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Journal of the Korean Society of Pediatric Nephrology 1999;3(2): 123-129.
신증후군을 동반한 연쇄상구균 감염후 급성사구체신염의 임상적 고찰
문상애, 육진원, 김지홍, 이재승, 정현주, 김병길
1연세대학교 의과대학 소아과학교실
2연세대학교 의과대학 소아과학교실
3연세대학교 의과대학 소아과학교실
4연세대학교 의과대학 소아과학교실
5연세대학교 의과대학 병리학교실
6연세대학교 의과대학 소아과학교실
A Clinical Study of Acute Poststreptococcal Glomerulonephritis with Nephrotic Syndrome
Sang-Ae Moon, Jin-Won Yook, Ji-Hong Kim, Jae-Seung Lee, Hyun-Joo Jeong, Pyung-Kil Kim
1Departments of Pediatrics, Yonsei University College of Medicine
2Departments of Pediatrics, Yonsei University College of Medicine
3Departments of Pediatrics, Yonsei University College of Medicine
4Departments of Pediatrics, Yonsei University College of Medicine
5Department of Pathology, Yonsei University College of Medicine
6Departments of Pediatrics, Yonsei University College of Medicine
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ABSTRACT
Purpose: Acute poststreptococcal glomerulonephritis(APSGN) is a renal disease which is characterized by glomerular proliferation and inflammatory changes due to immune reaction. Although the 95% of patients with APSGN seems to recover fully and present as benign course, the remaining patients show poor prognosis. Therefore comparative retrograde study between APSGN with and without nephrotic syndrome was done to find out the any prognostic indicator to predict the outcome in patients with APSGN.
Methods: We had retrospectively analyzed seventy-one patients who were diagnosed as APSGN clinically from Mar.1989 to Feb.1999 in Yonsei university medical center. Sixty-four of the patients was APSGN without nephrotic syndrome(Group A) and seven patients were in APSGN with nephrotic syndrome(Group B).
Results : Patients who were diagnosed as APSGN with nephrotic syndrome were seven(9.9%) out of seventy-one. In the comparative study, sex ratio was 1:1 in group A and 1.9: 1 in group B, onset mean age was $8.9{pm}2.6$ in group A and $8.8{pm}2.6$ in group B. Following clinical profiles were compared but there were no significant difference between these two groups: WBC count($9413{pm}2964;vs;9368{pm}2650(/mm^3)$), hemoglobin($10.6{pm}1.2;vs;10.0{pm}0.9(gm/dL)$), ASO($746.1{pm}640.7;vs;614.9{pm}475.9(IU/ml)$), $C_3(20.1{pm}17.0;vs;16.9{pm}13.1(mg/dL)$), $C_4(22.8{pm}9.5;vs;22.6{pm}6.9(mg/dL)$), BUN($25.8{pm}26.1;vs;28.1{pm}14.5(mg/dL)$), creatinin($0.8{pm}0.3;vs;0.8{pm}0.3(mg/dL)$), $C_{cr}(80.6{pm}28.8{pm}62.4{pm}31.4(ml/min/1.73;m^2$)), the duration of edma, gross hematuria, and hypertension. However, we found that there were a significant difference in the duration of proteinuria($1.95{pm}2.27;vs;13.3{pm}21.1(months)$)(P<0.05), decreased $C_3$ duration($1.9{pm}2.9;vs;7.3{pm}5.0(weeks)$)(P<0.05) and especially it was proloned according to the amount of early urine protein excretion.
Conclusion : Our study showed markedly prolonged duration of proteinuria and decreased $C_3$ duration in patients with APSGN with nephrotic syndrome. We were not able to find the definite prognostic factor that will guide the outcome of patients with APSGN accompaning nephrotic syndrome, but above findings seemed to represent as a relative indication of the outcome of the disease. All patients recovered completely and we did not experience any cases that progressed into the renal failure.
Key words: Acute poststreptococcal glomerulonephritis | Proteinuria | Nephrotic syndrome
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