Journal of Clinical Medicine

Editorial

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4 pages, 198 KiB

Open AccessEditorial

Biomarkers in Pediatric Nephrology—From Bedside to Bench and Back Again

by Kinga Musiał

J. Clin. Med. 2022, 11(19), 5919; https://doi.org/10.3390/jcm11195919 - 7 Oct 2022

Cited by 1 | Viewed by 1152

Abstract

The progress in biomarker research is characterized by the perpetual quest for parameters that fulfill the strict criteria of sensitivity, specificity, ease and speed in performance and cost-effectiveness [...] Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

Research

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11 pages, 1505 KiB

Open AccessArticle

The Usefulness of Vanin-1 and Periostin as Markers of an Active Autoimmune Process or Renal Fibrosis in Children with IgA Nephropathy and IgA Vasculitis with Nephritis—A Pilot Study

by Małgorzata Mizerska-Wasiak, Emilia Płatos, Karolina Cichoń-Kawa, Urszula Demkow and Małgorzata Pańczyk-Tomaszewska

J. Clin. Med. 2022, 11(5), 1265; https://doi.org/10.3390/jcm11051265 - 25 Feb 2022

Cited by 4 | Viewed by 2021

Abstract

This study aimed to evaluate the usefulness of vanin-1 and periostin in urine as markers of the autoimmune process in kidneys and renal fibrosis in IgA nephropathy (IgAN) and IgA vasculitis with nephritis (IgAVN). From a group of 194 patients from the Department [...] Read more.

This study aimed to evaluate the usefulness of vanin-1 and periostin in urine as markers of the autoimmune process in kidneys and renal fibrosis in IgA nephropathy (IgAN) and IgA vasculitis with nephritis (IgAVN). From a group of 194 patients from the Department of Pediatrics and Nephrology, who were included in the Polish Pediatric Registry of IgAN and IgAVN, we qualified 51 patients (20 with IgAN and 31 with IgAVN) between the ages of 3 and 17, diagnosed based on kidney biopsy, for inclusion in the study. All of the patients received glucocorticosteroids, immunosuppressive drugs, or renoprotective therapy. The control group consisted of 18 healthy individuals. The concentration of vanin was significantly higher in the IgAN and IgAVN groups than in the control group. The concentration of vanin/creatinine correlates positively with the level of IgA and negatively with the serum level of C3 at the end of the observation. Urinary vanin-1 concentration may be useful as a marker of the active autoimmune process in IgAN and IgAVN in children, but the study needs confirmation on a larger group of children, along with evaluation of the dynamics of this marker. Urinary periostin is not a good marker for children with IgAN and IgAVN, especially in stage 1 and 2 CKD. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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6 pages, 213 KiB

Open AccessArticle

Analysis of Indications for Voiding Cystography in Children

by Natalia Kopiczko, Aleksandra Dzik-Sawczuk, Karolina Szwarc, Anna Czyż and Anna Wasilewska

J. Clin. Med. 2021, 10(24), 5809; https://doi.org/10.3390/jcm10245809 - 11 Dec 2021

Cited by 3 | Viewed by 2057

Abstract

In this study, we report the experience of our center with the prognosis of vesicoureteral reflux, depending on the indications for voiding cystography, during a 12-year period. Retrospective analysis included 4302 children who were analyzed according to the indication for voiding cystography: (1) [...] Read more.

In this study, we report the experience of our center with the prognosis of vesicoureteral reflux, depending on the indications for voiding cystography, during a 12-year period. Retrospective analysis included 4302 children who were analyzed according to the indication for voiding cystography: (1) a febrile urinary tract infection, (2) urinary tract malformations on ultrasonography and (3) lower urinary tract dysfunction. Vesicoureteral reflux was found in 917 patients (21.32%; 24.1% of girls and 17.9% of boys). In group (1), reflux was found in 437/1849 cases (23.63%), group (2) in 324/1388 cases (23.34%) and group (3) in 156/1065 cases (14.65%). A significantly lower prevalence of reflux and its lower degree was found in children from group (3) when compared to other groups (p < 0.01). VURs were confirmed in over 20% of children with urinary tract malformations on ultrasonography or after a febrile urinary tract infection, suggesting the need for voiding cystography in these children. Indications for this examination in children with lower urinary tract dysfunction should be limited. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

11 pages, 435 KiB

Open AccessArticle

Urinary Beta-2-Microglobulin and Late Nephrotoxicity in Childhood Cancer Survivors

by Eryk Latoch, Katarzyna Konończuk, Katarzyna Taranta-Janusz, Katarzyna Muszyńska-Rosłan, Magdalena Sawicka, Anna Wasilewska and Maryna Krawczuk-Rybak

J. Clin. Med. 2021, 10(22), 5279; https://doi.org/10.3390/jcm10225279 - 13 Nov 2021

Cited by 3 | Viewed by 2067

Abstract

The objectives of this study were to evaluate urinary beta-2-microglobulin (β2M) levels in long-term childhood cancer survivors and to establish its association with anticancer drug-induced nephrotoxicity. The study consisted of 165 childhood cancer survivors (CCS) who were in continuous complete remission. We reported [...] Read more.

The objectives of this study were to evaluate urinary beta-2-microglobulin (β2M) levels in long-term childhood cancer survivors and to establish its association with anticancer drug-induced nephrotoxicity. The study consisted of 165 childhood cancer survivors (CCS) who were in continuous complete remission. We reported that CCS had a significantly higher level of β2M (p < 0.001) and β2M/Cr. ratio (p < 0.05) than healthy peers. Among all participants, 24 (14.5%) had decreased eGFR (<90 mL/min/1.73 m²). A significant positive correlation between β2M/Cr. ratio and body mass index (coef. 14.48, p = 0.046) was found. Furthermore, higher levels of urinary β2M were detected among CCS with a longer follow-up time (over 5 years) after treatment. Subjects with decreased eGFR showed statistically higher urinary β2M levels (20.06 ± 21.56 ng/mL vs. 8.55 ± 3.65 ng/mL, p = 0.007) compared with the healthy peers. Twelve survivors (7.2%) presented hyperfiltration and they had higher urinary β2M levels than CCS with normal glomerular filtration (46.33 ± 93.11 vs. 8.55 ± 3.65 ng/mL, p = 0.029). This study did not reveal an association between potential treatment-related risk factors such as chemotherapy, surgery, radiotherapy, and the urinary β2M level. The relationship between treatment with abdominal radiotherapy and reduced eGFR was confirmed (p < 0.05). We demonstrated that urinary beta-2-microglobulin may play a role in the subtle kidney injury in childhood cancer survivors; however, the treatment-related factors affecting the β2M level remain unknown. Further prospective studies with a longer follow-up time are needed to confirm the utility of urinary β2M and its role as a non-invasive biomarker of renal dysfunction. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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19 pages, 4665 KiB

Open AccessArticle

Clinical and Epidemiological Analysis of Children’s Urinary Tract Infections in Accordance with Antibiotic Resistance Patterns of Pathogens

by Katarzyna Werbel, Dorota Jankowska, Anna Wasilewska and Katarzyna Taranta-Janusz

J. Clin. Med. 2021, 10(22), 5260; https://doi.org/10.3390/jcm10225260 - 12 Nov 2021

Cited by 3 | Viewed by 2687

Abstract

The study was conducted to analyze urinary tract infections (UTI) in children by considering epidemiology and antibiotic resistance patterns of pathogens in accordance with inflammatory parameters. The research included 525 patients who demonstrated 627 episodes of UTI. The increasing resistance of bacteria was [...] Read more.

The study was conducted to analyze urinary tract infections (UTI) in children by considering epidemiology and antibiotic resistance patterns of pathogens in accordance with inflammatory parameters. The research included 525 patients who demonstrated 627 episodes of UTI. The increasing resistance of bacteria was observed over the years covered by the study (p < 0.001). There was a significant increase of resistance to amoxicillin with clavulanic acid (p = 0.001), gentamicin (p = 0.017) and ceftazidime (p = 0.0005). According to the CART method, we managed to estimate C-reactive protein (CRP), procalcitonin (PCT) and white blood cell (WBC) values, in which antibiotic sensitivity was observed. In children with CRP > 97.91 mg/L, there was a high percentage of sensitive cases to amoxicillin with clavulanic acid (87.5%). Values of WBC above 14.45 K/µL were associated with E. coli more sensitivity to ampicillin. 100% of children with CRP > 0.42 mg/L and PCT ≤ 6.92 ng/mL had confirmed sensitivity to cefuroxime. Concerning sensitivity to gentamicin, the most optimal cut-off point of WBC was >7.80 K/µL, while in the case of nitrofurantoin, it was CRP value > 0.11 mg/L (which was presented in 98.50% of children). These results may guide us with antibiotic therapy and help to inhibit increasing antibiotic resistance. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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12 pages, 825 KiB

Open AccessArticle

Adenine Nucleotide Metabolites in Uremic Erythrocytes as Metabolic Markers of Chronic Kidney Disease in Children

by Joanna Piechowicz, Andrzej Gamian, Danuta Zwolińska and Dorota Polak-Jonkisz

J. Clin. Med. 2021, 10(21), 5208; https://doi.org/10.3390/jcm10215208 - 8 Nov 2021

Viewed by 1994

Abstract

Chronic kidney disease (CKD) is associated with multifaceted pathophysiological lesions including metabolic pathways in red blood cells (RBC). The aim of the study was to determine the concentration of adenine nucleotide metabolites, i.e., nicotinamide adenine dinucleotide (NAD)-oxidized form, nicotinamide adenine dinucleotide hydrate (NADH)-reduced [...] Read more.

Chronic kidney disease (CKD) is associated with multifaceted pathophysiological lesions including metabolic pathways in red blood cells (RBC). The aim of the study was to determine the concentration of adenine nucleotide metabolites, i.e., nicotinamide adenine dinucleotide (NAD)-oxidized form, nicotinamide adenine dinucleotide hydrate (NADH)-reduced form, nicotinic acid mononucleotide (NAMN), β-nicotinamide mononucleotide (NMN), nicotinic acid adenine dinucleotide (NAAD), nicotinic acid (NA) and nicotinamide (NAM) in RBC and to determine a relationship between NAD metabolites and CKD progression. Forty-eight CKD children and 33 age-matched controls were examined. Patients were divided into groups depending on the CKD stages (Group II-stage II, Group III- stage III, Group IV- stage IV and Group RRT children on dialysis). To determine the above-mentioned metabolites concentrations in RBC liquid chromatography-mass spectrometry was used. Results: the only difference between the groups was shown concerning NAD in RBC, although the values did not differ significantly from controls. The lowest NAD values were found in Group II (188.6 ± 124.49 nmol/mL, the highest in group IV (324.94 ± 63.06 nmol/mL. Between Groups II and IV, as well as III and IV, the differences were statistically significant (p < 0.032, p < 0.046 respectively). Conclusions. CKD children do not have evident abnormalities of RBC metabolism with respect to adenine nucleotide metabolites. The significant differences in erythrocyte NAD concentrations between CKD stages may suggest the activation of adaptive defense mechanisms aimed at erythrocyte metabolic stabilization. It seems that the implementation of RRT has a positive impact on RBC NAD metabolism, but further research performed on a larger population is needed to confirm it. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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15 pages, 1902 KiB

Open AccessArticle

Evaluation of Vascular Endothelial Function in Children with Type 1 Diabetes Mellitus

by Karolina Nocuń-Wasilewska, Danuta Zwolińska, Agnieszka Zubkiewicz-Kucharska and Dorota Polak-Jonkisz

J. Clin. Med. 2021, 10(21), 5065; https://doi.org/10.3390/jcm10215065 - 29 Oct 2021

Cited by 4 | Viewed by 1768

Abstract

Diabetic kidney disease belongs to the major complications of diabetes mellitus. Here, hyperglycaemia is a key metabolic factor that causes endothelial dysfunction and vascular changes within the renal glomerulus. The aim of the present study was to assess the function of the vascular [...] Read more.

Diabetic kidney disease belongs to the major complications of diabetes mellitus. Here, hyperglycaemia is a key metabolic factor that causes endothelial dysfunction and vascular changes within the renal glomerulus. The aim of the present study was to assess the function of the vascular endothelium in children with type 1 diabetes mellitus (type 1 diabetes) by measuring selected endothelial lesion markers in blood serum. The selected markers of endothelial lesions (sVCAM-1, sICAM-1, sE-SELECTIN, PAI-1, ADMA and RAGE) were assayed by the immunoenzymatic ELISA method. The study involved 66 patients (age: 5–18 years) with type 1 diabetes and 21 healthy controls (age: 5–16 years). In the type 1 diabetes patients, significantly higher concentrations of all of the assayed markers were observed compared to the healthy controls (p < 0.001). All of the evaluated markers positively correlated with the disease duration, the age, and BMI of the patients, while only PAI-1 and sE-SELECTIN were characteristic of linear correlations with the estimated glomerular filtration rate (eGFR). It can be concluded that endothelial inflammatory disease occurs in the early stages of type 1 diabetes mellitus in children. The correlations between PAI-1, sE-SELECTIN, and eGFR suggest an advantage of these markers over other markers of endothelial dysfunction as prognostic factors for kidney dysfunction in children with type 1 diabetes. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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15 pages, 661 KiB

Open AccessArticle

The Usefulness of Urinary Periostin, Cytokeratin-18, and Endoglin for Diagnosing Renal Fibrosis in Children with Congenital Obstructive Nephropathy

by Agnieszka Turczyn, Małgorzata Pańczyk-Tomaszewska, Grażyna Krzemień, Elżbieta Górska and Urszula Demkow

J. Clin. Med. 2021, 10(21), 4899; https://doi.org/10.3390/jcm10214899 - 24 Oct 2021

Cited by 5 | Viewed by 2104

Abstract

Congenital obstructive nephropathy (CON) leads to renal fibrosis and chronic kidney disease. The aim of the study was to investigate the predictive value of urinary endoglin, periostin, cytokeratin-18, and transforming growth factor-β1 (TGF-β1) for assessing the severity of renal fibrosis in 81 children [...] Read more.

Congenital obstructive nephropathy (CON) leads to renal fibrosis and chronic kidney disease. The aim of the study was to investigate the predictive value of urinary endoglin, periostin, cytokeratin-18, and transforming growth factor-β1 (TGF-β1) for assessing the severity of renal fibrosis in 81 children with CON and 60 controls. Children were divided into three subgroups: severe, moderate scars, and borderline lesions based on 99mTc-ethylenedicysteine scintigraphy results. Periostin, periostin/Cr, and cytokeratin-18 levels were significantly higher in the study group compared to the controls. Children with severe scars had significantly higher urinary periostin/Cr levels than those with borderline lesions. In multivariate analysis, only periostin and cytokeratin-18 were independently related to the presence of severe and moderate scars, and periostin was independently related to borderline lesions. However, periostin did not differentiate advanced scars from borderline lesions. In ROC analysis, periostin and periostin/Cr demonstrated better diagnostic profiles for detection of advanced scars than TGF-β1 and cytokeratin-18 (AUC 0.849; 0.810 vs. 0.630; 0.611, respectively) and periostin for detecting borderline lesions than endoglin and periostin/Cr (AUC 0.777 vs. 0.661; 0.658, respectively). In conclusion, periostin seems to be a promising, non-invasive marker for assessing renal fibrosis in children with CON. CK-18 and TGF-β1 demonstrated low utility, and endoglin was not useful for diagnosing advanced scars. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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9 pages, 226 KiB

Open AccessArticle

Bone Morphogenetic Proteins (BMPs), Extracellular Matrix Metalloproteinases Inducer (EMMPRIN), and Macrophage Migration Inhibitory Factor (MIF): Usefulness in the Assessment of Tubular Dysfunction Related to Chronic Kidney Disease (CKD)

by Kinga Musiał and Danuta Zwolińska

J. Clin. Med. 2021, 10(21), 4893; https://doi.org/10.3390/jcm10214893 - 23 Oct 2021

Cited by 3 | Viewed by 1833

Abstract

Bone morphogenetic proteins (BMP), extracellular matrix metalloproteinases inducer (EMMPRIN), and macrophage migration inhibitory factor (MIF) are known to be closely connected to renal tubule damage by experimental data; however, this has not been analyzed in children with chronic kidney disease (CKD). The aim [...] Read more.

Bone morphogenetic proteins (BMP), extracellular matrix metalloproteinases inducer (EMMPRIN), and macrophage migration inhibitory factor (MIF) are known to be closely connected to renal tubule damage by experimental data; however, this has not been analyzed in children with chronic kidney disease (CKD). The aim of this study was to determine their usefulness in the assessment of CKD-related tubular dysfunction. The study group consisted of 61 children with CKD stages 1–5 and 23 controls. The serum and urine concentrations of BMP-2, BMP-6, EMMPRIN, and MIF were assessed by ELISA and their fractional excretion (FE) was calculated. The serum and urine concentrations of BMP-2, BMP-6, EMMPRIN, and MIF were significantly elevated in children with CKD vs. controls. The FE of BMP-2, FE BMP-6, and EMMPRIN increased significantly in CKD stages 1–2, but exceeded 1% in CKD stages 3–5. FE MIF became higher than in controls no sooner than in CKD 3–5, but remained below 1%. The FE values for BMP-2, BMP-6, and EMMPRIN of <1% may result from the tubular adaptive mechanisms, whereas those surpassing 1% suggest irreversible tubular damage. The analysis of serum/urinary concentrations and fractional excretion of examined parameters may allow the assessment of CKD-related tubular dysfunction. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

13 pages, 710 KiB

Open AccessArticle

NT-proBNP as a Potential Marker of Cardiovascular Damage in Children with Chronic Kidney Disease

by Piotr Skrzypczyk, Magdalena Okarska-Napierała, Radosław Pietrzak, Katarzyna Pawlik, Katarzyna Waścińska, Bożena Werner and Małgorzata Pańczyk-Tomaszewska

J. Clin. Med. 2021, 10(19), 4344; https://doi.org/10.3390/jcm10194344 - 24 Sep 2021

Cited by 4 | Viewed by 2042

Abstract

Assessing cardiovascular disease (CVD) in children with chronic kidney disease (CKD) is difficult. Great expectations have been associated with biomarkers, including the N-terminal pro-brain natriuretic peptide (NT-proBNP). This study aimed to determine the correlation between NT-proBNP and cardiovascular complications in children with CKD. [...] Read more.

Assessing cardiovascular disease (CVD) in children with chronic kidney disease (CKD) is difficult. Great expectations have been associated with biomarkers, including the N-terminal pro-brain natriuretic peptide (NT-proBNP). This study aimed to determine the correlation between NT-proBNP and cardiovascular complications in children with CKD. Serum NT-proBNP, arterial stiffness, common carotid artery intima-media thickness (cIMT), echocardiographic (ECHO) parameters (including tissue Doppler imaging), and biochemical and clinical data were analyzed in 38 pediatric patients with CKD (21 boys, 12.2 ± 4.2 years). Mean NT-proBNP in CKD patients was 1068.1 ± 4630 pg/mL. NT-proBNP above the norm (125 pg/mL) was found in 16 (42.1%) subjects. NT-proBNP correlated with glomerular filtration rate (GFR) (r = −0.423, p = 0.008), and was significantly higher in CKD G5 (glomerular filtration rate grade) patients compared to CKD G2, G3, and G4 children (p = 0.010, p = 0.004, and p = 0.018, respectively). Moreover, NT-proBNP correlated positively with augmentation index (AP/PP: r = 0.451, p = 0.018, P2/P: r = 0.460, p = 0.016), cIMT (r = 0.504, p = 0.020), and E/E’ in ECHO (r = 0.400, p = 0.032). In multivariate analysis, logNT-proBNP was the only significant predictor of cIMT Z-score (beta = 0.402, 95CI (0.082–0.721), p = 0.014) and P2/P1 (beta = 0.130, 95CI (0.082–0.721), p = 0.014). Conclusions: NT-proBNP may serve as a possible marker of thickening of the carotid artery wall in pediatric patients with CKD. The final role of NT-proBNP as a biomarker of arterial damage, left ventricular hypertrophy, or cardiac diastolic dysfunction in CKD children needs confirmation in prospective studies. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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9 pages, 231 KiB

Open AccessArticle

Urinary Levels of Cathepsin B in Preterm Newborns

by Monika Kamianowska, Marek Szczepański, Anna Krukowska, Aleksandra Kamianowska and Anna Wasilewska

J. Clin. Med. 2021, 10(18), 4254; https://doi.org/10.3390/jcm10184254 - 19 Sep 2021

Cited by 1 | Viewed by 1487

Abstract

Increased investment in perinatal health in developing countries has improved the survival of preterm newborns, but their significant multiorgan immaturity is associated with short and long-term adverse consequences. Cathepsin B, as a protease with angiogenic properties, may be related to the process of [...] Read more.

Increased investment in perinatal health in developing countries has improved the survival of preterm newborns, but their significant multiorgan immaturity is associated with short and long-term adverse consequences. Cathepsin B, as a protease with angiogenic properties, may be related to the process of nephrogenesis. A total of 88 neonates (60 premature children, 28 healthy term children) were included in this prospective study. We collected urine samples on the first or second day of life. In order to determine the concentration of cathepsin B in the urine, the commercially available enzyme immunoassay was used. The urinary concentrations of cathepsin B normalized with the urinary concentrations of creatinine (cathepsin B/Cr.) in newborns born at 30–34, 35–36, and 37–41 (the control group) weeks of pregnancy were (median, Q1–Q3) 4.00 (2.82–5.12), 3.07 (1.95–3.90), and 2.51 (2.00–3.48) ng/mg Cr, respectively. Statistically significant differences were found between the group of newborns born at 30–34 weeks of pregnancy and the control group (p < 0.01), and between early and late preterm babies (PTB) (p < 0.05). The group of children born at 35–36 weeks of pregnancy and the control group did not differ significantly. This result suggests that the elevated urinary cathepsin B/Cr. level may be the result of the kidneys’ immaturity in preterm newborns. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

10 pages, 256 KiB

Open AccessArticle

Alpha-1 Acid Glycoprotein and Podocin mRNA as Novel Biomarkers for Early Glomerular Injury in Obese Children

by Anna Medyńska, Joanna Chrzanowska, Katarzyna Kościelska-Kasprzak, Dorota Bartoszek, Marcelina Żabińska and Danuta Zwolińska

J. Clin. Med. 2021, 10(18), 4129; https://doi.org/10.3390/jcm10184129 - 13 Sep 2021

Cited by 9 | Viewed by 2022

Abstract

Introduction: Obesity, which is a serious problem in children, has a negative impact on many organs, including kidneys, and obesity-related glomerulopathy (ORG) is an increasingly common cause of ESKD (end-stage kidney disease) in adults. Early-detected and -treated glomerular lesions are reversible, so it [...] Read more.

Introduction: Obesity, which is a serious problem in children, has a negative impact on many organs, including kidneys, and obesity-related glomerulopathy (ORG) is an increasingly common cause of ESKD (end-stage kidney disease) in adults. Early-detected and -treated glomerular lesions are reversible, so it is important to find a useful marker of early damage. The study aimed to evaluate the albumin-to-creatinine ratio (ACR), urinary alpha-1-acid glycoprotein (α1-AGP), and mRNA of podocyte-specific proteins as indicators of glomerular injury and their relationship with the degree of obesity and metabolic disorders. Materials and Methods: A total of 125 obese children and 33 healthy peers were enrolled. Patients were divided into two groups, depending on SDS BMI values. ACR, α1-AGP, mRNA expression of nephrin, synaptopodin, podocin, and C2AP protein in urine sediment were measured. Results: ACR values did not differ between groups and were within the normal range. α1-AGP and mRNA expression were significantly higher in obese children compared with controls. mRNA expression of the remaining podocyte proteins was similar in both groups. No significant differences concerning all examined parameters were found depending on the degree of obesity. There was a positive significant correlation between α1-AGP and ACR. Conclusions: Increased α1-AGP before the onset of albuminuria suggests its usefulness as a biomarker of early glomerular damage in obese children. An increased podocin mRNA expression also indicates podocyte damage and may be linked to ORG development. The lack of increase in expression of other podocyte proteins suggests that podocin mRNA may be a more specific and sensitive biomarker. The degree of obesity has no impact on the tested parameters, but further studies are needed to confirm it. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

14 pages, 288 KiB

Open AccessArticle

Differences between Obese and Non-Obese Children and Adolescents Regarding Their Oral Status and Blood Markers of Kidney Diseases

by Katarzyna Maćkowiak-Lewandowicz, Danuta Ostalska-Nowicka, Jacek Zachwieja and Elżbieta Paszyńska

J. Clin. Med. 2021, 10(16), 3723; https://doi.org/10.3390/jcm10163723 - 21 Aug 2021

Cited by 3 | Viewed by 2249

Abstract

(1) Background: A rarely discussed effect of obesity-related glomerulopathy (ORG) may slowly lead to irreversible glomerular damage and the development of chronic kidney disease. These patients need to undertake medical care, but whether they should be included in intensive oral care is still [...] Read more.

(1) Background: A rarely discussed effect of obesity-related glomerulopathy (ORG) may slowly lead to irreversible glomerular damage and the development of chronic kidney disease. These patients need to undertake medical care, but whether they should be included in intensive oral care is still not mandatory. The study aimed to assess a relationship between renal, metabolic, and oral health indicators among pediatric patients affected by simple obesity. (2) Methods: 45 children and adolescents with simple obesity hospitalized (BMI 34.1 ± 4.8 kg/m², age 15.4 ± 2.3) and compared with 41 aged-matched healthy controls (BMI 16.4 ± 2.4 kg/m², age 15.4 ± 2.7). Echocardiography, 24-h ambulatory blood pressure monitoring, ultrasound exam with Doppler, and laboratory tests including kidney and metabolic markers were performed. Oral status was examined regarding the occurrence of carious lesions using decay missing filling teeth (DMFT), gingivitis as bleeding on probing (BOP), and bacterial colonization as plaque control record (PCR). (3) Results: The strongest correlation was revealed between BMI and concentration of uric acid, cystatin C, GFR estimated by the Filler formula (r = 0.74; r = 0.48; r = −0.52), and between oral variables such as PCR and BOP (r = 0.54; r = 0.58). Children and adolescents with obesity demonstrated untreated dental caries, less efficient in plaque control and gingivitis. (4) Conclusions: No specific relation to markers of kidney disease were found; however, more frequent gingivitis/bacterial colonization and significant differences in oral status between obese and non-obese patients were revealed. Susceptibility to inflammation may be conducive to developing metabolic syndrome and kidney damage in the form of obesity-related glomerulopathy and contribute to future dental caries. Uric acid seems to indicate metabolic syndrome and cardiovascular complications (LVMI > 95 percentiles). Cystatin C and uric acid might aspire to be early markers of kidney damage leading to obesity-related glomerulopathy. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

14 pages, 1145 KiB

Open AccessArticle

Serum Sclerostin Is Associated with Peripheral and Central Systolic Blood Pressure in Pediatric Patients with Primary Hypertension

by Piotr Skrzypczyk, Anna Ofiara, Michał Szyszka, Anna Stelmaszczyk-Emmel, Elżbieta Górska and Małgorzata Pańczyk-Tomaszewska

J. Clin. Med. 2021, 10(16), 3574; https://doi.org/10.3390/jcm10163574 - 13 Aug 2021

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Abstract

Recent studies showed the significance of the canonical Wnt/beta-catenin pathway and its inhibitor—sclerostin, in the formation of arterial damage, cardiovascular morbidity, and mortality. The study aimed to assess serum sclerostin concentration and its relationship with blood pressure, arterial damage, and calcium-phosphate metabolism in [...] Read more.

Recent studies showed the significance of the canonical Wnt/beta-catenin pathway and its inhibitor—sclerostin, in the formation of arterial damage, cardiovascular morbidity, and mortality. The study aimed to assess serum sclerostin concentration and its relationship with blood pressure, arterial damage, and calcium-phosphate metabolism in children and adolescents with primary hypertension (PH). Serum sclerostin concentration (pmol/L) was evaluated in 60 pediatric patients with PH and 20 healthy children. In the study group, we also assessed calcium-phosphate metabolism, office peripheral and central blood pressure, 24 h ambulatory blood pressure, and parameters of arterial damage. Serum sclerostin did not differ significantly between patients with PH and the control group (36.6 ± 10.6 vs. 41.0 ± 11.9 (pmol/L), p = 0.119). In the whole study group, sclerostin concentration correlated positively with height Z-score, phosphate, and alkaline phosphatase, and negatively with age, peripheral systolic and mean blood pressure, and central systolic and mean blood pressure. In multivariate analysis, systolic blood pressure (SBP) and height expressed as Z-scores were the significant determinants of serum sclerostin in the studied children: height Z-score (β = 0.224, (95%CI, 0.017–0.430)), SBP Z-score (β = −0.216, (95%CI, −0.417 to −0.016)). In conclusion, our results suggest a significant association between sclerostin and blood pressure in the pediatric population. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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13 pages, 777 KiB

Open AccessArticle

Hyperuricemia Is an Early and Relatively Common Feature in Children with HNF1B Nephropathy but Its Utility as a Predictor of the Disease Is Limited

by Marcin Kołbuc, Beata Bieniaś, Sandra Habbig, Mateusz F. Kołek, Maria Szczepańska, Katarzyna Kiliś-Pstrusińska, Anna Wasilewska, Piotr Adamczyk, Rafał Motyka, Marcin Tkaczyk, Przemysław Sikora, Bodo B. Beck and Marcin Zaniew

J. Clin. Med. 2021, 10(15), 3265; https://doi.org/10.3390/jcm10153265 - 24 Jul 2021

Cited by 7 | Viewed by 3333

Abstract

Background: Hyperuricemia is recognized as an important feature of nephropathy, associated with a mutation in the hepatocyte nuclear factor-1B (HNF1B) gene, and could serve as a useful marker of the disease. However, neither a causal relationship nor its predictive value have been proven. [...] Read more.

Background: Hyperuricemia is recognized as an important feature of nephropathy, associated with a mutation in the hepatocyte nuclear factor-1B (HNF1B) gene, and could serve as a useful marker of the disease. However, neither a causal relationship nor its predictive value have been proven. The purpose of this study was to assess this in children with renal malformations, both with (mut+) and without HNF1B mutations (mut-). Methods: We performed a retrospective analysis of clinical characteristics of pediatric patients tested for HNF1B mutations, collected in a national registry. Results: 108 children were included in the study, comprising 43 mut+ patients and 65 mut- subjects. Mean sUA was higher and hyperuricemia more prevalent (42.5% vs. 15.4%) in HNF1B carriers. The two groups were similar with respect to respect to age, sex, anthropometric parameters, hypertension, and renal function. Renal function, fractional excretion of uric acid and parathyroid hormone level were independent predictors of sUA. The potential of hyperuricemia to predict mutation was low, and addition of hyperuricemia to a multivariate logistic regression model did not increase its accuracy. Conclusions: Hyperuricemia is an early and common feature of HNF1B nephropathy. A strong association of sUA with renal function and parathyroid hormone limits its utility as a reliable marker to predict HNF1B mutation among patients with kidney anomalies. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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11 pages, 453 KiB

Open AccessArticle

Involvement of Hemopexin in the Pathogenesis of Proteinuria in Children with Idiopathic Nephrotic Syndrome

by Agnieszka Pukajło-Marczyk and Danuta Zwolińska

J. Clin. Med. 2021, 10(14), 3160; https://doi.org/10.3390/jcm10143160 - 17 Jul 2021

Cited by 11 | Viewed by 2349

Abstract

Hemopexin (Hpx) is considered a factor in the pathogenesis of idiopathic nephrotic syndrome (INS). The aim of the study was to evaluate the serum and urine values of Hpx (sHpx and uHpx) in children with INS, analyze the role of Hpx, and assess [...] Read more.

Hemopexin (Hpx) is considered a factor in the pathogenesis of idiopathic nephrotic syndrome (INS). The aim of the study was to evaluate the serum and urine values of Hpx (sHpx and uHpx) in children with INS, analyze the role of Hpx, and assess its usefulness as a marker of the disease course. 51 children with INS and 18 age-matched controls were examined. Patients were divided into subgroups depending on the number of relapses (group IA—the first episode of INS, group IB—with relapses) and according to method of treatment (group IIA treated with gluco-corticosteroids (GCS), group IIB treated with GCS and other immunosuppressants). Hpx concentrations were determined by enzyme-linked immunosorbent assay (ELISA). sHpx and uHpx values in relapse were elevated in the whole INS group versus controls (p < 0.000). In remission their levels decreased, but still remained higher than in the control group (p < 0.000). In group IB uHpx levels were increased during remission as compared to group IA (p < 0.006). No significant impact of immuno-suppressants on sHpx was observed, but uHpx excretion in group IIA was higher in relapse (p < 0.026) and lower in remission (p < 0.0017) as compared to group IIB. The results suggest the role of Hpx in the pathogenesis of INS. Hpx may be a useful indicator for continuation of treatment, but it requires confirmation by further controlled studies. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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12 pages, 950 KiB

Open AccessArticle

An Examination of the Relationship between Urinary Neurotrophin Concentrations and Transcutaneous Electrical Nerve Stimulation (TENS) Used in Pediatric Overactive Bladder Therapy

by Joanna Bagińska, Edyta Sadowska and Agata Korzeniecka-Kozerska

J. Clin. Med. 2021, 10(14), 3156; https://doi.org/10.3390/jcm10143156 - 17 Jul 2021

Cited by 2 | Viewed by 2284

Abstract

This article aims to explore changes in urinary concentrations of selected neurotrophins in the course of TENS therapy in children with overactive bladder (OAB). A two-group open-label prospective study was conducted. The intervention group comprised 30 children aged between 5 and 12 years [...] Read more.

This article aims to explore changes in urinary concentrations of selected neurotrophins in the course of TENS therapy in children with overactive bladder (OAB). A two-group open-label prospective study was conducted. The intervention group comprised 30 children aged between 5 and 12 years old with OAB refractory to conservative therapy. They received 12 weeks of TENS therapy in a home setting. The urinary neurotrophins, NGF, BDNF, NT3, NT4, were measured by ELISA at baseline and at the end of the TENS therapy. Total urinary neurotrophins levels were standardized to mg of creatinine (Cr). We compared the results with the reference group of 30 participants with no symptoms of bladder overactivity. The results revealed that children with OAB both before and after TENS therapy had higher NGF, BDNF, and NT4 concentrations in total and after normalization to Cr than the reference group in contrast to NT3. The response to the therapy expressed as a decrease of urinary neurotrophins after TENS depended on the age and the presenting symptoms. In conclusion, children older than 8 years of age with complaints of daytime incontinence responded better to TENS. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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8 pages, 619 KiB

Open AccessArticle

Are Tubular Injury Markers NGAL and KIM-1 Useful in Pediatric Neurogenic Bladder?

by Joanna Bagińska and Agata Korzeniecka-Kozerska

J. Clin. Med. 2021, 10(11), 2353; https://doi.org/10.3390/jcm10112353 - 27 May 2021

Cited by 6 | Viewed by 1756

Abstract

The lack of early biomarkers of renal damage in children with neurogenic bladder (NB) prompts us to investigate the role of promising proteins: neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1). This prospective analysis was conducted on 58 children with NB and [...] Read more.

The lack of early biomarkers of renal damage in children with neurogenic bladder (NB) prompts us to investigate the role of promising proteins: neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1). This prospective analysis was conducted on 58 children with NB and 25 healthy children. We assessed urinary levels of NGAL and KIM-1 in both groups. Age, sex, anthropometric measurements, activity assessment, renal function, and urodynamics parameters were analyzed. The differences between the median uNGAL and uKIM-1 in the NB group compared to control were recorded. However, only uNGAL levels were statistically significantly higher. Statistically significant correlation was found between gender, recurrent urinary tract infections, bladder trabeculation, its compliance, activity assessment, and uNGAL. To conclude, elevated levels of uNGAL may be considered a biomarker of tubular injury in children with NB due to MMC in contrast to uKIM-1. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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14 pages, 632 KiB

Open AccessArticle

Serum Periostin as a Potential Biomarker in Pediatric Patients with Primary Hypertension

by Michał Szyszka, Piotr Skrzypczyk, Anna Stelmaszczyk-Emmel and Małgorzata Pańczyk-Tomaszewska

J. Clin. Med. 2021, 10(10), 2138; https://doi.org/10.3390/jcm10102138 - 15 May 2021

Cited by 2 | Viewed by 2204

Abstract

Experimental studies suggest that periostin is involved in tissue repair and remodeling. The study aimed to evaluate serum periostin concentration as potential biomarker in pediatric patients with primary hypertension (PH). We measured serum periostin, blood pressure, arterial damage, biochemical, and clinical data in [...] Read more.

Experimental studies suggest that periostin is involved in tissue repair and remodeling. The study aimed to evaluate serum periostin concentration as potential biomarker in pediatric patients with primary hypertension (PH). We measured serum periostin, blood pressure, arterial damage, biochemical, and clinical data in 50 children with PH and 20 age-matched healthy controls. In univariate analysis, children with PH had significantly lower serum periostin compared to healthy peers (35.42 ± 10.43 vs. 42.16 ± 12.82 [ng/mL], p = 0.038). In the entire group of 70 children serum periostin concentration correlated negatively with peripheral, central, and ambulatory blood pressure, as well as with aortic pulse wave velocity (aPWV). In multivariate analysis, periostin level significantly correlated with age (β = −0.614, [95% confidence interval (CI), −0.831–−0.398]), uric acid (β = 0.328, [95%CI, 0.124–0.533]), body mass index (BMI) Z-score (β = −0.293, [95%CI, −0.492–−0.095]), high-density lipoprotein (HDL)-cholesterol (β = 0.235, [95%CI, 0.054–0.416]), and triglycerides (β = −0.198, [95%CI, −0.394–−0.002]). Neither the presence of hypertension nor blood pressure and aPWV influenced periostin level. To conclude, the role of serum periostin as a biomarker of elevated blood pressure and arterial damage in pediatric patients with primary hypertension is yet to be unmasked. Age, body mass index, uric acid, and lipid concentrations are key factors influencing periostin level in pediatric patients. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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11 pages, 2111 KiB

Open AccessArticle

Galectin-3—A New Player of Kidney Damage or an Innocent Bystander in Children with a Single Kidney?

by Eryk Latoch, Katarzyna Konończuk, Anna Jander, Elżbieta Trembecka-Dubel, Anna Wasilewska and Katarzyna Taranta-Janusz

J. Clin. Med. 2021, 10(9), 2012; https://doi.org/10.3390/jcm10092012 - 8 May 2021

Cited by 1 | Viewed by 1743

Abstract

The aim of this study was to evaluate the galectin-3 (Gal-3) level in children with a congenital solitary functioning kidney (cSFK) and determine its association with common renal function parameters. The study consisted of 68 children (49 males) with cSFK. We demonstrated that [...] Read more.

The aim of this study was to evaluate the galectin-3 (Gal-3) level in children with a congenital solitary functioning kidney (cSFK) and determine its association with common renal function parameters. The study consisted of 68 children (49 males) with cSFK. We demonstrated that children with cSFK had a lower level of galectin-3 than that of healthy subjects (p < 0.001). No significant differences in serum cystatin C (Cys C) levels between the cSFK children and the reference group were found. The subjects with cSFK and reduced estimated glomerular filtration rate (eGFR) had significantly higher levels of Gal-3 and Cys C compared to those with normal eGFR (p < 0.05). Children with eGFR <60 mL/min/1.73 m² showed significant statistical differences between the values of area under ROC curve (AUC) for Gal-3 (AUC 0.91) and Cys C (AUC 0.96) compared to that for creatinine level (AUC 0.76). Similar analyses carried out among cSFK children with eGFR <90 mL/min/1.73 m² revealed an AUC value of 0.69 for Gal-3, 0.74 for Cys C, and 0.64 for creatinine; however, no significant superiority was shown for any of them. The receiver operating characteristic (ROC) analyses for identifying the SFK children among all participants based on the serum levels of Gal-3 and Cys C did not show any diagnostic profile (AUCs for Gal-3 and Cys C were 0.22 and 0.59, respectively). A positive correlation between the Gal-3 and Cys C concentrations was found (r = 0.39, p = 0.001). We demonstrated for the first time that Gal-3 might play an important role in the subtle kidney damage in children with cSFK. However, further prospective studies are required to confirm the potential applicability of Gal-3 as an early biomarker for kidney injury and possible progression to CKD. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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7 pages, 224 KiB

Open AccessArticle

Is Urinary Netrin-1 a Good Marker of Tubular Damage in Preterm Newborns?

by Monika Kamianowska, Marek Szczepański, Natalia Chomontowska, Justyna Trochim and Anna Wasilewska

J. Clin. Med. 2021, 10(4), 847; https://doi.org/10.3390/jcm10040847 - 19 Feb 2021

Viewed by 1699

Abstract

There is a lack of a good marker for early kidney injury in premature newborns. In recent publications, netrin-1 seems to be a promising biomarker of kidney damage in different pathological states. The study aimed to measure the urinary level of netrin-1 depending [...] Read more.

There is a lack of a good marker for early kidney injury in premature newborns. In recent publications, netrin-1 seems to be a promising biomarker of kidney damage in different pathological states. The study aimed to measure the urinary level of netrin-1 depending on gestational age. A prospective study involved 88 newborns (I-60 premature newborns, II-28 healthy term newborns). Additionally, premature babies were divided for 2 groups: IA-28 babies born between 30–34 weeks of gestation and IB-32 born at 35–36 weeks. The median urinary concentration of netrin-1 was: IA-(median, Q1–Q3) 63.65 (56.57–79.92) pg/dL, IB-61.90 (58.84–67.17) pg/dL, and II-60.37 (53.77–68.75) pg/dL, respectively. However urinary netrin-1 normalized by urinary concentration of creatinine were IA-547.9 (360.2–687.5) ng/mg cr., IB-163.64 (119.15–295.96) ng/mg cr., and II-81.37 (56.84–138.58) ng/mg cr., respectively and differ significantly between the examined groups (p = 0.00). The netrin-1/creatinine ratio is increased in premature babies. Further studies examining the potential factors influencing kidney function are necessary to confirm its potential value in the diagnosis of subclinical kidney damage in premature newborns. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

14 pages, 1962 KiB

Open AccessArticle

Tumor Necrosis Factor-Like Weak Inducer of Apoptosis and Selected Cytokines—Potential Biomarkers in Children with Solitary Functioning Kidney

by Hanna Nosek, Dorota Jankowska, Karolina Brzozowska, Katarzyna Kazberuk, Anna Wasilewska and Katarzyna Taranta-Janusz

J. Clin. Med. 2021, 10(3), 497; https://doi.org/10.3390/jcm10030497 - 1 Feb 2021

Cited by 2 | Viewed by 2200

Abstract

This study was performed to explore serum tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and its dependent cytokines urinary excretion: monocyte chemoattractant protein-1 (MCP-1) and regulated on activation, normal T cell expressed and secreted chemokine (RANTES) with their relation to the [...] Read more.

This study was performed to explore serum tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and its dependent cytokines urinary excretion: monocyte chemoattractant protein-1 (MCP-1) and regulated on activation, normal T cell expressed and secreted chemokine (RANTES) with their relation to the kidney function parameters in children with solitary functioning kidney (SFK). The study included 80 children and adolescents (median age 9.75 year) with congenital and acquired (after surgical removal) SFK. Serum TWEAK and urinary MCP-1 and RANTES levels were significantly higher in SFK patients (p < 0.05). The serum TWEAK was positively related to serum creatinine (r = 0.356; p < 0.001). Moreover, in SFK the receiver operating characteristic analyses revealed good diagnostic profile for serum TWEAK with AUC (Area Under The Curve)—0.853, uRANTES—0.757, and for RANTES/cr.: AUC—0.816. Analysis carried out to identify children with impaired renal function (albuminuria and/or decreased estimated glomerular filtration rate < 90 mL/min/1.73 m² and/or hypertension) showed good profile for TWEAK (AUC—0.79) and quite good profile for uRANTES and RANTES/cr. (AUC 0.66 and 0.631, respectively). This is the first study investigating serum TWEAK and urinary excretion of MCP-1 and RANTES together in children with SFK. Obtained results indicate that TWEAK and RANTES may serve as potential markers of renal impairment. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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Review

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8 pages, 555 KiB

Open AccessReview

The Use of Artificial Intelligence Algorithms in the Diagnosis of Urinary Tract Infections—A Literature Review

by Natalia Goździkiewicz, Danuta Zwolińska and Dorota Polak-Jonkisz

J. Clin. Med. 2022, 11(10), 2734; https://doi.org/10.3390/jcm11102734 - 12 May 2022

Cited by 14 | Viewed by 2752

Abstract

Urinary tract infections (UTIs) are among the most common infections occurring across all age groups. UTIs are a well-known cause of acute morbidity and chronic medical conditions. The current diagnostic methods of UTIs remain sub-optimal. The development of better diagnostic tools for UTIs [...] Read more.

Urinary tract infections (UTIs) are among the most common infections occurring across all age groups. UTIs are a well-known cause of acute morbidity and chronic medical conditions. The current diagnostic methods of UTIs remain sub-optimal. The development of better diagnostic tools for UTIs is essential for improving treatment and reducing morbidity. Artificial intelligence (AI) is defined as the science of computers where they have the ability to perform tasks commonly associated with intelligent beings. The objective of this study was to analyze current views regarding attempts to apply artificial intelligence techniques in everyday practice, as well as find promising methods to diagnose urinary tract infections in the most efficient ways. We included six research works comparing various AI models to predict UTI. The literature examined here confirms the relevance of AI models in UTI diagnosis, while it has not yet been established which model is preferable for infection prediction in adult patients. AI models achieve a high performance in retrospective studies, but further studies are required. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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11 pages, 372 KiB

Open AccessReview

Current Concepts of Pediatric Acute Kidney Injury—Are We Ready to Translate Them into Everyday Practice?

by Kinga Musiał

J. Clin. Med. 2021, 10(14), 3113; https://doi.org/10.3390/jcm10143113 - 15 Jul 2021

Cited by 8 | Viewed by 4181

Abstract

Pediatric acute kidney injury (AKI) is a major cause of morbidity and mortality in children undergoing interventional procedures. The review summarizes current classifications of AKI and acute kidney disease (AKD), as well as systematizes the knowledge on pathophysiology of kidney injury, with a [...] Read more.

Pediatric acute kidney injury (AKI) is a major cause of morbidity and mortality in children undergoing interventional procedures. The review summarizes current classifications of AKI and acute kidney disease (AKD), as well as systematizes the knowledge on pathophysiology of kidney injury, with a special focus on renal functional reserve and tubuloglomerular feedback. The aim of this review is also to show the state-of-the-art in methods assessing risk and prognosis by discussing the potential role of risk stratification strategies, taking into account both glomerular function and clinical settings conditioned by fluid overload, urine output, or drug nephrotoxicity. The last task is to suggest careful assessment of eGFR as a surrogate marker of renal functional reserve and implementation of point-of-care testing, available in the case of biomarkers like NGAL and [IGFBP-7] × [TIMP-2] product, into everyday practice in patients at risk of AKI due to planned invasive procedures or treatment. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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10 pages, 282 KiB

Open AccessReview

Bacterial Colonization as a Possible Source of Overactive Bladder Symptoms in Pediatric Patients: A Literature Review

by Katarzyna Kilis-Pstrusinska, Artur Rogowski and Przemysław Bienkowski

J. Clin. Med. 2021, 10(8), 1645; https://doi.org/10.3390/jcm10081645 - 13 Apr 2021

Cited by 4 | Viewed by 2066

Abstract

Overactive Bladder (OAB) is a common condition that is known to have a significant impact on daily activities and quality of life. The pathophysiology of OAB is not completely understood. One of the new hypothetical causative factors of OAB is dysbiosis of an [...] Read more.

Overactive Bladder (OAB) is a common condition that is known to have a significant impact on daily activities and quality of life. The pathophysiology of OAB is not completely understood. One of the new hypothetical causative factors of OAB is dysbiosis of an individual urinary microbiome. The major aim of the present review was to identify data supporting the role of bacterial colonization in overactive bladder symptoms in children and adolescents. The second aim of our study was to identify the major gaps in current knowledge and possible areas for future clinical research. There is a growing body of evidence indicating some relationship between qualitative and quantitative characteristics of individual urinary microbiome and OAB symptoms in adult patients. There are no papers directly addressing this issue in children or adolescents. After a detailed analysis of papers relating urinary microbiome to OAB, the authors propose a set of future preclinical and clinical studies which could help to validate the concept in the pediatric population. Full article

(This article belongs to the Special Issue Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice)

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