The Usefulness of Measuring Urinary Proteins by SDS-PAGE in Children with Type I DM without Overt Proteinuria / 대한신장학회잡지

BACKGROUND: The present study was done to evaluate the usefulness of SDS-PAGE in measuring glomerular proteins and tubular proteins in patients with type I DM without overt proteinuria. METHODS: The study population consisted of 76 children with type I DM who have been participated in the Taegu Diabetic Camp from 1997 to 2000. We measured urine albumin, NAG, beta2-microglobulin, creatinine level in urine samples collected for 12 hours in 22 children and simultaneously we analyzed urinary proteins by SDS-PAGE. In remainder 54 children, we measured urine albumin, NAG, creatinine level in random morning urines and urinary proteins by SDS-PAGE. RESULTS: In 22 of 76 children, urinary albumin-to-creatinine ratio (mg/mg), NAG (U/g) and beta2-microglobulin (microgram/g) were 0.021, 2.99 and 170.2, respectively. Positive correlation between urine albumin and NAG was statistically significant (r=0.51, p< 0.05). No significant relations between urinary proteins, such as albumin, NAG, beta2-microglobulin, and clinical characteristics, such as age, duration of illness, HbA1c, were observed. In diagnosing `microalbuminuria', sensitivity of SDS-PAGE was 63% and band of tubular proteins was not detected in any children. CONCLUSION: We thought that SDS-PAGE could be one of useful methods in diagnosing early stage of diabetic nephropathy. The more large scale study is necessary.

Short-term Result of Radiofrequency Catheter Ablation in Pediatirc Patients with Paroxysmal Tachycardia

PURPOSE: To find out the efficacy, safety and early complication of radiofrequency catheter ablation(RFCA) in pediatric patients with paroxysmal tachycardia, we compared short-term results of RFCA in pediatric patients to adult patients. METHODS: We studied 25 patients(11 pediatric patients, 14 adult patients), who underwent RFCA due to paroxysmal supraventricular tachycardia(PSVT) or idiopathic ventricular tachycardia(VT) from November 1997 to August 1998. We evaluated PSVT or idiopathic VT mechanism and compared total procedure times, total energy durations and complication rates between pediatric patients and adult patients. RESULTS: Among the 25 patients, the mechanisms of tachycardia were atrioventricular reentrant tachycardias in 14 patients, atrioventricular nodal reentrant in 10 patients and idiopathic left ventricular in 1 patient. Among the 11 pediatric patients, atrioventricular reentrant was found in 9 patients, atrioventricular nodal reentrant in 1 patient and idiopathic left ventricular in 1 patient. while among the 14 adult patients, atrioventricular reentrant was found in 5 patients and atrioventricular nodal reentrant in 9 patients. Total procedure time was 190+/-52 minutes in pediatric patients and 161+/-49 minutes in adult patients(P=0.17). Total energy duration was 244+/-223 seconds in pediatric patients and 187+/-122 seconds in adult patients(P=0.45). There were no major complications related to RFCA except minor hematomas at puncture sites. CONCLUSION: Considering the total procedure time, total energy duration and complication rates, there were no significant differences between pediatric patients and adult patients. RFCA showed relatively high success rate and one recurrence after initial success. Thus, we consider RFCA is as a good therapeutic modality which can cure tachycardia, especially PSVT.

Glomerular Hypertrophy and Sclerosis in Rats with Chronic Puromycin Aminonucleoside Nephropathy / 대한신장학회잡지

PURPOSE: This experimental study was conducted to determine serial morphological changes of rat's kidney with chronic puromycin aminonucleoside (PAN) nephropathy. Special emphasis was given to the occurrence of glomerular hypertrophy and its relationship to the subsequent development of focal segmental glomerulosclerosis(FSGS). METHODS: Sprague-Dawley rats weighing 200-230g were used and divided into control(n=9) and experimental group(n=15). Rats were given subcutaneous injections of PAN at a dose of of 2mg/100g body weight, or an equivalent volume of normal saline and six injection were given over a period of 9 weeks, at weeks 0, 1, 3, 5, 7 and 9. At weeks 4, 8 and 11, rats were sacrificed and kidney weight, kidney weight/body weight(%) and various laboratory tests including serum protein and albumin were determined. Renal tissues were prepared with Histochoice(R) fixative and paraffin embedding for morphologic study. RESULTS: Kidney weight and kidney weight/body weight(%) were increased significantly in experimental group compared to controls at 4, 8 and 11 weeks. Heavy proteinuria along with lowering of serum protein and albumin and elevation of serum cholesterol was seen in experimental group at week 4 and this change became more marked on weeks 8 and 11. The frequency of FSGS in experimental animal, at week 4, 8 and 11 were 0.6%, 10.6% and 26.2% respectively(p<0.05) and the development of FSGS was more marked in juxtamedullary glomeruli compared to cortical glomeruli. Glomerular surface area showed significant increase in experimental animals compared to controls(p<0.01), the percentage of increase being 12.0, 14.7 and 12.3% at week 4, 8 and 11. And the surface areas of juxtamedullary glomeruli were larger than those of cortical glomeruli throughout the study period. CONCLUSION: In summary, present study indicates that glomerular hypertrophy occurs and precedes the development of FSGS in rats with chronic PAN nephropathy and juxtamedullary glomeruli are more susceptible to developing FSGS compared to cortical glomeuli.

Henoch-Schonlein Nephritis Children

PURPOSE: This retrospective study has been undertaken to find out the clinical outcome of children with HS nephritis and its relationship with initial clinical presentation and/or renal pathologic finding. PATIENTS AND METHODS: Study population consisted of 59 children with HS nephritis who have been admitted to the Pediatric department of KyungPook University Hospital from 1987 to 1999, and biopsy was done with indications of heavy proteinuria ( > 1 g/m2/day ) lasting over 1 month, nephrotic syndrome, and persistent hematuria and/or proteinuria over 1 year. Patients were divided clinically into 3 groups ; isolated hematuria, hematuria with proteinuria and heavy proteinuria (including nephrotic syndrome). Biopsy findings were graded from I-V according to International Study of Kidney Disease in Children (ISKDC). RESULTS: Mean age of presentation was 8.1+/-3.0 years and slight male proponderance was noted ( 33 boys and 26 girls ). Histopathologic grading showed Grade I ; 2, Grade II ; 44, and Grade III ; 13 cases. Clinical outcome at the follow-up period of 1-2 years (49 cases) and 3-4 years (30 cases) showed normal urinalysis in 15 ( 30.6% ) and 18 cases ( 60.0%), persistent isolated hematuria in 20 ( 40.8% ) and 2 cases ( 6.7 % ), hematuria with proteinuria in 11 ( 22.5% ) and 8 cases ( 26.6% ), and persistent heavy proteinuria in 3 ( 6.1% ) and 2 cases ( 6.7% ) respectively. Clinical outcome according to histopathologic grading showed the frequency of normalization of urinalysis being lower in Grade III compared to grade I or II. Clinical outcome according to initial clinical presentation showed no relationship to the normalization of urinalysis at follow-up periods. However, 15-20% of children with initial heavy proteinuria showed persistent heavy proteinuria ( 3 out of 20 cases at 1-2 years, and 2 out of 10 case at 3-4 years of follow-up periods). CONCLUSION: The majority of children with HS nephritis (histopathologic grade I, II, III) improved within 3-4 years, and persistent heavy proteinuria was seen only in a few of children with initial clinical presentation of heavy proteinuria.

Comparison of Growth Hormone Secretory Ability between Insulin, Propranolol-levodopa, and Clonidine in Growth Hormone Deficiency Patients / 대한소아내분비학회지

PURPOSE:Several drugs such as insulin, propranolol, levodopa, glucagon and clonidine have been used for pharmacological growth hormone(GH) provocative test, and each medical center chooses different combinations of drugs during GH provocative tests. In this study, authors compared three drugs insulin(RI), clonidine(C), and propranolol-levodopa(P-L) in terms of GH secretory ability to select the most effective drug. METHODS:Study patients consisted of 63 children with idiopathic growth hormone deficiency, who were diagnosed 'H deficiency'in the department of pediatrics, Kyungpook National University Hospital between January, 1995 and December, 1995. Peak values of GH by each drug were analyzed and following results were obtained. RESULTS:Numbers of patients who showed peak GH values of or = 10ng/mL were 23, 22 and 18 respectively in GH provocative test using RI, 48, 12 and 3, respectively in GH provocative test using P-L, 55, 8 and 0, respectively in GH provocative test using C. The numbers of patients showing peak growth hormone values over 6ng/mL were more significantly in GH provocative test using RI than those using P-L or C(P<0.05). CONCLUSION: Among drugs authors have been using in GH provocative tests, RI was more effective in stimulating growth hormone secretion than P-L or C. Authors feel that RI should be included in GH provocative tests for the diagnosis of growth hormone deficiency.