• Clinical and Experimental Pediatrics
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• v.46 no.9
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• pp.854-857
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• 2003

Purpose : It is known that single umbilical artery is frequently associated with gastrointestinal or urogenital anomaly, however, routine renal sonography has been debated in healthy neonate with isolated single umbilical artery. This study is designed to determine the usefulness of routine renal sonography in apparently healthy infants with an isolated single umbilical artery. Methods : Thirty healthy neonates with a single umbilical artery without a major anomaly from January 1995 to July 2002 were enrolled. The authors investigated the clinical background of babies and their mothers after renal sonography after 72 hours of age. When the abnormalities were found at the first renal sonography, the severity of hydronephrosis and degree of obstruction and renal function were analyzed by follow up renal sonography, voiding cystourethrography(VCUG) and technetium-99m-dimercaptosuccinic acid(DMSA) scan or technetium-99m-mercaptoacetyl-triglycerine (MAG3) scan. Results : Among the 30 healthy patients with isolated single umbilical artery, five patients(16.7%) showed abnormalities on first renal sonography with one major(3.3%) and four(13.4%) minor renal anomaly(minimal or mild hydroneohrosis). One major renal anomaly(severe hydronephrosis) showed severe decreased renal function on MAG3 scan without reflux, and the other four minor regressed spontaneously on follow up study. Conclusion : The value of routine early renal sonograpy for detecting renal anomaly in healthy infants with an isolated single umbilical artery remained unclear because most of the anomalies would regress spontaneously in the follow up study.

• Clinical and Experimental Pediatrics
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• v.46 no.10
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• pp.977-982
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• 2003

Purpose : This study aimed to examine the excretion of various urinary proteins in children with a history of urinary tract infection(UTI), with or without vesicoureteral reflux(VUR) or reflux nephropathy, and to identify means of predicting the severity of VUR or the presence of reflux nephropathy as indicated by these markers, and to know how these markers are changed after resolution of VUR. Methods : We studied 30 children with previous UTI, without VUR and renal scarring(group I), 12 children with VUR, without evidence of renal scarring(group II), and 34 children with VUR and renal scarring(group III). 24-hour or 12-hour urine ${\beta}_2$ microglobulin(${\beta}_2$ MG), microalbumin and N-acetyl-${\beta}$-D-glucosaminidase(NAG) were measured in each child. Urinary protein excretions were analyzed according to the degree of VUR(mild VUR : a grade reflux I-III, severe VUR : a grade reflux IV-V). Cases of bilateral VUR were graded by the higher grade of reflux detected. A total of 46 children with primary VUR were followed. Among these patients, VUR was completely resolved in 16 children. Voiding cystourethrography(VCUG) and DMSA scan were performed every year. Values for urinary markers were estimated every year. Results : 24 or 12 hour urine microalbumin and NAG excretions were significantly increased in group III compared to group I(microalbumin : $27.7{\pm}26.0mg/gCr$ vs $15.0{\pm}10.7mg/gCr$, P<0.05, NAG : $15.2{\pm}18.7U/gCr$ vs $3.4{\pm}2.2U/gCr$, P<0.05). Urinary ${\beta}_2$ MG excretions were not significantly different between groups. Urinary NAG excretions were elevated in the group of children with severe VUR compared to mild VUR($26.8{\pm}27.1U/gCr$ vs $7.6{\pm}3.8U/gCr$, P<0.05). After resolution of VUR, urinary microalbumin and NAG excretions were decreased(P<0.05). Conclusion : Urinary microalbumin and NAG may be useful clinical indicators to predict the presence of reflux nephropathy and the resolution of VUR. Especially, urinary NAG excretions may be used as a possible method to predict the severity of VUR.

• Childhood Kidney Diseases
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• v.11 no.2
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• pp.229-238
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• 2007

Purpose : Since the first febrile UTI(urinary tract infection) in infants is commonly associated with vesicoureteral reflux(VUR), imaging studies such as renal ultrasonography, dimercaptosuccinic acid(DMSA) scan, and voiding cystourethrography(VCUG) are recommended. How-ever, because of the invasiveness of VCUG, it is difficult to perform in all young infants with febrile UTI. The purpose of this study is to compare the clinical and laboratory characteristics, radiologic findings between the young infant group(1 to 6month, n=121) and the old infant group(7 to 24months, n=91), and to determine the clinical and radiologic risk factors that predict the presence of VUR before the VCUG in patients with their first febrile UTI under 2 years of age. Methods : We reviewed the medical records of 211 first febrile UTI patients under 2 years of age retrospectively, and compared clinical, laboratory, and radiologic findings between the two age groups. Results : The young infant group had a male preponderance and a higher incidence of Escherichia coli in their urine culture. The incidence of acute renal parenchymal defects on DMSA scans were significantly increased in the young infant group. The incidence of VUR was 29% in patients who had a VCUG, but there were no differences in the incidence of VUR between the two age groups. Abnormal findings on DMSA scan significantly correlated with higher incidence of VUR in the young infant group. Incidence of abnormal findings DMSA scan significantly increased with high grade VUR(garde III-V ). Conclusion : In treating first febrile UTI patients under 2 years, physicians have to consider such characteristics as age less than 6 months, male preponderance, E.coli in the urine culture, and increased incidence of abnormal findings on DMSA scans which correlated well with the presence of VUR. The results of the DMSA scan might help us to predict the presence of VUR before the VCUG in first febrile UTI and help us to reduce performing invasive radio-logic studies especially in the young infant group. (J Korean Soc Pediatr Nephrol 2007;11:229-238)

• The Korean Journal of Nuclear Medicine
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• v.26 no.2
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• pp.290-298
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• 1992

Although early diagnosis of urinary tract infection is important, the radiologic evaluation is still controversial because of the low sensitivity and the lack of cost-effectiveness. This study was carried out to evaluate the clinical utility of high resolution triple head $^{99m}Tc-DMSA$ SPECT imaging in urinary tract infection. We prospectively performed $^{99m}Tc-DMSA$ planar and SPECT imaging, ultrasound of kidney (US), intravenous pyelography (IVP) and voiding cystourethrography (VCU) in all 60 adult patients with UTI [26 with first episode of acute pyelonephritis (APN), 22 with recurrent APN, and 12 persistent asymptomatic pyuria] and 25 normal persons. To assess reversibility of the renal cortical defect (RCD), $^{99m}Tc-DMSA$ SPECT was repeated 1 to 8 months later in those patients with abnormal initial findings. Overall detection rate of $^{99m}Tc-DMSA$ SPECT imaging was 83% (50/60), but planar, US, IVP and VCU showed abnormal findings in 68%, 28%, 32% and 13%, respectively. 25 out of 27 patients with normal or single RCD were all normal in other radioligic studies. Only two patients showed vesicoureteral reflux (VUR) on VCU (grade I) and mild hydronephrosis on IVP. But, high proportion of those with multiple RCD showed abnormal findings on US (17/33), IVP (18/33), and VCU (7/33): 67% in any of these 3 studies. Especially, 3 out 7 patients with VUR showed multiple RCD on $^{99m}Tc-DMSA$ SPECT without any abnormality on IVP or US. 25 normal persons showed normal findings in all studies except one false positive finding on $^{99m}Tc-DMSA$ SPECT imaging. Follow-up $^{99m}Tc-DMSA$ SPECT was done in 28 patients (13 with single RCD, 15 with multiple RCD). All 13 patients with single RCD showed improvement. Those with multiple RCD presented improvement in 4, no change in 10, and aggravation in 1 on follow-up studies. With these results, we conclude: 1) $^{99m}Tc-DMSA$ SPECT imaging is superior to planar imaging, US, IVP or VCU in detection of renal lesion in urinary tract infection. $^{99m}Tc-DMSA$ SPECT is useful as a initial diagnostic tool in adult patients with urinary tract infection. 2) The multiple RCD on $^{99m}Tc-DMSA$ SPECT represent the high probability of irreversible tissue change and need of extensive urological work-up.

• Childhood Kidney Diseases
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• v.12 no.2
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• pp.157-163
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• 2008

Purpose : Several studies have reported the recent increase in the incidence of acute poststreptococcal glomerulonephritis(APSGN). The objective of this study is to see changes of clinical findings/manifwstation in children with APSGN. Methods : Medical records of 63 children who were diagnosed with APSGN in the deparment of Pediatrics, Kyungpook National University Hospital, between January 1992 and December 2006 were reviewed retrospectively. We analyzed various clinical characteristics such as age, sex, degrees of proteinuria, degrees of hematuria, and presence or absence of histories of systemic antibiotic use in children with APSGN, and compared the children with APSGN who were diagnosed between 1992 and 2000 to those who were diagnosed between 2001 and 2006. Results : Age of the patients ranged from 2-14 years(median 7.11 years) at the time of disease onset. Study patients consisted of 41 boys and 22 girls. APSGN followed infection of the throat in 87% of cases. Patient developed an acute nephritic syndrome 12 days after an antecedent streptococcal pharyngitis. Forty patients presented with gross hematuria. Fortyone patients had hypertension at the time of diagnosis. Hypertension disappeared within 7.8$\pm$8.2 days, gross hematuria within 11.3$\pm$17.2 days and microscopic hematuria within 3.5$\pm$3.9 months from the disease onset. Patients in 2001-2006 had significantly higher increase of antistreptolysin O(ASO) titer. However, no significant differences in clinical characteristics were observed. Age, sex, severity of proteinuria, gross or microscopic hematuria, antibiotic therapy did not affect the clinical manifestations of glomerulonephritis. In other words, hypertension, duration of hematuria, recovery of serum C3 level are not different between the two time periods. Conclusion : Our data indicates that patients in 2001-2006 had significantly higher level of ASO titer. However, they did not show significant clinical differences. To evaluate the causes of the resurgence of APSGN, a national epidemic is needed.

• Pediatric Infection and Vaccine
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• v.29 no.2
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• pp.84-95
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• 2022

Purpose: Urinary tract infections (UTIs) are the most common serious bacterial infections in young infants. Lumbar puncture (LP) has been used to diagnose coexisting meningitis in infants under 90 days of age with suspected UTI in many hospitals. However, the incidence of bacterial meningitis associated with UTIs is low. We aimed to describe the prevalence of concomitant bacterial meningitis in young infants with UTIs. Methods: The medical records of infants with the first episode of UTI admitted to the Chung-Ang University Hospital from January 2010 to December 2019 were retrospectively reviewed. Infants aged < 90 days who underwent LP with initial evaluation were included. Demographic and clinical features, laboratory findings, and imaging findings were collected and analyzed. Results: Eighty-six infants with UTIs were enrolled in the study. The median age was 61.5 days (interquartile range, 42.3-73.8 days) and boys (90.7%) were predominant. Escherichia coli was the most common pathogen (n=80, 93.0%) and followed by Klebsiella species (n=5, 5.8%). Fifteen (18.1%) specimens produced extended spectrum β-lactamase (ESBL). Five (5.8%) infants had positive blood culture results. Seven (8.1%) infants showed pleocytosis in the cerebrospinal fluid, but none had coexisting bacterial meningitis. Twenty-four (30.8%) infants showed renal dilatation or hydronephrosis on ultrasonography. Dimercaptosuccinic acid (DMSA) scans revealed cortical defects in 17 (21.3%) infants while voiding cystourethrography revealed vesicoureteral reflux in 6 (46.2%) infants. Conclusion: Co-existing bacterial meningitis was not observed in young infants with UTIs. LP could not be routinely performed considering the clinical condition of <90 days old UTI patients.