Coronary Risk Factors in Kawasaki Disease

PURPOSE: Kawasaki disease is an acute febrile vasculitis that may cause coronary artery dilatation after the acute phase. We assessed the risk factors of coronary artery dilatation in patients diagnosed with Kawasaki disease. METHODS: From January 1995 through April 2003, a total of 362 patients with Kawasaki disease were enrolled. After dividing these patients into two groups by presence of coronary artery dilatation, we analyzed and compared the early symptoms and laboratory findings. RESULTS: A total of 362 patients were divided into two groups: Group 1 consisted of 65 patients(18.0%) with coronary artery dilatation, while Group 2 consisted of 297 patients(82.0%) with normal coronary arteries. Group 1 exhibited longer duration of fever during the early symptoms and showed elevated levels of CRP and cardiac Troponin-I(cTnI). WBC count, hemoglobin, hematocrit, platelet count, erythrocyte sedimentation rate, hepatic enzymes, serum albumin, CK-MB, total eosinophil count, age and sex were not significantly different between the two groups. CONCLUSION: As the severity of early inflammatory reaction increased, the risk of coronary artery dilatation increased accordingly. Therefore it is essential to establish a treatment to reduce the early inflammatory reaction in order to decrease coronary artery complications.

Study for Clinical Indicators of Prediction for Histological Finding of IgA Nephropathy

PURPOSE: Efforts to predict the clinicopathological outcome of IgA nephropathy have been made but have yielded conflicting results and have not helped in deciding the appropriate timing of the renal biopsy. In this study, we reviewed the predictive factors of clinicopathological outcome for finding out the criteria of renal biopsy timing of IgA nephropathy. METHODS: Forty children diagnosed with biopsy proven IgA nephropathy at Wonju Christian Hospital were studied retrospectively, based on medical records. RESULTS: Among 39 patients, 2 children progressed to higher serum creatinine level. One of them reached to the end stage renal disease within 2 year 7 months. According to WHO histopathological classification, there were 15 cases of class I, 14 cases of class II, 7 cases of class III, and 3 cases of class IV. In the mild histological classes(class I, II), gross hematuria was shown in 23 out of 29 children(P=0.02). In the severe histological classes(class III, IV), gross hematuria was noted in 4 out of 10(P>0.05). The tubulointerstitial changes were grade 1 in 24 cases, grade 2 in 4 cases, grade 3 in 8 cases, and grade 4 in 3 cases. With an increase in the tubulointerstitial grade, the 24 hour urine protein/albumin ratio increased. Serum creatinine less than 0.79 mg/dL could predict the lower grade(grade 1 and 2) of tubulointerstitial changes. But serum creatinine greater than 1.13 mg/dL could predict the higher grade(grade 3 and 4) of tubulointerstitial changes. In children with gross hematuria(n=27), serum creatinine was lower(0.78 vs 1.09 mg/dL, P=0.027), serum IgA was higher(316.3 vs 198.8 mg/dL), and the cases of lower WHO classification(I and II) were more common(23 vs 4, P=0.029) than the children with microscopic hematuria. CONCLUSION: Serum creatinine less than 0.79 mg/dL, macroscopic hematuria, and higher 24 hour urine protein/albumin ratio would predict the lower grade glomerulo tubulointerstitial lesion in IgA nephropathy and could be used as the criteria delaying the renal biopsy.

Study for Clinical Indicators of Prediction for Histological Finding of IgA Nephropathy

PURPOSE: Efforts to predict the clinicopathological outcome of IgA nephropathy have been made but have yielded conflicting results and have not helped in deciding the appropriate timing of the renal biopsy. In this study, we reviewed the predictive factors of clinicopathological outcome for finding out the criteria of renal biopsy timing of IgA nephropathy. METHODS: Forty children diagnosed with biopsy proven IgA nephropathy at Wonju Christian Hospital were studied retrospectively, based on medical records. RESULTS: Among 39 patients, 2 children progressed to higher serum creatinine level. One of them reached to the end stage renal disease within 2 year 7 months. According to WHO histopathological classification, there were 15 cases of class I, 14 cases of class II, 7 cases of class III, and 3 cases of class IV. In the mild histological classes(class I, II), gross hematuria was shown in 23 out of 29 children(P=0.02). In the severe histological classes(class III, IV), gross hematuria was noted in 4 out of 10(P>0.05). The tubulointerstitial changes were grade 1 in 24 cases, grade 2 in 4 cases, grade 3 in 8 cases, and grade 4 in 3 cases. With an increase in the tubulointerstitial grade, the 24 hour urine protein/albumin ratio increased. Serum creatinine less than 0.79 mg/dL could predict the lower grade(grade 1 and 2) of tubulointerstitial changes. But serum creatinine greater than 1.13 mg/dL could predict the higher grade(grade 3 and 4) of tubulointerstitial changes. In children with gross hematuria(n=27), serum creatinine was lower(0.78 vs 1.09 mg/dL, P=0.027), serum IgA was higher(316.3 vs 198.8 mg/dL), and the cases of lower WHO classification(I and II) were more common(23 vs 4, P=0.029) than the children with microscopic hematuria. CONCLUSION: Serum creatinine less than 0.79 mg/dL, macroscopic hematuria, and higher 24 hour urine protein/albumin ratio would predict the lower grade glomerulo tubulointerstitial lesion in IgA nephropathy and could be used as the criteria delaying the renal biopsy.

A Case of Intracerebral Thrombosis and Cortical Hemorrhage Complicated by Streptococcus pneumoniae Meningitis

Streptococcus pneumoniae is the most common pathogen of bacterial meningitis in childhood. It causes such intracranial complications as hydrocephalus, cerebral edema, inappropriate secretion of antidiuretic hormone(SIADH), and convulsion, and also such cerebral vascular complications as vasculitis, thrombosis, aneurysm, infarction, and subarachnoid hemorrhage. We report a male of 4 months old who had intracerebral cortical hemorrhage and sinovenous thrombosis complicated by streptococcus pneumoniae meningitis. Also, we reviewed the literature on intracerebral vascular complications related to bacterial meningitis.

The Diagnostic Significance of Various Laboratory Findings in Hemophagocytic Lymphohistiocytosis: A Receiver Operating Characteristic Curve Analysis / 대한소아혈액종양학회지

PURPOSE: The clinical findings of almost all of the hemophagocytic lymphohistiocytosis (HLH) patients are not significant. Early enforcement of bone marrow study for quicker detection of laboratory abnormalities in routine laboratory test, which is perfomed in febrile patients, is critical for early diagnosis of HLH. In this study, we tried to elucidate more significant laboratory test for the early diagnosis of HLH. METHODS: The study group and control group consisted of 13 HLH patients, and 46 febrile patients with causes like fever of unknown origin, kawasaki disease or acute lymphoblastic leukemia, respectively. Receiver operating characteristic (ROC) curve analysis of various laboratory findings of hyperpyrexic patients on the first day of admission were performed. RESULTS: The total WBC count, platelet count, serum triglyceride, serum transaminase, and serum ferritin revealed statistically significant differences between the study and the control group (P< 0.05). The ROC curve analysis revealed that serum triglyceride was the most efficient test for the differential diagnosis between HLH and febrile patients with other causes. And the serum transaminase, triglyceride and ferritin revealed a statistically significant difference between the study and the leukemia patients group (P< 0.05). The ROC curve analysis revealed that serum transaminase was the most efficient test for differential diagnosis between HLH and acute leukemia. CONCLUSION: In patients with persistent hyperpyrexia, the elevated serum triglyceride level is an important clue for the early diagnosis of HLH. In patient with persistent hyperpyrexia, and abnormal CBC findings, the elevated serum transaminase level is an important clue for the early diagnosis of HLH.