Browsing by Author "Spasojević, Brankica (10839232100)"

Introduction En bloc kidney transplantation (EBKT) overcomes the problems of insufficient nephron mass of the solitary kidney of the youngest donors and the creation of a vascular anastomosis with small blood vessels. Although there are positive experiences with EBKT in adult patients, there is little data in pediatric recipients. Case outline The kidney donor was a six-month-old male infant (7 kg), and the recipient was a 16-year-old adolescent girl (58.7 kg). The estimated glomerular filtration rate increased during the one-year follow-up after EBKT and reached 88.8 ml/min/1.73 m2, which was accompanied by an increase in the dimensions of the medial and lateral kidneys. Normalization of proteinuria and tubular functions occurred six and 12 months after transplantation, respectively. Conclusion EBKT in an adolescent girl was performed without vascular complications, with satisfactory kidney function and physiological values of proteinuria after a one-year follow-up. EBKT of infants could increase the number of cadaveric donors but also enable better function and survival of the graft, given that the growth and functional maturation of the infant’s kidneys continue postnatally in the body of the graft recipient. © 2024, Serbia Medical Society. All rights reserved.

Despite recent advances in the management of children with chronic renal disease (CRD), growth retardation remains its most visible comorbid condition. Growth retardation has adverse impact on morbidity and mortality rates, quality of life and education, and in adult patients on job family life, and independent leaving accomodation. Pathophysiology of impaired growth in CRD is complex and still not fully understood. The following complications are: anorexia, malnutrition, inflammation, decreased residual renal function, dialysis frequency and adequacy, renal anemia, metabolic acidosis, fluid/electrolyte imbalance, renal osteodistrophy, growth hormone (GH) and insulin-like growth factor -1 (IGF-1) resistance. Malnutrition is most frequent and most important factor contributing to the degree of growth retardation in infancy. The degree of renal dysfunction is the major determinant of variability in growth from third year of age until puberty onset, while in puberty hypergonadotropic hypogonadism has negative effect. The main factors that influence growth after renal transplantation are the age of the recipient and glucocorticoid drugs dosage with negative effect and allograft function with positive effect. In order to improve growth in children with CRD it is necessary to include: diet with optimal caloric intake, correction of fluid/ electrolyte imbalance, correction of acidosis, renal osteodistro-phy and anemia. If growth velocity is insufficient to normalize growth, it is necessary to start recombinant human GH (rhGH) therapy at 0.05 mg/kg per day (0.35 mg/kg per week or 28 IU/m2 per week) administered by subcutaneous injection. © 2014, Serbia Medical Society. All rights reserved.

Background: This study was conducted to retrospectively investigate the indications for renal biopsy in native kidneys and to analyze pathological findings in the last 10 years in a single tertiary pediatric hospital in Serbia. Methods: All patients who underwent renal biopsy at our hospital between 2001 and 2010 were included in the present study. Renal biopsy was performed under fluoroscopy with a biopsy gun. All renal biopsies were studied under light and immunofluorescent microscopy, while electron microscopy was rarely performed. Results: The study group included 150 patients (56% female) who underwent 158 percutaneous native kidney biopsies. Median age was 11.5 years (range 0.2-20 years). The most frequent indications for renal biopsy were nephrotic syndrome (32.9%), asymptomatic hematuria (23.4%), urinary abnormalities in systemic diseases (15.8%) and proteinuria (11.4%). Primary glomerulonephritis (GN) was the most common finding (57.4%), followed by secondary GN (15.5%) and tubulointerstitial diseases (4.5%). According to histopathological diagnosis, the most common causes of primary GN were focal segmental glomerulosclerosis (20.9%), mesangioproliferative GN (14.6%), IgA nephropathy (8.9%) and minimal change disease (13%). Lupus nephritis (6%) and Henoch-Schönlein nephritis (4%) were the most common secondary glomerular diseases. Conclusions: The epidemiology of glomerular disease in our single-center report is similar to that in data from adjacent Croatia and Greece. Focal segmental glomerulosclerosis was the dominant histopathological finding, followed by mesangioproliferative GN and IgA nephropathy. © 2012 Società Italiana di Nefrologia.

Introduction/Objective Jeune syndrome (JS) is a rare hereditary ciliopathy characterized by asphyxiating thoracic dystrophy, shortened limbs and brachydactyly. Extraskeletal anomalies such as chronic renal failure (CRF), hepatic fibrosis, and retinitis pigmentosa may be a part of the JATD phenotype. The aim of this study is to present long-term follow-up of JS patients with early progressive kidney disease. Methods This is a retrospective study of pediatric patients with JS and CRF who were treated at the University Children’s Hospital between January 1980 and December 2014. The patients’ data were retrospectively reviewed from the medical records. Results There were thirteen patients from 11 families, five girls and eight boys mean aged 4.3 years at the time of diagnosis. All of the patients had characteristic skeletal findings, retinal degeneration and an early onset of CRF at age range from 1.5 to 7 years. Five patients had neonatal respiratory distress and congenital liver fibrosis was diagnosed in five patients. One patient died due to complications of CRF, while others survived during follow-up of mean 11 years. IFT140 mutations were found in four genetically tested patients. Conclusion The average incidence rate of JS with renal phenotype in Serbia was about 0.2 per one million of child population. Long-term survival of JS patients depends on renal replacement therapy, while skeletal dysplasia, growth failure, respiratory and eyes problems have impact on the patients’ quality of life. © 2017, Serbia Medical Society. All rights reserved.

Introduction Renovascular hypertension is a rare cause of arterial hypertension in the pediatric population. The aim of this report was to present the treatment outcome in a girl with severe stenosis of the renal artery on a solitary kidney. Case outline A 6.5-year-old girl, otherwise healthy, was found to be highly hypertensive (up to 200/140 mmHg) during a systematic examination for school enrollment. The imaging evaluation revealed that she had a single kidney with critical renal artery stenosis. Medication with three antihypertensive drugs was unsuccessful. The angioplasty attempt was complicated by artery wall dissection and the pseudoaneurysm development. This complication was treated surgically with an autologous saphenous vein graft by-pass. Postoperatively, acute kidney injury developed, which required continuous renal replacement therapy for two days, followed by hemorrhagic shock and the need for reintervention with retroperitoneal hematoma evacuation. After three years, aneurismal dilated vein graft was replaced by a synthetic one (PTFE) in London. Angioplasty of the synthetic graft was performed twice due to the development of proximal stenosis and restenosis. After 11 years of follow-up, the girl has well controlled blood pressure under two antihypertensives, with normal renal function without proteinuria. Conclusion This case illustrates that angioplasty for single artery stenosis in children is a high-risk procedure, which may result in an aneurism formation or bleeding and a need for several kidney revascularization procedures. In order to preserve kidney function, it requires a serious multidisciplinary approach by nephrologists, interventional radiologists/cardiologists, and vascular surgeons. © 2024, Serbia Medical Society. All rights reserved.