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Journal of the Korean Society of Pediatric Nephrology 2004;8(2): 186-194.
발견 양상에 따른 소아 막증식성 사구체신염의 임상적 및 병리조직학적분석
전창호, 강미선, 정우영
1인제대학교 의과대학 소아과학교실
2인제대학교 의과대학 해부병리학교실
3인제대학교 의과대학 소아과학교실
A Clinical and Pathological Analysis of Children with Membranoproliferative Glomerulonephritis According to the Clinical Manifestations at Presentation
Chang-Ho Jeon, Mi-Seon Kang, Woo-Yeong Chung
1Department of Pediatrics, Inje University, School of Medicine
2Department of Pathology, Inje University, School of Medicine
3Department of Pediatrics, Inje University, School of Medicine
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Purpose: Membranoproliferative glomeulonephritis(MPGN) has been diagnosed in an increasing number of asymptomatic cases. These cases have been detected by school urinary screening test even though the total cases of MPGN show a decreasing trend. We have analyzed the clinical and pathological characteristics of children with MPGN according to the clinical manifestations at the time of disease presentation.
Methods: A total of 18 patients who had been diagnosed with idiopathic MPGN by percutaneous renal biopsy from January 1990 to February 2004 were involved in our study. The patients were divided into 2 groups as the school urinary screening(A) group and the symptomatic(S) group according to the clinical manifestations at the time of disease presentation.
Results : Out of the total 18 patients, 8(44.4%) were in the S group and 10(55.6%) were in the A group. The mean serum total protein, albumin and $C_3$ levels in the S group were significantly lower than those levels of the A group, respectively($4.9{pm}1.2;g/dL,;vs;7.0{pm}0.5;g/dL;P=0.002,;2.8{pm}0.9;g/dL;vs.;4.1{pm}0.3;g/dL;P=0.002,;63.9{pm}36.4;mg/dL;vs.;100.8{pm}39.5;g/dL;P=0.041$). The mean total protein amount of 24 hour collected urine in the S group were significantly higher than that of the A group($3684.0{pm}2601.3;mg/m^2;vs.;559.4{pm}4.6.9;mg/m^2$, respectively, P=0.001). Hypocomplementemia was observed in 11(61.1%) out of 18 patients at the time of disease onset, 7(87.5%) in the S group and 4(40%) in the A group. However the hypocomplementemia was decreased in 6(33.3%) out of 18 patients at the time of final follow-up, 3(37.5%) in the S group and 3(30%) in the A group. According to the pathologic type, hypocomplementemia was observed 8 patients(61.5%) with type I disease, 1 patients (100%) with type II disease, 2 patients(50%) in type III disease at the disease onset, but 4 patients(30.8%) in type I disease, 1 patient(100%) in type II disease, 1 patient(33.3%) with type III disease at the time of last follow-up. The incidence of cellular crescent formation and tubular atropy. as observed on light microscopy, were higher in the S group compared to the A group. Mean grade of capillary wall thickening and, mesangial proliferation were significantly higher in the S group.
Conclusion : MPGN, as diagnosed in patients with only asymptomatic urinary abnormalities, has been increasing, it is more frequent in asymptomatic patients than in patients with presenting symptoms. Our result suggests that MPGN should be considered in the renal biopsy diagnosis regardless of serum $C_3$ level when urinary abnormalities are found by school urinary screening test.
Key words: Membranoproliferative Glomerulonephritis | Children | School urinary screening test
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