Relationship between B/C genotype of hepatitis B virus and hepatitis B virus related-nephritis in children / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the relationship between genotype of hepatitis B virus and hepatitis B virus related-glomerular nephritis in (HBV-GN) children.</p><p><b>METHOD</b>Totally 176 HBV-DNA positive children with chronic hepatitis B were randomly collected. Among the 176 patients, 92 were HBV carriers, 84 were cases with chronic hepatitis. The genotypes of their serum HBV, liver function, and HBV-DNA load were detected. When children showed nephrotic syndrome, renal biopsy was performed.</p><p><b>RESULT</b>Of the serum samples of 176 cases, 85 (48.3%) were genotype C, 72 (40.9%) were genotype B, 13 (7.4%) were genotype B/C, and 6 (3.4%) were non-B/C genotype which were excluded. Among the analyzed 157 cases, the ratio of HBV-GN in the HBeAg positive group (78.3%) was significantly higher than that in the negative group (21.7%) (χ(2) = 18.301, P < 0.001). And, the ratio of HBV-GN in the genotype C group (73.9%) was significantly higher than that in the genotype B group (26.1%) (P < 0.039). The ratio of hematuria or proteinuria in the genotype C group (20%, 18.8%) was significantly higher than that in the genotype B group (8.3%, 5.6%) (P < 0.039; P value = 0.013); and the alteration of ALT or C3 in the genotype C group (10.2%, 15.3%) was more frequent than those in the genotype B group (2.8%, 2.8%) (P = 0.005; P = 0.008). There were no significant differences in kidney dysfunction or hepatomegaly. Further, the ratio of HBV-GN was more significantly frequent in HBV-DNA highly loading group (79.2%) than which in HBV-DNA lowly loading group (20.8%) (P = 0.000). Finally, in HBV-GN group, genotype C cases (88.2%) more frequently had high HBV-DNA load condition than genotype B cases (11.8%) (P = 0.021).</p><p><b>CONCLUSION</b>Children with HBV infection in Gansu province showed mainly genotypes C or B, while genotype C seemingly predominant. Patients with genotype C more frequently showed proteinuria or hematuria. The high HBV-DNA load may be related with HBV-GN. It is a potential reason in the mechanism of HBV-GN that patients with genotype C had more possibility to have HBV-DNA high load. Analysis of HBV genotype for HBV patients maybe helpful in diagnosis and treatment.</p>

Evaluation of the applicability of three prediction equations for estimating glomerular filtration rate in children with chronic kidney disease / 中华儿科杂志

<p><b>OBJECTIVE</b>Accurate and reliable assessment of renal function is important in the management of children with chronic kidney disease (CKD). Glomerular filtration rate (GFR) is the best index of assessing kidney function. For assessment of GFR, both gold standard tests and prediction equations have been used. The well-known 24-hour endogenous creatinine clearance (Ccr), the Schwartz formula and the Filler formula are increasingly used in daily clinical practice. However, there are few studies on the applicability of these prediction equations for estimating GFR in Chinese children with CKD. The aim of this study was to compare these prediction equations estimating GFR with an isotope clearance method [isotope glomerular filtration rate (rGFR)] in such patients.</p><p><b>METHOD</b>Children aged 1-16 years who underwent isotope (99m)Tc-diethylenetriaminepentaacetic acid ((99m)Tc-DTPA) GFR testing (Gates' method) between the year of 2002 and 2005 were studied retrospectively. GFR was estimated using: (1) 24-hour Ccr, which was calculated using the standard formula: [urine creatinine (milligrammes per millilitre) × 24-hour urine volume/serum creatinine (milligrammes per millilitre) × 1440] × [1.73 (m(2))/body surface area (m(2))]; (2) the Schwartz formula, which is: eGFR (ml/min per 1.73 m(2)) = k × height (centimetres)/serum creatinine (micromoles per litre), where k is 62 in males at 13 years of age and older, 40 in infants, and 49 in all other children; and (3) the Filler formula, which is: logGFR = 1.962 + [1.123 × log(1/Cys C)], where cystatin C is measured in milligrammes per litre. Serum and urinary creatinine levels were detected by alkaline kinetic method. Serum cystatin C was analysed by particle-enhanced immunoturbidimetric assay. Bias and precision were evaluated.</p><p><b>RESULT</b>Thirty subjects (18 males and 12 females; mean age 9.4 years) fulfilling both inclusion criteria and exclusion criteria were included in this study. The mean (SD) rGFR was 81.57 (36.92) ml/min per 1.73 m(2); 18 subjects were in CKD stage I, 8 in CKD stage II, 8 in CKD stage III, and 1 in CKD stage IV. Only the mean 24 h Ccr-eGFR was slightly higher than rGFR (0.4 ml/min per 1.73 m(2) higher). Within 95% limits of agreement, the maximum absolute value of bias was about 50 ml/min per 1.73 m(2). Accuracy (estimated GFR values within ± 30% of rGFR) for all formulae was poor, ranging from 23.3% to 43.3%. All formulae overestimate or underestimate rGFR in different CKD stages.</p><p><b>CONCLUSION</b>In Chinese children with CKD, there was a significant difference between measured GFR and estimated GFR using 24h Ccr, Schwartz formula and Filler formula. More suitable GFR predictive equations to assess glomerular function of such patients should be developed.</p>

Survey Analysis on Blood Lead Level of Children in Jinchang City of Gansu Province / 实用儿科临床杂志

Objective To estimate blood lead level of children in Jinchang city of Gansu province.Methods According to relevant request,256 children(male 133,female 123) aged 2-7 years from some kindergartens in Jinchang city were randornly selected from Oct. 2004 to Jun. 2005. Blood lead level was measured by atom-absorbing graphiteingle method.Results The average blood lead level of 256 children was(126.30?52.98)?g/L.The lowest blood lead level was 28.3 ?g/L while the highest was 268.0 ?g/L.And 160 children(62.54%) were found with a blood lead level ≥100 ?g/L(the diagnostic level of lead poisoning in children).The blood lead level became higher with the increase of children′s age,as groups aged 2-3 years group were lower than aged 5-6 years and 6-7 years groups,of which the differenes had statistical significance(P0.05).Conclusion Blood lead levels of children in Jinchang city and prevalence of lead poisoning are both relatively higher,to which enough attention shall be paid.

Changes of urine enzyme series and analysis of the related factors in 4 clinical types of purpuric nephritis / 实用儿科临床杂志

control group from the high to the low. When the typeⅢand type Ⅳglomerular function was changed (BUN and BCr in high value),the drainage quantity of the enzymes evidently increased.Conclusions Urine enzyme series can sensitively reflect the damage of renal tubules in early stage, even if BUN and BCr value is on the normal level , and the drainage quantity of these enzymes are changed more or less, which show that renal tubule damage exists. The value of BUN and BCr is positively correlated with the drainage quantity of these enzymes.the more urine enzymes are drained out, the more renal tubule function is involved, therefore, the more renal globe function is damaged.