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Bakkaloğlu SA, Büyükkaragöz B, Pınarbaşı AS, Leventoğlu E, Saygılı S, Çomak E, Yıldırım ZY, Akıncı N, Dursun İ, Karabay Bayazıt A, Kavaz Tufan A, Akman S, Yılmaz A, Noyan A, Ağbaş A, Serdaroğlu E, Delibaş A, Elmacı AM, Taşdemir M, Ezgü FS, Sever L. Comprehensive evaluation of patients with primary hyperoxaluria type 1: A nationwide study. Nephrology (Carlton) 2024; 29:201-213. [PMID: 38290500 DOI: 10.1111/nep.14273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/10/2024] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Primary hyperoxaluria type 1 (PH1) is characterized by increased endogenous oxalate production and deposition as calcium oxalate crystals. The main manifestations are nephrocalcinosis/nephrolithiasis, causing impaired kidney function. We aimed to evaluate the clinical characteristics and overall outcomes of paediatric PH1 patients in Turkey. METHODS This is a nationwide, multicentre, retrospective study evaluating all available paediatric PH1 patients from 15 different paediatric nephrology centres in Turkey. Detailed patient data was collected which included demographic, clinical and laboratory features. Patients were classified according to their age and characteristics at presentation: patients presenting in the first year of life with nephrocalcinosis/nephrolithiasis (infantile oxalosis, Group 1), cases with recurrent nephrolithiasis diagnosed during childhood (childhood-onset PH1, Group 2), and asymptomatic children diagnosed with family screening (Group 3). RESULTS Forty-eight patients had a mutation consistent with PH1. The most common mutation was c.971_972delTG (25%). Infantile oxalosis patients had more advanced chronic kidney disease (CKD) or kidney failure necessitating dialysis (76.9% vs. 45.5%). These patients had much worse clinical course and mortality rates seemed to be higher (23.1% vs. 13.6%). Patients with fatal outcomes were the ones with significant comorbidities, especially with cardiovascular involvement. Patients in Group 3 were followed with better outcomes, with no kidney failure or mortality. CONCLUSION PH1 is not an isolated kidney disease but a systemic disease. Family screening helps to preserve kidney function and prevent systemic complications. Despite all efforts made with traditional treatment methods including transplantation, our results show devastating outcomes or mortality.
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Affiliation(s)
| | | | - Ayşe Seda Pınarbaşı
- Diyarbakır Children's Hospital, Pediatric Nephrology Unit, Diyarbakır, Turkey
| | - Emre Leventoğlu
- Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Seha Saygılı
- Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, İstanbul University, İstanbul, Turkey
| | - Elif Çomak
- Department of Pediatric Nephrology, Akdeniz University, Antalya, Turkey
| | - Zeynep Y Yıldırım
- İstanbul Faculty of Medicine, Department of Pediatric Nephrology, Istanbul University, İstanbul, Turkey
| | - Nurver Akıncı
- Department of Pediatric Nephrology, Şişli Etfal Research and Training Hospital, İstanbul, Turkey
| | - İsmail Dursun
- Department of Pediatric Nephrology, Erciyes University, Kayseri, Turkey
| | | | - Aslı Kavaz Tufan
- Department of Pediatric Nephrology, Osmangazi University, Eskişehir, Turkey
| | - Sema Akman
- Department of Pediatric Nephrology, Akdeniz University, Antalya, Turkey
| | - Alev Yılmaz
- İstanbul Faculty of Medicine, Department of Pediatric Nephrology, Istanbul University, İstanbul, Turkey
| | - Aytül Noyan
- Adana Hospital, Department of Pediatric Nephrology, Başkent University, Adana, Turkey
| | - Ayşe Ağbaş
- Department of Pediatric Nephrology, Haseki Research and Training Hospital, İstanbul, Turkey
| | - Erkin Serdaroğlu
- Department of Pediatric Nephrology, Dr. Behçet Uz Children Hospital, İzmir, Turkey
| | - Ali Delibaş
- Department of Pediatric Nephrology, Mersin University, Mersin, Turkey
| | - Ahmet Midhat Elmacı
- Pediatric Nephrology Unit, Konya Maternal and Children Hospital, Konya, Turkey
| | - Mehmet Taşdemir
- Department of Pediatric Nephrology, İstinye University, İstanbul, Turkey
| | - Fatih S Ezgü
- Department of Pediatric Inborn Metabolic Disorders, Gazi University, Ankara, Turkey
- Department of Pediatric Genetic Disorders, Gazi University, Ankara, Turkey
| | - Lale Sever
- Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, İstanbul University, İstanbul, Turkey
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2
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Burlaka I. Apoptosis-Controlling, Clinical, Laboratory, Anamnestic Factors in Prediction of the Early Stage of Diabetic Nephropathy in Children. Glob Pediatr Health 2023; 10:2333794X231214456. [PMID: 38106637 PMCID: PMC10722950 DOI: 10.1177/2333794x231214456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Background. The most prevalent microvascular consequence of type 1 diabetes (T1D) is diabetic nephropathy (DN). Aim of the Study. To find the clinical, anamnestic, and genetic markers that characterize and forecast early diabetic nephropathy in T1D children. Methods. One hundred four children with T1D and DN between the ages of 2 and 17 were surveyed. Stepwise logistic regression models and linear regression models were used. Results. BMI, systolic blood pressure, concurrent kidney pathology, anamnesis viral infections, ESR level, serum cholesterol, blood urea, number of DKA episodes/year, and GFR were determined to be predictors of early DN in children with T1D. Bcl-xL, caspase-3, and HIF-1alfa were discovered to predict DN among all previously identified variables influencing apoptosis. Conclusion. BMI, systolic blood pressure, concurrent kidney disease, anamnesis viral infections, ESR level, serum cholesterol, blood urea, number of DKA episodes/year, GFR, apoptotic and hypoxia markers were discovered as variables predicting early DN.
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3
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Stern R, Chen L, Chan AP, Wozniak LJ, Pearl M. Angiotensin II type 1 receptor antibodies and native kidney function in pediatric liver and intestinal transplant recipients. Pediatr Nephrol 2023; 38:4175-4185. [PMID: 37432534 DOI: 10.1007/s00467-023-06055-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/10/2023] [Accepted: 05/26/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Angiotensin II type-1 receptor antibody (AT1R-Ab) has been associated with vascular injury and kidney dysfunction in pediatric kidney transplant recipients. The role of AT1R-Ab in the development of chronic kidney disease in pediatric liver and intestinal transplant recipients has not been explored. METHODS Twenty-five pediatric intestinal transplant recipients and 79 pediatric liver transplant recipients had AT1R-Ab levels measured at varying time points in the post-transplant period. Estimated glomerular filtration rate (eGFR) was determined using creatinine based CKiD U25 equation and measured at time of AT1R-Ab measurement, at 1 year post-AT1R-Ab measurement, at 5 years post-AT1R-Ab measurement, and at the most recent routine clinic visit. The prevalence of hypertension and antihypertensive medication use were also evaluated. RESULTS Younger age at time of AT1R-Ab measurement was associated with AT1R-Ab positivity in liver transplant recipients. There was no association between AT1R-Ab status and change in eGFR, prevalence of hypertension, or use of antihypertensive medications at the described time points. CONCLUSIONS AT1R-Ab positivity was not associated with a decline in eGFR or hypertension in pediatric liver and intestinal transplant recipients. Further studies are needed using other markers of kidney function, such as cystatin C, to validate this finding. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Rachel Stern
- Department of Pediatric Nephrology, University of California Los Angeles, Los Angeles, CA, USA.
| | - Lucia Chen
- Department of Medicine Statistics Core, University of California Los Angeles, Los Angeles, CA, USA
| | - Alvin P Chan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of California Los Angeles, Los Angeles, CA, USA
| | - Laura J Wozniak
- Pediatric Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Meghan Pearl
- Department of Pediatric Nephrology, University of California Los Angeles, Los Angeles, CA, USA
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4
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Leventoğlu E, Büyükkaragöz B, Kavas FÇ, Holoğlu MC, Kavgacı A, Fidan K, Dalgıç A, Bakkaloğlu SA, Tunaoğlu FS, Söylemezoğlu O. Electrocardiographic measurements in children with pre-dialysis chronic kidney disease and undergoing kidney replacement therapy. Eur J Pediatr 2023; 182:4993-5005. [PMID: 37624446 DOI: 10.1007/s00431-023-05154-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
Cardiovascular diseases are the main causes of morbidity in children with chronic kidney disease (CKD). Electrocardiography (ECG) can provide important information about cardiac functions and parameters associated with sudden cardiac death. This study aims to evaluate the potentially dangerous changes in CKD and kidney replacement therapies by ECG and to determine the value of ECG in predicting cardiovascular outcome compared with echocardiography. 101 patients with CKD were divided into subgroups according to treatment modalities as pre-dialysis CKD, hemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation (KTx). Differences in anthropometric measurements, laboratory results, blood pressures, ECG monitoring were compared within groups as well as with 40 healthy controls. Available echocardiographic findings were noted. In the patients, HD group had highest frequency of hypertension. ECG revealed prolonged QTc as more frequent (16.8% vs 0%, p = 0.006) and higher QTcD (56.7 ± 6.5 vs 39.9 ± 5.1 ms, p = 0.001) in the patients compared to controls, especially in dialysis patients, whereas lowest values were in KTx subgroup. Left ventricular (LV) hypertrophy (LVH) was more frequent (47.1%) in HD compared to other CKD subgroups in ECG (p = 0.052). Echocardiography also showed LV mass index as highest in HD and lowest in KTx (121.4 ± 55.7 vs 63.7 ± 18.3 g/m2, p = 0.000), with numerically highest LVH in HD (58.3%, p = 0.063). Conclusion: ECG can be used to detect cardiovascular problems in patients with CKD, especially in HD. As ECG results were in line with echocardiography, patients with ECG abnormalities suggestive of LVH should be referred for echocardiographic assessment. What is Known: • Cardiovascular diseases such as coronary artery disease, congestive heart failure, arrhythmias and sudden cardiac death are major causes of morbidity and mortality in chronic kidney disease. • Electrocardiography has significant advantages in demonstrating cardiac functions in children because it is readily available, non-invasive and often non-experts can interpret the results. What is New: • The heart rate is higher, QTc is longer and QTcD is higher in dialysis patients and the prolonged QTc is more frequent in patients with underlying glomerular diseases. • Left ventricular hypertrophy is more common in HD patients and those with hypertension, hypercalcemia, anemia or glomerular etiology. The cardiovascular risky conditions are less frequent in the patients with kidney transplantation.
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Affiliation(s)
- Emre Leventoğlu
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey.
| | - Bahar Büyükkaragöz
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Furkan Çağrı Kavas
- Faculty of Medicine, Department of Pediatrics, Gazi University, Ankara, Turkey
| | - Mert Can Holoğlu
- Faculty of Medicine, Department of Pediatrics, Gazi University, Ankara, Turkey
| | - Akif Kavgacı
- Faculty of Medicine, Department of Pediatric Cardiology, Gazi University, Ankara, Turkey
| | - Kibriya Fidan
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Aydın Dalgıç
- Faculty of Medicine, Department of Transplantation Surgery, Gazi University, Ankara, Turkey
| | - Sevcan A Bakkaloğlu
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Fatma Sedef Tunaoğlu
- Faculty of Medicine, Department of Pediatric Cardiology, Gazi University, Ankara, Turkey
| | - Oğuz Söylemezoğlu
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
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5
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Mahmood S, Tanvir EM, Komarova T, Islam MN, Khatun M, Hossain MF, Ng JC, Whitfield KM, Hossain MS, Khalil MI, Shaw PN. Relationships between growth indicators, liver and kidney function markers, and blood concentrations of essential and potentially toxic elements in environmentally exposed young children. Int J Hyg Environ Health 2023; 253:114237. [PMID: 37544043 DOI: 10.1016/j.ijheh.2023.114237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/08/2023] [Accepted: 07/28/2023] [Indexed: 08/08/2023]
Abstract
Environmental exposure to multiple metals and metalloids is widespread, leading to a global concern relating to the adverse health effects of mixed-metals exposure, especially in young children living around industrial areas. This study aimed to quantify the concentrations of essential and potentially toxic elements in blood and to examine the potential associations between multiple elements exposures, growth determinants, and liver and kidney function biomarkers in children living in several industrial areas in Dhaka, Bangladesh. The blood distribution of 20 trace elements As, Ag, Bi, Br, Cd, Co, Cr, Cu, I, Mn, Hg, Mo, Ni, Pb, Se, Sb, Tl, V, U, and Zn, growth determinants such as body mass index and body fats, blood pressure, liver and kidney injury biomarkers including serum alanine aminotransferase and alkaline phosphatase activities, serum calcium, and creatinine levels, blood urea nitrogen, and hemoglobin concentrations, and glomerular filtration rate were measured in 141 children, aged six to 16 years. Among these elements, blood concentrations of Ag, U, V, Cr, Cd, Sb, and Bi were measured below LOQs and excluded from subsequent statistical analysis. This comprehensive study revealed that blood concentrations of these elements in children, living in industrial areas, exceeded critical reference values to varying extents; elevated exposure to As, Pb, Br, Cu, and Se was found in children living in multiple industrial areas. A significant positive association between elevated blood Tl concentration and obesity (β = 0.300, p = 0.007) and an inverse relationship between lower As concentration and underweight (β = -0.351, p < 0.001) compared to healthy weight children indicate that chronic exposure to Tl and As may influence the metabolic burden and physical growth in children. Concentration-dependent positive associations were observed between the blood concentrations of Cu, Se, and Br and hepatic- and renal dysfunction biomarkers, an inverse association with blood Mo and I level, however, indicates an increased risk of Cu, Se, and Br-induced liver and kidney toxicity. Further in-depth studies are warranted to elucidate the underlying mechanisms of the observed associations. Regular biomonitoring of elemental exposures is also indispensable to regulate pollution in consideration of the long-term health effects of mixed-elements exposure in children.
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Affiliation(s)
- Shakil Mahmood
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh; Department of Biochemistry, Gonoshasthaya Samaj Vittik Medical College, Gono Bishwabidyalay (University), Dhaka, 1344, Bangladesh
| | - E M Tanvir
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, 4072, Australia; Institute of Food & Radiation Biology, Atomic Energy Research Establishment, Bangladesh Atomic Energy Commission, Savar, Dhaka, 1349, Bangladesh
| | - Tatiana Komarova
- Inorganic Chemistry Laboratory, Queensland Public Health and Scientific Services, Coopers Plains, Queensland, 4108, Australia
| | - Md Nazrul Islam
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, Queensland, 4102, Australia; Department of Applied Chemistry and Chemical Engineering, University of Chittagong, Chittagong, 4331, Bangladesh
| | - Mahbuba Khatun
- Department of Biochemistry and Molecular Biology, Gono Bishwabidyalay (University), Dhaka, 1344, Bangladesh
| | - Md Fuad Hossain
- Department of Biochemistry and Molecular Biology, Gono Bishwabidyalay (University), Dhaka, 1344, Bangladesh
| | - Jack C Ng
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, Queensland, 4102, Australia
| | - Karen M Whitfield
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, 4072, Australia; Pharmacy Department, Royal Brisbane and Women's Hospital, Metro North Health Services District, Herston, Queensland, 4029, Australia
| | - Md Sabir Hossain
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Md Ibrahim Khalil
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh.
| | - P Nicholas Shaw
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, 4072, Australia.
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6
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Favel K, Irvine M, Ronsley R, Panagiotopoulos C, Mammen C. Glomerular filtration rate abnormalities in children with type 1 diabetes. Can J Diabetes 2022; 46:457-463.e1. [DOI: 10.1016/j.jcjd.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
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7
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Leventoğlu E, Pekçetin Şişik P, Çelik İE, Büyükkaragöz B. The effect of COVID-19 restriction on metabolic syndrome in primary hypertension. Pediatr Int 2022; 64:e15144. [PMID: 35831258 DOI: 10.1111/ped.15144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/28/2021] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Primary hypertension (HT) has been increasingly reported in parallel to the increase in the prevalence of obesity in children, both of which are important components of metabolic syndrome. The aim of this study was to investigate the effects of COVID-19 restrictions, which are believed to induce lifestyle changes and physical inactivity, on the parameters of metabolic syndrome in children with primary hypertension. METHODS This was an observational, pre-post study conducted on pediatric patients with primary HT. The first phase of the study was the period prior to when COVID-19 restrictions were put in place in Turkey, and the second phase was up to the date when the restrictions were lifted. Anthropometric and blood pressure measurements, laboratory tests, and hypertensive-mediated organ damage at both phases of the study were compared. RESULTS Severe restrictions due to the COVID-19 pandemic were associated with an increase in mean ± standard deviation body mass index (BMI) (26.4 ± 7.3 vs. 27.2 ± 7.1, P = 0.002), antihypertensive drug use (n = 53 (57.6%) vs. n = 59 (64.1%), P < 0.0001), fasting blood glucose level (89.4 ± 12.6 vs. 94.1 ± 14.2, P = 0.013), and a borderline elevation in total cholesterol (21 [22.8%] vs. 28 [30.4%], P < 0.0001). These increases negatively affected end organs, with an increased frequency of interventricular septum hypertrophy (n = 12 [13%] vs. n = 17 [18.5%], P = 0.031). CONCLUSIONS COVID-19 restrictions were associated with an increased risk of parameters associated with metabolic syndrome in patients with primary hypertension. Physicians should carefully monitor the weight, blood pressure, fasting plasma glucose level, and total cholesterol levels in patients during periods of movement/activity restrictions such as during the COVID-19 pandemic.
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Affiliation(s)
- Emre Leventoğlu
- Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
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8
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Leibler JH, Ramirez-Rubio O, Velázquez JJA, Pilarte DL, Obeid W, Parikh CR, Gadupudi S, Scammell MK, Friedman DJ, Brooks DR. Biomarkers of kidney injury among children in a high-risk region for chronic kidney disease of uncertain etiology. Pediatr Nephrol 2021; 36:387-396. [PMID: 32504218 DOI: 10.1007/s00467-020-04595-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/09/2020] [Accepted: 04/28/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Mesoamerican Nephropathy (MeN), a form of chronic kidney disease of uncertain etiology, is a leading cause of death in Central America. The disease often presents in young adult male agricultural workers and progresses rapidly. Given the young age at presentation, we hypothesized that children in Central America experience subclinical kidney injury prior to working life. METHODS We assessed specimens from a cross-sectional study of youth, aged 7-17 years, predominantly residing in a high-risk region of Nicaragua (n = 210). We evaluated urinary concentrations and risk factors for kidney injury biomarkers neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), interleukin-18 (IL-18), monocyte chemoattractant protein 1 (MCP-1), and chitinase-3-like protein 1 (YKL-40). We evaluated the association between biomarkers and contemporaneous eGFR and compared biomarker concentrations with reference values from healthy children in other countries. RESULTS Median uNGAL, uIL-18, and uKIM-1 concentrations exceeded healthy reference values. A one-year increase in age was associated with 40% increase in odds of being in the highest quartile of uNGAL (OR 1.4; (95%CI 1.2, 1.5); p < 0.0001). Youth who reported ever experiencing dysuria had 2.5 times the odds of having uNGAL concentrations in the top quartile (OR 2.5; (95%CI 1.4, 4.6); p = 0.003). Girls had significantly higher concentrations of all biomarkers than boys. Nine percent of children demonstrated low eGFR (≤ 100 ml/min/1.73 m2), while 29% showed evidence of hyperfiltration (eGFR ≥ 160 ml/min/1.73 m2), both potentially indicative of renal dysfunction. CONCLUSIONS Children residing in regions of Nicaragua at high risk for MeN may experience subclinical kidney injury prior to occupational exposures.
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Affiliation(s)
- Jessica H Leibler
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St., 430W, Boston, MA, 02118, USA.
| | - Oriana Ramirez-Rubio
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | - Damaris López Pilarte
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Wassim Obeid
- Division of Nephrology, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Chirag R Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Salini Gadupudi
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Madeleine K Scammell
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St., 430W, Boston, MA, 02118, USA
| | - David J Friedman
- Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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9
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Burlaka IA, Mityuryayeva IO, Shevchenko TA, Holoborodko AD, Kovalchuk IV, Lantukh LO. Clinical, Laboratory, Instrumental, Anamnestic Characteristics in Children With Type I Diabetes Mellitus and Early Stage of Diabetic Nephropathy. Glob Pediatr Health 2021; 8:2333794X211063052. [PMID: 34988261 PMCID: PMC8721692 DOI: 10.1177/2333794x211063052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
Type 1 diabetes (T1D) is mainly a disease of children and young adults. Diabetic nephropathy (DN) is a common finding in diabetic patients. Microalbuminuria is the earliest clinical evidence of DN. Aim of the study was analysis of clinical, laboratory, instrumental, anamnestic examinations data in pediatric patients with T1D and early stage of DN in order to evaluate possible factors associated with early stage of DN and predictors of DN development and progression. A survey of 105 children (62 males, 43 females) with T1D and DN aged 5 to 17 years in Endocrinology unit on Clinical Pediatric Hospital №6 (Kyiv, Ukraine) done. Following clinical and biochemical characteristics found associated with an early DN: inflammatory phenotype (increased ESR, decreased albumin/globulin ratio), functional cardiovascular disorders (increased systolic blood pressure, “minor” ECG changes), signs of secondary metabolic disorders (high HbA1c, increased serum cholesterol level, increase ALAT and ASAT levels). Kidney function impairment at early stage of DN shows: higher MAU grade, GFR decline, rise in serum creatinine level as compared to T1D group. Presence of concomitant kidney and endocrine disease; positive family history found in a bigger number of patients with DN. DKA episodes number found as a factor associated with higher levels of MAU in children with DN. Patients who had microalbuminuria and more than 5 episodes of DKA/year (poorly controlled T1D) have higher progression rate to macroalbuminuria as compared to those who have less than 5 episodes of DKA/year after a 6-year follow-up study.
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10
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Transmembrane 6 superfamily member 2 167K allele improves renal function in children with obesity. Pediatr Res 2020; 88:300-304. [PMID: 31923913 DOI: 10.1038/s41390-020-0753-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/23/2019] [Accepted: 12/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The transmembrane 6 superfamily member 2 (TM6SF2) E167K polymorphism influences estimated glomerular filtration rate (eGFR) in adults without diabetes and without obesity. We aimed exploring the impact of this polymorphism on eGFR in children with obesity with and without non-alcoholic fatty liver disease (NAFLD). METHODS We genotyped 531 children with obesity for TM6SF2 E167K polymorphism. NAFLD was defined by ultrasound detected liver steatosis and/or ALT > 40 IU/L. RESULTS Patients carrying the TM6SF2 167K allele showed higher eGFR levels compared with E167 homozygous patients both among subjects with and without NAFLD. A general linear model confirmed a direct and significant association of eGFR values with TM6SF2 genotype both in patients with and without NAFLD. This association, however, was stronger in patients with NAFLD. CONCLUSIONS Children with obesity carrying the TM6SF2 167K allele show higher eGFR levels compared with E167 allele homozygous subjects, independently of NAFLD. A major effect of this polymorphism in the presence of NAFLD was captured.
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Abstract
OBJECTIVES Cardiovascular (CV) diseases play a leading role in the mortality of adult liver transplant (LT) recipients. However, data regarding CV risk factors in children after LT remain sparse. The present study assessed the presence of CV risk factors and signs of CV impairment in LT children. METHODS A total of 42 LT recipients (21 men, age 9.93 ± 3.57 years) were studied. Body composition [body mass index standard deviation score, percentage of body fat (by bioimpedance analysis)], lipid profiles, glycemic control, blood pressure, and arterial stiffness [assessed by aortic pulse wave velocity (PWV)] were evaluated. The effect of different treatment modalities [tacrolimus (TAC) (n = 30) or cyclosporine (CyA) (n = 11)] was also analyzed. RESULTS Almost 18% of children were overweight or obese. Patients on TAC had a significantly higher body fat mass and percentage of body fat compared with the CyA group (P < 0.02). Borderline to high lipid values were present in 40% of patients. Children on CyA had higher serum cholesterol levels compared to TAC (P < 0.004). Nineteen percent of patients had hypertension. Half of the patients had glomerular filtration rate values <90 mL/min/1.73 m, whereas PWV values were above the 95th percentile in 12%. CONCLUSIONS Increased body fat, chronic kidney disease, high lipid content, hypertension, and increased arterial stiffness are already present and are in part related to the type of immunosuppression regimen in LT children >5 years following transplantation. Long-term follow-up is needed to evaluate their impact on CV health and survival.
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12
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Variation in estimated glomerular filtration rate at dialysis initiation in children. Pediatr Nephrol 2017; 32:331-340. [PMID: 27695987 DOI: 10.1007/s00467-016-3483-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Data guiding the timing of dialysis initiation in children are limited. We sought to determine current practice and secular trends in Canada with respect to the timing of dialysis initiation in children based on estimated glomerular filtration rate (eGFR). METHODS This observational study included incident chronic dialysis patients aged ≤21 years identified from the Canadian Organ Replacement Register who started dialysis in Canada between January 2001 and December 2010 at any of the nine participating Canadian centers (n = 583). Youth were categorized utilizing CKiD Schwartz eGFR into ≥10.5 (higher) or <10.5 ml/min/1.73 m2 (lower) eGFR groups. Differences at dialysis initiation by facility and region were examined, and secular trends were determined. RESULTS Median eGFR at dialysis initiation was 8.1 (interquartile range 5.4-11.0) ml/min/1.73 m2. Overall, 29 % of the patients started dialysis with an eGFR of ≥10.5 ml/min/1.73 m2. The proportion of children starting with higher eGFR increased from 27.3 % in 2001 to 35.4 % in 2010 (p = 0.04) and differed by treatment facility (12-70 %; p = 0.0001). Factors associated with higher eGFR at dialysis initiation in the adjusted regression model were female sex [odds ratio (OR) 1.48; 95 % confidence interval (CI) 1.02-2.14], genetic cause of end-stage kidney disease (OR 2.77; 95 % CI 1.37-5.58) and living ≥50 km from treatment facility (OR 1.47; 95 % CI 1.01-2.14). CONCLUSIONS One-third of the children were found to have initiated dialysis with an eGFR ≥10.5 ml/min/1.73 m2, however significant practice variation exists with respect to timing of dialysis initiation by treatment facility. More data is required to evaluate the clinical implications of this practice variation.
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Bjornstad P, Cherney DZ, Maahs DM, Nadeau KJ. Diabetic Kidney Disease in Adolescents With Type 2 Diabetes: New Insights and Potential Therapies. Curr Diab Rep 2016; 16:11. [PMID: 26803647 PMCID: PMC5841446 DOI: 10.1007/s11892-015-0708-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease (ESRD) and dialysis in the Western world. Early DKD, including microalbuminuria and renal hyperfiltration, is common in adolescents with type 2 diabetes (T2D). Furthermore, youth-onset T2D carries a higher risk of progressive DKD than adult-onset T2D of similar diabetes duration. DKD is characterized by a long clinically silent period without signs of disease. Therefore, a major challenge in preventing DKD is the difficulty in identifying high-risk T2D patients at an early stage. The Type 2 Diabetes in Adolescents and Youth (TODAY) study demonstrated a high initial prevalence that increased over time, irrespective of treatment arm. This key observation underscores the importance of discovering new therapeutic targets to supplement conventional management, in order to reduce DKD risk. In this review, we focus on early DKD in T2D and summarize potential novel biomarkers and therapeutic targets.
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Affiliation(s)
- Petter Bjornstad
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA.
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 13123 East 16th Ave, Box B265, Aurora, CO, 80045, USA.
| | - David Z Cherney
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - David M Maahs
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 13123 East 16th Ave, Box B265, Aurora, CO, 80045, USA
- Department of Medicine, Division of Nephrology, University of Colorado, Aurora, CO, USA
| | - Kristen J Nadeau
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 13123 East 16th Ave, Box B265, Aurora, CO, 80045, USA
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Pottel H, Hoste L, Delanaye P. Abnormal glomerular filtration rate in children, adolescents and young adults starts below 75 mL/min/1.73 m(2). Pediatr Nephrol 2015; 30:821-8. [PMID: 25403744 DOI: 10.1007/s00467-014-3002-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/24/2014] [Accepted: 10/27/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The chronic kidney disease (CKD) classification system for children is similar to that for adults, with both mainly based on estimated glomerular filtration rate (eGFR) combined with fixed cut-off values. The main cut-off eGFR value used to define CKD is 60 mL/min/1.73 m(2), a value that is also applied for children older than 2 years of age, adolescents and young adults. METHODS Based on a literature search, we evaluated inclusion criteria for eGFR in clinical trials or research studies on CKD for children. We also collected information on direct measurements of GFR (mGFR) in children and adolescents, with the aim to estimate the normal reference range for GFR. Using serum creatinine (Scr) normal reference values and Scr-based eGFR-equations, we also evaluated the correspondence between Scr normal reference values and (e)GFR normal reference values. RESULTS Based on our literature search, the inclusion of children in published CKD studies has been based on cut-off values for eGFR of >60 mL/min/1.73 m(2). The lower reference limits for mGFR far exceed this adult threshold. Using eGFR values calculated using Scr-based formulas, we found that abnormal Scr levels in children already correspond to eGFR values that are below a cut-off of 75 mL/min/1.73 m(2). CONCLUSIONS Abnormal GFR in children, adolescents and young adults starts below 75 mL/min/1.73 m(2), and as abnormality is a sign of disease, we recommend referring children, adolescents and young adults with an (e)GFR of <75 mL/min/1.73 m(2) for further clinical assessment.
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Affiliation(s)
- Hans Pottel
- Department of Public Health and Primary Care, Campus Kulak Kortrijk, University of Leuven, Etienne Sabbelaan 53, 8500, Kortrijk, Belgium,
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Cerqueira DC, Soares CM, Silva VR, Magalhães JO, Barcelos IP, Duarte MG, Pinheiro SV, Colosimo EA, Simões e Silva AC, Oliveira EA. A predictive model of progression of CKD to ESRD in a predialysis pediatric interdisciplinary program. Clin J Am Soc Nephrol 2014; 9:728-35. [PMID: 24458086 DOI: 10.2215/cjn.06630613] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The incidence of ESRD in children has increased over the last two decades. Nevertheless, there are still limited data on risk factors related to the emergence of ESRD among patients with CKD. The aim of this study was to develop a model of prediction of ESRD in children and adolescents with CKD (stages 2-4) enrolled in a predialysis interdisciplinary management program. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this retrospective cohort study, 147 patients with CKD admitted from 1990 to 2008 were systematically followed up at a tertiary pediatric nephrology unit for a median of about 4.5 years. The primary outcome was the progression to CKD stage 5. A predictive model was developed using Cox proportional hazards model and evaluated by c statistics. RESULTS The median renal survival was estimated at 98.7 months (95% confidence interval [95% CI], 68.7 to 129.6 months). The probability of reaching CKD stage 5 was estimated as 52% in 10 years. The most accurate model included eGFR, proteinuria at admission, and primary renal disease. Risk score ranged from 0 to 13 points (median, 4 points). The accuracy of the score applied to the sample was high, with c statistics of 0.865 (95% CI, 0.80 to 0.93) and 0.837 (95% CI, 0.76 to 0.91) at follow-up of 2 and 5 years, respectively. By survival analysis, it was estimated that at 10 years after admission, the probability of renal survival was about 63% for patients in the low-risk group and 43% for the medium-risk group; all patients assigned to the high-risk group had CKD stage 5 (P<0.001). CONCLUSION The predictive model of progression of CKD might contribute to early identification of a subgroup of patients at high risk for accelerated renal failure.
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Affiliation(s)
- Debora C Cerqueira
- Department of Pediatrics, Pediatric Nephrourology Unit,, †Nutrition Division, and, ‡Department of Statistics, National Institute of Science and Technology of Molecular Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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