Midori Hojo

Idiopathic membranoproliferative glomerulonephritis in Japanese children

The course of idiopathic membranoproliferative glomerulonephritis (MPGN) in 41 Japanese children (21 boys, 20 girls) is reported. The mean follow-up period was 8 years, 9 months; 29 children with MPGN (71%) were identified by school urinary screening; 32 patients had type I MPGN, 2 type II and 7 type III; 10 patients were treated with multiple low-dose cocktail therapy (MLD), 8 with MLD followed by high-dose alternate-day (ALD) prednisolone and 21 with high-dose ALD prednisolone alone. In 1 patient, MPGN progressed to end-stage renal failure. The serum creatinine level in all of the remaining 40 patients was ≤ 1.3 mg/dl at the last follow-up. Urinalysis was normal in 24 (59%). Of the 17 patients who still had urinary abnormalities, 4 had nephrotic syndrome. The incidence of remission of urinary abnormalities was highest in the patients treated with high-dose ALD prednisolone. Rebiopsy was performed in 33 patients, and revealed slight histological improvement in 11 (33%) patients, moderate improvement in 8 (24%), marked improvement in 5 (15%) and deterioration or no improvement in 9 patients (27%). Relatively few side effects of treatment were observed. The superior outcome of the MPGN patients in this compared with other studies may be the result of earlier detection and treatment.

Two-dimensional Doppler echocardiographic assessment of closure of the ductus arteriosus in normal newborn infants

To elucidate the mechanism involved in closure of the ductus arteriosus (DA), 50 normal full-term infants were examined with two-dimensional and pulsed Doppler echocardiography. The examinations were performed initially within 1 hour after delivery and serially for 3 days. The two-dimensionally derived long-axis plane of the DA disclosed a characteristic localized protrusion into its lumen in 30% of the subjects within 1 hour, in 80% by 4 hours, in 96% by 8 hours, and in all by 24 hours after birth. In 10 infants in whom the intraluminal protrusion did not appear within 4 hours after birth, none had any recognizable changes in the inner diameter or length of the DA during this initial period. The development of the intraluminal protrusion resulted in localized narrowing of the ductal lumen. Doppler echocardiography revealed a high-velocity jet within and downstream from the narrowed portion of the DA. Thereafter, ductal narrowing progressed along the entire length. The intraluminal protrusion may be early evidence of ductal changes leading to eventual functional and anatomic closure.

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.

Two cases of congenital nephrotic syndrome

The clinical course and renal histological changes in two patients with congenital nephrotic syndrome are presented. Both patients developed edema and proteinuria at 2 days of age. Steroids and immunosuppressive drugs were not used in either patient. One patient showed gradual disappearance of nephrotic syndrome and proteinuria during the 16-month follow-up. In the other patient, the nephrotic state persisted and nephrotic complications necessitated bilateral nephrectomy when she was 12 months old. Renal biopsy showed minimal change lesions in one patient, while the nephrectomized kidneys showed mild mesangial proliferation and matrix increase in the glomeruli. No tubular dilatation or microcysts were observed in either patient.

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.