• Childhood Kidney Diseases
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• v.6 no.1
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• pp.61-67
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• 2002

Purpose: The urinary mass screening program in school aged population has been performed since 1981, but the consensus on the follow-up schedule and the management of isolated proteinuria has not been reached yet. The aim of this study was to investigate the cause of isolated proteinuria and to propose a guideline for the treatment and follow-up afterwards Methods: The medical records of 114 cases of isolated proteinuria detected through the analysis of urinary mass screening and evaluated at the pediatric outpatient clinic of Asan Medical Center from January 1990 to July 2001 have been reviewed. Results: The classification of isolated proteinuria was as follows. Transient proteinuria $32\%$, orthostatic proteinuria $65\%$, persistent proteinuria $3\%$, In orthostatic proteinuria group, daytime and nighttime proteinuria were $319.2{\pm}189.1\;mg/dL$ and $56.5{\pm}56.1\;mg/dL$. In persistent proteinuria group, daytime and nighttime proteinuria were $1140{\pm}540.5\;mg/dL$ and $289{\pm}58\;mg/dL$. After 30 month follow-up, 2 cases of persistent proteinuria were needed renal biopsy and 1 case revealed focal segmental glomerular sclerosis. In all cases, serum creatinine, albumin and complements levels were normal. In the orthostatic proteinuria group, no significant renal diseases were detected. Conclusion: Since most of the isolated proteinuria detected through the school urinary mass screening were orthostatic proteinuria or transient proteinuria, initially aggressive diagnostic method such as renal biopsy is not needed and regular follow- up with quantitation of proteinuria is warranted.(J Korean Soc Pediatr Nephrol 2002 ; 6 61-7)

• Childhood Kidney Diseases
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• v.7 no.2
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• pp.142-149
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• 2003

Purpose : The urinary mass screening program for the detection of urinary abnormalities in school aged population has been performed in Seoul since 1981. Nation-wide urinary mass screening program was also performed since 1998. The aim of this study was to analyze the cause and nature of isolated proteinuria detected by chance on the urinary mass screening test in Busan and Kyungsangnam-do Province Methods : The medical records of 44 cases of isolated proteinuria detected by chance on the urinary mass screening test in Busan and Kyungsangnam-do Province, and evaluated for urinary abnormalities at the pediatrics outpatients renal clinics of Busan Paik Hospital from April 2002 to August 2003 were reviewed prospectively. Results : The cause and incidence of isolated proteinuria were as follows; transient proteinuria 4 cases(9.1%), orthostatic proteinuria 36 cases(81.8%) and persistent proteinuria 4 cases (9.1%). The total protein amount of the 24 hour urine were $121.0{\pm}136.4\;mg$ in transient proteinuria, $179.1{\pm}130.0\;mg$ in orthostatic proteinuria and $1532.8{\pm}982.5\;mg$ in persistent proteinuria. In the orthostatic proteinuria group, the total protein amount of the 24 hour urine was in the range of 40-616 mg. Spot urine protein/creatinine ratio(PCR) were $0.10{\pm}0.01$ in transient proteinuria, $0.61{\pm}0.61$ in orthostatic proteinuria and $4.35{\pm}4.04$ in persistent proteinuria. In the orthostatic proteinuria group, spot me PCR was in the range of 0.09-2.32. Renal biopsy was peformed in 4 children of the persisitent proteinuria group. They showed minimal change in 1 case, membranoproliferatiye glomerulonephritis in 2 cases and secondary renal amyloidosis in 1 case. Conclusion : The majority of isolated proteinuria which was detected by chance on school urinary mass screening were transient or orthostatic proteinuria. Even though the incidence of persistent proteinuria was much lower, it is necessary to take care of these children regularly and continuously, because persistent proteinuria itself is a useful marker of the progressive renal problems.

• Childhood Kidney Diseases
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• v.8 no.1
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• pp.74-79
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• 2004

Orthostatic proteinuria is documented as a benign condition and the most common cause of isolated proteinuria. The etiology and pathogenesis of orthostatic proteinuria is not clear yet. Recently there were a few report that nutcracker syndrome seemed to cause orthostatic proteinuria. We experienced a case of a twelve-yeat-old female patient with incidently discovered orthostatic proteinuria who was suspected to have nutcracker phenomenon by doppler sonography. We confirmed this patient as nutcracker syndrome by renal venography.

• Childhood Kidney Diseases
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• v.1 no.2
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• pp.136-143
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• 1997

Purpose : To evaluate the prevalence and clinical manifestations of various glomerulonephritis(GN) in children with asymptomatic urinary abnormalities, a clinicopathological analysis of 134 biopsied cases which were subdivided into 3 groups of proteinuria with hematuria, isolated hematuria and isolated proteinuria was done. Methods : We conducted retrospective study with review of histopathologic findings and clinical manifestations of the 134 cases with asymptomatic urinary abnormalities diagnosed by percutaneous renal biopsy which were done between January 1986 and December 1996 at department of pediatrics, Pusan Paik hospital. Results : 1) The proportion of children with asymptomatic urinary abnormalities was 43.2% of all biosied cases. 2) Among these, primary GN were 95 cases and secondary GN were 39 cases, it's ratio was 2.44:1. As a whole, the most common pathologic diagnosis was IgA nephropathy(IgAN, 26.9%), which was followed by $Henoch-Sch\"{o}nlein$ purpura nephritis(HSPN, 17.9%), minimal change lesion(MC, 17.2%), thin GBM disease(12.7%), Hepatitis B associated glomerulonephritis(HBGN, 6.0%), poststreptococcal glomerulonephritis(PSAGN, 3.0%), mesangial proliferative glomerulonephritis(MesPGN, 2.2%), membranoproliferative glomerulonephritis (MPGN, 2.2%), Alport syndrome (1.5%) and Fibrillary nephritis(0.7%). 3) In proteinuria with hematuria, the most common pathologic diagnosis was IgAN(34.6%), which was followed by HSPN(19%), MC(17.7%), thin GBM disease(8.9%), HBGN(6.3%), PSAGN(3.6%), MesPGN(1.2%), MPGN(1.2%) and Alport syndrome(1.2%). 4) Major causes of isolated hematuria were thin GBM disease(19.6%), IgAN(17.6%), HSPN(17.6%), MC(11.8%). 5) Isolated proteinuria was due to of 3 cases of MC and 1 case of HBGN. Conclusion : The prevalence of glomerulonephritis with asymptomatic urinary abnormalities in children were 43.2% of all biopsed cases. When these children were subdivided into 3 groups, proteinuria with hematuria was accounted 58.9%(79 cases) and then isolated hematuria was 38.1%(51 cases), isolated proteinuria was only 3%(4 cases) respectively. The most common pathologic diagnosis was IgA nephropathy in patient with proteinuria and hematuria, and thin GBM disease in patient with isolated hematuria.

• Childhood Kidney Diseases
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• v.5 no.2
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• pp.156-163
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• 2001

Purpose We performed urinary mass screening(UMS) program for 2,804 children of second grade elemantary school 8 years of age in Paju city with cooperation of Paju City Health Center to determine the prevalence of asymptomatic proteinuria and hematuria, and to estimate the risk of incipient renal diseases. Also we attempted to evaluate the significance of hematuria in UMS in addidtion to proteinuria. Methods : 2,804 children of the 2nd grade of elementary school who lived in Paju city were included to our UMS program in 2000. They were constituted with 1,428 boys and 1,376 girls. The screening program was carried out in 3 steps The 1st screenig test was performed at schools and then students with abnormal results were examined repeatedly at Paju City Health Center and our hospital. Those students who showed proteinuria and/or hematuria in the 1st and 2nd test were referred to our hospital to undertake the 3rd close examination including physical examination, laboratory tests and radiologic tests. Results : (I) The prevalence of urinary abnormality in the 1st screening test was $8.3\%$(233 students), comprised of $5.9\%$ of boys, $10.8\%$ of girls. (2) Among 2,804 children tested in the first screening, prevalences of asymptomatic proteinuria and isolated hematuria were 64($2.3\%$), 163($5.8\%$) respectively, and the prevalence of proteinuria with hematuria was 6($0.2\%$). (3) Among 233 students with urinary abnormalities at the 1st screening test, 102 students applied to the 2nd test. 32 children, about one third of them, were also found to have abnormal urinary findings ; isolated hematuria 30, proteinuria with hematuria 2. (4) Those findings of clinical evaluation for children with isolated hematuria at the hospital showed as follows: idiopathic isolated microscopic hematuria 21, normal 6, urinary tract infection 1, idiopathic hypercalciuria 1 and simple renal cyst 1. Those 2 students with proteinuria and hematuria seemed to have chronic glomerulonephritis. Conclusion : (1) The clinical evaluation for children who showed positive results at the 1st screening test should be done judiciously. Because of high false positive rate, almost who showed positive results was normal, only a few of them had pathologic conditions. In this study, actual incidence of incipient renal diseases in children of 8 year old was calculated to be $0.4\%$. (2) The definite conclusion whether a urinary mass screening test can alter the prognosis of incipient renal diseases could not be drawn with this study. Further study must be necessary (3) We could acknowledge the significance of hematuria in UMS, but it is necessary that one should be judicious in managing and follow-up those that show abnormal results. (J Korean Soc Pediatr Nephrol 2001;5 : 156-63)

• Childhood Kidney Diseases
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• v.6 no.1
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• pp.92-96
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• 2002

Oligomeganephronia is rare congenital anomaly characterized by striking reduction of the number of nephrons, which are markedly hypertrophied in renal hypoplasia. Since the first description of oligomeganephronia in bilateral renal hypoplasia in 1962, dozens of cases were reported. Van Acker reported the first case of oligomeganephronia developed in the solitary kidney and 8 cases were searched in the literature. We report a case of oligomeganephronia in the solitary kidney in 13 years old boy, presented with isolated proteinuria as a first case in Korea. (J Korean Soc Pediatr Nephrol 2002 ; 6:92-6)

• Childhood Kidney Diseases
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• v.3 no.2
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• pp.161-169
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• 1999

Purpose : The urinary mass screening program for the detection of proteinuria in school aged population has been performed in Seoul since 1981. Systematic evaluation in corporation with the Seoul School Health Center for students with proteinuria identified in the mass screening has been performed from 1987. The results of urinary mass screening up to 1994 was reported. I report here the results of urinary mass screening from 1995 to 1997 and compare them with previous results and attempt to reveal the significance of urinary mass screening. Objects and Methods : In the 3-year period between 1995 and 1997, annually about 460,000 students comprising 3 different age groups; 5th grade of elementary school, 2nd grade of middle school and 2nd grade of high school were chosen, corresponding to the approximate ages of 11, 14, and 17 years, respectively. These subjects accounted for 26% of total school aged children in Seoul. The screening program was carried out in 3 steps. The 1st test was performed with dipstick at school and the 2nd at the Seoul School Health Center. Those students who showed proteinuria in the 1st and 2nd tests were referred to the hospital. Laboratory examinations including renal biopsies were performed to those students with pathologic proteinuria to clarify the incipient renal diseases. Results : 1) The prevalence of asymptomatic proteinuria was 0.28% in the 1st test. It peaked at the group of 14 years old as 0.34%, compared with 0.26% at the group of 11 years old and 0.24% at the group of 17 years old. It reached to 0.26% in male and 0.30% in female. 2) 25 percent of those having proteinuria at the first test were positive at the second test. 3) The proportion of patients with proteinuria by 3rd test were as follows; 25% of transient proteinuria, 55% of orthostatic proteinuria, 6% of constant proteinuria, 12% of proteinuria with hematuria, and 2% of transient proteinuria with isolated hematuria. Pathologic proteinuria were totaled as 20%. The prevalence of renal diseases among the age group of 7-18 years old was estimated to be 1.4 per 10,000. 4) Renal biopsy performed on 38 children with proteinuria at the third test revealed IgA nephropathy in 17(44%), focal segmental glomerusclerosis in 5(13%), minimal change disease in 4(11%), membranoproliferative glomeronephritis in 3(8%), $Henoch-Sch\"{o}nlein$ purpura nephritis in 3(8%), and others in 6(16%). Therefore, the prevalence of IgA nephropathy among the age group of 7-18 years old was estimated to be 0.64 per 10,000. 5) The prevalence of chronic renal failure was estimated to be 5.7 per 1 million of 7 to 18 years age group. Conclusions : 1) The prevalence of proteinuria in the first screening test was 0.28% and finally only 5% of them showed the pathologic proteinuria at the third test. 2) The prevalence of IgA nephropathy and chronic renal failure were 0.63 per 10,000 and 5.7 per 1 million, respectively among school-aged children in Seoul.

• Childhood Kidney Diseases
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• v.3 no.1
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• pp.57-63
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• 1999

Purpose : To evaluate the diagnostic significance of simultaneous examination of hematuria and proteinuria in the urinary mass screening for early detection ot incipient renal diseases. Method and Object : During the period of 4 months from August to December in 1997, we did urinary mass screening on students of first grade of high school (16 years aged group) nationwide together with Korean Association of Health(KAH). In the first screening test, Comber-10 $N^{(R)}$ M dipsticks were used to detect proteinuria, hematuria, pyuria and nitrite simultaneously. Total 26,508 students (16 years aged group) from 33 high schools in every province in Korea, respectively, complied to the urinary mass screening. After then, one high school in Seoul was selected to reveal the true incidence of incipient renal diseases among students who showed hematuria in the initial screening through intensive examinations. Those who had hematuria and/or proteinuria visited the Paik hospital, and underwent blood tests and ultrasonographic examinations. The results were evaluated. Results 1) The initial screening revealed that the prevalence of proteinuria, hematuria, pyuria and positive nitrite urine, were $0.73\%,\;2.69\%,\;0.23\%\;and\;0.03\%$, respectively. 2) The first urinary screening among 875 students from one high school in Seoul selected fir the second test showed proteinuria, hematuria, pyuria and positive nitrite urine, were $0.91\%,\;4.68\%,\;0.34\%\;and\;0\%$, respectively. a) Total 8 among 875 students showed proteinuria, but one of them had orthostatic proteinuria and those remaining 7 students had transient proteinuria. b) There were 41 students who had hematuria in the initial screening. Among 33 who complied the second test, only one student showed asymptomatic isolated hematuria and those remaining students were normal. Conclusion : 1) Because of high false positive hematuria rate in the urinary mass screening, it dosen't seem to be appropriate that hematuria screening using dipsticks be included in the urinary mass screening. 2) A unified organization is needed from the fret that so various results of urinary mass screening came out. 3) Positive rates of pyuria and nitrite were so low that validity of urinary mass screening for urinary tract infection needs more studies.

• Childhood Kidney Diseases
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• v.4 no.2
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• pp.120-126
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• 2000

Purpose : This retrospective study has been undertaken to find out the clinical outcome of children with HS nephntis and its relationship with initial clinical presentation and/or renal pathologic finding. Patients and methods : Study population consisted of 59 children with HS nephritis who have been admitted to the Pediatric department of Kyungpook University Hospital from 1987 to 1999, and biopsy was done with indications of heavy proteinuria (> 1 g/m2/day) lasting over 1 month, nephrotic syndrome, and persistent hematuria and/or proteinuria over 1 year. Patients were divided clinically into 3 groups ; isolated hematuria, hematuria with proteinuria and heavy proteinuria (including nephrotic syndrome). Biopsy findings ore graded from I-V according to International Study of Kidney Disease in Children (ISKDC). Results : Mean age of presentation was $8.1{\pm}3.0$ years and slight male preponderance m noted (33 boys md 26 girls). Histopathologic grading showed Grade I ; 2, Grade II ; 44, and Grade III ; 13 cases. Clinical outcome at the follow-up period of 1-2 year (49 cases) and 3-4 years (30 cases) shooed normal urinalysis in 75 (30.6$\%$) and 18 cases (60.0$\%$), persistent isolated hematuria in 20 (40.8$\%$) and 2 cases (6.7$\%$), hematuria with proteinuria in 11 (22.5$\%$) and 8 cases (26.6$\%$), and persistent heavy proteinuria in 3 (6.1$\%$) and 2 cases (6.7$\%$) respectively. Clinical outcome according to histopathologic grading showed the frequency of normalization of urinalysis being lower in Grade III compared to grade I or II. Clinical outcome according to initial clinical presentation showed no relationship to the normalization or urinalysis at follow-up periods. However, 15-20$\%$ of children with initial heavy proteinuria showed persistent heavy proteinuria (3 out of 20 cases at 1-2 years, and 2 out of 10 case at 3-4 years of follow-up periods). Conclusion : The majority of children with HS nephritis (histopathologic grade I, II, III) improved within 3-4 years and persistent heavy proteinuria was seen only in a kw of children with initial clinical presentation of heavy proteinuria.

• Childhood Kidney Diseases
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• v.10 no.2
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• pp.238-243
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• 2006

Nephrotic syndrome in childhood is known to be associated with a hypercoagulable state and thromboembolic complications, among which cerebral venous thrombosis is a very rare and serious one, with only a few isolated reports in the literature. A 9-year-old boy with known nephrotic syndrome was admitted due to a relapse with massive proteinuria and generalized edema. He complained of a prolonged frontal headache. The enhanced brain magnetic resonance imaging(MRI) showed a high signal in the region of the superior sagittal sinus and right transverse sinus consistent with a thrombus. He was managed with steroids, cyclosporine and warfarin. His headache subsided 2 weeks later and proteinuria resolved 1 month later. An MRI 2 months later was normal. We describe this case and review the literature to emphasize the importance of recognizing this potentially life threatening complication and initiating anticoagulation therapy.