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Journal of the Korean Society of Pediatric Nephrology 2006;10(2): 152-161.
학교 집단 소변 검사로 발견 된 막증식성 사구체신염 I형의 특성
최정연, 박미영, 이용직, 하일수, 정해일, 최용, 박영서, 한혜원, 진동규, 정우영, 김기혁, 유기환, 박용훈
1영남대학교 의과대학 소아과학교실
2영남대학교 의과대학 소아과학교실
3영남대학교 의과대학 소아과학교실
4서울대학교 의과대학 소아과학교실
5서울대학교 의과대학 소아과학교실
6서울대학교 의과대학 소아과학교실
7울산대학교 의과대학 소아과학교실
8을지대학교 의과대학 소아과학교실
9성균관대학교 의과대학 소아과학교실
10인제대학교 의과대학 소아과학교실
11국민건강보험공단 일산병원 소아과
12고려대학교 의과대학 소아과학교실
13영남대학교 의과대학 소아과학교실
The Characteristics of Membranoproliferative Glomerulonephritis I Detected from School Urine Screening
Jung-Youn Choi, Mi-Young Park, Yong-Jik Lee, Il-Soo Ha, Hae-Il Cheong, Yong Choi, Young-Seo Park, Hye-Won Han, Dong-Kyu Jin, Woo-Yeong Chung, Kee-Hyuck Kim, Kee-Hwan Yoo, Yong-Hoon Park
1Department of Pediatrics Yeungnam University
2Department of Pediatrics Yeungnam University
3Department of Pediatrics Yeungnam University
4Seoul National University
5Seoul National University
6Seoul National University
7Ulsan University
8Eulji University
9Sungkyunkwan University
10Inje University
11NHIC Ilsan Hospital
12Korea Univeristy
13Department of Pediatrics Yeungnam University
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ABSTRACT
Purpose : In Korea, the school urine screening program is a useful tool for screening urine abnormalities. It is particularly useful in early detection of membranoproliferative glomerulonephritis(MPGN) I, which frequently progresses to chronic renal failure. In this study, we studied the medical history, laboratory findings, and histologic findings of MPGN to gain helpful information on early detection and treatment.
Methods : The subjects were 19 children, who were diagnosed with MPGN from kidney biopsies that were performed in ten nationwide university hospitals because of abnormal urine findings from school urine screening programs conducted from July 1999 to April 2004. We divided the patients into 2 groups, a nephrotic range proteinuria group(n=8) and a non-nephrotic proteinuria group(n=11), and retrospectively analyzed the clinical features, laboratory findings, histologic findings, treatment, and clinical course.
Results : The mean age at the first abnormal urinalysis was $10.6{pm}2.2$ years in the nephrotic proteinuria group and $9.6{pm}3.2$ years in the non-nephrotic proteinuria group. The mean age at the time of kidney biopsy was $11.3{pm}2.3$ years in the nephrotic range proteinuria group and $10.4{pm}3.2$ years in the non-nephrotic proteinuria group respectively. There was no significant difference in the mean age and sex between the two groups. In the nephrotic proteinuria group, 6 children had a low plasma C3 level and in the non-nephrotic proteinuria group, 8 children had a low plasma C3 level, but there was no significant difference between the 2 groups. There was no significant difference in the laboratory test results(including WBC count, RBC count, platelet count and other serologic tests) between the 2 groups except for 24 hour urine protein secretion. There was no difference between the 2 groups with regard to the acute and chronic changes in the glomerulus on light microscopic findings, IgG, IgA, Ig M, C1q, C3, C4, fibrogen deposition on immunofluoroscence findings, and mesangial deposits, subendothelial deposits, and subepithelial deposits on electron microscopic findings. The children were treated with corticosteroids, ACE(angiotensin-converting enzyme) inhibitors, dipyridamole and other immunosuppressive agents. During the course of treatment, there were no children whose clinical condition worsened. Among 19 children, 3 children went into remission(2 in the nephrotic proteinuria group, 1 in the non-nephrotic proteinuria group) and 9 children went into a partial remission(4 in the nephrotic proteinuria group, 5 in the non-nephrotic proteinuria group) on urinalysis. There was no significant difference in the treatment results between the two groups.
Conclusion : The 73.7% of children who were incidentally diagnosed with MPGN by the school urine screening program had reduced C3. 42.1% of the children had nephrotic range proteinuria. There were no significant differences in clinical features, laboratory test results, light microscopic, immunofluorescence microscopic, and electron microscopic findings between the nephrotic proteinuria group and the non-nephrotic proteinuria group except for the 24 hour urine protein secretion. Therefore, for early detection of MPGN during the school urine screening program, we strongly recommend a kidney biopsy if children have abnormal urine findings such as persistent proteinuria and persistent hematuria, or if the serum C3 is reduced.
Key words: School urine screening program | Membranoproliferative glomerulonephritis | Prognosis
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