Primary renal artery aneurysm has been estimated to account for an incidence of 0.015-1% with associated morbidities including renovascular hypertension and rupture. Renovascular hypertension associated renal artery aneurysms in children is not a common disease. In patients with complicated renal vascular disease, renal autotransplantation has been used as an alternative to percutaneous transluminal angioplasty, which may be hazardous in these situations. We report a case of a renal artery aneurysm in a 13-year-old Korean child presenting hypertension detected during school health examination. Preoperative workup demonstrated a 2.8x2.1x1.9 cm saccular aneurysm in the right renal hilum that was not amendable to endovascular repair. A surgical strategy including extracorporeal renal artery reconstruction with autotransplantation was applied in order to restore renal artery anatomy and to treat renovascular hypertension. Immediately he complained of severe right flank pain and postoperative doppler sonography revealed lack of perfusion. On the 5th day after autotransplantation, the patient underwent a transplant nephrectomy. He was well postoperatively and was found to have a normal kidney function and stable blood pressure control without antihypertensive medication. This is the first pediatric case of renal artery aneurysm in Korea who underwent extracorporeal repair followed by autotransplantation failure. More pediatric cases with renal artery aneurysm should be reported to identify therapeutic outcome and long term prognosis.
Adolescent* ; Aneurysm* ; Angioplasty ; Autografts ; Blood Pressure ; Child* ; Flank Pain ; Humans ; Hypertension ; Hypertension, Renovascular ; Incidence ; Kidney ; Korea ; Nephrectomy ; Perfusion ; Prognosis ; Renal Artery* ; Rupture ; School Health Services ; Vascular Diseases

Infection is the most important cause of death in children with nephrotic syndrome. Influenza viral infections can be fatal for these children, given the annual outbreak of this virus, with the mortality rate being similar to that of respiratory syncytial virus in healthy children. Pneumonia is recognized as the most important complication of influenza infections, as it is associated with high death rates. However, the influenza vaccine, as well as antiviral agents, can be used for prevention and treatment. Therefore, aggressive management with influenza vaccination and antiviral agents will lower the overall mortality rate in children with nephrotic syndrome. Here we report the case of a 7-year-old boy with nephrotic syndrome and influenza A virus (H1N1) pneumonia.
Antiviral Agents ; Cause of Death ; Child* ; Humans ; Influenza A virus ; Influenza Vaccines ; Influenza, Human* ; Male ; Mortality ; Nephrotic Syndrome* ; Pneumonia ; Respiratory Syncytial Viruses ; Vaccination

Kawasaki disease (KD) is a systemic vasculitis that can affect many organ systems. Renal manifestations include pyuria, hematuria, proteinuria, tubulointerstitial nephritis, acute renal failure, hemolytic uremic syndrome, or renal scarring. Although its precise pathogenesis remains unknown, it is considered an autoimmune disease. In the literature, it has been reported that KD may develop in conjunction with urinary tract infections. However, many of these previous studies did not use imaging methods such as renal sonograms, dimercaptosuccinic acid renal scans, and voiding urethrocystograms. We report a case of an 8-month old male infant with high grade vesicoureteral reflux, who developed incomplete KD after recurrent pyelonephritis. Acute pyelonephritis can be an early manifestation of KD. Such cases require the evaluation of urinary tract anomalies according to the guidelines for the management of urinary tract infections.
Acute Kidney Injury ; Autoimmune Diseases ; Cicatrix ; Hematuria ; Hemolytic-Uremic Syndrome ; Humans ; Infant* ; Male ; Mucocutaneous Lymph Node Syndrome* ; Nephritis, Interstitial ; Proteinuria ; Pyelonephritis* ; Pyuria ; Succimer ; Systemic Vasculitis ; Urinary Tract ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

PURPOSE: Urinary tract infections (UTIs) are the most common source of bacterial infections in infants and young children. Accurate diagnosis and treatment is important because of their association with renal scarring, which can lead to complications. Urine endothelin-1 (ET-1) is the major renal isoform produced and released by renal mesangial cells in response to glomerular injury. This study aimed to investigate whether urinary levels of ET-1 can be used as a biomarker for UTI diagnosis. METHODS: We conducted a prospective study using medical records of 70 patients below the age of 18 years, who visited Chung-Ang University Hospital from July 2012 to July 2013. We classified the patients into the UTI and control groups based on urine culture studies. The UTI group was further divided into upper and lower UTI groups using 99m-Technetium dimercaptosuccinic acid scintigraphy. Urine ET-1 was measured using enzyme linked immunosorbent assay with 0.3 mL urine. RESULTS: The UTI and control groups were comprised of 45 and 25 patients, respectively. Mean urine ET-1 levels were significantly higher in the UTI group than in the control group (1.41+/-0.35 pg/mL vs. 0.33+/-0.07 pg/mL, P=0.04). There was no significance difference in the quantitative value between the upper and lower UTI groups (P=0.552). There was no correlation between urine ET-1 and serum C-reactive protein (Pearson correlation [R]=0.24), urine ET-1 and serum white blood cell count (R=0.19). CONCLUSION: Our study suggests that urine ET-1 can be used for early diagnosis of UTI in children.
Bacterial Infections ; Biomarkers ; C-Reactive Protein ; Child* ; Cicatrix ; Diagnosis ; Early Diagnosis ; Endothelin-1* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Infant ; Leukocyte Count ; Medical Records ; Mesangial Cells ; Pediatrics ; Prospective Studies ; Radionuclide Imaging ; Succimer ; Urinary Tract Infections*

INTRODUCTION: Persistent vesicoureteral reflux (VUR), a major cause of urinary tract infection (UTI) in children, can result in serious renal complications, such as reflux nephropathy and chronic renal failure. We evaluated the clinical characteristics and prognostic factors of VUR. METHODS: From December 1993 to May 2011, we examined 117 children with vesicoureteral reflux who were admitted to the Department of Pediatrics and Urology, Chungbuk National University hospital for a UTI. The patients were managed medically or surgically. RESULTS: Male patients had a slightly higher prevalence of VUR than female patients (55%). The degrees of the 161 refluxing ureters, as classified by the International Reflux Study Committee, were as follows: grade I, 15 ureters; grade II, 32 ureters; grade III, 54 ureters; grade IV, 26 ureters; grade V, 34 ureters. One hundred and sixty-one renal units (115 cases) underwent a 99m TC-DMSA renal scan, and 62% showed abnormal findings. The incidence of renal cortical defects showed a direct correlation with the severity of VUR. Ninety-four refluxing ureters were followed up medically, and 66 ureters (67%) either disappeared or improved. However, 9 refluxing ureters persisted. The spontaneous resolution rate of VUR seemed to be higher in younger patients with lower grades of reflux, and without renal cortical defects. Sixty-seven refluxing ureters (41%) were treated surgically, 62 refluxing ureters (92%) disappeared, and 5 refluxing ureters (8%) persisted. CONCLUSION: The incidence of renal cortical defects in patients with UTIs was 62% (in a 99m TC-DMSA renal scan), and showed a direct correlation with the severity of VUR. The spontaneous resolution rate seemed to be lower in the patients with higher grades of VUR, older age (over 4 years old) and diffuse renal cortical defects.
Child ; Chungcheongbuk-do ; Female ; Humans ; Incidence ; Kidney Failure, Chronic ; Male ; Pediatrics ; Prevalence ; Ureter ; Urinary Tract Infections ; Urology ; Vesico-Ureteral Reflux*

PURPOSE: The purpose of this study was to assess the therapeutic efficacy of methylprednisolone pulse therapy in children with IgA nephropathy and Henoch-Schonlein Purpura (HSP) nephritis combined with proteinuria. METHODS: We retrospectively reviewed the clinical records of 21 patients who were diagnosed with IgA nephropathy and HSP nephritis based on percutaneous renal biopsy. Of the 21 patients, 15 were diagnosed with IgA nephropathy and 6 were diagnosed with HSP nephritis. They had mild to severe proteinuria at the time of diagnosis or during follow-up. Group 1 (n=7) received methylprednisolone pulse therapy three times every couple of months, and Group 2 (n=14) received oral steroid therapy. The follow-up periods for Group 1 and 2 were 14.0 (9-54) months and 26.5 (14-34) months, respectively. There was no significant difference in the follow-up duration between the two groups. RESULTS: The average age at diagnosis and biopsy was lower in Group 1 compared to Group 2, but it was not significantly different. At admission, all patients in both groups had hematuria and 5 patients (71.4%) of Group 1 and 14 patients (100%) of Group 2 had proteinuria. Before treatment, there was no significant difference of spot urine protein/creatinine ratio between the two groups. During follow-up, 7 patients of Group 1 (100%) and 10 patients of Group 2 (71.4%) showed complete improvement of proteinuria and the spot urine protein/creatinine ratio in Group 1 was significantly lower than Group 2. CONCLUSION: In patients with IgA nephropathy and HSP nephritis with proteinuria, methylprednisolone pulse therapy was more effective than oral steroid therapy in the reduction of proteinuria. To investigate the effects on long-term prognosis, large-scale prospective studies are needed.
Biopsy ; Child* ; Diagnosis ; Follow-Up Studies ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Methylprednisolone* ; Nephritis* ; Prognosis ; Proteinuria* ; Purpura, Schoenlein-Henoch ; Retrospective Studies

PURPOSE: The pharmacokinetics of tacrolimus, one of the most widely used immunosuppressive drugs, are known to vary by sex, age, and ethnicity during pediatric transplantation. This study assessed the pharmacokinetic characteristics and associated factors of tacrolimus in Korean children receiving a kidney transplant. METHODS: We retrospectively reviewed the pharmacokinetic data (therapeutic dose, trough level, clearance, and half-life) of 9 children who were given tacrolimus as one of their initial immunosuppressive drugs after kidney transplantation. In addition, we compared the findings to data from 10 adult kidney transplant recipients. RESULTS: The mean age of our pediatric patients was 13.9 years, and the male-to-female ratio was 4:5. The mean dose of tacrolimus was 0.19+/-0.14 mg/kg/day. The mean dose of tacrolimus for males was 0.23+/-0.12 mg/kg/day, which was significantly higher than the dose for females (0.16+/-0.14 mg/kg/day). The trough level was not significantly different between both groups. The clearance rate of tacrolimus for males was also significantly higher than females. Although the dosage of tacrolimus for patients over the age of 12 years was lower (0.18+/-0.13 vs. 0.21+/-0.16 mg/kg/day) and the trough level was higher (8.2+/-4.5 vs. 7.2+/-4.2 mg/mL) than that for patients under the age of 12 years, there was no significant difference between them. However, there were significant differences between children and adults in dose, clearance, and half-life of tacrolimus. CONCLUSION: Out study suggests that the pharmacokinetics of tacrolimus tends to vary with sex and age. Therefore, large-scale prospective studies are required to verify the proper therapeutic dosage of tacrolimus in Korean children.
Adult ; Child ; Female ; Half-Life ; Humans ; Kidney ; Kidney Transplantation* ; Male ; Pharmacokinetics* ; Retrospective Studies ; Tacrolimus* ; Transplantation

Continuous renal replacement therapy (CRRT) has become the preferred dialysis modality to support critically ill children with acute kidney injury. As CRRT technology and clinical practice advances, experiences using CRRT on small infants and neonates have increased. In neonates with hyperammonemia or acute kidney injury during extracorporeal membrane oxygenation (ECMO) therapy, CRRT can be a safe and effective technique. However, there are many limitations of CRRT in neonates, including vascular access, bleeding complications, and lack of neonate-specific devices. This review discusses the basic principles of CRRT and the special considerations when using this technique in neonates and infants.
Acute Kidney Injury ; Child ; Critical Illness ; Dialysis ; Extracorporeal Membrane Oxygenation ; Hemorrhage ; Humans ; Hyperammonemia ; Infant* ; Infant, Newborn* ; Renal Replacement Therapy*

Cardiovascular disease (CVD) has been identified as one of the most important factors influencing the long-term prognosis of patients with chronic kidney disease (CKD). However, in pediatric CKD, the clinical importance of CVD tends to be overlooked due to the lack of typical manifestations of CVD in this population. The literature has identified several traditional risk factors of CVD that originate from CKD, including hypertension, diabetes mellitus, dyslipidemia and obesity, in addition to new and non-traditional risk factors including anemia, secondary hyperparathyroidism, oxidative stress and inflammation. In cases of pediatric CKD, cardiovascular disease is usually restricted to subclinical manifestations such as left ventricular hypertrophy, thickening of intimal media on the carotid artery and calcification of the coronary artery. Therefore, risk factors of CVD in pediatric CKD patients should be closely monitored.
Anemia ; Cardiovascular Diseases* ; Carotid Arteries ; Child ; Coronary Vessels ; Diabetes Mellitus ; Dyslipidemias ; Humans ; Hyperparathyroidism, Secondary ; Hypertension ; Hypertrophy, Left Ventricular ; Inflammation ; Obesity ; Oxidative Stress ; Prognosis ; Renal Insufficiency, Chronic* ; Risk Factors

No abstract available.