Trajectory of Estimated Glomerular Filtration Rate Predicts Renal Injury in Children with Multicystic Dysplastic Kidney.

BACKGROUND/AIMS: Children with a solitary functioning kidney have a risk of renal injury caused by hyperfiltration. Timely intervention with renin-angiotensin inhibitors may be beneficial. We examined whether trajectory of estimated glomerular filtration rate (eGFR) would predict renal injury, defined as microalbuminuria/proteinuria, hypertension, and/or a decline in eGFR. METHODS: Seventeen patients (male 7, female 10) with multicystic dysplastic kidney (MCDK; median age 13 years, range 6-19 years) followed in our clinic were examined retrospectively. An eGFR decline was defined as a fall to < 90 mL/min/1.73 m2 or a decline of > 5 mL/min/1.73 m2/year for those with baseline eGFR of ≥90 or < 90 mL/min/1.73 m2 respectively. RESULTS: Nine patients had renal injury at the time of investigation. Compared with 8 patients without renal injury, those with renal injury tended to be older (14.7 ± 4.2 vs. 11.4 ± 4.6 years) and the birth weight was smaller (2,538 ± 281 vs. 2,966 ± 361 g, p < 0.05). The frequency of contralateral congenital anomaly of kidney and urinary tract (cyst, hydronephrosis, or vesicoureteral reflux) were not different. The trajectory of eGFR in those without renal injury was either an increase (n = 3) or unidentifiable (n = 5), whereas that in the renal injury group was exclusively an increase followed by decline (p < 0.05). The average age of the onset of eGFR decline was 9.4 ± 4.2 years and that of the start of renal injury (albuminuria/proteinuria 5, eGFR decline 4, hypertension 1) was 12.5 ± 4.2 years. CONCLUSION: All the children with MCDK who developed renal injury had eGFR trajectory of increase followed by decline. Renal injury followed the peak eGFR by 3 years on average. This observation is in agreement with the hyperfiltration theory and underscores the importance of following eGFR trajectory closely.

[Association between childhood oral allergy syndrome and sensitization against four major pollens (Japanese cedar, orchard grass, short ragweed, alder)].

BACKGROUND/AIM: Although OAS (oral allergy syndrome) during childhood is believed to be rare, it seems to be increasing these days. METHODS, SUBJECTS: We here report 16 cases of childhood OAS, which were diagnosed, in our division. In addition to these reports, we investigated the rate of sensitization against four major pollens (Japanese cedar, orchard grass, short ragweed, alder) among 1067 pediatric patients with allergic diseases (median age: 4 years old) in our division. The sensitization was examined by IgE CAPRAST and above class 2 was judged as positive sensitization. RESULTS: OAS in childhood differs from that in adulthood in some ways. One is that childhood OAS does not always accompany with pollinosis. The most frequent allergen in our study was kiwi fruits followed by tomato, orange and melon among these patients. The sensitization rate against alder was equivalent as that against orchard grass and short ragweed, but less than that against Japanese cedar. CONCLUSION: Childhood OAS may have different mechanisms from adulthood OAS which almost always accompanies with pollinosis or latex allergy.