Erratum: Is routine screening examination necessary for detecting thromboembolism in childhood nephrotic syndrome? / 소아과

No abstract available.

Is routine screening examination necessary for detecting thromboembolism in childhood nephrotic syndrome? / 소아과

PURPOSE: The incidence of thromboembolic episodes in children with nephrotic syndrome (NS) is low; however, these episodes are often severe. Moreover, both pulmonary thromboembolism (PTE) and renal vein thrombosis (RVT) rarely show clinical symptoms. This study was performed to determine the benefits of routine screening in the detection of thrombosis in childhood NS. METHODS: Among 62 children with nephrotic syndrome, a total of 54 children (43 males, 11 females) were included in this study. When the patients experienced their first NS episode, we performed renal Doppler ultrasonography in order to detect RVT. To rule out the possibility of PTE, a lung perfusion scan was performed. Computed tomographic (CT) pulmonary angiography was recommended to patients who showed possible signs of PTE. All patients were evaluated for clinical signs of thrombosis, biochemical indicators of renal disease, as well as clotting and thrombotic parameters. RESULTS: RVT or related clinical symptoms were not observed in any children. Based on the findings of the lung perfusion scans, 15 patients (27.8%) were observed with as a high probability of PTE. We were able to perform a CT pulmonary angiography only on 12 patients, and 5 patients were diagnosed with PTE (prevalence 8.1%). The serum fibrinogen level in the group with PTE was significantly higher (776.7+/-382.4 mg/dL, p<0.05) than that in the group without PTE, and other parameters were not significantly different between each group. CONCLUSION: Further studies are required for clarifying the role of renal Doppler ultrasonography for the detection of RVT in NS. Children with NS who developed non-specific respiratory symptoms should be evaluated for the diagnosis of PTE. In the management of NS, a lung perfusion scan should be performed at the time of the initial episode of NS regardless of the pulmonary symptoms, since patients having PTE are either often asymptomatic, or present with nonspecific symptoms.

A case of Swyer-James Syndrome Successfully Treated with Methylprednisolone Pulse Therapy / 소아알레르기및호흡기학회지

Swyer-James syndrome (SJS) is characterized by a small- or normal-sized unilateral hyperlucent lung with decreased vascularity and air trapping on plain radiographs. SJS is considered to be a postinfectious form of bronchiolitis obliterans and has occurred following childhood pulmonary infection by adenovirus, measles, influenza virus, Bordetella pertussis, Mycobacterium tuberculosis or Mycoplasma pneumoniae. The standard treatment modality for SJS is supportive care. Despite the prominent role of inflammation in the pathogenesis of SJS, the use of corticosteroids has remained controversial. We report herein a case of SJS which was successfully treated with monthly methylprednisolone pulse therapy, resulting in complete remission as verified by high resolution computed tomography.

Should Voiding Cystourethrography be Performed for Infants with Urinary Tract Infection?

PURPOSE: This study was performed to assess necessity of voiding cystourethrography (VCUG) for infants with urinary tract infection(UTI) who had both normal renal sonography and normal DMSA renal scans. METHODS: We reviewed 117 infants hospitalized for UTI between February 2002 and July 2007 at Sanggye Paik Hospital. The diagnosis of UTI was made by culture from a urine specimen obtained by suprapubic puncture(n=57), catheterization(n=58), or collection bag method (n=2, twice positive culture of the same organism). All patients had undergone renal sonography, DMSA renal scan and VCUG. Children with both normal renal sonography and normal DMSA renal scans were evaluated for the presence or severity of vesicoureteral reflux (VUR). RESULTS: Of the 117 patients, 96 were boys and 21 were girls. 28 patients(23.9%) had VUR. 59(50.4%) showed both normal renal sonography and normal DMSA renal scans. Among these 59 patients, 7(11.9%) showed VUR. Three of them had grade I-II reflux, two grade III reflux, and the other two grade IV reflux. One of them showed bilateral VUR, grade IV reflux on the right and grade III on the left. CONCLUSIONS: Although the negative predictive value of both normal renal sonography and normal DMSA renal scan for VUR was 88.1%, 7 patients had VUR and two of them had high grade reflux(grade IV). So, we suggest that VCUG should be performed in infants with UTI despite both normal renal sonography and normal DMSA renal scans.