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Amira Peco-Antić

Publications and source records attributed to Amira Peco-Antić.

16 recordsLinked to original sources
PubMed2006

Infantile polyarteritis nodosa presenting as hyponatraemic hypertensive syndrome.

UNLABELLED: The association of arterial hypertension with hyponatraemic dehydration, known as hyponatraemic hypertensive syndrome (HHS), is a rare and serious hypertensive complication. Here, we describe a 17-mo-old girl who presented with severe hyponatraemic dehydration, hypokalaemia, polyuria, and nephrotic-range proteinuria associated with malignant arterial hypertension and systemic inflammatory disease. Diagnosis of classic polyarteritis nodosa (c-PAN) was made on the basis of renal arteriography demonstrating small arterial aneurysms in association with non-aneurismal changes such as arterial cut-off, arterial tapering stenosis and nephrogram perfusion defect. A decrease of blood pressure by antihypertensive treatment resulted in the normalization of HHS abnormalities. However, c-PAN became well controlled only after 4 mo of immunosuppressive therapy. CONCLUSION: The main interest of this case was the uncommon presentation of systemic polyarteritis nodosa in a very young child. Renal ischaemia from intrarenal vessel disease may have been the trigger event for HHS in our case. Management of PAN-associated severe arterial hypertension is based on immunosuppressive and antihypertensive treatment.

Female↗
PubMed2004

ACE and AT1 receptor gene polymorphisms and renal scarring in urinary bladder dysfunction.

The objective of this study was to investigate whether DNA polymorphisms of the renin-angiotensin system (RAS) genes were associated with renal scar formation in pediatric patients with bladder dysfunction (BD). Although these children are born healthy, due to persistence of immature voiding habits and evolution of BD, some develop progressive renal damage. It has been suggested that the DD genotype of the angiotensin I-converting enzyme (ACE) gene might be an adverse renal prognostic factor. The insertion/deletion (I/D) polymorphism of the ACE gene and the A1166C polymorphism of the angiotensin II type 1 receptor (ATR1) gene were identified by polymerase chain reaction amplification in 42 children with BD (aged 5-14 years) and 198 healthy adult controls. Twelve children had urgency syndrome and 30 had dysfunctional voiding. Renal scarring was found in 16 patients, while 26 patients had normal kidneys on dimercaptosuccinic acid scan. In children with renal lesions there was significant over-representation of the DD genotype compared with either controls or patients without renal damage ( P<0.05). On multivariate analysis, the DD genotype was the only factor that had a significant impact on renal scar formation, introducing a 2.51-fold risk (odds ratio 2.51, 95% confidence interval 1.04-6.04, P=0.04). The A1166C gene polymorphism was not significantly associated with the development of parenchymal damage in children with BD. Our findings introduce ACE I/D gene polymorphism as an independent risk factor for parenchymal destruction in pediatric patients with BD.

Adolescent↗
PubMed2004

[Renoprotective effect of ramipril in children with chronic renal failure--the experience of one centre].

The objective of our study was to evaluate the changes of blood pressure (BP), urinary protein excretion (PRT/Cr) and renal function (GFR) after long-term administration of ACE inhibitor, ramipril. This prospective trial, a part of the European Multicentric Escape Study, included 14 patients (5 girls and 9 boys), mean-age 11 years, with congenital renal malformations. The basic inclusion criteria were stable chronic renal failure (CRF) and mean arterial pressure (MAP) above 50 percentile defined by 24-hour ABPM or earlier antihypertensive medication. The patients were studied 6 months before and up to 36 months after the introduction of ramipril therapy. The dosage of ramipril ranged from 4.7 to 7.7 mg/ m2 SBA, mean 37.8 (+/- 4.03) mg/m2 SBA. The patients were controlled every two months for BP, proteinuria and GFR, while 24-hour ABPM was performed in 6 months. The significant decrease of regular and 24-hour ambulatory blood pressure (ABP), systolic, diastolic and MAP, was found within the first months of treatment, while ramipril-induced reduction of proteinuria and slowing down of GFR were delayed. BP did not differ significantly among patients, but antiproteinuric effect and influence on GFR showed large individual variations. Antiproteinuric and antihypertensive effects of ramipril correlated with underlying proteinuria, GFR and blood pressure. However, there was no constant relationship between changes of proteinuria and BP. Ramipril has been shown to: lower BP significantly, decrease proteinuria slowly, and significantly decelerate GFR after 18 months of treatment. Considering favorable preliminary results of lower BP, decrease of proteinuria and decelerated GFR, an optimal renal protection by long-term therapy with ACE inhibitors may be expected in children with CRF caused by congenital renal malformations.

Adolescent↗
PubMed2004

[The benefit of plasmapheresis in a patient with steroid-resistant nephrotic syndrome and anuria--long-term follow-up].

Recently, plasma exchange (PE) has been added to the treatment regimen for patients with steroid-, cyclophosphamide-, and cyclosporine-resistant nephrotic syndrome. This is a case report of a female patient with severe acute renal failure (ARF) during the relapse of steroid-resistant nephrotic syndrome (SRNS) who recovered completely after PE and became steroid-sensitive in further follow-up of 48 months. An 8-year-old girl was referred to Nephrology Department of the University Children's Hospital due to relapse of SRNS complicated with ARF. Her nephrotic syndrome (mesangioproliferative glomerulonephritis) was diagnosed at the age of 17 months. During the following 6 years, she was given several therapeutic regimens including pulse prednisolone, cyclophosphamide, Cyclosporine (CyA), but she continued to have frequent relapses and during the last six months she was steroid- and cyclosporine-resistant. Three days before admission, she was febrile, had cellulites of the lower abdominal wall, diarrhea, vomiting, hypovolemic shock with generalized edema, severe hypoproteinemia and hypoalbuminemia. In a local hospital, she was treated with fresh frozen plasma, albumin, methylprednisolone, furosemide and antibiotics, but she became anuric and was referred to our hospital. There were no signs of hemolysis. Anuria lasted for 12 days. She was discharged after 42 days in remission with normal GFR. Principal treatment included: 13 sequential hemodialysis sessions (30% of body weight was removed as excess volume), 6 PE, corticosteroids, CyA, ACE inhibitor, antibiotics, antimycotics, and cimetidine. Six PE sessions were performed every other day. In further 48-month follow-up, while under the treatment of CyA the patient had a few steroid-sensitive relapses, the first being 6 months after PE. The second kidney biopsy showed focal segmental glomerulosclerosis with no signs of apparent CyA nephrotoxicity. "Malignant" course of disease in our patient was a good reason to introduce PE into the treatment. Since PE was the only additional mode of treatment, it is believed that its effect was crucial for milder activity of the disease.

Anuria↗
PubMedDate not supplied

[Evaluation of representative blood pressure measurement in children on hemodialysis].

The diagnosis of hypertension in patients on chronic haemodialysis is not easy because the blood pressure changes as a consequence of therapy (haemodialysis) and attenuated circadian rhythm of blood pressure is often present. The estimation of representative blood pressure levels is difficult because it is not known whether blood pressures measured before starting or after completion of haemodialysis are predictive for the average interdialytic blood pressure. Our group of patients consisted of 18 children with endstage renal failure, aged 13.5 +/- 3.2 years, treated with chronic haemodialysis from 0.1 to 110 (mean 25.8, median 19) months. Ambulatory blood pressure monitoring was performed during 44 h interdialytic period. Blood pressure was also measured with sphygmomanometer before starting and after completion of heamodialysis. The average blood pressure values for the last ten haemodialyses were evaluated as well. Multiregression analysis showed significant correlation between interdialytic blood pressure (systolic and diastolic) and blood pressures measured before haemodialysis (r = 0.74; p < 0.001, r = 0.78; p < 0.001, respectively) and after haemodialysis (r = 0.76; p < 0.01, r = 0.6; p < 0.05, respectively). Statistically high correlation between these blood pressures was also confirmed for the average blood pressure values for the last 10 haemodialyses (r = 0.78; p < 0.001, r = 0.75; p < 0.001 and r = 0.78; p < 0.001, r = 0.86; p < 0.001, respectively). Our findings show that blood pressures measured before starting or after completion of haemodialysis give good information about interdialytic blood pressure in children on chronic haemodialysis.

Adolescent↗
PubMedDate not supplied

[Acute oliguric renal failure in hypoxic neonates born at full term].

INTRODUCTION: Acute renal failure (ARF) is a frequent clinical condition in neonatal intensive care units (NICU). The leading cause of neonatal ARF is perinatal asphyxia (PS). The aim of this study was to examine the relationship between the degree of PS and the severity of ARF in term neonates. METHODS: A prospective survey of 31 term neonates with Ps and but without congenital malformations or sepsis was performed in NICU of the regional Hospital of Gynaecology and Obstetrics in Belgrade (average number of deliveries about 6000 per year). ARF was diagnosed in the first 7 days of life when plasma creatinine was above 133 mumol/L for at least 48 hours while maternal renal function was normal. The degree of PS was determined according to Apgar score (AS) at 1 min. The severe PS was defined as AS < 3 and moderate PS as AS 4-6. RESULTS: Twenty neonates (64%) had oliguric ARF with urine output of 0.37 +/- 0.16 ml/kg/h while the others had nonoliguric ARF with urine output of 2.4 +/- 0.7 ml/kg/h. Most of neonates with oliguric ARF (65%) had severe perinatal asphyxia while in those with nonoliguric ARF moderate perinatal asphyxia predominated (73%). DISCUSSION: During hypoxic-ischaemic events many organs are injured, and the most vulnerable ones are kidneys and central nervous system. Our results showed a strong connection between perinatal asphyxia and A, which was in accordance with the results of other studies. Neonates with severe perinatal asphyxia had serious impairment of renal function, which was confirmed with strong correlation between Apgar score and plasma creatinine. In neonates with oliguric ARF, but not in those with nonliguric ARF, the highly positive linear correlations were found between AS and urinary output (r = 0.77; p < 0.01), plasma creatinine (r = 0.78; p < 0.01), fractional excretion of sodium (r = 0.76; p < 0.01), and index of renal failure (r = 0.80; p < 0.01). Only in oliguric neonates with severe perinatal asphyxia (31%) the outcome was fatal. CONCLUSION: We conclude that in tgerm neonates with severe perinatal asphyxia oliguric ARF was the predominant type of ARF. There is a good prediction of the severity of oliguric ARF according to the degree of perinatal asphyxia determined by Apgar score at 1 min.

Acute Kidney Injury↗
PubMedDate not supplied

[Chronic renal failure in children in Yugoslavia].

UNLABELLED: The aim of this study was to analyse the demographic variables of chronic non-terminal (CRF) and terminal (TRF) renal failure patients (pts) younger than 19 years treated in Serbia in June 2001. The prevalence of CRF pts was registered as 4.7 per million total population (pmtp) or 14.1 per million child population (pmcp) while corresponding values for TRF pts were 4.5 pmtp or 13.5 pmcp. The incidence of TRF pts during the period Jan. 2000-Jan. 2002 was 4.35 pmcp. Boys dominated only among CRF pts (34:14); 60.4% being between the ages of 6 and 19 yrs while at the time of diagnosis of HBI, 33.3% of boys were yanger than 2 yrs. The causes of CRF were: reflux nephropathy 58.3%, congenital kidney disease 16.7%, familial/hereditary 14.6%, glomerulonephritis 6.2% and Willms tu 4.1%. Reflux nephropathy was also the most common underlying disease of TRF accounted for 36.9% of total cases, while glomerulonephritis was responsible for 23.9%. Reflux nephropathy was associated with neural tube defect in 53.3% and with congenital lower urinary tract obstruction in 66.7%. The most of CRF (81.25%) and TRF pts (95.6%) were from Serbia, the others were from Monte Negro and Republic Srpska. The most of CRF (65%) and TRF (80%) pts were treated in University Children's Hospital in Belgrade. Of CRF pts 46% had serum creatinine 100-200 mumol/l, in 11% of pts it was 400-600 mumol/l and 2% of pts were in pre-terminal CRF. One third of CRF pts had proteinuria 150-500 mg/l, and second third had proteinuria greater of 1000 mg/l. Anemia was present in 54% of CRf pts, and arterial hypertension in 56%. Hemodialysis was dominant treatment modality for TRF pts and only 23.9% had functioning transplant. CONCLUSION: This is the first national study of demographic characteristics of pediatric CRF in Serbia. Since its prevalence is considerably lower than that in Western and North European countries the true prevalence is some what higher. The increasing incidence of pediatric TRF from 2.85 pmcp to 4.35 pmcp reflect better diagnosis and treatment of these patients in the recent years.

Adolescent↗
PubMedDate not supplied

[Renovascular hypertension in a child with type 1 neurofibromatosis].

Arterial hypertension in pediatric patients with neurofibromatosis type 1 (NF 1) is usually due to renal artery stenosis (RAS) mainly involving the proximal part of the vessel. The treatment modalities are highly individualized. In severe and/or bilateral RAS, antihypertensive drugs are either ineffective or have the potential risk for acute renal failure, while percutaneous transluminal angioplasty (PTA) has limited success due to the ostial localization of RAS and the tough fibrotic tissue involved that is refractory to dilatation Renal autotransplantation has potential advantages when medical control and PTA/or bypass techniques failed. Here we report 5 year-old girl with NF 1 and hyponatremic hypertensive syndrome due to severe bilateral disease, occluded proximal part of the right artery and ostial stenosis (80%) of the left one. Only left kidney was identified on 99 m Tc DTPA, but the right one was visualized on the renal ultrasonography and in the late phase of arterial renography due to well developed collateral circulation. Multiple antihypertensive drugs (nifedipine, labetolol and minoxidil) in maximal doses and PTA failed to normalize BP while short term therapy with ACEI with NF1 and hyponatremic hypertensive syndrome due to severe bilateral renovascular disease; occluded proximal part of the right renal artery and ostial stenosis (80%) of the left one. Only left kidney was identified on 99 m Tc DTPA, but the right one was visualized on the renal ultrasonography and in the late phase of arterial renography due to well developed collateral circulation. Multiple antiphypertensive drugs (nifedipine, labetolol and minoxidil) in maximal doses and PTA failed to normalize BP while. short term therapy with ACEI, captopril induced transient acute renal failure. Autotransplantation of right kidney saved its function and improved BP control. Our current case Autotransplantation of right kidney saved its function and improved BP control. Our current case is illustrative for a difficult management of renovascular hypertension in children with NF1. This is the first and up to now the only case of autotransplantation performed in Yugoslavia.

Child, Preschool↗
PubMedDate not supplied

[Continuous ambulatory monitoring of blood pressure and the left ventricular mass index in children with kidney diseases].

INTRODUCTION: Numerous epidemiological studies have shown that blood pressure (BP) is positively related to cardiovascular morbidity and mortality. Although the relationship between BP and the incidence of morbid events is consistent and highly significant, it is difficult to predict the absolute risk. Several studies have shown that the organ damage associated with hypertension correlate to a greater degree with 24 h average BP than with clinic BP and the most of them evaluated left ventricular hypertrophy in these patients. OBJECTIVE: To evaluate the correlation between left ventricular mass index (LVMi) and BP, BP variability, pulse pressure (PP), BP load and hyperbaric index (HBI). DESIGN AND METHODS: Ambulatory blood pressure monitoring (ABPM) was performed in 30 children with renal disease aged 12.7 +/- 5.5 years. Ten of them had normal renal function, 3 had renal transplant and 17 of them had end-stage renal disease and were on chronic haemodialysis. All of the patients were submitted to an echocardiographic evaluation and LVMi was calculated according to Penn convention. Ambulatory blood pressure monitoring was performed during the 24 h period and average values of systolic and diastolic BP were evaluated. As an index of variability of BP values we used standard deviation (SD) of mean. Evaluation of average BP values has some disadvantages--it does not take into account the peaks of blood pressure and the values are lower if the circadian rhythm of BP is preserved--for this reason BP load and HBI were evaluated as well. BP load represented the percentage of BPs exceeding the upper limits of normal and HBI the integrated area under the ambulatory BP curve. For the upper limits of normal was used 95th percentile from the multicenter study of German authors. RESULTS: There was no correlation between LVMi and evaluated parameters. CONCLUSIONS: The response of myocardium to chronic increase of the afterload is highly individual, and probably the role of genetics in this is very important. Echocardiography (LVMi) could not be used with certainty for the evaluation of ventricular mass.

Blood Pressure Monitoring, Ambulatory↗
PubMedDate not supplied

[Voiding dysfunction in children aged five to 15 years].

Voiding dysfunction in children was analyzed in 91 patients in a period from January 1st to October 1st 1998. Most of the patients had functional voiding disorder (92.31%), and only 7.69% manifested monosymptomatic night enuresis. The number of girls was bigger in the group of patients with voiding dysfunction while the boys were predominant in the group with monosymptomatic nocturnal enuresis. More than a half of children with functional voiding disorder had repeated urinal infections (58.23%), incontinence (93.49%), need for urgent voiding (68.13%), and vesicoureteral reflux (47.61%). The most common type of voiding dysfunction was urge syndrome/urge incontinence. The incidence of dysfunctional voiding disorder was more often in children with scaring changes of kidney which were diagnosed by static scintigraphy.

Adolescent↗
PubMedDate not supplied

[Management of idiopathic nephrotic syndrome in childhood].

The management of idiopathic nephrotic syndrome (INS) in children includes immunosuppressive and symptomatic treatment. The response to corticosteroid therapy is the best prognostic marker of the disease. The majority of children with INS (about 85%) are steroid-sensitive as they normalize proteinuria within 4 weeks of daily, oral prednisone administration. The most of steroid-sensitive patients (94%) has minimal change of nephrotic syndrome, while the majority (80.5%-94.4%) of those who are steroid-resistant has focal segmental glomerulosclerosis or mesangioproliferative glomerulonephritis. Initial therapy of INS consists of 60 mg/m2/day prednisone daily for 4 weeks followed by 40 mg/m2 on alternate days for 4 weeks, thereafter decreasing alternate day therapy every month by 25% over the next 4 months. Thus, the overall duration of the initial corticosteroids course is 6 months that may be significantly protective against the future development of frequent relapses. Approximately 30% of patients experience only one attack and are cured after the first course of therapy; 10-20% have only 3 or 4 steroid-responsive episodes before permanent cure; the remaining 40-50% of patients are frequent relapsers, or steroid-dependent. Standard relapse therapy consists of 60 mg/m2/ day prednisone until urine is protein free for at least 3 days, followed by 40 mg/m2 on alternate days for 4 weeks. The treatment of frequent-relapses and steroid-dependent INS includes several different regimens: maintenance (6 months) alternate steroid therapy just above steroid threshold (0.1-0.5 mg/kg/48h), levamisole, alkylating agents (cyclophosphamide or chlorambucil) or cyclosporine. The worse prognosis is expected in steroid-resistant patients who are the most difficult to treat. Renal biopsy should be performed in them. At present, there is no consensus on therapeutic regimen for steroid-resistant patients. The following immunosuppressive drugs have been used with varying success: cyclosporine, intravenous methyl prednisone pulses alone or combined with or followed by alkylating agents, plasma-exchange, and angiotensin-converting enzyme (ACE) inhibitors. Symptomatic treatment includes: 1) dietary regimen with normal protein intake and salt restriction, 2) calcium and vitamin D are prescribed with steroids, 3) diuretics should be used in case of severe edema, 4) infusion of albumin in case of severe hypovolemia, 5) treatment of hypertension, 6) anticoagulant therapy, and 7) prophylactic antibiotics in high-risk patients.

Child↗
PubMedDate not supplied

[Renal transplantation again at the University Children's Hospital of Belgrade].

After a 15-year break, pediatric renal transplantation restarted again at the University Children's Hospital of Belgrade. Owing to this, best relationship between the number of new patients with terminal renal failure and those with functioning graft has been recently achieved, and mortality of children with terminal renal failure has been decreased to zero. The aim of this paper was to show the recent results achieved in pediatric renal transplantation at the University Children's Hospital in Belgrade. During the period from June 2001 till June 2003, 10 patients, 6 boys and 4 girls, aged 5 to 15 years (9.5+/-3.8) underwent transplantation of kidney harvested from a live matched donor. Out of these, two patients underwent pre-emptive transplantation. Urine from the graft started immediately after anastomosis was performed, while serum creatinine normalized after 15 to 120 hours. Daclizumab was the most commonly used as immunosuppressive induction agent, but the maintenance immunosuppressive therapy consisted of Imuran or Mycophenolate Mofetil (MMF), Neoral or Tacrolimus (FK 506) and prednisone. At the end of follow up, after 18.7+/-8.4 months, nine patients had normal, and one patient slightly decreased renal graft function. Growth after transplantation and nutritional status were improved in all patients, and all of them achieved complete psychosocial rehabilitation. These results showed that the University Children's Hospital in Belgrade fulfilled all necessary conditions to become a specialized Center for Pediatric Renal Transplantation.

Adolescent↗
PubMedDate not supplied

[Classic and automated blood pressure monitoring in children with scarring nephropathy].

INTRODUCTION: Renal scarring is the most common cause of arterial hypertension in children. High blood pressure (BP) and microalbuminuria contribute to the progression of chronic renal disease. OBJECTIVE: The aims of the study were: to assess BP in children with renal scarring by continuous ambulatory blood pressure measurement (ABPM) in comparison to the casual method (CBP), and to determine the correlation between ambulatory blood pressure (ABP) and/or casual blood pressure (CBP) values and proteinuria in children with renal scarring, METHOD: This forward-looking study comprised thirty-five children (26 girls and 9 boys), aged between 3-18 years, 10.4 +/- 3.9, X +/- SD. Blood pressure was measured using the casual method (CBP) with a mercury manometer; BP was measured three times and the average was taken as a referent value. ABPM was performed using the oscillometric method with the SpaceLabs device, model 90207. RESULTS: 45.71% of patients were classified as hypertensive by ABPM, while only 22.6% of CBP measurements were above the 95th percentile (p < 0.01). "White coat hypertension" was present in 40% of the patients. Non-dipping BP alteration was detected in 37.14% of the patients. CONCLUSION: Nocturnal systolic hypertension (systolic non-dipping alteration) is very frequent in children with renal scarring. Nocturnal diastolic blood pressure, detectable only via ABPM, is positively correlated with proteinuria and may be an initial sign of the progression of renal scarring. ABPM is more sensitive than CBP in the evaluation of BP in children with renal scarring.

Adolescent↗
PubMedDate not supplied

[Ambulatory blood pressure values in healthy children].

Ambulatory blood pressure monitoring (ABPM) is an important tool in the diagnosis and management of childhood hypertension. Normal ambulatory blood pressure (ABP) values in children with body heights between 100 and 120 cm have not been reported. The aim of the study was to establish the normal range of values for ABPM in these children. 24-hour ABPM was performed in 40 normotensive (auscultatory casual blood pressure was obtained before ABPM) subjects, aged from 4 to 6 years (26 males, 14 females) with body heights between 95 and 125 cm. ABPM was carried out on non-dominant arm using the oscillometric device (SpaceLab 90207) with appropriate cuff size. The monitor was programmed to measure BP every 15 min. during the day (6 a.m. to 10 p.m.) and every 30 min. during the night (10 p.m. to 6 a.m.). The mean daytime SBP/DBP in boys and girls was 108+/-6/67+/-5 and 105+/-5/66+/-1, respectively. The mean nighttime SBP/DBP in boys and girls was 98+/6/56+/-5 and 97+/-7/56+/-4, respectively. There was a significant difference between day and night readings of SBP, DBP and heart rate (nocturnal fall was observed). The distribution of ABP noted in this study could serve as preliminary reference. A multicenter study should be performed to provide normal ranges of ABP.

Blood Pressure↗