BACKGROUND: Nephritis is a common manifestation of IgA vasculitis and is morphologically indistinguishable from IgA nephropathy. While MEST-C scores are predictive of kidney outcomes in IgA nephropathy, their value in IgA vasculitis nephritis has not been investigated in large multiethnic cohorts. METHODS: Biopsies from 262 children and 99 adults with IgA vasculitis nephritis ( N =361) from 23 centers in North America, Europe, and Asia were independently scored by three pathologists. MEST-C scores were assessed for correlation with eGFR/proteinuria at biopsy. Because most patients ( N =309, 86%) received immunosuppression, risk factors for outcomes were evaluated in this group using latent class mixed models to identify classes of eGFR trajectories over a median follow-up of 2.7 years (interquartile range, 1.2-5.1). Clinical and histologic parameters associated with each class were determined using logistic regression. RESULTS: M, E, T, and C scores were correlated with either eGFR or proteinuria at biopsy. Two classes were identified by latent class mixed model, one with initial improvement in eGFR followed by a late decline (class 1, N =91) and another with stable eGFR (class 2, N =218). Class 1 was associated with a higher risk of an established kidney outcome (time to ≥30% decline in eGFR or kidney failure; hazard ratio, 5.84; 95% confidence interval, 2.37 to 14.4). Among MEST-C scores, only E1 was associated with class 1 by multivariable analysis. Other factors associated with class 1 were age 18 years and younger, male sex, lower eGFR at biopsy, and extrarenal noncutaneous disease. Fibrous crescents without active changes were associated with class 2. CONCLUSIONS: Kidney outcome in patients with biopsied IgA vasculitis nephritis treated with immunosuppression was determined by clinical risk factors and endocapillary hypercellularity (E1) and fibrous crescents, which are features that are not part of the International Study of Diseases of Children classification.

• MeSH
• biopsie MeSH
• dítě MeSH
• dospělí MeSH
• hodnoty glomerulární filtrace MeSH
• IgA nefropatie * komplikace   farmakoterapie   patologie   MeSH
• IgA vaskulitida * komplikace   farmakoterapie   patologie   MeSH
• ledviny patologie   MeSH
• lidé MeSH
• mladiství MeSH
• nefritida * komplikace   MeSH
• proteinurie etiologie   MeSH
• retrospektivní studie MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Takzvaná Hippokratova Přísaha vychází ze standardizované podoby přísahy v antickém světě a představuje bezpochyby nejslavnější, nejdiskutovanější a nejkomentovanější součást Corpus Hippocraticum, souboru spisů s lékařskou tematikou, jejichž autorství je tradičně připisováno osobě legendárního lékaře Hippokrata. Studie nejprve představí charakter tohoto stručného textu i různé teorie o vzniku Přísahy stejně jako doklady jejího nejstaršího užití. Druhá část studie se soustředí na historii lékařských sponzí v Československu od roku 1918, mapuje proměny textu sponzí po roce 1948 (zejména na základě dosud nepublikovaných archivních materiálů) a uvádí podobu současných lékařských sponzí v České republice se zřetelem k formulacím samotné Hippokratovy Přísahy; v přehledné tabulce je uvedeno jejich české i latinské znění.

The so-called Hippocratic Oath is based on a standardized form of oath in the ancient world and is undoubtedly the most famous, most discussed and most commented part of the Corpus Hippocraticum, collection of medical writings whose authorship is traditionally attributed to the legendary physician Hippocrates. The study will first introduce the nature of this brief text and the various theories about the origins of the Oath, as well as the evidence for its earliest use. The second part of the study focuses on the history of medical oaths in Czechoslovakia since 1918, especially on the changes in the text of the oaths after 1948 (mainly on the basis of so far unpublished documents from the archives), and presents the form of current medical oaths in the Czech Republic, with reference to the formulations of the Hippocratic Oath itself; an overview table lists both the Czech and Latin versions of the current medical oaths.

• MeSH
• dějiny lékařství MeSH
• Hippokratova přísaha * MeSH
• lékařská etika dějiny   MeSH
• lidé MeSH
• studium lékařství MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• Česká republika MeSH
• Československo MeSH

BACKGROUND: High prevalence of arterial hypertension is known in pediatric renal transplant patients, but how blood pressure (BP) distribution and control differ between age groups and whether sex and age interact and potentially impact BP after transplantation have not been investigated. METHODS: This retrospective analysis included 336 pediatric renal transplant recipients (62% males) from the Cooperative European Pediatric Renal Transplant Initiative Registry (CERTAIN) with complete BP measurement at discharge and 1, 2 and 3 years post-transplant. RESULTS: At discharge and 3 years post-transplant, arterial hypertension was highly prevalent (84% and 77%); antihypertensive drugs were used in 73% and 68% of the patients. 27% suffered from uncontrolled and 9% from untreated hypertension at 3 years post-transplant. Children transplanted at age < 5 years showed sustained high systolic BP z-score and received consistently less antihypertensive treatment over time. Younger age, shorter time since transplantation, male sex, higher body mass index (BMI), high cyclosporine A (CSA) trough levels, and a primary renal disease other than congenital anomalies of the kidney and urinary tract (CAKUT) were significantly associated with higher systolic BP z-score. Sex-stratified analysis revealed a significant association between high CSA and higher systolic BP in older girls that likely had started puberty already. An association between BP and estimated glomerular filtration rate was not detected. CONCLUSIONS: BP control during the first 3 years was poor in this large European cohort. The description of age- and sex-specific risk profiles identified certain recipient groups that may benefit from more frequent BP monitoring (i.e. young children) or different choices of immunosuppression (i.e. older girls).

• MeSH
• časové faktory MeSH
• cyklosporin aplikace a dávkování   škodlivé účinky   farmakokinetika   MeSH
• dítě MeSH
• hypertenze diagnóza   epidemiologie   etiologie   MeSH
• imunosupresiva aplikace a dávkování   škodlivé účinky   farmakokinetika   MeSH
• lidé MeSH
• longitudinální studie MeSH
• měření krevního tlaku statistika a číselné údaje   MeSH
• mladiství MeSH
• následné studie MeSH
• předškolní dítě MeSH
• prevalence MeSH
• příjemce transplantátu statistika a číselné údaje   MeSH
• registrace statistika a číselné údaje   MeSH
• rejekce štěpu imunologie   prevence a kontrola   MeSH
• retrospektivní studie MeSH
• sexuální faktory MeSH
• takrolimus aplikace a dávkování   škodlivé účinky   farmakokinetika   MeSH
• transplantace ledvin škodlivé účinky   MeSH
• věkové faktory MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: Variable effects of steroid minimization strategies on blood pressure in pediatric renal transplant recipients have been reported, but data on the effect of steroid withdrawal on ambulatory blood pressure and circadian blood pressure rhythm have not been published so far. METHODS: In a prospective, randomized, multicenter study on steroid withdrawal in pediatric renal transplant recipients (n = 42) on cyclosporine, mycophenolate mofetil, and methylprednisolone, we performed a substudy in 28 patients, aged 11.2 ± 3.8 years, for whom ambulatory blood pressure monitoring (ABPM) data were available. RESULTS: In the steroid-withdrawal group, the percentage of patients with arterial hypertension, defined as systolic and/or diastolic blood pressure values recorded by ABPM > 1.64 SDS and/or antihypertensive medication, at month 15 was significantly lower (35.7%, p = 0.002) than in controls (92.9%). The need of antihypertensive medication dropped significantly by 61.2% (p < 0.000 vs. control), while in controls, it even rose by 69.3%. One year after steroid withdrawal, no patient exhibited hypertensive blood pressure values above the 95th percentile, compared to 35.7% at baseline (p = 0.014) and to 14.3% of control (p = 0.142). The beneficial impact of steroid withdrawal was especially pronounced for nocturnal blood pressure, leading to a recovered circadian rhythm in 71.4% of patients vs. 14.3% at baseline (p = 0.002), while the percentage of controls with an abnormal circadian rhythm (35.7%) did not change. CONCLUSIONS: Steroid withdrawal in pediatric renal transplant recipients with well-preserved allograft function is associated with less arterial hypertension recorded by ABPM and recovery of circadian blood pressure rhythm by restoration of nocturnal blood pressure dipping.

• MeSH
• alografty imunologie   patofyziologie   MeSH
• ambulantní monitorování krevního tlaku MeSH
• cirkadiánní rytmus fyziologie   MeSH
• cyklosporin aplikace a dávkování   škodlivé účinky   MeSH
• dítě MeSH
• glukokortikoidy aplikace a dávkování   škodlivé účinky   MeSH
• hodnoty glomerulární filtrace fyziologie   MeSH
• homologní transplantace škodlivé účinky   MeSH
• hypertenze chemicky indukované   diagnóza   prevence a kontrola   MeSH
• imunosupresiva aplikace a dávkování   škodlivé účinky   MeSH
• krevní tlak účinky léků   MeSH
• kyselina mykofenolová aplikace a dávkování   škodlivé účinky   MeSH
• ledviny imunologie   patofyziologie   MeSH
• lidé MeSH
• methylprednisolon MeSH
• mladiství MeSH
• nenasazení léčby * MeSH
• prospektivní studie MeSH
• rejekce štěpu imunologie   patofyziologie   prevence a kontrola   MeSH
• transplantace ledvin škodlivé účinky   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

• MeSH
• domovy pro seniory MeSH
• lidé MeSH
• ošetřovatelská péče MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• novinové články MeSH
• rozhovory MeSH
• Geografické názvy
• Austrálie MeSH

BACKGROUND: Febrile urinary tract infections (fUTIs) are common after kidney transplantation (KTx); however, prospective data in a multicenter pediatric cohort are lacking. We designed a prospective registry to record data on fUTI before and after pediatric KTx. METHODS: Ninety-eight children (58 boys and 40 girls) ≤ 18 years from 14 mid-European centers received a kidney transplant and completed a 2-year follow-up. RESULTS: Posttransplant, 38.7% of patients had at least one fUTI compared with 21.4% before KTx (p = 0.002). Before KTx, fUTI was more frequent in patients with congenital anomalies of kidneys and urinary tract (CAKUT) vs. patients without (38% vs. 12%; p = 0.005). After KTx, fUTI were equally frequent in both groups (48.7% vs. 32.2%; p = 0.14). First fUTI posttransplant occurred earlier in boys compared with girls: median range 4 vs. 13.5 years (p = 0.002). Graft function worsened (p < 0.001) during fUTI, but no difference was recorded after 2 years. At least one recurrence of fUTI was encountered in 58%. CONCLUSION: This prospective study confirms a high incidence of fUTI after pediatric KTx, which is not restricted to patients with CAKUT; fUTIs have a negative impact on graft function during the infectious episode but not on 2-year graft outcome.

• MeSH
• dítě MeSH
• horečka epidemiologie   etiologie   MeSH
• incidence MeSH
• infekce močového ústrojí komplikace   epidemiologie   etiologie   MeSH
• lidé MeSH
• mladiství MeSH
• nemoci ledvin chirurgie   MeSH
• opožděný nástup funkce štěpu epidemiologie   etiologie   MeSH
• předškolní dítě MeSH
• prospektivní studie MeSH
• rejekce štěpu epidemiologie   etiologie   MeSH
• rizikové faktory MeSH
• sexuální faktory MeSH
• transplantace ledvin škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH

• MeSH
• těžké vrozené vady MeSH

• Konspekt
• Pediatrie
• NLK Obory
• perinatologie a neonatologie
• NLK Publikační typ
• vzácné tisky