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The clinical course of urolithiasis in children under 3 years of age

100%
Aaslid A., Tkaczyk M.
Progress in Health Sciences
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2014
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vol. 4
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issue 1
68-74
XX
Purpose: Certain risk factors of urolithiasis may be diagnosed in 75% of children with stones. They include genetic, anatomic, metabolic and nutrition causes. The diagnostics' evaluation should determine and rule out anatomic factors and establish metabolic disorders. The treatment is based on an increased fluid intake, and alterations in the nutrition pattern. The aim was to analyze the clinical course of urolithiasis in children below 3, and detect the possible factors affecting the success of therapy. Materials and methods: Between 2009 and 2013, we retrospectively investigated the cases of 68 children (34 boys and 34 girls) under 3 years who were treated in the clinic. Urolithiasis was diagnosed at the mean age of 10 months; the average follow-up lasted 26 months until reaching 3 years. The retrospective analysis was based on medical documentation and direct contact with parents. Results: Among the risk factors, the most common was hyperciuria. The treatment of children was based on an increased daily fluid intake and dietary recommendations. Among the specific treatments, the most common were citrates (51%). In the majority of cases, the therapy lasted over a year after the clinical absence of stones. This therapy was successful in 62% of children. The factors contributing to the success of the treatment were: a negative family history of urolithiasis, unilateral stones, normal urinalysis, decrease of the Ca/Cr index, and compliance of dietary and medical recommendations. Conclusions: The treatment is based on the elimination of risk factors, and alterations in the dietary pattern. High percentage of parents did not respect the medical recommendations.
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Mycophenolate mofetil for treatment of idiopathic nephrotic syndrome – a single center experience (preliminary study)

81%
Tomczyk D., Jander A., Mihailescu J., Tkaczyk M.
Progress in Health Sciences
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2014
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vol. 4
|
issue 1
61-67
XX
Introduction: Mycophenolate mofetil (MMF) is used in treatment of idiopathic nephrotic syndrome in children (INS). Purpose: To evaluate clinical results of MMF treatment in steroid-dependent (SD) and steroid-resistant (SR) nephrotic syndrome. Materials and methods: A retrospective analysis of 26 patients (19 boys, 7 girls) with SDINS and SRINS treated with MMF during the years 2003–2013 was made. The remission length of INS and number of relapses per year before the introduction of MMF and after 12 months was calculated. An analysis of the side effects was made. Results: The median age of INS diagnosis was 26.5 months (IQRs 24-36 months). Nineteen of the patients (73%) suffered from SDINS whereas the remaining 7 (27%) had SRINS. Twenty three (88.5%) patients underwent renal biopsy: minimal change disease (MCD) in 69.6% (n=16), focal segmental glomerulosclerosis (FSGS) in 17.4% (n=4), membranoproliferative glomerulonephritis (MPGN) in 8.7% (n=2) and mesangial cell proliferation in one case. The median MMF dosage was 956.0 mg/m2/24h (IQRs 768.1-1059.7 mg/m2/24h). Eleven patients (42.3%) were taking MMF together with cyclosporine A (CsA). In patients suffering from SDINS, there was a trend to lower the recurrence rate during MMF treatment [2.0/year (IQRs 0.25-2.0 per year) vs 2.0/year (IQRs 1.0-2.75 per year), p=0.09]. Remission without proteinuria was significantly longer in patients treated with MMF; remission median was 8.5 month (IQRs 6.25-11.0 month) vs 4.5 month (IQRs 4.0-7.5 month), (p=0.014), similarly the average length of remission without corticosteroids was 6.0 months (IQRs 0.25-8.5 months) vs 3.0 months (IQRs 0.0-7.25) months (p=0.028). In children SRINS, 4/7 children MMF treatment was clinically ineffective. Side effects of the treatment were: leucopenia (n =10), hyperbilirubinemia (n = 3), gastrointestinal disorders (n = 1) and anemia (n = 1). Conclusion: This study confirmed the efficacy of the treatment with MMF in SDINR in comparison with previously used drugs, with a small number of side effects.
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