• Childhood Kidney Diseases
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• v.9 no.1
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• pp.15-20
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• 2005

Purpose : Nutcracker syndrome must be considered when hematuria or proteinuria occurs in a healthy child. The purpose of this study is to investigate the prevalence of nutcracker syndrome among children with asymptomatic hematuria or proteinuria, and to obtain the ratios of the peak velocity of the left renal vein between the aortomesenteric portion and the hilar portion in children with asymptomatic hematuna or protelnuria in which nutcracker syndrome was excluded and to observe whether the ratios are affected by sex, age or urinalysis findings. Methods : Using Doppler ultrasonography, we measured the flow velocity and obtained the peak velocity ratios of the left renal vein at the aortornesenteric portion and at the hilar Portion of the left kidney in children with asymptomatic hematuria or proteinuria who visited the Division of Pediatric Nephrology, Severance Hospital from May 2001 to March 2004. Results : Of 304 children with asymptomatic hematuna or proteinuria, 107 children(35.2%) were diagnosed with nutcracker syndrome. For 197 children with asymptomatic hematuria or proteinuria excluding nutcracker syndrome, the mean ratio of the peak velocity was 2.54 $\pm$0.73, which was not affected by sex, age or urinalysis findings. Conclusion : Nutcracker syndrome was the major cause of asymptomatic hematuria or proteinurla In children, comprising 35% of all cases. Doppler ultrasonography was helpful in the screening of nutcracker syndrome and prevention of its complications. For children with asymptomatic hematuria or proteinuria excluding nutcracker syndrome, the peak velocity ratio of the left renal vein did not differ from that of normal children and was not affected by sex, age or urinalysis findings. (J Korean Soc Pediatr Nephrol 2005;9:15-20)

• Childhood Kidney Diseases
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• v.10 no.1
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• pp.27-32
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• 2006

Purpose : Conservative management of multicystic dysplastic kidney(MCDK) without nephrectomy has recently been advocated. The purpose of this study was to determine the clinical course of conservatively managed MCDK and to find out possible predictive factors for involution of MCDK by ultrasonography(US). Methods : A retrospective analysis was made on 45 patients(26 boys and 20 girls) in whom MCDK was detected and had been traced by US between Dec. 1993 and Aug. 2005 at Severance Hospital. Results : Median follow-up time was 30 months(range 2-102 months). All patients under-went radionuclide scans and voiding eystourethrograms. The serial follow-up US showed complete involution in 11(24%), partial involution in 19(41%), and no interval change or increased in cyst size in 13(28%) patients. Nephrectomy was done in 3 patients(7%) due to relapsing urinary tract infection(UTI) and severe abdominal distension. The mean age of complete involution of MCDK was 37 months(range 12-84 months). Episodes of UTI were present in 17 patients(37%) and additional genitourinary(GU) abnormalities were found in 22 patients(44%). Hypertension and renal insufficiency was complicated in one patient. No child developed malignant tumor. Univariate analysis showed that five variables were associated with complete involution of the MCDK; gender, site, UTI episode, additional GU abnormalities, and renal length on initial US. After adjusting using the Pearson model, the presence of additional GU abnormalities was exclusively associated with complete involution among the 5 variables(P=0.034). Conclusion : In our review of 46 cases of MCDK, non-surgical approach for patients with MCDK was advisable and we could predict poor prognosis when MCDK is associated with other GU anomalies.

• Childhood Kidney Diseases
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• v.3 no.2
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• pp.123-129
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• 1999

Purpose: Acute poststreptococcal glomerulonephritis(APSGN) is a renal disease which is characterized by glomerular proliferation and inflammatory changes due to immune reaction. Although the 95% of patients with APSGN seems to recover fully and present as benign course, the remaining patients show poor prognosis. Therefore comparative retrograde study between APSGN with and without nephrotic syndrome was done to find out the any prognostic indicator to predict the outcome in patients with APSGN. Methods: We had retrospectively analyzed seventy-one patients who were diagnosed as APSGN clinically from Mar.1989 to Feb.1999 in Yonsei university medical center. Sixty-four of the patients was APSGN without nephrotic syndrome(Group A) and seven patients were in APSGN with nephrotic syndrome(Group B). Results: Patients who were diagnosed as APSGN with nephrotic syndrome were seven(9.9%) out of seventy-one. In the comparative study, sex ratio was 1:1 in group A and 1.9: 1 in group B, onset mean age was $8.9{\pm}2.6$ in group A and $8.8{\pm}2.6$ in group B. Following clinical profiles were compared but there were no significant difference between these two groups: WBC count($9413{\pm}2964\;vs\;9368{\pm}2650(/mm^3)$), hemoglobin($10.6{\pm}1.2\;vs\;10.0{\pm}0.9(gm/dL)$), ASO($746.1{\pm}640.7\;vs\;614.9{\pm}475.9(IU/ml)$), $C_3(20.1{\pm}17.0\;vs\;16.9{\pm}13.1(mg/dL)$), $C_4(22.8{\pm}9.5\;vs\;22.6{\pm}6.9(mg/dL)$), BUN($25.8{\pm}26.1\;vs\;28.1{\pm}14.5(mg/dL)$), creatinin($0.8{\pm}0.3\;vs\;0.8{\pm}0.3(mg/dL)$), $C_{cr}(80.6{\pm}28.8{\pm}62.4{\pm}31.4(ml/min/1.73\;m^2$)), the duration of edma, gross hematuria, and hypertension. However, we found that there were a significant difference in the duration of proteinuria($1.95{\pm}2.27\;vs\;13.3{\pm}21.1(months)$)(P<0.05), decreased $C_3$ duration($1.9{\pm}2.9\;vs\;7.3{\pm}5.0(weeks)$)(P<0.05) and especially it was proloned according to the amount of early urine protein excretion. Conclusion: Our study showed markedly prolonged duration of proteinuria and decreased $C_3$ duration in patients with APSGN with nephrotic syndrome. We were not able to find the definite prognostic factor that will guide the outcome of patients with APSGN accompaning nephrotic syndrome, but above findings seemed to represent as a relative indication of the outcome of the disease. All patients recovered completely and we did not experience any cases that progressed into the renal failure.

• Clinical and Experimental Pediatrics
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• v.48 no.8
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• pp.832-838
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• 2005

Purpose : Mycoplasma pneumoniae infection is relatively common in childhood. Its extrapulmonary manifestations have been reported so much, but hepatitis associated with it has been reported rarely in Korea. Methods : A clinical study was performed on 556 patients of M. pneumoniae pneumonia diagnosed serologically at Gil hospital from January 2001 to December 2004. We reviewed 65 cases among these patients, who had elevated level of serum AST and ALT greater than 50 IU/L respectively without evidence of hepatitis A, B, C, Cytomegalovirus and Ebstein-Barr virus infections. Results : Hepatitis occurred in 11.7% of Mycoplasma pneumoniae pneumonia, especially in fall and winter times. Male to female ratio was 1.2 : 1 and the mean age was 4 years and 3 months. Besides hepatitis, cough(95.4%), sputum(52.3%) and dyspnea(12.3%) were common as pulmonary manifestations. And among gastrointestinal manifestations, nausea/vomiting(26.2%) was the most common symptom, followed by poor oral intake(12.3%), diarrhea(12.3%) and abdominal pain(6.2%). In addition to hepatomegaly(4.6%) and splenomegaly(4.6%), coarse breathing sound was the most common physical manifestation, followed by rale(63.1%), pharyngeal injection(26.2%), and rash(10.8%). Anemia was noted in 20.0%, neutrophilia in 10.8%, eosinphilia in 38.5% and thrombocytosis in 6.2%, respectively. Mean level of ESR and CRP was 32.02 mm/hr and 6.69 mg/dL, respectively. Mean level of AST and ALT was 293.80 IU/L and 181.48 IU/L, respectively. Hyperbilirubinemia was noted in 7.7% and hypoalbuminemia was noted in 58.5%. Lobar or lobular pneumonia(78.5%) was the most common finding in chest X-ray and left lower lobe(39.2%) was most commonly affected. Pleural effusion was noted in 26.2%. Mean duration of hospitalization was 9.91 days. Serum AST/ALT level was normalized within 9.94 days and pulmonary consolidation resolved within 14.29 days. Conclusion : The prognosis of M. pneumoniae hepatitis is good. However, liver function should be considerately checked in M. pneumoniae infection because its incidence is not so low.

• Clinical and Experimental Pediatrics
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• v.51 no.4
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• pp.420-425
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• 2008

Purpose : The purpose of this study was to evaluate acute childhood seizures, one of the most important causes of emergency room visits, to provide appropriate medical services. Methods : We reviewed the medical records of 433 (4.6%) pediatric patients with acute seizures that visited the emergency room at Masan Samsung hospital from 2004 to 2006. Results : The male to female ratio was 1.4:1 and the mean age was $40.9{\pm}34.9$ months range. The order of geographical distribution was Masan, Changwon, Haman, and others. Fever was present in 40.6% of patients; December (14.8%) was the most frequent month for visits and generalized tonic clonic seizures (62.7%) were the most common type of seizure. The average frequency and duration of the seizure was $1.5{\pm}1.0$ and $6.7{\pm}13.2$ minutes respectively. Febrile seizures were present in 69.7% of patients and afebrile seizures in 30.3%. The causes of the febrile seizures were acute pharyngotonsillitis (44.6%), acute bronchitis, gastroenteritis, pneumonia, urinary tract infection, and unknown origin, in order of frequency. The most common cause of an afebrile seizure was epilepsy (71.5%) followed by a benign convulsion with mild gastroenteritis (BCwMG), sequela of a perinatal brain injury or brain malformation, and acute CNS infection. Evaluation of the causes of an acute seizure according to age showed that febrile seizures, epilepsy, and the sequela of perinatal brain injuries were more common between 2 and 6 years of age and epilepsy, febrile seizures and acute CNS infection, in order of frequency, were common between 6 and 15 years of age. Many patients, 49.4%, were discharged without admission. Conclusion : The common characteristics of pediatric patients presenting to the emergency room were male gender, an age between 2-6 years, presenting during the month of December, with generalized tonic clonic seizures due to acute pharyngitis. The most common presentation for the group less than 6 years of age was a febrile seizure and in the group more than 6 years of age, it was epilepsy. In many cases, the seizures stopped by the time the family presented to the emergency room.