J Korean Soc Pediatr Nephrol > Volume 9(2); 2005 > Article
Journal of the Korean Society of Pediatric Nephrology 2005;9(2): 193-200.
위축성 신반흔의 위험인자
이정원, 김현진, 이승주
1서울 시립동부병원 소아과
2이화여자대학교 의과대학 소아과학교실
3이화여자대학교 의과대학 소아과학교실
Risk Factors for Atrophic Renal Scar
Jung-Won Lee, Hyun-Jin Kim, Seoung-Joo Lee
1Department of Pediatrics, Seoul Municipal Dongbu Hospital
2Department of Pediatrics, Ewha Womans University College of Medicine
3Department of Pediatrics, Ewha Womans University College of Medicine
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ABSTRACT
Purpose : An atrophic renal scar(RS) is one of the underlying causes for childhood hyper tension and chronic renal failure. The risk factors for atrophic renal scar were evaluated.
Methods : 41 children, who presented with first febrile urinary tract Infection at the Ewha Womans University Hospital between 1995 and 2003 and had generalized atrophic RS on $^{99m}Tc-DMSA$ renal scan, were retrospectively studied. Atrophic RS was divided into severe atrophic RS(n=14) if relative uptake on renal scan was below 10$%$, or mild atrophic RS(n=27) if relative uptake on renal scan was between 10-35$%$. RS was defined as congenital if the scar was detected on the first renal scan, and as acquired if the scar developed on the follow-up renal scan from acute pyelonephritis of the first renal scan. The control group was consisted of randomly selected 41 children with segmental RS. The risk factors for atrophic RS such as the generation time, VUR, gender and ACE gene polymorphism were evaluated.
Results : The age distribution of atrophic RS and segmental RS did not differ significantly (P>0.05). The rate of congenital RS in atrophic RS was 61.0$%$(25/41), which was significantly higher than 9.8$%$(4/41) of segmental RS(P<0.01). Atrophic RS developed mote frequently in male children(M:F 68.3$%$ 31.7$%$) than segmental RS(M:F 41.4$%$ .58.5$%$)(P<0.05). Vesicoureteral reflux(VUR) was found in 92.7$%$(38/41) of 4he atrophic RS, which was significantly higher than 53.7$%$(22/41) of segmental RS(P<0.05). In children without VUR, the male to female ratio did not differ between atrophic RS and segmental RS(P>0.05) But in children with VUR, there was a higher proportion of males with severe atrophic RS than segmental RS($85.7%:45.5%$) ACE gene polymorphism did not differ between the atrophic and segmental RS groups, irrespective of the presence of VUR(P>0.05).
Conclusion : Most atrophic RSs were congenital which could not be preventable postnatally and the major risk factors were VUR and the male gender. ACE gene polymorphism was not the significant risk factor for an atrophic RS. (J Korean Soc Pedialr Nephrol 2005;9:193-200)
Key words: Atrophic renal scar | Congenital | Gendor | Vesicoureteral reflux | ACE gene polymorphism
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