Yoshihiko Oda

Henoch–Schönlein purpura nephritis associated with human parvovirus B19 infection

diseases,1 including erythema infectiosum, hydrops fetalis, transient aplastic crisis, neurologic diseases,2 rheumatologic diseases and vasculitis. In 1985, Lefrère et al. reported the first case of Henoch–Schönlein purpura (HSP) associated with B19 infection.3 Thereafter several cases of HSP associated with B19 were reported.4–7 Among these cases, only two patients have had renal involvement. We present in the present paper a patient with clinically and histologically typical Henoch–Schönlein purpura nephritis (HSPN) associated with B19.

Haloperidol-induced rhabdomyolysis without neuroleptic malignant syndrome in a handicapped child

A 6-year-old severely handicapped boy with haloperidol-induced mild rhabdomyolysis without neuroleptic malignant syndrome is reported. He had suffered from frontal lobe epilepsy, severe mental retardation and involuntary movements. To reduce the involuntary movements, oral administration of haloperidol was started. Haloperidol was effective for the involuntary movements, and he became well. However, his urine was sometimes dark brown, and the myoglobin level in his urine was increased. After discontinuation of haloperidol, his urine never became dark brown. It was suspected that haloperidol might cause mild rhabdomyolysis without neuroleptic malignant syndrome. Neuroleptic malignant syndrome is a rare but severe adverse effect of neuroleptics, and is usually accompanied by rhabdomyolysis. Although there have been a few adult cases presenting rhabdomyolysis without neuroleptic malignant syndrome, this patient might be the first child case with such symptoms. We have to pay attention to this syndrome when using haloperidol even in children.

Glomerular CD8+ cells predict progression of childhood IgA nephropathy

Abstract The aim of this study was to evaluate whether the infiltrating T-lymphocyte can be a predictor in the disease progression of IgA nephropathy (IgAN). Twenty children with IgAN, followed for more than 5 years, were divided into progressive (n=5) and non-progressive groups (n=15). We assessed glomerular and interstitial infiltration of T-lymphocytes (CD4+ and CD8+ cells) and expression of α-smooth muscle actin (α-SMA) and transforming growth factor- β (TGF- β) using an indirect immunofluorescence method on the renal biopsies. We analyzed their relationship to the degree of proteinuria, histological changes, and prognosis. The number of CD8+ cells in glomeruli and in interstitium was higher in the progressive group than in the non-progressive group. The glomerular α-SMA staining was more intensive in the progressive group than in the non-progressive group. Urinary protein and the degree of histological changes were also higher in the progressive group than in the non-progressive group. Among these markers, the number of glomerular CD8+ cells was the most apparent difference between the two groups. In conclusion, these results indicate that the number of glomerular CD8+ cells is the most sensitive predictor of disease progression in childhood IgAN.

Exercise-induced acute renal failure in a patient with renal hypouricemia

Abstract We describe a case of exercise-induced acute renal failure (ARF) in a patient with hypouricemia. Following recovery from ARF, the patient’s serum urate concentration was 0.6–0.9 mg/dl, and the ratio of urate clearance to creatinine clearance (Cua/CCr) was 41.9%–56.6%. There was no change in the Cua/CCr following the administration of pyrazinamide or probenecid, suggesting defects of tubular urate/anion exchangers. Because the renal biopsy revealed acute tubular necrosis without uric acid crystals, the ARF of this patient might be due to oxygen free radicals resulting from exercise stress and hypouricemia.

Hemiballismus associated with Influenza A infection

A case of 2-year and 3-month-old boy developing right hemiballismus and transient selective unilateral involvement in the left thalamus on MRI during Influenza A infection is reported. Hemiballismus is an extremely rare neurological complication and, to our knowledge, this is the first case showing hemiballismus during Influenza A infection.

Japanese siblings with congenital chloride diarrhea

inherited disorder due to an intestinal absorption defect of chloride in exchange for HCO3 –. The high fecal chloride leads to osmotic diarrhea, dehydration, hypochloremia and metabolic alkalosis, which last for life. Although congenital chloride diarrhea has been reported worldwide, it is rare in Japan. To the best of our knowledge, only two pairs of siblings have been reported.2,3 We report in the present paper two Japanese siblings with congenital chloride diarrhea, who are believed to be the third case of Japanese siblings with this disorder.

Three cases of Henoch-Schönlein purpura preceded by IgA nephropathy.

A short addition to the IgA nephropathy Henoch-Sch6nlein purpura common pathogenic correspondence. I have under my care two brothers, one with IgA nephropathy resulting in end-stage renal failure and another with HenochSchOnlein syndrome followed by persistent significant proteinuria and intermittent frank haematuria [1, 2]. The elder brother had two bouts of frank haematuria in 1989 and was lost to follow-up. He represented in late 1993 in end-stage renal failure and has been dialysis-dependent since. Biopsy findings were compatible with IgA nephropathy. The younger brother had severe HenochSch6nlein syndrome in 1990. His main clinical problems were severe abdominal pain and intussusception. His urine remained free of blood and protein throughout a protracted Denis G. Gill Department of Nephrology Childrens Hospital Temple Street Dublin 1, Ireland

Successful multimodal therapy with chemotherapy and surgery for bilateral pulmonary metastases secondary to hepatoblastoma

Two children with hepatoblastoma and bilateral pulmonary metastases were effectively treated with an aggressive combination of chemotherapy and surgery. Chemotherapeutic agents included cyclophosphamide, vincristine, THP-adriamycin, and cis-platinum. The pulmonary metastases were temporarily responsive to a regimen of these agents, recurred, and were subsequently resected without further recurrence. Such multimodal therapy is advocated for the treatment of pulmonary metastases secondary to hepatoblastoma.