Microalbuminuria in children with primary and white-coat hypertension

Microalbuminuria serves as an early marker of hypertension-related renal damage in adults. However, data on the prevalence of microalbuminuria in paediatric hypertensive patients in general and in children with white-coat hypertension (WCH) specifically are lacking. The aim of our study was to investigate the prevalence of microalbuminuria in children with primary hypertension (PH) and WCH, respectively. This was a retrospective case review of children with PH and WCH treated at three paediatric nephrology centres. Untreated children with either form of hypertension for whom measurements of urinary albumin excretion (UAE) had been performed were enrolled in the study. The study cohort comprised 52 children (39 boys) with hypertension (26 children with PH, 26 with WCH). Microalbuminuria (>3.2 mg/mmol creatinine) was present in 20% of children with PH and none of the children with WCH (p < 0.01). Children with PH had a higher median UAE than those with WCH (1.27 ± 1.92 vs. 0.66 ± 0.46 mg/mmol creatinine, p < 0.05). Based on these results, we suggest that children with PH have an increased prevalence of microalbuminuria, while children with WCH show no signs of hypertension-related renal damage.

Risk factors for renal insufficiency in children with urethral valves

Posterior urethral valves (PUV) associated with renal dysplasia are one of the most common causes of end stage kidney disease (ESKD) in childhood. In order to identify risk factors for the progression of this condition to early renal failure, we have retrospectively analyzed the clinical course, renal function, and first postnatal renal ultrasound in a sample of 42 young male patients with PUV, who were followed at a single center. Twelve (28.6%) were diagnosed with ESKD at a median age of 11.3 years. Our comparison of PUV patients without decreased estimated glomerular filtration rate (eGFR) (group A; K/DOQI CKD stage 0-1) with PUV patients showing a decreased eGFR (group B; K/DOQI CKD stage 2-5) revealed the following significant risk factors for loss of eGFR: renal volume <3rd percentile (P < 0.001), elevated echogenicity (P = 0.001), pathologic corticomedullary differentiation (P < 0.001), >3 febrile urinary tract infections (P = 0.012), and decreased eGFR at 1 year of age (P < 0.001). Receiver operating characteristic curve analysis in the cohort confirms that patients showing a renal volume >88.2 ml/m(2) body surface area (BSA) are not at risk to develop K/DOQI CKD stage 5 (sensitivity 75%, specificity 77.3%, positive/negative predictive value 37.5/94.4%). Ultrasound promises to be a valuable tool for identifying endangered patients.

[The manual "Problematic use and dependence of prescipted drugs" in daily routine care - a study among participants in a training to qualify in "primary addiction treatment"]

BACKGROUND

To strengthen the position of physicians regarding problematic use and dependence of prescripted drugs a manual was issued by the German Medical Association in 2007.  A study among participants in a training to qualify in "primary addiction treatment" was conducted. The utilisation of the manual, its relevance for routine care and self-estimated changes in drug prescription were examined.

METHODS

All 542 participants in training courses between 1.9.2008 and 31.12.2009 were asked about participation in a survey 12 weeks later. A number of 267 took part in this investigation.

RESULTS

A proportion of 60,7 % among GPs that received the manual dealt with them beyond the training course. From 178 physicians, who confirmed the provision of drug prescription, a number of 56 stated changes in their drug prescription. A higher probabilty for changes in drug prescription was given in case of a high percentage of new informations that could be culled from the manual.

CONCLUSION

The interest for the manual beyond the training course and the amount of self-estimated changes in drug prescription should encourage to use this within training measures in a systematic way.

Oligohydramnios associated with sonographically normal kidneys

We report a male newborn presenting with sonographically normal kidneys, oligohydramnios during late pregnancy, and persisting anuric renal failure. Despite intensive treatment, the patient suffered from severe hypotension and died at the age of 4 weeks. At autopsy, kidneys were found to be normal; on histology, deranged renal structures, in particular proximal tubuli and vessels, were noted, leading to the diagnosis of renal tubular dysgenesis (RTD). The diagnosis was confirmed by 2 heterozygous nonsense mutations of the ACE gene. Because the recurrence rate of RTD is 25% for the autosomal recessive trait, knowledge and genetic diagnosis of the disease is important for the parents.

Mutations in CYP24A1 and idiopathic infantile hypercalcemia

BACKGROUND

Vitamin D supplementation for the prevention of rickets is one of the oldest and most effective prophylactic measures in medicine, having virtually eradicated rickets in North America. Given the potentially toxic effects of vitamin D, the recommendations for the optimal dose are still debated, in part owing to the increased incidence of idiopathic infantile hypercalcemia in Britain in the 1950s during a period of high vitamin D supplementation in fortified milk products. We investigated the molecular basis of idiopathic infantile hypercalcemia, which is characterized by severe hypercalcemia, failure to thrive, vomiting, dehydration, and nephrocalcinosis.

METHODS

We used a candidate-gene approach in a cohort of familial cases of typical idiopathic infantile hypercalcemia with suspected autosomal recessive inheritance. Identified mutations in the vitamin D-metabolizing enzyme CYP24A1 were evaluated with the use of a mammalian expression system.

RESULTS

Sequence analysis of CYP24A1, which encodes 25-hydroxyvitamin D 24-hydroxylase, the key enzyme of 1,25-dihydroxyvitamin D(3) degradation, revealed recessive mutations in six affected children. In addition, CYP24A1 mutations were identified in a second cohort of infants in whom severe hypercalcemia had developed after bolus prophylaxis with vitamin D. Functional characterization revealed a complete loss of function in all CYP24A1 mutations.

CONCLUSIONS

The presence of CYP24A1 mutations explains the increased sensitivity to vitamin D in patients with idiopathic infantile hypercalcemia and is a genetic risk factor for the development of symptomatic hypercalcemia that may be triggered by vitamin D prophylaxis in otherwise apparently healthy infants.

[Internet and mobile phone interventions to decrease alcohol consumption and to support smoking cessation in adolescents: a review]

OBJECTIVE

The aim of this study was to review the published literature on Internet and mobile phone interventions to decrease alcohol consumption and for smoking cessation in adolescents.

METHODS

Electronic searches of PubMed, MEDLINE, Web of Science, PsycINFO, ERIC, and the Cochrane Register of Controlled Trials were conducted in August 2009. Additionally, reference lists of previously published reviews and meta-analyses within this topic were checked. Studies, published in scientific journals, containing English abstracts, and reporting results about the effectiveness of an intervention were included into the review.

RESULTS

Initial searches in the literature databases identified 2 263 articles of which 31 were eligible for inclusion in this review: 19 articles address internet interventions to decrease alcohol consumption, 7 Internet interventions for smoking cessation, and 5 mobile phone text messaging interventions for smoking cessation. No articles concerning mobile phone interventions to decrease alcohol consumption in adolescents were identified. 16 out of the 19 studies that aimed at decreasing alcohol consumption by the use of the Internet were conducted in college or university students from the United States or New Zealand and the majority of these studies were based on the social norms approach. Good empirical evidence exists concerning the efficacy of web-based social norms interventions to decrease alcohol consumption in students. In the field of smoking cessation, Internet interventions are much more heterogeneous concerning the target group and the provided interventions. So far, 5 controlled studies concerning Internet interventions for smoking cessation in adolescents are available, 2 of these studies were effective in decreasing the smoking prevalence at the last follow-up. Interventions using mobile phone text messaging for smoking cessation were well accepted and promising; however, they were primarily tested within pilot studies and conclusions about their efficacy are not possible so far.

CONCLUSION

Suggestions for the implementation of certain intervention approaches in Germany could not be derived from the existing studies. For research in Germany, it is suggested to work on the following topics: (1) testing the efficacy of web-based social norms interventions to decrease alcohol consumption in student and non-student samples, (2) testing the efficacy of Internet interventions for smoking cessation, and (3) testing the efficacy of text messaging interventions for smoking cessation.

Genomic scans detect signatures of selection along a salinity gradient in populations of the intertidal seaweed Fucus serratus on a 12 km scale

Detecting natural selection in wild populations is a central challenge in evolutionary biology and genomic scans are an important means of detecting allele frequencies that deviate from neutral expectations among marker loci. We used nine anonymous and 15 EST-linked microsatellites, 362 AFLP loci, and several neutrality tests, to identify outlier loci when comparing four populations of the seaweed Fucus serratus spaced along a 12km intertidal shore with a steep salinity gradient. Under criteria of at least two significant tests in at least two population pairs, three EST-derived and three anonymous loci revealed putative signatures of selection. Anonymous locus FsB113 was a consistent outlier when comparing least saline to fully marine sites. Locus F37 was an outlier when comparing the least saline to more saline areas, and was annotated as a polyol transporter/putative mannitol transporter - an important sugar-alcohol associated with osmoregulation by brown algae. The remaining loci could not be annotated using six different data bases. Exclusion of microsatellite outlier loci did not change either the degree or direction of differentiation among populations. In one outlier test, the number of AFLP outlier loci increased as the salinity differences between population pairs increased (up to 14); only four outliers were detected with the second test and only one was consistent with both tests. Consistency may be improved with a much more rigorous approach to replication and/or may be dependent upon the class of marker used.

Reference levels for serum thyroid function tests of diagnostic and prognostic significance

A controversy exists on the value of upper thyrotropin (TSH) reference level. Currently available studies are based on cross-sectional data leaving uncertainty about the prognostic significance of the upper TSH reference level. With the present study we sought to establish reference values for serum thyroid function tests that are of both diagnostic and prognostic significance. We used data from the prospective population-based Study of Health in Pomerania (SHIP) with a 5 year follow-up (6080 person-years). We included data from 1203 subjects (525 women) without prevalent subclinical or manifest thyroid disorders. An event-free reference population was separated comprising 1053 subjects (473 women). When comparing reference values as analyzed from either the whole reference population or the event-free reference population, we observed notable differences in TSH reference intervals. While the lower TSH reference values were similar in both populations, the upper value was 1.95 mIU/l and thus by 7.6% lower in subjects without incident events compared to the whole reference population. Both populations did not substantially differ with respect to serum FT3 and FT4 reference intervals. The upper TSH reference value is lower than recommended when both diagnostic and prognostic significance are considered in the definition of the TSH reference range.