Noriaki Kasai

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.

Effect of Immunosuppressive Agents on Persistent Glomerulonephritis in Childhood

From 1971 to 1975, frequent percutaneous renal biopsies, using a new technique which is easy to perform even in small infants, were done in 35 cases of persistent glomerulonephritis. We had already reported the outcome and the significance of frequent biopsy in children, particularly in persistent glomerulonephritis and progressive glomerulonephritis. In each case, renal biopsy was done twice or more, depending on the clinical course of the disease. We classified persistent glomerulonephritis of childhood into three categories: 1) persistent glomerulonephritis without any signs of progression, 2) slowly progressive glomerulonephritis, and 3) rapidly progressive glomerulonephritis. Our criteria for persistent glomerulonephritis are as follows: 1. It includes glomerulonephritis of unknown origin as well as well-defined glomerul ar diseases. 2. The urine contains a considerable amount of protein and microscopic hematuria, which are stationary. Glomerular lesions are not progressive, otherwise called ‘dormant volcano’. 3. In twelve out of 35 cases, we used immunosuppressive agents, and the rest cases were controls (23 cases).