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Świȩtoń D, Grzywińska M, Czarniak P, Gołȩbiewski A, Durawa A, Teodorczyk J, Kaszubowski M, Piskunowicz M. The Emerging Role of MR Urography in Imaging Megaureters in Children. Front Pediatr 2022; 10:839128. [PMID: 35402364 PMCID: PMC8984115 DOI: 10.3389/fped.2022.839128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Megaureter, described as ureter dilatation more than 7 mm in diameter, commonly associated with other anomalies, is still a diagnostic and therapeutic challenge. Magnetic resonance urography (MRU) appears as a promising method in urinary tract imaging, providing both anatomical and functional information. There are several postprocessing tools to assess renal function (including differential renal function) and severity of ureteral obstruction based on MRU. Still, the place of this method in the diagnostic algorithm of ureteropelvicalyceal dilatation with megaureter remains underestimated. Analysis of imaging findings in a group of children diagnosed with megaureter was done. MATERIAL AND METHODS A retrospective analysis of magnetic resonance urography (MRU) was performed in 142 consecutive patients examined from January 2013 to September 2019. Twenty-five patients meeting the criteria of megaureter (dilatation more than 7 mm) in MRU were included in the further analysis. The MRU, ultrasound (US), and scintigraphy results were compared and analyzed together and compared with clinical data. RESULTS The sensitivity and specificity of US was comparable to the MRU in the assessment of upper urinary tract morphology (p > 0.05). In five out of 25 children, megaureter was found in each kidney; in a single case, both poles of a duplex kidney were affected. In the diagnosis of ureter ectopia, the MRU was superior to the US for which sensitivity did not exceed 16%. The US showed limited value in the diagnostics of segmental ureter dysplasia as a cause of primary megaureter when compared with MRU. Four cases were visualized in MRU studies, whereas the US examination was negative (all confirmed during surgery). There was a moderate correlation between relative renal function between fMRU and scintigraphy (t = 0.721, p = 0.477) and in the severity of obstruction assessment between both methods (r = 0.441, p < 0.05). However, in 10 kidneys with megaureter, the results in scintigraphy were inconclusive due to the signal from the megaureter imposing on the renal field. CONCLUSIONS MRU seems to be a preferred method in the diagnostic algorithm for megaureter, providing both anatomical and functional information. MRU is superior to US and scintigraphy in diagnosing urinary tract anomalies with megaureter.
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Affiliation(s)
- Dominik Świȩtoń
- Second Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Piotr Czarniak
- Department of Paediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrzej Gołȩbiewski
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdańsk, Gdańsk, Poland
| | - Agata Durawa
- Second Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Jacek Teodorczyk
- Department of Nuclear Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Mariusz Kaszubowski
- Faculty of Management and Economics, Department of Statistics and Econometrics, Gdańsk University of Technology, Gdańsk, Poland
| | - Maciej Piskunowicz
- First Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
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Świętoń D, Bernard W, Grzywińska M, Czarniak P, Durawa A, Kaszubowski M, Piskunowicz M, Szurowska E. A Comparability of Renal Length and Volume Measurements in MRI and Ultrasound in Children. Front Pediatr 2021; 9:778079. [PMID: 34956985 PMCID: PMC8692871 DOI: 10.3389/fped.2021.778079] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/08/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction: Despite the significant increase in use of magnetic resonance imaging (MRI) in children, there is still a lack of normal reference values of renal size in this method and reference values are being interpolated from the ultrasound (US) studies. The study provides comparative analysis of agreement in renal length and volume measurements between MRI and ultrasound. Materials and Methods: Ninety-three children with a mean age of 8.0 ± 6.0 years, who had undergone both renal US and MRI exams, were included in the study. Participants were divided into three subgroups; each kidney was considered separately. Group 1 included 106 kidneys without any anomalies. Group 2 comprised 48 kidneys with a dilated collecting system. Group 3 included 32 kidneys with a duplicated collecting system. Measurements were taken in three dimensions, and renal volume was calculated from the ellipsoid formula. Results: We found no significant difference between US and MRI measurements in Group 1 and Group 2. In Group 3, the difference between measurements in both imaging methods was significant. The mean difference varied from 0.05% in Group 1, 2.95% in Group 2, to 4.99% in Group 3. Conclusion: The US and MRI are comparable methods in renal size measurements. The interpolation of sonographic renal length and volume reference values to the MRI in the pediatric population is justified, as there is a strong agreement between both methods. Both methods can be used interchangeably for following up of the renal size changes in the pediatric population.
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Affiliation(s)
- Dominik Świętoń
- Second Radiology Department, Medical University of Gdansk, Gdańsk, Poland
| | - Weronika Bernard
- Faculty of Medicine, Medical University of Gdansk, Gdańsk, Poland
| | | | - Piotr Czarniak
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdańsk, Poland
| | - Agata Durawa
- Second Radiology Department, Medical University of Gdansk, Gdańsk, Poland
| | - Mariusz Kaszubowski
- Department of Statistics and Econometrics, Faculty of Management and Economics, Gdansk University of Technology, Gdansk, Poland
| | - Maciej Piskunowicz
- First Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
| | - Edyta Szurowska
- Second Radiology Department, Medical University of Gdansk, Gdańsk, Poland
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Suligowska K, Czarniak P, Pakalska-Korcala A, Drewek K, Sabiniewicz R, Maj A, Król E, Zdrojewski T. The necessity of prevention and treatment in the population of adolescents based on a comprehensive health assessment: the SOPKARD-Junior study. Pol Arch Intern Med 2020; 130:358-367. [PMID: 32250577 DOI: 10.20452/pamw.15280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Klaudia Suligowska
- Department of Preventive Medicine and Education, Medical University of Gdańsk, Gdańsk, Poland; Department of Dental Techniques and Masticatory System Dysfunctions, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Czarniak
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Pakalska-Korcala
- Mental Health Clinic for Children and Adolescents, Gdansk Medical Centre, Gdańsk, Poland
| | - Konrad Drewek
- Department of Trauma and Orthopedic Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Robert Sabiniewicz
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdańsk, Gdańsk, Poland
| | - Adrian Maj
- Department of Periodontology and Oral Mucosal Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - Ewa Król
- Department of Nephrology, Transplantation Medicine and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Zdrojewski
- Department of Preventive Medicine and Education, Medical University of Gdańsk, Gdańsk, Poland.
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Suligowska K, Czarniak P, Krawczyk M, Szcześniak P, Król E, Kusiak A, Sabiniewicz R, Wierzba T, Utracka A, Urban M, Wytrykowska A, Pakalska A, Drewek K, Giczewska A, Popowski P, Wrotkowska M, Marczulin J, Bochniak M, Zdrojewski T. An assessment of health status and health behaviours in adolescents: main points and methods of the SOPKARD-Junior programme. Arch Med Sci 2018; 14:38-51. [PMID: 29379531 PMCID: PMC5778424 DOI: 10.5114/aoms.2016.63742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 07/12/2016] [Accepted: 10/16/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The study involved preparing and implementation a model of complex screening programme for adolescents and comparison of anthropometric examinations between the population of the SOPKARD-Junior programme and representative sample of Polish children in the same age. MATERIAL AND METHODS The screening programme in 14-15 year old pupils (n = 282) included: anthropometric, blood pressure, echocardiographic, electrocardiographic, carotid arteries, kidney and thyroid ultrasound examinations, as well as respiratory, dental and masticatory system, orthopaedic, psychological and psychiatric assessment. Blood and urine tests were also performed. The results of anthropometric examinations from the SOPKARD-Junior and OLAF programmes were used for comparative analysis. RESULTS Statistically significant (p < 0.001) differences between young people from Sopot and their peers in the general Polish population were found in height (+3.61 cm for boys), body mass (+5.19 kg for boys and +3.99 kg for girls), body mass index (+0.99 kg/m2 for boys and +1.33 kg/m2 for girls), waist circumference (+4.52 cm for boys and +4.52 cm for girls) and hip circumference (+2.51 cm for boys). The highest attendance rate was achieved for examinations performed in school (e.g. anthropometric and blood pressure measurements - n = 268; 95%) and the lowest for the echocardiograpy performed in local hospital (n = 133; 47%). The mean score of the programme quality (scale 1-6) assessed by children was 4.63. CONCLUSIONS The SOPKARD-Junior programme represents an attempt to develop a model of screening assessments for teenagers in Poland. Preliminary results of the SOPKARD-Junior programme indicate small differences in the biological development of Sopot youth in comparison with their peers from Polish population of the OLAF programme. The high attendance rate on research conducted at the school indicate that proposed health examinations in adolescents are acceptable and feasible.
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Affiliation(s)
- Klaudia Suligowska
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdansk, Poland
| | - Piotr Czarniak
- Department of Paediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdansk, Poland
| | - Michał Krawczyk
- Department of Respiratory Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Przemysław Szcześniak
- Department of Paediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Król
- Department of Nephrology, Transplantation Medicine and Internal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Aida Kusiak
- Department of Periodontology and Oral Mucosal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Robert Sabiniewicz
- Department of Paediatric Cardiology and Congenital Heart Disease, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Wierzba
- Department of Physiology, Medical University of Gdansk, Gdansk, Poland
| | | | - Magdalena Urban
- Department of Dental Techniques and Masticatory System Dysfunctions, Medical University of Gdansk, Gdansk, Poland
| | - Anna Wytrykowska
- Department of Dental Techniques and Masticatory System Dysfunctions, Medical University of Gdansk, Gdansk, Poland
| | - Anna Pakalska
- Mental Health Clinic for Children and Adolescents, Gdansk Medical Centre, Gdansk, Poland
| | - Konrad Drewek
- Department of Trauma and Orthopaedic Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Anna Giczewska
- Department of Biomedical Engineering, Gdansk University of Technology, Gdansk, Poland
| | - Piotr Popowski
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Magdalena Wrotkowska
- Department of Hygiene and Epidemiology, Medical University of Gdansk, Gdansk, Poland
| | - Joanna Marczulin
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdansk, Poland
| | - Mariusz Bochniak
- Department of Periodontology and Oral Mucosal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Zdrojewski
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdansk, Poland
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Cackowska M, Bułło-Piontecka B, Liberek T, Czarniak P, Ptasińska-Perkowska A, Król E, Dębska-Ślizień A. SP154THE EPIDEMIOLOGY OF GLOMERULONEPHRITIS ON THE BASIS OF KIDNEY BIOPSY FROM ONE KIDNEY CENTER. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx141.sp154] [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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Piskunowicz M, Świętoń D, Rybczyńska D, Czarniak P, Szarmach A, Kaszubowski M, Szurowska E. Comparison of voiding cystourethrography and urosonography with second-generation contrast agents in simultaneous prospective study. J Ultrason 2016; 16:339-347. [PMID: 28138405 PMCID: PMC5269521 DOI: 10.15557/jou.2016.0034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 10/04/2016] [Revised: 10/15/2016] [Accepted: 10/18/2016] [Indexed: 11/28/2022] Open
Abstract
Background The invasiveness and exposure to radiation in voiding cystourethrography led to the introduction of alternative methods of diagnosis of vesicoureteral reflux, including contrast enhanced voiding urosonography. While there is a limited number of studies comparing these methods using new generation ultrasound contrast agents, none of them compared both methods simultaneously. This study is aimed at assessing agreement between contrast enhanced voiding urosonography with second-generation ultrasound contrast agents and voiding cystourethrography. Methods From April 2013 to May 2014, 83 children (37 female and 46 male), mean age 3.5 years, age range from 1 month to 17.5 years, underwent prospective simultaneous assessment by contrast enhanced voiding urosonography and voiding cystourethrography, with a total of 166 uretero-renal units evaluated. Results The sensitivity of voiding cystourethrography and contrast enhanced voiding urosonography were comparable, amounting to 88%, however, neither reached 100% for the entire studied population. The negative predictive value of voiding urosonography and voiding cystourethrography was 97%, and there was no difference between both methods. Conclusion Voiding cystourethrography and contrast enhanced voiding urosonography are comparable methods in diagnosis of vesicoureteral reflux, and can be performed alternatively. However, some limitations of contrast enhanced voiding urosonography must be remembered.
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Affiliation(s)
- Maciej Piskunowicz
- Department of Radiology, Medical University of Gdańsk, Poland; M. Piskunowicz and D. Świętoń contributed equally to this work and are considered co-first authors
| | - Dominik Świętoń
- Department of Radiology, Medical University of Gdańsk, Poland; M. Piskunowicz and D. Świętoń contributed equally to this work and are considered co-first authors
| | | | - Piotr Czarniak
- Department of Paediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Poland
| | | | - Mariusz Kaszubowski
- Institute of Statistics, Department of Economic Sciences, Faculty of Management and Economics, Gdańsk University of Technology, Poland
| | - Edyta Szurowska
- Department of Radiology, Medical University of Gdańsk, Poland
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Abstract
OBJECTIVES This study evaluated the uptake of Western Australian (WA) pharmacist vaccination services, the profiles of consumers being vaccinated and the facilitators and challenges experienced by pharmacy staff in the preparation, implementation and delivery of services. DESIGN Mixed-methods methodology with both quantitative and qualitative data through surveys, pharmacy computer records and immuniser pharmacist interviews. SETTING Community pharmacies in WA that provided pharmacist vaccination services between March and October 2015. PARTICIPANTS Immuniser pharmacists from 86 pharmacies completed baseline surveys and 78 completed exit surveys; computer records from 57 pharmacies; 25 immuniser pharmacists were interviewed. MAIN OUTCOME MEASURES Pharmacy and immuniser pharmacist profiles; pharmacist vaccination services provided and consumer profiles who accessed services. RESULTS 15 621 influenza vaccinations were administered by immuniser pharmacists at 76 WA community pharmacies between March and October 2015. There were no major adverse events, and <1% of consumers experienced minor events which were appropriately managed. Between 12% and 17% of consumers were eligible to receive free influenza vaccinations under the National Immunisation Program but chose to have it at a pharmacy. A high percentage of vaccinations was delivered in rural and regional areas indicating that provision of pharmacist vaccination services facilitated access for rural and remote consumers. Immuniser pharmacists reported feeling confident in providing vaccination services and were of the opinion that services should be expanded to other vaccinations. Pharmacists also reported significant professional satisfaction in providing the service. All participating pharmacies intended to continue providing influenza vaccinations in 2016. CONCLUSIONS This initial evaluation of WA pharmacist vaccination services showed that vaccine delivery was safe. Convenience and accessibility were important aspects in usage of services. There is scope to expand pharmacist vaccination services to other vaccines and younger children; however, government funding to pharmacists needs to be considered.
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Affiliation(s)
- H Laetitia Hattingh
- Faculty of Health Sciences, School of Pharmacy, Curtin University, Perth, Western Australia, Australia
| | - T Fei Sim
- Faculty of Health Sciences, School of Pharmacy, Curtin University, Perth, Western Australia, Australia
| | - R Parsons
- Faculty of Health Sciences, School of Occupational Health & Social Work and School Pharmacy, Curtin University, Perth, Western Australia, Australia
| | - P Czarniak
- Faculty of Health Sciences, School of Pharmacy, Curtin University, Perth, Western Australia, Australia
| | - A Vickery
- Department of General Practice, The University of Western Australia, Perth, Western Australia, Australia
| | - S Ayadurai
- Faculty of Health Sciences, School of Pharmacy, Curtin University, Perth, Western Australia, Australia
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Rutkowski B, Czarniak P, Krol E, Szczesniak P, Zdrojewski T. Overweight, obesity, hypertension and albuminuria in Polish adolescents--results of the Sopkard 15 study. Nephrol Dial Transplant 2013; 28 Suppl 4:iv204-11. [DOI: 10.1093/ndt/gft328] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Wozniak Z, Zagozdzon P, Pencina M, Krawczyk M, Lewczuk A, Czarniak P, Szczesniak P, Sworczak K, Zdrojewski T. Thirty year risk of cardiovascular disease and key risk factors increase with increasing thyroid stimulating hormone in adolescents. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1539] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Czarniak P, Załuska-Leśniewska I, Zagożdżon I, Żurowska A. Difficulties in diagnosing severe Pneumocystis jiroveci pneumonia after rituximab therapy for steroid-dependent nephrotic syndrome. Pediatr Nephrol 2013; 28:987-8. [PMID: 23549855 PMCID: PMC3631112 DOI: 10.1007/s00467-013-2457-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 02/25/2013] [Accepted: 03/01/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Piotr Czarniak
- Department of Nephrology and Hypertension for Children and Adolescents, Medical University of Gdańsk, Gdańsk, Poland ,Medical University of Gdańsk, Gdańsk, Poland
| | - Iga Załuska-Leśniewska
- Department of Nephrology and Hypertension for Children and Adolescents, Medical University of Gdańsk, Gdańsk, Poland
| | - Ilona Zagożdżon
- Department of Nephrology and Hypertension for Children and Adolescents, Medical University of Gdańsk, Gdańsk, Poland
| | - Aleksandra Żurowska
- Department of Nephrology and Hypertension for Children and Adolescents, Medical University of Gdańsk, Gdańsk, Poland
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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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Krawczyk M, Czarniak P, Szcześniak P, Król E, Pakalska Korcala A, Kusiak A, Molęda Ciszewska B, Ignaszewska Wyrzykowska A, Wyrzykowski B, Zdrojewski T. The prevalence of risk factors for atherosclerosis among middle school students in Sopot, Poland: results of the SOPKARD 15 programme. Kardiol Pol 2011; 69:540-545. [PMID: 21678286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND SOPKARD 15 is a comprehensive programme to assess the health status of a population of teenagers. The aspects assessed in the study are: physical development, nutritional status, arterial blood pressure, lipid and carbohydrate metabolism, oral hygiene, and psychological parameters. AIM To assess the prevalence of cardiovascular risk factors in the study population. METHODS We examined 372 children (185 girls) at the age of 14. The cut-off values for normal lipid blood levels were based on the NCEP-Peds guidelines. Body mass index was assessed on the basis of the Polish centile charts. Blood pressure values assessed against the centile charts were the mean values calculated on the basis of the second and third measurements. RESULTS Systolic and diastolic blood pressure values were elevated in 15.81% and 10.90% of the subjects, respectively. Abnormal blood glucose was detected in fewer than 6% of the children. Total cholesterol was elevated in 8% and borderline in 24% of the subjects; 8.5% of children were overweight and 7.4% were obese; 5.0% of the subjects took very little physical exercise; 16.4% of boys and 23.4% of girls admitted smoking. Dental examination revealed inflamed gums in 77.6% of the subjects. The diagnosis of a depressive episode was confirmed in 4.2% of the teenagers. CONCLUSIONS 1. Due to the high prevalence of the risk factors there is a need to launch a comprehensive cardiovascular prevention programme among the teenagers. 2. A considerable proportion of children with lipid abnormalities indicate the need for more frequent lipid profile testing in children.
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Król E, Rutkowski B, Czarniak P, Kraszewska E. Aging or comorbid conditions - what is the main cause of kidney damage? J Nephrol 2010; 23:444-452. [PMID: 20349419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2009] [Indexed: 05/29/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is widespread in the general population. It is generally accepted that worsening renal function is common with aging. However, the question still remains whether it is caused by the natural process of aging or whether coexisting chronic diseases and comorbid conditions contribute to deteriorating renal function. METHODS The frequency of albuminuria-the marker of early kidney damage-was evaluated according to different coexisting conditions in younger (18/64 years old, n=2,074) and elderly (=65 years old, n=395) participants of the Polish study PolNef on early detection of CKD. Multivariate logistic regression was performed to identify associations between elevated levels of albuminuria, age and coexisting conditions. RESULTS 12% of the younger group demonstrated albuminuria compared to 18% of the elderly. Independent predictors of detecting an elevated level of albuminuria for the whole examined population were male gender (2.48, 1.59-3.88), hypertension ineffectively treated (1.8, 1.34-2.4), diabetes (1.67, 1.11-2.49), and age (1.56, 0.97-2.52) at border levels of significance. Moreover, elevated levels of albuminuria occurred more frequently in the obese elderly group (1.89, 0.98-3.63, p=0.058). The following predictors were found based on gender: for men, hypertension regardless of efficacy of treatment, diabetes, smoking, and age at border level of significance, in contrast to women who had the sole predictor of ineffectively treated hypertension. CONCLUSIONS The influence of aging alone on kidney damage is not evident. Moreover, it is different in males and females. Hypertension is the only coexisting comorbid condition contributing to kidney damage in both males and females. Advanced age together with comorbid conditions is more harmful to the kidney in males.
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Affiliation(s)
- Ewa Król
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland.
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Czarniak P, Zurowska A, Szcześniak P, Drozyńska-Duklas M, Maternik M, Gołebiewski A, Komasara L, Preis K, Domzalska I, Sowa A. [Preliminary results of a program for the early management of children with congenital hydronephrosis]. Pol Merkur Lekarski 2009; 26:322-324. [PMID: 19580198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED Antenatal hydronephrosis is one of the most frequently diagnosed congenital abnormalities in the fetus. The aim of the study is to present the preliminary results of a newly launched Pommeranian Program for Early Management of CAKUT in Children. MATERIAL AND METHODS 105 neonates and infants with hydronephrosis were assessed between Jan and Dec 2007 (27 girls and 78 boys). All patients had postnatal ultrasound performed. Static and dynamic scyntigraphy and cystography were performed according to set indications. Therapeutic decisions were made following a team meeting between pediatric nephrologists and urologists. RESULTS 56.2% of children with hydronephrosis had documented prenatal findings: 61%--pyelectasis, 15.3% renal cysts, 5.1% unspecified renal pathology, in 18.6% no renal pathology. 82.6% of newborns had term births but perinatal complications were observed in 30.5%. Initial postnatal diagnosis was performed by neonatal wards in 22.8% newborns and by the children's pediatrician in 31.4% of infants. Following referral to nephro-urology centre cystography was performed in 22.9% of infants and scintigraphy in 36.2%. 21.9% of infants were qualified for surgical intervention at an average age of 24 + 13 weeks. CONCLUSIONS 1. Only half of the children with congenital hydronephrosis are to nephro-urology care following prenatal diagnosis. 2. A large number of perinatal complications are observed in newborns with prenatally diagnosed hydronephrosis. 3. The management of newborn hydronephrosis requires better cooperation between obstetricians, neonatologists, pediatric nephrologists and urologists.
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Affiliation(s)
- Piotr Czarniak
- Medical University of Gdańsk, Department of Pediatric and Adolescent Nephrology and Hypertension.
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Czarniak P, Zurowska A, Gołebiewski A, Komasara L, Preis K, Domzalska-Popadiuk I, Sowa A. [Program of early nephro-urologic management of children with congenital hydronephrosis]. Pol Merkur Lekarski 2009; 26:273-275. [PMID: 19580186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Congenital anomalies of kidney and urinary tract (CAKUT) are the main cause of end stage renal disease in childhood. Early prenatal detection with planned postnatal diagnosis and therapy are the mainstay of management of neonates with CAKUT which is aimed at the conservation of renal tissue. The above assumptions led to the establishment of the Pommeranian Program for Management of Children with CAKUT. The strategy of the program is to coordinate prenatal diagnosis performed by obstetricians, postnatal care by neonatologists and early management by pediatric nephrologists and urologists. It will involve approximately 200 neonates annually. The basic concept of the program includes the following: 1. Delivery of a child with congenital hydronephrosis detected prenatal should take place in a center with specialist neonatal care. 2. Child with a congenital hydronephrosis should remain under specialist nephro-urologic care immediately after delivery. 3. Child with a congenital hydronephrosis should be qualified to scheduled urologic surgery after results of diagnostic tests and according to general status. 4. Model of integrated care on a child with congenital hydronephrosis should consist in close cooperation between obstetricians, neonatologists, pediatric nephrologists, and urologists.
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Wołyniec W, Jankowska MM, Król E, Czarniak P, Rutkowski B. Current diagnostic evaluation of autosomal dominant polycystic kidney disease. Pol Arch Med Wewn 2008; 118:767-773. [PMID: 19202957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Despite changing epidemiology of chronic kidney disease, autosomal dominant polycystic kidney disease (ADPKD) is one of the most prevalent causes of end stage renal disease. The first symptoms of the disease occur usually in the 3rd or 4th decade of life, however, it can often be diagnosed much earlier. Advances in the understanding of the disease may lead, in the near future, to slowing the progression of ADPKD in asymptomatic individuals. ADPKD is diagnosed on the basis of family history (autosomal dominant inheritance) and radiological imaging. Ultrasound examination (US) of the kidneys is the most important imaging diagnostic method. US is highly sensitive and specific in patients >30 years of age. In US, Ravine criteria are applied and their modifications with other imaging techniques (computed tomography [CT], magnetic resonance [MR]). In all cases, however, there are multiple cysts in both kidneys and, importantly, concomitant renal enlargement can be observed, which is typical of ADPKD. High expectations for early ADPKD diagnosis are risen by genetics and proteomics. However, these methods are not used routinely. The most sensitive parameter in the evaluation of the disease progression is total renal volume. This parameter is presently used in clinical studies, but its utility in monitoring an individual patient has not been fully proven. Unfortunately, MR and CT are expensive and in case of significantly enlarged kidneys US does not yield accurate assessment of their size and is not sensitive enough for monitoring the disease progression. The rate of glomerular filtration rate (GFR) decline is usually constant. Therefore, it is important to monitor GFR in individuals who have developed renal insufficiency. Other tests, including markers of kidney injury, e.g. albuminuria, or vascular flow parameters, are used mainly in clinical studies. Thus, before more efficient therapeutic approaches have been developed, an early diagnosis and prevention of the disease complications are most essential.
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Affiliation(s)
- Wojciech Wołyniec
- Department of Nephrology, Transplantology and Internal Medicine, Medical University, Gdańsk, Poland.
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Wołyniec W, Jankowska MM, Król E, Czarniak P, Rutkowski B. Current diagnostic evaluation of autosomal dominant polycystic kidney disease. Pol Arch Intern Med 2008. [DOI: 10.20452/pamw.552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Król E, Rutkowski B, Czarniak P, Kraszewska E, Lizakowski S, Szubert R, Czekalski S, Sułowicz W, Wiecek A. Early detection of chronic kidney disease: results of the PolNef study. Am J Nephrol 2008; 29:264-73. [PMID: 18812692 PMCID: PMC2786021 DOI: 10.1159/000158526] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [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: 06/02/2008] [Accepted: 07/17/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Continuous increase in the number of patients with end-stage renal disease demands early detection of chronic kidney disease (CKD). The aim of the present study was to diagnose CKD in its earliest stages in a randomly selected population using a diagnostic algorithm developed by the working group. METHODS An algorithm for the diagnostic procedure was created to identify patients with CKD requiring further nephrological care. Randomly chosen adult inhabitants of a city with a population of 60,000 were invited to participate in this study. Screening procedures included a microalbuminuria dipstick test accompanied by blood pressure measurement and medical questionnaire. In further diagnosis of CKD, estimated glomerular filtration rate (eGFR), albumin concentration in urine, urinalysis and ultrasound examination were used according to the algorithm. Multivariate logistic regression was performed to identify associations between participants' characteristics and albuminuria. RESULTS Out of 9,700 invited subjects, 2,471 individuals participated in the PolNef study. Albuminuria was detected in 15.6% of the investigated population using the dipstick test and thereafter confirmed in 11.9% by the turbidimetric method. The modeling of multivariate logistic regression indicated the following independent predictors of albuminuria: male sex, diabetes, nocturia and hypertension. For people without diabetes and without hypertension, nocturia independently predicted detection of albuminuria. 481 people received a consultation with a nephrologist, and 96% of them were recognized as having CKD. At least 9% of patients with CKD had eGFR by MDRD <60 ml/min/1.73 m(2). Six persons were referred for further treatment because of newly diagnosed kidney tumor. CONCLUSIONS CKD in early stages occurs frequently in the studied population. The proposed diagnostic algorithm seems to be a powerful tool to identify subjects at risk of CKD. The role of nocturia as an independent predictor of albuminuria, both in the general population and in people without diabetes or hypertension, should be further examined.
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Affiliation(s)
- Ewa Król
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
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Czarniak P, Król E, Zdrojewski T, Szcześniak P, Krawczyk M, Ignaszewska-Wyrzykowska A, Zurowska A, Rutkowski B. [Program of early diagnosis of chronic renal disease in children--SopKard 15 nephrological project]. Pol Merkur Lekarski 2008; 24 Suppl 4:108-110. [PMID: 18924519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The Sopot Program of Cardiac Infarct and Stroke Prevention--SopKard 1999-2009 was established for health promotion to decrease cardio-vascular diseases mortality. To serve these purposes a new project SopKard 15 for adolescents was created. The main aim of SopKard 15 is evaluation of health status with particular attention to risk factors of civilization diseases, with chronic kidney disease (CKD) among them. In population of 14-year-old students a complex nephrological examination including medical history, blood pressure measurements, ultrasound examination, and laboratory tests with e.g. albuminuria, urinalysis, and serum creatinine and cystatin C levels was performed. Nephrology part of Program SopKard 15 aspired to early detection of CKD and verifies normal value for this age group.
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Affiliation(s)
- Piotr Czarniak
- Akademia Medyczna w Gdańsku, Klinika Chorób Nerek i Nadciśnienia Tetniczego Dzieci i Młodziezy.
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21
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Drozynska-Duklas M, Załuska-Leśniewska I, Bałasz-Chmielewska I, Czarniak P, Zurowska A. [Kidney transplantation into a neurogenic bladder in myelomeningocele patient (MMC)]. Pol Merkur Lekarski 2008; 24 Suppl 4:117-118. [PMID: 18924522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
UNLABELLED We report a 24-year-old patient with neurogenic bladder due to myelomeningocele (MMC) who received a kidney transplant without prior bladder reconstruction. Following transplantation recurrent episodes of febrile pyelonephritis were observed with elevations of creatinine. A year after Tx a bladder augmentation was performed with appendicostomy to enable intermittent catheterization. Following surgery only sporadic episodes of UTI have been observed and his renal function is stable. CONCLUSION bladder reconstruction surgery in patients with neurogenic bladder is feasible post transplantation though the optimal timing is prior to a kidney Tx.
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Drozyńska-Duklas M, Zurowska A, Czarniak P, Maternik M. [Estimation of GFR from serum creatinine and cystatin C-A comparison of 2 methods in patients with neurogenic bladder due to myelomeningocle (MMC)]. Pol Merkur Lekarski 2008; 24 Suppl 4:119-120. [PMID: 18924523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
UNLABELLED Glomerular filtration rate (eGFR) calculated from serum creatinine can be overestimated in patients with muscle mass deficits. AIM The aim of this study was to compare eGFR calculated from serum levels of creatinine and cystatin C in a group of patients with neurogenic bladder due to MMC. MATERIAL AND METHODS GFR calculations were performed for 67 patients using Schwartz formula for creatinine measured by colorimetric method and Filler formula for cystatin C measured by immunonephelometric method. RESULTS Statistically significant lower eGFR values were obtained with calculations based on cystatin C levels. CONCLUSION Cystatin C is a useful marker for GFR estimations in patients with reduced muscle mass.
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Maternik M, Zurowska A, Czarniak P, Drozyńska-Duklas M, Gołebiewski A. [Evolving pattern of bladder dysfunction in boys with posterior urethral valves (PUV)]. Pol Merkur Lekarski 2008; 24 Suppl 4:111-114. [PMID: 18924520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
UNLABELLED Bladder dysfunction is present in 50-80% boys born with PUV. THE AIM OF THE STUDY To assess the effect of age on the pattern of voiding dysfunction. MATERIAL AND METHODS An analysis of urodynamic findings was performed in 62 boys with PUV divided into younger (mean 6.02 yrs) and older (mean 15.6 yrs) age groups. RESULTS In younger boys a higher prevalence of decreased bladder compliance (p < 0.0001), detrusor instability (p < 0.001) and detrusor sphincter dyssynergy (p < 0.05) was noted. In older boys a higher prevalence of low detrusor pressure was observed (p < 0.01). CONCLUSION The pattern of bladder dysfunction in boys with PUV evolves with age.
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Affiliation(s)
- Michał Maternik
- Klinika Chorób Nerek i Nadciśnienia Dzieci i Młodziezy Akademii Medycznej w Gdańsku.
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Maternik M, Zurowska A, Czarniak P, Drozyńska-Duklas M, Kosiak W, Gołebiewski A. [Chronic renal disease in boys with posterior urethral valve]. Przegl Lek 2006; 63 Suppl 3:146-8. [PMID: 16898515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
UNLABELLED Posterior urethral valve (PUV) is the most common anatomical cause of bladder outlet obstruction with an incidence ranging from 1/3000 to 1/8000 births. In spite of early valve ablation deterioration of renal function is frequently reported during childhood and adolescence. AIM OF THE STUDY To evaluate the frequency and progression of chronic renal disease in boys born with PUV. MATERIALS AND METHODS The presence of chronic renal disease (CRD) in 58 boys with posterior urethral valve (PUV) was assessed by renal ultrasound and estimation of glomerular filtration rate (GFR). GFR was estimated by the method of Schwartz. Chronic renal disease was defined according to NFK K/DOQI Guidelines and classified into 5 stages. RESULTS 48 (82%) patients with PUV had CRD. Among the patients observed from birth 89% already demonstrated CRD in the first year of life. CONCLUSIONS 1. The vast majority of boys with PUV (83%) demonstrate symptoms of chronic renal disease. 2. CRD in boys with PUV is frequently evident from the first year of life. 3. PUV patients require regular nephrologic assessment from birth.
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Affiliation(s)
- Michał Maternik
- Klinika Nefrologii Dzieciecej, Akademii Medycznej w Gdańsku.
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Czarniak P, Kosiak W, Chojnicki M, Król E, Zurowska A. [Prevalence of congenitial kidney and urinary tract anomalies in neonates and infants with congenital heart disease]. Przegl Lek 2006; 63 Suppl 3:124-6. [PMID: 16898508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Congenital heart diseases are the most frequent anomalies and one of the most important reasons of mortality and morbidity in neonates and infants. Coincidence of additional malformation aggravates prognosis. The frequency of incidence of other anomalies accompanying congenital hart diseases is defined as 11 to 45%. AIM Estimation of the frequency of a coincidence of congenital kidney anomalies on the basis of the ultrasound examination (US) in children with congenital heart disease in first year of life. MATERIAL AND METHODS Abdominal US were done in 350 neonates and infants hospitalized in Department of Pediatric Cardiology Medical University of Gdansk in the first twenty-four hours after diagnosis of congenital heart disease. Examinations were performed in 187 male (53%) and 163 female (47%) in average age 54.9 days (range from 1 to 349 days). RESULTS In examined population congenital kidney anomalies were found in 4.9% of children from which 18% represent hipoplasia, and another 18% dysplasia. 15.3% of examined patients were diagnosed by dilatation of collecting system, whereof 3% mild, 7% moderate, and 5% severe degree. CONCLUSIONS 1. The frequency of incidence of kidney anomalies and collecting system dilatation in the examined population of neonates and infants with congenital heart disease accounts for 20.2%. 2. Abdominal ultrasound screening with carefully examination of urinary tract should be performed in neonates and infants with congenital heart disease.
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Affiliation(s)
- Piotr Czarniak
- Klinika Nefrologii Dzieciecej, Instytutu Pediatrii, Akademii Medycznej w Gdańsku.
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Król E, Rutkowski B, Czekalski S, Sułowicz W, Wiecek A, Lizakowski S, Czarniak P, Szubert R, Karczewska-Maksymienko L, Orlikowska M, Kraszewska E, Magdoń R. [Early diagnosis of renal diseases--preliminary results from the pilot study PolNef]. Przegl Lek 2005; 62:690-3. [PMID: 16463703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Continuous increase of the number of patients with chronic kidney failure which require renal replacement therapy, in Poland as all as over the world, demands the analysis of epidemiological situation concerning renal diseases. Early diagnosis of nephropathy permits not only an adequate treatment, but also facilitates the introduction of the therapy that slows the progression of kidney failure. The aim of the pilot study PolNef was an attempt to evaluate the epidemiology of renal diseases in Poland on the basis of a randomly selected population from a city numbering 60 thousand people. As a screening test, allowing to distinguish patients requiring further diagnostic of nephropathy, the microalbuminuria dipstick test accompanied by blood pressure measurement and questionnaire was accepted. Microalbuminuria was detected in more than 18% of the population investigated up till now. It was more frequent in male, in obese, and in smokers. More than 33% of all participants consulted by the nephrologist required permanent nephrological care and for the next 32% another nephrological consultation in 6 to 12 month should be ordered. Decreased clearance of creatinine was found in above 17% participants and 6 patients were referred for further treatment because of new diagnosis of renal tumor. Identification in investigated population patients with of an early stage of kidney disease needs further nephrological diagnosis and treatment is especially important from the point of view of every single patient and also may bring substantial economic benefits for health protection system as well.
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Affiliation(s)
- Ewa Król
- Klinika Nefrologii, Transplantologii i Chorób Wewnetrznych Akademii Medycznej w Gdańsku
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Czarniak P, Kosiak W, Chojnicki M, Maternik M, Zurowska A, Ereciński J. [Prevalence of hyperechoic renal pyramid syndrome in neonates and infants with congenital heart disease--ultrasound study of the abdominal cavity in the years 1996-2000]. Wiad Lek 2005; 58 Suppl 1:7-10. [PMID: 16060076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
UNLABELLED The normal medullary pyramids both in children and in adults are non-echoic on ultrasound evaluation when compared with renal cortex. Hyperechoic pyramids are associated with abnormal function of renal tubules. This sonographic finding has been described in various diseases including transient renal insufficiency in neonates and hypercalciuria induced by long-term furosemide therapy. The aim of this study was to evaluate the occurrence of hyperechoic pyramids in neonates and infants with congenital heart diseases. MATERIAL AND METHODS The examined population consisted of 350 neonates and infants (187 male - 53%, 163 female - 47%), mean age 54,9 +/- 75,7 days (range 1 - 349 days) with new recognized congenital heart disease. All renal sonographic evaluations were performed from January 1st 1996 to December 31st 2000. RESULTS A total of 19 (5.5%) neonates had increased echogenicity of the renal medullary pyramids. Almost 2/3 of cases were diagnosed in neonates with cyanotic congenital heart diseases. In infants with congenital heart disease hyperechoic pyramids were found in 5 (1.4%) cases. CONCLUSIONS 1. In our study was shown, that the main reason of hyperechoic pyramids syndrome was neonatal asphyxia in association with cyanotic congenital heart disease. 2. Further nephrological evaluation is necessary in all case of hyperechoic pyramids syndrome. 3. Ultrasound examination of urinary tract should be an integral part of a complex evaluation of a patient with congenital heart disease.
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Affiliation(s)
- Piotr Czarniak
- Z Kliniki Nefrologii Dzieciecej Instytutu Pediatrii oraz z Kliniki Kardiologii Dzieciecej Instytutu Pediatrii Akademii Medycznej w Gdańsku
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Stachowicz-Stencel T, Bień E, Zawitkowska-Klaczyńska J, Dudkiewicz E, Drozyńska E, Katski K, Polczyńska K, Sierota D, Stefanowicz J, Szołkiewicz A, Kaczorowska-Hać B, Czauderna P, Stoba C, Kosiak W, Czarniak P, Balcerska A, Kowalczyk JR. [Malignant pelvic neoplasms in children treated in two Polish oncology centres]. Med Wieku Rozwoj 2004; 8:159-68. [PMID: 15738589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND Extensive diagnostic and therapeutic dilemmas appear in children With primary malignant neoplasms located in the minor pelvis. THE AIM OF THE STUDY To evaluate the clinical symptoms, disease course and the results of treatment in patients with malignant pelvic neoplasms. MATERIAL AND METHODS The study included 31 children (13 boys and 18 girls; aged 2 months to 16 years; mean age -- 8 years) treated in the Departments of Paediatric Oncology and Haematology in Gdansk and Lublin during the period of 1992-2003. The group comprised 17 patients with soft tissue sarcomas (MTM) (55%), 12 with germinal tumours (TGM) (39%) and tow. with neuroblastoma (NBL) (6%). The great majority of children (90%) presented with highly advanced disease (stages III + IV -- in 28 out of 31 patients). RESULTS with data analysis we were able to distinguish two categories of patients with different prognosis: with MTM and TGM. Most of he MTM tumours (11/17 - 65%) were localized in the urinary tract, the remaining six developed within pelvic muscles. Ten out of twelve TGM tumours (83%) were located in the ovaries. Radical tumour resection, especially primary resection, was shown to play the key role in both groups. Among TGM patients it was performed in 75% while in MTM patients -- in only 12%. All of these patients entered clinical remission and remain disease free. After adjuvant chemo- and/or radiotherapy secondary tumour resection was done in 17% of TGM and 41% of MTM patients. CONCLUSION in patients, who were not able to undergo radical tumour resection (mainly MTM patients), the disease progressed and led to death.
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Affiliation(s)
- Teresa Stachowicz-Stencel
- Klinika Pediatrii, Hematologii, Onkologii i Endokrynologii, Akademia Medyczna, Debinki 7, 80-211 Gdańsk, Poland.
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Zurowska A, Kosiak W, Czarniak P, Bałasz I, Marczak E. [Efficacy and safety of renal biopsy in children performed with an automatic biopsy device under control of ultrasonographic imaging]. Pol Merkur Lekarski 2001; 10:277-8. [PMID: 11434176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
UNLABELLED The efficacy and safety of kidney biopsy in children performed with an automatic Biopty Gun device under real time ultrasound was analysed. The procedure was performed under sedation during short hospitalisation with ultrasound assessment of complications performed after 24 hours. 98% of 131 biopsies yielded representative material with an average 16 glomeruli obtained per biopsy. Symptomatic perirenal haematomas were observed in 80%, subcapsular haematomas in 3.8% and arteriovenous fistulas in 4.6% of children on post biopsy ultrasound. They resolved spontaneously in all patients. CONCLUSIONS Real time ultrasound guidance with the use of automatic biopsy devices should become the standard practice for kidney biopsy in children due to its efficacy and safety. The procedure should be performed during short hospitalization to enable ultrasound monitoring of early complications.
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Affiliation(s)
- A Zurowska
- Klinika Nefrologii Dzieciecej, Akademii Medycznej w Gdańsku
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30
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Bałasz I, Zurowska A, Kosiak W, Czarniak P, Zagozdzon I, Marczak E. [Bilateral hydrothorax in a 13-year old girl treated with continuous ambulatory peritoneal dialysis renal replacement therapy]. Pol Merkur Lekarski 2001; 10:289-90. [PMID: 11434181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Bilateral hydrothorax is a very rare complication of ambulatory peritoneal dialysis in children. We present a case of a 13-year-old girl who developed bilateral acute hydrothorax during after seven months of CCPD. Peritoneal dialysis was temporarily discontinued and the child was transferred to haemodialysis. Six weeks later the patient was successfully resumed CCPD.
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Affiliation(s)
- I Bałasz
- Klinika Nefrologii Dzieciecej Akademii Medycznej w Gdańsku
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Zurowska A, Gockowska Z, Czarniak P, Marczak E. [Changing clinical course of hemolytic uremic syndrome in children]. Pol Merkur Lekarski 2000; 8:234-5. [PMID: 10897626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
An incidence of hemolytic-uraemic syndrome as a cause of the acute renal failure in childhood, its early survival rate and long-term sequela quences were compared in the 1970s, 1980s, and 1990s in the same geographical area. 196 children with HUS were treated between 1972-1999. 94% had a typical D+ HUS. The majority were of patients severely ill with 87% requiring peritoneal dialysis of an average 14 days duration. The children were grouped into three 9-year periods for comparison (1972-1980, 1981-1989, 1990-1999). 105 patients were followed for 2-27 years (mean 1 years). An incidence of HUS as a cause of ARF in childhood ranged from 58% and 50% in the 1970s and 1980s to 30% in the past decade. With time survival rate has improved dramatically over the years from 80% and 75% to 97% in the 1990s. Deo spite better short term outcome the late consequences of HUS are serious. The longer the follow-up, the greater percentage of patients with severe outcome. At last follow-up only 32% children showed full recovery. 33% are on renal replacement therapy or have impaired renal function. The severity of the initial lesions to the kidney measured by the duration of anuria is a marker of poor late prognosis. With improving early outcome the clinical significance of HUS is focusing on its severe long-term consequences.
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Affiliation(s)
- A Zurowska
- Klinika Nefrologii Dzieciecej Akademii Medycznej w Gdańsku
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Zurowska A, Czarniak P, Kosiak W, Bałasz I, Zagozdzon I. [Bilateral renal obstruction caused by cystine stones in a child with Henoch-Schönlein syndrome]. Pol Merkur Lekarski 2000; 8:287-8. [PMID: 10897654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Haematuria is a typical symptom of glomerular involvement in Henoch-Schoenlein syndrome in children. The authors present an unusual case of haematuria and deterioration of renal function caused by cystine stones in a child with anaphylactic purpura. This 6 year old girl was hospitalized because of severe gastrointestinal symptoms in the course of a typical Henoch-Schoenlein syndrome. After 4 weeks of illness--the child demonstrated haematuria and oliguria with severe loin pain and a rise in serum creatinine to 5.8 mg%. Urine findings of mainly non-glomerular erythrocytes and slight proteinuria were suggestive of a non-glomerular cause of renal failure. Ultrasound examination revealed the unexpected finding of bilateral kidney obstruction caused by multiple renal stones. Cystine crystals observed under microscopic examination of the urinary sediment and a positive cyanide-nitroprusside test suggested cystinuria as the cause of nephrolithiasis. High water intake and alkalization of urine and captopril for cystine excretion reduction resulted in fast improvement of renal function and and with time complete dissolution of calculi. The symptoms of Henoch-Schoenlein syndrome resolved over several weeks, and the child did not develop any signs of glomerular involvement.
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Affiliation(s)
- A Zurowska
- Kliniki Nefrologii Dzieciecej Akademia Medyczna w Gdańsku
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Zurowska A, Kosiak W, Czarniak P, Bałasz I, Zagozdzon I. [Ultrasound of exit-site and tunnel infections in children on peritoneal dialysis]. Pol Merkur Lekarski 2000; 8:297-8. [PMID: 10897660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Ultrasound diagnosis of catheter related infections in patients on peritoneal dialysis is easy to perform diagnostic procedure which enables more precise diagnosis and better follow-up of therapy. The authors present three cases of exit site and tunnel infections in children, illustrating the value of ultrasound evaluation in their diagnosis and in decisions on conservative treatment or catheter removal.
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Affiliation(s)
- A Zurowska
- Kliniki Nefrologii Dzieciecej Akademii Medycznej w Gdańsku
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Ratajczak B, Wierzba J, Irga N, Czarniak P, Kosiak W, Samet A, Chabior M. [The clinical course of fungal urinary tract infection in neonates]. Pediatr Pol 1996; 71:331-7. [PMID: 8975221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The authors present the clinical course of 8 cases of fungal infection of the urinary tract in newborns. Three of the investigated children were premature or with intrauterine hypotrophy, a congenital defect of the urinary tract was detected in one child. In 5 cases the fungal infection followed bacterial septicaemia. Two of the 8 children required peritoneal dialysis, another two required insertion of intravenous catheters for parenteral feeding, and four required bladder catheterisation. The diagnosis of fungal urinary tract infection was established on the basis of urine culture, the presence of specific serum anti-candida antibodies and results of ultrasonographic examination (vs). In 7 of 8 cases the possibility of fungal infection was suggested by US examination. Seven children were treated with fluconazole combined with 5-fluorocytosine, one was treated with fluconazole. Pyelostomy was performed, in two of the patients all of them received supportive treatment. Our clinical observations point to the necessity of prophylaxis in case of predisposing factors to fungal infection and the use of abdominal ultrasonography for detection of early stages of fungal urinary tract infection.
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Affiliation(s)
- B Ratajczak
- I Klinika Chorób Dzieci Akademii Medycznej w Gdańsku
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Balcerska A, Drozyńska E, Stefanowicz J, Bień E, Szutowicz E, Czarniak P. [Clinical course and risk of fungal infections development in children with treated with chemo- and radiotherapy for solid tumors]. Pol Tyg Lek 1995; 50:70-2. [PMID: 8650039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The authors estimated the incidence of mycotic infections among children patients with histological diagnosis of solid tumors during the period of neutropenia. Superficial mycoses including mucoses were observed in 35.3% of analysed patients, while a disseminated mycotic infections of a severe clinical course were seen in 2.9% neutropenic patients. Prophylactic administration of Diflucan (1-2 mg/kg/24h)(fluconazole) in neutropenic patients proved efficient in great majority of children, preventing the occurrence of severe mycotic complications.
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Affiliation(s)
- A Balcerska
- I Klinika Chorób Dzieci Instytutu Pediatrii AMG
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