Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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최근 10년간 소아의 연구균 감염 후 급성 사구체 신염에 관한 임상적 연구

A Clinical Study of Acute Poststreptococcal Glomerulonephritis in Children, from 1994 to 2003

  • 구소은 (울산대학교 의과대학 서울아산병원 소아과) ;
  • 한혜원 (울산대학교 의과대학 서울아산병원 소아과) ;
  • 박영서 (울산대학교 의과대학 서울아산병원 소아과)
  • Koo, So Eun (Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Han, Hyewon (Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Park, Young Seo (Department of Pediatrics, Asan Medical Center, College of Medicine, University of Ulsan)
  • 투고 : 2005.01.05
  • 심사 : 2005.03.07
  • 발행 : 2005.06.15
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초록

목 적 : APSGN은 소아에서 흔히 볼 수 있는 급성 사구체 신염의 하나로, 대부분의 환자에서 급성기 이후 완전한 회복을 보이지만, 소수의 환자에서는 급성기 합병증으로 사망하거나, 이후에 만성 신부전으로 진행하기도 하는 것으로 알려져 있다. 최근 과거에 비하여 발생빈도가 줄어들었으나, 여전히 소아에서 흔히 볼 수 있는 신질환으로 최근 10년간의 임상 양상을 살펴보고, 과거의 보고들과의 차이를 알아보고자 하였다. 방 법 : 1994년 1월부터 2003년 12월까지 서울아산병원 소아과에서 APSGN으로 진단받고 입원 또는 외래 치료를 시행한 105명의 환아를 대상으로 후향적으로 의무기록을 검토하여 연구하였다. 결 과 : APSGN으로 진단받은 환아들의 남녀비는 2 : 1이었고, 평균연령은 $8.5{\pm}2.6$세였다. 연평균 발생 비율은 $10.5{\pm}4.9$였고, 연중 발생을 살펴보면 대부분(60.0%)의 환아가 10월에서 1월 사이에 발생하였다. 내원 당시 부종이 82명(78.1%), 육안적 혈뇨 70명(66.7%), 고혈압 50명(47.6%), 핍뇨 22명(20.9%)에서 나타났고, 현미경적 혈뇨 105명(100%), ASO 양성 99명(94%), C3 감소 96명(91.45), 단백뇨 67명(63.8%)에서 나타났고, BUN이 증가한 경우가 38명(26.2%)였다. C3가 감소하였던 96명 중 70명(75.3%)에서 8주째 정상으로 회복되었다. 22명의 환아에서 신장조직 검사를 시행하였다. 급성기 증상은 대부분의 환아에서 1-2주 사이에 소실되었다. 결 론 : APSGN의 임상양상은 과거의 연구들과 비교하여 큰 차이가 없었고, 급성기 회복률 및 단기예후는 우수하였다.

Purpose : Acute poststreptococcal glomerulonephritis(APSGN) is a common form of glomerulonephritis in children. Most patients recover completely after the acute phase but a few patients have acute complications or progress to chronic renal disease. In recent years, the frequency of APSGN has been was decreasing but is still common in children. So we studied the clinical characteristics of APSGN from 1994 to 2003 and compared it with past studies. Methods : We studied 105 patients who were diagnosed with APSGN in the Department of Pediatrics, Asan Medical Center between January 1994 and December 2003, with a retrospective chart review. Results : The mean age was $8.5{\pm}2.6$ years. The male to female ratio was 2 : 1. Average annual incidence was $10.5{\pm}4.9$ most patients(60.0 percent) occurred from October to January. Edema was seen in 82 cases(78.1 percent), gross hematuria in 70 cases(66.7 percent), hypertension in 50 cases (47.6 percent) and oliguria in 22 cases(20.9 percent). Microscopic hematuria was seen in 105 cases (100 percent), positive ASO in 99 cases(94.2 percent), proteinuria in 67 cases(63.8 percent) and azotemia in 38 cases(36.2 percent). Serum complement 3(C3) level decreased in 96 cases and returned to normal within eight weeks in 70 patients(75.3 percent). Kidney biopsy was carried out in 22 cases. Most acute symptoms subsided within 2 weeks of onset. Conclusion : We concluded that there was no significant difference between clinical features of recent and past APSGN in children, and short term prognoses were excellent.

키워드

참고문헌

  1. Burke EC, Titus JL. Poststreptococcal acute glomerulonephritis in children. Med Clin North Am 1996;50:1141-58
  2. Jordan SC, Lemire JM. Acute Glomerulonephritis, diagnosis and treatment. Pediatr Clin North Am 1982;29:857-73
  3. Davis ID, Avner ED. Glomerulonephritis associated with infection. In : Behman RE, Kliegman RM, Jenson MB, editors. Nelson's textbook of Pediatrics. 17th ed. Philadelphia : W.B. Saunders Co, 2003:1740-1
  4. Meadow SR. Poststreptococcal nephritis a rare disease? Arch Dis Child 1965;50:379-92 https://doi.org/10.1136/adc.50.5.379
  5. Lewis EJ, Couser WG. The immunologic basis of human renal disease. Pediatr Clin North Am 1971;18:467-507
  6. Dodge WF, Spargo BH, Travis LB, Srivastava RN, Carvajal HF, DeBeukelaer MM, et al. Poststreptococcal glomerulonephritis. A prospective study in children. N Engl J Med 1972;286:273-8 https://doi.org/10.1056/NEJM197202102860601
  7. Potter EV, Lipschultz SA, Abidh S, Poon-King T, Earle DP. Twelve to seventeen-year follow up of patients with poststreptococcal acute glomerulonephritis in Trinidad. N Engl J Med 1982;16:725-9
  8. Baldwin DS, Gluck MC, Scharcht RH, Gallo GR. The long term course of poststreptococcal glomerulonephritis. Ann Intern Med 1974;80:342-58 https://doi.org/10.7326/0003-4819-80-3-342
  9. Garcia R, Rubio L, Rodriguez-Iturbe B. Long term prognosis of epidemic poststreptococcal glomerulonephritis in Maracibo : follow-up studies 11-12years after the acute episode. Clin Nephrol 1981;15:291-8
  10. Clark G, White R, Glasgow EF, Chantler C, Cameron JS, Gill D, et al. Poststreptococcal glomerulonephritis in children. Clinicopathological correlations and long-term prognosis. Pediatr Nephrol 1988;2:381-8 https://doi.org/10.1007/BF00853424
  11. Cole BR, Luis SM. Acute proliferative glomerulonephritis and crescentic glomerulonephritis. In : Barratt TM, Avner ED, Harmon WE, editors. Pediatric Nephrology 4th ed. Baltimore : Lippincott Williams Co, 1998:669-78
  12. Berrios X, Lagomarsino E, Solar E, Sandoval G, Guzman B, Riedel I. Post-streptococcal acute glomerulonephritis in Chile- 20 years of experience. Pediatr Nephrol 2004;19:306-12 https://doi.org/10.1007/s00467-003-1340-9
  13. Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents : a working group report from the National High Blood Pressure Education Program. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Pediatrics 1996;98:649-58
  14. Popovic-Rolovic M, Kostic M, Antic-peco A, Jovanovic O, Popovic D. Medium-and long-term prognosis of patients with acute poststreptococcal glomerulonephritis. Nephron 1991;58:393-9 https://doi.org/10.1159/000186469
  15. Tejani A. Ingulli E. Poststreptococcal glomerulonephritis. Current clinical and pathologic concepts. Nephron 1990;55:1-5
  16. Buzio C, Allegri L, Mutti A, Perazzoli F, Bergamschi E. Significance of albuminuria in the follow-up of acute poststreptococcal glomerulonephritis. Clin Nephrol 1994;41:259-64
  17. Nissenson AR, Mayon-White R, Potter EV, Mayon-White V, Abidh S, Poon-King T, et al. Continued abscence of clinical renal disease seven to twelve years after poststreptococcal acute glomerulonephritis in Trinidad. Am J Med 1979;67:255-62 https://doi.org/10.1016/0002-9343(79)90400-5
  18. Rodriguez-Iturbe B. Poststreptococcal glomerulonephritis. In : Massry SG, Glassock RJ, editors. Current therapy in Nephrology and Hypertension. 4th ed. St. Louis : Mosby-Year Book Co, 1998:141-5
  19. Song YK, Kim CK, Lee YI. Statiscal studies on acute glomerulonephritis in children. J Korean Pediatr Soc 1969;12: 423-30
  20. Bai SK, Cheun SJ, Kim PK, Yun DJ. Clinical follow-up studies on acute glomerulonephritis 220 cases. J Korean Pediatr Soc 1973;16:305-13
  21. Koo JH, Cho NK, Lee SB. Clinical studies on 123 cases of acute glomerulonephritis in children. Kyungpook Univ Med J 1977:18:279-86
  22. Lee HJ, Ko KW. A clinicopathologic study on postinfectious glomerulonephritis. J Korean Pediatr Soc 1988;31:723-30
  23. Kasahara T, Hayakana H, Okubo S, Okugawa T, Kabuki N, Tomizawa S, et al. Prognosis of acute poststreptococcal glomerulonephritis is excellent in children, when adequately diagnosed. Pediatr Int 2001;43:463-7
  24. Sul JH, Lee C, Kim PK, Yun DJ. Serum C3 levels in acute poststrepococcal glomerulonephritis. J Korean Pediatr Soc 1980;23:474-8
  25. Lee YS, Oh KS, Kim SH, Kim SH, Kee BK. Serum C3 & C4 levels and its clinical significance in acute poststreptococcal glomerulonephritis. J Korean Pediatr Soc 1986;29:45-50
  26. Moon KR, Park CH, Kim SK, Kim JH, Ra CS. Clinical study of acute glomerulonephritis in children. J Korean Pediatr Soc 1986;29:60-7
  27. Potter EV, Abidh S, Sharrett AR, Burt EG, Svartman M, Finklea JF, et al. Clinical healing two to six years after poststreptococcal glomerulonephritis in Trinidad. N Eng J Med 1978;298:767-72 https://doi.org/10.1056/NEJM197804062981404
  28. Bircan Z, Kervancioglu M, Demir F, Katar S, Onur H. Frequency of microscopic hematuria in acute poststreptococcal glomerulonephritis. Pediatr Nephrol 1999;13:269-70
  29. Ma JS, Chang SJ, Byun HS, Sohn C. Clinical study on acute glomerulonephritis in children. J Korean Pediatr Soc 1982;25:19-28
  30. Lee JG, Lee DJ, Lee SB, Koo JH. A clinical study on children with acute glomerulonephritis. J Korean Pediatr Soc 1983;26:48-56
  31. Kim JO, Shin SM, Park YH. A clinical study on children with acute glomerulonephritis. J Korean Pediatr Soc 1989;32:779-89
  32. West CD, McAdams AJ, McConville JM, Davis NC, Holland NH. Hypocomplementemic and normocomplementemic persistent glomerulonephritis; clinical and pathologic characteristics. J Pediatr 1965;67:1089-109 https://doi.org/10.1016/S0022-3476(65)80213-X
  33. Holm SE. The pathogenesis of acute post-streptococcal glomerulonephritis in new lights. APMIS 1988;96:189-93 https://doi.org/10.1111/j.1699-0463.1988.tb05289.x
  34. Mclean RH, Scharger MA, Rothfield NF, Berman NM. Normal complement in early poststreptococcal glomerulonephritis. Br Med J 1977;21:1326
  35. Choi DS, Chung YH. A trend of Serum C3 and C4 levels in acute poststreptococcal glomerulonephritis. J Korean Pediatr Soc 1989;32:965-71
  36. Dedeoglu IO, Springate JE, Waz WR, Stapleton FB, Feld LG. Prolonged hypocomplementemia in poststreptococcal acute glomerulonephritis. Clin Nephrol 1996;46:302-5
  37. Kim PK, Kim KS, Lee C, Kim NA, Lee JS. Diagnostic value of serum immunoglobulins in glomerulonephritis. J Korean Pediatr Soc 1981;24:652-8
  38. Roy S, Pitcock JA, Etteldorf JN. Prognosis of acute poststreptococcal glomerulonephritis in childhood : Prospective study and review of the literature. Adv Pediatr 1976;23:35-69
  39. Jennings RB, Earle DP. Poststreptococcal glomerulonephrtis : Histopathologic and clinical studies of the acute, subsiding acute and early chronic latent phases. J Clin Invest 1961;40:1525-95 https://doi.org/10.1172/JCI104382
  40. White AV, Hoy WE, McCredie DA. Childhood poststreptococcal glomerulonephritis as a risk factor for chronic renal disease in later life. Med J Aust 2001;174:492-6