ASSESSMENT OF RISK FACTORS FOR PROGRESSION OF SECONDARY GLOMERUPATHIES IN CHILDREN

2021 ◽  
pp. 91-96
Author(s):  
I. A. Kozyro ◽  
◽  
A. V. Sukalo ◽  
A. P. Mirilenko ◽  
Keyword(s):  
Risk Factors ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Predictive Accuracy ◽  
Morphological Changes ◽  
Systemic Vasculitis ◽  
Systemic Disease ◽  
Pediatric Nephrology ◽  
Kidney Damage ◽  
Rate Of Progression

The problem of glomerular kidney damage remains relevant in pediatric nephrology due to the variety of reasons for its development and tendency to progression. According to the data of the Belarusian Center for Pediatric Nephrology and Renal Replacement Therapy, glomerulopathies (GP) occupy 2nd place in the structure of the causes of end-stage chronic kidney disease (CKD). The peculiarities of the course of GP dictate the need to search for informative predictors of the risk of adverse events, which will predict and prevent renal damage with a high degree of probability. Purpose of the study: to determine the rate of progression of secondary GP in children and to establish the main risk factors for its development. Materials and methods. 118 patients who were under observation and treatment at the Belarusian Center for Pediatric Nephrology and Renal Replacement Therapy of the "2nd Children's City Clinical Hospital" in Minsk, aged 3 to 17 years, were included in the study. We used the method of continuous targeted selection of patients with morphologically verified kidney damage due to the systemic disease. The analysis of the data of 4 study groups was carried out: 1) children with SLE, lupus nephritis (LN), retrospective group, n = 30; 2) children with SLE, LN, prospective group, n = 35; 3) patients with nephritis due to IgA vasculitis Schoenlein- Henoch (IgAV), n = 33; 4) patients with nephritis due to systemic vasculitis (SV), including ANCA-associated (AAV), n = 20. The duration of the period from the onset of the disease to reaching the 3rd stage of CKD and predictors that determine the rate of progression of GP using Kaplan-Meier method was studied. Results. Anamnestic, clinical, laboratory, immunological (blood concentration of markers of T and B lymphocyte activation RANTES and BAFF), proinflammatory (caspase 1, IL1e and TNFa), vascular (VEGF) and tissue (TGF1fi) growth factors), metabolic status (adiponectin, leptin, obestatin, vitamin D 25 (OH) D), instrumental, morphological changes were analyzed. Each of the variables was considered as a likely risk factor for the progression of GP. Conclusion. A mathematical model has been developed for predicting the risk of progression of secondary GP in children, including risk factors as predictors: anamnestic factors of kidney damage, non-compliance with therapy, persistent nephrotic proteinuria, increased serum creatinine over 200 umol/l. The predictive accuracy of the model was 93,6 % (95 % CI 84,8-100 %).

scholarly journals ASSESSMENT OF RISK FACTORS AND RATE OF PROGRESSION OF PRIMARY GLOMERULOPATHIES

2021 ◽  
pp. 47-55
Author(s):  
I.A. Kozyro ◽  
◽  
A.V. Sukalo ◽  
A.P. Mirilenko ◽  
Keyword(s):  
Risk Factors ◽  
B Lymphocyte ◽  
Predictive Accuracy ◽  
Clinical Laboratory ◽  
Morphological Changes ◽  
Pediatric Nephrology ◽  
Lymphocyte Activation ◽  
Rate Of Progression ◽  
B Lymphocyte Activation ◽  
Group 2

Purpose of the study: to determine the rate of progression of primary chronic glomerulopathies (GP) in children and to establish the main risk factors for the development of this process. Materials and methods. 188 children who were under observation and treatment at the Republican Center for Pediatric Nephrology and Renal Replacement Therapy of the "2nd Children's City Clinical Hospital" in Minsk, aged 3 to 17 years, with morphologically verified kidney damage, were included in the study: group №1 - children with minimal change disease (MCD), n=53; group №2 with IgM nephropathy (IgMN), n=26; group №3 with focal segmental glomerulosclerosis (FSGS), n=55; group №4 with IgA nephropathy (IgAN), n=54.The duration of the period from the onset of the disease to reaching the 3rd stage of CKD and predictors that determine the rate of progression of GP using Kaplan-Meier method was studied. Results. Anamnestic, clinical, laboratory, immunological (blood concentration of markers of T and B lymphocyte activation RANTES and BAFF), proinflammatory (caspase 1, IL1β and TNFα), vascular (VEGF) and tissue (TGF1β) growth factors), metabolic status (adiponectin, leptin, obestatin, vitamin D 25 (OH) D), instrumental, morphological changes were analyzed. Each of the variables was considered as a likely risk factor for the progression of GP. Conclusion. A mathematical model has been developed for predicting the risk of progression of secondary GP in children, including risk factors as predictors: impaired renal function at the onset of the disease, non-compliance with therapy, and a decrease in the estimated glomerular filtration rate (eGFR) at the onset of the disease less than 87 ml/min. The predictive accuracy of the model was 90,9% (95%ДИ 79,3-100%).

Characteristics of the course of nephritis associated with Iga-vasculitis Henoch-Schoenlein in children

2020 ◽  
Vol 24 (3) ◽  
pp. 64-71
Author(s):  
A. V. Sukalo ◽  
I. A. Kazyra
Keyword(s):  
Clinical Laboratory ◽  
Morphological Changes ◽  
Pediatric Nephrology ◽  
Morphological Characteristics ◽  
Lymphocyte Activation ◽  
Renal Tissue ◽  
Kidney Damage ◽  
Iga Vasculitis ◽  
Factors Affecting ◽  
Treatment Regimens

INTRODUCTION. Among systemic vasopathies in children, IgA vasculitis Henoch Schoenlein (HS) is the most common, according to various authors, kidney damage is noted in 25-80 % and usually determines the prognosis of the disease.THE AIM of the study was to analyze clinical, laboratory, immunological, morphological characteristics, features of the course and treatment of nephritis associated with IgA vasculitis HS in children, as well as factors affecting the prognosis.PATIENTS AND METHODS. The study included 31 patients with morphologically verified nephritis due to IgA vasculitis HS (18 – boys, 13 – girls) aged 3 to 17 years, who were monitored at the Nephrology Department of the "2nd Children's City Clinical Hospital" of the National Center for Pediatric Nephrology and Renal Replacement therapy in Minsk from 2010 to 2019 yrs.The following parameters were analyzed: the clinical variant of kidney damage, laboratory tests (including the study of BAFF, RANTES lymphocyte activation molecules, pro-inflammatory IL1β, caspase1, TNFα, growth factors VEGF, TGF), 24 hours monitoring and office blood pressure measurements, ECHO cardiography with indicescalculation, ultrasound of the carotid arteries with the thickness of intima-media complex, morphological changes in the renal tissue, as well as treatment regimens.RESULTS. The contribution of deGal-IgA1, markers of T and B lymphocytes activation, pro-inflammatory and profibrotic molecules in the development of the disease is shown. Arterial hypertension was registered in 42 % of children, signs of heart remodeling according to the calculated indices in 19,3 %. Decrease level of adiponectin, vitamin D, leptin, increase concentration of obestatin, Pro-BNP, hs-CRP, and TSAT indicator classify patients with nephritis due to IgA vasculitis HS at moderate risk for the developmentof cardio-vascular disorders, which suggests the need for timely correction.CONCLUSION. In most cases, nephritis with IgA vasculitis HS has a benign course with rare relapses and progression to the end stage of chronic kidney disease (6,5 %).

Serious Infectious Events and Immunoglobulin Replacement Therapy in Patients With Autoimmune Disease Receiving Rituximab: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Sarah Stabler ◽  
Jonathan Giovannelli ◽  
David Launay ◽  
Angélique Cotteau-Leroy ◽  
Marion Heusele ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Autoimmune Disease ◽  
Replacement Therapy ◽  
Systemic Vasculitis ◽  
Immunoglobulin Replacement Therapy ◽  
History Of ◽  
Immunoglobulin Replacement ◽  
Cd4 Lymphocyte ◽  
Autoimmune Cytopenia

Abstract Background Rituximab (RTX) is widely administered to patients with autoimmune disease (AID). This study aimed to estimate the incidence of serious infectious events (SIEs) after RTX initiation in patients with AID. We also described the characteristics and risk factors of SIEs, and immunoglobulin replacement therapy (IgRT) strategies. Methods Patients treated between 2005 and 2016 were included in this retrospective monocentric cohort study. An RTX course was defined as the complete RTX treatment regimen received by a given patient for AID. SIEs and IgRT were right-censored at 24 months after RTX initiation. Results Two hundred twenty-one patients were included (corresponding to 276 RTX courses). Reasons for RTX initiation included connective tissue disease (38%), systemic vasculitis (36%), and autoimmune cytopenia (22%). The 1- and 2-year incidences of SIEs were 17.3 (95% confidence interval [CI], 12.0–22.5) and 11.3 (95% CI, 8.1–14.5) per 100 person-years, respectively. Forty-seven SIEs were observed, mostly comprising pneumonias (45%) and bacteremias (21%). When documented, the microorganisms were bacterial (55%) and fungal (12%). Identified risk factors of SIEs were age, history of diabetes, history of cancer, concomitant steroid treatment, and low CD4 lymphocyte count at RTX initiation. IgRT was started in 22 RTX courses (8%). Conclusions In patients with AID treated with RTX, the 1- and 2-year incidence of SIE was 17.3 and 11.3 per 100 person-years, respectively. Reports of SIE characteristics, risk factors, and IgRT strategies highlight the need for an appropriate and individualized assessment prior to and following RTX to prevent SIEs, particularly in patients with comorbidities.

Clinical course and mortality risk factors in critically ill children requiring continuous renal replacement therapy

2010 ◽  
Vol 36 (5) ◽  
pp. 843-849 ◽  
Author(s):  
Maria J. Santiago ◽  
Jesús López-Herce ◽  
Javier Urbano ◽  
Maria José Solana ◽  
Jimena del Castillo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Mortality Risk ◽  
Clinical Course ◽  
Critically Ill Children

scholarly journals Early identification of risk factors for refractory secondary hyperparathyroidism in patients with long-term renal replacement therapy

2004 ◽  
Vol 19 (5) ◽  
pp. 1168-1173 ◽  
Author(s):  
F. H. Jorna ◽  
T. J. M. Tobe ◽  
R. M. Huisman ◽  
P. E. de Jong ◽  
J. T. M. Plukker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Replacement Therapy ◽  
Secondary Hyperparathyroidism ◽  
Replacement Therapy ◽  
Early Identification

Single-center experience with intraoperative extracorporeal membrane oxygenation use in lung transplantation

2017 ◽  
Vol 41 (2) ◽  
pp. 89-93 ◽  
Author(s):  
Tugba Cosgun ◽  
Sandra Tomaszek ◽  
Isabelle Opitz ◽  
Markus Wilhelm ◽  
Macé M. Schuurmans ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Replacement Therapy ◽  
Extracorporeal Membrane Oxygenation ◽  
Lung Transplantation ◽  
Replacement Therapy ◽  
Support Group ◽  
Ecmo Support ◽  
Independent Risk Factors ◽  
Group 2 ◽  
Group 1

Background: Studies have shown that survival after lung transplantation is impaired if extracorporeal membrane oxygenation (ECMO) support is implemented. We investigated the outcome and potential independent risk factors on survival in recipients undergoing lung transplantation with intraoperative ECMO support. Materials and methods: Medical records of recipients were retrospectively evaluated (January 2000-December 2014). Retransplantation and bridge to transplantation on ECMO were excluded. Recipients (n = 291) were divided into 2 groups: those who needed intraoperative ECMO support (Group 1, n = 134) and those who did not receive intraoperative ECMO support (Group 2, n = 157). Independent risk factors were identified by a stepwise backward regression analysis. Results: 1-year survival was 84.2% in Group 1 vs. 90.4% in Group 2, and 5-year survival was 52.8% in Group 1 vs. 70.5% in Group 2 (p = 0.002). Multivariate analysis indicated that recipient age (p = 0.001), renal replacement therapy (p = 0.001) and intraoperative ECMO support (p = 0.03) were significant risk factors for overall survival. The rate of postoperative early surgical complications was comparable between the two groups (p = 0.09). The number of patients requiring renal replacement therapy and experiencing late pulmonary complications was significantly higher in Group 1 (p = 0.02). Conclusions: Our data showed that lung transplantation with intraoperative ECMO support is associated with poor outcomes.

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