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05 June 2011, Volume 26 Issue 06 Previous Issue    Next Issue

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Clinical analysis of maintenance hemodialysis in children. JIAO Li-ping，CHEN Lu，SUN Qiang，MA Jun-mei，SHEN Ying. 2011, 26(06): 429.  Abstract ( )   To provide the reference of future treatment for end stage renal disease （ESRD） in children by analyzing the clinical characteristics of ESRD patients on maintenance hemodialysis （MHD）.  Methods　23 cases including 12 males and 11 females aged from 2.5 to 15.6 years on MHD were analyzed. The cause of ESRD and exiting MHD， complication of HD and dialysis adequacy were assessed. Results　The main cause of ESRD was chronic glomerulonephritis（87.0%）， whereas 21.7% patients of unknown reason. The vascular accesses of all patients were temporary dual-lumen catheters when initiating HD. About 87.0% established arterio-venous fistula successfully later. The mean spKt/V was （1.52±0.39） and URR was （70.70±10.52）% in patients with fistula， which was much higher than （1.08±0.50） and （56.44±17.33）% in patients of catheters respectively. The main complications were hypertension（87.0%），hypotension（5.6%）and dialysis disequilibrium syndrome （4.7%）. The reasons of exiting our treatment were going back to local hospital （43.5%）， renal transplantation （17.4%）， giving up treatment （8.7%） and death （4.3%）. Conclusion　There is lack of screening and systematic monitoring of ESRD children in our country. Our results indicate that ESRD children should establish arterio-venous fistula as soon as possible in order to achieve HD adequacy. The complication of hypertension should be paid more attention. HD and renal transplantation were main treatment of ESRD children older than school age.

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Clinical and pathological features of idiopathic membranous nephropathy in children. LING Yi-hong，CHEN Li-zhi，JIANG Xiao-yun， LU Hui-yu，MO Ying，SUN Liang-zhong，XIAO 2011, 26(06): 432.  Abstract ( )   To investigate the clinical and pathological features of idiopathic membranous nephropathy （IMN） in children. Methods　The clinicopathological features of children with renal-biopsy-diagnosed IMN between July 1999 and July 2009 in our hospital were retrospectively analyzed in our study. Results　Thirteen pediatric patients diagnosed with IMN were included. The median age was 11.4（3.0～14.5）years with 11 males and 2 females. The median interval time between renal biopsy and the onset of IMN was 3.7（1.4～65.3）months. Due to IMN，8 children presented with nephritis-type nephrotic syndrome（NS），1 with simplex-type NS，3 with proteinuria and hematuria and 1 with recurrent macroscopic hematuria at the initial visit. One case had hypertension. Renal insufficiency was not noted in any patient. The Results of renal histopathology suggested that： （1）Four cases were in stage Ⅰand 9 in stage Ⅱ. Four cases showed glomerulus sclerosis （the percentages of glomerulus sclerosis were 11.8%，2.9%，7.5%，4.5%，respectively） and 1 case showed segmental sclerosis（the percentage of segmental sclerosis was 4.5%）. Three cases were associated with tubular atrophy. Formation of crescent fiber cells occurred in 1 case（3.8%）. （2）The predominant immunoglobulins in the subepithelial deposits were IgG and C3（12 and 10 in 12 cases，respectively）. Among them，a few cases were combined with IgM，Fg，C1q and IgA deposition，but the depositional strength was significantly weaker than IgG and C3. （3）Under electron microscope，13 cases showed different degrees of membrane thickening. Intracapillary microthromb were observed in two cases. According to different clinicopathology features，the patients were treated with prednisone and/or immuno-suppressive drugs therapy，combined or separately used with angiotensin converting enzyme inhibitor/angiotension receptor blocker（ACEI/ARB）. In 9 cases with NS due to IMN，5 patients achieved complete remission（CR），1 achieved partial remission（PR） and 3 failed to the previous therapy. The 3 unresponsive patients all achieved CR after the combined treatment with mycophenolate mofetil（2 cases） or high-dose IVIG（1 case）. Among the 3 proteinuria-hematuria patients，1 case had negative proteinuria but persistent microscope hematuria after therapy，and the rest 2 cases were both lost to follow-up. Macroscopic hematuria successfully disappeared but microscope hematuria was persistentin the recurrent macroscopic hematuria patient. Conclusions　IMN is much more common in school-age boy and it mainly presents with nephritis-type NS. Most patients are in stageⅠorⅡ.Immunofluorescence reveals that the predominant immunoglobulins in the subepithelial deposits are IgG and C3. All the cases show different degrees of membrane thickening under electron microscope. Nowadays，there are no unified and effective treatments for pediatric IMN. It is necessary to establish a normalized management，treatment and follow-up system for childhood IMN in China.

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The use of APACHEⅡand ATN-ISI in children acute kidney injury.　　 XUN Mai，LI Zhi-hui， DUAN Cui-rong，ZHANG Yi，WU Tian-hui， YIN Yan. 2011, 26(06): 436.  Abstract ( )   Compare the estimate effect of prognosis between the APACHEⅡand ATN-ISI in children with actue kidney injury. Methods　Analyze the data of 167 infants with actue kidney injury（From Jan. 2004 to Apr. 2010）.The infants were divided into two groups（primary and secondary group）. Results　Both the two systems could effectively evaluate the death rate in secondary group.ATN-ISI could effectively evaluate the death rate in primary group but APACHEⅡcouldn’t. Both the two systems could effectively evaluate the renal prognosis in primary group but could not effectively evaluate the renal prognosis in secondary group. Conclusions　Both the two systems can effectively evaluate the death rate in secondary group.ATN-ISI is better than APACHEⅡin estimating the death rate in primary group and it is more appropriate in children. There is no difference between the two systems when evaluating the kidney prognosis.

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Significant change of Zeta chain of peripheral blood in children with primary nephrotic syndrome.　　 ZHENG Rong-hao，ZHU Guang-hua，WANG Ping，LIU Jia-ying，XIA Min，HE Wei-xun. 2011, 26(06): 439.  Abstract ( )   To detect the expression level of Zeta chain， and to probe its influence on the immunodeficiency and its role in children with PNS. Methods　Twenty-six children in first-onset，twenty-two children in relapse and thirty children in remission with PNS were studied， respectively.Twenty-one children were also studied as healthy control. The expression level of Zeta chain was examined by three-color flow-cytometry. Results　The mean fluorescence intensity（MFI） of Zeta chain in T and NK cell of peripheral blood was significantly reduced in first-onset and relapse as compared with healthy controls， respectively. （P < 0.05）， while an significant increase was observed during remission as compared with first-onset and relapse， respectively. （P < 0.05）. However， the proportion of T and NK cell of peripheral blood between groups was not significantly different （P > 0.05）. Between remission and healthy controls， the MFI of Zeta chain in T and NK cell of peripheral blood was not significantly difference （P > 0.05）. The MFI of Zeta chain in T and NK cell of peripheral blood was also not significantly difference between first-onset and relapse（P > 0.05）. Among these children with PNS， when nine children in first-onset and five children in relapse achieved remission， the expression level of Zeta chain was increased significantly（P < 0.05）， and there were two children in first-onset whose Zeta chain expression level was reduced again when relapse. Conclusions　The expression level of Zeta chain is significantly reduced in first-onset and relapse，and it is similar to that expressd in normal control in remission in children with PNS. Therefore， Zeta chain might be involved in the process of first-onset and relapse. The Zeta chain of peripheral blood might be one of markers which might be helpful to monitor disease condition and evaluate the effect of treatment in children with PNS

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The value of cystatin C and urine protein/creatinine ratio detection in predicting early renal damage of children with Henoch-Sch?nlein purpura. WANG Zheng-yan，SHAN Chun-ming，XU Jun-hua. 2011, 26(06): 443.  Abstract ( )   To evaluate the value of combined detection of serum cystatin C （Cys C） and urine protein series in predicting renal damage of childhood Henoch-Sch?nlein purpura （HSP）. Methods　Serum Cys C and urine protein series were tested in 46 child HSP patients，using liquid transmission turbidity and immune nephelometry. Urine protein series included transferrin （TRF），NAG /UCr，IGGU /UCr，ALBU /UCr and α1MU/UCr. Meanwhile，serum creatinine，urine and serum urea nitrogen were determined. The results were compared with those of healthy control group. Results　The value of serum Cys C and urine protein series in HSP patients were higher than those of control group （4.28±0.36） mg/L vs （0.65±0.43） mg/L for serum Cys C（P < 0.01）；80.43%（37/46） HSP patients whose routine urinalysis were negative had abnormal tested value of six indexes in complete blood test and urine analysis. The value of serum Cys C had a positive correlation with urine protein series. Conclusion　Six indexes in complete blood test and urine analysis including serum Cys C and urine protein series help to reveal early renal damage in HSP patients，whilst negative urinalysis can’t rule out early renal damage. The sensitivity and specificity of serum Cys C are superior to urine protein series. These six indexes are appropriate indicators in diagnosis of early renal injury in childhood HSP patients.

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The clinical features and follow-up study of 100 cases of Kawasaki disease. LIU Yu-ling，FU Si-mao，LI Xiao-ling，LIN Hang-liang，CHEN Ming，LI Xing-xi. 2011, 26(06): 446.  Abstract ( )   To explore the clinical features， etiological factors， treatments and prognosis of 100 cases of Kawasaki disease（KD）. Methods　Totally 100 patients with KD in our department treated from 2000 to 2005 was included in the study. A retrospective study was carried out to analyze clinical characteristics，treatment and outcomes of these patients. Results　Clinical features： age of onset （2.01±1.35） years，the age of follow-up （8.2±1.68） years；male to female ratio was 1.7 ∶ 1. Tipical KD（88）， including recurrence KD（2）， incomplete KD（12）. Cardiova-scular complications existed in 25 patients，including coronary artery complications（22）， pericardial effusion（2）， myocarditis（1），transient coronary artery ectasia（18） and coronary aneurysm formation（4），（small tumors in 1 case，medium-sized tumor in 2 cases and a huge tumor in 1 case）. Non-cardiovascular complications cases included hepatitis or impaired liver function（34），gallbladder hydrops（3），paralytic intestinal obstruction（1），aseptic meningitis（3），facial palsy（5），pneumonia （53），urethritis（12）and arthritis（6）. Treatment and efficacy： 89 patients within 10 days of the course were given IVIG 2 g/kg；12 patients without response were given a 2nd IVIG；2 IVIG non-responsive patients were added the use of glucocorticoid；11 cases diagnosed as subacute were given IVIG 1～2 g/（kg·d），3 cases with coronary aneurysm formation （P < 0.05）.Those without coronary artery lesions withdrawed the treatment at the course of 6 to 8 weeks；18 patients with coronary artery dilation were tracked from 6 months to 1 year to discontinuation；3 cases of small and medium-sized coronary aneurysm withdrawed in the course of 1 to 3 years；1 case of giant coronary aneurysm was given aspirin for 7 years. Follow-up and prognosis：56 patients were followed up to ≥ 5 years， up to 10 years. Abnormal follow-up echocardiography occurred in 10 cases （17.8%）.Among them， 1 case of giant coronary artery aneurysms was currently still on the expansion of tumor-like coronary artery， for the others the pulmonary valve or tricuspid valve regurgitation and cardiac function were normal. Exercise EECG abnormalities existed in 17 cases （30.3%）. Among them，5 cases were with cardiovascular complications（5）（P > 0.05）. The course of 4 cases with coronary aneurysm had no obvious abnormalities of exercise ECG. Non-cardiovascular complication cases recovered completely. No deaths occurred. Conclusion　Most of KD coronary complications are transient coronary artery ectasia. The occurrence of coronary aneurysm is related to the time of diagnosis and use of IVIG. No specific changes of the exercise ECG exist in the patients with coronary artery complication who are in the acute period and have been followed for five years. The patients with more EECG abnormalities need long-time follow-up. Non-cardiovascular complications involve multiple systems， but the prognosis is good.

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Detection of myocardial T2* and liver T2* in β- thalassemia major patients with iron overload and the analysis of  related factors. GAO Hong-ying，CHEN Guang-fu，CHEN Juan-juan. 2011, 26(06): 450.  Abstract ( )   To study the status of myocardial T2* and liver T2* in β- thalassemia major（β-TM） patients with iron overload and its relationship with clinical test data. Methods　In June 2010，on a voluntary basis，out of the 80 β-TM patients over 7 years under regular blood transfusion therapy，51 were chosen to receive myocardial MRI T2* （myocardial T2*） and liver MRI T2* （liver T2*） tests. The results were compared with age，SF，LVEF，transfusion time，chelation time and Hb. Results　Eleven out of 51 cases （21.6%） were myocardial iron overload，including 3 mild cases，3 moderate cases and 5 severe cases. Forty-three out of 51 cases （84.3%） were liver iron overload，including 14 mild cases，17 moderate cases and 12 severe cases. There was no correlation between myocardial T2* and SF，LVEF or liver T2*. SF was positively correlated with liver T2*（r = 0.558，P < 0.01）. The transfusion time of myocardial T2* > 20 ms group was less than that of myocardial T2* < 20 ms group （P < 0.05）. There was no statistical significance between the liver iron overload incidence ratios of the two groups （P > 0.05） . Two out of 11 myocardial iron overload cases had lower LVEF（18.2%）. Conclusion　The group of TM patients demonstrates lower myocardial iron overload incidence and higher liver iron overload incidence. As SF increases，liver iron overload becomes more severe；myocardial iron overload can not be predicted or determined by examining SF level. There is no correlation between myocardial iron overload and liver iron overload. LVEF can not be a reliable factor to predict myocardial iron overload.

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Study on variation of plasma matrix metalloproteinase， tissue inhibitor of metalloproteinase and B-type natriuretic peptide in children with congestive heart failure before and after treatment with ACEI. CAI Qiang*，TANG Hui，YI Qi-jian. 2011, 26(06): 454.  Abstract ( )   To investigate variation of plasma matrix metalloproteinase-9 （MMP-9）， tissue inhibitor of metalloproteinase-1（TIMP-1） and B-type natriuretic peptide （BNP） in children with congestive heart failure before and after treatment with angiotension converting enzyme inhibitor（ACEI）. Methods　Twenty patients （male 13， female 7， aged 3 monthes ~8 years） with congestive heart failure（CHF） hospitalized in Yibin Second Hospital during Jannury 2001 to December 2010 were divided into two groups， routine treatment as control group and plus benalapril as treatment group. Left ventricular end of diastole diameter （LVDd），left ventricular end of systole diameter（LVDs），left ventricular end of diastole volume（LVEDV），left ventricular end of systole volume （LVESV） and left ventricular ejection fraction（LVEF） were measured by echocardiography；plasma matrix metalloproteinase-9（MMP-9） and tissue inhibitor of metalloproteinase-1（TIMP-1） were determined by enzyme linking immune assay（ELISA）；plasma B-type natriuretic peptide（BNP） was determined by immune fluorescence method before and after six months' treatment. Twelve healthy children（male 7，female 5，aged （3.4±2.6） years were included as normal group. Results　Compared with before treatment， there were no differences in LVDd、 LVDs and LVEF（P all > 0.05），LVEDV and LVESV decreased（P all < 0.05） after six monthes treatment in control group；there were markedly differences in LVDd，LVDs， LVEDV，LVESV and LVEF between before and after six months' treatment in treatment group （P all < 0.05）. There was more decrease in LVDd，LVDs，LVEDV and LVESV，more increase in LVEF in treatment group after six months of treatment compared with control group（P all < 0.05）.Compared with normal group， plasma level of MMP-9 and BNP were significantly increased，but TIMP-1 was significantly decreased（P all < 0.05）. Plasma MMP-9 and BNP concentration were decreased，While TIMP-1 concentration was increased in both control group and treatment group compared with that of before treatment（P all < 0.05）. There was more decrease in plasma MMP-9 and BNP concentration， and more increase in TIMP-1 concentration in treatment group compared with control group（P all < 0.05）. Conclusion　There is more decrease in plasma MMP-9 and BNP concentration， and more increase in TIMP-1 concentration in children with CHF treated with ACEI.