Risk Factors for Atrophic Renal Scar

PURPOSE: An atrophic renal scar(RS) is one of the underlying causes for childhood hypertension and chronic renal failure. The risk factors for atrophic renal scar were evaluated. METHODS: 41 children, who presented with first febrile urinary tract infection at the Ewha Womans University Hospital between 1995 and 2003 and had generalized atrophic RS on 99mTc-DMSA renal scan, were retrospectively studied. Atrophic RS was divided into severe atrophic RS(n=14) if relative uptake on renal scan was below 10%, or mild atrophic RS(n= 27) if relative uptake on renal scan was between 10-35%. RS was defined as congenital if the scar was detected on the first renal scan, and as acquired if the scar developed on the follow-up renal scan from acute pyelonephritis of the first renal scan. The control group was consisted of randomly selected 41 children with segmental RS. The risk factors for atrophic RS such as the generation time, VUR, gender and ACE gene polymorphism were evaluated. RESULTS: The age distribution of atrophic RS and segmental RS did not differ significantly (P>0.05). The rate of congenital RS in atrophic RS was 61.0%(25/41), which was significantly higher than 9.8%(4/41) of segmental RS(P0.05). But in children with VUR, there was a higher proportion of males with severe atrophic RS than segmental RS(85.7%:45.5%). ACE gene polymorphism did not differ between the atrophic and segmental RS groups, irrespective of the presence of VUR(P>0.05). CONCLUSION: Most atrophic RSs were congenital which could not be preventable postnatally and the major risk factors were VUR and the male gender. ACE gene polymorphism was not the significant risk factor for an atrophic RS.

Suprapubic Bladder Aspiration Assisted by Ultrasound

PURPOSE: Suprapubic bladder aspiration(SBA) of urine is the most reliable method to obtain urine avoiding contamination in non-toilet trained infants. Ultrasonography is a useful tool for guiding the anatomic location as well as for direct visualization during procedure. We evaluated the success rate and complication of ultrasound(US) assisted SBA. METHODS: Sixty infants who visited Ewha Womans University Mokdong Hospital, with suspected urinary tract infection were randomly divided into the US assisted (n=32) and blind SBA(control, n=28) group. In US assisted SBA group, the anteroposterior(AP), transverse, and sagittal diameters and the volume of the bladder were measured. In the blind SBA group, urine was blindly aspirated when the urinary bladder was palpated at the suprapubic area. The rate of successful urine aspiration, the number of attempts until successful aspiration, aspirated urine volume were compared between the two groups. RESULTS: The success rate was 100%(32/32) in the US assisted group, which was significantly higher than 85.7%(24/28) of the control group (P3 cm, transverse diameter >4 cm, depth >4 cm and bladder volume >5 mL. CONCLUSION: US assistance can significantly improve the success rate of SBA in infant with suspected urinary tract infection.

A Case of C1q Nephropathy in Steroid-Dependent Nephrotic Syndrome

C1q nephropathy is an immune complex glomerulonephritis defined by the presence of mesangial C1q deposits in immunofluorescence microscopy and electron dense deposits on electron microscopy. It was described as a distinct disease entity in 1985 by Jennette and Hipp. Thirty four cases were reported in the literature but there has been no pediatric case reported in Korea yet. It commonly presents with steroid-resistent nephrotic syndrome in older children and young adults, and occasionally nephritic-nephrotic syndrome or rapidly progressive glomerulonephritis. We report a case of C1q nephropathy in a 23-month-old girl with steroid-dependent nephrotic syndrome.