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Nephrology Co-Treated with Palmitate and Ciglitazone

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Nephrology Co-Treated with Palmitate and Ciglitazone Arch Dis Child 2005;90(Suppl II):A29–A32 A29 on glucose uptake. There was no improvement in glucose uptake in cells Nephrology co-treated with palmitate and ciglitazone. Western Blot: Using the antiphosphotyrosine antibody 4G10, there was a clear insulin effect in control cells, including upregulation of a G60 SINGLE CENTRE OUTCOME OF CHILDHOOD PRIMARY band at the level of the insulin receptor substrate 1 (IRS1). These changes RENOVASCULAR HYPERTENSION were not present in palmitate treated cell lysates. Immunofluorescence: Control cells demonstrated cytoplasmic GLUT 4 Arch Dis Child: first published as on 21 March 2005. Downloaded from S. D. Marks, R. Davies, M. J. Dillon, P. Duffy, I. Gordon, G. Hamilton, staining compared with stimulated cells that had a marked increase in R. HLord, C. McLaren, D. Roebuck, V. Shah, R. Shroff, S. E. Stephen, cell membrane GLUT 4. There was minimal change in GLUT 4 staining in K. Tullus. Great Ormond Street Hospital for Children NHS Trust, London, UK palmitate treated cells following stimulation. Conclusion: Human podocytes in vitro have impaired glucose Aims: To evaluate the clinical outcomes, morbidity, and mortality of transport in response to insulin stimulation following treatment with children undergoing medical and surgical interventions in renovascular palmitate. Furthermore, there is a reduction in phosphorylation of hypertension in a tertiary and quaternary paediatric nephrology service proteins involved in insulin signalling and a decrease in GLUT 4 over the past 30 years. transport to the cell membrane. These findings suggest that free fatty acid Methods: Patients were identified through searches of the Paediatric induces insulin resistance in human podocytes. Nephrology database at Great Ormond Street Hospital for Children. Exclusion criteria included hypertension secondary to vasculitis (such as polyarteritis nodosa) and transplant renal artery stenosis. G62 PANCREATITIS IN CHILDREN WITH CHRONIC RENAL Results: Full data were available for a total of 109 patients (70 male FAILURE (CRF) (64%)) who presented at aged 0.5–17.0 (median 7.7) years with renovascular hypertension. Twenty three (21%) patients were asympto- P. A. Brogan1, K. Tullus2, W. Van’t Hoff2, R. Trompeter2, L. Rees2. 1Institute matic with hypertension noted as an incidental finding and 27 (25%) of Child Health, London, UK; 2Great Ormond St Hospital, London, UK diagnosed secondary to a hypertension associated syndrome (namely neurofibromatosis type 1, Williams, and velo-cardial facial syndromes). Aims: To describe the incidence, cause, and complications of Systolic blood pressure at presentation was 120–270 (median 167) pancreatitis in a single centre population of children with CRF. mm Hg. Patients required between two and nine (median 4) anti- Methods: Local and hospital-wide database searches and retro- hypertensive agents. There was evidence of end organ damage with 73 spective case note review. (67%) patients with left ventricular hypertrophy, 36 (33%) with Results: From April 1995 to January 2004, 22/1010 children with 2 hypertensive retinopathy, and 40 (37%) with proteinuria. The estimated CRF (GFR ,80 mls/min/1.73 m ) developed acute pancreatitis, repre- glomerular filtration rate was 67–122 (median 108) mls/min/1.73 m2. senting a prevalence of 2.1%. Detailed data were available from 17 Medical management was undertaken in all patients by consultant children, with 18 episodes of pancreatitis. There were 13 females and 4 paediatric nephrologists. Forty six (42%) children underwent 73 males of median age 11.8 years (1.0–18.2 years). Median (range) pre- 2 interventional radiological and/or surgical procedures for treatment of morbid calculated GFR was 54 (,10–80) mls/min/1.73 m ; 8/17 had 2 hypertension, including transluminal angioplasty (in 33), nephrectomy a GFR less than 15 mls/min/1.73 m . The cause of CRF was congenital (in 17), and revascularisation and autotransplantation procedures (in malformation of the renal tract (n = 5); haemolytic uraemic syndrome 23) by interventional radiologist, urologists, and transplant and vascular (HUS (n = 3)); systemic lupus erythematosus (n = 2); congenital nephrotic surgeons. Twenty three (50%) patients were deemed to be cured as they syndrome (n = 2); metabolic disease (n = 2); focal segmental glomerulo- were normotensive off all antihypertensives after therapeutic interven- sclerosis (n = 1); and presumed calcineurin toxicity (n = 2; 1 cardiac trans- plant; 1 bone marrow transplant). 5/17 were undergoing dialysis 3 PD tions. This was possible in 47% of nephrectomies, 27% of angioplasties, http://adc.bmj.com/ and 26% of surgical procedures. The major complications of angioplasty (prevalence of pancreatitis 2.7%); 2 HD (pancreatitis prevalence 2.2%). included one fatal haemorrhage from graft tear, stent migration, Three children developed pancreatitis a median of 23 months post renal thrombosis, haematoma, and focal defects on DMSA scan. There were transplantation, representing a pancreatitis prevalence of 0.9% in this no major complications post-nephrectomy but one patient had a transplant population. Acute on CRF during the episode of pancreatitis thrombosis of the affected kidney after a revascularisation procedure. was common, with 5/12 children not previously on dialysis needing tem- Conclusions: 10% of childhood hypertension is due to renovascular porary dialysis (4 PD, 1 HD). The diagnostic sensitivity of pancreatic enzy- disease. While many patients present with uncontrollable hypertension, mes for the identification of pancreatitis within 48 hours of onset of the possibility of curative therapeutic interventions with angioplasty and symptoms was 89% for hyperamylasaemia alone, rising to 100% when hyerlipasaemia was also considered. This sensitivity fell when positive surgery remain on an individual patient basis with a multidisciplinary on September 29, 2021 by guest. Protected copyright. team decision. Out of 46 children who underwent interventional diagnosis was defined as enzyme levels three times the upper limit of procedures, 50% were cured off treatment at follow up. normal. A major causal factor for pancreatitis was identified in 13/18 episodes: D+ HUS (n = 3); peritonitis on PD (n = 3); lupus pancreatitis (n = 2); post gastrostomy insertion (n = 1); bowel perforation (n = 1); con- G61 PODOCYTES DISPLAY INSULIN RESISTANCE UPON genital malformation of the pancreas (n = 1); chronic pancreatitis with EXPOSURE TO FREE FATTY ACID pseudocyst (n = 1); and methyl malonic acidaemia (n = 1). Additional risks 1 3 3 2 2 1 identified were hypercalcaemia (64% of cases), and poly-pharmacy. R. Lennon , G. I. Welsh , I. Hers , M. Sabin , J. Shield , P. W. Mathieson , Pancreatitis was associated with considerable acute morbidity although no M. A. Saleem1. 1Academic and Childrens Renal Unit, Bristol, UK; 2Paediatric 3 child required pancreatic resection. 2/17 had chronic/recurrent pancrea- Endocrinology, Bristol Childrens Hospital, Bristol, UK; Department of titis and 3/17 developed diabetes mellitus. One child died 6 months Biochemistry, Bristol University, Bristol, UK following the episode of pancreatitis. Conclusion: There is an increased prevalence of acute pancreatitis in Background: We have previously demonstrated that human podocytes children with CRF. The cause of this is multifactorial. The renal prognosis in vitro are insulin sensitive and able to rapidly transport glucose utilising following pancreatitis is generally favourable with recovery of acute on the glucose transporter GLUT 4. We hypothesised that, as with other CRF, although there is an increased risk of diabetes following pancreatitis. insulin responsive cells, it would be possible to induce insulin resistance in human podocytes. Insulin resistance is a feature of type 2 diabetes mellitus, and is strongly associated with diabetic nephropathy. G63 NATIONAL AUDIT OF LIPID MONITORING AND Conditionally immortalised human podocytes were grown to confluency MANAGEMENT IN UK RENAL TRANSPLANT and fully differentiated. Cells were incubated for 24 hours in serum free RECIPIENTS medium containing 5% BSA (fatty acid free) and 750 mM palmitate (a saturated free fatty acid). For SDS-PAGE and immunofluorescence, cells N. J. A. Webb, S. Stephens, H. Maxwell, M. Fitzpatrick, D. Hughes, L. Rees, were stimulated with insulin (200 nM) and glucose (25 mM). Cells for N. Moghal1, K. Franks. British Association for Paediatric Nephrology, UK glucose transport were stimulated with insulin alone before adding labelled glucose. The PPARc agonist ciglitazone (20 mM) was added to a Background: UK Renal Association guidelines (2002) state that fasting proportion of the cultures. cholesterol and triglyceride levels should be measured in all children Glucose Transport: The ratio of insulin stimulated to basal glucose commencing renal replacement therapy and at annual intervals. Despite uptake was a mean of 1.9 for control cells and this effect was this guideline, there appears to be much variation in practice nationally. significantly reduced by treatment with palmitate for 24 hours (p 0.003). Aims: To determine the frequency with which lipid levels are There was less of a reduction in cells treated with palmitate for less than monitored in paediatric renal transplant recipients. 12 hours and there was no reduction in glucose uptake in cells treated Methods: A single audit nurse reviewed the medical records and with BSA alone. With ciglitazone, glucose uptake was increased in results databases of all patients managed by the tertiary
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