Kaori Tomonaga

Long-term follow-up of type III membranoproliferative glomerulonephritis in children

Abstract Seven patients with type III membranoproliferative glomerulonephritis (MPGN) were followed for 9–17 years. Their mean age at presentation was 11.0 years. Their urinary abnormalities were detected by school urinary screening in five, and two patients presented with nephrotic syndrome. With time, urinalysis became normal in five, proteinuria persisted in one and nephrotic syndrome persisted in one. All had serum creatinine levels below 1 mg/dl at the last follow-up. All were initially hypocomplementemic. Serum C3 levels became normal in five patients but decreased again in three without clinical changes. Mesangial proliferation was initially slight or moderate in five but, except for one patient, histological changes persisted in follow-up biopsies even though in two the urinalysis became normal. Electron micrographic studies using silver-methenamine staining revealed subepithelial and subendothelial deposits associated with basement membrane disruption and layering of the lamina densa, an abnormality typical of MPGN type III. These observations suggest long-term outcome of type III MPGN is good despite persisting changes in type III lesions.

Clinical course of lupus membranous glomerulonephritis in children

AbstractBackground. Lupus nephritis (LN) is not a common renal disorder of childhood. Few pediatric nephrologists, except for those in a large center, see enough patients with LN to build up a substantial amount of experience. Membranous glomerulonephritis (MGN) associated with systemic lupus erythematosus (SLE), so-called lupus membranous glomerulonephritis (LMGN), is also rare in patients with LN. Methods. In 36 children with SLE, we investigated the clinical course of 4 children (1 boy and 3 girls) who showed MGN. Their mean age at presentation was 7.8 years and the mean follow-up period was 7.1 years. Results. Presenting symptoms were chance hematuria and proteinuria (H and P) in 2 children, edema in 1, and petechiae and thrombocytopenia in 1. The initial biopsy showed MGN in 3 children and diffuse proliferative glomerulonephritis in 1 child, in whom transition to MGN was observed. Two patients, who presented with chance H and P and showed MGN on the initial biopsy, later developed clinical signs of SLE, 3 and 5 years after presentation, respectively. During the course, all patients developed nephrotic syndrome, but at the last follow-up, H and P was detected in 1 child and proteinuria in 1 child. Urinalysis results were normal in 2 children. No patient had nephrotic syndrome or developed renal failure. Conclusions. The clinical course of LMGN in the 4 children seemed to be favorable. Two patients with MGN developed clinical signs of SLE several years after the renal manifestation.

Hepatitis B virus‐associated nephropathy: 17 year progression from onset to end‐stage renal failure

Hepatitis B virus‐associated nephropathy (HB nephropathy) was first described in 1971. There have been few reports on the long‐term prognosis in children with HB nephropathy. A case is reported here of a child who presented with symptoms of acute glomerulonephritis at 12 years of age and progressed to end‐stage renal failure 17 years after the clinical onset, in spite of the seroconversion of HB virus by formation of HBe antibody.

Urea kinetics and other dialysis indices in children undergoing ambulatory peritoneal dialysis

AbstractBackground. Peritoneal dialysis (PD) is an established treatment for children with end-stage renal failure. Creatinine clearance and urea kinetics are used to quantitate the dialysis treatment, but the means to assess the adequacy of dialysis in children are still controversial. Methods. We studied serum chemistry, dietary protein intake (DPI), protein catabolic rate (PCR), weekly urea clearance/body water (Kt/Vurea), weekly creatinine clearance (Ccr/week), clinical signs and symptoms during PD treatment, and peritoneal transport function in 17 children (4 to 18 years of age) with end-stage renal disease treated with PD. Fourteen children were on continuous ambulatory peritoneal dialysis (CAPD) and 3 were on automated peritoneal dialysis. Results. The mean values of the parameters tested were: blood urea nitrogen, 71 mg/dl; creatinine, 9.8 mg/dl; total protein, 6.4 g/dl; albumin, 4.0 g/dl; total Ccr, 70 l/week per 1.73 m2; DPI, 1.76 g/kg per day; PCR, 1.17 g/kg per day, and total Kt/Vurea, 2.28/week. The mean patients clinical assessment score was 11.7, out of 15 and the mean doctors clinical assessment score was 11.7, out of 14. The correlation between Kt/Vurea and creatinine clearance was 0.84 (P < 0.0001). Kt/Vurea and clinical assessment scores (patients and doctors scores) did not show a good correlation (r = 0.32; P = 0.228, and r = 0.47; P = 0.064, respectively). Peritoneal function seemed to be preserved after an average duration of 32 months on PD. Conclusions. These patients appeared to be fairly well dialyzed, judging from the values for the various dialysis indices obtained in this study and comparing them with adult indices.