Objective To study the risk factors and prognostic characteristics of pediatric silent lupus nephritis(SLN)with class Ⅲ to V.Methods A retrospective study was conducted to collect clinical data from 30 children diagnosed with SLN at the Department of Pediatrics,Second Xiangya Hospital,Central South University,from May 2007 to April 2023.Based on renal pathological classification,the patients were divided into a class Ⅱ group(12 cases)and a class Ⅲ to Ⅴ group(18 cases).The risk factors for the occurrence of class Ⅲ to Ⅴ SLN were analyzed,and the prognostic characteristics were summarized.Results Among the 30 SLN patients,the median follow-up time was 61.50 months.There were no statistically significant differences in the proportions of patients who discontinued glucocorticoids or achieved low disease activity status,nor in the annual decline rate of estimated glomerular filtration rate(eGFR)between the class Ⅱ and class Ⅲ to V groups(P>0.05).However,three patients in the class Ⅱ group progressed to stage 1 chronic kidney disease(CKD),while eight patients in the class Ⅲ to Ⅴ group reached stage 1 CKD,and four patients reached stage 2 CKD.Among the 26 female SLN patients,serum complement C3 levels in the class Ⅲ to Ⅴ group were lower than those in the class Ⅱ group(P<0.05).Serum C3 levels in SLN patients,as well as in female SLN patients,were negatively correlated with the fluorescence intensity of IgA,IgG,and C3 immune complexes in the kidneys(P<0.05).Additionally,serum C3 levels in female SLN patients were negatively correlated with the renal pathological activity index(P<0.05).Binary logistic regression analysis indicated that being female and having low serum complement C3 levels were risk factors for the occurrence of class Ⅲ to Ⅴ SLN in children(P<0.05).Conclusions Class Ⅲ to Ⅴ SLN is not uncommon among SLN children,and there remains a risk of long-term renal function progression.Being female and having low serum complement C3 levels are identified as risk factors for class Ⅲ to Ⅴ SLN in children.

Female ; Humans ; Infant ; Male ; Nephrotic Syndrome ; congenital ; pathology ; therapy

Objective To analyze the correlation between clinical characteristics and pathological findings lupus nephritis (LN) in children,together with the correlation of the renal vascular lesion respectively with the glomerular lesion and tubulointerstitial lesion.Methods Forty-one cases of LN in children diagnosed by percutaneous renal biopsy from Jan.2008 to Sep.2012 in Pediatrics of the Second Xiangya Hospital of Central South University were collected.Clinical manifestations and the lab findings of the blood and urine of all the patients were analyzed,and all the frozen sections were evaluated according to the standard of ISN/RPS2003 for LN.The glomerular lesion and tubalointerstitial lesion separately were also evaluated,respectively.The wall thickening/outer diameter ratio,intima thickening/outer diameter ratio and medial thickening/outer diameter ratio of the arterioles were measured.Results The percentage of clinical manifestation with LN increased coupled with the degree of pathological damage.In the different stages of pathological damage,both the glomerular lesion and tubulointerstitial lesion were getting much more serious along with the progressiveness of pathological damage,and what's more,they had a positive correlation(r =0.959,P ＜ 0.05).The wall thickness/outer diameter ratio in all cases was greater than 0.5,in dicating the thickness of vessel wall.Conclusion Renal vascular lesion really existed and is characterized by the progressive loss of integrity of the intima and the medial thickening.

Objective To research the changes of clinical symptoms and serum free radical in children with severe Henoch-Sch(o)nlein purpura (HSP) between before and after accepted hemoperfusion.And evaluate the curative effect of hemoperfusion treatment for severe HSP and discuss the mechanism.Methods Twenty-three severe HSP patients in Children's Medical Center of the Second Xiangya Hospital of Central South University which were divided into 2 groups:13 cases were divided into traditional treatment group,10 cases were divided into hemoperfusion group; 11 healthy children were divided into healthy control group.The alleviate situation of clinical symptoms were observed and recorded such as purpura,abdominal pain,joint pain,hematuria,albuminuria,and the changes of urine RBC count,24 hour urine protein quantitative before and after hemoperfusion and traditional treatment.Collected the serum before and after the first time hemoperfusion treatment,after the second time hemoperfusion treatment,after the third time hemoperfusion treatment in hemoperfusion group;Collected the serum before and after conventional therapy in traditional treatment group; Collected only once serum in healthy control group.And then their superoxide anion(O2-·),hydroxy radical(· OH),hydrogen dioxide(H2O2),malonaldehyde(MDA) values were detected with spectrophotometry.The differences of each index among each group were compared respectively.Results After treatment,the clinical symptoms of 23 severe HSP children such as rash,abdominal pain,joint pain,hematuria,albuminuria which were reliefed compared to before treatment.The urine erythrocyte count,24 hour urine protein quantitative were reduced in 2 groups,but the symptoms of perfusion group children relieved faster,and the clinical index decreased more obviously.The serum O2-·,· OH,H2O2,MDA levels of 23 HSP children were significantly higher than those of the healthy control group (all P ＜ 0.01).In the traditional treatment group,compared between before and after treatment,the indexes were decreased (all P ＜ 0.05) ; After 3 times of hemoperfusion,all indexes were decreased in hemoperfusion group,but only after the third hemoperfusion the indexes were decreased statistically significant(all P ＜ 0.05).But compared with the hemoperfusion group,the index were decreased more apparently in after the third hemoperfusion,and it was statistically significant (P ＜ 0.05).Conclusions 1.The serum free radicals are increased in severe HSP children,they may play a role in vasculitis.2.For severe HSP,the recent therapeutic effect of hemoperfusion ally with traditional treatment is better than the alone traditional treatment.3.Hemoperfusion ally with traditional treatment can remove more effectly the serum free radicals,reduce lipid peroxide products,then mitigate the damage of the oxidate stress to the vascular endothelial.

Acute Disease ; Child ; Humans ; Lupus Erythematosus, Systemic ; complications ; Male ; Pancreatitis ; etiology

OBJECTIVETo explore possible correlations between renal Th1/Th2 ratio and renal microvascular injury in children with Henoch-Sch-nlein purpura nephritis (HSPN).

METHODSThirty-two children with HSPN were enrolled. They were classified into four groups by renal pathology: HSPN class II (n=8), HSPN class IIIa (n=7), HSPN class IIIb (n=10) and HSPN class IV/V (n=7). Five patients undergoing nephrectomy due to trauma were used as the controls. INFγ, IL-4 and CD34 in the renal tissues were measured by immunohistochemical analysis. INFγ was used as a marker of Th1, IL-4 was used as a marker of Th2 and CD34 was used as a marker of microvessel. The renal microvessel density was evaluated according to the Weidner standard. The relationships among the local Th1/Th2 ratio, renal pathological grade, microvessel score and microvessel density were studied.

RESULTSImmunohistochemical analysis showed a lower expression of INFγ and a higher expression of IL-4 in the HSPN groups than in the control group. The local Th1/Th2 ratio in the HSPN groups decreased and correlated significantly with the renal pathological grade. There were significant differences among four HSPN subgroups (P<0.05). Compared with the control group, the renal microvessel density in the HSPN class II and class IIIa groups increased significantly (P<0.05), but it decreased in the HSPN class IV/V group (P<0.05). The renal microvessel scores in the HSPN class IIIa, class IIIb and class IV/V groups increased significantly compared with those in the control and the HSPN classⅡ. The increased renal microvessel scores were associated with more severe renal pathological changes. A negative correlation was found between the local Th1/Th2 ratio and the microvessel density in kidneys (r=-0.921, P<0.01).

CONCLUSIONSThe decrease of Th1/Th2 ratio in kidneys might be responsible for renal microvascular injury in children with HSPN.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Kidney ; blood supply ; pathology ; Male ; Microvessels ; pathology ; Nephritis ; immunology ; pathology ; Purpura, Schoenlein-Henoch ; immunology ; pathology ; Th1 Cells ; immunology ; Th2 Cells ; immunology

Child ; Humans ; Hypereosinophilic Syndrome ; drug therapy ; pathology ; Male ; Nephrotic Syndrome ; pathology

OBJECTIVETo investigate the changes of blood pressure by 24-hour ambulatory blood pressure (ABP) monitoring in children with primary nephrotic syndrome (PNS) and explore the relationship of the changes in blood pressure with rennin-angiotensin-aldosterone system (RAAS) in these children.

METHODSABP and casual blood pressure (CBP) monitoring were performed in 114 children with PNS. Plasma levels of rennin activity (PRA), angiotensin II (AngII) and aldosterone (ALD) were measured. The correlation of plasma levels of PRA, AngII and ALD with ABP was evaluated.

RESULTSOf the 114 children with PNS, 101 (88.6%) presented elevated blood pressure. Mild or severe masked hypertension was found in 45 children (39.5%). Eighty (70.2%) children showed non-dipper blood pressure. The index and load of systolic blood pressure were higher than those of diastolic blood pressure. The blood pressure index and blood pressure load during sleep were higher than those during wakefulness. The boy presented higher diastolic blood pressure index and load than girls. Decubitus blood PRA, AngII and ALD levels in children with PNS were significantly higher than normal controls. The group with elevated blood pressure presented significantly higher decubitus blood PRA, AngII and ALD levels than the group with normal blood pressure. AngII level was significantly positively correlated with the index and load of both systolic blood pressure and diastolic blood pressure.

CONCLUSIONSThe children with PNS present a high incidence of hypertension, with a large percentage of masked hypertension and non-dipper blood pressure. Systolic blood pressure increases more significantly than diastolic blood pressure. Blood pressure during sleep increases more significantly than that during wakefulness. Diastolic blood pressure increases more significantly in boys than in girls. RAAS activity is elevated and the elevated RAAS activity might increase the blood pressure mainly by AngII in children with PNS.

Adolescent ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Child ; Child, Preschool ; Female ; Humans ; Male ; Nephrotic Syndrome ; physiopathology ; Renin-Angiotensin System ; physiology

OBJECTIVETo evaluate the efficacy and safety of ganciclovir therapy for congenital cytomegalovirus (CMV) infection in newborn infants.

METHODSThe randomized controlled trials (RCTs) and quasi-RCTs on ganciclovir therapy for congenital CMV were reviewed in the following electronic databases: PubMed (January 1988 to January 2009), EMbase (January 1988 to January 2009), the Cochrane library (Issue 3, 2003 and Issue 1, 2009), the Chinese Journals Full-text Database (January 1994 to January 2009), the Chinese Biological Medical Disc (January 1994 to January 2009) and the Chinese Medical Current Contents (January 1994 to January 2009). Quality assessment, data extraction, and meta analysis were performed.

RESULTSTen papers were included. Meta analysis showed that the ganciclovir therapy increased the improvement rate (91.4% vs 34.0%; p<0.01) and led CMV infection indexes to become negative in more patients (87.6% vs 15.3%; p<0.01) and decreased incidence of hearing disturbance (4.7% vs 37.2%; p<0.01) as compared with the non-ganciclovir therapy control group. The incidence of the ganciclovir-therapy-related side effects was low.

CONCLUSIONSGanciclovir treatment may increase the improvement rate and the rate of CMV infection indexes becoming negative, and decrease incidence of hearing disturbance, with few side effects, in newborn infants with CMV infection. However the supporting evidence is not strong due to few trials and more high-quality research is needed.

Antiviral Agents ; therapeutic use ; Cytomegalovirus Infections ; complications ; congenital ; drug therapy ; Follow-Up Studies ; Ganciclovir ; therapeutic use ; Hearing Disorders ; etiology ; Humans ; Infant, Newborn

Child ; Humans ; Kidney ; pathology ; Lymphoma, T-Cell, Cutaneous ; pathology ; Male ; Skin Neoplasms ; pathology