Reduced Blood Pressure Dipping Is A Risk Factor for the Progression of Chronic Kidney Disease in Children

Background: Elevated blood pressure and proteinuria are well-established risk factors for chronic kidney disease (CKD) progression in children. This study aimed to analyze risk factors for CKD progress, emphasizing detailed ambulatory blood pressure (ABPM) data. Methods: In 55 children with CKD II−V, observed for ≥1 year or until initiation of kidney replacement therapy, we analyzed ABPM, clinical, and biochemical parameters. Results: At the beginning, the glomerular filtration rate (eGFR) was 66 (interquartile range—IQR: 42.8−75.3) mL/min/1.73 m2, and the observation period was 27 (16−36) months. The mean eGFR decline was 2.9 ± 5.7 mL/min/1.73 m2/year. eGFR decline correlated (p < 0.05) with age (r = 0.30), initial proteinuria (r = 0.31), nighttime systolic and mean blood pressure (r = 0.27, r = 0.29), and systolic and diastolic blood pressure dipping (r = −0.37, r = −0.29). There was no relation between mean arterial pressure during 24 h (MAP 24 h Z-score) and eGFR decline and no difference in eGFR decline between those with MAP 24 h < and ≥50 th percentile. In multivariate analysis, systolic blood pressure dipping (beta = −0.43), presence of proteinuria (beta = −0.35), and age (beta = 0.25) were predictors of eGFR decline. Conclusions: Systolic blood pressure dipping may be a valuable indicator of CKD progression in children.

Evaluation of Active Renin Concentration in A Cohort of Adolescents with Primary Hypertension

Our study aimed to assess active renin concentration in children with primary hypertension. Thus, we evaluated active renin concentration, clinical parameters, office and ambulatory blood pressure, and biochemical parameters in 51 untreated adolescents with primary hypertension (median: 14.4 [interquartile range—IQR: 13.8–16.8] years) and 45 healthy adolescents. Active renin concentration did not differ between patients with hypertension and healthy children (median: 28.5 [IQR: 21.9–45.2] vs. 24.9 [IQR: 16.8–34.3] [pg/mL], p = 0.055). In the whole group of 96 children, active renin concentration correlated positively with serum potassium and office and ambulatory systolic and diastolic blood pressures. Among children with hypertension, patients with isolated systolic hypertension had lower renin concentration than patients with systolic-diastolic hypertension (26.2 [IQR: 18.6–34.2] vs. 37.8 [IQR: 27.0–49.6] [pg/mL], p = 0.014). The active renin concentration did not differ between patients with isolated systolic hypertension and healthy children. In multivariate analysis, diastolic blood pressure Z-score (beta = 0.238, 95 confidence interval [0.018–0.458], p = 0.035) was the only predictor of active renin concentration in the studied children. We concluded that active renin concentration is positively associated with blood pressure and potassium in children, and diastolic blood pressure was the strongest predictor of renin level. Patients with isolated systolic hypertension may differ from patients with systolic-diastolic hypertension in less severe activation of the renin-angiotensin-aldosterone system.

[Peritonitis determined by the site of intra-abdominal surgery]

The aim of this study was to determine bacterial flora infecting the peritoneal cavity during intraabdominal surgery by site of operation. Three groups of patients were examined. 29 patients who underwent surgery on the stomach, duodenum, biliary tract or pancreas, 15 patients operated on because of acute appendicitis and 63 patients operated on because of colon or rectum tumours. At the end of the operation but before closure cultures were obtained by swab from the completed anastomosis site. Samples were placed into transport medium and transported promptly to the laboratory. The results of the bacteriological examinations showed that the peritoneal cavity of all patients operated on were infected with bacteria characteristic for the digestive tract, especially by Enterobacteriaceae spp., Enterococcus spp. and Bacteroides spp. From patients operated on because of rectum or colon tumours 3 or 4 bacterial species were isolated most often and they were often infected with P. aeruginosa and C. albicans. This was in contrast to patients from the other groups. In patients infected with polymicrobial flora, B. fragilis and E. coli or enterococci and E. coli and enterococci were most often seen.

[Evaluation of bacterial flora in patients after intraabdominal surgical procedures throughout a 12 year period]

The aim of this study was to analyse the composition of the bacterial flora in 295 patients who underwent surgical treatment in our clinic throughout the period of 12 years. 448 specimens were bacteriologically examined. Bacterial pathogens were isolated from 390 (87.1%). Among aerobic bacteria, Enterococcus faecalis was the most often isolated (35.6% - from the peritoneum, 17.8% from the wound). Among anaerobic bacteria, Bacteroides fragilis - 44.9% were the most often isolated. 530 aerobic bacterial strains from Enterococcus, Enterobacteriaceae, Staphylococcus and the nonfermentable rods were carefully analysed. Special attention was paid to the development of the resistance to 3 antibiotics (cefoperazone, ciprofloxacin and gentamycin) in 3 time periods: from 1984 to 1987, from 1988 to 1992 and from 1993 to 1996. Resistance of the bacterial strains to cefoperazone was 38.7% in the first time period; 39.5% in the second; and later increased to 53.8%. Resistance to ciprofloxacin was identical in the first two periods - 10.3%; and subsequently, it increased to 22.6%. The increase of resistance to gentamycin was the most significant--it went up from 24.5% to 44.8 and then dropped to 40.3%.

CONCLUSION

Constant monitoring of the bacterial flora enables rational antibiotic application, which is essential due to the observed increase of bacteria strain resistance.

The influence of MHC class II antigen blockade by perfusion with a monoclonal antibody on rat renal graft survival

To decrease immunogenicity of the rat kidney, grafts were perfused with an anti-MHC class II monoclonal antibody (mAb). How effectively this procedure blocked class II-positive cells, which were mainly dendritic in appearance, was checked by immunostaining renal sections after perfusion and comparing them with in vitro stained sections. Optimum conditions were applied for graft pretreatment before transplantation. This procedure prolonged graft survival, though not satisfactorily from the biological point of view (9.6 +/- 0.8 versus 7.7 +/- 0.5 days in the control group; P less than 0.02). The dendritic cells were not killed but blocked. Several hours after transplantation, the mAb dissociated from these class II-positive cells. It was also shown that donor cells migrate into the recipient's spleen early after transplantation. The number of these cells was smaller when the transplanted organ was perfused with the mAb. Further studies are suggested to deplete the graft of donor dendritic cells more adequately. They should also combine graft perfusion with anti-class II mAb and recipient immunosuppression at reduced doses.

[Conservative treatment of perforation of the transverse colon caused by a catheter for continuous peritoneal dialysis. A case report]

In rare cases of intestinal perforation in patients dialysed peritoneally may be the dialyzing catheter introduced into the peritoneal cavity for repeated use. The therapeutic procedure (conservative or operative) is the matter of dispute. The authors present a female patient, aged 62, undergoing intermittent peritoneal dialysis for terminal renal failure. The perforation of the transverse colon due to the dialyzing catheter was successfully treated conservatively: the catheter was removed, antibacterial drugs, parenteral nutrition and bedrest were administered. Uraemia was controlled by haemodialysis.