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Mizerska-Wasiak M, Turczyn A, Cichoń-Kawa K, Małdyk J, Miklaszewska M, Drożdż D, Bieniaś B, Sikora P, Drożyńska-Duklas M, Żurowska A, Szczepańska M, Pańczyk-Tomaszewska M. IgA vasculitis nephritis clinical course and kidney biopsy - national study in children. Pediatr Rheumatol Online J 2021; 19:150. [PMID: 34620183 PMCID: PMC8495907 DOI: 10.1186/s12969-021-00616-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/24/2021] [Accepted: 07/20/2021] [Indexed: 11/12/2022] Open
Abstract
UNLABELLED The aim of the study was to investigate the relationship between the severity of typical clinical symptoms, severity of histopathological lesions in kidney biopsies in IgA vasculitis nephritis (IgAVN) and to propose indications for kidney biopsy in children. MATERIAL AND METHODS This retrospective study enrolled 106 patients, included in the IgAVN registry of Polish children, diagnosed by kidney biopsy. Renal and extrarenal symptoms at onset of the disease were analyzed. Biopsy results were assessed using Oxford classifications (MEST-C). The patients were divided into 3 groups depending on the severity of proteinuria: A-nephrotic proteinuria with hematuria; B-non-nephrotic proteinuria with hematuria; C-isolated hematuria. RESULTS The first symptoms of nephropathy were observed at the 0.7 (1-128.4) months from the onset of extrarenal symptoms. Kidney biopsy was performed on 39 (6-782) days after the onset of nephropathy symptoms. MEST-C score 4 or 5 was significantly more frequent in children from group A than in groups B and C. Significantly higher mean MEST-C score was found in patients with abdominal symptoms than without. In group A: S0 and T0 we found in significantly shorter time to kidney biopsy than in S1, T1-2 p < 0.05) and in group B the significantly shorter time in T0 compare to T1-2 p < 0.05). The ROC analysis shows that S1 changes appear in kidney biopsies in group A with cut off 21 days (AUC 0,702, p = 0.004, sensitivity 0.895 specificity 0.444) T1-2 changes after 35 days (AUC 0.685, p = 0.022, sensitivity 0.750, specificity 0.615), and in goupn B T1-2 cut off is 74 days (AUC 0,738, p = 0.002, sensitivity 0.667, specificity 0.833). CONCLUSIONS In childhood IgAVN, the severity of changes in the urine is clearly reflected in the result of a kidney biopsy. The biopsy should be performed in patients with nephrotic proteinuria no later than 3 weeks after the onset of this symptom in order to promptly apply appropriate treatment and prevent disease progression. Accompanying abdominal symptoms predispose to higher MESTC score.
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Affiliation(s)
| | - Agnieszka Turczyn
- grid.13339.3b0000000113287408Department of Paediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Karolina Cichoń-Kawa
- grid.13339.3b0000000113287408Department of Paediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Jadwiga Małdyk
- grid.13339.3b0000000113287408Department of Pathomorphology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Miklaszewska
- grid.5522.00000 0001 2162 9631Department of Pediatric Nephrology, Jagiellonian University, Collegium Medicum, Cracow, Poland
| | - Dorota Drożdż
- grid.5522.00000 0001 2162 9631Department of Pediatric Nephrology, Jagiellonian University, Collegium Medicum, Cracow, Poland
| | - Beata Bieniaś
- grid.411484.c0000 0001 1033 7158Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Przemysław Sikora
- grid.411484.c0000 0001 1033 7158Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Magdalena Drożyńska-Duklas
- grid.11451.300000 0001 0531 3426Department of Paediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdansk, Poland
| | - Aleksandra Żurowska
- grid.11451.300000 0001 0531 3426Department of Paediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdansk, Poland
| | - Maria Szczepańska
- grid.411728.90000 0001 2198 0923Department of Paediatrics, Medical University of Silesia, Zabrze, Poland
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Mizerska-Wasiak M, Such-Gruchot A, Cichoń-Kawa K, Turczyn A, Małdyk J, Miklaszewska M, Drożdż D, Firszt-Adamczyk A, Stankiewicz R, Rybi-Szumińska A, Wasilewska A, Szczepańska M, Bieniaś B, Sikora P, Pukajło-Marczyk A, Zwolińska D, Pawlak-Bratkowska M, Tkaczyk M, Zachwieja J, Drożyńska-Duklas M, Żurowska A, Gadomska-Prokop K, Grenda R, Pańczyk-Tomaszewska M. The Role of Complement Component C3 Activation in the Clinical Presentation and Prognosis of IgA Nephropathy-A National Study in Children. J Clin Med 2021; 10:jcm10194405. [PMID: 34640422 PMCID: PMC8509710 DOI: 10.3390/jcm10194405] [Citation(s) in RCA: 3] [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: 08/30/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to evaluate the influence of the intensity of mesangial C3 deposits in kidney biopsy and the serum C3 level on the clinical course and outcomes of IgAN in children. The study included 148 children from the Polish Pediatric IgAN Registry, diagnosed based on kidney biopsy. Proteinuria, creatinine, IgA, C3 were evaluated twice in the study group, at baseline and the end of follow-up. Kidney biopsy was categorized using the Oxford classification, with a calculation of the MEST-C score. The intensity of IgA and C3 deposits were rated from 0 to +4 in immunofluorescence microscopy. The intensity of mesangial C3 > +1 deposits in kidney biopsy has an effect on renal survival with normal GFR in children with IgAN. A reduced serum C3 level has not been a prognostic factor in children but perhaps this finding should be confirmed in a larger group of children.
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Affiliation(s)
- Małgorzata Mizerska-Wasiak
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.S.-G.); (K.C.-K.); (A.T.); (M.P.-T.)
- Correspondence:
| | - Agnieszka Such-Gruchot
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.S.-G.); (K.C.-K.); (A.T.); (M.P.-T.)
| | - Karolina Cichoń-Kawa
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.S.-G.); (K.C.-K.); (A.T.); (M.P.-T.)
| | - Agnieszka Turczyn
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.S.-G.); (K.C.-K.); (A.T.); (M.P.-T.)
| | - Jadwiga Małdyk
- Department of Pathology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Monika Miklaszewska
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, 30-663 Cracow, Poland; (M.M.); (D.D.)
| | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, 30-663 Cracow, Poland; (M.M.); (D.D.)
| | - Agnieszka Firszt-Adamczyk
- Department of Pediatrics and Nephrology, Ludwik Rydygier Hospital, 87-100 Torun, Poland; (A.F.-A.); (R.S.)
| | - Roman Stankiewicz
- Department of Pediatrics and Nephrology, Ludwik Rydygier Hospital, 87-100 Torun, Poland; (A.F.-A.); (R.S.)
| | - Agnieszka Rybi-Szumińska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, 15-089 Bialystok, Poland; (A.R.-S.); (A.W.)
| | - Anna Wasilewska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, 15-089 Bialystok, Poland; (A.R.-S.); (A.W.)
| | - Maria Szczepańska
- Department of Pediatrics, SMDZ in Zabrze, Silesian Medical University, 41-808 Zabrze, Poland;
| | - Beata Bieniaś
- Department of Pediatric Nephrology, Medical University of Lublin, 20-059 Lublin, Poland; (B.B.); (P.S.)
| | - Przemysław Sikora
- Department of Pediatric Nephrology, Medical University of Lublin, 20-059 Lublin, Poland; (B.B.); (P.S.)
| | - Agnieszka Pukajło-Marczyk
- Department of Pediatric Nephrology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.P.-M.); (D.Z.)
| | - Danuta Zwolińska
- Department of Pediatric Nephrology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.P.-M.); (D.Z.)
| | - Monika Pawlak-Bratkowska
- Department of Pediatrics, Immunology and Nephrology, Polish Mothers Memorial Hospital Research Institute, 93-338 Lodz, Poland; (M.P.-B.); (M.T.)
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mothers Memorial Hospital Research Institute, 93-338 Lodz, Poland; (M.P.-B.); (M.T.)
| | - Jacek Zachwieja
- Department of Pediatric Nephrology and Dialysis, Medical University of Poznan, 61-701 Poznan, Poland;
| | - Magdalena Drożyńska-Duklas
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, 80-210 Gdansk, Poland; (M.D.-D.); (A.Ż.)
| | - Aleksandra Żurowska
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, 80-210 Gdansk, Poland; (M.D.-D.); (A.Ż.)
| | - Katarzyna Gadomska-Prokop
- Department of Nephrology, Kidney Transplantation and Hypertension, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (K.G.-P.); (R.G.)
| | - Ryszard Grenda
- Department of Nephrology, Kidney Transplantation and Hypertension, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (K.G.-P.); (R.G.)
| | - Małgorzata Pańczyk-Tomaszewska
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.S.-G.); (K.C.-K.); (A.T.); (M.P.-T.)
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3
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Mizerska-Wasiak M, Gajewski Ł, Cichoń-Kawa K, Siejko A, Małdyk J, Spława-Neyman A, Zachwieja J, Firszt-Adamczyk A, Stankiewicz R, Drożyńska-Duklas M, Żurowska A, Bieniaś B, Sikora P, Pukajło-Marczyk A, Zwolińska D, Szczepańska M, Pawlak-Bratkowska M, Tkaczyk M, Stelmaszczyk-Emmel A, Pańczyk-Tomaszewska M. Relationship between Gd-IgA1 and TNFR1 in IgA nephropathy and IgA vasculitis nephritis in children - multicenter study. Cent Eur J Immunol 2021; 46:199-209. [PMID: 34764788 PMCID: PMC8568023 DOI: 10.5114/ceji.2021.108177] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY To evaluate the relationship between serum Gd-IgA1 (sGd-IgA1) and serum and urine TNFR1 (sTNFR1, uTNFR1) levels as possible prognostic factors in IgA nephropathy (IgAN) and IgA vasculitis nephritis (IgAVN). MATERIAL AND METHODS From 299 patients from the Polish Registry of Pediatric IgAN and IgAVN, 60 children (24 IgAN and 36 IgAVN) were included in the study. The control group consisted of 20 healthy children. Proteinuria, haematuria, serum creatinine as well as IgA and C3 levels were measured and glomerular filtration rate (GFR) was calculated at onset and at the end of the follow-up. Kidney biopsy findings were evaluated using the Oxford classification. Serum Gd-IgA1 and serum and urine TNFR1 levels were measured at the end of follow-up. RESULTS Serum Gd-IgA1 level was significantly higher in IgAN and IgAVN patients in comparison to the control group. Urine TNFR1 was significantly higher in IgAN than in IgAVN and the control group. We did not observe any differences in sTNFR1 level between IgAN, IgAVN and control groups. We found a positive correlation between Gd-IgA1 and creatinine (r = 0.34), and negative between Gd-IgA1 and GFR (r = -0.35) at the end of follow-up. We observed a negative correlation between uTNFR1/creatinine log and albumin level and protein/creatinine ratio. We did not find any correlations between Gd-IgA1 and TNFR1. CONCLUSIONS The prognostic value of sGd-IgA1 in children with IgAN and IgAVN has been confirmed. TNFR1 is not associated with Gd-IgA1 and is not a useful prognostic marker in children with IgAN/IgAVN and normal kidney function.
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Affiliation(s)
| | - Łukasz Gajewski
- Student’s Scientific Group at the Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Karolina Cichoń-Kawa
- Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Agata Siejko
- Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Jadwiga Małdyk
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Spława-Neyman
- Department of Pediatric Nephrology and Dialysis, Poznan University of Medical Sciences, Poznań, Poland
| | - Jacek Zachwieja
- Department of Pediatric Nephrology and Dialysis, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Roman Stankiewicz
- Department of Pediatrics and Nephrology, Ludwik Rydygier Hospital, Toruń, Poland
| | | | - Aleksandra Żurowska
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland
| | - Beata Bieniaś
- Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Przemysław Sikora
- Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | | | - Danuta Zwolińska
- Department of Pediatric Nephrology, Wroclaw Medical University, Wrocław, Poland
| | - Maria Szczepańska
- Department of Pediatrics, SMDZ in Zabrze, Silesian Medical University, Zabrze, Poland
| | - Monika Pawlak-Bratkowska
- Department of Pediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
| | - Anna Stelmaszczyk-Emmel
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland
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4
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Martuszewski A, Paluszkiewicz P, Wawrzyniak-Dzierżek E, Drożyńska-Duklas M, Bąbol-Pokora K, Myśliwiec M, Szymczak D, Irga-Jaworska N, Młynarski W, Kałwak K, Ussowicz M. Successful Salvage Haploidentical Alpha-Beta T Cell-Depleted Stem Cell Transplantation After Busulfan-Based Myeloablation in a Patient With IPEX Syndrome: A Case Report. Transplant Proc 2019; 51:3150-3154. [PMID: 31611124 DOI: 10.1016/j.transproceed.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND X-linked immunodysregulation syndrome with polyendocrinopathy and enteropathy (IPEX) is caused by FOXP3 gene mutations that block the generation of regulatory T lymphocytes. We report an 18-month-old boy with classic IPEX who underwent 2 hematopoietic stem cell transplantations (HSCTs). METHODS The first HSCT from an unrelated 8/10 HLA-matched umbilical cord blood donor (UCB) was performed after a conditioning regimen consisting of treosulfan, fludarabine, thiotepa, and thymoglobulin. Due to complete rejection of the UCB transplant, a second transplantation from a 6/10 HLA-matched mother was performed after alpha-beta T-cell depletion. The second conditioning regimen consisted of busulfan, fludarabine, a single dose of cyclophosphamide 1 g/m2, and Grafalon (Neovii Pharmaceuticals, Rapperswil, Switzerland). The T-cell depletion product contained 15.06 x 106 CD34+ cells per kilogram body weight (BW) and 4.19 x 105 alpha-beta T lymphocytes per kilogram BW. Due to acute graft rejection, the boy was treated with thymoglobulin, and full donor chimerism in both T lymphocytes and mononuclear cells was achieved. The immunosuppressive therapy was stopped 1 year after transplantation. To date, the patient remains free from graft-vs-host disease (GVHD) and immunosuppression. CONCLUSIONS HSCT after busulfan-based reduced-toxicity conditioning in patients with IPEX syndrome is feasible and well tolerated and can result in full donor engraftment. Monitoring of chimerism and aggressive therapy in cases of graft rejection are warranted due to the high reactivity of residual autologous T lymphocytes. T-cell depletion reduces the risk of GVHD and the need for steroid therapy, which is especially challenging in patients with diabetes.
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Affiliation(s)
- Adrian Martuszewski
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, Wrocław, Poland
| | - Patrycja Paluszkiewicz
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, Wrocław, Poland
| | - Elżbieta Wawrzyniak-Dzierżek
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, Wrocław, Poland
| | | | - Katarzyna Bąbol-Pokora
- Laboratory of Immunopathology and Genetics, Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź, Łódź, Poland
| | - Małgorzata Myśliwiec
- Department of Paediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, Gdańsk, Poland
| | - Donata Szymczak
- Department and Clinic of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wrocław Medical University, Wrocław, Poland
| | - Ninela Irga-Jaworska
- Department of Paediatrics, Haematology and Oncology, Medical University of Gdańsk, Gdańsk, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź, Łódź, Poland
| | - Krzysztof Kałwak
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, Wrocław, Poland
| | - Marek Ussowicz
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wrocław Medical University, Wrocław, Poland.
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Zachwieja J, Silska-Dittmar M, Żurowska A, Drożyńska-Duklas M, Hyla-Klekot L, Kucharska G, Stankiewicz R, Olszak-Szot I, Drożdż D, Moczulska A, Zwolińska D, Medyńska A, Sikora P, Bieniaś B, Tkaczyk M, Rogowska-Kalisz A, Ostalska-Nowicka D. Multicenter analysis of the efficacy and safety of a non-standard immunosuppressive therapy with rituximab in children with steroid-resistant nephrotic syndrome. Clin Exp Pharmacol Physiol 2018; 46:313-321. [PMID: 30346047 DOI: 10.1111/1440-1681.13046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 03/05/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 12/20/2022]
Abstract
The aim of the study was a multicenter analysis of the efficacy and safety of a non-standard immunosuppressive therapy with rituximab (Rtx) in children with steroid-resistant nephrotic syndrome (SRNS) with particular emphasis on the possibility of permanent discontinuation or dose reduction of other immunosuppressive drugs such as glucocorticoids and cyclosporine A after 6 months of observation. The study group consisted of 30 children with idiopathic nephrotic syndrome, who were unresponsive to standard immunosuppressive treatment, and hospitalized in the years 2010-2017 in eight paediatric nephrology centres in Poland. The children were administered a single initial infusion of rituximab at the dose of 375 mg/m2 of the body surface area. Proteinuria, the daily supply of glucocorticoids, and cyclosporine were assessed at the moment of the start of the treatment and after 6 months since its commencement. Before Rtx therapy, complete remission was found in 13 patients (43%) and partial remission was found in 8 patients (26%). These numbers increased to 16 (53%) and 12 (40%), respectively. At the start of the treatment 23 patients (76.6%) were treated with cyclosporine A. After 6 months, this number decreased to 15 patients (35%). At the start of the treatment, 18 patients (60%) were treated with prednisone. After 6 months, this number decreased to 8 patients (44%). Children with SRNS may potentially benefit from Rtx treatment despite relative risk of side effects. The benefits may include reduction of proteinuria or reduction of other immunosuppressants.
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Affiliation(s)
- Jacek Zachwieja
- Department of Paediatric Nephrology and Dialysis, University of Poznan, Poznan, Poland
| | | | - Aleksandra Żurowska
- Department of Paediatric Nephrology and Dialysis, University of Gdansk, Gdansk, Poland
| | | | - Lidia Hyla-Klekot
- Department of Paediatric Nephrology and Dialysis, University of Katowice, Katowice, Poland
| | - Grażyna Kucharska
- Department of Paediatric Nephrology and Dialysis, University of Katowice, Katowice, Poland
| | - Roman Stankiewicz
- Department of Paediatric Nephrology and Dialysis, University of Torun, Torun, Poland
| | - Ilona Olszak-Szot
- Department of Paediatric Nephrology and Dialysis, University of Torun, Torun, Poland
| | - Dorota Drożdż
- Department of Paediatric Nephrology and Dialysis, University of Krakow, Krakow, Poland
| | - Anna Moczulska
- Department of Paediatric Nephrology and Dialysis, University of Krakow, Krakow, Poland
| | - Danuta Zwolińska
- Department of Paediatric Nephrology and Dialysis, University of Wroclaw, Wroclaw, Poland
| | - Anna Medyńska
- Department of Paediatric Nephrology and Dialysis, University of Wroclaw, Wroclaw, Poland
| | - Przemysław Sikora
- Department of Paediatric Nephrology and Dialysis, University of Lublin, Lublin, Poland
| | - Beata Bieniaś
- Department of Paediatric Nephrology and Dialysis, University of Lublin, Lublin, Poland
| | - Marcin Tkaczyk
- Department of Paediatric Nephrology and Dialysis, University of Lodz, Lodz, Poland
| | - Anna Rogowska-Kalisz
- Department of Paediatric Nephrology and Dialysis, University of Lodz, Lodz, Poland
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6
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Krzemińska K, Maternik M, Drożyńska-Duklas M, Szcześniak P, Czarniak P, Gołębiewski A, Zurowska A. High efficacy of biofeedback therapy for treatment of dysfunctional voiding in children. Cent European J Urol 2012; 65:212-5. [PMID: 24578964 PMCID: PMC3921803 DOI: 10.5173/ceju.2012.04.art6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 05/25/2012] [Revised: 08/16/2012] [Accepted: 08/21/2012] [Indexed: 11/22/2022] Open
Abstract
Introduction Dysfunctional voiding is a frequent condition in children associated with symptoms of incontinence. The aim of this study was to present the efficacy of biofeedback treatment on the resolution of clinical symptoms in a large cohort of children with urodynamically confirmed dysfunctional voiding. Material and methods 81 children (75 girls and 6 boys) aged 6-18 years (mean: 10.32 ±3.17 yrs.) with a dysfunctional voiding pattern are presented. 74/81 (92.6%) of children were unresponsive to standard urotherapy and prior pharmacotherapy. Symptoms of bladder dysfunction were evaluated by questionnaire, bladder diary and an urodynamic study according to definitions and standards set by ICCS. The biofeedback training was planned for 2 months. Each session consisted of about 30 repeats of 5 s contraction and 30 s relaxation of pelvic floor muscles and external urethral sphincter. Biofeedback was performed together with standard urotherapy. Results 67 (82.72%) of the 81 children declared wetting during the day and 41 (50, 62%) – wetting during the night. 32/81 (39.5%) children had increased voiding frequency and 43 (53.08%) had decreased bladder capacity. Following 2 months of biofeedback therapy daytime incontinence resolved in 34/67 (50.7%) children and nighttime incontinence in 22/41 (53.65%). A further 40,3% declared partial improvement in daytime and 26.7% in nighttime wetting. Conclusions Biofeedback treatment is an effective therapeutic option for children with dysfunctional voiding. Pelvic floor therapy with biofeedback should be offered to children with dysfunctional voiding resistant to standard urotherapy.
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Affiliation(s)
- Katarzyna Krzemińska
- Department Pediatric & Adolescent Nephrology & Hypertension Medical University Gdańsk, Poland
| | - Michał Maternik
- Department Pediatric & Adolescent Nephrology & Hypertension Medical University Gdańsk, Poland
| | | | - Przemysław Szcześniak
- Department Pediatric & Adolescent Nephrology & Hypertension Medical University Gdańsk, Poland
| | - Piotr Czarniak
- Department Pediatric & Adolescent Nephrology & Hypertension Medical University Gdańsk, Poland
| | - Andrzej Gołębiewski
- Department Pediatric & Adolescent Surgery and Urology Medical University Gdańsk, Poland
| | - Aleksandra Zurowska
- Department Pediatric & Adolescent Nephrology & Hypertension Medical University Gdańsk, Poland
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