Hypertension is a major risk factor of atherosclerosis which results in cardiovascular disease, and remains a major health problem worldwide. While children are more likely to have secondary hypertension, recent studies support the theory that the prevalence of essential hypertension in children and adolescents is increasing with the global epidemic of childhood obesity, and close attention is needed. Evaluation of hypertension in the pediatric age group should be guided by the age at presentation, and renal diseases must be considered in every child with hypertension, because of the prevalence of renovascular and renal parenchymal disorders as the etiology in any age group. The majority of children with chronic kidney disease are hypertensive, and many have associated end organ damage. Thus, once hypertension has been confirmed, end organ care as well as pharmacologic therapy must be continued. In renovascular hypertension, as cure could be gained with surgical/endovascular intervention, accurate diagnosis is important and it is recommended that every suspected child should undergo angiography.
Adolescent ; Angiography ; Atherosclerosis ; Cardiovascular Diseases ; Child ; Humans ; Hypertension ; Hypertension, Renovascular ; Obesity ; Prevalence ; Renal Insufficiency, Chronic ; Risk Factors

Congenital anomalies of the kidney and urinary tract (CAKUT) account for more than 50% of abdominal masses found in neonates and involve about 0.5% of all pregnancies. CAKUT has a major role in renal failure, and increasing evidence suggests that certain abnormalities predispose to the development of hypertension and cardiovascular disease in adulthood. To understand the pathogenesis of human renal anomalies, understanding the development of kidney is important. Diverse anomalies of the kidney corresponding to defects at a particular stage of development have been documented recently; however, more research is required to understand the molecular networks underlying kidney development, and such an investigation will provide a clue to the therapeutic intervention for CAKUT.
Cardiovascular Diseases ; Humans ; Hypertension ; Infant, Newborn ; Kidney ; Pregnancy ; Renal Insufficiency ; Urinary Tract ; Vesico-Ureteral Reflux

Acute renal failure is the generic term for an abrupt and sustained decrease in renal function resulting in retention of nitrogenous and non nitrogenous waste product. This may results in life threatening consequences including volume overload, hyperkalemia, and metabolic acidosis. Acute renal failure is both common and carries high mortality rate, but as it is often preventable, identification of patients at risk and and appropriate management are crucial. This review summarized the most recent information on definition, epidemiology, clinical causes and management of acute renal failure in pediatric patients.
Acidosis ; Acute Kidney Injury* ; Epidemiology ; Humans ; Hyperkalemia ; Mortality ; Nitrogen ; Pediatrics* ; Waste Products

Cytomegalovirus (CMV) is the single most common infection following kidney transplantation and despite prophylactic strategies and the development of new antiviral agents, it still remains a cause of considerable morbidity and mortality. Current literature suggests that CMV infection may trigger rejection. We report a case of late CMV disease in a preemptive seropositive recipient who did not receive CMV prophylaxis. Diarrhea and abdominal cramping persisted after the administration of mycophenolate mofetil (MMF) six months after transplantation and resulted in ileal perforation at eight months after transplantation. The boy recovered after six weeks of treatment with ganciclovir. MMF has been mooted as a risk factor for CMV infection since its introduction, and further investigations are required to confirm its role. More attention to infectious complications is necessary and serial monitoring of viral load is recommended when MMF is administered.
Antiviral Agents ; Colic ; Cytomegalovirus ; Diarrhea ; Ganciclovir ; Kidney ; Kidney Transplantation ; Mycophenolic Acid ; Risk Factors ; Transplants ; Viral Load

PURPOSE: Growing data on the relationship between cytokine expression and the progression of renal diseases make these cytokines potential targets for therapeutic interventions. Weexamined the helper T1-cell- and macrophage-associated cytokines in anti-glomerular basement membrane (GBM) antibody-induced nephritis in mice and their temporal relationships with renal tissue fibrosis. METHODS: Kidneys were harvested on days 1, 3, 7, 11, and 16 after glomerulonephritis was induced with anti-GBM antibody. The progression of renal fibrosis was serially monitored to quantitate the accumulation of cortical extracellular matrix, and various cytokines were measured simultaneously. RESULTS: A single injection of anti-GBM antibody successfully produced severe crescentic glomerulonephritis. Proteinuria increased abruptly and both mesangial matrix expansion and interstitial fibrosis progressed rapidly. Cortical fibronectin and type III collagen increased continuously, reaching a peak on day 7, and the deposition of type III collagen followed the same pattern, in parallel with that of urinary transforming growth factor 1 (TGF-1) expression. Serial cytokine measurements revealed a sustained increase in interleukin (IL) 6 and monocyte chemoattractant protein 1 (MCP1) from day 3, but neither IL12, IL18, nor interferon changed significantly. Real-time polymerase chain reaction confirmed these features at the transcription level. CONCLUSION: MCP1 and IL6 correlated with the progression of renal fibrosis, with no increase in Th1- inducing cytokines. This confirms MCP1 and IL6 as attractive therapeutic targets for renal fibrosis in crescentic glomerulonephritis.
Animals ; Anti-Glomerular Basement Membrane Disease ; Autoantibodies ; Basement Membrane ; Chemokine CCL2 ; Collagen Type III ; Cytokines ; Extracellular Matrix ; Fibronectins ; Fibrosis ; Glomerulonephritis ; Interferons ; Interleukin-12 ; Interleukin-18 ; Interleukin-6 ; Interleukins ; Kidney ; Mice ; Nephritis ; Proteinuria ; Real-Time Polymerase Chain Reaction ; Transforming Growth Factors

PURPOSE: Regional anticoagulation with trisodium citrate for continuous renal replacement therapy(CRRT) is an effective and safe method, with lower bleeding risk. However it is not widely used because of complex current protocols used to prevent anticipated metabolic derangements. We evaluated simplified regional anticoagulation protocols with ACD-A(R) solution and commercially available calcium-containing dialysis solution. METHODS: The medical records of twenty-eight patients who underwent CRRT were reviewed. Hemofilter life span according to the anticoagulation method used was compared, and laboratory findings at pre- and 48 hours post-CRRT initiation were compared in the citrate-based CRRT group. RESULTS: Of the twenty-eight patients, five patients underwent citrate-based CRRT. Hemofilter life span was 1.60+/-0.72 days, showing no significant differences with the hemofilter life span in the heparin based and LMWH based CRRT group. No patients experienced hemorrhagic complications. PT, aPTT, sodium, tCO2, iCa levels showed no difference in pre- and post-CRRT. Total calcium levels were increased. At the recommended postfilter iCa level, i.e., 0.25-0.39 mmol/L, all five patients needed increased amount of citrate infusion, and Ca infusion requirement was decreased. CONCLUSION: Simplified regional citrate anticoagulation with calcium-containing dialysate is an effective and safe method, and is not associated with increased hemofilter clotting. However, increased postfilter iCa level is recommended.
Calcium ; Child* ; Citric Acid* ; Dialysis ; Hemorrhage ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Medical Records ; Renal Replacement Therapy* ; Sodium

Continous renal replacement therapy(CRRT) is becoming increasingly popular for the support of critically ill patients with acute renal failure, and the development of pump-driven volumetric-control CRRT machines with small extracorporeal volumes has lead to the widespread use of venovenous form of CRRT in pediatric field. Basic principles are diffusion and convection. CRRT is indicated in the hemodynamically unstable pediatric patients for hypervolemic anuric acute renal failure, electrolyte abnormalities, multiorgan failure, catabolic patients with increased nutritional needs and hyperammonemia, etc. To date, experiences are limited for pediatric CRRT, but current reports support that CRRT is feasible and useful in children and even infants, and the survival rate of the patients on CRRT is as same as adults. We describe the basic principles, equipments, methods and complications of CRRT, with special considerations on small children to meet the current need for CRRT.
Acute Kidney Injury ; Adult ; Child ; Convection ; Critical Illness ; Diffusion ; Humans ; Hyperammonemia ; Infant ; Pediatrics* ; Renal Replacement Therapy* ; Survival Rate

Parvovirus B19(PV B19) is a nonenveloped single-stranded DNA virus that causes a wide variety of diseases ranging from benign childhood infection such as slapped-cheek rash(fifth disease) to life threatening diseases such as hydrops fetalis in fetuses or aplastic anemic crises in patients with hemolytic anemia. In immunocompromised hosts including organ transplant recipients, this infection can cause chronic anemia. Recently, the reports of cases of PV B19 infection have been increasing in transplant recipients and most reported cases of PV B19 infection-associated anemia in renal transplant recipients were successfully treated with intravenous immunoglobulin infusion. We experienced two cases of aplastic anemia caused by PV B19 infection in pediatric renal transplant recipients. The patients were an 8- year-old boy and 12-year-old boy who received allograft kidneys from their mothers. Anemia developed 2 weeks after transplantation and their serum was positive for PV B19 PCR. They were treated with 400 mg/kg of intravenous immunoglobulin(IVIG) for 5 consecutive days. In one of the case, anemia was corrected promptly after the first 5-day course of IVIG therapy but in the other, anemia persisted but responded to the second course of IVIG therapy. One year later, the patients have normal hematocrit levels and stable renal function. These are the first cases of PV B19 infection treated successfully with IVIG in pediatric renal transplant recipients in Korea.
Allografts ; Anemia ; Anemia, Aplastic ; Anemia, Hemolytic ; Child ; DNA, Single-Stranded ; Fetus ; Hematocrit ; Humans ; Hydrops Fetalis ; Immunocompromised Host ; Immunoglobulins ; Immunoglobulins, Intravenous ; Kidney Transplantation ; Kidney* ; Korea ; Male ; Mothers ; Parvovirus* ; Polymerase Chain Reaction ; Transplantation ; Transplants

BACKGROUND: Pyelonephritis is one of the major causes of chronic renal failure in children, and the transforming growth factor-beta1 (TGF-beta1) is a molecule with pivotal roles in fibrogenesis. This study was performed to investigate the alteration and clinical implications of urinary TGF-beta1/creatinine ratio in children with acute pyelonephritis. METHODS: Urine was collected from 67 normal children and 25 children with acute pyelonephritis. After routine urinalysis, urine TGF-beta1 was quantitated by ELISA method and creatinine was measured by alkaline picrate method. Urinary TGF-beta1/ creatinine ratios in children with pyelonephritis were compared with those of age-matched controls, and sequential changes of the ratios in pyelonephritic children were traced after antibiotic treatment. Correlation of urinary TGF-beta1/creatinine ratio with the degree of pyuria and renal scar was analyzed each. RESULTS: Neonates showed higher urinary TGF-beta1/creatinine ratios than older children. The ratio increased in acute pyelonephritis and gradually returned to the control level two days after antibiotic treatment. Urinary TGF-beta1/creatinine ratio in acute pyelonephritis was not correlated with the degree of pyuria and renal scar. CONCLUSION: The age should be considered in evaluation of urinary TGF-beta1/creatinine ratio in children. The ratio increases in acute pyelonephritis, and is independent of the degree of pyuria or renal scarring.
Child ; Cicatrix ; Creatinine ; Enzyme-Linked Immunosorbent Assay ; Humans ; Infant, Newborn ; Kidney Failure, Chronic ; Pyelonephritis* ; Pyuria ; Transforming Growth Factor beta1 ; Urinalysis

PURPOSE: Acute poststreptococcal glomerulonephritis (APSGN) is a common form of glomerulonephritis in children. Most patients recover completely after the acute phase but a few patients have acute complications or progress to chronic renal disease. In recent years, the frequency of APSGN has been was decreasing but is still common in children. So we studied the clinical characteristics of APSGN from 1994 to 2003 and compared it with past studies. METHODS: We studied 105 patients who were diagnosed with APSGN in the Department of Pediatrics, Asan Medical Center between January 1994 and December 2003, with a retrospective chart review. RESULTS: The mean age was 8.5+/-2.6 years. The male to female ratio was 2: 1. Average annual incidence was 10.5+/-4.9 most patients (60.0 percent) occurred from October to January. Edema was seen in 82 cases (78.1 percent), gross hematuria in 70 cases (66.7 percent), hypertension in 50 cases (47.6 percent) and oliguria in 22 cases (20.9 percent). Microscopic hematuria was seen in 105 cases (100 percent), positive ASO in 99 cases (94.2 percent), proteinuria in 67 cases (63.8 percent) and azotemia in 38 cases (36.2 percent). Serum complement 3 (C3) level decreased in 96 cases and returned to normal within eight weeks in 70 patients (75.3 percent). Kidney biopsy was carried out in 22 cases. Most acute symptoms subsided within 2 weeks of onset. CONCLUSION: We concluded that there was no significant difference between clinical features of recent and past APSGN in children, and short term prognoses were excellent.
Azotemia ; Biopsy ; Child* ; Chungcheongnam-do ; Complement C3 ; Edema ; Female ; Glomerulonephritis* ; Hematuria ; Humans ; Hypertension ; Incidence ; Kidney ; Male ; Oliguria ; Pediatrics ; Prognosis ; Proteinuria ; Renal Insufficiency, Chronic ; Retrospective Studies