Factors associated with Renal Scarring in Children with a First Episode of Febrile Urinary Tract Infection

PURPOSE: Development of renal scarring is associated with delayed diagnosis and treatment of urinary tract infection(UTI). This study was performed to clarify how soon treatment should be started to inhibit renal scarring after onset of UTI and the factors associated with renal scarring in children with a first episode of febrile UTI. METHODS: We retrospectively reviewed 163 patients with a first episode of febrile UTI under the age of 2 years from April 2000 to April 2004. All patients had a DMSA renal scan and voiding cystourethrogram done in the diagnostic period, 6 months after which a follow-up renal scan was done. After patients were divided into 2 groups according to the duration of fever prior to start of treatment, the duration of fever after start of treatment, and total duration of fever, initial and follow-up DMSA scan findings were analyzed among the different groups. We compared the factors associated with renal scars between the groups with and without renal scars. RESULTS: The initial DMSA renal scan identified abnormal finding in 23% of the patients who were treated 24 hr prior to treatment. Renal scars developed in 34% of patients with remission of fever 48 hr after treatment. The risk for renal scars was significantly higher in children who had total duration of fever >72 hr(67%) than in those with shorter duration(19%). In children with renal scars, VUR was most highly associated with an increased risk of renal scar formation. CONCLUSION: Although children with a first episode of febrile UTI are treated within 24hr after onset of the fever, renal damage cannot be prevented completely and it is mainly associated with VUR.

Acute Leukoencephalopathy During Cyclosporin A Therapy in a Pediatric Patient with Nephrotic Syndrome

Cyclosporin A-induced central neurotoxicity has been rarely reported in patients with nephrotic syndrome. We report a pediatric patient who developed acute leukoencephalopathy diagnosed by MRI during CsA therapy for nephrotic syndrome.

Efficacy and safety of lamivudine therapy in patients with liver cirrhosis associated with chronic hepatitis B / 대한내과학회지

BACKGROUND: Lamivudine has been reported to be effective and safe in the treatment of chronic hepatitis B. However, in patients with advanced liver cirrhosis (LC) who have less hepatic reserve function and so higher chances of serious complications, its outcomes remained to be clarified. We evaluated the effectiveness and safety of lamivudine in patients with LC caused by hepatitis B. METHODS: Twenty four patients with HBV-associated LC who had clinical evidence of hepatic dysfunction (Child-Pugh Class A:B:C = 13:7:4) as well as 76 patients with biopsy-proven chronic hepatitis B (CH) as controls were administered with 150 mg of lamivudine orally everyday for at least more than 6 months. Serum HBeAg and HBV-DNA (liquid phase hybridization assay) as well as CBC, prothrombin time and biochemistry were tested sequentially during the follow-up period. RESULTS: All patients in both groups became negative for HBV-DNA in their sera during the treatment. Five out of 24 LC (21%) and 33 (43%) of 76 CH patients were relapsed within the follow-up periods of median 19 and 22 months, respectively (p=0.42). HBeAg seroconversion was observed in 7 of 19 LC (37%) and 25 of 69 CH (36%) patients with positive HBeAg (p=0.52). The hemoglobin, white blood cell and platelet counts were not changed significantly in both groups during the follow-up periods. The prothrombin time, serum cholesterol and bilirubin levels were also not changed significantly during the treatment. All of 76 CH patients had not presented any fatal complication during the follow-up periods. In contrast, 3 out of 4 LC patients in Child-Pugh class C died of serious complications (1 out of 5 relapsers, 2 of 19 persistent responders, p=NS; 1 died of sepsis, 2 of variceal bleeding). CONCLUSION: Lamivudine therapy may be as effective in patients with LC as in those with CH in terms of the clearance of serum HBV-DNA and the seroconversion of HBeAg. Our data also suggest that the lamivudine therapy is as safe even in decompensated LC as in CH.