• Childhood Kidney Diseases
• /
• v.26 no.2
• /
• pp.91-96
• /
• 2022

The messenger RNA-based vaccine for the coronavirus disease 2019 (COVID-19) may induce glomerulonephritis, including immunoglobulin A nephropathy (IgAN). New-onset IgAN triggered by vaccination against COVID-19 has been reported rarely, especially in children. Herein, we report a pediatric case of newly diagnosed IgAN after administration of the Pfizer vaccine for COVID-19. A 12-year-old girl was referred to our hospital for evaluation of gross hematuria after inoculation with the second dose of Pfizer's COVID-19 vaccine; she had no adverse effects after the first dose. At the time of admission, she showed heavy proteinuria and persistent hematuria. Kidney biopsy revealed an IgAN, and she was treated with an oral steroid and an angiotensin-converting enzyme inhibitor. Four months after discharge, the proteinuria and hematuria resolved completely.

• Childhood Kidney Diseases
• /
• v.18 no.1
• /
• pp.24-28
• /
• 2014

Purpose: The purpose of this study was to assess the therapeutic efficacy of methylprednisolone pulse therapy in children with IgA nephropathy and Henoch- Sch$\ddot{o}$nlein Purpura (HSP) nephritis combined with proteinuria. Methods: We retrospectively reviewed the clinical records of 21 patients who were diagnosed with IgA nephropathy and HSP nephritis based on percutaneous renal biopsy. Of the 21 patients, 15 were diagnosed with IgA nephropathy and 6 were diagnosed with HSP nephritis. They had mild to severe proteinuria at the time of diagnosis or during follow-up. Group 1 (n=7) received methylprednisolone pulse therapy three times every couple of months, and Group 2 (n=14) received oral steroid therapy. The follow-up periods for Group 1 and 2 were 14.0 (9-54) months and 26.5 (14-34) months, respectively. There was no significant difference in the follow-up duration between the two groups. Results: The average age at diagnosis and biopsy was lower in Group 1 compared to Group 2, but it was not significantly different. At admission, all patients in both groups had hematuria and 5 patients (71.4%) of Group 1 and 14 patients (100 %) of Group 2 had proteinuria. Before treatment, there was no significant difference of spot urine protein/creatinine ratio between the two groups. During followup, 7 patients of Group 1 (100%) and 10 patients of Group 2 (71.4%) showed complete improvement of proteinuria and the spot urine protein/creatinine ratio in Group 1 was significantly lower than Group 2. Conclusion: In patients with IgA nephropathy and HSP nephritis with proteinuria, methylprednisolone pulse therapy was more effective than oral steroid therapy in the reduction of proteinuria. To investigate the effects on long-term prognosis, large-scale prospective studies are needed.

• Childhood Kidney Diseases
• /
• v.7 no.2
• /
• pp.150-156
• /
• 2003

Purpose : Efforts to predict the clinicopathological outcome of IgA nephropathy have been made but have yielded conflicting results and have not helped in deciding the appropriate timing of the renal biopsy. In this study, we reviewed the predictive factors of clinicopathological outcome for finding out the criteria of renal biopsy timing of IgA nephropathy. Methods : Forty children diagnosed with biopsy proven IgA nephropathy at Wonju Christian Hospital were studied retrospectively, based on medical records. Results : Among 39 patients, 2 children progressed to higher serum creatinine level. One of them reached to the end stage renal disease within 2 year 7 months. According to WHO histopathological classification, there were 15 cases of class I, 14 cases of class II, 7 cases of class III, and 3 cases of class IV. In the mild histological classes(class I, II), gross hematuria was shown in 23 out of 29 children(P=0.02). In the severe histological classes(class III, IV), gross hematuria was noted in 4 out of 10(P>0.05). The tubulointerstitial changes were grade 1 in 24 cases, grade 2 in 4 cases, grade 3 in 8 cases, and grade 4 in 3 cases. With an increase in the tubulointerstitial grade, the 24 hour urine protein/albumin ratio increased. Serum creatinine less than 0.79 mg/dL could predict the lower grade(grade 1 and 2) of tubulointerstitial changes. But serum creatinine greater than 1.13 mg/dL could predict the higher grade(grade 3 and 4) of tubulointerstitial changes. In children with gross hematuria(n=27), serum creatinine was lower(0.78 vs 1.09 mg/dL, P=0.027), serum IgA was higher(316.3 vs 198.8 mg/dL), and the cases of lower WHO classification(I and II) were more common(23 vs 4, P=0.029) than the children with microscopic hematuria. Conclusion : Serum creatinine less than 0.79 mg/dL, macroscopic hematuria, and higher 24 hour urine protein/albumin ratio would predict the lower grade glomerulo tubulointerstitial lesion in IgA nephropathy and could be used as the criteria delaying the renal biopsy.

• The Journal of Korean Medicine
• /
• v.30 no.4
• /
• pp.93-107
• /
• 2009

Objective: Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in adults. However, there is not a satisfactory treatment for MN. This study aimed to evaluate the effect of Houttuyniae Herba Extract (HHE) on MN induced by cationic bovine serum albumin (cBSA). Methods: Mice were divided into 4 groups. The first group, Normal, was injected with saline. The second group, Control, was treated with cBSA (10mg/kg i.p) only. The third group, HHE-250, was treated with cBSA (10mg/kg i.p) and HHE (250mg/kg, p.o). The fourth group, HHE-500, was treated with cBSA (10mg/kg i.p) and HHE (500mg/kg, p.o). After treatment for 4 weeks, we measured change of body weight, 24 hrs proteinuria, serum albumin, total cholesterol, triglyceride, BUN, creatinine, IgA, IgM, IgG, TNF-${\alpha}$, IL-1${\beta}$ levels and the mRNA expression of IFN-${\gamma}$, IL-6, and IL-10. The morphologic changes of renal glomeruli were also observed with a light microscope and an electron microscope. Results: The levels of 24 hrs proteinuria and serum triglyceride, BUN, IgG, TNF-${\alpha}$, IL-1${\beta}$ significantly decreased in both HHE groups, while the level of serum albumin significantly increased in both HHE groups. The mRNA expression of IFN-${\gamma}$ and IL-6 in splenocytes considerably increased in both HHE groups. The mRNA expression of IL-10 in splenocytes considerably decreased in both HHE groups. In histological findings of kidney tissue, thickening of GBM decreased in both HHE groups. Conclusions: This study shows that HHE might be effective for treatment of acute stage MN. More clinical data and studies are to be done for efficient application.

• Childhood Kidney Diseases
• /
• v.14 no.1
• /
• pp.51-61
• /
• 2010

Purpose : Previous studies have suggested that Chemokine (C-C motif) ligand-2 (CCL-2; also known as MCP-1) and CCL-5 (also known as RANTES) are possibly associated with the pathogenesis of various inflammatory and non-inflammatory renal diseases. The present study was conducted to investigate association of polymorphisms of CCL-2 and CCL-5 genes with childhood IgA nephropathy (IgAN). Methods : The authors analyzed six single nucleotide polymorphisms (SNPs) of CCL-2 and CCL-5 in 196 pediatric IgAN patients and in 285 healthy controls. We compared variations in SNPs between two several sets of IgAN subgroups, allocated by presence of proteinuria (>4 mg/$m^2$/hour), podocyte foot process effacement, and pathologically advanced disease markers, such as interstitial fibrosis, tubular atrophy, or global sclerosis. Results : Genotypic data of IgAN patients and controls showed no significant SNP frequency difference in both of of CCL-2 and CCL-5. Even though two linkage disequilibrium blocks were formed, there was no significance in the haplotype analysis. In the patient subgroup analysis, no SNP of CCL-2 and CCL-5 was found to be associated with the presence of proteinuria, podocyte foot process effacement, and pathologically advanced disease markers. Conclusion : Our data indicate that no association exists between CCL-2 and CCL-5 SNPs and childhood IgAN susceptibility, and presence of proteinuria, podocyte foot process effacement, and pathologic progression of IgAN.

• Childhood Kidney Diseases
• /
• v.16 no.2
• /
• pp.73-79
• /
• 2012

Purpose: The association of mitochondrial DNA (mtDNA) mutations, deletions and copy number with progressive changes in patients with some glomerular disease and end-stage renal disease have been reported. In this study, we performed mtDNA mutation analysis in children with IgA nephropathy to investigate its role in progressive clinical course. Methods: Seven children with IgA nephropathy were involved in this study. MtDNA isolated from platelet was amplified by PCR and sequenced entirely. Results: The mean age at renal biopsy was $11.5{\pm}2.2$ year and the mean age at latest evaluation was $17.9{\pm}3.2$ year. The mean follow-up period were $7.8{\pm}3.1$ years. Patients was divided into 2 groups according to the amount of proteinuria at presenting manifestation. Group 2 patients were nephrotic syndrome. Renal function reveals within normal range in all patients. In group 2 patients, the mean serum albumin level was significantly lower than those of group 1 ($3.7{\pm}0.6g/dL$ vs. $4.7{\pm}0.2g/dL$, P=0.0241) and the mean total cholesterol level was significantly higher than those of group 1 ($222.7{\pm}35.7mg/dL$ vs. $148.3{\pm}29.1mg/dL$, P=0.0283). In Group 2 patients, total amount of protein of 24 hour collected urine also significantly higher than those of group 1 ($1,466.0{\pm}742.5mg$ vs. $122.5{\pm}48.1mg$, P=0.0135). Pr/Cr ratio in random urine sample was also higher in group 2 than those of group 1 but the statistical significance was not noted ($1.8{\pm}1.6$ vs. $0.2{\pm}0.2$, P=0.0961). Deletion of mtDNA nt 8272-8281 were observed in two patients, one patient in each groups, respectively. This is noncoding lesion. No patients demonstrated the mtDNA mutations. Conclusions: We have identified a deletion of mtDNA nt 8272-8281 in two children with IgA nephropathy. Further studies are needed to clarify the role of mitochondrial function in the progressive change of IgA nephropathy.

• Childhood Kidney Diseases
• /
• v.13 no.2
• /
• pp.248-251
• /
• 2009

The urachus is a normal embryonic remnant of the primitive dome. It generally exists as a fibrous cord extending from the dome of the bladder to the umbilicus. Disorders of the urachus are developed as a result of its incomplete regression. The urachal cyst is the most common urachal anomaly, and is usually asymptomatic in infancy and childhood. However, when the cysts are large or accompanied with secondary infection, they may be detected in its early stage. A sonography or CT scan may be helpful to confirm the diagnosis of urachal cyst. The managements of infected urachal cyst are varied from simple drainage to radical excision. Here, we report an unusual case of urachal cyst infection that occurred during corticosteroids therapy in a girl with IgA nephropathy.

• Korean Journal of Acupuncture
• /
• v.24 no.4
• /
• pp.163-180
• /
• 2007

Objective : Oriental medicines have been applied to Membranous nephropathy(MN) for the purpose on increasing renal blood flow and modulating immune activity in according to Oriental medicine theories. Magsungsinyeom-bang (MSSYB) is one of the prescription which is known to show positive results in clinic with lack of laboratorial evidence. Thus, this study was aimed to evaluate the effects of MSSYB and partially investigate the mechanisms of it. Methods : The effect of MSSYB was evaluated by the morphology for the GBM thickening, protein excretion in urine and biochemical parameters in serum using cBSA-induced MN mice model. Mice were administered with MSSYB(250 or 500 mg/kg) or PBS for control group from experimental week 3 for 4 weeks. Results : 24 hrs proteinuria and the concentrations BUN was significantly decreased in the MS groups compared to the control group while the concentrations of serum albumin was higher in the MS groups than control group. MSSYB didn't affect the ratio of CD3e+/CD or 19CD4+/CD8 in the spleen and kidney, but inhibit the expression of IL-1${\beta}$, TNF-${\alpha}$, IL-6, and production of IgG and IgM. In histological analysis of kidney tissue, thickening of GBM was significantly decreased in the MS group compared to control group. Conclusions : MSSYB showed the positive results on the cBSA-induced membranous nephropathy in mice, thus, it could be a useful candidate for oriental drug for treating the membranous nephropathy in clinic.

• The Korea Journal of Herbology
• /
• v.26 no.4
• /
• pp.115-124
• /
• 2011

Objective : Membranous nephropathy(MN) is one of the most common causes of nephrotic syndrome in adults. MN has been defined as granular subepithelial deposition of IgG immune complexes along the glomerular basement membrane(GBM). However, there is not a satisfactory treatment for MN. We aimed to identify the effect of Impatiens balsamina Linne(IBL) treatment on cationic bovine serum albumin(cBSA)-induced MN in a mouse model. Methods : Mice were divided into 4 groups. The normal group was injected with saline. The Control group was treated with cBSA(50 mg/kg i.p) only. The third group IBL-100, was treated with cBSA(50 mg/kg, i.p) and IBL(100 mg/kg, p.o). The fourth group IBL-400, was treated with cBSA(50 mg/kg, i.p) and IBL (400 mg/kg, p.o). After cBSA and IBL treatment for 6 weeks, we measured change of body weight, proteinuria, serum albumin, total cholesterol, triglyceride, BUN, creatinine, IgA, IgM, IgG, TNF-${\alpha}$, IL-6 and IL-$1{\beta}$ levels. The morphologic changes of renal glomeruli were also observed with a light microscope. Results : The level of proteinuria significantly decreased and serum albumin increased in groups treated with cBSA and IBL extract compared with the control. The levels of serum triglyceride, BUN, IgG, TNF-${\alpha}$, IL-$1{\beta}$ significantly decreased in both IBL groups. In histological findings of kidney tissue, thickening of GBM decreased in both IBL groups. Conclusions : This study shows that IBL might be effective for treatment of acute stage MN. More clinical data and studies are to be done for efficient application.

• The Journal of Internal Korean Medicine
• /
• v.29 no.1
• /
• pp.104-116
• /
• 2008

Objective : Membranous nephropathy (MN) is the most common cause of adult nephrotic syndrome worldwide. MN has been defined as granular subepithelial deposition of IgG immune complexes along the glomerular basement membrane (GBM). We aimed to identify the effects of Chungyeolmaksungbang (CYMSB) treatment on cBSA-induced in MN mouse model. Methods : The effect of Chungyeolmaksungbang treatment was studied on the morphology and protein excretion in the cationized bovine serum albumin (cBSA)induced mouse chronic serum sickness nephritis model. One group of mice was given intra-peritoneal (i.p.) immunizing doses of cBSA and complete Freund's adjuvant. One week later, these animals began a single i.p. injection of cBSA for 4 weeks. A second group followed the same injection protocol, but was given CYMSB p.o. Results : Proteinuria significantly was decreased and serum albumin was increased in the group treated with cBSA and CYMSB extract compared with the control. Serum BUN was significantly decreased on CYMSB compared with control. CD3e+/CD19 cells ratio of peripheral blood was decreased and CD4+/CD8 cells was increased. Level of $IL-1{\beta}$ was significantly decreased, and $IFN-{\gamma}$ was significantly increased. Concentration of IgG and IgM was significantly decreased compared with control. Thickness of GBM was decreased on histological analysis of kidney. Deposition of CD4 and CD8 was decreased on immunohistochemical staining of kidney. Conclusions : We conclude that CYMSB treatment may could be a useful remedy agents for treating the MN with cBSA.