Browsing by Author "Paripovic, Dusan (14621764400)"

Background/aim: Juvenile obesity is associated with several metabolic abnormalities, one of them being atherogenic dyslipidemia. Suboptimal fetal growth is associated with obesity risk in childhood, but also with increased rate of metabolic diseases in later life. This study investigated associations of neonatal data (Apgar score, birth weight and birth length) with low-density lipoprotein and high-density lipoprotein (LDL and HDL) subclasses in a group of obese children, as well as a possible impact of breastfeeding duration on obesity-associated lipoprotein subclasses distributions. Materials and methods: We included 42 obese children, aged 14.2 ± 2.1 years. LDL and HDL subfractions were separated by gradient gel electrophoresis and biochemical parameters were assessed by routine methods. Results: Compared with obese children with Apgar ≥ 9, the group with Apgar < 9 had significantly higher percentages of small, dense LDL particles (P < 0.05), due to reduced LDL I (P < 0.01) and increased LDL III subclasses (P < 0.05). Birth weight was positively associated with the proportions of LDL I particles (P < 0.001), whereas birth height positively correlated with the amount of HDL 2b subclasses (P < 0.05). The group of never or less than 3 months breastfed children had significantly smaller LDL size (P < 0.01) and lower proportion of HDL 2a particles (P < 0.05) than their ≥3 months breastfed peers. Conclusion: The results showed significant associations of neonatal characteristics with LDL and HDL particle distributions in obese children. In addition, our results point toward positive aspects of longer breastfeeding duration on lipoprotein particle distributions in obese children. © TÜBİTAK.

The epidemiological information from well-defined populations regarding childhood chronic kidney disease (CKD), particularly those concerning non-terminal stages, are scanty. The epidemiology of CKD in children is often based on renal replacement therapy (RRT) data, which means that a considerable number of children in earlier stages of CKD are missed as they will reach end-stage renal disease (ESRD) in adulthood. Here, we report the basic epidemiological data on childhood CKD in Serbia, gathered over the 10-year period of activity of the Serbian Pediatric Registry of Chronic Kidney Disease. Since 2000-09, data on incidence, prevalence, aetiology, treatment modalities and outcome of children aged 0-18 years, with CKD Stages 2-4 and CKD Stage 5, were collected by reporting index cases from paediatric centres. Three hundred and thirty-six children were registered (211 boys, 125 girls, male/female ratio 1.7). The median age at registration was 9.0 years [interquartile range (IQR) 3-13]. Median follow-up was 4.0 years (IQR, 1-9). The median glomerular filtration rate (GFR) at the time of the registration was 39.6 mL/min/1.73m(2) (IQR, 13.8-65.4). Median annual incidence of CKD 2-5 stages was 14.3 per million age-related population (p.m.a.r.p.), while those of CKD 2-4 or CKD 5 were 9.1 and 5.7 p.m.a.r.p., respectively. The median prevalence of CKD 2-5 was 96.1 p.m.a.r.p., 52.8 p.m.a.r.p. in CKD 2-4 and 62.2 p.m.a.r.p. in CKD 5. The main causes of CKD were congenital anomalies of kidney and urinary tract and hereditary nephropathies. Kidney survival was the worst in children with glomerular diseases and in those with advanced CKD. Haemodialysis was the most common first modality of RRT. Mortality rate was 4.5%, mainly due to cardiovascular and infectious complications. Epidemiology of paediatric CKD in Serbia is similar to that reported from developed European countries. The knowledge of the epidemiology of earlier stages of CKD is essential for both institution of renoprotective therapy and planning of RRT, a fact of paramount importance in countries with limited resources.

BACKGROUND: Office blood pressure (BP) trajectories may help assess hypertension progression and the effects of antihypertensive treatment in children with chronic kidney disease. METHODS: Analysis of antihypertensive treatment and BP slopes in 320 patients from the 4C study (Cardiovascular Comorbidity in Children with Chronic Kidney Disease) cohort with chronic kidney disease before renal replacement therapy, based on a minimum of 3 individual observations and 2 years of follow-up. RESULTS: At enrollment, 70 (22%) patients had uncontrolled or untreated hypertension, 130 (41%) patients had controlled hypertension, and 120 (37%) patients had normotension without antihypertensive treatment. Antihypertensive treatment medication was prescribed for 53% of patients at baseline and initiated or added for 91 patients (AHT-I [group with intensification of antihypertensive treatment] group, 28%) during follow-up. Overall BP SD score remained stable over time in the cohort (β=-0.037±0.034, P=0.34 and -0.029±0.348, P=0.093 per year for systolic and diastolic BP SD score). In the AHT-I group, systolic and diastolic BP SD scores were higher at baseline and decreased significantly during follow-up (-0.22±0.07, P<0.003 and -0.12±0.05 SD score per year, P=0.01). Only 8 of 70 (11%) patients from the previously untreated/uncontrolled group remained untreated at the last observation, while 31 (44%) were controlled during follow-up. Of the 120 normotensive patients at baseline, 60% remained normotensive while 40% progressed to uncontrolled/untreated (n=23, 19%) or controlled (n=24, 20%) hypertension. CONCLUSIONS: Although the overall BP of the population remained stable over time, individual patterns of BP management showed considerable variability. BP control improved significantly with intensified antihypertensive therapy; however, a significant number of previously normotensive individuals developed new-onset hypertension during the observation period. © 2025 American Heart Association, Inc.

Introduction: There are discrepant findings regarding the effect of dyslipidemia on disease progression in adult patients with chronic kidney disease (CKD). Methods: In a prospective cohort study of children with stage 3 to 5 (predialysis) CKD, triglycerides (TGs), total cholesterol (CHOL), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured semiannually. We investigated whether CKD progression is associated with serum lipid levels at baseline and with lipid trajectories during follow-up. CKD progression was defined as the time to a composite event of 50% reduction in estimated glomerular filtration rate (eGFR), eGFR < 10 ml/min per 1.73 m2, or start of kidney replacement therapy. By semiparametric group-based trajectory modeling (GBTM), 2 trajectories were defined for each lipid, termed “high” and “low.” Results: A total of 681 patients aged 12.2 ± 3.3 years with a mean eGFR of 26.9 ± 11.6 ml/min per 1.73 m2 were included. Kidney diagnosis was classified as congenital anomalies of the kidneys and urinary tracts (CAKUT) in 69%, glomerulopathy in 8.4%, and other disorders in 22.6% of patients. During a median of 5.1 years of follow-up, 59% of patients reached the composite end point. Kidney survival was significantly different for HDL-C (P = 0.0128), but not for other lipid trajectories in the Kaplan-Meier analysis. There was no significant association of any of the lipid trajectories with CKD progression in Cox proportional hazard models. Variables consistently associated with CKD progression in models for each lipid at baseline and for lipid trajectories included age, a diagnosis other than CAKUT, eGFR at baseline, albuminuria, the serum albumin level, and diastolic blood pressure (BP). Conclusions: These data do not support an important role for lipids in the progression of CKD in children. © 2025 International Society of Nephrology

Introduction: Urinary tract infection (UTI) is one of the most common bacterial infectious diseases in children. The aim of this study was to determine the total prooxidant and antioxidant capacity of children with UTI, as well as changes of oxidative status parameters according to acute inflammation persistence and acute kidney injury (AKI) development. Materials and methods: The patients enrolled in the study comprised 50 Caucasian children (median age was 6 months) with UTI. Total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), inflammation marker C-reactive protein (CRP) and renal function parameters urea and creatinine were analyzed in patient's serums. Results: According to duration of inflammation during UTI, TAS values were significantly higher (0.99 vs. 0.58 mmol/L, P = 0.017) and OSI values were significantly lower (0.032 vs. 0.041 AU, P = 0.037) in the subjects with longer duration of inflammation than in the subjects with shorter duration of inflammation. We did not find significant difference in basal values of oxidative status parameters according to AKI development. Conclusions: OSI values could detect the simultaneous change of TAS and TOS due to change in the oxidative-antioxidant balance during the recovery of children with UTI. TAS and OSI as markers of oxidative stress during UTI are sensitive to accompanying inflammatory condition. Further investigations are needed to evaluate whether TAS, TOS and OSI could be used to monitor disease severity in children with UTI. © Croatian Society of Medical Biochemistry and Laboratory Medicine.

Introduction: Urinary tract infection (UTI) is one of the most common bacterial infectious diseases in children. The aim of this study was to determine the total prooxidant and antioxidant capacity of children with UTI, as well as changes of oxidative status parameters according to acute inflammation persistence and acute kidney injury (AKI) development. Materials and methods: The patients enrolled in the study comprised 50 Caucasian children (median age was 6 months) with UTI. Total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), inflammation marker C-reactive protein (CRP) and renal function parameters urea and creatinine were analyzed in patient's serums. Results: According to duration of inflammation during UTI, TAS values were significantly higher (0.99 vs. 0.58 mmol/L, P = 0.017) and OSI values were significantly lower (0.032 vs. 0.041 AU, P = 0.037) in the subjects with longer duration of inflammation than in the subjects with shorter duration of inflammation. We did not find significant difference in basal values of oxidative status parameters according to AKI development. Conclusions: OSI values could detect the simultaneous change of TAS and TOS due to change in the oxidative-antioxidant balance during the recovery of children with UTI. TAS and OSI as markers of oxidative stress during UTI are sensitive to accompanying inflammatory condition. Further investigations are needed to evaluate whether TAS, TOS and OSI could be used to monitor disease severity in children with UTI. © Croatian Society of Medical Biochemistry and Laboratory Medicine.

BACKGROUND: Carotid intima-media thickness (cIMT) may identify early alterations in the vascular phenotype in children with chronic kidney disease (CKD). METHODS AND RESULTS: Investigation of longitudinal changes in cIMT SD scores (SDS) in 670 patients from the 4C Study (Cardiovascular Comorbidity in Children With CKD Study), aged 6 to 17 years, with CKD stage 3 to 5 at baseline. The longitudinal trajectory of cIMT SDS over up to 8 years was examined using a longitudinal mixed-effects model. The yearly progression rate in cIMT SDS (β=0.20 [95% CI, 0.13–0.28]) remained positive during the initial 4.5-year follow-up period but slowed down quadratically with increasing observation time (β=−0.02 [95% CI, −0.03 to −0.01]). Risk factors for increased cIMT SDS included time since baseline, younger age, higher height SDS, female sex, elevated diastolic blood pressure, and lower serum albumin, but not estimated glomerular filtration rate. In patients with progressive CKD, higher albuminuria was additionally associated with an increase in cIMT SDS. In patients with stable CKD, serum phosphate and time were the only risk factors identified for elevated cIMT SDS. Annual rates of change in blood pressure were positively correlated with the rate of change in cIMT SDS within the first 4.5 years (for systolic: β=0.42 [95% CI, 0.22–0.62]; for diastolic: β=1.56 [95% CI, 1.01–2.11]). CONCLUSIONS: The results show a significant longitudinal increase in cIMT SDS in children with CKD. Changes in blood pressure are associated with the progression of cIMT SDS, suggesting a relevant impact of blood pressure modulation on cIMT SDS. © 2025 The Author(s).