• Childhood Kidney Diseases
• /
• v.19 no.2
• /
• pp.184-189
• /
• 2015

Poststreptococcal glomerulonephritis (PSGN) is one of the most well-known and important infectious renal diseases resulting from a prior infection with group A ${\beta}$-hemolytic streptococcus. The typical clinical characteristics of the disease reflect acute onset with gross hematuria, edema, hypertension and moderate proteinuria after the antecedent streptococcal infection. In children, usually PSGN is healed spontaneously but if it combines with fast progressing glomerulonephritis, it would be developed to chronic renal failure. Therefore, it is important to make a fast diagnosis and treatment by simple tools to predict the course and the prognosis of disease. Sonography is a simple tool for diagnosis but there is no typical renal sonographic finding in PSGN, so it is difficult to predict the course and the prognosis of disease by sonographic findings. In comparison between two cases of renal sonographic findings in PSGN, a patient who showed more increased echogenicity in more extended area of renal sonography had the severe results of renal pathology, prolonged treatment period and low serum C3 level. Here, we report the different findings of renal sonography and pathology depending on the degree of severity between two patients. Thus, it is necessary to gather more information from further studies to make a consensus about the relationship between the renal sonography and the prognosis of disease in PSGN.

• Childhood Kidney Diseases
• /
• v.13 no.1
• /
• pp.1-13
• /
• 2009

Type 1 diabetes mellitus commonly occurs in childhood and adolescence, although the prevalence of type 2 diabetes mellitus in these age groups is now being increased in the western world and Korea. Diabetic nephropathy developing in 15-25% of subjects with type 1 diabetes mellitus and in similar or higher percentage of type 2 diabetes mellitus patients is the leading cause of end-stage renal disease worldwide. Although prepubertal diabetic duration may contribute less to the development of microvascular complications than pubertal and postpubertal duration, diabetic nephropathy in susceptible patients almost certainly begins soon after disease onset and may accelerate during adolescence, leading to microalbuminuria or incipient DN. Type 1 diabetes is commonly associated with a period of hyperfiltration followed by the development of persistent microalbuminuria after as little as 7-10 years of type 1 diabetes. Microalbuminuria is associated with pathologic lesions that are so advanced as to overlap with those seen in patients with overt proteinuria and declining kidney function, therefore, microalbuminuria currently considered the best clinical indicator of overt diabetic nephropathy risk. This review covers the natural history and renal manifestations of diabetic nephropathy in children and adolescents.

• Journal of Nutrition and Health
• /
• v.29 no.10
• /
• pp.1059-1071
• /
• 1996

This study was performed to investigate the effect of dietary protein level on renal senescence. Male rats of 337.8$\pm$5.7g body weight were underlateral nephrectomy or shamoperation. The rats were divided into high protein(40% casein), normal protein(15% casein) and low protein(8% casein)diets and fed experimental diets ad libitum for 24 weeks. The results are summarized as follows. There was a hypertophy of the remnant kidney of uninephrectomized rats of 40% or 15% protein group, coming up to the comparable weights of both kidneys of sham-operated rats. However, the hypertrophic effect was not seen in uninephrectomized rats of 8% protein group. Serum albumin was lower in uninephrectomized rats. With increasing dietary protein level blood urea nitrogen was increased, whereas, urinary urea nitrogen excretion was decreased. Urinary solute excretion was higher in uninephrectomized group than in sham-operated group. However, effect of dietary protein level on urinary solute excretion varied dpending on th solutes tested. GFR and urinary protein excretion, throughout experiment, increased with feeding period and with dietary protein level. Proteinuria was most severe in uninephrectomized rats fed 40% casein diet. Maximum urine concentration ability measured after dehydration was not different among the experimental groups. Light microscopic examination showed focal segmental glomerulosclerosis and mild increas of glomerular mesangial matrix in uninephrectomized rats fed 40% and 15% protein diet, however, which was not observed in uninephrectomized rats fed 8% protein diet and in sham-operated rats fed 40% diet. Immunofluorescence studies revealed segmental deposits of albumin in the mesangium and capillary loops in high protein and uninephrectomized groups. Minimal granular deposition of IgG was noted in the mesangium of all experimental groups. In conclusion, high protein intake accelerated deterioration of renal function and it was correlated with morphological change. Low protein intake was effective in preventing these changes.

• The Journal of Korean Medicine
• /
• v.29 no.1
• /
• pp.67-84
• /
• 2008

Objective : The main purpose of this study was to evaluate the effect of Jasinwhalhyul-tang (Zishenhuoxue-tang, JWT) on MRL/MpJ-Ipr/Ipr mouse model with systemic lupus erythematosus. Methods: The effect of JWT on MRL/MpJ-Ipr/Ipr mice that have autoimmune disease similar to SLE in humans was evaluated after JWT per oral in the present study. Mice were administered with Jasinwhalhyul-tang (Zishenhuoxue-tang, JWT) (80 or 400mg/kg) or distilled water for control group from experimental week 10 for 22 weeks. Results : The amount of erythematosus skin lesion and proteinuria were significantly decreased. The size and weight of cervical lymph nodes and spleen were significantly reduced. The ratio between activated $CD3^+CD69^+$ T-cells and undifferentiated $CD3^+CD4^-CD8^-$ T-cells in lymph nodes, spleen and kidney was effectively reduced. The gene expression of TGF-$\beta$ in spleen and kidney was increased. The amount of anti-dsDNA IgG in blood was decreased. The gene expression of TGF-$\beta$ in normal mouse spleen cells was increased depending on concentration by treatment of with T cell stimulating agent. In the histological examination of skin and kidney, the amount of infiltration of immune cells involved in the inflammatory response was decreased. Conclusions : According to the above results, JWT should be considered as an applicable therapeutic agent to SLE in clinical practice. Further research is required to investigate other efficacies of JWT on SLE.

• Clinical and Experimental Pediatrics
• /
• v.50 no.12
• /
• pp.1180-1187
• /
• 2007

Systemic lupus erythematosus (SLE) is an episodic, multi-system, autoimmune disease characterized by widespread inflammation of blood vessels and connective tissues and by the presence of antinuclear antibodies (ANAs), especially antibodies to native (double-stranded) DNA (dsDNA). Its clinical manifestations are extremely variable, and its natural history is unpredictable. Untreated, SLE is often progressive and has a significant fatality rate. The most widely used criteria for the classification of SLE are those of the American College of Rheumatology (ACR), which were revised in 1982 and modified in 1997. The presence of four criteria have been diagnosed as a SLE. Rashes are common at onset and during active disease. The oral mucosa is the site of ulceration with SLE. Arthralgia and arthritis affect most children and these symptoms are short in duration and can be migratory. Lupus nephritis may be more frequent and of greater severity in children than in adults. The initial manifestation of nephritis is microscopic hematuria, followed by proteinuria. The most common neuropsychiatric symptoms are depression, psychosis(hallucination and paranoia) and headache. CNS disease is a major cause of morbidity and mortality. Pericarditis is the most common cardiac manifestation. Libman-Sacks endocarditis is less common in children. The most frequently described pleuropulmonary manifestations are pleural effusions, pleuritis, pneunonitis and pulmonary hemorrhage. During the active phase ESR, CRP, gamma globulin, ferritin and anti-dsDNA are elevated. Antibodies to dsDNA occur in children with active nephritis. Antibodies to the extractable nuclear antigens (Sm, Ro/SS-A, La/SS-B) are strongly associated with SLE. Specific treatment should be individualized and based on the severity of the disease. Sepsis has replaced renal failure as the most common cause of death.

• Clinical and Experimental Pediatrics
• /
• v.59 no.3
• /
• pp.145-148
• /
• 2016

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal condition characterized by skin rash, fever, eosinophilia, and multiorgan involvement. Various drugs may be associated with this syndrome including carbamazepine, allopurinol, and sulfasalazine. Renal involvement in DRESS syndrome most commonly presents as acute kidney injury due to interstitial nephritis. An 11-year-old boy was referred to the Children's Hospital of Pusan National University because of persistent fever, rash, abdominal distension, generalized edema, lymphadenopathy, and eosinophilia. He previously received vancomycin and ceftriaxone for 10 days at another hospital. He developed acute kidney injury with nephrotic range proteinuria and hypocomplementemia. A subsequent renal biopsy indicated the presence of acute tubular necrosis (ATN) and late exudative phase of postinfectious glomerulonephritis (PIGN). Systemic symptoms and renal function improved with corticosteroid therapy after the discontinuation of vancomycin. Here, we describe a biopsy-proven case of severe ATN that manifested as a part of vancomycin-induced DRESS syndrome with coincident PIGN. It is important for clinicians to be aware of this syndrome due to its severity and potentially fatal nature.

• Clinical and Experimental Pediatrics
• /
• v.56 no.1
• /
• pp.13-18
• /
• 2013

Purpose: Kawasaki disease (KD) is a systemic vasculitis and affects many organ systems. It often presents sterile pyuria, microscopic hematuria, and proteinuria due to renal involvement. The aims of this study were to define clinical characteristics of acute KD patients with pyuria and to analyze meaning of pyuria in KD. Methods: The medical records and laboratory findings including serum and urine test of 133 patients with KD admitted to Yeungnam University Hospital from March 2006 to December 2010 were reviewed retrospectively. Results: Forty patients had sterile pyuria and their clinical characteristics including age, gender and body weight were not significantly different with those who did not have pyuria. Fever duration after treatment was significantly longer in KD patients with pyuria. Erythrocyte sedimentation rate, C-reactive protein and serum concentration of alanine aminotransferase were significantly higher in patients with pyuria. Hyponatremia and coronary artery lesion were seen more often in patients with pyuria but there was no significant difference. Also serum blood urea nitrogen was significantly higher in KD patients with pyuria. Urine ${\beta}_2$-microglobulin was elevated in both patients groups and showed no difference between two groups. Conclusion: We found more severe inflammatory reaction in KD patients with pyuria. We also found elevation of some useful parameters like ${\beta}_2$-microglobulin that indicate renal involvement of KD through the urine test. Careful management and follow up will need for KD patients with pyuria and it is necessary in the future to study the specific parameters for renal involvement of KD.

• Childhood Kidney Diseases
• /
• v.9 no.2
• /
• pp.231-236
• /
• 2005

Juvenile rheumatoid arthritis(JRA) is the most common major connective tissue disease in children. Renal involvement in JRA is rare. Among the renal lesions that have been reported in JRA, amyloidosis and drug-induced nephropathy are the most common. Crescentic glomerulonephritis in JRA has rarely been reported. We report a case of ANCA-associated pauci-immune crescentic glomerulonephritis in JRA. The patient was a 15-year old boy with a 3-year history of JRA. He presented with gross hematuria, proteinuria, positive p-ANCA and elevation of BUN and creatinine. Pathologic findings revealed focal necrotizing and crescentic glomerulonephritis. There were no significant immunoglobulin or complement deposits. His renal function recovered after intravenous methylprednisolone pulse therapy and oral steroid use. In Korea, this is the first reported case of pauci-immune crescentic glomerulonephritis in JRA. (J Korean Soc Pediatr Nephrol 2005;9:231-236)

• Journal of Society of Preventive Korean Medicine
• /
• v.4 no.2
• /
• pp.294-312
• /
• 2000

The effects of Gamisoohwabunchungum and Gamisoohwabunchungum plus Cervi Pantotrichum Cornu on rats with nephrosis induced by a single tail-intravenous injection of PAN(puromycin amjnonucleoside), 2.5mg/100g of body weight was evaluated in the present study. The effects of Gamisoohwabunchungum and Gamisoohwabunchungum plus Cervi Pantotrichum Cornu on PAN nephrosis was evaluated by measuring the concentrations of albumin, total protein, total lipid, cholesterol, triglyceride in the serum and the amount of protein in the urin. The results are summarized as follows; 1 In The Gamisoohwabunchungum and Gamisoohwabunchungum plus Cervi Pantotrichum Cornu group as compared to The Control group, The concentrations of albumin and total protein in the serum were significantly increased. 2. In The Gamisoohwabunchungum and Gamisoohwabunchungum plus Cervi Pantotrichum Cornu group as compared to The Control group, The concentrations of total lipid, cholesterol and triglyceride in the serum were significantly decreased 3. In The Gamisoohwabunchungum and Gamisoohwabunchungum plus Cervi Pantotrichum Cornu group as compared to The Control group, The amount of urine protein during 24 hours were significantly decreased . 4. In The Gamisoohwabunchungum plus Cervi Pantotrichum Cornu group as compared to The Gamisoohwabunchungum group, The concentrations of total protein in the serum were significantly increased. 5. In The Gamisoohwabunchungum plus Cervi Pantotrichum Cornu group as compared to The Gamisoohwabunchungum group, The concentrations of cholesterol and triglyceride in the serum were significantly decreased To conclude, it can be inferred that Gamisoohwabunchungum and Gamisoohwabunchungum plus Cervi Pantotrichum Cornu have the effects of improving proteinuria, hypoproteinemia, hyperlipidemia in nephrotic syndrome.

• Journal of Yeungnam Medical Science
• /
• v.33 no.1
• /
• pp.59-63
• /
• 2016

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and severe drug-induced hypersensitivity syndrome characterized by hematological abnormalities and multiorgan involvement. Liver involvement is the most common visceral manifestation. However, renal failure has been rarely described. The common culprit drugs are anticonvulsants and allopurinol. We experienced a patient with DRESS syndrome with acute interstitial nephritis caused by concomitant administration of quinolone and non-steroidal anti-inflammatory drugs (NSAIDs). A 41-year-old man presented with a diffuse erythematous rash and fever which developed after administration of quinolone and NSAIDs for a month due to prostatitis. He was diagnosed with DRESS syndrome. Skin rash, fever, eosinophilia, and elevations of liver enzymes improved with conservative treatment and discontinuation of the causative drugs. However, deterioration of his renal function occurred on day 8 of admission. The levels of blood urea nitrogen and serum creatinine increased and oliguria, proteinuria and urinary eosinophils were observed. Ultrasonography showed diffuse renal enlargement. The clinical features were compatible with acute interstitial nephritis. Despite intravenous rehydration and diuretics, renal function did not improve. After hemodialysis, his renal function recovered completely within 2 weeks without administration of systemic corticosteroid.