Renal patients often suffer from chronic disease, based of long-term consequences of lower urinary tract dysfunction or long lasting glomerular diseases. Patients on dialysis and recipients of the renal graft are specific subpopulation. Nevertheless long-term therapeutic strategy, monitoring and slowing the rate of renal insufficiency or maintaining the best achievable condition of patients on renal replacement therapy, several problems of quality of life, adherence to treatment, psychological and physical development (in patients with substantial growth failure and hormonal retardation), as well of optimal transition to adult center remain to be significant issues for the nephrology team.

Treatment and medical management of children with Crohn’s disease (CD) vary from clinical approach towards adults due to individual features of the disease specific for young patients. Therefore paediatric section of ECCO (European Crohn’s and Colitis Organization) together with ESPGHAN (EuropeanSociety of Paediatric Gastroenterology, Hepatology and Nutrition) working group have established the first Consensus guidelines on the medical management of paediatric CD.

The efficacy of antimicrobial prophylaxis in children with vesicoureteral reflux is debated for years, and the recommendations of societies of nephrology or pediatrics are different. New England Journal of Medicine has recently published a reliable analysis in children with vesicoureteral reflux - RIVUR (Randomized Intervention for Children with Vesicoureteral Reflux). Authors present the results of the study, their relevance to clinical practice and suggest possible perspectives.

This article summarizes current recommendations for management of urinary tract infections in children made by the American Academy of Pediatrics and the United Kingdom’s National Institute for Health and Care Excellence. However, the new recommendations regarding voiding cystourethrograms (VCUG) is being questioned. We recommend that you also read the last section of this article entitled “Controversy” to understand the questioning of the new recommendations.

Infectious diseases in childhood are very rarely associated with states of emergency. The most common emergencies in children are: dehydration, convulsions, neuroinfections and sepsis. The aim of article is to present the most common infectious diseases in childhood in Poland, which may be complicated by life-threatening conditions. Many of them are vaccine preventable. Article provides arguments for doctors in discussion with the
movements against vaccinations.

A child skin is different than adult skin in terms of structure. It is thin, immature and prone to irritation. The clinical picture and course of skin diseases in children is often different from those found in adults. Moreover, some skin diseases are developmental period- and child’s age-specific. Understanding ofthe child skin structure distinctness and the knowledge of most frequent childhood dermatoses seems to be necessary in pediatric practice. In this articlewe present the most frequent dermatoses and skin lesions in children.

Chest pain in children and adolescents is one of the most common reasons for visits to the pediatrician and family doctor. It causes a great deal of anxiety in patients, their parents and the medical staff. It often leads to the performance of a number of tests to assess the cardiovascular system. In children, unlike in adults, the cause is rarely cardiac (0.6-4%). A detailed history and physical examination, which are essential elements in the evaluation of a childwith chest pain, are sufficient in the vast majority of cases, to exclude a cardiac cause of the pain. We review the main causes and characteristics of chestpain in children. Furthermore, we also present the most important features that may serve as warning signs of chest pain of cardiac origin, as well as anoverview of the most common cardiac causes of chest pain.

Diabetic ketoacidosis (DKA) is an acute metabolic complication, which occurs in people with type 1 diabetes. DKA results from relative or absolute deficiency of circulating insulin level and the combined effects of increased levels of the contrregulatory hormones like: glucagon, catecholamines, cortisol, growth hormone. The risk of DKA increases in children with newly diagnosed diabetes, below 2 years of age, with poor metabolic control, during puberty, with failure in insulin pump therapy, from poorer socioeconomic backgrounds. DKA is the main cause of death in type 1 diabetic children. The death in DKA is mainly caused by cerebral edema. Diagnostic and therapeutic management of children with DKA should take place in specialized diabetes wards or in intensive care units.

The work is a brief overview of the current state of knowledge of retinopathy of prematurity (ROP). This article presents the causes of occurrence of the disease and its symptoms and complications. It relates the procedures for the prevention and the treatment of ROP.

Epilepsy is one of the most frequent neurologic diseases in children. The new definition of epilepsy, classification of epileptic syndromes and rules fordiagnosis and treatment based on the newest publication are presented in this article. Antiepileptic drugs side effects, vaccinations and educational problems are also discussed.

Gilbert’s syndrome is a type of mild functional hyperbilirubinemia which usually manifests itself during adolescence. The disease is caused by mutation in UDP-glucuronosyltransferase gene, usually in the form of insertion of two nucleotides in the promoter of UDP-glucuronosyltransferase 1A TATAA (TA7/7) gene. This mutation results in the reduction of liver ability to conjugate bilirubin with glucuronic acid by approximately 60-70%. Inmost cases, the disease is asymptomatic. The first symptom is usually yellowing of the skin, mucous membranes and/or whites of the eyes, without associated itching. During the diagnostic process, it is particularly important to pay attention to elevated total bilirubin levels, with the predominance of unconjugated fraction, at the normal levels of transaminases, gamma-glutamyl transpeptidase, alkaline phosphatase and the proper concentration of bile acids. Genetic tests, including the analysis of the promoter sequence of UGT1A1 gene and identification of polymorphism (TA insertion) maybe helpful in the diagnosis. In this paper we reviewed the current state of knowledge concerning etiology and pathogenesis, clinical picture, diagnosis and influence of Gilbert’s syndrome on other illnesses.

Clinical problems of cerebral palsy (CP) are associated with disorganization of central control of any movement activity. Damage of the structures involving movement control causes antigravity mechanism dysfunction. Children develop abnormal (compensatory) antigravity mechanism and pathological motility. Persistent activity in abnormal patterns disturbs sensorimotor experiences and leads to contractures and deformations (CP, and especially itsspastic forms, are “short muscles” disease). Early neurodevelopmental improvement (B. K. Bobath method, V. Vojta method) is important in the management, so by normalizing antigravity mechanizm facilitate normal gathering of sensorimotor experiences and decrease risk of development of locomotor system deformations. Neurodevelopmental improvement is vital, yet not the only form of management. Depends on child’s age and CP’s form and severity rehabilitation process’s focuses are planned differently, but it is always essential that management is comprehensive. Apart from physiotherapeutic management rehabilitation of children with CP involves also use of: specialist orthopedic equipment that prevents contractures and body deformations, plaster casts putted on feet and shins that curbs spasticity, botulinum toxin that decreases spastic muscles tone, tenotomy and transposition of the muscles with increased tone - especially in prevention of hips dislocation and feet deformation, neurosurgery (e.g. SDR - selective dorsal rhisotomy - surgery that permanently eliminates spasticity).

The paper contains the review of contemporary state of knowledge about the importance of serum concentrations mediated by food specific immunoglobulins G and their G4 fractions. The author presents the official position of international allergological organisations that have prohibited theuse of these antibodies’ titers in the diagnostics of food allergy and other non-allergic food hypersensitivity disorders due to their lack of correlation with clinical symptoms.

Down’s syndrome (trisomy 21) is a chromosomal aberration manifested as a complex of dysmorphic features in the human organism, in a clinical picture some characteristic changes occur in the oral cavity. The presence of a large tongue and small mouth, nasal airway obstruction, hypotonia of theorbicularis oris muscle and tongue, overgrown palatine and pharyngeal tonsils, causes not only problems in the correct respiration, swallowing down, the correct articulation and the mastication, but also is leading to the occurrence of malocclusion in 80-90% patients.

Microbiota colonizing the gut creates a complex set of diverse groups of microorganisms, which affects the mechanisms that regulate the functioning ofthe most human systems and organs. Microbial hypothes is of chronic disease development assumes that microbes, especially in newborns and infants, are able to program the health status in later years. Disturbed microbiota composition can result in abnormal activation of the immune and metabolic processes, and induce the development of civilization diseases. The article describes the factors influencing the intestinal microbiome in early childontogeny, presents the concept of microbial programming, and the importance of probiotics in the prevention of civilization diseases.

Background:

Colonoscopy is one of the basic procedure in gastroenterology. An adequate bowel preparation is valuating result of colonoscopy. In common use are different methods of colon cleansing. The lack of low-volume cleansing medications, their bad taste and problem with cooperation ofthe child makes the procedure of bowel preparation difficult, time-consuming and less effective than in the adult population.

Aim:

The aim of this study was to evaluate the effectiveness of used in children and adolescent bowel preparation method in Department of Gastroenterology.

Methods:

We evaluated a two-day bowel preparation based on Fortrans solution (concentration: 1 sachet/1 liter of water). The solution was administered at a volume of 15 ml/kg b.w. (max 1 l) on day 1 and 45 ml/kg b.w. (max 3 l) in 2 day preparation. Additionally were used rectal enemas. Colonoscopy wasperformed at day 3. The analysis included a group of 95 patients, aged 4 to 17 years who underwent colonoscopy in the 1st quarter of 2014 (mean age 13;51 boys and 44 girls; without any intestinal resection surgery). Bowel cleansing assessment was based on the description from procedure. We describe 4groups of bowel preparation: 1 - good, 2 - medium, 3 - bad, 4 - very bad (the study was impossible to proceed).

Results:

In 65 children (68%) preparation of the intestine was rated as good, in 15 (16%) as a medium. In 14 cases (15%) preparation of the intestine wasbad. Only in 1 patient (1%) colonoscopy was totally non-diagnostic because of the very poor preparation. During colonoscopy, the cecum was reachedin 95,8% and terminal ileum in 93,4%.Conclusions: Method used in the Department of Gastroenterology allows good or medium bowel preparation in 84% of children and adolescent patients.

Vitamin D-deficient rickets is nowadays rarely diagnosed because of commonly used vitamin D preventive supplementation during infancy. However genetic disorders, where clinical presentation is similar to typical rickets are a significant problem as total resistance to commonly used supplements ofvitamin D appears. This article presents a case of almost 2 year-old boy with diagnosed vitamin D-dependent rickets type I. The clinical aspects of the disease, the results of additional tests, the treatment and the differential diagnosis were discussed. The authors paid special attention to the diagnosticand therapeutic difficulties associated with vitamin-D-dependent rickets, highlighting both the need for early diagnosis, long-term treatment and multi-professional care.

The paper presents basic information about Bean’s syndrome and a description of the clinical course and treatment of the disease in the case of a young girl - patient of IP-CZD.

We present a case of abdominal tumor for example nephroblastoma. Initially, Wilms’ tumor may not provide any typical symptoms. In contrast, it is often noticeable by parents as a tumor of the abdomen. Diagnosed early and treated properly it can be cured in almost 100%.