• Title/Summary/Keyword: 혈뇨의 진단과정

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A Histological and Clinical Study of the Children with Thin Glomerular Basement Membrane (사구체 기저막 비박화를 보인 소아들의 조직학적 및 임상적 고찰)

  • Kim Young-Chol;Lee Dong-Won;Cho Min-Hyun;Kwak Jung-Sik;Ko Cheol-Woo
    • Childhood Kidney Diseases
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    • v.9 no.1
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    • pp.31-37
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    • 2005
  • Puruose : Thin glomerular basement membrane disease(TGBMD) is found in patients with family history of hematuria. TGBMD is autosomal dominant and is known to be one of the commonest causes of asymptomatic hematuria. This study was conducted to evaluate the histological and clinical features of patients with TGBMD. Methods : 150 cases diagnosed with TGBMD by renal biopsy while admitted in the department of pediatrics, Kyungpook National University Hospital between January 1999 and December 2003 comprised the study group. The following parameters were retrospectively anaIyzed age of onset, hematuria pattern, existence of proteinuria, process of diagnosis, laboratory findings, thickness and character of basement membrane and family history. Results : The mean age at the time of diagnosis was 7.9 years. The male to female ratio was 65:77. 94 patients or 66% visited the hospital with a chief complaint of persistent microscopic hematuria. Gross hematuria accounted for 13 cases or 9%. 78 cases(55%) were found to have hematuria for the first time from a routine school urinalysis screening. The renal biopsy showed the thickness of basement membrane to be 186$\pm$36 nm. Focal lamellation of the basement membrane was found in eight cases. In the family history, hematuria was shown in 10 cases on the Paternal side, 13 on The maternal side and none on both sides. In seven cases, hematuria was shown among siblings. No significant differences were found among the laboratory test results which were conducted at an average interval of fifteen months. Conclusion : TGBMD is one of the major causes of asymptomatic hematuria in children, which was diagnosed in increasing numbers since school urinary mass screening test started in 1998. In cases with familial progressive renal disease or focal duplication in the basement membrane Alport syndrome should be considered.

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A Study on the Morphology of Dysmorphic Erythrocytes for the Differential Diagnosis in Hematuria (혈뇨의 감별진단을 위한 이형적혈구의 형태학적 연구)

  • Yoon, Chul-Jong;Park, Chung-Oh;Moon, Hi-Joo;Yoon, Ki-Eun
    • Applied Microscopy
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    • v.29 no.3
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    • pp.331-341
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    • 1999
  • Examination of the morphology of red blood cells in the urine has been shown to be a promising adjunct in determining whether hematuria represents glomerular or nonglomerular bleeding. This is due to distortion of RBCs as they Pass across the basement membrane of the glomerular capillaries. It is concluded that is method can greatly help the clinician in distinguishing between glomerular and nonglomerular bleeding in patients with hematuria and channeling such patients toward the most appropriate investigations. We have experimented dysmorphic red blood cells that 5 patients of the hematuria are distorted with irregular outlines and often have small blobs extruding from the red cell membrane. Tried urinary sediments were seen with phase contrast microscope and confirmed scanning electron microscope. There are seen acanthocytes, anulocytes, ghost cells and sphero-echinocytes in dysmorphic erythrocytes. Clinical diagnosis was referred from the result of the biopsy-proven. Scanning electron microscopic findings of the hematuria are good diagnostic tool that disclose in distorted red blood cells from patients with glomerular disorders.

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Asymptomatic Primary Hematuria in Children (소아의 무증상성 일차성 혈뇨)

  • Cho Min-Hyun;Jang You-Cheol;Kim Young-Cheol;Koo Ja-Hoon;Ko Cheol-Woo
    • Childhood Kidney Diseases
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    • v.8 no.2
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    • pp.166-175
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    • 2004
  • Purpose: Present study has been undertaken to determine the distribution of various renal diseases causing asymptomatic hematuria in children and to evaluate the benefit of doing renal biopsy in these children. Methods: Study population consisted of 146 children with asymptomatic primary hematuria who had been admitted to the pediatric departmen of Kyungpook National University Hospital for the past 4 years from 1999 to 2002. In 122 out of 146 cases, renal biopsy was performed percutaneously and in 24 out of 146 cases, diagnosed as idiopathic hypercalciuria, oral calcium loading test was performed. Results: The age$(mean{\pm}SD)$ at onset or discovery of hematuria of the 146 children in-cluded in this study was $8.0\pm3.2$ years and the proportion of boys and girls was 54.8% and 45.2%, respectively. In 76 out of 146 cases(52%), asymptomatic hematuria was first diagnosed by school urinalysis screening. The proportion of histopathologic findings based on 122 biopsies was as follows : Thin Glomerular Basement Membrane(TGBM) 73 cases(50%): IgA nephropathy 20 cases(14%): Alport syndrome 6 cases(4%), Membranous Glomerulonephropathy(MGN) 4 cases(3%): Membranoproliferative Glomerulonephritis(MPGN) 2 cases(1%); IgA nephropathy with TGBM 3 cases(2%): 'normal' glomeruli 14 cases(10%) Twenty four cases (16%) were diagnosed as idiopathic hypercalciuria. During follow-up periods, 15% of 146 cases became hematuria-free and renal function did not deteriorate in any cases. Conclusion: Unless hematuric children manifest poor prognostic indicators for renal survival, we would recommend long term regular follow-up prior to a renal biopsy.

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An analysis of current condition of student's selection process in Hansung science highschool (한성과학고등학교 학생 선발과정의 현황 분석)

  • Dong, Hyo-Kwan;Jhun, Young-Seok
    • Journal of Gifted/Talented Education
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    • v.13 no.4
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    • pp.65-94
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    • 2003
  • The purpose of this study is to acquire the information on the current situation of students' selection process in order to renovate the system of picking up the students. As a first step of the study, we examined the validity of the factors of the single-out system such as qualification and the process for the application and the standards and proceeding of the selection. Then we analysed the result of the entrance examination of Hansung Science Highschool in 2002. The analysis was on the correlation between the result of entrance examination and the achievement in the school and the decision of the course after graduation. To know on the achievement of the students, we investigated the records of regular tests and asked the teachers' opinion in math and science classes. As a result, we gained the following points: First, the present single-out system has a danger of excluding students who are much talented in science and math field because it is based on students' achievements in middle schools; Second, the new selection system should consider the character and attitude of the applicants in addition to their knowledge; Third, the continuous observation of the teacher in middle school should be an important factor of the picking up system; Fourth, more questions requiring divergent thinking ability and inquiry skill should be developed as selective examination question. Also examination questions should cover the various contents from mathematics to science, and do not affect pre-learning; Finally, the system of present letting all students stand in one line should be changed into that of letting students in various lines. We can consider using multi-step selection system.