The Prevalence of Obesity and Metabolic Abnormalities in Korean Pediatric Population / 대한소아소화기영양학회지

PURPOSE: Childhood obesity can be complicated by hypertension, hyperlipidemia, non-alcoholic fatty liver disease, and diabetes mellitus. The aim of this study was to evaluate the prevalence of obesity and metabolic complications of children and adolescents based on the degree of obesity. METHODS: We analyzed the records of 8,880 students who received student health examinations between May 2006 and October 2008 at the Eulji General Hospital. The prevalence of obesity was evaluated by the body mass index and obesity index. A total of 1,076 obese students had blood tests. We analyzed aspartate aminotransferase (AST), alanine aminotransferase (ALT), fasting glucose, total cholesterol, and blood pressure according to the degree of obesity. RESULTS: According to the body mass index, the overall prevalence of obesity was 7.2% (7.8% of male and 6.5% of female students). Based on the obesity index, 12.3% of students (mild: 6.3%, moderate: 5.0%, and severe: 1.0%) were obese. The prevalence of hypercholesterolemia, ALT elevation, and hypertension were increased as a function of the degree of obesity (p<0.05), but hyperglycemia showed no significant differences (p=0.298). The overall prevalence of ALT elevation was 17.7% (mild obese group, 10.4%; moderate obese group, 20.5%; and severe obese group, 46.8%). The prevalence of hypercholesterolemia, hypertension, and hyperglycemia were significantly higher in the elevated ALT group (24.7%, 42.6%, and 5.2%, respectively) compared to the normal ALT group (11.1%, 29.8%, and 2.0%, respectively; p<0.05). CONCLUSION: Hypercholesterolemia, liver function test abnormalities, and hypertension were associated with the degree of obesity. We should focus our attention on managing obese children and adolescents to prevent metabolic complications.

A Case of Continuous Venovenous Hemodiafiltration in the Treatment of Neonatal Hyperammonemia Due to Methylmalonic Acidemia

Acute hyperammonemia is a medical emergency in the newborn. Efficient, prompt removal of serum ammonia is essential in preventing irreversible brain damage in order to prevent the profound central nervous system dysfunction due to hyperammonia. We report a case of 2.3 kg, 5-day old girl with methylmalonic acidemia who presented with severe hyperammonemia and was successfully treated with continuous venovenous hemodiafiltration(CVVHDF). CVVHDF is an effective and safe method of ammonia removal in the newborn.

Antifibrotic Effects of Phosphodiesterase (PDE) Inhibitor in Experimental Interstitial Fibrosis induced by Unilateral Ureteral Obstruction

PURPOSE: Phosphodiesterase (PDE) inhibitor increases the cellular content of cAMP, and cAMP suppresses connective tissue growth factor (CTGF) expression induced by TGF-beta1. Therefore, we investigated whether PDE inhibitor suppresses renal fibrosis without suppression of TGF-beta. MATERIALS AND METHODS: Renal interstitial fibrosis was produced by ligation of left ureter in Sprague-Dawley rats. Cilostazol, a selective PDE3 inhibitor, and dipyridamole, a hybrid PDE5, PDE6, and PDE8 inhibitor, were provided in drinking water for 7 days. In addition to the Masson-trichrome score of renal tissue, the concentration of fibronectin and TGF-beta1 in renal tissue-conditioned media was measured by ELISA. RESULTS: Masson-trichrome score and fibronectin concentration were significantly lower in cilostazol-treated group compared to the control group (P<0.05). Though dipyridamole treatment seemed to suppress the Masson-trichrome score and fibronectin concentration too, the decrements were not statistically significant. There was no difference in TGF-beta1 concentration among the groups. CONCLUSION: A selective PDE3 inhibitor cilostazol suppresses renal fibrosis without alteration of TGF-beta expression.

A Case of Hemolysis after Minor ABO Mismatched Kidney Transplantation

A 9-year-old boy of B blood group with end-stage renal disease due to IgA nephropathy received group O kidney transplantation from his father. On day 9, he developed intravascular hemolysis, and anti-B autoantibody formation was confirmed. We diagnosed as immune hemolytic anemia due to passenger lymphocyte from donor, and cyclosporine withdrawl was done. Anemia resolved spontaneously, but on day 18, graft dysfunction developed, and graft biopsy revealed acute allograft rejection. Although hemolysis due to autoantibody is very rare and often mild, and the role of hemoglobinuria on acute rejection in this case is not certain, we recommend consideration of aggressive management on severe hemolysis after minor mismatched kidney transplantation.

A Case of Posttransplant Lymphoproliferative Disease (PTLD) Following Renal Transplantation in a Child

Posttransplant lymphoproliferative disease (PTLD) represents a diverse lymphoproliferative disorder ranging from nonspecific reactive hyperplasia to malignant immunoblastic sarcoma developed in a setting of immunosuppression following organ or cellular transplantation. It is often associated with Epstein-Barr virus (EBV) infection and high dose immunosuppression. PTLD after renal transplantation was reported at first in adult in Korea in 1997. In children there have been several cases of PTLD after liver transplantation but PTLD after renal transplantation has not been reported. This is a case report of PTLD developed 4 months after renal transplantation in a 9-year-old boy. The major clinical manifestations were fever, multiple lymph nodes enlargement and blood-tinged stool. EBV was detected by in-situ hybridization in the enlarged cervical lymph node and the colonic tissue. Histological examination revealed B-cell lineage. Use of ganciclovir and reduction of the immunosuppression level resulted in complete remission of PTLD. This is the first pediatric case report of PTLD following renal transplantation in Korea.

Efficacy of 23-valent Pneumococcal Polysaccharide Vaccine in Steroid Responsive Nephrotic Syndrome

PURPOSE: Streptococcus pneumoniae is a major pathogen in both adults and children, causing significant morbidity and mortality. In patients with nephrotic syndrome, Streptococcus pneumoniae is a major cause of spontaneous peritonitis, and the increasing incidence of penicillin-resistance strain facilitates the development of effective vaccine. The limitation of current pneumococcal polysaccharide vaccine prompted development of polysaccharide-protein conjugate vaccine. METHODS: We reviewed the medical record of total 225 steroid responsive nephrotic patients to ascertain the effectiveness of 23-valent pneumococcal polysaccharide vaccine. RESULTS: Twenty-eight patients have developed peritonitis during the courses, and 7 of those have recurrent peritonitis. Fifty-five patients were vaccinated and followed-up for 1-108 months (mean 38.5 months), and during the follow-up period, pneumococcus related peritonitis was not detected. Vaccine-related relapse of nephrotic syndrome was absent. CONCLUSION: In spite of the non-consensus about the efficacy of PPV23, clinically it benefits, and until the clinical trial of PCV7 is completed, PPV23 will be recommended.

Analysis of Isolated Proteinuria on School Urinary Mass Screening

PURPOSE: The urinary mass screening program in school aged population has been performed since 1981, but the consensus on the follow-up schedule and the management of isolated proteinuria has not been reached yet. The aim of this study was to investigate the cause of isolated proteinuria and to propose a guideline for the treatment and follow-up afterwards. Methods: The medical records of 114 cases of isolated proteinuria detected through the analysis of urinary mass screening and evaluated at the pediatric outpatient clinic of Asan Medical Center from January 1990 to July 2001 have been reviewed. RESULTS: The classification of isolated proteinuria was as follows. Transient proteinuria 32%, orthostatic proteinuria 65%, persistent proteinuria 3%. In orthostatic proteinuria group, daytime and nighttime proteinuria were 319.2+/-89.1 mg/dL and 56.5+/-6.1 mg/dL. In persistent proteinuria group, daytime and nighttime proteinuria were 1140+/-40.5 mg/dL and 289+/-8 mg/dL. After 30 month follow-up, 2 cases of persistent proteinuria were needed renal biopsy and 1 case revealed focal segmental glomerular sclerosis. In all cases, serum creatinine, albumin and complements levels were normal. In the orthostatic proteinuria group, no significant renal diseases were detected. CONCLUSION: Since most of the isolated proteinuria detected through the school urinary mass screening were orthostatic proteinuria or transient proteinuria, initially aggressive diagnostic method such as renal biopsy is not needed and regular follow-up with quantitation of proteinuria is warranted.

Three Cases of Urine Abnormalities Associated with Ketogenic Diet

Ketogenic diet is a high-fat, low carbohydrate, low protein diet used in treatment of pediatric epilepsy since the 1920s. Currently it is used primarily to treat refractory childhood epilepsy. Few serious complications caused by ketogenic diet have been reported. Short-term complications include dehydration, hypoglycemia, vomiting, diarrhea, and refusal to eat. Long-term complications include kidney stones, recurrent infections, metabolic derangement, hypercholesterolemia, irritability, lethargy, and refusal to eat. We experienced 3 cases of infantile spasm patients, whose refractory seizures were controlled with ketogenic diet, but various urinary abnormalities developed.

Analysis of Factors Affecting Height Growth After Transplantation in Children

Ki-1 positive anaplastic large cell lymphoma is a newly described high-grade lymphoma and is defined by histopathological and immunologic criteria. We experienced a case of systemically involving Ki-1 positive anaplastic large cell lymphoma in a 44 year- old female which initially manifested as pleural effusion. Abdominopelvic CT scan showed the evidence of marked lymphadenopathy in retroperitoneal and both external and inguinal lymph nodes. On cytologic examination of pleural fluid, tumor cells revealed pleomorphic large isolated cells with prominent nucleoli and abundant cytoplasms. The nuclei were large with irregular profiles including some deep invaginations. Also, occasional multilobed/ multinucleated and binucleated nuclei were seen. Immunohistochemical examination was performed to differentiate from the undifferentiated adenocarcinoma, Hodgkin's disease, non-Hodgkin's lymphoma and malignant histiocytosis. The neoplastic cells were positive for leukocyte common antigen, CD3, CD30(Ki-1) but negative for cytokeratin, epithelial membrane antigen, and CD15. A histologic diagnosis of Ki-1 positive anaplastic lymphoma was made by biopsies of the inguinal lymph node, polypoid lesions of the stomach and cecum.

A Case of Tubulointerstitial Nephritis and Uveitis

Tubulointerstitial nephritis and uveitis (TINU) is a rare syndrome of unknown etiology involving the kidney and the eye. This is the first case report of TINU in Korea. The diagnosis of TINU was confirmed in a 15-year-old girl on the basis of pathologically proven tubulointerstital nephritis and bilateral uveitis. Although the renal symptoms disappeared spontaneously, uveitis showed only partial response to topical steroid treatment and persisted for more than 11 months. TINU should be included in the differential diagnosis of tubulointerstitial nephritis of unknown etiology.

Two cases of Nephrotic Syndrome Associated with Kimura's Disease

A total of 362 bile samples from 104 patients with evidence of biliary tract obstruction were submitted for diagnostic cytology from January, 1989 to April, 1991. The patients were classified based on the obstructive cause, and the cytologic results were reviewed. 298 of the specimens were from patients with intrabiliary malignant stricture, and 17 were from patients with extrabiliary malignant compression or benign biliary obstruction. Bile cytology was positive for carcinoma in 42 samples from patients with intrabiliary malignant stricture, and the diagnostic sensitivity was 14%. There were no false positive cases. We concluded that the cause of low sensitivity was degenerative change of cell due to prolonged sampling time. What is noteworthy was the high prevalence of Clonorchis sinensis eggs, being detected in 25 patients with intrabiliary malignancy, supporting the association between clonorchiasis and biliary tree malignancy.