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Colceriu MC, Aldea PL, Boț (Răchişan) AL, Bulată B, Delean D, Grama A, Mititelu A, Decea RM, Sevastre-Berghian A, Clichici S, Pop TL, Mocan T. The Utility of Noninvasive Urinary Biomarkers for the Evaluation of Vesicoureteral Reflux in Children. Int J Mol Sci 2023; 24:17579. [PMID: 38139407 PMCID: PMC10743802 DOI: 10.3390/ijms242417579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/10/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Vesicoureteral reflux (VUR) is one of the most important disorders encountered in pediatric nephrology due to its frequency and potential evolution to chronic kidney disease (CKD). The aim of our study was to identify noninvasive and easy-to-determine urinary markers to facilitate the diagnosis and staging of VUR. We performed a cross-section study including 39 patients with VUR followed over three years (August 2021-September 2023) and 39 children without urinary disorder (the control group). We measured the urinary concentration of interleukin-6 (IL-6), cathelicidin (LL-37), and neutrophil gelatinase-associated lipocalin (NGAL) in VUR and healthy controls. Moreover, we analyzed the correlation between these biomarkers and the presence of renal scars (RS), reflux nephropathy (RN), and CKD. The NGAL concentrations were significantly higher in patients with VUR than in the controls (p = 0.02). Regarding the severity of the reflux, NGAL/creatinine and LL-37/creatinine were positively correlated with severe reflux (p = 0.04, respectively, p = 0.02). In patients with VUR and RS, LL-37/creatinine was significantly lower (p = 0.01). LL-37/creatinine with an AUC of 0.71 and NGAL/creatinine with an AUC of 0.72 could be acceptable diagnostic tests for severe VUR. In conclusion, urinary IL-6, NGAL, and LL-37 could serve as valuable markers for diagnosing and predicting outcomes in patients with VUR and RN.
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Affiliation(s)
- Marius-Cosmin Colceriu
- Discipline of Physiology, Department of Functional Biosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (R.M.D.); (A.S.-B.); (S.C.); (T.M.)
- Second Pediatric Discipline, Department of Mother and Child, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania (A.G.); (A.M.); (T.L.P.)
| | - Paul Luchian Aldea
- Discipline of Public Health and Management, Department of Community Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Andreea-Liana Boț (Răchişan)
- Second Pediatric Discipline, Department of Mother and Child, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania (A.G.); (A.M.); (T.L.P.)
- Pediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania; (B.B.)
| | - Bogdan Bulată
- Pediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania; (B.B.)
| | - Dan Delean
- Pediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania; (B.B.)
| | - Alina Grama
- Second Pediatric Discipline, Department of Mother and Child, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania (A.G.); (A.M.); (T.L.P.)
- Second Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
| | - Alexandra Mititelu
- Second Pediatric Discipline, Department of Mother and Child, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania (A.G.); (A.M.); (T.L.P.)
| | - Roxana Maria Decea
- Discipline of Physiology, Department of Functional Biosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (R.M.D.); (A.S.-B.); (S.C.); (T.M.)
| | - Alexandra Sevastre-Berghian
- Discipline of Physiology, Department of Functional Biosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (R.M.D.); (A.S.-B.); (S.C.); (T.M.)
| | - Simona Clichici
- Discipline of Physiology, Department of Functional Biosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (R.M.D.); (A.S.-B.); (S.C.); (T.M.)
| | - Tudor Lucian Pop
- Second Pediatric Discipline, Department of Mother and Child, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania (A.G.); (A.M.); (T.L.P.)
- Second Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
| | - Teodora Mocan
- Discipline of Physiology, Department of Functional Biosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (R.M.D.); (A.S.-B.); (S.C.); (T.M.)
- Nanomedicine Department, Regional Institute of Gastroenterology and Hepatology, 400158 Cluj-Napoca, Romania
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Aldea PL, Santionean MD, Elec A, Munteanu A, Antal O, Loga L, Moisoiu T, Elec FI, Delean D, Bulata B, Rachisan (Bot) AL. An Integrated Approach Using HLAMatchmaker and Pirche II for Epitopic Matching in Pediatric Kidney Transplant-A Romanian Single-Center Study. Children (Basel) 2023; 10:1756. [PMID: 38002848 PMCID: PMC10670802 DOI: 10.3390/children10111756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/20/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023]
Abstract
(1) Background: Renal transplantation (KT) is the most efficient treatment for chronic kidney disease among pediatric patients. Antigenic matching and epitopic load should be the main criteria for choosing a renal graft in pediatric transplantation. Our study aims to compare the integration of new histocompatibility predictive algorithms with classical human leukocyte antigen (HLA) matching regarding different types of pediatric renal transplants. (2) Methods: We categorized our cohort of pediatric patients depending on their risk level, type of donor and type of transplantation, delving into discussions surrounding their mismatching values in relation to both the human leukocyte antigen Matchmaker software (versions 4.0. and 3.1.) and the most recent version of the predicted indirectly identifiable HLA epitopes (PIRCHE) II score. (3) Results: We determined that the higher the antigen mismatch, the higher the epitopic load for both algorithms. The HLAMatchmaker algorithm reveals a noticeable difference in eplet load between living and deceased donors, whereas PIRCHE II does not show the same distinction. Dialysis recipients have a higher count of eplet mismatches, which demonstrates a significant difference according to the transplantation type. Our results are similar to those of four similar studies available in the current literature. (4) Conclusions: We suggest that an integrated data approach employing PIRCHE II and HLAMatchmaker algorithms better predicts histocompatibility in KT than classical HLA matching.
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Affiliation(s)
- Paul Luchian Aldea
- Clinical Institute of Urology and Renal Transplantation, 400006 Cluj-Napoca, Romania; (P.L.A.)
| | - Maria Diana Santionean
- Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania;
| | - Alina Elec
- Clinical Institute of Urology and Renal Transplantation, 400006 Cluj-Napoca, Romania; (P.L.A.)
| | - Adriana Munteanu
- Clinical Institute of Urology and Renal Transplantation, 400006 Cluj-Napoca, Romania; (P.L.A.)
| | - Oana Antal
- Clinical Institute of Urology and Renal Transplantation, 400006 Cluj-Napoca, Romania; (P.L.A.)
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Luminita Loga
- Clinical Institute of Urology and Renal Transplantation, 400006 Cluj-Napoca, Romania; (P.L.A.)
| | - Tudor Moisoiu
- Clinical Institute of Urology and Renal Transplantation, 400006 Cluj-Napoca, Romania; (P.L.A.)
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Florin Ioan Elec
- Clinical Institute of Urology and Renal Transplantation, 400006 Cluj-Napoca, Romania; (P.L.A.)
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Dan Delean
- Department of Mother and Child, Discipline of Pediatrics II, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Bogdan Bulata
- Department of Mother and Child, Discipline of Pediatrics II, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Andreea Liana Rachisan (Bot)
- Department of Mother and Child, Discipline of Pediatrics II, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
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Pop TL, Aldea CO, Delean D, Bulata B, Boghiţoiu D, Păcurar D, Ulmeanu CE, Grama A. The Role of Predictive Models in the Assessment of the Poor Outcomes in Pediatric Acute Liver Failure. J Clin Med 2022; 11:432. [PMID: 35054127 PMCID: PMC8778932 DOI: 10.3390/jcm11020432] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES In children, acute liver failure (ALF) is a severe condition with high mortality. As some patients need liver transplantation (LT), it is essential to predict the fatal evolution and to refer them early for LT if needed. Our study aimed to evaluate the prognostic criteria and scores for assessing the outcome in children with ALF. METHODS Data of 161 children with ALF (54.66% female, mean age 7.66 ± 6.18 years) were analyzed based on final evolution (32.91% with fatal evolution or LT) and etiology. We calculated on the first day of hospitalization the PELD score (109 children), MELD, and MELD-Na score (52 children), and King's College Criteria (KCC) for all patients. The Nazer prognostic index and Wilson index for predicting mortality were calculated for nine patients with ALF in Wilson's disease (WD). RESULTS PELD, MELD, and MELD-Na scores were significantly higher in patients with fatal evolution (21.04 ± 13.28 vs. 13.99 ± 10.07, p = 0.0023; 36.20 ± 19.51 vs. 20.08 ± 8.57, p < 0.0001; and 33.07 ± 8.29 vs. 20.08 ± 8.47, p < 0.0001, respectively). Moreover, age, bilirubin, albumin, INR, and hemoglobin significantly differed in children with fatal evolution. Function to etiology, PELD, MELD, MELD-Na, and KCC accurately predicted fatal evolution in toxic ALF (25.33 vs. 9.90, p = 0.0032; 37.29 vs. 18.79, p < 0.0001; 34.29 vs. 19.24, p = 0.0002, respectively; with positive predicting value 100%, negative predicting value 88.52%, and accuracy 89.23% for King's College criteria). The Wilson index for predicting mortality had an excellent predictive strength (100% sensibility and specificity), better than the Nazer prognostic index. CONCLUSIONS Prognostic scores may be used to predict the fatal evolution of ALF in children in correlation with other parameters or criteria. Early estimation of the outcome of ALF is essential, mainly in countries where emergency LT is problematic, as the transfer to a specialized center could be delayed, affecting survival chances.
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Affiliation(s)
- Tudor Lucian Pop
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
- Center of Expertise in Pediatric Liver Rare Disorders, 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
| | - Cornel Olimpiu Aldea
- Pediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania; (C.O.A.); (D.D.); (B.B.)
| | - Dan Delean
- Pediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania; (C.O.A.); (D.D.); (B.B.)
| | - Bogdan Bulata
- Pediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania; (C.O.A.); (D.D.); (B.B.)
| | - Dora Boghiţoiu
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.B.); (D.P.); (C.E.U.)
- Department of Pediatrics, Grigore Alexandrescu Emergency Clinical Hospital for Children, 011743 Bucharest, Romania
| | - Daniela Păcurar
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.B.); (D.P.); (C.E.U.)
- Department of Pediatrics, Grigore Alexandrescu Emergency Clinical Hospital for Children, 011743 Bucharest, Romania
| | - Coriolan Emil Ulmeanu
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.B.); (D.P.); (C.E.U.)
- Department of Pediatrics, Grigore Alexandrescu Emergency Clinical Hospital for Children, 011743 Bucharest, Romania
| | - Alina Grama
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
- Center of Expertise in Pediatric Liver Rare Disorders, 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
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Grama A, Aldea C, Burac L, Delean D, Boghitoiu D, Bulata B, Nitescu V, Ulmeanu C, Pop TL. Acute liver failure secondary to toxic exposure in children. Arch Med Sci 2022; 18:84-91. [PMID: 35154529 PMCID: PMC8826985 DOI: 10.5114/aoms.2019.87716] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 04/03/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Acute liver failure (ALF) is a syndrome defined by jaundice, coagulopathy (INR > 1.5) and hepatic encephalopathy in patients with no evidence of prior liver disease. Toxins and drugs are a frequent cause of ALF in children. MATERIAL AND METHODS The aim of our study was to establish the causes of toxic ALF in children followed up in our hospital in the period of January 2000 to August 2018. We retrospectively studied all hospital records of patients who developed ALF after mushroom/drug exposure and had been admitted to our hospital, the main pediatric toxicology center in north-western Romania. RESULTS In the last 18 years, 123 patients were admitted to our clinic with toxic ALF (89 patients secondary to mushroom ingestion and 34 patients after drug exposure). In the 2000-2012 period accidental mushroom poisoning was the leading cause of toxic ALF. Unfortunately, during the last years, voluntary drug ingestions have increased dramatically. The most commonly incriminated drug was acetaminophen (52.94%). CONCLUSIONS ALF in mushroom poisoning is associated with a high mortality in children, despite optimal medical therapy. This etiology was one of the most important causes of death in our cohort. The difficulty in accessing emergency liver transplantation is an obstacle common to many Eastern European pediatric centers. Fortunately, in the last 5 years the incidence of mushroom intoxications has decreased in our area. It is worrying that over the last few years there has been an increased incidence of toxic ALF after drug exposure (for suicidal purposes or due to lenient regulations for prescribing hepatotoxic medications).
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Affiliation(s)
- Alina Grama
- 2 Paediatric Clinic, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Cornel Aldea
- Nephrology Clinic, Emergency Clinic Hospital for Children, Cluj-Napoca, Romania
| | - Lucia Burac
- 2 Paediatric Clinic, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Dan Delean
- Nephrology Clinic, Emergency Clinic Hospital for Children, Cluj-Napoca, Romania
| | - Dora Boghitoiu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Bogdan Bulata
- Nephrology Clinic, Emergency Clinic Hospital for Children, Cluj-Napoca, Romania
| | - Violeta Nitescu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Coriolan Ulmeanu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Tudor Lucian Pop
- 2 Paediatric Clinic, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
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Duicu C, Cozea I, Delean D, Aldea AA, Aldea C. Antibiotic resistance patterns of urinary tract pathogens in children from Central Romania. Exp Ther Med 2021; 22:748. [PMID: 34055063 DOI: 10.3892/etm.2021.10180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023] Open
Abstract
One of the most frequent bacterial infections in children are urinary tract infections (UTIs). In recent years, an increasing incidence of UTIs caused by resistant bacterial strains has been observed, especially with extended-spectrum β-lactamase-producing Enterobacteriaceae that represent about 15% of UTIs. A retrospective study was performed comprising 331 pediatric cases with UTI. Our study aimed to detect the resistance of the uropathogens to common drugs used in UTI treatment. High resistance rates have been recorded for ampicillin, amoxicillin, trimethoprim/sulfamethoxazole (TMP/SMX), cefuroxime, and ciprofloxacin, among E. coli and Klebsiella. The multidrug-resistance (MDR) rate was detected in one-third of the uropathogens, among which more than half were isolated in patients with urinary tract abnormalities. Our study highlighted that nitrofurantoin, ceftriaxone, amikacin and carbapenem may be used for the empirical treatment for febrile or complicated UTI in children. This is the first comprehensive study that evaluates antibiotic resistance in UTIs in children, and their association with urinary tract abnormalities in Romania. As a result of this research, the protocol for initial empiric treatment of infants with febrile or complicated UTI should be modified considering a detailed and ongoing monitoring of local sensitivity of uropathogens to antimicrobial agents.
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Affiliation(s)
- Carmen Duicu
- Department of Pediatrics, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540142 Târgu Mureş, Romania
| | - Iulia Cozea
- Pediatric Clinic 1, Emergency County Hospital, 540139 Târgu Mureş, Romania
| | - Dan Delean
- Pediatric Nephrology Department, Emergency Clinical Hospital for Children, 400124 Cluj-Napoca, Romania
| | - Andreea Alexandra Aldea
- Neurology Clinic, Clinical Recovery Hospital Cluj-Napoca, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Cornel Aldea
- Pediatric Nephrology Department, Emergency Clinical Hospital for Children, 400124 Cluj-Napoca, Romania
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Grama A, Aldea CO, Burac L, Delean D, Bulata B, Sirbe C, Duca E, Boghitoiu D, Coroleuca A, Pop TL. Etiology and Outcome of Acute Liver Failure in Children-The Experience of a Single Tertiary Care Hospital from Romania. Children (Basel) 2020; 7:E282. [PMID: 33317098 PMCID: PMC7763257 DOI: 10.3390/children7120282] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Acute liver failure (ALF) is a rare disease, associated with high mortality, despite optimal medical therapy without emergency liver transplantation. Knowing the possible cause of ALF plays a vital role in the management, as the child could benefit from effective specific therapies in emergencies. METHODS We have analyzed the etiology and outcome of ALF in children followed-up in a tertiary care hospital between January 2012-December 2018. The patients were grouped into different age categories: neonates (0-1 month), infants (1-12 months), children (1-14 years), and teenagers (14-18 years). RESULTS 97 children (46 males, 47.42%, the mean age of 7.66 ± 8.18 years) were admitted with ALF. The most important causes of ALF were in neonates and infants, infections (72.72%), and metabolic disorders (43.47%), in children and adolescents were the toxic causes (60% and 79.41%). The mortality rate was 31.95% (31 patients), mainly in ALF due to infections or metabolic disorders. CONCLUSIONS In neonates and infants, the main causes of ALF were infections and metabolic diseases, while in older children and teenagers, were toxin-induced liver injuries. The mortality among neonates and infants was significantly higher than in other ages. Early recognition and immediate therapeutic intervention could improve the outcome of these patients.
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Affiliation(s)
- Alina Grama
- 2nd Pediatric Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania; (A.G.); (L.B.); (C.S.); (E.D.)
- Center of Expertise in Pediatric Liver Rare Disorders, 2nd Pediatric Clinic, Emergency Clinic Hospital for Children, 400177 Cluj-Napoca, Romania
- University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (D.B.); (A.C.)
| | - Cornel Olimpiu Aldea
- Pediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinic Hospital for Children, 400177 Cluj-Napoca, Romania; (C.O.A.); (D.D.); (B.B.)
| | - Lucia Burac
- 2nd Pediatric Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania; (A.G.); (L.B.); (C.S.); (E.D.)
- Center of Expertise in Pediatric Liver Rare Disorders, 2nd Pediatric Clinic, Emergency Clinic Hospital for Children, 400177 Cluj-Napoca, Romania
| | - Dan Delean
- Pediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinic Hospital for Children, 400177 Cluj-Napoca, Romania; (C.O.A.); (D.D.); (B.B.)
| | - Bogdan Bulata
- Pediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinic Hospital for Children, 400177 Cluj-Napoca, Romania; (C.O.A.); (D.D.); (B.B.)
| | - Claudia Sirbe
- 2nd Pediatric Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania; (A.G.); (L.B.); (C.S.); (E.D.)
| | - Emanuela Duca
- 2nd Pediatric Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania; (A.G.); (L.B.); (C.S.); (E.D.)
| | - Dora Boghitoiu
- University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (D.B.); (A.C.)
| | - Alexandra Coroleuca
- University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (D.B.); (A.C.)
| | - Tudor Lucian Pop
- 2nd Pediatric Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania; (A.G.); (L.B.); (C.S.); (E.D.)
- Center of Expertise in Pediatric Liver Rare Disorders, 2nd Pediatric Clinic, Emergency Clinic Hospital for Children, 400177 Cluj-Napoca, Romania
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Grama A, Burac L, Aldea CO, Bulata B, Delean D, Samasca G, Abrudan C, Sirbe C, Pop TL. Vitamin D-Binding Protein (Gc-Globulin) in Acute Liver Failure in Children. Diagnostics (Basel) 2020; 10:E278. [PMID: 32375318 PMCID: PMC7278011 DOI: 10.3390/diagnostics10050278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 02/05/2023] Open
Abstract
This study aimed to analyse vitamin d-binding protein (Gc-globulin) serum levels in acute liver failure (ALF) in children in relation to disease outcomes and correlations with other known markers used to evaluate the severity of ALF. Our study included 34 children (mean age 4.87 ± 5.30 years) with ALF of different causes (metabolic, 26.47%; autoimmune, 23.53%; toxic, 20.59%; infection, 17.65%; unknown, 11.76%) and 30 children without any liver injury (mean age 6.11 ± 4.26 years). The outcome was poor in 14 patients (41.18%), including one child with liver transplantation (2.94%). Serum Gc-globulin levels were significantly lower in ALF patients compared to the control group (151.57 ± 171.8 mg/L vs. 498.63 ± 252.50 mg/L; p < 0.000001), with an optimum cut-off of 163.5 mg/L (Area Under the Curve, AUC, 0.8921; sensitivity, 76.50%; specificity, 100%). Levels were also lower in patients with poor outcomes compared to survivors (59.34 ± 33.73 mg/L vs. 216.12 ± 199.69 mg/L; p < 0.0001), with an optimum cut-off 115 mg/L (AUC, 0.7642; sensitivity, 100%; specificity, 50%). Gc-globulin serum levels were variable according to ALF aetiology, i.e., lower in metabolic, infectious, or unknown causes compared to autoimmune and toxic causes. Gc-globulin serum levels were decreased in children with ALF and lower in those with poor outcomes compared with survivors. Gc-globulin serum levels were correlated with other known parameters used to evaluate the severity of ALF and could help to identify patients at high risk for poor outcomes.
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Affiliation(s)
- Alina Grama
- 2nd Paediatric Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400177 Cluj-Napoca, Romania; (A.G.); (L.B.); (C.S.)
- Centre of Expertise in Paediatric Liver Rare Diseases, 2nd Paediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
- University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Lucia Burac
- 2nd Paediatric Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400177 Cluj-Napoca, Romania; (A.G.); (L.B.); (C.S.)
- Centre of Expertise in Paediatric Liver Rare Diseases, 2nd Paediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
| | - Cornel Olimpiu Aldea
- Paediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania; (C.O.A.); (B.B.); (D.D.)
| | - Bogdan Bulata
- Paediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania; (C.O.A.); (B.B.); (D.D.)
| | - Dan Delean
- Paediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania; (C.O.A.); (B.B.); (D.D.)
| | - Gabriel Samasca
- Laboratory of Medical Analysis, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania; (G.S.); (C.A.)
| | - Carmen Abrudan
- Laboratory of Medical Analysis, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania; (G.S.); (C.A.)
| | - Claudia Sirbe
- 2nd Paediatric Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400177 Cluj-Napoca, Romania; (A.G.); (L.B.); (C.S.)
| | - Tudor Lucian Pop
- 2nd Paediatric Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400177 Cluj-Napoca, Romania; (A.G.); (L.B.); (C.S.)
- Centre of Expertise in Paediatric Liver Rare Diseases, 2nd Paediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
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Abstract
RATIONALE Malformative uropathies represent a major cause of Chronic Kidney Disease (CKD) in children. Genitourinary system is the most frequent and sever affected in Prune-Belly syndrome cases. That is why the findings of early diagnosis and vigilant monitoring for these situations remain a major challenge for the medical team. PATIENT CONCERNS We present the clinical course of a 10 years old child with diagnosis of Prune-Belly syndrome. A urinary tract abnormality was suspected starting 25 weeks of gestation, when a routine ultrasound showed oligohydramnios, increased size urinary bladder, bilateral hydronephrosis and megaureters, thin abdominal wall. DIAGNOSIS Prenatal suspicion of Prune-Belly syndrome plays a deciding role in renal disease progression. A detailed clinical exam at birth established the diagnosis of Prune-Belly syndrome. Renal ultrasound confirmed bilateral grade III hydronephrosis and megaureters, with empty bladder, suggesting an obstruction at this level. A persistent urachus was confirmed by catheterization. Later it was used for imaging study that showed bilateral high grade reflux. INTERVENTIONS The main goal of any treatment is to preserve kidney function. Treatment options depend on the clinical picture. The pregnancy was closely monitorized, but fetal distress appeared so early labor was induced at 32 weeks. At beginning a temporary catheter was placed into the urachus which expressed urine. The urachus drain was left in place until the age of 6 weeks, when a bilateral ureterostomy was performed. Skeletal and genital malformations were present too; the child has undergone several surgeries to solve these abnormalities. OUTCOMES At the age of 10 years, he is a well-adapted child. He has had fewer than 3 urinary tract infections per year. Long term follow-up showed a relatively slow decline in the estimated Glomerular Filtration Rate in our child (62 ml/1.73m/min). LESSONS This case suggests that induced early labor could prove beneficial for early upper urinary tract decompression through earlier access to surgery. This is an option especially in situations or region where vesicoureteric or vesicoamniotic shunt placement is not available.
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Affiliation(s)
- Aldea Cornel
- Department of Nephrology and Dyalisis Children, 2nd Pediatric Clinic, Emergency Hospital for Children, Cluj-Napoca
| | - Carmen Duicu
- 1st Pediatric Department, University of Medicine, Pharmacy, Science and Technology, Tîrgu Mureş
| | - Dan Delean
- Department of Nephrology and Dyalisis Children, 2nd Pediatric Clinic, Emergency Hospital for Children, Cluj-Napoca
| | - Bogdan Bulata
- Department of Nephrology and Dyalisis Children, 2nd Pediatric Clinic, Emergency Hospital for Children, Cluj-Napoca
| | - Magdalena Starcea
- 4th Pediatric Clinic, Department of Nephrology and Dialysis Children, Emergency Hospital for Children Iaşi, Romania
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Rusu CC, Racasan S, Moldovan D, Potra A, Tirinescu D, Budurea C, Orasan R, Patiu IM, Bondor C, Vladutiu D, Delean D, Danu A, Kacso IM. Ghrelin and acyl ghrelin levels are associated with inflammatory and nutritional markers and with cardiac and vascular dysfunction parameters in hemodialysis patients. Int Urol Nephrol 2018; 50:1897-1906. [PMID: 30006785 DOI: 10.1007/s11255-018-1933-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/06/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Exogenous ghrelin is associated with cardiovascular protection in experimental and human studies. Nevertheless ESRD patients have increased ghrelin levels and severe cardiovascular comorbidities. This study aims to elucidate the metabolic factors influencing endogenous ghrelin/acyl ghrelin levels and to analyze the relation between endogenous ghrelin/acyl ghrelin levels and cardiac and vascular function markers in hemodialysis patients. METHODS The cross-sectional study was conducted in hemodialysis patients (n = 88); 50 of them were men, mean age 61.1 ± 13.5 years, 17% had diabetes. We assessed nutritional and inflammatory status and analyzed the determinants of ghrelin/acyl ghrelin and their relation with cardiac and vascular function. RESULTS Ghrelin is correlated with IL-1β (r = 0.88, p < 0.0001), triglycerides, total cholesterol (TC), and Kt/V. IL-1β is the strongest predictor of ghrelin levels (p < 0.0001). Acyl ghrelin is correlated with TC (r = 0.36, p = 0.001), LDL-cholesterol, serum bicarbonate, body mass index. TC is the strongest predictor for acyl ghrelin levels (p = 0.038). Patients with high ghrelin levels had significantly decreased nitroglycerin-mediated dilation (p = 0.05) and higher IL-1β levels (p < 0.001); increased NT-proBNP is associated with lower levels of acyl ghrelin (r = - 0.33, p = 0.02) in male patients. CONCLUSION The inflammatory marker IL-1β is in our study the strongest predictor of ghrelin levels while the nutritional marker-total cholesterol is the strongest predictor for acyl ghrelin levels in HD patients. High endogenous ghrelin level is associated with high IL-1β and with vascular smooth muscle cell dysfunction. Low acyl ghrelin level is associated with high NT-proBNP (a cardiac dysfunction marker) in male HD patients. There is a direct correlation between endogenous ghrelin level and inflammatory markers, which is not related with cardiovascular protection.
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Affiliation(s)
- Crina Claudia Rusu
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania.
| | - Simona Racasan
- Nefromed Dialysis Center, 40 Ana Aslan Street, Cluj-Napoca, Romania
| | - Diana Moldovan
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Alina Potra
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Dacian Tirinescu
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Cristian Budurea
- Nefromed Dialysis Center, 40 Ana Aslan Street, Cluj-Napoca, Romania
| | - Remus Orasan
- Nefromed Dialysis Center, 40 Ana Aslan Street, Cluj-Napoca, Romania
| | - Ioan Mihai Patiu
- Nefromed Dialysis Center, 40 Ana Aslan Street, Cluj-Napoca, Romania
| | - Cosmina Bondor
- Department of Informatics and Biostatistics, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj, 6 Pasteur Street, 400349, Cluj-Napoca, Romania
| | - Dan Vladutiu
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Dan Delean
- Nefromed Dialysis Center, 40 Ana Aslan Street, Cluj-Napoca, Romania
| | - Alexandra Danu
- Nephrocare Dialysis Center Dej, 9 Gutinului Street, 405200, Dej, Romania
| | - Ina Maria Kacso
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
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Aldea C, Munteanu T, Delean D, Bulata B, Bungardi A, Man S, Gafencu M, Duicu C. CHALLENGING INFANTILE NEPHROTIC SYNDROME – MANAGEMENT AND DIAGNOSTIC ISSUES Lecturer Cornel Aldea1 MD, PhD, Teodora Munteanu1 MD, Dan Delean1 MD, Bogdan Bulata1 MD, Adriana Bungardi1 MD, Prof. Sorin Man2 , MD, PhD, Prof. Mihai Gafencu3 , MD, PhD, Conf. Carmen Duicu4 MD, PhD 1 Department of Nephrology and Dialysis Children, 2nd Pediatric Clinic, Emergency Hospital for Children, Cluj-Napoca 2 3rd Pediatric Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 3 “Louis Turcanu” Emergency Hospital for Children, “Victor Babes” University of Medicine and Pharmacy, Timisoara 4 1st Pediatric Department, University of Medicine and Pharmacy, Tg. Mures. Ro J Pediatr 2018. [DOI: 10.37897/rjp.2018.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Aldea C, Munteanu T, Delean D, Bulată B, Bungardi A, Man S, Gafencu M, Duicu C. Sindromul nefrotic infantil – provocări de diagnostic şi management. Ro J Pediatr 2018. [DOI: 10.37897/rjp.2018.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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12
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Rusu CC, Racasan S, Kacso IM, Moldovan D, Potra A, Bondor C, Orasan R, Patiu IM, Budurea C, Tirinescu D, Danu A, Delean D. SP684TOTAL GHRELIN AND ACYLGHRELIN DETERMINANTS IN HEMODIALYSIS PATIENTS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx155.sp684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Spârchez M, Lupan I, Delean D, Bizo A, Damian L, Muntean L, Tămaș MM, Bolba C, Simionescu B, Slăvescu C, Felea I, Lazăr C, Spârchez Z, Rednic S. Primary complement and antibody deficiencies in autoimmune rheumatologic diseases with juvenile onset: a prospective study at two centers. Pediatr Rheumatol Online J 2015; 13:51. [PMID: 26590091 PMCID: PMC4654875 DOI: 10.1186/s12969-015-0050-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our aim was to investigate the prevalence and clinical relevance of inherited complement and antibody deficiency states in a large series of patients with various autoimmune rheumatologic diseases (ARD) with juvenile onset. METHODS A total number of 117 consecutive patients from 2 tertiary referral hospitals were included in the study. All patients underwent genetic screening for type I C2 deficiency and C4 allotyping. Serum levels of immunoglobulin classes measured systematically throughout their regular medical care were recorded retrospectively. RESULTS Our cohort of patients included 84 with juvenile idiopathic arthritis (JIA), 21 with systemic lupus erythematosus (SLE), 6 with systemic vasculitis, 2 with juvenile scleroderma, 2 with idiopathic uveitis, 1 with mixed connective tissue disease and 1 with SLE/scleroderma overlap syndrome. We have found 16 patients with evidence of primary immunodeficiency in our series (13.7%), including 7 with C4 deficiency, 5 with selective IgA deficiency, 3 with C2 deficiency and 2 with unclassified hypogammaglobulinemia (one also presented C4D). Of the 84 patients with JIA, 4 (4.8%) had a complement deficiency, which was less prevalent than in the SLE cohort (23.8%), but all of them have exhibited an aggressive disease. Most of our patients with primary antibody deficiencies showed a more complicated and severe disease course and even the co-occurrence of two associated autoimmune diseases (SLE/scleroderma overlap syndrome and SLE/autoimmune hepatitis type 1 overlap). CONCLUSIONS Our findings among others demonstrate that complement and immunoglobulin immunodeficiencies need careful consideration in patients with ARD, as they are common and might contribute to a more severe clinical course of the disease.
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Affiliation(s)
- Mihaela Spârchez
- 2nd Department of Paediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, 3-5 Crisan Street, Cluj-Napoca, 400177, Romania. .,Emergency Children's Hospital, Cluj-Napoca, Romania.
| | - Iulia Lupan
- Molecular Biology Center, Interdisciplinary Research Institute on Bio-Nano-Sciences, Babes-Bolyai University Cluj-Napoca, Cluj-Napoca, Romania
| | - Dan Delean
- Emergency Children’s Hospital, Cluj-Napoca, Romania
| | - Aurel Bizo
- 2nd Department of Paediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, 3-5 Crisan Street, Cluj-Napoca, 400177 Romania ,Emergency Children’s Hospital, Cluj-Napoca, Romania
| | - Laura Damian
- Rheumatology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Laura Muntean
- Rheumatology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania ,Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maria Magdalena Tămaș
- Rheumatology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania ,Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Bianca Simionescu
- 2nd Department of Paediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, 3-5 Crisan Street, Cluj-Napoca, 400177 Romania ,Emergency Children’s Hospital, Cluj-Napoca, Romania
| | - Cristina Slăvescu
- 2nd Department of Paediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, 3-5 Crisan Street, Cluj-Napoca, 400177 Romania ,Emergency Children’s Hospital, Cluj-Napoca, Romania
| | - Ioana Felea
- Rheumatology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Călin Lazăr
- Emergency Children’s Hospital, Cluj-Napoca, Romania
| | - Zeno Spârchez
- 3rd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Rednic
- Rheumatology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania ,Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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