The Effect of Steroid Therapy on Growth and Bone Density in Children with Nephrotic Syndrome

PURPOSE: Long-term steroid therapy for various glomerular disorders in children has been known to decrease serum Vit D3 level and develop osteomalacia. The aim of this study was to observe the effect of long-term steroid therapy on growth and bone density in children with nephrotic syndrome. METHODS: Bone density of 17 steroid-treated nephrotic syndrome was compared with that of 17 similar aged healthy children by biochemical measurement, bone age and bone mineral density. Serum Vit D3, calcium, phosphorus and alkaline phosphatase were measured and bone mineral content was measured in the lumbar vertebra by dual energy X-ray absorptiometry (HOLOGIC QDR 2000 X-Ray Bone densitometer). RESULTS: There was no significant difference in height ,weight and bone age between the two groups. The mean bone density was significantly lower in children receiving steroid (0.58 +/- 0.04g/cm2) than in the control group (0.65 +/- 0.07g/cm2) (P<0.001). There was no significant correlation between duration of steroid therapy and decrement of bone density. Serum Vit D3 level was significantly lower in the group receiving steroid (16.7 +/- 6.1pg/ml) than in the control group (31.0 +/- 5.8pg/ml) (P<0.001). CONCLUSION: we conclude that alternate-day steroid therapy doesn't affect growth but may lead to decrement of serum Vit D3 level and bone mineral density in children with nephrotic syndrome.

A Case of Methylmalonic Acidemia

We experienced a case of vitamin B12 unresponsive methlymalonic acidemia in a 4 day old female, who had poor feeding, dehydration with metabolic acidosis, and hyperammonernia and died at 7 days of age. Diagnosis was made by gas chromatography and mass spectrometry, and this case is probably a methylmalonyl CoA mutase apoenzyme deficiency type.

Clinical Manifestations and Hematologic Complications of Epstein-Barr Virus Infection in Korean Children

PURPOSE: Epstein-Barr virus (EBV) is associated with various diseases and complications caused by the host's immune reactions. This study focuses on various clinical findings and hematologic complications in childhood EBV infection. METHODS: The study group was thirty-eight EBV infected children (Anti-EBV VCA IgM; positive) who were admitted to the Department of Pediatrics, Korea University from January 1996 to July 1997. Patients were evaluated by clinical and laboratory findings. RESULTS: The mean age was 5.1 years old and the male-female ratio was 1.2:1. Fever was the most common clinical manifestation, which was present in 30 (79%) cases. Lymphadenopathy was present in 22 (58%) cases, throat injection in 18 (47%) cases, nausea and vomiting were in 13 (34%) cases, cough in 13 (34%) cases, skin rashes in 11 (29%) cases, hepatomegaly in 10 (26%) cases. AST and/or ALT levels were elevated in 18 (45%) cases and Bilirubin level was elevated in 9 (24%) cases. Twenty cases had hematologic complications. Neutropenia was present in 6 (16%) cases, thrombocytopenia in 1 (3%) case, both anemia and neutropenia in 3 (8%) cases, both anemia and thrombocytopenia in 2 (5%) cases, both neutropenia and thrombocytopenia in 1 (3%) case, pancytopenia in 7 (18%) cases. CONCLUSION: A presumptive diagnosis of EBV infection may be made by the presence of clinical symptoms such as fever, pharyngitis, lymphadenopathy, and hematologic complications such as unknown neutropenia, anemia, thrombocytopenia, and pancytopenia. In such conditions, specific serologic studies for EBV should be performed and confirmed by specific serologic studies.