• Childhood Kidney Diseases
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• v.4 no.1
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• pp.1-5
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• 2000

Purpose: The plcr of spot urine has been uised to predict the timed urine protein excretion. Although this method reduces errors caused by variations in urine volume, it is relatively thconvenient and expensive. Recently, a more rapid and less expensive screening method with specific gravity(SG) has been reported, and we have examined whether estimated-creatinine(Cr-est) with urine 5G could be used in place of urine creatinine to predict 24-hour collected urine protein excretion in children. Methods: We had retrospectively analyzed protein, creatinine and urine SG in randomized spot urine samples of 147 patients from March 1998 till June 1998 in Korea university Guro hospital and compared the urinary protein creatinine ratio(P/Cr) with the protein estimated-creatinine ratio(P/Cr-est). We compared the correlation of urinary creatinine vs-urine 5G with the timed urine pretein excretion. Results: 1) urine SG accurately estimated urine creatinine concentration (r=0.407, P<0.001, Cr=SG x 4485.82-4482.87). 2) P/Cr correlated with urine protein excretion measured in a 24-hour urine collection (r=0.771, P<0.001, 24-hour collected urine protein : 0.338 x (P/Cr) 4+667.885). 3) P/Cr-est correlated with a 24-hour collected urine protein (r=0.723, P<0.001, 24-hour collected urine protein =0.354 x (P/Cr-est)+726.044), Conclusions: These results suggest that P/Cr-est with urine SG could be useful method for screening proteinuria in children.

• Childhood Kidney Diseases
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• v.12 no.2
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• pp.150-156
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• 2008

Purpose : Many results have reported a correlation between the spot urine protein/creatinine ratio(P/C ratio) and 24-hour urinary protein(24UP) amount. This study was designed to evaluated correlation between 24UP amounts and P/C ratio in children and to find the factors that affect this correlation. Methods : 210 patients who visited the Department of Pediatrics in Busan Paik Hospital from september 2003 to december 2007 were included in this study. All the patients were divided into I, II, III/A, B, C group[I:24UP(mg/$m^2$/day)]<100, II: 100$\leq$24UP<1,000, III: 24UP$\geq$1,000, A: Cr excretion(mg/kg)<15, B: 15$\leq$Cr excretion<25, C: Cr excretion$\geq$25)]. Pearson correlation analysis was performed between 24UP and P/C ratio to evaluate the relationship. We defined fractional difference between 24UP and P/C ratio, and then performed multiple regression analysis. Results : There was a strong positive linear correlation between 24UP and P/C ratio in all patients, and the correlation was also good in each group. The factors affecting accurate quantitation of proteinuria using spot urine P/C ratio was creatinine excretion. Conclusion : Spot urine P/C ratio is a useful test to predict proteinuria roughly. Therefore, we expect that urine P/C ratio can be used as parameter instead of 24UP, if we set cutoff value of P/C ratio considered to creatinine excretion according to age and sex in large pediatric population.

• Childhood Kidney Diseases
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• v.26 no.2
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• pp.69-73
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• 2022

Proteinuria is an early hallmark of kidney disease and a major risk factor for systemic cardiovascular diseases. There are several methods to measure proteinuria, such as the urine dipstick test, 24-hour urinary protein excretion method, and spot urine for the protein-to-creatinine ratio. The urine dipstick test is simple but inaccurate. The 24-hour urinary protein excretion method is the gold standard; however, it is cumbersome, especially in children. Spot urine for the protein-to-creatinine ratio is simple and accurate, but has limitations. Specific urinary protein such as albumin can be measured instead of the total protein content. Tests should be avoided in situations that cause transient proteinuria or false-positive results. It should be performed correctly, and its limitations should be recognized and interpreted accurately.

• Clinical and Experimental Pediatrics
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• v.46 no.2
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• pp.173-177
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• 2003

Purpose : Recently, different results about factors affecting accurate quantitation of 24-hr urinary protein(24UP) amount using spot urine protein/creatinine ratio(PCR) have been reported. The current study was designed to evaluate correlation between 24UP amounts and PCR in children, and the effect of 24UP amounts, age, sex, and glomerular filtration rate(GFR) on this correlation. Methods : Among 94 patients who visited the department of pediatrics in Busan Paik Hospital from March 2002 to August 2002, 68 patients whose urinary creatinine excretion was ${\geq}15mg/kg/day$ were included in this study. All the patients were divided into I, II/A, B group(I : 24UP<500 mg/day, II : $24UP{\geq}500mg/day$, A : <10 years of age, B : ${\geq}10years$ of age). Pearson correlation analysis was performed between 24UP and PCR to evaluate the relationship. We defined fractional difference between 24UP and PCR, and then performed multiple regression analysis with 24UP amount, age, GFR and fractional difference. Results : There was a strong positive linear correlation between 24UP and PCR(R=0.936, P<0.0001) in all patients, and the correlation was also good in each group. Using PCR cutoff values of 0.5, the PCR provided high sensitivity, specificity, positive and negative predictive value in predicting 24UP amount ${\geq}500mg$. The factors affecting accurate quantitation of proteinuria using spot urine PCR was age, not 24UP amount, GFR or sex. Conclusion : Spot urine PCR is a useful test but has limitations in predicting 24UP amount. Therefore, it should be used only as screening method. Age-adjusted PCR cutoff values may be necessary to predict 24UP amount in children with proteinuria.

• Asian-Australasian Journal of Animal Sciences
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• v.19 no.9
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• pp.1291-1297
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• 2006

The potential of the spot urine sampling technique as an alternative to performing a total urine collection to predict the microbial nitrogen supply was evaluated in crossbred bulls. In a completely randomized design, 20 growing crossbred bulls were assigned four levels of feed intake (120, 100, 80 and 60% of voluntary dry matter intake) on diets comprised of wheat straw and concentrate mixture (50:50). After three months of experimental feeding, a metabolism trial was conducted for ten days, during which spot urine collections were performed every 6 h post feeding on days 9 and 10. The daily urinary excretion of allantoin (A) and purine derivatives (PD) decreased with the reduction in feed intake while creatinine (C) excretion remained similar in animals fed at different levels. The microbial nitrogen (MN) supply calculated from the PD excreted in total urine (35.08 to 72.08 g/d) was higher at increased levels of feed intake. PD concentration in spot urine samples had poor correlation with feed intake except at 12 h post feeding. A/C ratio and PD/C ratio in spot urine samples remained similar irrespective of sampling time and significantly (p<0.01) correlated with daily urinary PD excretion, digestible organic matter intake and dry matter (DM) intake. However, no significant differences were evident in these ratios among animals fed at levels 120, 100 and 80% of voluntary dry matter intake (VDMI) at different times post feeding. These results suggests that the spot urine sampling technique to predict the microbial protein supply is not suitable for detecting small differences in MN supply and hence, estimation of PD excreted in total urine (mmol/d) is necessary to assess precisely the MN supply in crossbred bulls.

• Childhood Kidney Diseases
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• v.8 no.2
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• pp.159-165
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• 2004

Purpose: This study aimed to compare the clinical outcome of acute poststreptocaccal glomerulonephritis (APSGN) between patients who had presented with gross hematuria and those with microscopic hematuria. Methods: Thirty-nine patients with acute poststreptococcal glomerulonephritis, who were diagnosed from January 2000 to April 2003 were enrolled. Results: The mean age was 8.85 years and the male to female ratio was 1.1:1 Seventeen patients presented with gross hematuria at diagnosis(group A) and twenty-two patients had microscopic hematuria only(group B). There were no significant differences between the two groups in the incidence of edema, fever or history of respiratory infection and oliguria. But hypertension was more frequent in group B. Laboratory data showed decreased C3 and C4 level in group B. Spot urine protein/creatinine ratio and 24hr urine protein showed higher levels in group A. Conclusion; Patients with gross hematuria at diagnosis had lower incidence of hypertension and a higher rate of nephrotic range of proteinuna than patients with microscopic hematuria. However, no difference in the duration of admission or complication rate was observed. All patients had clinical improvement during follow-up. We conclude that gross hematuria is not a significant prognostic factor for poststreptococcal glomerulonephritis.

• Childhood Kidney Diseases
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• v.13 no.1
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• pp.56-62
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• 2009

Purpose : The aim of this study was to evaluate the clinical usefulness of measurement of ${\beta}_2$ microglobulin (${\beta}_2$ MG), N-acetyl-$\beta$-D-glucosaminidase (NAG) of spot urine samples as indices of renal tubular damage and microalbumin of spot urine samples as a parameter of glomerular damage in children with vesicoureteral reflux (VUR) or renal defects. Methods : We studied 91 children with previous UTI. The children were classified as 62 children without VUR and renal defects (group I), 10 children with VUR, without renal defects (group II), and 19 children with VUR and renal defects (group III). Patients having VUR were separated according to the degree of VUR (mild VUR: VUR grade I-III, severe VUR: VUR grade IV-V). Urinary excretion of ${\beta}_$ microglobulin (${\beta}_2$ MG), microalbumin, N-acetyl-$\beta$-D-glucosaminidase (NAG), creatinine were measured in samples of morning urine specimens. Children with VUR or renal defects detected by voiding cystourethrography (VCUG) and DMSA renal scan were investigated. Results : Microalbumin/Cr ratio of spot urine was significantly increased in group III compared group I ($42.3{\pm}27.2\;mg/gCr$ vs $25.2{\pm}10.9\;mg/gCr$, P<0.05). NAG/Cr ratio of spot urine was significantly increased in group II compared group I ($3.70{\pm}23.4\;mg/gCr$ vs $18.7{\pm}12.7\;mg/gCr$, P<0.05). There was no statistically significant difference of ${\beta}_2$ MG/Cr ratio among three groups. Conclusion : Urinary microalbumin excretion of morning urine sample may be a simple and reliable clinical indicators for early identification of renal damage in children with VUR and renal defects. Urinary microalbumin excretion may be useful marker to predict the the severity of VUR.

• Journal of The Korean Society of Clinical Toxicology
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• v.17 no.1
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• pp.7-13
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• 2019

Purpose: Owing to the increased agricultural use of the herbicide glufosinate ammonium (GLA), the incidence of GLA poisoning has recently increased. Therefore, we investigated the possible predictive factors associated with severe complications following GLA poisoning. Methods: A retrospective analysis of medical records was conducted based on 76 patients who had visited our regional emergency medical center with GLA poisoning from 2006 to 2017. Severe complications were defined as respiratory failure requiring intubation, systolic blood pressure less than 90 mmHg, Glasgow Coma Scale (GCS) less than 8, and presence of seizure. Results: Age, ingested amount and ingested amount per weight were significantly greater in the severe group (p<0.001). PSS grade 2 or higher was more common in the severe group (p<0.001), and In addition, the APACHE II score was significantly higher in the severe group (p<0.001), as were the SOFA scores (p=0.002). Serum ammonia levels were significantly higher in the severe group (p=0.007), while MDRD-GFR was smaller in the severe group (p=0.002). The spot urine protein levels were significantly higher in the severe group (p=0.005), as was the urine protein to creatinine ratio (p=0.001). Upon multivariate analysis, the amount ingested per weight and PSS grade 2 or higher were identified as significant predictors. Conclusion: Our study showed that MDRD-GFR was significantly lower in the severe group after GLA poisoning. PSS grade 2 or higher and ingested amount per weight may be useful to evaluate the severity of complications after GLA poisoning.

• Childhood Kidney Diseases
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• v.23 no.1
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• pp.53-57
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• 2019

Renal cortical necrosis (RCN) is patchy or diffuse ischemic destruction of the renal cortex caused by significantly reduced renal arterial perfusion. It is a rare cause of acute kidney injury (AKI) and is associated with high mortality. Here, we review the case of RCN in a 15-year-old boy who developed AKI. A 15-year-old boy was referred to our hospital from a local hospital due to a sharp decrease in his renal function. He presented with acute flank pain, nausea with vomiting, and oliguria for the past two days. He had taken a single dose of antihistamine for nasal congestion. At our hospital, his peak blood pressure was 148/83 mmHg and he had a high body mass index of $32.9kg/m^2$. The laboratory data showed a blood urea nitrogen (BUN) of 28.4 mg/dL, a creatinine of 4.26 mg/dL, and a glomerular filtration rate estimated from the serum cystatin C of $20.2mL/min/1.73m^2$. Proteinuria (spot urine protein to creatinine ratio 1.66) with pyuria was observed. Kidney sonography showed parenchymal swelling and increased renal echogenicity. Due to rapidly progressing nephritis, steroid pulse therapy (750 mg/IV) was done on the second day of his admission and the patient showed complete recovery with normal renal function. However, the kidney biopsy findings revealed renal cortical hemorrhagic necrosis. Multifocal, relatively well-circumscribed, hemorrhagic necrotic areas (about 25%) were detected in the tubulointerstitium. Although RCN is an unusual cause of AKI, especially in children, pediatricians should consider the possibility of RCN when evaluating patients with rapidly decreasing renal function.

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