Wei-Perng Chen

Lupus Nephritis in Children—A Review of 167 Patients

BACKGROUND Relatively few studies have been made of children with lupus nephritis. The prognosis of children with lupus nephritis is ominous for those with diffuse proliferative glomerulonephritis and active interstitial inflammation. Up to now few studies have been made on this subject. OBJECTIVES To evaluate the clinical course, histopathology, and prognosis of lupus nephritis in children, to identify the risk factors for renal failure and mortality, and to share our experience in treating lupus nephritis in children. METHODS Retrospectively, 167 children under 18 years of age with lupus nephritis at Veterans General Hospital-Taipei, Taiwan from 1979 to 1991 were studied. All patients received renal biopsy and follow-up biopsies were performed in 36 children. The clinical and serologic parameters at the time of renal biopsy were recorded. RESULTS There were 55 (33%) patients with class II, 30 (18%) with class III, 69 (41.3%) with class IV, and 13 (7.8%) with class V nephritis based on initial biopsy. The mean follow-up time was 59 months. Follow-up biopsies were histologically stationary in 29 patients, progressive in five, and regressive in two. The results revealed that those with persistent hypertension, anemia, increased serum creatinine concentration, and decreased creatinine clearance rate at initial biopsy were more prone to develop renal failure. Low titer of CH50 hemolytic assay appeared to be a poor prognostic indicator. The overall renal and patient 5-year survival rates were 93.1% (135/145) and 91.08% (143/157), respectively. They were 87.7% (50/57) and 82% (55/67), respectively, of patients with class IV proliferative glomerulonephritis. CONCLUSIONS The prognosis of children with class IV nephritis in this study was better than that reported previously. All children surviving without renal failure were maintaining their normal lives with little organ dysfunction. The improved results may be due to earlier renal biopsy for precise histopathologic definition, better supportive care, and selective use of aggressive therapy, including methylprednisolone pulse therapy, intravenous cyclophosphamide, intravenous prostaglandin E1 therapy, high-dose intravenous gammaglobulin therapy, and cyclosporin A for those with high risk factors.

Persistent Transforming Growth Factor-Beta 1 Expression May Predict Peritoneal Fibrosis in CAPD Patients with Frequent Peritonitis Occurrence

The efficiency of continuous ambulatory peritoneal dialysis depends on the permeability of the peritoneal membrane. Peritoneal fibrosis (PF) causes loss of the dialytic function. Several studies have indicated that PF is closely related to the proliferation of peritoneal fibroblasts and the deposition of extracellular matrix. Transforming growth factor-beta 1 (TGF-β1) plays a major role in stimulating extracellular matrix deposition. Frequent peritonitis occurrence may cause persistent TGF-β1 mRNA expression. In an attempt to search for a factor related to PF, we designed a longitudinal study to measure TGF-β1 levels in dialysate and TGF-β1 mRNA expression in peritoneal mononuclear cells from peritoneal dialysate before onset, once a week during peritonitis, and after peritonitis in high and low peritonitis occurrence (HPO and LPO) patients. Fifteen patients with a LPO rate and 5 patients with a HPO rate were followed up longitudinally. Meanwhile, TGF-β1 levels and TGF-β1 mRNA expression were augmented in peritoneal dialysate effluents before, during, and after the episodes of peritonitis. The peritoneal permeability was evaluated by the peritoneal equilibration test. The results revealed that in the LPO group, TGF-β1 and TGF-β1 mRNA were detectable at early stages of peritonitis, but the levels decreased rapidly and were undetectable 2 weeks after peritonitis. On the other hand, in the HPO group, TGF-β1 and TGF-β1 mRNA persisted for a long time. We could detect TGF-β1 and TGF-β1 mRNA in dialysate effluents and peritoneal mononuclear cells even 2, 3, and 4 weeks after episodes of peritonitis. When compared with that of first or second episode of peritonitis, the peritoneal function evaluated with the peritoneal equilibration test was found to obviously deteriorate during the third episode of peritonitis. These findings were confirmed by an in situ hybridization technique to evaluate the relationship between TGF-β1 mRNA expression and PF from biopsied peritoneal specimens. These findings suggest that the high TGF-β1 levels in the dialysate are related to an increased expression of TGF-β1 in the peritoneum. Thus, the persistent TGF-β1 expression in the peritoneum may serve as a useful parameter in predicting PF in continuous ambulatory peritoneal dialysis patients with frequent peritonitis occurrence.

Fabrication of InGaP/Al/sub 0.98/Ga/sub 0.02/As/GaAs oxide-confined collector-up heterojunction bipolar transistors

A partially oxidized Al/sub 0.98/Ga/sub 0.02/As layer was introduced between the emitter and base of collector-up heterojunction bipolar transistors (C-up HBTs) to suppress the leakage current and improve the current gain. Dependence of device current gain and leakage current on oxidation temperature was investigated. At lower oxidation temperature, the current gain can be effectively improved. Current gain and base sheet resistance were 79 and 203 ohm/sq. for the C-up HBT oxidized at 400/spl deg/C.

Improvement of AlGaInP light emitting diode by sulfide passivation

The brightness of AlGaInP light emitting diodes (LEDs) has been raised by a factor of 1.12 at 20 mA by sulfide passivation. Meanwhile, the sulfide also can decrease leakage current of AlGaInP LEDs at -2 V to nearly one thousandth of that in the as-fabricated device. The possible causes for the brightness increase of AlGaInP LEDs after sulfide treatment including surface roughness, reduction of Fresnel loss, and effective injection of carriers were demonstrated.

IgG subclass/IgM ratio and response to therapy in focal segmental glomerulosclerosis

Abstract. Focal segmental glomerulosclerosis (FSGS) is relatively steroid resistant and no clinical or histological marker can predict the response to therapy. To investigate the role of serum immunoglobulin subclass/IgM in predicting the response to therapy in FSGS, serum concentrations of total IgG, IgG subclasses, and the ratio of serum IgG subclasses to total IgG (% IgG subclass) were measured in 27 children during the acute nephrotic state. Prednisolone, cyclophosphamide, and Persantine (dipyridamole) were given for 12 weeks. We divided the patients into good responders or poor responders according to clinical response. The clinical and nephrotic status were similar in both groups. Fourteen patients were good responders with higher serum IgG1/IgM than that of non-responders (4.00±0.67 vs. 1.61±0.20, P<0.05). There was no significant difference in IgG2/IgM between these two groups. These results suggest that higher serum IgG1/IgM ratios may be associated with a better clinical response. These changes may reflect dysregulation of immunoglobulin class switching in patients with FSGS.

Peritonitis in children being treated with continuous ambulatory peritoneal dialysis

An eight-year retrospective study was performed to determine the incidence of peritonitis in a pediatric continuous ambulatory peritoneal dialysis (CAPD) population of 24 children, half of whom were boys and half, girls. All suffered from end stage renal disease (ESRD). When these children, aged 2 through 17 years (mean: 10.7 +/- 3.8), were examined, the incidence of peritonitis was one episode every 15.2 patient-months. Microbiologic evaluation showed that 76.4% of the 34 episodes were culture positive, with Staphylococci species (coagulase negative staphylococci 32.4%, Staphylococcus aureus 14.7%) causing most cases especially early in dialysis. Half the patients presented with a triad of symptoms (fever, abdominal pain and cloudy dialysate), with cloudy dialysate was the major presentation (88%). Peritonitis was treated with intraperitoneal administration of cefacin and/or netromycin when suspected, and 52.9% of the episodes needed hospitalization. Except for two patients who died of complications (sepsis, acute pancreatitis), all episodes of peritonitis were cured; in four episodes it was necessary to remove a catheter, and two of those cases came from fungal peritonitis. Peritonitis rates differed among disconnect systems. The manual spike had peritonitis rate of one episode per 4.6 patient-months which was higher than the O-set (one episode/22.2 patient-months), UV-XD and Y-set disconnect systems. Therefore, the major causes of peritonitis arose from contamination provoked by the technical aspect of the procedure. Nutrition status was stable in these patients. Serum albumin and total protein were adequate in all patients without relation to episode of peritonitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Improvement of AlInP-AlGaInP MQW light-emitting diode by meshed contact layer

The optical output power of the AlInP-AlGaInP light-emitting diodes was pronouncedly enhanced 1.45 times at 20 mA without degrading the electrical characteristics by introducing the meshed GaAs contact layer. Both theoretical simulation and experimental analysis were used to demonstrate the feasibility of the proposed structure.

Elimination of burn-in effect in carbon-doped InGaP/GaAs HBTs by hydrogen lateral diffusion

Abstract Hydrogen lateral diffusion by annealing at low temperature was proposed to eliminate the burn-in effect in carbon-doped InGaP/GaAs heterojunction bipolar transistors (HBTs). After a thermal annealing at 480 °C for 30 min, the current gain variations caused by the electrical stress decreased from 42.7% to 2.6% as the emitter width was reduced from 100 to 5 μm. After the annealing process, the sheet resistance was decreased from 194.4 to 162.7 ohm/sq. as the van der Pauw line widths was reduced from 65 to 5 μm. Effective doping concentration in base layer was increased by removal of incorporated hydrogen atoms. Degradation of device characteristics was not obvious after annealing by comparing the ratio difference of current gain to base sheet resistance.

Clinical Aspects of the Hemolytic Uremic Syndrome

Hemolytic uremic syndrome (HUS) can be clinically classified into two types: typical cases with a diarrheal prodrome of association with E. coli O157, and atypical cases without antecedent diarrhea. However, HUS is not common in Taiwan. To evaluate the clinical course, complications and outcome of HUS in children, and to identify the risk factors for mortality, retrospectively, seven cases of HUS in our hospital in the past 6 years were studied. Six of them were boys, and one was a girl. Their ages ranged from 0.67 to 3 years. None of them were preceded by diarrheal prodrome. Acute renal failure, hypertension and liver involvement were noted in all cases. Stroke and seizure developed in three of the cases with sequelae. Two cases progressed into end-stage renal disease (ESRD). One case developed acute respiratory distress syndrome (ARDS). Two cases (28.5%) expired. ESRD especially associated with ARDS was highly related to mortality.

Early Detection of Neonatal Adrenal Hemorrhage by Ultrasonography

To investigate clinical features and course of neonatal adrenal hemorrhage (NAH) from July 1992 to August 1993, fifteen babies suffering from NAH born at Veterans General Hospital-Taipei were included. Portable ultrasound scanner was used for initial screening. The frequency of NAH was approximately 0.35% which is lower than other reports. The distribution of their birth weight was 3 cases lower than 3000 gm, 3 cases over 4000 gm and 9 cases within 3000 to 4000 gm. Only one was premature and another one post-term. Four of them had a history of either prenatal or perinatal asphyxia. Only one patient had a palpable abdominal mass. On the sonographic findings, eleven had bleeding in the right-side, two in the left-side and two in both sides. Only one had adrenal calcification. During their early life, no patient developed adrenal cortical insufficiency or secondary profuse bleeding. Two patients had pathologic jaundice. Two patients had severe anemia. After conservative treatment, none of them developed any severe complication. In conclusion, with the aid of renal sonoscreening in the newborn, we can discover NAH early and give adequate treatment at once. Severe complications also can be prevented.