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Effect of Diet and Water Intake on Aquaporin 2 Function.

Childhood Kidney Diseases.2016;20(1):11-17. doi:10.3339/jkspn.2016.20.1.11

Appropriate control of diet and water intake is important for maintaining normal blood pressure, fluid and electrolyte homeostasis in the body. It is relatively understood that the amount of sodium and potassium intake directly affects blood pressure and regulates ion transporters; Na and K channel functions in the kidney. However, little is known about whether diet and water intake regulates Aquaporin (AQP) function. AQPs, a family of aquaporin proteins with different types being expressed in different tissues, are important for water absorption by the cell. Water reabsorption is a passive process driven by osmotic gradient and water permeability is critical for this process. In most of the nephron, however, water reabsorption is unregulated and coupled to solute reabsorption, such as AQP1 mediated water absorption in the proximal tubule. AQP2 is the only water channel founded so far that can be regulated by hormones in the kidney. AQP2 expressed in the apical membrane of the principal cells in the collecting tubule can be regulated by vasopressin (antidiuretic hormone) controlling the final volume of urine excretion. When vasopressin binds to its receptor on the collecting duct cells, it stimulates the translocation of AQP2 to the membrane, leading to increased water absorption via this AQP2 water channel. However, some studies also indicated that the AQP2 is also been regulated by vasopressin independent mechanism. This review is focused on the regulation of AQP2 by diet and the amount of water intake on salt and water homeostasis.
Absorption ; Aquaporin 2* ; Arginine Vasopressin ; Blood Pressure ; Diet* ; Drinking* ; Homeostasis ; Humans ; Ion Transport ; Kidney ; Membranes ; Nephrons ; Osmolar Concentration ; Permeability ; Potassium ; Sodium ; Vasopressins ; Water*

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Clinical Manifestation Patterns and Trends in Poststreptococcal Glomerulonephritis.

Kee Hyuck KIM

Childhood Kidney Diseases.2016;20(1):6-10. doi:10.3339/jkspn.2016.20.1.6

Poststreptococcal glomerulonephritis (PSGN) is one of the most recognized diseases in pediatric nephrology. Typical clinical features include rapid onset of gross hematuria, edema, and hypertension, and cases are typically preceded by an episode of group A β-hemolytic streptococcus pharyngitis or pyoderma. The most common presenting symptoms of PSGN are the classic triad of glomerulonephritis: gross hematuria, edema, and hypertension . However, patients with PSGN sometimes present with unusual or atypical clinical symptoms that often lead to delayed diagnosis or misdiagnosis of the disease and increased morbidity. Additionally, the epidemiology of postinfectious glomerulonephritis (PIGN), including PSGN, has changed over the past few decades. This paper reviews atypical clinical manifestations of PSGN and discusses the changing demographics of PIGN with a focus on PSGN.
Delayed Diagnosis ; Demography ; Diagnostic Errors ; Edema ; Epidemiology ; Glomerulonephritis* ; Hematuria ; Humans ; Hypertension ; Nephrology ; Pharyngitis ; Pyoderma ; Streptococcus

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Antibiotics and Probiotics Prophylaxis for Recurrent Urinary Tract Infection in Children.

Jung Won LEE

Childhood Kidney Diseases.2016;20(1):1-5. doi:10.3339/jkspn.2016.20.1.1

Since many years, continuous low dose antibiotic prophylaxis (CAP) has been used for children at a risk for recurrent urinary tract infection (UTI), especially those with vesicoureteral reflux (VUR). The incidence of recurrent UTI has been shown to be higher in children with VUR with bladder and bowel dysfunction (BBD) than in those with VUR without BBD. Therefore, CAP has been recommended for children with BBD and VUR because of the increased risk of UTI. However, the use of CAP has become highly controversial because of bacterial resistance developed due to antibiotic over-usage. The preventive effects of probiotics have been proved in various adult urogenital infections, and the antimicrobial activities of lactobacilli against uropathogens have been demonstrated in previous in vitro studies. However, a critical assessment of their efficacy in children with UTI is lacking. The importance of the use of urogenital probiotics is that it is a natural approach that replenishes the depleted normal flora to create a better environment to fight off uropathogens. Probiotics have a great potential, particularly today with the increasing threat of antibiotic-resistant microorganisms.
Adult ; Anti-Bacterial Agents* ; Antibiotic Prophylaxis ; Child* ; Humans ; Incidence ; Probiotics* ; Urinary Bladder ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

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Two Cases of Toxic Epidermal Necrolysis Associated with Deflazacort Therapy in Nephrotic Syndrome: Successfully Treated with Cyclosporine A.

Myung Hee LIM ; Hee Jung BAE ; Sun Young PARK ; Sae Yoon KIM ; Yong Hoon PARK

Childhood Kidney Diseases.2016;20(2):97-100. doi:10.3339/jkspn.2016.20.2.97

Toxic epidermal necrolysis (TEN) is a rare, acute, serious, and potentially fatal skin disease, in which cell death causes the epidermis to separate from the dermis. It is thought to be a hypersensitivity complex that affects the skin and mucous membranes, and is caused by certain medications, infections, genetic factors, underlying immunologic disease, or more rarely, cancers. We report two cases of TEN associated with deflazacort (DFZ), a derivative of prednisolone, used in the first episode of nephrotic syndrome (NS). The skin eruption appeared on the 4(th) and 5(th) weeks after DFZ administration, while NS was in remission. The widespread lesions were managed by intensive supportive treatment, discontinuation of DFZ, and oral administration of cyclosporine. Both patients showed a rapid improvement in symptoms of TEN without any complications or relapse of NS.
Administration, Oral ; Cell Death ; Cyclosporine* ; Dermis ; Epidermis ; Humans ; Hypersensitivity ; Immune System Diseases ; Mucous Membrane ; Nephrotic Syndrome* ; Prednisolone ; Recurrence ; Skin ; Skin Diseases ; Stevens-Johnson Syndrome*

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The Relevance between Renal Ultrasonographic Findings and Disease Course in Two Poststreptococcal Glomerulonephritis (PSGN) Patients.

Jin Hee LEE ; Yu Kyung AN ; Ha Yeong YOO ; Byung Ok KWAK ; Hye Won PARK ; So Dug LIM ; Jae Sung SON ; So Chung CHUNG ; Kyo Sun KIM

Childhood Kidney Diseases.2015;19(2):184-189. doi:10.3339/chikd.2015.19.2.184

Poststreptococcal glomerulonephritis (PSGN) is one of the most well-known and important infectious renal diseases resulting from a prior infection with group A beta-hemolytic streptococcus. The typical clinical characteristics of the disease reflect acute onset with gross hematuria, edema, hypertension and moderate proteinuria after the antecedent streptococcal infection. In children, usually PSGN is healed spontaneously but if it combines with fast progressing glomerulonephritis, it would be developed to chronic renal failure. Therefore, it is important to make a fast diagnosis and treatment by simple tools to predict the course and the prognosis of disease. Sonography is a simple tool for diagnosis but there is no typical renal sonographic finding in PSGN, so it is difficult to predict the course and the prognosis of disease by sonographic findings. In comparison between two cases of renal sonographic findings in PSGN, a patient who showed more increased echogenicity in more extended area of renal sonography had the severe results of renal pathology, prolonged treatment period and low serum C3 level. Here, we report the different findings of renal sonography and pathology depending on the degree of severity between two patients. Thus, it is necessary to gather more information from further studies to make a consensus about the relationship between the renal sonography and the prognosis of disease in PSGN.
Child ; Consensus ; Diagnosis ; Edema ; Glomerulonephritis* ; Hematuria ; Humans ; Hypertension ; Kidney Failure, Chronic ; Pathology ; Prognosis ; Proteinuria ; Streptococcal Infections ; Streptococcus ; Ultrasonography

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Imperforate Hymen Causing Hematocolpos and Acute Urinary Retention in a 14-Year-Old Adolescent.

Geum Hwa LEE ; Mi Jung LEE ; Young Sik CHOI ; Jae Il SHIN

Childhood Kidney Diseases.2015;19(2):180-183. doi:10.3339/chikd.2015.19.2.180

We report the case of a 14-year-old girl who visited the emergency room because of suprapubic discomfort and sudden acute urinary retention. She did not have any significant medical and surgical history, and her neurological examinations were all normal. Urinary catheterization led to the passage of 500 mL urine. Abdominal ultrasonography showed a hematocolpos that was compressing the urinary bladder. Gynecologic history taking revealed that the patient has not had menarche yet. Therefore, a cruciate incision was performed and her urination became normal. As the surgical outcome after adequate hymenotomy for imperforate hymen is usually good, the diagnosis of imperforate hymen is important. However, this condition is easily missed in the clinic because the first physician visited by the patient rarely takes a detailed gynecologic history or performs appropriate physical examinations. Although rare, imperforate hymen should be considered as a cause of acute urinary retention in the adolescence period. If an adolescent girl presents with abdominal pain and voiding dysfunction, a detailed gynecologic history and appropriate physical examinations of the genital introitus should be performed.
Abdominal Pain ; Adolescent* ; Diagnosis ; Emergency Service, Hospital ; Female ; Hematocolpos* ; Humans ; Hymen* ; Menarche ; Neurologic Examination ; Physical Examination ; Ultrasonography ; Urinary Bladder ; Urinary Catheterization ; Urinary Catheters ; Urinary Retention* ; Urination

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Severe Anemia Due to Parvovirus Infection Following Treatment with Rituximab in a Pediatric Kidney Transplant Recipient: Anemia after Treatment of Rituximab in Kidney Recipient Patient.

Seung Yun KIM ; Hyoung Jin LEE ; Eujin PARK ; Yo Han AHN ; Il Soo HA ; Hae Il CHEONG ; Hee Gyung KANG

Childhood Kidney Diseases.2015;19(2):176-179. doi:10.3339/chikd.2015.19.2.176

Rituximab (RTX), a monoclonal antibody against the B-cell marker CD20, is commonly used as a treatment for antibody-mediated diseases or B-lymphocyte-mediated diseases. Destruction of B cells may reverse the disease course in many conditions; however, patients who are treated with RTX cannot respond appropriately to de novo infection due to lack of B lymphocytes. Here, we report one such case. A 7-year-old renal allograft recipient presented with severe anemia due to parvovirus infection after RTX treatment. The patient had focal segmental glomerulosclerosis and had received cadaveric kidney transplantation 6 months previously. She was treated with high-dose steroid for acute rejection and RTX for Epstein Barr Virus infection 3 months previously. At presentation, her hemoglobin level was 5.4 g/dL and leukocyte and platelet counts were normal. She had microcytic normochromic anemia and high viral load of parvovirus B19(70,578 copies/mL). Intravenous immunoglobulin (200 mg/kg.d) treatment controlled the progression of anemia and parvovirus infection. De novo parvovirus infection during the B lymphocyte-depletion period may have precipitated the severe anemia in this case. Close monitoring of infection is required after RTX therapy.
Allografts ; Anemia* ; B-Lymphocytes ; Cadaver ; Child ; Glomerulosclerosis, Focal Segmental ; Herpesvirus 4, Human ; Humans ; Immunoglobulins ; Kidney Transplantation ; Kidney* ; Leukocytes ; Parvoviridae Infections* ; Parvovirus* ; Platelet Count ; Transplantation* ; Viral Load ; Rituximab

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Two Pediatric Patients with Herbal Medicine-Induced Nephrotic Syndrome.

Sohyoung YANG ; Arum OH ; Tae Sun HA

Childhood Kidney Diseases.2015;19(2):171-175. doi:10.3339/chikd.2015.19.2.171

Nephrotic syndrome (NS) is a common chronic disease in children; in 90 percent of cases, the condition is primary (idiopathic). Toxic nephropathy can be induced by herbal medicines, and is mainly manifested as tubulointerstitial nephritis and rarely, as glomerulopathy. Here in, we describe two cases of steroid-sensitive NS, which developed after the patients received herbal medicines. A 5-year-old boy and an 8-year-old girl were separately admitted within a short time period with acute onset of generalized edema, proteinuria, hypoalbuminemia, and hypercholesterolemia. Each patient had previously taken herbal medicine, which had been prescribed by different oriental medical clinics for different conditions. The patients were diagnosed with herbal medicine-induced NS and were treated empirically by a standard steroid therapy, with subsequent resolution of their NS. One patient relapsed, but her NS again responded to steroid therapy. We described two unusual cases of prototypical pediatric, steroid-sensitive NS, which was presumed to be minimal-change disease that developed after the administration of herbal medicines. We also reviewed the literature.
Child ; Child, Preschool ; Chronic Disease ; Edema ; Female ; Herbal Medicine ; Humans ; Hypercholesterolemia ; Hypoalbuminemia ; Male ; Nephritis, Interstitial ; Nephrotic Syndrome* ; Pediatrics ; Proteinuria

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A Case of Hypereosinophilic Syndrome with Bladder Involvement in a 7-Year-Old Boy.

Yoon Kyoung PARK ; Hyung Eun YIM ; Kee Hwan YOO

Childhood Kidney Diseases.2015;19(2):167-170. doi:10.3339/chikd.2015.19.2.167

Hypereosinophilic syndrome (HES) is characterized by the presense of hypereosinophilia with evidence of target organ damage. We report a patient diagnosed with eosinophilic cystitis and HES. A 7 year old boy had hematuria, dysuria, and increased urinary frequency for 1 day. Laboratory examinations revealed hypereosinophilia (eosinophils, 2,058/microL), hematuria, and proteinuria. Abdominal sonography revealed diffuse and severe wall thickening of the bladder. The patient was treated initially with antibiotics. However, his symptoms did not improve after 7 days. A computed tomography scan demonstrated severe wall thickening of the bladder and the hypereosinophilia persisted (eosinophils, 2,985/microL). The patient complained of chest discomfort, dyspnea, epigastric pain, and vomiting on hospital day 10. Parasitic, allergic, malignancy, rheumatologic, and immune workups revealed no abnormal findings. Chest X-rays, electrocardiography, and a pulmonary function test were normal; however, the hypereosinophilia was aggravated (eosinophils, 3,934/microL). Oral deflazacort was administered. A cystoscopic biopsy showed chronic inflammation with eosinophilic infiltration. The patient's respiratory, gastrointestinal, and urinary symptoms improved after 6 days of steroids, and he was discharged. The eosinophil count decreased dramatically (182/microL). The hypereosinophilia waxed and waned for 7 months, and the oral steroids were tapered and stopped. This case describes a patient diagnosed with eosinophilic cystitis and HES.
Anti-Bacterial Agents ; Biopsy ; Child* ; Cystitis ; Dyspnea ; Dysuria ; Electrocardiography ; Eosinophils ; Hematuria ; Humans ; Hypereosinophilic Syndrome* ; Inflammation ; Male* ; Proteinuria ; Respiratory Function Tests ; Steroids ; Thorax ; Urinary Bladder* ; Vomiting

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Hyponatremia May Reflect Severe Inflammation in Children with Kawasaki Disease.

I Re LEE ; Se Jin PARK ; Ji Young OH ; Gwang Cheon JANG ; Uria KIM ; Jae Il SHIN ; Kee Hyuck KIM

Childhood Kidney Diseases.2015;19(2):159-166. doi:10.3339/chikd.2015.19.2.159

PURPOSE: The aim of the present study was to investigate the risk factors for the development of coronary artery lesions (CALs) and to determine whether hyponatremia is associated with CALs in children with Kawasaki disease (KD). METHODS: We retrospectively analyzed the data of 105 children with KD who were admitted to Ilsan Hospital between January 2000 and July 2011. RESULTS: Erythrocyte sedimentation rate (P = 0.013), total bilirubin levels (P = 0.017) were higher and serum sodium levels (P = 0.027) were lower in KD children with CALs than those without. White blood cell (WBC) counts (P = 0.006), neutrophil counts (P = 0.003) were higher and albumin levels (P = 0.009) were lower in KD children with hyponatremia than those without. On multiple logistic regression analysis, hyponatremia (P = 0.024) and intravenous immunoglobulin??resistance (P = 0.024) were independent risk factors for CALs in KD. Furthermore, serum sodium levels were correlated negatively with WBC counts (P = 0.004), neutrophil counts (P < 0.001), total bilirubin levels (P = 0.005) and positively with albumin levels (P = 0.009). CONCLUSION: Our study indicates that hyponatremia may reflect severe inflammation in children with KD.
Bilirubin ; Blood Sedimentation ; Cardiovascular Abnormalities ; Child* ; Coronary Vessels ; Humans ; Hyponatremia* ; Inflammation* ; Leukocytes ; Logistic Models ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils ; Retrospective Studies ; Risk Factors ; Sodium

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