• Clinical and Experimental Pediatrics
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• v.46 no.7
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• pp.687-694
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• 2003

Purpose : Regeneration and repair after ischemic renal injury appears to be modulated by circulating or locally produced growth factors. This study examined the changes of serum insulin like growth factor(IGF-I) and renal expression of IGF-I and II, vascular endothelial growth factor(VEGF), transforming growth $factor-{\beta}$($TGF-{\beta}$), and connective tissue growth factor(CTGF) during the active regeneration period after acute ischemic injury. Methods : Sera and kidney tissue samples(whole kidney, cortex, outer medullae and inner medullae) were obtained before and after one, three, five and seven days of 40 minutes bilateral renal pedicle clamping. Acute renal failure was assessed by measuring the concentration of serum creatinine. Serum IGF-I level was measured by radioimmunoassay. The mRNA expression in kidney was measured by RT-PCR. The distribution of IGF-I and CTGF was detected by immunohistochemistry. Resuts : Serum IGF-I concentration after one day following acute ischemic renal injury was significantly decreased compared to preischemic value. The mRNA levels of IGF-I, IGF-II, $TGF-{\beta}1$ and VEGF in whole kidney were temporally decreased on day one of ischemic injury. IGF-I and IGF-II expressions in outer medullae were significantly decreased on day one after ischemic injury. $TGF-{\beta}1$, CTGF and VEGF expressions were markedly decreased in medullae after one day of ischemic injury compared to other kidney sections. IGF-I was markedly decreased in cortical tubules on day one of uremic rat. CTGF was markedly increased on tubule within three days of ischemic injury. Conclusion : These findings suggest that IGFs, $TGF-{\beta}1$ and CTGF may involve in the pathogenesis or the recovery from acute ischemic renal injury.

• Childhood Kidney Diseases
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• v.15 no.2
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• pp.107-115
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• 2011

Acute kidney injury (AKI) is associated with mortality and may lead to increased medical expense. A modified criteria (pediatric RIFLE [pRIFLE]: Risk, Injury, Failure, Loss, and End-stage renal disease) has been proposed to standardize the definition of AKI. The common causes of AKI are renal ischemia, nephrotoxic medications, and sepsis. A majority of critically ill children develop AKI by the pRIFLE criteria and need to receive intensive care early in the course of AKI. Factors influencing patient survival (pediatric intensive care unit discharge) are known to be low blood pressure at the onset of renal replacement therapy (RRT), the use of vasoactive pressors during RRT, and the degrees of fluid overload at the initiation of RRT. Early intervention of continuous RRT (CRRT) has been introduced to reduce mortality and fluid overload that affects poor prognosis in patients with AKI. Here, we briefly review the practical prescription of pediatric CRRT and literatures on the outcomes of patients with AKI receiving CRRT and associations among AKI, fluid overload, and CRRT. In conclusion, we suggest that an increased emphasis should be placed on the early initiation of CRRT and fluid overload in the management of pediatric AKI.

• Childhood Kidney Diseases
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• v.15 no.2
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• pp.101-106
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• 2011

Acute renal failure means that the word does not contain a mild kidney injury. In addition, the criteria for acute renal failure per researcher are different, and it is difficult in interpreting the results of research on acute renal failure. Therefore, rather than acute renal failure, a new term "acute kidney injury" meaning to include all the levels of injury is introduced. In 2002, to diagnose by means of serum creatinine, glomerular filtration rate and urine output, a detailed classification of acute kidney injury, the RIFLE criteria has been proposed. In 2007, the RIFLE criteria by transforming, AKIN criteria has been proposed. The pediatric RIFLE criteria for children has also been proposed. The author reviews here these criteria by comparing them.

• Journal of Veterinary Clinics
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• v.29 no.5
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• pp.372-376
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• 2012

Acute kidney injury (AKI) is a serious problem associated with high morbidity and mortality. Ischemia-reperfusion is an important cause of acute kidney injury. This study was performed to ascertain clinically useful biomarkers for the diagnosis of AKI. In three miniature pigs, AKI were induced by 60 minutes of bilateral renal ischemia by the clamping renal artery. Blood and urine samples were collected from the pigs prior to clamping (baseline) and 0, 1, 3 and 5 days post-clamping. Serum blood urea nitrogen (BUN), creatinine, sodium and uric acid were measured in serum and urine samples. Fractional excretion of sodium ($FE_{Na}$) and fractional excretion of uric acid ($FE_{UA}$) were calculated. Also, interleukin (IL)-6, IL-18, liver type fatty acid binding protein (L-FABP) and glutathione-S-transferase (GST) were detected by Western immunoblotting. Serum BUN and creatinine levels were increased significantly at day 1 post-clamping in all three miniature pigs. However, $FE_{Na}$ and $FE_{UA}$ showed marked individual differences. Western immunoblotting revealed significantly increased levels of IL-6, IL-18, L-FABP and GST in post-ischemic urine, compared to pre-clamping. While more research concerning the variance of $FE_{Na}$ and $FE_{UA}$ is needed, serum BUN, creatinine, IL-6, IL-18, L-FABP and GST may be sensitive urine biomarkers for diagnosis of AKI together with other biomarkers in the porcine ischemia-reperfusion model.

• Childhood Kidney Diseases
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• v.18 no.1
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• pp.13-17
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• 2014

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 neonatespecific devices. This review discusses the basic principles of CRRT and the special considerations when using this technique in neonates and infants.

• Tuberculosis and Respiratory Diseases
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• v.51 no.6
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• pp.503-516
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• 2001

Background : The present study was carried out in association with neutrophilic respiratory burst in the lung in order to clarify the pathogenesis of acute respiratory distress syndrome(ARDS) following acute severe hemorrhage. Because oxidative stress has been suggested as one of the principal factors causing tissue injury, the role of free radicals from neutrophils was assessed in acute hemorrhage-induced lung injury. Method : In Sprague-Dawley rats, hemorrhagic shock was induced by withdrawing blood(20 ml/kg of B.W) for 5 min and the hypotensive state was sustained for 60 min. To determine the mechanism and role of oxidative stress associated with phospholipase A2(PLA2) by neutrophils, the level of lung leakage, pulmonary myeloperoxidase(MPO), and the pulmonary PLA2 were measured. In addition, the production of free radicals was assessed in isolated neutrophils by cytochemical electron microscopy in the lung. Results : In hypotensive shock-induced acute lung injury, the pulmonary MPO, the level of lung leakage and the production of free radicals were higher. The inhibition of PLA2 with mepacrine decreased the pulmonary MPO, level of lung leakage and the production of free radicals from neutrophils. Conclusion : A. neutrophilic respiratory burst is responsible for the oxidative stress causing acute lung injury followed by acute, severe hemorrhage. PLA2 activation is the principal cause of this oxidative stress.

• Journal of Korean Orthopaedic Sports Medicine
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• v.11 no.1
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• pp.8-16
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• 2012

With the increase of participation in the sport activities, there has been a commensurate rise in the number of sport injuries. A more commonly encountered injured region in the upper-extremity is the wrist. Sport injuries are often characterized as overuse and traumatic. Traumatic injuries include fractures, dislocations, and ligament tears often seen in contact or collision sports. Overuse injuries, represented damages by a level of repetitive microtrauma sufficient to overwhelm the tissues$^{\circ}{\O}$ ability to adapt, include inflammatory conditions such as De Quervain$^{\circ}{\O}s$ disease, extensor carpi ulnaris tendinitis, intersection syndrome. Also included is a traumatic problem such as stress fractures of the hook of the hamate, subluxation of the extensor carpi ulnaris tendon, chronic scapholunate instabilities, and degenerative triangular fibrocartilage tears. This review will focus on both overuse and traumatic injuries of the wrist in the athletes. A significant emphasis will be placed on the evaluation, pearls and pitfalls of conservative and operative treatments.

• Pediatric Infection and Vaccine
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• v.24 no.2
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• pp.112-116
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• 2017

Kawasaki disease (KD) is an acute febrile mucocutaneous lymph node syndrome that commonly presents with stable hemodynamic status during the acute phase. An 8-year-old boy initially presented with severe hypotension and acute kidney injury. He was placed in the intensive care unit and was diagnosed with KD. Observed clinical features were defined as KD shock syndrome. His coronary artery was dilated during the subacute phase. Furthermore, he was given anti-hypertensive medications, owing to hypertension as an unusual complication of KD. We knew the importance of monitoring for blood pressure considering vasculitis as an aspect of the main pathogenesis of KD.

• The Journal of Internal Korean Medicine
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• v.35 no.1
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• pp.92-105
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• 2014

Objectives : Cisplatin is a widely used cancer therapy drug. However, nephrotoxicity resulting in increased oxidative stress is a major side effect of cisplatin chemotherapy, thereby limiting its chemotherapeutic use. Lycium chinense Miller (LCM) has been used as a traditional herbal medicine in various febrile and inflammatory diseases such as night sweat, cough, nosebleed, bronchitis, pulmonary tuberculosis, etc. In this study we investigated the protective and antioxidative potential of LCM against cisplatin-induced nephrotoxicity in rats. Methods : Twenty-four 8-week-old male Wistar rats were divided into four groups: normal untreated; cisplatin treatment only; LCM 10 mg/kg plus cisplatin treatment; and LCM 30 mg/kg plus cisplatin treatment. Twenty-four hours after the last cisplatin injection, all the rats were sacrificed, and serological changes were evaluated. The levels of NF-${\kappa}B$ activity and NOX-4, $p47^{phox}$, $p22^{phox}$, COX-2, iNOS, SOD, catalase expressions were analyzed in Western blot analysis. Results : Cisplatin injection caused an increase in the BUN level, which is a reliable indicator of renal toxicity. The levels of BUN, renal ROS, and renal TBARS were significantly reduced in the LCM groups compared with the cisplatin-only groups. The levels of $p47^{phox}$ and $p22^{phox}$, which are NADPH oxidase subunits, were increased in the cisplatin-only groups, whereas they were decreased in the LCM groups. The levels of renal NF-${\kappa}B$ activity and COX-2, iNOS expressions were increased significantly in the cisplatin-only groups compared with the normal groups, whereas they were decreased in the LCM groups. Compared with the cisplatin-only groups, renal GSH and GSH/GSSG increased in the LCM groups. Also, the administration of LCM increased levels of SOD and catalase as compared with the cisplatin-only groups. Conclusions : These results suggest that LCM protects cisplatin-induced nephrotoxicity via a mechanism that may involves the inhibition of oxidative stress by the activation of antioxidants.

• Childhood Kidney Diseases
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• v.11 no.2
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• pp.229-238
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• 2007

Purpose : Since the first febrile UTI(urinary tract infection) in infants is commonly associated with vesicoureteral reflux(VUR), imaging studies such as renal ultrasonography, dimercaptosuccinic acid(DMSA) scan, and voiding cystourethrography(VCUG) are recommended. How-ever, because of the invasiveness of VCUG, it is difficult to perform in all young infants with febrile UTI. The purpose of this study is to compare the clinical and laboratory characteristics, radiologic findings between the young infant group(1 to 6month, n=121) and the old infant group(7 to 24months, n=91), and to determine the clinical and radiologic risk factors that predict the presence of VUR before the VCUG in patients with their first febrile UTI under 2 years of age. Methods : We reviewed the medical records of 211 first febrile UTI patients under 2 years of age retrospectively, and compared clinical, laboratory, and radiologic findings between the two age groups. Results : The young infant group had a male preponderance and a higher incidence of Escherichia coli in their urine culture. The incidence of acute renal parenchymal defects on DMSA scans were significantly increased in the young infant group. The incidence of VUR was 29% in patients who had a VCUG, but there were no differences in the incidence of VUR between the two age groups. Abnormal findings on DMSA scan significantly correlated with higher incidence of VUR in the young infant group. Incidence of abnormal findings DMSA scan significantly increased with high grade VUR(garde III-V ). Conclusion : In treating first febrile UTI patients under 2 years, physicians have to consider such characteristics as age less than 6 months, male preponderance, E.coli in the urine culture, and increased incidence of abnormal findings on DMSA scans which correlated well with the presence of VUR. The results of the DMSA scan might help us to predict the presence of VUR before the VCUG in first febrile UTI and help us to reduce performing invasive radio-logic studies especially in the young infant group. (J Korean Soc Pediatr Nephrol 2007;11:229-238)