Epidemiology of Chronic Kidney Disease in Children: A Report from Lithuania

Silent Hearing Loss in Kidney Transplant Patients Receiving Tacrolimus: A Fact or a Myth?

Background

It has been claimed that tacrolimus may have harmful effects on the auditory system, where it has been linked to ototoxicity and sensorineural hearing loss (SNHL). We evaluated silent SNHL in kidney transplant recipients (KTRs) receiving tacrolimus and the different factors affecting it compared to healthy controls.

Materials and Methods

In this case control study, hearing functions were studied in 42 KTRs receiving tacrolimus as maintenance immunosuppressive therapy for more than 3 months in comparison to 27 age- and gender-matched healthy subjects using tympanometry, pure-tone audiometry (PTA), extended high frequency audiometry (EHFA), and transient evoked oto-acoustic emissions (TEOAEs). Also, different factors were studied in relation to SNHL.

Results

PTA showed that 23.8%, 21.4%, and 4.8% had mild, moderate, and severe SNHL, respectively. One-fifth of KTRs had severe SNHL, according to EHFA. According to TEOAEs, 28.6% of KTRs had abnormal hearing. There was a significant positive correlation between the tacrolimus trough levels and the results of both the PTA (P = 0.002) and EHFA (P = 0.035) tests.

Conclusion

SNHL was detected in about half of the studied KTRs. Silent SNHL in KTRs might be associated with higher tacrolimus trough levels.

Kidney Damage in Pediatric Obesity: Insights from an Emerging Perspective

The role of obesity as a risk factor for chronic kidney disease (CKD) in adulthood has been well established. Over the last years, kidney damage (KD) has emerged as a significant consequence of obesity since childhood. Indeed, a complex interplay of metabolic factors, including insulin resistance (IR), hypertension, oxidative stress, adipose tissue dysfunction, and systemic inflammation, might affect renal hemodynamics, contributing to CKD development over time in at-risk young patients. As the prevalence of pediatric obesity continues to rise globally, understanding the implications for kidney health in terms of early intervention is of paramount importance. Careful monitoring of kidney function within a multidisciplinary approach in children with obesity is crucial for detecting early KD, allowing for timely lifestyle modifications and treatment. In this framework, continued research is essential to further elucidate mechanisms linking obesity and KD and to explore not only effective preventive strategies but also the long-term impact of obesity on kidney health in children with obesity. Given the intimate link of KD with the metabolic milieu in children with obesity, we aimed to provide a comprehensive and insightful overview on KD and its implications in pediatric obesity by reviewing the most recent literature in the field.

Assessment of brain-derived neurotrophic factor and irisin concentration in children with chronic kidney disease: a pilot study

Patients suffering from chronic kidney disease (CKD) are particularly placed at risk of multiorgan complications. One of them is malnutrition, which adds up to a higher mortality factor among them. This study was designed to determine the usefulness of brain-derived neurotrophic factor (BDNF) and irisin assays in the assessment of CKD development. The study group included 28 children with CKD at stages 2-5 treated conservatively. The outcome of our study revealed decreased serum BDNF and irisin levels in CKD patients, whereas urine concentrations were increased for BDNF and decreased for irisin, comparing to healthy controls. There was a positive correlation between anthropometric measures and urine BDNF concentration, as well as anthropometric measures and both serum and urine irisin levels in the study group, however no dependence of the tested markers on the stage of CKD was observed. In recent years, a role of myokines was described as vital for maintaining metabolic homeostasis therefore we suspect a potential role of these multifaceted markers in detecting malnutrition in CKD children.

The Interplay between Metabolic Adaptations and Diet in Cancer Immunotherapy

Over the past decade, cancer immunotherapy has significantly advanced through the introduction of immune checkpoint inhibitors and the augmentation of adoptive cell transfer to enhance the innate cancer defense mechanisms. Despite these remarkable achievements, some cancers exhibit resistance to immunotherapy, with limited patient responsiveness and development of therapy resistance. Metabolic adaptations in both immune cells and cancer cells have emerged as central contributors to immunotherapy resistance. In the last few years, new insights emphasized the critical role of cancer and immune cell metabolism in animal models and patients. During therapy, immune cells undergo important metabolic shifts crucial for their acquired effector function against cancer cells. However, cancer cell metabolic rewiring and nutrient competition within tumor microenvironment (TME) alters many immune functions, affecting their fitness, polarization, recruitment, and survival. These interactions have initiated the development of novel therapies targeting tumor cell metabolism and favoring antitumor immunity within the TME. Furthermore, there has been increasing interest in comprehending how diet impacts the response to immunotherapy, given the demonstrated immunomodulatory and antitumor activity of various nutrients. In conclusion, recent advances in preclinical and clinical studies have highlighted the capacity of immune-based cancer therapies. Therefore, further exploration into the metabolic requirements of immune cells within the TME holds significant promise for the development of innovative therapeutic approaches that can effectively combat cancer in patients.

Particulars of breastfeeding age in preterm child (case report)

Background. General physicians often encounter preterm infants and adverse sequelae of prematurity-related morbidities. Interruption of intrauterine development leads to considerable deficits in the internal organs structure and function. It can lead to endothelial dysfunction, hypertension, proteinuria and metabolic abnormalities that persist throughout life. Children born early or low birth weight (LBW) infants also have relatively increased risk for the deve­lopment of kidney injury later in life. Often these infants have history of treatment at the intensive care unit due to hypoxic damage or inflammatory response that also affects kidneys necessitating the use of nephrotoxic medications. The treatment and diagnosis outcomes were applied to make a conclusion about clinical features of the preterm 7-month-old girl. The data were analyzed using PubMed/MEDLINE and Google Scholar databases. The aim is to summarize particulars of breastfeeding period in a LBW baby, providing a physician with practical information regar­ding organization of a follow-up. Material and methods. The baby was moderately preterm (32–33 weeks of gestation) with LBW (2100 g). Her mother was consulted regarding hypertension and threat of miscarriage during pregnancy. The child had renal borderline states in the newborn period. Apgar score was low, neonatal resuscitation and respiratory support by the continuous positive airway pressure were used. The newborn had poor regulation of body temperature, depended on environmental factors and prone to rapid heat loss, so she was nursed in incubator. A feeding tube was used despite poor sucking at the first days after delivery and breastfeeding was continued as soon as possible. Eventually, formula feeding was started. Results. Fever, vomiting, dehydration, loss of body weight and oliguria appeared in the 7-month-old baby after the upper respiratory tract infection. Examination showed the stigmas, neurodevelopmental delay, physical growth gap. Blood tests revealed anemia of the first stage and a rapid increase in the level of white blood cells with a left shift and electrolyte imbalance. The laboratory tests of primary and secondary hemostasis were normal. Physical, chemical and microscopic urine properties were changed according to results of urine test. The sonography revealed changes in renal tissue and thymic hyperplasia. The child was diagnosed with acute pyelonephritis and treated. Conclusions. Physicians should focus attention on the stigmas, neurodevelopmental delay, physical growth gap, life history, clinical signs and results of examination to make timely conclusion about child’s general state. Kidney injury could be diagnosed in preterm LBW infants.

A Pilot Comparative Study between Creatinine- and Cystatin-C-Based Equations to Estimate GFR and Kidney Ultrasound Percentiles in Children with Congenital Anomalies of the Kidney and Urinary Tract

Congenital anomalies affecting the kidneys present significant challenges in pediatric nephrology, needing precise methods for assessing renal function and guiding therapeutic intervention. Bedside Schwartz formula with the cystatin-C-based Full Age Spectrum formula and Chronic Kidney Disease in Children (CKiD) U 25 formula used in estimating glomerular filtration rate (eGFR) and also to assess if the eGFR in association with kidney length percentiles can be a monitoring parameter for the progression of chronic kidney disease in children with congenital anomalies of the kidney and urinary tract (CAKUT). A total of 64 pediatric patients (median age at diagnostic was 12 months with an interquartile range of 2 to 60) were diagnosed with congenital anomalies in the kidney and urinary tract between June 2018 and May 2023 at "Louis Turcanu" Emergency Hospital for Children in Timisoara, Romania. Baseline characteristics, CAKUT types, associated pathologies, CKD staging, and eGFR using creatinine and cystatin C were analyzed. The mean age at the moment of examination was 116.50 months; (65, 180). Chronic kidney disease staging revealed a predominance of patients in CKD stages G1 and A1. Analysis of eGFR methods revealed a small mean difference between eGFR estimated by creatinine and cystatin C, with a moderate-strong positive correlation observed between the eGFR and ultrasound parameters. Using cystatin-C-based formulas for eGFR, in conjunction with ultrasound measurements, may offer reliable insights into renal function in pediatric patients with congenital anomalies affecting the kidney and urinary tract. However, the economic aspect must be taken into consideration because cystatin C determination is approximately eight times more expensive than that of creatinine. An interdisciplinary approach is crucial for managing patients with CAKUT.

Melamine in Iranian foodstuffs: A systematic review, meta-analysis, and health risk assessment of infant formula

The presence of melamine in food is one of the most significant threats to consumer health and food safety now confronting the communities. The goal of this systematic review and meta-analysis was to determine the melamine content of different food products available on the Iranian market. The pooled melamine concentration (95% confidence interval) on 484 samples of animal-based foodstuffs was as follows: 0.22 (0.08, 0.36 mg kg^-1) for milk, 0.39 (0.25, 0.53 mg kg^-1) for coffee mate, 1.45 (1.36, 1.54 mg kg^-1) for dairy cream, 0.90 (0.50, 1.29 mg kg^-1) for yoghurt, 1.25 (1.20, 1.29 mg kg^-1) for cheese, 0.81 (-0.16, 1.78 mg kg^-1) for hen eggs, 1.28 (1.25, 1.31 mg kg^-1) for poultry meat, 0.58 (0.35, 0.80 mg kg^-1) for chocolates, and 0.98 (0.18, 1.78 mg kg^-1) for infant formula. Based on the results of health risk assessment study on toddlers under 2 years old who ingested infant formula (as a melamine-sensitive group), all groups of toddlers are at an acceptable level of non-carcinogenic risk (THQ ≤ 1). Toddlers were classified according to their ILCR (carcinogenic risk) levels due to infant formula consumption as follows: under 6 months (0.0000056), 6-12 months (0.0000077), 12-18 months (0.0000102), and 18-24 months (0.0000117). The melamine carcinogenicity in infant formula for children had an ILCR value of 0.000001-0.0001 in the investigation, which was considerable risk. According to the findings, Iranian food products (notably infant formula) should be analyzed for melamine contamination on a regular basis.

Association Between Salivary Cytokines, Chemokines and Growth Factors and Salivary Gland Function in Children with Chronic Kidney Disease

Introduction

Chronic kidney disease (CKD) is a systemic inflammatory disease that leads to multiple organ complications not only in the kidneys and the cardiovascular system, but also in the oral cavity. CKD children experience reduced saliva secretion (hyposalivation), which leads to increased incidence of dental caries and significant impairment of patients' quality of life. However, the causes of salivary gland dysfunction in children with CKD are unknown. The present study is the first to evaluate the inflammatory and anti-inflammatory profile in the saliva of children with CKD at different stages of renal failure with normal and reduced salivary gland function.

Methods

Thirty children with CKD (age 9-16) and thirty age- and gender-matched healthy children were classified for the study. Salivary inflammatory and anti-inflammatory profile were assayed using the multiplex ELISA assay.

Results

We demonstrated statistically significant changes in salivary pro-inflammatory (↑TNF-α, ↓IL-7), anti-inflammatory (↑IL-10), Th1 (↑INF-γ, ↑IL-15), Th2 (↑IL-4, ↑IL-5, ↑IL-6, ↑IL-9) and Th17 (IL-17) cytokines as well as chemokines (↑MCP-1/CCL-2, ↑MIP-1α/CCL3, ↓MIP-1β/CCL4, ↓EOTAXIN/CCL11) and growth factors (↑G-CSF, ↑FGF) in unstimulated saliva of children with CKD compared to the controls. Although the evaluation of the salivary inflammatory profile does not indicate a particular dominance of any of the branches of the immune system, we observed a statistically significant increase in the concentration of all Th2 cytokines assayed. The multivariate regression analysis showed that the content of salivary cytokines, chemokines and growth factors depends on the secretory function of the salivary glands, ie, salivary flow, total protein concentration and amylase activity in the saliva. Salivary MIP-1α/CCL3 was the most effective to differentiate children with CKD and hyposalivation from patients with normal saliva secretion.

Discussion

Inflammation is involved in salivary gland dysfunction in children with CKD, although further studies on in vitro and in vivo models are necessary to confirm this hypothesis.

Multi-pollutant air pollution and renal health in Asian children and adolescents: An 18-year longitudinal study

BACKGROUND

Few studies have examined the effects of multi-pollutant air pollution on renal health, especially in children and adolescents. This study investigated the association between long-term ambient air pollution exposure and renal health in Asian children and adolescents.

METHODS

This study included 10,942 children and adolescents from Taiwan and Hong Kong between 2000 and 2017. PM_2.5, NO₂ and O₃ concentrations were estimated using satellite-based spatiotemporal regression models. Two-year average concentrations, those of the year of visit and the preceding year, were used. Linear mixed models were used to examine the association between air pollution and yearly changes in estimated glomerular filtration rate (eGFR). Cox regression models with time-dependent covariates were used to examine the association between air pollution and the development of chronic kidney disease (CKD).

RESULTS

Median age of the participants was 19 years (range: 2-25). The overall average concentration of PM_2.5, NO₂ and O₃ was 26.7 μg/m³, 44.1 μg/m³ and 51.1 μg/m³, respectively. The mean yearly change in eGFR was 0.37 μL/min/1.73 m² and the incidence rate of CKD was 6.8 per 1,000 person-years. In single-pollutant models, each 10 μg/m³ increase in PM_2.5 was associated with a 0.45 μL/min/1.73 m² [95% confidence interval (CI): 0.28-0.63] reduction in the yearly increase in eGFR and 53% [hazard ratio (HR): 1.53 (95%CI: 1.07-2.2)] greater risk of incident CKD. Each 10 μg/m³ increase in NO₂ was associated with a 7% [HR (95%CI): 1.07 (1.00-1.15)] higher risk of incident CKD, while an equivalent increase in O₃ was associated with a 19% [HR (95%CI): 0.81 (0.67-0.98)] lower risk.

CONCLUSIONS

Long-term exposure to ambient PM_2.5 and NO₂ was associated with a slower growth of eGFR and a higher risk of incident CKD in children and adolescents. Our findings suggest that air pollution control in early life is imperative to improve lifelong renal health and alleviate the CKD burden.

Terminological relationships between nursing diagnoses for children with kidney diseases

OBJECTIVE

To identify the relationships between the statements of nursing diagnoses for children with kidney diseases prepared according to the International Classification for Nursing Practice (ICNP®) with the diagnoses of NANDA International (NANDA-I).

METHODS

Methodological study operationalized by the steps: 1) Survey of clinical findings through interviews and physical examination with children; 2) Elaboration of nursing diagnoses through Gordon's clinical judgment; 3) Cross-mapping of diagnostic statements between the NANDA-I and ICNP® classification systems; 4) Content validation using the Delphi technique, in two rounds, with specialist nurses.

RESULTS

90 children participated. A total of 151 diagnoses were made, of which 66.3% (n=100) used ICNP® terminology and 33.7% (n=51) used NANDA-I; 55 diagnoses showed equivalence of meanings.

CONCLUSIONS

Cross-mapping of diagnoses was achieved starting from the reality of children, using clinical reasoning and validation by specialist nurses.

Prevalence of Nonalcoholic Fatty Liver Disease in Children with Renal Failure Underwent Treatment with Dialysis

Background

In this study, we aimed to investigate the prevalence of nonalcoholic fatty liver disease (NAFLD) in children with renal failure under treatment with dialysis and its association with biochemical measurements.

Methods

In this cross-sectional study, children aged less than 18 years with chronic kidney disease (CKD) who were under treatment with dialysis at least 3 months ago were enrolled. To evaluate fatty liver in those patients who had no recent liver ultrasonography (last 6 months), liver ultrasonography was performed. The characteristics of patients with renal failure with and without NAFLD based on the ultrasonographic evaluation were compared. The association between NAFLD and the studied variables was evaluated.

Results

In this study, 39 children (31 males and 8 females) with renal failure who underwent treatment with dialysis were included. From the studied population, six (19.4%) had NAFLD based on ultrasonographic evaluation. There were no differences between renal failure patients with and without NAFLD regarding the biochemical and anthropometric characteristics (P > 0.0).

Conclusions

The prevalence of NAFLD in our studied children with renal failure who underwent treatment with dialysis was like the general population and it was not associated with the biochemical and anthropometric characteristics of the patients. Given the importance of NAFLD in renal failure patients as well as its subtle nature, it is recommended to screen patients with CKD for NAFLD.

Relações terminológicas entre diagnósticos de enfermagem para crianças com doenças renais

RESUMO Objetivo: Identificar as relações dos enunciados de diagnósticos de enfermagem para crianças com doenças renais elaborados segundo a Classificação Internacional para a Prática de Enfermagem (CIPE®) com os diagnósticos da NANDA Internacional (NANDA-I). Métodos: Estudo metodológico operacionalizado pelas etapas: 1) Levantamento dos achados clínicos por meio de entrevista e exame físico com crianças; 2) Elaboração dos diagnósticos de enfermagem mediante o julgamento clínico de Gordon; 3) Mapeamento cruzado dos enunciados de diagnósticos entre os sistemas de classificação NANDA-I e CIPE®; 4) Validação de conteúdo utilizando a técnica Delphi, em duas rodadas, com enfermeiros especialistas. Resultados: Participaram 90 crianças. Foram elaborados 151 diagnósticos, dos quais 66,3% (n= 100) da terminologia da CIPE® e 33,7% (n= 51) da NANDA-I; 55 diagnósticos apresentaram equivalência de significados. Conclusões: O mapeamento cruzado de diagnósticos foi alcançado partindo-se da realidade de crianças, com uso de raciocínio clínico e validação por enfermeiros especialistas.

Hearing assessment in Egyptian children with chronic renal failure on regular hemodialysis and renal transplantation children

INTRODUCTION

Hearing impairment is frequent in patients with end-stage renal disease (ESRD). We aimed to assess the prevalence of hearing impairment in children on regular hemodialysis and renal transplantation.

MATERIALS AND METHODS

Transient-evoked otoacoustic emissions (TEOAEs) has been done for 80 children on regular hemodialysis and 40 with renal transplant.

RESULTS

In hemodialysis group, TEOAEs showed that 53.8% children had hearing affection, it was significantly related to dialysis duration, dialysis adequacy, vascular access infection, hepatitis C virus (HCV) infection, and ototoxic drugs (p = 0.001, 0.037, 0.011, 0.004, 0.030, 0.007, and 0.044, respectively). In renal transplant group hearing impairment was 25%. There was significant relation with period of dialysis before transplantation and biopsy proved rejection (p = 0.008, <0.001, respectively).

CONCLUSION

Hearing impairment is a common finding in ESRD patients. Thus audiological assessment must be done in these patients.