ABSTRACT
PURPOSE:Urine examination for microalbuminuria during the clinical silent years can help to identify those patients most likely to progress to overt nephropathy. The normalization of the AER(Albumin Excretion Rate) by alteration of glomerular hemodynamics may be the key to preventing or delaying overt nephropathy. The prognostic and therapeutic implications have led to attempts to identify patients with microalbuminuria as early as possible.Because diagnosis of microalbuminuria has required a 12 or 24 hour urine collection,there has been interested in developing tests that might serve as a first-stage screen for microalbuminuria. Most reports have dealt with the usefulness of either the albumin concentration or the albumin/creatinine ratio in a timed or randomly collected urine specimen. Exercise induced albumin excretion is increased compared to resting and could unmask latent glomerular damage. The purpose of this study is to evaluate diagostic significance of urinary albumin measurement after exercise in children with insulin dependent diabetes. METHODS:Fifty-seven patients with IDDM collected their overnight urine from 22:00 to 6:00 in following morning. Exercised method for urine examination was 100M running and collected 2 hour urine after exercise. The AER and Albumin/ creatinine ratio(ACR) were measured in the urine and compared with before and after exercise. RESULTS:Mean ages of diabetic children was 13.7 yrs old and duration of diabetes was 4.1+/-2.7yrs, HbA1c 8.6+/-1.9%,Systolic BP 107+/-10mmHg and Diastolic BP 67+/-8mmHg. The exercise induced AER was increased compared to before exercise(10.3+/-10.5 vs 18.1+/-16.0 mg/24hr). The exercise induced ACR also increased too(1.4+/-1.5 mg/g.Cr vs 4.1+/-3.6mg/g.Cr)(P<0.01). Two(3.5%) children with IDDM was positive for microalbuminuria in terms of AER before exercise and 8 children(14%) after exercise. No one positive for microalbuminuria in terms of Alb/cr before and after exercise. The charateristics of 8 children with microalbuminuria after exercise was no specific difference between positive and negative microalbuminuria. There was specific correlation between microalbuminuria and HbA1c(P<0.05) but sex, ages, duration of diabetes & blood pressure were not correlated with incidence of microalbuminuria. CONCLUSION: The mean timed urinary albumin excretion after exercise was significantly higher than before exercise. Measurement of timed urinary albumin excretion after exercise will be helpful for detecting microalbuminuria earlier.
Subject(s)
Child , Humans , Blood Pressure , Creatinine , Diabetes Complications , Diabetes Mellitus, Type 1 , Diabetic Nephropathies , Diagnosis , Hemodynamics , Incidence , Insulin , RunningABSTRACT
BACKGROUND: Aseptic meningitis is an acute viral infection of the central nervous system that occurs commonly in childhood. Although the etiologic agent is not always identified, the human enteroviruses are responsible for most cases of aseptic meningitis in which a cause can be identified. Enterovirus causes approximately 80% of all cases of aseptic meningitis. In 1993, there was a nationwide epidemic of aseptic meningitis by echovirus 9 and 30. We reported that the cause of aseptic meningitis in 1994 was echovirus 3 and coxsackievirus B3 and echovirus 7 in 1995. This study was done to detect the causative agent of aseptic meningitis in spring, 1996. METHODS: To isolate the causative viruses, stool and cerebrospinal fluid specimens from the patients with aseptic meningitis, who were admitted to Severance Hospital in 1996, were collected. Cultured RD cells and HEp-2 cells were inoculated with specimens to see the cytopathic effects. Neutralizing antibody tests using enterovirus serum pool were done on the specimens with the cytopathic effects. RNA was isolated from the cultured supernatants of the infected cells. Oligonucleotide was synthesized by PCR, which was run on polyacrylamide gel after purification with HPLC. After running the DNA produced by using Geneamp RNA PCR kit, electrophoresis was done. RESULTS: Enteroviruses were isolated from 14 out of 17 patients. Among these fourteen, Coxsackievirus B1 was isolated in 13 patients and poliovirus in one patient. PCR product from these viruses showed a 152bp band on electrophoresis. CONCLUSION: The causative virus of aseptic meningitis in patients who were admitted to Severance Hospital during the spring season of 1996 was Coxsackievirus B1.
