• Childhood Kidney Diseases
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• v.16 no.1
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• pp.63-67
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• 2012

Acute pyelonephritis (APN) is a relatively common bacterial infection in children. In previously healthy children, acute kidney injury (AKI) is very rare in the course of APN without urinary tract obstruction, renal hypoperfusion due to hypotension or exposure to nephrotoxic agents. We describe a case of AKI secondary to APN and renal abscess in a child with vesicoureteral reflux. With antibiotic treatment and adequate hydration, the patient was improved. APN should be included in the differential diagnosis of AKI and adequate treatment by proper antibiotics is crucial for full recovery of renal function.

• Childhood Kidney Diseases
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• v.10 no.2
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• pp.174-181
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• 2006

Purpose : To analyse the results of the renal biopsies and the clinical diagnoses of patients who had undergone percutaneous kidney biopsies in the department of pediatrics at Kyunghee University Hospital for 22 years from 1984 to 2005. Methods : We retrospectively reviewed the medical records of 1559 patients and analyzed the chief complaints that led to a renal biopsy, age, sex, histopathologic findings and diagnosis. Routine kidney biopsies were performed by automated gun biopsy guided by real time ultrasonography. The diagnoses were made based on the specimen's light microscopy, immunofluorescence microscopy and electron microscopy findings and clinical symptoms and signs. Results : The mean age of the patients was 10 years with the male to female ratio being 1.3:1. The chief complaints that led to a renal biopsy included hematuria only(753 cases, 48.3%), proteinuria only(125 cases, 8.0%) and hematuria combined with proteinuria(537 cases, 34.4%). The most frequent histopathological finding was primary glomerular disease(75.4%) which included IgA nephropathy(30.1%) and mesangial proliferative glomerulonephritis(27.6 %). Systemic disease comprised 11.4% which included Henoch-$Sch\ddot{o}nlein$ nephritis(10.5%) and lupus nephritis(0.8%). Alport syndrome was found in 1.1% of cases which was attributed to hereditary causes. 628 children(40.3%) visited the clinic due to abnormal school urine screening abnormalities and among these, 237 children had mesangial proliferative glomerulonephritis and 234 children who had IgA nephropathy were managed thereafter. Conclusion : IgA nephropathy and mesangial proliferative glomerulonephritis were the two major forms of primary glomerulonephritis found in Korean children who had kidney biopsies from 1984 to 2005.

• Childhood Kidney Diseases
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• v.13 no.2
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• pp.267-270
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• 2009

Neuroleptic malignant syndrome (NMS) is a rare, but a potentially life threatening condition associated with the use of antipsychotics. The most frequent signs and symptoms of NMS include fever, muscle rigidity, autonomic dysfunction such as tachycardia, tachypnea, and labile blood pressure. Acute complications of NMS include disseminated intravascular coagulation, sepsis, seizure, myocardial infarction, acute renal failure due to rhabdomyolysis and death. We report a rare case of acute renal failure due to rhabdomyolysis associated with neuroleptic malignant syndrome.

• Childhood Kidney Diseases
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• v.13 no.2
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• pp.242-247
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• 2009

Type 1 diabetes mellitus (T1DM) commonly occurs in childhood and adolescence and diabetic nephropathy is a serious metabolic complication of T1DM that leads to serious morbidity. With poor glycemic control prepubertal diabetes duration contributes to the risk of long-term microvascular complications, however, the younger age at onset or longer prepubertal diabetes duration seems to prolong the time to development of microalbuminuria or later end-stage renal disease (ESRD). Therefore, there have been a few cases of diabetic nephropathy in prepubertal patients and therefore the ESRD cases developed during adolescence in T1DM children were very rare. Here we report an adolescent with T1DM who had poor glycemic control and was diagnosed as diabetic nephropathy in a prepubertal period and leading to end-stage renal disease during adolescence.

• The Journal of Internal Korean Medicine
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• v.30 no.4
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• pp.832-844
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• 2009

Objectives : This study was to observe the nephroprotective effects of the traditional prescription, Taeksa-san(TSS). TSS has generally been used for treating various renal diseases, including renal failure. Methods : Three different dosages of TSS extract were orally administered once a day for 28 days, At the 23rd day after TSS extract treatment, cisplatin was also treated. Then, 5 days after cisplatin treatment, all the rats (6 groups of 8 rats each) were sacrificed. Changes in the body weight, kidney weight, serum BUN and creatinine levels were observed with changes on the kidney MDA and GSH contents. The results were compared with captopril 100mg/kg, of which the effects on cisplatin-induced acute renal failures are already confirmed. Results : Dramatic decrease of body weight, increase of kidney weight, increase of serum BUN and creatinine levels were detected in the cisplatin control as compared with the intact control. In addition, marked increase of kidney MDA contents and decrease of kidney GSH contents were also detected in the cisplatin control as compared with the intact control. This means that cisplatin-induced ARF is induced by oxidative stress and related lipid peroxidation in the present study. However, these ARFs and inhibition of antioxidant effects induced by cisplatin were dose-dependently reduced by treatment with all three different dosages of TSS extracts. Conclusion : This study suggests that TSS extracts show favorable effects on cisplatin-induced rat ARF.

• The Journal of Internal Korean Medicine
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• v.31 no.3
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• pp.620-630
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• 2010

Purpose : The object of this study was to observe the nephroprotective effects of Manjeonmoktong-san(MJMTS), which has traditionally been used as Korean medicine for treating various renal diseases, on cisplatin-induced rat acute renal failure. Methods : At first, three different dosages of MJMTS extract were orally administered once a day for 28 days. On the 23rd day after MJMTS extract treatment, cisplatin was treated. Then, 5 days after cisplatin treatment, all the rats (6 groups of 8 rats each) were checked in the present study. The changes to the body weight, kidney weight, serum BUN and creatinine levels were observed with changes on the kidney MDA and GSH contents. The results were compared with captopril 100mg/kg in which the effects on cisplatin-induced acute renal failures were already confirmed. Results : It showed dramatical decrease on the body weight, increase of serum BUN and creatinine levels were detected in cisplatin control as compared with intact control. In addition marked increase of kidney MDA contests and decrease of kidney GSH contents were also detected in cisplatin control as compared with intact control. it means that cisplatin induced ARF are induced by oxiidative stress and related lipid peroxidation in the present study. However, these ARFs and inhibition of antioxidant effects induced by cisplatin were dose-dependently reduced by treatment of all three different dosages of MJMTS extracts. Conclusion : This study suggests that MJMTS extracts have favorable effects on the cisplatin-induced rat ARF.

• The Journal of Internal Korean Medicine
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• v.31 no.3
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• pp.600-611
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• 2010

Purpose : This study was to observe the nephroprotective effects of the traditional prescription, Opi-san(OPS). OPS has been generally used for treating various edematous renal diseases, including acute renal failure. Methods : Three different dosages of OPS extracts were administered once a day for 28 days (5 mg/kg, single intraperitoneally administered). On the 23rd day after OPS extract treatment, cisplatin was treated. All the rats (6 groups of 8 rats each) were checked as follows. Changes of body weight, kidney weight, serum BUN and creatinine levels were observed, as well as changes to the kidney MDA and GSH contents. The results were compared with captopril 100 mg/kg, of which the effects on cisplatin-induced acute renal failures were already confirmed. Results : Cisplatin-induced ARF were induced by oxidative stress and related lipid peroxidation in the present study. However, these ARF and inhibition of antioxidant effects induced by cisplatin were dose-dependently reduced by treatment of OPS extracts except in the 100 mg/kg treated group. The effects of OPS extracts at 500 mg/kg were similar to those of 100 mg/kg of captopril. Conclusion : This study suggests that OPS extracts 500 mg/kg showed favorable effects on the cisplatin-induced rat's ARF as similar to 100 mg/kg of captopril.

• Quality Improvement in Health Care
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• v.7 no.2
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• pp.204-216
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• 2000

Background : There has been a concern that the quality of care provided to end-stage renal disease (ESRD) patients in the United States may not be as good as recommended. This paper illustrates a composite measure to assess, the quality of care received by ESRD patients undergoing in-center hemodialysis by incorporating outcomes for 4 major treatment areas. The 4 treatment areas are: dialysis treatments, anemia control, nutritional management, and blood pressure control. Methods : The major data source for the study was the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study Wave 1 (DMMS-1) d Sixteen categories of a composite quality indicator were constructed by combining 4 dichotomous variables (16=2*2*2*2). representing the optimal vs. less than optimal level of outcome for each of the 4 treatment outcome measure respectively. Optimal outcome level for each treatment area was defined based on the recommendation from the National Kidney Foundation: (a) delivered dialysis doses (Kt/V) ${\geq}$ 1.2; (b) hematocrit level ${\geq}$ 30%; (c) serum albumin concentration ${\geq}$ 3.8g/dl ; and (d) blood pressure of <140 / <90mmHg. The 16 quality indicator were ranked according to their relative quality weights, which were estimated from its association with the relative risk of survival, adjusting for patient's baseline severity and dialysis facility characteristics. Results : Out of the entire sample of 2,179 patients, only 229 (10%) meet th recommended outcome levels for all 4 treatment areas. Overall, the study patients were distributed evenly over the 16 quality indicators, indicating a great variation in the quality of ESRD care. It appears that the rank of the 16 quality-indicators is driven by serum albumin concentration, suggesting that serum albumin concentration may be the most powerful predictor of ESRD patient survival among the 4 outcome measures. Conclusion : The developed quality indicator has the advantage of describin a range of care for dialysis patients and thus providing a more complete picture of care as compared to previous studies that have focused on only single or few components of the ESRD care.

• Journal of Microbiology and Biotechnology
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• v.25 no.2
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• pp.296-301
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• 2015

Chronic kidney diseases are based on uncontrolled immunological and inflammatory responses to pathophysiological renal circumstances such as glomerulonephritis, which is caused by immunological mechanisms of glomerular inflammation with increased production of renal pro-inflammatory cytokines. Pentoxifylline (PTX) exhibits anti-inflammatory properties by inhibiting cytokine and chemokine production through aggregation of erythrocytes and thrombocytes. We synthesized a series of 1,7-substituted methylxanthine derivatives by the Traube purine reaction, and the formation of purine ring was completed through nitrosation, a reduction of the nitroso to the amine by catalytic hydrogenation as derivatives of PTX. Then we studied biological activities such as renal anti-inflammatory effects of the synthesized compounds in the production of cytokines such as nitric oxide (NO), interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α) and of chemokines such as monocyte chemoattractant protein-1 and IL-8 in Raw 264.7 and HK-2 cells. Renal antiinflammatory activities of this novel series of N-1 and N-7-substituted methylxanthine showed that the N-7 methyl-group-substituted analogs (S7b) showed selective 61% and 77% inhibition of the production of NO and IL-8. The other replacement of the N-1-(CH₂)₄COCH₃ roup, as in the case of compound S6c, also showed an effective 50% and 77% inhibition of TNF-α and IL-8 production in LPS-stimulated Raw 264.7 and HK-2 cells.

• Childhood Kidney Diseases
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• v.24 no.1
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• pp.1-13
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• 2020

Immunoglobulin (Ig)A vasculitis nephritis (IgAVN), also referred to as Henoch-Schönlein purpura nephritis, is a relatively benign disease in children. However, two 24-year European cohort studies have reported high sustained rates of hypertension, severe proteinuria, and renal dysfunction in patients with IgAVN. Notably, the incidence and exacerbation rates of proteinuria, hypertension, and renal dysfunction during pregnancy were high even in women who recovered from IgAVN before pregnancy. Patients with IgAVN need lifelong care. Trials have been performed to investigate early biomarkers and genes associated with poor prognosis to identify high-risk patients in whom IgAVN may progress to severe renal disease. Urinary IgA/cr, IgM/cr levels, and HLAB35 and angiotensinogen gene expression were shown to be predictors of progression of IgAVN to severe renal dysfunction. The 2019 Single Hub and Access point for paediatric Rheumatology in Europe (SHARE) initiative group published guidelines for pediatric IgAVN, following the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines established in 2012. Compared with the KDIGO guidelines, the SHARE guidelines recommend earlier corticosteroid administration in cases of mild proteinuria (>0.5 g/d). Clinical trials of targeted budesonide delivery to the distal ileum, monoclonal antibody targeting C5, eculizumab and anti-CD20 monoclonal antibody administration, among others are currently underway in patients with IgA nephropathy. It is expected that newer therapeutic agents would become available for IgAVN in the near future. This review summarizes IgAVN with emphasis on recently published literature, including possible preventive strategies, predictive biomarkers for progression of IgAVN, and various treatments.