Introduction. A comprehensive analysis of the polymorphisms of the genes of the renin-angiotensin system in children with different nosological forms of nephropathies is a necessary step in determining the clinical and genetic features of the formation of chronic kidney disease (CKD). Aim: to establish the features of ACE (D/I), GT (Thr174Met), AGT (Met235Thr) and AGTR1 (A1166C) gene polymorphisms in CKD children and determine their significance in the progression of the disease. Materials and methods. A retrospective and prospective study included one hundered 1 to 17 years children with nephropathies, examined in the children’s nephrology department of the Samara Regional Hospital over 10 years. In children, the identification of single nucleotide polymorphisms of genes was carried out using an allele-specific polymerase chain amplification reaction using test systems. Evaluation of clinical and paraclinical markers of progression in CKD was carried out twice a year. The results of the study were evaluated with the calculation of the Student–Fisher criteria and correlation analysis. Results. in patients with kidney diseases, there was a trend towards an increase in the occurrence of single nucleotide polymorphisms of genes that affect the renin-angiotensin system (RAS). CKD patients at the stage 3–5 accounted for 35%. They had D/D ACE alleles combined with alleles AGT Thr174Met (27.9 ± 6.83%) and Met235Thr (41.86 ± 7.5%), Thr235Thr (30.2 ± 7.0%) and AGTR1 A1166C (37.2 ± 7.32%) more often than in milder CKD (0 and 7.5 ± 3.37%; 5.2 ± 2.94% and 5.2 ± 2.94%; respectively, p ≤ 0.010). Соnclusion. The study of clinical and genetic features of CKD is relevant for the purpose of timely implementation of preventive measures.
Coronaviruses, seven of which are known to infect humans, can range from asymptomatic infection to malnutrition and death. Russia has over 12.4 million confirmed cases of COVID-19 at the time of writing, with nearly 334,000 deaths. While all other coronaviruses affect cardiovascular disease, the SARS-CoV-2 virus also has a tropism for the cardiovascular system, gastrointestinal tract, liver, pancreas, kidneys, and nervous system. In this review, we describe the important gastrointestinal manifestations of COVID-19 in children and discuss possible underlying pathophysiological mechanisms for their occurrence.
Chronic kidney disease and a decrease in its progression is a global health problem. However, the risk factors associated with the primary nosology of glomerular diseases of children have not been sufficiently studied.Purpose. To determine early risk factors for the progression of chronic kidney disease for more effective prevention of chronization of the process, based on the analysis of clinical and anamnestic data, the features of the manifestation of the primary developed glomerular pathology, and taking into account nosological forms.Material and methods. The experience of own clinical observations, retro- and prospective, related to the formation of chronic kidney disease of children with glomerular pathology is summarized. The study was conducted on the basis of the children’s uronephrological center of the Samara Regional Clinical Hospital named after V.D. Seredavin.Results. The universal risk factors are systematized: transferred critical conditions in the perinatal period with the development of acute kidney injury; prenatally established CAKUT syndrome; the presence of a genetic predisposition to kidney diseases, a complex of allergic diseases in the family; the carriage of persistent infections, hemolytic strains of streptococcus, social determinant, environmental conditions, etc. Specific early risk factors for disease progression, features of the onset of kidney pathology and biomarkers of progression that determine early kidney damage have been identified. The features of nephroprotection are formulated: interdisciplinarity with the inclusion of organizational, social components; operational communication with the outpatient link; the use of social networks for educational processes — the patient’s family, training of first-contact doctors.
Transition of an adolescent patient with chronic kidney disease (CKD) from pediatric to adult healthcare system is an urgent problem Worldwide. The purpose of this research was to generalize the idea of readiness of adolescents with CKD to transfer into adult nephrology healthcare system, to describe the challenges of such transition period and to determine the roles of participants in the process and their mutual interactions in order to develop and implement the working regional model for organizing the transition of adolescents with CKD within a clustered system of provision of specialized healthcare services. Materials and methods used: a single-center cross-sectional questionnaire surveying of adolescents and young adults with CKD regarding their readiness to transition in two observation groups was carried out on the basis of both adult and pediatric sections of the Samara Oblast Regional Clinical Hospital named after V.D. Seredavin (Samara, Russia) in Jan. 2021-March 2023. Group 1 consisted of young adults aged 18 to 22 y/o with CKD stages 2 to 3; and Group 2 included adolescents aged 13 to 18 y/o with CKD stages 2 to 5. The results were then evaluated with the TRxANSITION Index (formerly TRxANSITION Scale), PedsQL and the SF-36 questionnaire. Adolescents’ parents/caretakers took a survey on the independence of their children as well. Results: the data on the insufficient independence of adolescents were obtained, as follows: 66.7% [34.9-90.1%] (n=8) “never” took medication on their own, 50.0% [21.1-78.9%] (n=6) have never asked their physicians questions (p<0.001), 50.0% [21.1-78.9%] (n=6) “never” and 33.3% [9.9-65.1%] (n=4) “almost never” did they agree to meet with the physician (p=0.005). Adolescents experienced difficulties in both communicating and working together with a physician: 33.3% [9.9-65.1%] (n=4) and 25.0% [5.5-57.2%] (n=3) “difficult,” respectively; 50.0% [21.1-78.9%] (n=6) and 58.3% [27.7-84.8%] (n= 7) “almost difficult,” respectively (p<0.001). On the other hand, “almost everything” and “everything” do they know about their health status 47.1% [23.0-72.2%] (n=8) and 35.4% [14.2-61.7%] (n=6), respectively, of young adults with CKD vs. adolescents (p<0.001). Conclusion: structurization of the participants’ roles in the communication system “patient and his family members - medicine professionals - psychologists - social workers” contributes to the stabilization of an adolescent with CKD during the transition period.
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