The Differences in Frequencies and Clinical Manifestations According to the Causes of Membranous Nephropathy in Children

Mun, Yun-Hee; Kim, Se-Jin; Kim, Sung-Do; Cho, Byoung-Soo

J Korean Soc Pediatr Nephrol > Volume 10(2); 2006 > Article

J Korean Soc Pediatr Nephrol 2006;10(2): 162-173.

소아 막성 신병증의 원인에 따른 빈도 및 임상양상의 차이

문윤희, 김세진, 김성도, 조병수

¹경희대학교 의과대학 소아과학교실
²경희대학교 의과대학 소아과학교실
³경희대학교 의과대학 동서신장병 연구소
⁴경희대학교 의과대학 동서신장병 연구소

The Differences in Frequencies and Clinical Manifestations According to the Causes of Membranous Nephropathy in Children

Yun-Hee Mun, Se-Jin Kim, Sung-Do Kim, Byoung-Soo Cho

¹Department of Pediatrics College of Medicine Kyung-Hee University
²Department of Pediatrics College of Medicine Kyung-Hee University
³East-West Kidney Disease Research Institute College of Medicine Kyung-Hee University
⁴East-West Kidney Disease Research Institute College of Medicine Kyung-Hee University

ABSTRACT

PURPOSE: To report the decreasing incidence of HBV(Hepatitis B virus)-associated membranous nephropathy in children after HBV vaccination and to elucidate the clinical course and treatment strategies of IMN (Idiopathic membranous nephropathy). METHODS: We retrospectively reviewed the clinico-pathological findings of HBV-MN and IMN patients who underwent a renal biopsy from 1986 to 2005. We compared the HBV-MN and the IMN groups and the remission and the non-remission groups of patients with IMN. RESULTS: Among 24 cases of MN patients, HBV-MN comprised 6 cases(25%) and IMN 18 cases(75%). Clinical masnifestations were nephrotic syndrome(3 cases, 50%), nephritic syndrome(1 case, 16.7%), asymptomatic(2 cases, 33.4%) in the HBV-MN group, asymptomatic(10 cases, 55.5%), nephrotic syndrome(5 cases, 27.8%), and gross hematuria(3 cases, 16.7%) in the IMN group. From 1996 to 2000, there were 2 cases(28%) of HBV-MN and 5 cases(72%) of IMN. After 2001, all 10 cases were IMN. In the HBV-MN group, 4 cases(66.7%) received interferon and 1 case received methylprednisolone pulse therapy. In the IMN group, 16 cases (88.9%) received methylprednisolone, 8 cases(44.4%) were in complete remission, 2 cases (11.1%) were in partial remission, 2 cases(11.1%) were in chronic renal failure, and 5 cases (27.8%) were lost to follow-up with sustained proteinuria, 1 case(5.6%) continued to have frequent relapse of nephrotic syndrome without renal insufficiency. In the comparison between remission and non-remission groups, nephrotic range proteinuria and hypertension were more significantly common in the non-remission group(P<0.05). CONCLUSION: With HBV vaccination, HBV-MN has decreased markedly. IMN is a rare glomerular disease in children. Because the prognosis for patients with nephrotic range proteinuria is poor, this group needs more aggressive treatment.

Key words: Idiopathic membranous nephropathy | Hepatitis B-associated membranous nephropathy | Children | Clinical manifestation