p = 0.044).ConclusionThe most important risk factors for rapid RRF decline in children during the first year of chronic PD include higher baseline daily diuresis and proteinuria, and additional factors are systolic BP and age at the onset of PD; while high baseline GFR and low peritoneal transport status may be the only important factors during the second year.

Introduction : We evaluated outcomes in children with chronic kidney disease stage 5 (CKD 5) treated in the first pediatric dialysis unit in Poland during 1973-2012. Material and methods: The retrospective analysis included 208 children with CKD 5 undergoing renal replacement therapy (RRT), stratified into four decades of treatment: 1973–1982, 1983–1992, 1993–2002, and 2003–2012. Results : The most common causes of CKD 5 included glomerulonephritis in 27.4% and pyelonephritis secondary to urinary tract anomalies in 25.5% of children. Among 208 children, 172 (82.7%) survived and 17.3% died. Kidney transplantation (KTx) was performed in 47.6% of children, including pre-emptive KTx in 1.92% of children. Chronic dialysis was continued in 34.1% of children, and RRT was withdrawn in 1%. The overall mortality rate was 6.2 per 100 patient-years, and 3-year survival was 83.9%. The highest mortality rate of 23.4 per 100 patient-years was observed among children in whom RRT was initiated in 1973–1982, with subsequent reduction of the mortality rate to 4.5 and 2.1 per 100 patient-years in 1993–2002 and 1983–1992 respectively. No deaths were noted after 2002. Cardiovascular problems were the most common cause of death, found in 36.1% of patients (p < 0.01). Identified risk factors for mortality included young age, low residual diuresis, anemia at the time of RRT initiation, and hypertriglyceridemia and hypoalbuminemia during RRT. Conclusions : In years 1973–2012 significant improvement in prognosis among children with CKD 5 was achieved. Identified predictors of mortality included young age at initiation of RRT, low residual diuresis, anemia and hypertriglyceridemia.

This study aimed to determine the frequency of associated urological abnormalities in children with unilateral renal agenesis (RA) or multicystic dysplastic kidney (MCDK). In total, 38 children (10 girls, 28 boys) were studied: 21 with RA and 17 with MCDK. In 14 children (37%) anomalies of the urinary tract were suspected prenatally in ultrasound studies. In the remaining 24 children the diagnosis of RA/MCDK was made postnatally: in 13 (34%) in the first 7 days of life, in 11 (29%) at the age of 8 days to 34 months, mean 10.6+/-8.05 months. Voiding cystourethrography was done in 36 (95%) children, the isotopic 99mTc-EC/DMSA scan of the kidney in 29 (67%), and urography in 8. Urological anomalies were present in 11 (29%) children: in 7 (33%) with RA and in 4 (24%) with MCDK. Vesicoureteral reflux was diagnosed in 8 children: grade II in 4, III in 3, and IV in 1 (in 1 child to duplicated, in 1 to ectopic kidney); ureterovesical junction obstruction in 2 (9.5%); and ureteropelvic junction obstruction in 1 (4.8%). Among them, 2 children demanded surgery on the contralateral urinary tract: pyeloplasty in 1, antireflux procedure in 1; while 9 children were treated conservatively. Compensatory hypertrophy of the contralateral kidney was found in 90% of children. Thus due to an increased risk of pathological changes in the single functioning kidney, lifelong nephrological care is recommended in patients with unilateral RA/MCDK.

Patient Male, 0 FINAL DIAGNOSIS: Bland-White-Garland syndrome Symptoms: Cardiomegaly, feeding problems Medication: - Clinical Procedure: Reimplantation of the left coronary artery to the aorta Specialty: Pediatrics and Neonatology. Objective Rare disease. Background Bland-White-Garland syndrome (BWGS) is a very rare disease characterized by anomalous origin of the left coronary artery from the pulmonary trunk (ALCAPA). WBGS affects 1 in every 300 000 live births. Children typically present with dyspnea, pallor, and failure to thrive. Without surgical repair, most of these children die during the first months of life. Case report This case report describes 3-month-old boy admitted to the hospital because of feeding problems. The boy was born at term, with birth weight 3200 g, and was 10 points in Apgar score. He was breast-fed from birth. From the seventh week of age, his mother observed his increasing difficulties with feeding. Physical examination revealed pale skin, diminished heart sounds, tachycardia, cardiomegaly, and hepatomegaly. Results of urine and blood tests and ultrasonography of the central nervous system and abdomen were normal. The chest radiography showed cardiomegaly and electrocardiogram revealed anterolateral myocardial infarction. On echocardiography, an anomalous left coronary artery arising from the pulmonary artery was found. The life-saving treatment of choice was immediate surgical reimplantation of the left coronary artery to the aorta. Conclusions Children with congenital heart disease are often prone to malnutrition, but in rare cases failure to thrive and breast-feeding problems can be the first symptoms of life-threatening diseases like myocardial infarction secondary to Bland-White-Garland syndrome (BWGS).

Purpose To evaluate the effect of hypertension (HTN) and antihypertensive medications (AHM) on residual renal function (RRF) in children on CAPD and APD. Material/methods We retrospectively evaluated underlying kidney disease, systolic and diastolic blood pressure (SBP/DBP), presence and control of HTN (SBP/DBP ≥ 95th percentile), AHM, RRF (daily diuresis, residual glomerular filtration rate [rGFR]), biochemical parameters, BMI Z -score, and dialysis parameters during 12-month follow-up in 87 children (38 CAPD, 49 APD) aged 10.22 ± 4.31 years. The rate of RRF loss was expressed as absolute and relative [%] reduction. Results At baseline, HTN was found in 74.7% patients (CAPD/APD: 84.2%/67.3%, P = 0.06), most commonly in HUS and least frequently in CAKUT. The proportion of CAPD/APD patients with poorly controlled HTN was 70.0%/63.3% ( P = 0.50). Relative daily diuresis loss in children with uncontrolled HTN was higher ( P = 0.017) compared to children with SBP/DBP β = −0.30, P β = −0.31, P = 0.004); absolute rGFR loss to baseline rGFR ( β = −0.73, P β = −0.36, P = 0.02); relative daily diuresis loss to mean BMI Z -score ( β = −0.44, P = 0.04); and relative rGFR to baseline rGFR ( β = −0.37, P β = −0.21, P = 0.045). Conclusions 1. Maintaining blood pressure 2. Risk factors for rapid RRF loss in children on CAPD/APD include elevated SBP, high baseline diuresis/rGFR, proteinuria, and high glucose load in the dialysis fluid.

Background Diabetes and Nephrotic syndrome (NS) promote plaque-related gingivitis and yeast-like fungal infections. The study assesses the impact of Candida spp. and general disease- or treatment-related factors on plaque-related gingivitis severity in children and adolescents with Nephrotic syndrome /diabetes. Methods Body mass index (BMI), BMI standard deviation score, and oral cavity (Plaque Index – PLI, Gingival Index – GI, mucosa status, presence and Candida enzymatic activity) were assessed in 96 patients (32 with NS: 30- immunosuppressive treatment, 35 - type 1 diabetes, and 29 generally healthy), aged; 3–18 years. Laboratory included cholesterol and triglyceride measurements; in diabetic subjects– glycated haemoglobin, in NS: total protein, albumin, creatinine, haemoglobin, haematocrit, white cell count, urinary protein excretion. Medical records supplied information on disease duration and treatment. A statistical analysis was performed; Kendall Tau coefficient, chi-square test, t-test, and multiple regression analysis ( P 1 drug, drug doses, treatment duration, lipid disorders, and BMI; in diabetes, with blood glucose and glycated haemoglobin >8%. Conclusion Poor hygiene control is the main cause of gingivitis. Gingivitis severity is most likely related to age, lipid disorders and increase in body mass. Candida spp., in uncompensated diabetes and in those using immunosuppressive treatment, might intensify plaque-related gingivitis.

We performed a genome-wide association study (GWAS) of IgA nephropathy (IgAN), the most common form of glomerulonephritis, with discovery and follow-up in 20,612 individuals of European and East Asian ancestry. We identified six novel genome-wide significant associations, four in ITGAM-ITGAX, VAV3 and CARD9 and two new independent signals at HLA-DQB1 and DEFA. We replicated the nine previously reported signals, including known SNPs in the HLA-DQB1 and DEFA loci. The cumulative burden of risk alleles is strongly associated with age at disease onset. Most loci are either directly associated with risk of inflammatory bowel disease (IBD) or maintenance of the intestinal epithelial barrier and response to mucosal pathogens. The geo-spatial distribution of risk alleles is highly suggestive of multi-locus adaptation and the genetic risk correlates strongly with variation in local pathogens, particularly helminth diversity, suggesting a possible role for host-intestinal pathogen interactions in shaping the genetic landscape of IgAN.

Sympathetic activation, hypertension, hyperlipidemia, and immunosuppressive treatment are risk factors for vascular damage in children with glomerulopathies. Aim: To perform pulse wave analysis in children with glomerulopathies. Material and Methods: We studied 33 children (22♂, 11♀) aged 13.3 ± 3.9 years with glomerulopathies: Henoch-Schonlein nephropathy 9 patients, IgA nephropathy 7 patients, membranoproliferative glomerulonephritis 4 patients, mesangioproliferative glomerulonephritis 3 patients, minimal change disease 3 patients, focal segmental glomerulosclerosis (FSGS) 3 patients, and other nephropathies 4 patients. We evaluated age at the disease onset, development of hypertension, body mass index (BMI) Z-score, selected biochemical variables, glomerular filtration rate (ac. to Schwartz formula), and pulse wave parameters determined using a SphygmoCor device (AtCor Medical, Australia): aortic systolic pressure (AoSP), diastolic pressure (AoDP) and pulse pressure (AoPP), augmentation pressure (AP), augmentation index (AIx), augmentation index corrected for heart rate of 75 beats per minute (AIx-75HR) [%], and an index of myocardial oxygen supply and demand, subendocardial viability ratio (SEVR) [%]. The control group included 20 healthy children matched for age and gender. Results: Children with glomerulopathies showed trends for higher mean AP (P=0.08) and AIx (P=0.07), and a significantly higher mean AIx-75HR (P

We characterized two STEC O104 : H4 clinical isolates collected in Poland from a 7-year-old boy with haemolytic uraemic syndrome (HUS) and his nanny. This household outbreak began on 29 May 2011. Because of its time-frame, the outbreak was assumed to be part of the international STEC O104 : H4 outbreak that arose in Germany in May 2011. The two Polish isolates were Shiga-toxin-producing Escherichia coli (stx2 lpf) with enteroaggregative E. coli pathotype (aggR aap aggA), thereby sharing the unique virulence properties of the epidemic STEC O104 : H4 strain from the international outbreak. The Polish isolates were multi-drug resistant and carried bla(TEM), strA, strB, tetA, sul1 and sul2 markers together with the bla(CTX-M-15) gene for CTX-M-15 extended-spectrum β-lactamase. PFGE patterns and plasmid profiles of the Polish isolates and the epidemic STEC O104 : H4 strain corresponded closely. This finding suggested an epidemiological link between the Polish STEC O104 : H4 isolates and the international outbreak. Retrospective serological investigations proved person-to-person transmission of the epidemic STEC O104 : H4 strain from a father who had visited Dortmund, Germany, to his 7-year-old son in Giżycko, Poland. To the best of our knowledge, this is the first report of household transmission of Shiga-toxin-producing E. coli in Poland.

The aim of this study was to evaluate the usefulness of serum immunoglobulin A/complement factor 3 (IgA/C3) ratio for predicting histological severity of kidney lesions in children with IgA nephropathy (IgAN) based on World Health Organization (WHO) and the Oxford classification (OC). We studied 89 children with IgAN with a mean age of 11.38 ± 4.1 years (range 2–18 years). Based on available medical records, we retrospectively evaluated clinical data, IgA/C3 ratio, and kidney biopsy findings using the five-grade WHO classification and the OC The mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental sclerosis (S), tubular atrophy/interstitial fibrosis (T) (MEST) score (absent = 0, present = 1) calculated as the sum of M+E+S+T ranging from 0 to 4. Mean IgA/C3 ratio values were significantly higher (P

Background. It is estimated that 20–50% of adult patients start chronic dialysis therapy without prior contact with a nephrologist. The aim of this nationwide study was to assess clinical and metabolic status of children at the start of chronic dialysis in Poland with regard to the timing of the referral to a nephrologist. Methods. We studied data of 180 children (mean age 14±6 years) undergoing chronic dialysis in 13 (out of 14) dialysis pediatric centres in Poland. Patients were classified as early referrals (ERs) when they entered the dialysis programme at least 1 month after the first referral to a nephrologist or late referrals (LRs) when the dialysis was introduced within 1 month from the first visit. Results. Seventy-nine percent of pediatric patients were referred early (ER) to the dialysis centre and 21% were referred late (LR) and had to start dialysis within a month. When starting dialysis, LR patients had significantly higher levels of urea and phosphate as well as lower calcium and haemoglobin in comparison with ERs. Hypertension, pulmonary oedema, fluid overload, treatment in the intensive care unit (ICU) and body mass index (BMI) below 10th percentile turned out to be more frequent in the LR group. Peritoneal dialysis (PD) was used as the first method of dialysis in 59% of ERs and 46% of LRs. The majority of ER patients was treated in the predialysis period with calcitriol, phosphate binders and low protein diet (84%, 89%, 92% of all children, respectively), and 20% of them received epoetin. In the up to 3 years observation of our initial cohort, we also found that the patients who were referred late were less likely to receive kidney transplant (P ¼ 0.02). Conclusion. The results of the study indicate that the LR to a pediatric nephrologist was associated with poorer clinical and metabolic status of children entering chronic dialysis programmes.

Background. The aim of this nationwide analysis was to assess the incidence and current treatment profile of arterial hypertension in children undergoing chronic haemodialysis or peritoneal dialysis and attitudes of paediatric nephrologists towards the choice of antihypertensive drugs in their patients. Methods. The study group consisted of 134 children (89 males, 45 females, mean age 10.7 ± 5 years) from all 13 paediatric dialysis centres in Poland. The data were gathered through a questionnaire for each patient dialysed in November 2004. Results. The overall incidence of hypertension in the study group was 55% (74 of 134 patients; 47 males, 27 females). The incidence rate was similar in boys and girls (53 vs 60%) and in those on haemodialysis and peritoneal dialysis (56 vs 54%). Chronic glomerulonephritis as an underlying renal disease was significantly more frequent in the hypertensive than in the normotensive subjects (37 vs 10%, P= 0.004). Residual urine output was higher in normotensives (41 vs 10 ml/kg body weight; P < 0.001). Among those treated with antihypertensives: 32% were treated by monotherapy, 36% received two drugs, 22% received three drugs, while 7% received ≥4 drugs. The therapy was effective in only 57% of subjects. We observed no differences in biochemical and clinical parameters between those who responded to the therapy and those who failed to do so. Calcium channel blockers constituted the most frequently administered class of drugs [73% of children; in 43 out of 48 (90%) combined with other drugs, but in 11 out of 24 (46%) as a monotherapy]. In monotherapy, angiotensin-converting enzyme inhibitors and calcium channel blockers were administered most frequently. Conclusion. We conclude that the incidence of hypertension in dialysis children in Poland is high (55%). The effectiveness of antihypertensive treatment is rather low (58%) and the choice of drugs is limited.

The aim of this study was to assess relations between the clinical course of UTI, IL-6 and IL-8 levels, and the presence of inflammatory changes detected by renal scintigraphy using 99mTc-DMSA (DMSA).We studied 33 children aged 1-24 months (mean 7.1+/-5.8 months) with first-time UTI. The subjects were divided in two groups: with fever (group I, n=10) and without fever (group II, n=23). Inflammatory markers (ESR, CRP, leukocyte count), urinary IL-6 and IL-8 level, and DMSA scan were evaluated in all children.Urinary IL-6 and IL-8 levels [IL-6, IL-8/creatinine (pg/mg)] were significantly higher in group I than in group II (Il-6 level: 39.4+/-41.1 vs. 6.3+/-13.7, p0.01; IL-8 level: 791.1+/-1143.6 vs. 36+/-87.9, p0.001). We found positive correlation between urinary IL-6 and IL-8 levels and ESR, CRP, and leukocyte count (IL-6: r=0.43, p0.05; r=0.46, p0.05; and r=0.59, p0.001, respectively; IL-8: r=0.55, p0.05; r=0.72, p0.0001; and r=0.44, p0.05, respectively). We found no relation between urinary cytokine levels and the presence of inflammatory changes detected by DMSA scanning, despite slightly higher mean urinary cytokine levels in children with inflammatory changes in DMSA scan.We found significantly higher IL-6 and IL-8 levels in children with febrile UTI and elevated inflammatory markers. IL-6 and IL-8 levels do not differentiate between acute pyelonephritis and UTI in children to age 24 months.

StreszczenieZmiany w ilości i strukturze miąższu nerek u płodu są wykrywane ze znacznie mniejszą częstością niż poszerzenie układu kielichowo-miedniczkowego. Jeśli jednak znajdują swoje potwierdzenie w badaniach postnatalnych, mogą być sygnałem poważnych zaburzeń w czynności nerek w okresie niemowlęcym, a także sugerować postęp choroby nerek w wieku późniejszym. W celu spójnej i szybkiej weryfi kacji grupy dzieci zagrożonych rozwojem niewydolności nerek Polskie Towarzystwo Nefrologii Dziecięcej przygotowało zalecenia dotyczące diagnostyki pourodzeniowej w przypadku wad miąższu nerek podejrzewanych prenatalnie.AbstractCongenital malformations of kidney structure are detected less frequently than dilatation of the urinary tract in the prenatal evaluation of fetus. However, when confi rmed after birth may refl ect serious impairment of kidney function in infancy or put the child at risk of deterioration of glromerular fi ltration later in the life. In order to support adequate selection of high risk patients Polish Society for Paediatric Nephrology presented specifi c guidelines for postnatal evaluation of malformation of kidney structure in fetus and newborn.