The Differences in Frequencies and Clinical Manifestations According to the Causes of Membranous Nephropathy in Children

PURPOSE: To report the decreasing incidence of HBV(Hepatitis B virus)-associated membranous nephropathy in children after HBV vaccination and to elucidate the clinical course and treatment strategies of IMN (Idiopathic membranous nephropathy). METHODS: We retrospectively reviewed the clinico-pathological findings of HBV-MN and IMN patients who underwent a renal biopsy from 1986 to 2005. We compared the HBV-MN and the IMN groups and the remission and the non-remission groups of patients with IMN. RESULTS: Among 24 cases of MN patients, HBV-MN comprised 6 cases(25%) and IMN 18 cases(75%). Clinical masnifestations were nephrotic syndrome(3 cases, 50%), nephritic syndrome(1 case, 16.7%), asymptomatic(2 cases, 33.4%) in the HBV-MN group, asymptomatic(10 cases, 55.5%), nephrotic syndrome(5 cases, 27.8%), and gross hematuria(3 cases, 16.7%) in the IMN group. From 1996 to 2000, there were 2 cases(28%) of HBV-MN and 5 cases(72%) of IMN. After 2001, all 10 cases were IMN. In the HBV-MN group, 4 cases(66.7%) received interferon and 1 case received methylprednisolone pulse therapy. In the IMN group, 16 cases (88.9%) received methylprednisolone, 8 cases(44.4%) were in complete remission, 2 cases (11.1%) were in partial remission, 2 cases(11.1%) were in chronic renal failure, and 5 cases (27.8%) were lost to follow-up with sustained proteinuria, 1 case(5.6%) continued to have frequent relapse of nephrotic syndrome without renal insufficiency. In the comparison between remission and non-remission groups, nephrotic range proteinuria and hypertension were more significantly common in the non-remission group(P<0.05). CONCLUSION: With HBV vaccination, HBV-MN has decreased markedly. IMN is a rare glomerular disease in children. Because the prognosis for patients with nephrotic range proteinuria is poor, this group needs more aggressive treatment.

A Case of Recurrent Transient Small Bowel Intussusception / 대한소아소화기영양학회지

Isolated small bowel intussusception accounts for 10% of all pediatric intussusception. It is more common in children older than 2 years of age. Presentation usually is with vomiting and abdominal pain. Currant jelly stool and palpable mass are less frequent than typical intussusception. There are few reported cases of children with transient small bowel intussusception. We describe 3-year-old boy presented with intermittent cyclic crampy abdominal pain for 6 months was diagnosed as having recurrent transient small bowel intussusception by abdominal ultrasonography and small bowel series.

The Usefulness of N-terminal Pro-Brain Natriuretic Peptide in the Diagnosis of the Kawasaki Disease

PURPOSE: Kawasaki disease (KD) is a well-known generalized vasculitis involving cardiovascular system and there is no specific biochemical marker for detecting this disease. We performed a study to investigate the usefulness of plasma NT-proBNP as a biochemical marker for the diagnosis of KD. METHODS: We measured the plasma NT-proBNP concentrations in acute (complete KD, n=48; incomplete KD, n=10) and convalescent (n=31) phases of KD, and in patients with other acute febrile diseases (n=24) associated with rash or cervical lymphadenitis. RESULTS: The plasma NT-proBNP concentrations in patients with both complete and incomplete KD in the acute phase were significantly higher than in those with febrile illness (complete KD, 1211.9+/-1653.7 pg/mL; incomplete KD, 2245.9+/-2720.7 pg/mL versus febrile illness, 138.8+/-104.9 pg/mL; P<0.001). Also, the level of plasma NT-proBNP decreased significantly in the convalescent phase compared with level of NT-proBNP in acute phase (n=31, acute phase, 1390.2+/-1891.8 pg/ml; convalescent phase, 88.3+/-125.3 pg/mL; P<0.001). There were no significant correlations between the plasma concentrations of NT-proBNP and the clinical, laboratory and echocardiographic findings of acute phase of KD. The best cut-off level of NT-proBNP for the differential diagnosis of KD with other febrile disease was determined to be 287.0 pg/mL (sensitivity 0.862, specificity 0.917). CONCLUSION: We suggest that the measurement of plasma NT-proBNP level may be helpful for the definite diagnosis of KD, especially incomplete KD. Further studies are needed to investigate the usefulness of the NT-proBNP as a predictive marker for cardiovascular complications.