BACKGROUND: Primary, secondary and tertiary healthcare services in Europe create complex networks covering pediatric subspecialties, sociology, economics and politics. Two surveys of the European Society for Paediatric Nephrology (ESPN) in 1998 and 2017 revealed substantial disparities of kidney care among European countries. The purpose of the third ESPN survey is to further identify national differences in the conceptualization and organization of European pediatric kidney health care pathways during and outside normal working hours. METHODS: In 2020, a questionnaire was sent to one leading pediatric nephrologist from 48 of 53 European countries as defined by the World Health Organization. In order to exemplify care pathways in pediatric primary care nephrology, urinary tract infection (UTI) was chosen. Steroid sensitive nephrotic syndrome (SSNS) was chosen for pediatric rare disease nephrology and acute kidney injury (AKI) was analyzed for pediatric emergency nephrology. RESULTS: The care pathways for European children and young people with urinary tract infections were variable and differed during standard working hours and also during night-time and weekends. During daytime, UTI care pathways included six different types of care givers. There was a shift from primary care services outside standard working hours to general outpatient polyclinic and hospital services. Children with SNSS were followed up by pediatric nephrologists in hospitals in 69% of countries. Patients presenting with community acquired AKI were admitted during regular working hours to secondary or tertiary care hospitals. During nights and weekends, an immediate shift to University Children's Hospitals was observed where treatment was started by intensive care pediatricians and pediatric nephrologists. CONCLUSION: Gaps and fragmentation of pediatric health services may lead to the risk of delayed or inadequate referral of European children with kidney disease to pediatric nephrologists. The diversity of patient pathways outside of normal working hours was identified as one of the major weaknesses in the service chain.

• Publikační typ
• časopisecké články MeSH

BACKGROUND: Impaired kidney concentration capacity is present in half of the patients with autosomal dominant polycystic kidney disease (ADPKD). The kidney concentrating capacity was further impaired within the animal model of autosomal recessive polycystic kidney disease (ARPKD). To date, only one small study has investigated it in children having ARPKD. Therefore, we aimed to study the kidney concentrating ability in a larger cohort of children with ARPKD. METHODS: Eighteen children (median age 8.5 years, range 1.3-16.8) were retrospectively investigated. A standardized kidney concentrating capacity test was performed after the application of a nasal drop of desmopressin (urine osmolality > 900 mOsmol/kg). The glomerular filtration rate was estimated using the Schwartz formula (eGFR) and blood pressure (BP) was measured as office BP. RESULTS: Kidney concentrating capacity was decreased (urine osmolality < 900 mOsmol/kg) in 100% of children with ARPKD. The median urine osmolality after desmopressin application was 389 (range 235-601) mOsmol/kg. Sixteen patients (89%) were defined as hypertensive based on their actual BP level or their use of antihypertensive drugs. The maximum amounts of urinary concentration correlated significantly with eGFR (r = 0.72, p < 0.0001) and hypertensive scores (r = 0.50, p < 0.05), but not with kidney size. Twelve patients (67%) were defined as having CKD stages 2-4. The median concentrating capacity was significantly lower in children within this group, when compared to children with CKD stage 1 possessing a normal eGFR (544 mOsmol/kg, range 413-600 mOsmol/kg vs. 327 mOsmol/kg, range 235-417 mOsmol/l, p < 0.001). CONCLUSIONS: Impaired kidney concentrating capacity is present in most children with ARPKD and is associated with decreased eGFR and hypertension. A higher resolution version of the Graphical abstract is available as Supplementary information.

• MeSH
• chronická renální insuficience * komplikace   MeSH
• desmopresin MeSH
• dítě MeSH
• hodnoty glomerulární filtrace MeSH
• hypertenze * MeSH
• ledviny MeSH
• lidé MeSH
• polycystické ledviny autozomálně dominantní * MeSH
• polycystické ledviny autozomálně recesivní * komplikace   MeSH
• retrospektivní studie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Accurate blood pressure (BP) measurement and its correct interpretation are essential factors influencing proper diagnosis and hypertension therapy. There are 5 methods of BP measurement. The office/casual/clinic blood pressure measurement has a central role as the most used method. This measurement is significantly influenced by its users and also by patient's response. Therefore, most of hypertension guidelines in adults but also in pediatrics have recommended out-of-office BP methods, i.e. home blood pressure measurement or ambulatory blood pressure monitoring. Automated office blood pressure measurement (AOBP) with the patient alone in a room is new method of BP measurement recommended for BP measurement in adult population. The aim of the paper is AOBP overview about its use in adults and children age.

• Klíčová slova
• automatické klinické měření krevního tlaku,
• MeSH
• ambulantní monitorování krevního tlaku metody   trendy   MeSH
• dítě MeSH
• hypertenze diagnostické zobrazování   prevence a kontrola   MeSH
• krevní tlak fyziologie   MeSH
• lidé MeSH
• měření krevního tlaku * klasifikace   metody   trendy   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

Souhrn Arteriální hypertenze je jedním z nejdůležitějších, hlavních rizikových faktorů kardiovaskulární morbidity a mortality u dospělých a kardiovaskulárních a renálních onemocnění v dětském věku. Tato doporučení pro diagnostiku a léčbu hypertenze u dětí vycházejí ze současných doporučení Evropské společnosti pro hypertenzi.

• MeSH
• anamnéza MeSH
• antihypertenziva aplikace a dávkování   klasifikace   MeSH
• dítě MeSH
• hypertenze * diagnóza   klasifikace   terapie   MeSH
• krevní tlak MeSH
• lidé MeSH
• měření krevního tlaku metody   MeSH
• mladiství MeSH
• statistika jako téma MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

• Publikační typ
• tisková chyba MeSH

Most patients with congenital anomalies of the kidney and urinary tract (CAKUT) remain genetically unexplained. In search of novel genes associated with CAKUT in humans, we applied whole-exome sequencing in a patient with kidney, anorectal, spinal, and brain anomalies, and identified a rare heterozygous missense variant in the DACT1 (dishevelled binding antagonist of beta catenin 1) gene encoding a cytoplasmic WNT signaling mediator. Our patient's features overlapped Townes-Brocks syndrome 2 (TBS2) previously described in a family carrying a DACT1 nonsense variant as well as those of Dact1-deficient mice. Therefore, we assessed the role of DACT1 in CAKUT pathogenesis. Taken together, very rare (minor allele frequency ≤ 0.0005) non-silent DACT1 variants were detected in eight of 209 (3.8%) CAKUT families, significantly more frequently than in controls (1.7%). All seven different DACT1 missense variants, predominantly likely pathogenic and exclusively maternally inherited, were located in the interaction region with DVL2 (dishevelled segment polarity protein 2), and biochemical characterization revealed reduced binding of mutant DACT1 to DVL2. Patients carrying DACT1 variants presented with kidney agenesis, duplex or (multi)cystic (hypo)dysplastic kidneys with hydronephrosis and TBS2 features. During murine development, Dact1 was expressed in organs affected by anomalies in patients with DACT1 variants, including the kidney, anal canal, vertebrae, and brain. In a branching morphogenesis assay, tubule formation was impaired in CRISPR/Cas9-induced Dact1-/- murine inner medullary collecting duct cells. In summary, we provide evidence that heterozygous hypomorphic DACT1 variants cause CAKUT and other features of TBS2, including anomalies of the skeleton, brain, distal digestive and genital tract.

• MeSH
• adaptorové proteiny signální transdukční genetika   metabolismus   MeSH
• jaderné proteiny metabolismus   MeSH
• ledviny abnormality   MeSH
• lidé MeSH
• močové ústrojí * abnormality   MeSH
• myši MeSH
• protein dishevelled genetika   MeSH
• urogenitální abnormality * genetika   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• myši MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

Cíl studie: Porovnání metod stanovení sérového kreatininu (S-Kr) a zhodnocení vlivu použité metody na odhad glomerulární filtrace (eGFR) u dětí s onemocněním ledvin. Metody: S-Kr jsme vyšetřovali u 168 dětí (102 chlapců, medián věku 12,8 let, rozmezí 1,7-15,9 let). V každém vzorku byl S-Kr stanoven Jaffého metodou a enzymově (biochemický automatický analyzátor Advia 1800, Siemens, USA). GFR byla odhadnuta podle Schwartzova vzorce. Výsledky: Jaffého metoda poskytovala statisticky významně vyšší výsledky S-Kr (v průměru o 17 μmol/l) v nižším koncentračním rozmezí (do 200 μmol/l) a naopak, ve vyšších koncentracích (nad 250 μmol/l) poskytovala výsledky statisticky významně nižší (v průměru o 35 μmol/l). Do hodnoty S-Kr 60 μmol/l Jaffého metodou byly hodnoty eGFR podle očekávání nižší s vyšším S-Kr ve srovnání s enzymovou metodou. Hodnoty eGFR však byly paradoxně vyšší u všech pacientů se S-Kr nad 100 μmol/l při použití Jaffého metody. Tento paradox byl patrný zejména u dospívajících chlapců, a to především kvůli odlišnému koeficientu F použitému pro výpočet eGFR. Závěr: Odhad GFR závisí na přesnosti měření S-Kr a koeficientu F ve Schwartzově vzorci. Tyto vlivy mohou mít závažné klinické důsledky především u dětí s pokročilým chronickým onemocněním ledvin stadia 4 a 5 (nejvíce u adolescentních chlapců), kdy enzymová metoda poskytuje významně nižší hodnoty eGFR, což může vyústit v časnější zahájení dialyzační léčby.

• Klíčová slova
• Jaffého metoda,
• MeSH
• hodnoty glomerulární filtrace * MeSH
• klinická studie jako téma MeSH
• kreatinin metabolismus   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH

PURPOSE OF REVIEW: The goal is to review masked hypertension (MH) as a relatively new phenomenon when patients have normal office BP but elevated out-of-office BP. Firstly, it was described in children in 2004. It has received increased attention in the past decade. RECENT FINDINGS: The prevalence of MH in different pediatric populations differs widely between 0 and 60% based on the population studied, definition of MH, or method of out-of-office BP measurement. The highest prevalence of MH has been demonstrated in children with chronic kidney disease (CKD), obesity, diabetes, and after heart transplantation. In healthy children but with risk factors for hypertension such as prematurity, overweight/obesity, diabetes, chronic kidney disease, or positive family history of hypertension, the prevalence of MH is 9%. In healthy children without risk factors for hypertension, the prevalence of MH is very low ranging 0-3%. In healthy children, only patients with the following clinical conditions should be screened for MH: high-normal/elevated office BP, positive family history of hypertension, and those referred for suspected hypertension who have normal office BP in the secondary/tertiary center.

• MeSH
• chronická renální insuficience * MeSH
• dítě MeSH
• hypertenze * diagnóza   epidemiologie   MeSH
• lidé MeSH
• maskovaná hypertenze * diagnóza   epidemiologie   MeSH
• mladiství MeSH
• obezita MeSH
• rizikové faktory MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

Autosomal dominant polycystic kidney disease (ADPKD) resulting from pathogenic variants in PKD1 and PKD2 is the most common form of PKD, but other genetic causes tied to primary cilia function have been identified. Biallelic pathogenic variants in the serine/threonine kinase NEK8 cause a syndromic ciliopathy with extra-kidney manifestations. Here we identify NEK8 as a disease gene for ADPKD in 12 families. Clinical evaluation was combined with functional studies using fibroblasts and tubuloids from affected individuals. Nek8 knockout mouse kidney epithelial (IMCD3) cells transfected with wild type or variant NEK8 were further used to study ciliogenesis, ciliary trafficking, kinase function, and DNA damage responses. Twenty-one affected monoallelic individuals uniformly exhibited cystic kidney disease (mostly neonatal) without consistent extra-kidney manifestations. Recurrent de novo mutations of the NEK8 missense variant p.Arg45Trp, including mosaicism, were seen in ten families. Missense variants elsewhere within the kinase domain (p.Ile150Met and p.Lys157Gln) were also identified. Functional studies demonstrated normal localization of the NEK8 protein to the proximal cilium and no consistent cilia formation defects in patient-derived cells. NEK8-wild type protein and all variant forms of the protein expressed in Nek8 knockout IMCD3 cells were localized to cilia and supported ciliogenesis. However, Nek8 knockout IMCD3 cells expressing NEK8-p.Arg45Trp and NEK8-p.Lys157Gln showed significantly decreased polycystin-2 but normal ANKS6 localization in cilia. Moreover, p.Arg45Trp NEK8 exhibited reduced kinase activity in vitro. In patient derived tubuloids and IMCD3 cells expressing NEK8-p.Arg45Trp, DNA damage signaling was increased compared to healthy passage-matched controls. Thus, we propose a dominant-negative effect for specific heterozygous missense variants in the NEK8 kinase domain as a new cause of PKD.

• MeSH
• cilie patologie   MeSH
• kationtové kanály TRPP genetika   metabolismus   MeSH
• kinasy NEK genetika   metabolismus   MeSH
• ledviny metabolismus   MeSH
• lidé MeSH
• mutace MeSH
• myši MeSH
• novorozenec MeSH
• polycystická choroba ledvin * genetika   MeSH
• polycystické ledviny autozomálně dominantní * patologie   MeSH
• protein-serin-threoninkinasy genetika   metabolismus   MeSH
• serin genetika   metabolismus   MeSH
• transportní proteiny metabolismus   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• myši MeSH
• novorozenec MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH