The Effect of Human Albumin Infusion on the Clinical Course of Steroid Sensitive Nephrotic Syndrome

PURPOSE: Intravenous infusion of albumin has been widely used to relieve severe nephrotic edema in spite of beneficial or harmful effects. The purpose of this study is to examine the harmful effect of albumin on the clinical course of steroid sensitive nephrotic syndrome(SSNS). METHOD: We prospectively randomized the patients with nephrotic syndrome(biopsy proven or clinically compatible to minimal change nephrotic syndrome) into the albumin group(20% albumin 1 g/kg) or control group(5% D/W) between March 1997 and September 1999 at Ewha University Mokdong Hospital. We compared the clinical course of the albumin group(n=13) with the control group(n=13). RESULTS: 1. The duration of steroid therapy until complete remission in the albumin group was significantly longer than the control group(13.7+/-6.4 days vs 7.5+/-2.8 days)(P0.05) and the relapse frequency per year(1.9+/-0.8 vs 1.5+/-0.5) between the albumin and control groups. 3. Spot urine protein/creatinine ratio significantly increased in the albumin group at post-albumin 2, 4 days(P<0.05). There was no significant difference in the change of the daily percent weight loss, blood pressure, serum Na, K concentration between the albumin and control groups. CONCLUSION: Albumin infusion in SSNS delayed the response to steroid and shortened the remission duration to the first relapse. Albumin should be carefully used in nephrotic edema.

The Risk Factors of Renal Scar in Childhood Acute Pyelonephritis

PURPOSE: To observe the risk factors of renal scar in children with first acute pyelonephritis (APN) who had photopenic defects on initial 99mTc-DMSA spect renal scan. METHODS: Forty-seven children with first APN(M : F=33 : 14) who were admitted to Ewha Womans University Hospital from September, 1993 to Febrary, 1998, were divided into renal scar group(N=17, Kidney unit(KU)=18) and non-scar group(N=30, KU=39) according to follow-up 99mTc-DMSA spect renal scan. The risk factors were compared between the two groups. RESULTS: There was no significant difference in age, gender, laboratory parameters, causative organism, a pattern of defect on initial 99mTc-DMSA spect renal scan, the presence of vesicoureteral reflux(VUR) and rate of febrile break-through infection between renal scar and non-scar group(P>0.05). The duration of fever before the treatement(3.4+/-2.94 vs. 2.1+/-2.29) and the rate of prolonged fever over 5 days[47.1%(8/17) vs 10.0%(3/30)] were significantly different between the two groups(P<0.05). The severity of VUR was also significantly higher in renal scar group than non-renal scar group(P<0.05, r=0.64). CONCLUSION: Duration of fever before the treatment, prolonged fever and high-grade VUR were risk factors of renal scar in childhood APN. Prompt treatment, especially in children with severe VUR, is important to prevent renal scars.

Left Ventricular Mass Estimated by Three Methods of Echocardiography in Normal Children

PURPOSE: Left ventricular hypertrophy is an important diagnostic and prognostic finding in children with various cardiovascular diseases. Echocardiographic determination of the left ventricular mass is the most accurate method for assessing left ventricular hypertrophy non-invasively. The purposes of this study are 1) to establish a reproducible, validated method for determining left ventricular mass in children by echocardiography, 2) to investigate correlation between LV mass and several factors (body surface area, weight, age, height), and 3) to define reference standards for the left ventricular mass. METHODS: Left ventricular mass was estimated in 63 normal children by three different methods of echocardiography (M mode, modified Simpson's method, Are-length method). RESULTS: The mean LV mass per body surface area were 49.7 +/- 19.4gm/m2, 40.1 +/- 11.2gm/m2, 39.9 +/- 9.6gm/m2 by M mode, Simpson and Area-Length method respectively and was highest by the M mode method. The mean LV mass per body weight were 2.6 +/- 0.9gm/kg, 2.3 +/- 0.6gm/kg, 2.1 +/- 0.5gm/kg by M mode, Simpson and Area-Length method respectively and was highest by the M mode method. Lineal regression analysis between LV mass and body surface area revealed the highest correlation. The values of LV mass by all three method were well correlated. Correlation between Area-Length method and Simpson method was higher than that between Area-Length and M mode method. CONCLUSION: Echocardiography is a very useful method to measure the left ventricular ass. Body surface area is highly correlated with LV mass in all three methods. Area-Length method and Simpson method are superior to the M mode method.

Diagnostic Value of Dipstick Urinalysis (Leukocyte Esterase and Nitrite) as a Screening Test for Urinary Tract Infection in Acute Febrile Children

Fine-needle aspiration (FNA) biopsy has become the procedure of choice for initial diagnosis of adrenal masses. However, there have been relatively few reports discussing the FNA cytologic features of adrenal cortical carcinoma. Recently, we experienced a case of FNA cytology of bilateral adrenal cortical carcinoma in a 61-year old man. The smear revealed loosely cohesive pleomorphic tumor cells with hemorrhagic and necrotic background. The tumor cells showed oval to spindle hyperchromatic nuclei and prominent nucleoli with frequent mitotic figures. The cytoplasm of tumor cells was relatively abundant and sometimes vacuolated. These cytologic findings were interpreted as an adrenal cortical carcinoma, undifferentiated pattern.

Type I Vitamin D Dependent Rickets

PURPOSE: Vitamin D dependent rickets (VDDR) is a rare, autosomal recessively transmitted disorder characterized by hypocalcemia, hypophosphatemia, increased alkaline phosphatase, secondary hyperparathyroidism and many other clinical features. Type l VDDR arises from primary deficiency in the renal 1alpha-hydroxylase that produces 1,25 (OH)2D3. So patients with type I VDDR require life long administration of vitamin D. METHODS: There had been 6 children (4 boys and 2 girls) who were diagnosed as type I VDDR in the Department of Pediatrics, Seoul National University Children's Hospital from March 1983 to May 1997. The medical records, Clinical findings, laboratory, radiologic findings, and response to therapy of these children were analyzed retrospectively. RESULTS: The median age at diagnosis was 19.5 month, and 2 families (33.3%) had family history of rickets. The major presenting symptoms were bowing leg (100%), short stature (100%), and hypocalcemic tetany (67%). Serum levels of 1,25 (OH)2D3 7.0 3.06pg/mL (normal : 20-76pg/mL), respectively. Pretreatment serum levels of calcium (6.9 1.67mg/mL), phosphate (6.9 1.67mg/mL) and alkaline phosphatase (1892 966.4IU/L) were returned to normal levels after treatment (P<0.01). The height standard deviation scores (Z scores) were increased significantly, also (P<0.01). The side effects detected during vitamin D ttherapy were hypercalcemia (33%), hypercalciuria (67%) and nephrocalcinosis (50%). CONCLUSION: This is the first report of type I VDDR in our country. All patients revealed the characteristic clinical, laboratory and radiologic findings, and one third of patients had positive family history. The treatment improved all the clinical, laboratory and radiologic findings significantly including growth. However, complications developed in some patients during the long- term therapy of vitamin D.

The Diagnostic Value of CSF Tumor Necrosis Factor-alpha for Early Diagnosis of Bacterial Meningitis

PURPOSE: During the course of bacterial meningitis, TNF-alpha produced by macrophages and monocytes in response to LPS and other inflammatory and immune stimulation, is now recognized as a primary mediator in the pathogenesis of infection, injury and inflammation and in the process of host defence. TNF-alpha was increased vascular permeability by inducing morphologic and structural changes of endothelial cells by a direct toxic effect. The authers observed the concentration of CSF TNF-alpha, which was useful or not to differentiate bacterial meningitis from viral meningitis. METHODS: In 57 children with meningitis (10 bacterial meningitis, 47 viral meningitis) were studied, at Ewha Womans University Hospital from Jan. 1995 to Oct. 1995. In the time of diagnosis, chemistry, smear, culture, latex agglutination test, TNF-alpha of CSF were checked. In bacterial meningitis, Follow up spinal tapping was performed 48 hours, 1 week after treatement, in viral meningitis, follow up was performed 2 to 7 days after treatement. RESULTS: The positive rate of CSF TNF-alpha and mean concentration of CSF TNF-alpha were significantly different between two groups (bacterial meningitis : 90% (9/10), 1026 +/- 390.1pg/mL vs. viral meningitis : 6.3% (3/47), 12.6 +/- 61.9pg/mL) (P<0.01). Positive rate of the concentration of CSF TNF-alpha in the group of bacterial meningitis was changed 90% at pretreatement period, 80% at 48 hours after treatement, 10% at 7days after treatement. Changing of positive rate by the diagnositic method, the positive rate of culture of CSF was 10%, gram smear was 40%, latex agglutination was 50% at 48 hours after treatement. CONCLUSION: The concentration of CSF TNF-alpha was rapid and sensitive method of differentiation between bacterial meningitis and viral meningitis, which was reduced the use of excessive antivbiotics.

The Diagnostic Value of CSF Tumor Necrosis Factor-alpha for Early Diagnosis of Bacterial Meningitis

PURPOSE: During the course of bacterial meningitis, TNF-alpha produced by macrophages and monocytes in response to LPS and other inflammatory and immune stimulation, is now recognized as a primary mediator in the pathogenesis of infection, injury and inflammation and in the process of host defence. TNF-alpha was increased vascular permeability by inducing morphologic and structural changes of endothelial cells by a direct toxic effect. The authers observed the concentration of CSF TNF-alpha, which was useful or not to differentiate bacterial meningitis from viral meningitis. METHODS: In 57 children with meningitis (10 bacterial meningitis, 47 viral meningitis) were studied, at Ewha Womans University Hospital from Jan. 1995 to Oct. 1995. In the time of diagnosis, chemistry, smear, culture, latex agglutination test, TNF-alpha of CSF were checked. In bacterial meningitis, Follow up spinal tapping was performed 48 hours, 1 week after treatement, in viral meningitis, follow up was performed 2 to 7 days after treatement. RESULTS: The positive rate of CSF TNF-alpha and mean concentration of CSF TNF-alpha were significantly different between two groups (bacterial meningitis : 90% (9/10), 1026 +/- 390.1pg/mL vs. viral meningitis : 6.3% (3/47), 12.6 +/- 61.9pg/mL) (P<0.01). Positive rate of the concentration of CSF TNF-alpha in the group of bacterial meningitis was changed 90% at pretreatement period, 80% at 48 hours after treatement, 10% at 7days after treatement. Changing of positive rate by the diagnositic method, the positive rate of culture of CSF was 10%, gram smear was 40%, latex agglutination was 50% at 48 hours after treatement. CONCLUSION: The concentration of CSF TNF-alpha was rapid and sensitive method of differentiation between bacterial meningitis and viral meningitis, which was reduced the use of excessive antivbiotics.

Dermatophagoides Pteronyssinus Specific IgG-subclass Antibodies in Allergic Children

PURPOSE: Although immunoglobulin E play a major role in immediate hypersensitivity reactions, some reaginic activity is associated with IgG. Part of the reaginic activity is associated with IgG1, IgG4. In contrast with this reaginic activity of IgG4, allergen-specific IgG4 antibody is allergen neutralizing antibody and contribute to the benificial effect of immunotherapy. The role of specific IgG antibody in allergic disorder is uncertain. The Dermatophagoides pteronyssinus is well known as the major allergen triggering allergic disorder. For determining the distribution of specific IgE and IgG subclass antibodies and their role in allergic disorders. Mehtods : Specific IgE and IgG subclasses to Dermatophagoides pteronyssinus (Dp) were measured in 62 allergic children (Group I;Bronchial asthma, Group II; Bronchial asthma +Allergic rhintis) aged 8-13 year. All of them had positive skin test to Dp and every data were compared with thet of 42 normal control. RESULTS: 1) Dp specific IgE antibody titer was significantly higher in Group I, II, III than in control group (p< .01). 2) pecific IgG, IgG1, IgG2, IgG4 antibodies were higher in all three allergic groups than in control group (p< .01). 3) Specific IgG, IgG1, IgG2, IgG3, IgG4 antibodies were higher in patient with asthma and allergic thinitis than asthma or allergic rhnitis. 4) The linear correlation between specific IgE and IgG, IgG1 or IgG4 was not significant (p< 0.05). CONCLUSIONS: Specific IgE, IgG and IgG subclass antibodies were increased in allergic disorders than normal control. The level of specific IgG and IgG subclass antibodies were higher as the clinical symptoms were more severe.

Diagnostic Value of 99mTc-DMSA Renal Scan for Early Diagnosis of Acute Pyelonephritis in Children with Febrile Urinary Tract Infection

PURPOSE: For prevention of renal scar, early diagnosis and treatement of acute pyelonephritis are important in children with febrile urinary tract infection. But it has been difficult to differentiate acute pyelonephritis from lower urinary tract infection. We have performed this study to evaluate the diagnostic value of 99mTc-DMSA renal scan and to clarify the relationship among acute pyelonephritis, vesico-ureteral reflux and renal scar. METHODS: We have studied 100 patients with febrile urinary tract infection, from September, 1993 to June, 1995 at the Pediatric department of Ewha Womans University, Mok-dong hospital. Acute phase reactants, causative organism, renal ultrasound, 99mTc- DMSA renal scan on the acute stage, voiding cystouretherogram after 1-2 weeks of treatement, and follow-up 99mTc-DMSA renal scan were evaluated. RESULTS: Ther results are as follows; 1) 57 patients (57%) had defect on 99mTc-DMSA renal scan and diagnosed as acute pyelonephritis. 2) Acute phase reactants, renal ultrasound had low accuracy. 3) VUR was found in 31 (56.1%) of 57 patients with defect which was significantly higher than the 4 (9.3%) of 43 patients without defect on 99mTc-DMSA renal scan. 4) On the follow up 99mTc-DMSA renal scan, 34.8% of defects recorvered, and 65.2% of defects developed renal scar. CONCLUSIONS: 99mTc-DMSA renal scan is a valuable method for early diagnosis of acute pyelonephritis in children with febrile urinary tract infection. It would contribute to evaluate the relationship between acute pyelonephritis, vesico-ureteral reflux and renal scar.