The concentration of leptin and apelin in HT-OB children was significantly higher than in the C and HT-NW group. A similar finding for leptin level was demonstrated in comparison of HT-NW with C group. In children with HT-OB, the lack of decline in nocturnal DBP was associated with significantly higher BMI and the Cole's Index value. Children with HT-OB and lack of decline in nocturnal SBP showed lower leptin and insulin concentrations, and lower values of HOMA-IR as compared with dipping children. Positive correlation in the whole study group was found between adipokines levels and BP measurements. In conclusion, children with primary HT show higher concentration of adipokines compared with their healthy peers. The data on relationship of serum adipokines levels with anthropometric and BP parameters in children may be helpful to clarify the sequence of disturbances in the cardiovascular system in adults, which requires further examination.

Introduction: Adipose tissue through the many secreted adipocytokines creates a highly active metabolic and endocrine organ. The evaluation of serum adipocytokine concentration in children with chronic kidney disease (CKD) could serve as a marker of cardio-vascular complication progression and an index of outcome in adulthood and after kidney transplantation. Material and methods:The aim of the study was to evaluate simultaneously the serum concentrations of six different adipocytokines: adiponectin, apelin, chemerin, omentin, resistin, and vaspin, in 28 children with CKD stage 5 on haemodialysis and peritoneal dialysis. Results: The concentration of apelin, omentin, and resistin in children with CKD was significantly higher and the concentration of vaspin, adiponectin, and chemerin was significantly lower than in the control group. After adjusting to body mass index (BMI), the same results were obtained. After adjusting to body surface area (BSA), the concentration of vaspin, adiponectin, and chemerin did not differ between children with CKD and the control group. In analysis of the correlation between serum total adipocytokine levels in children with CKD we found a negative relationship in pairs: omentin-apelin and omentin-vaspin, and positive in pairs: adiponectin-chemerin and adiponectin-resistin. Conclusions: Our results show that changes in serum adipocytokines concentration are associated with the kidney dysfunction in CKD in children. Longitudinal studies on larger groups of paediatric cohorts would be helpful in investigating whether adipocytokines play a harmful role in the development of CKD and would enable further understanding of the risk factors for CKD progression.

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A 14-year-old Caucasian girl with a history of primary hypoparathyroidism and unstable calcium and phosphorus levels and on ongoing treatment was admitted to the Department of Pediatric Nephrology because of the onset of nephrocalcinosis and difficulties achieving normocalcemia. Coexistence of hypoparathyroidism, oral candidiasis, dental enamel hypoplasia, and subclinical Hashimoto's disease was strongly suggestive for autoimmune polyglandular syndrome (APS) type I. One of the clinical implications of this diagnosis is the high probability of future occurrence of adrenal insufficiency and hence the importance of maintaining a high level of suspicion in case of the onset of symptoms like weakness, fainting, hypotonia, or hyperkaliemia. Addison's disease would, in fact, be quite challenging for the future management of this patient.This clinical quiz highlighted the importance of careful evaluation of all multiorgan symptoms occurring in a patient to prevent further complications.Keywords Nephrocalcinosis . Autoimmune polyendocrine syndrome type 1 . Hypoparathyroidism . Children Case presentationA 14-year-old Caucasian girl with a history of primary hypoparathyroidism and unstable calcium and phosphorus levels and on ongoing treatment was admitted to the Department of Pediatric Nephrology because of the onset of nephrocalcinosis and difficulties achieving normocalcemia. The obstetric, neonatal, and developmental history was unremarkable. The child was born at full term after a normal seventh pregnancy and fifth delivery, with a birth weight of 3150 g and an Apgar score of 10. An adenoidectomy was performed at the age of 6 years. The first symptoms of the disease appeared at the age of 9 years and consisted of several episodes of syncope and seizures. At presentation, apart from a white-coated tongue, dental caries, and enamel hypoplasia, the clinical, neurological, cardiovascular, and ophthalmic examinations were norm a l . L a b o r a t o r y t e s t s r e v e a l e d h y p o c a l c e m i a , hyperphosphatemia, and low serum parathyroid hormone (sPTH). Computed tomography (CT) and magnetic resonance (MR) imaging revealed bilateral calcifications in the basal ganglia and the frontal lobes (Fig. 1). The thyroid gland was slightly heterogeneous on ultrasound, and antithyroid peroxidase (anti-TPO) antibodies were present, without any other clinical or biochemical features of hypothyreosis. A treatment of primary hypoparathyroidism based on calcium supplementation and 1-α-hydroxycholecalciferol administration was prescribed. During a period of 3 years (2011)(2012)(2013)(2014), the dosage had to be progressively increased due to persisting hypocalcemia, to a maximum of 4.0 g of calcium carbonate and 1.75 μg of 1-α-hydroxycholecalciferol daily. In January 2015, the patient was hospitalized because of dyspnea, generalized weakness, polydipsia, nausea, and tachycardia. She was severely hypercalcemic at that moment but recovered rapidly after intensive fluid therapy, loop diuretics, and temporary withdrawal of th...

Adrenal myelolipoma is a rare, benign tumor of the adrenal glands, in most cases, a clinically silent, hormonally inactive. Extremely rare occurs in the pediatric population. It may be accompanied by Cushing disease and congenital adrenal hyperplasia as well. Generally, this tumor is detected incidentally during routine imaging tests. The most sensitive diagnostic method to identify myelolipoma is a computed tomography. Asymptomatic tumors do not require treatment, whereas large lesions should be treated surgically. In this case, the myelolipoma tumor was detected in a 14-year-old girl with congenital adrenal hyperplasia and manifested with severe abdominal pain.

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W S T Ę P:Aktualnie nie posiadamy wiarygodnych danych dotyczących epidemiologii kamicy układu moczowego w populacji dzieci i młodzieży w Polsce. Wydaje się, że staje się ona chorobą cywilizacyjną i jest coraz częściej rozpoznawana w populacji pediatrycznej. Przyczyn tego zjawiska doszukuje się w zmieniających się nawykach żywie-niowych, braku aktywności fizycznej, epidemii otyłości a nawet globalnym ociepleniu klimatu. M A T E R I A Ł I M E T O D Y:Artykuł przedstawia wyniki retrospektywnej analizy grupy dzieci hospitalizowanych z powodu kamicy układu moczowego oraz metabolicznej predyspozycji do tworzenia się złogów w układzie moczowym, przeprowadzonej w latach 2010-2013 na Oddziale Nefrologii Dzieci Samodzielnego Publicznego Szpitala Klinicznego nr 1 w Zabrzu. Oceny dokonano pod kątem częstości występowania poszczególnych metabolicznych czynników ryzyka oraz ich związku z obrazem ultrasonograficznym. W Y N I K I I W N I O S K I:Grupa dzieci z podejrzeniem kamicy dróg moczowych lub stanu metabolicznej predyspozycji do rozwoju kamicy charakteryzuje się dużą różnorodnością zaburzeń biochemicznych sprzyjających krystalizacji złogów w drogach moczowych. Zaskakujące jest spostrzeżenie o braku powiązań pomiędzy nasileniem zmian o charakterze kamicy w badaniu ultrasonograficznym a zaburzeniami biochemicznymi potencjalnie predysponującymi do tworzenia się złogów. Obraz wapnicy nerek w badaniu ultrasonograficznym wykazuje natomiast wyraźny związek z hiperkalciurią. Pierwotne zaburzenie funkcji przytarczyc oraz przedawkowanie witaminy D rzadko stanowią wyjaśnienie przyczyny kamicy układu moczowego. S Ł O W A K L U C Z O W Ekamica układu moczowego, dzieci, hiperkalciuria, nefrokalcynoza

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