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Journal of the Korean Society of Pediatric Nephrology 2005;9(2): 183-192.
소아 Henoch-$Sch{ddot{o}}nlein$ 신염의 예후 인자
최현진, 조희연, 김어진, 이병섭, 강희경, 하일수, 정해일, 최용
1서울대학교 의과대학 소아과학교실
2서울대학교 의과대학 소아과학교실
3서울대학교 의과대학 소아과학교실
4서울대학교 의과대학 소아과학교실
5서울대학교 의과대학 소아과학교실
6서울대학교 의과대학 소아과학교실
7서울대학교 의과대학 소아과학교실
8서울대학교 의과대학 소아과학교실
Prognostic Factors in Children with Henoch-$Sch{ddot{o}}nlein$ Purpura Nephritis
Hyun Jin Choi, Hee Yeon Cho, Eo Jin Kim, Byong Sop Lee, Hee Gyung Kang, Il Soo Ha, Hae Il Cheong, Yong Choi
1Department of Pediatrics, Seoul National University College of Medicine
2Department of Pediatrics, Seoul National University College of Medicine
3Department of Pediatrics, Seoul National University College of Medicine
4Department of Pediatrics, Seoul National University College of Medicine
5Department of Pediatrics, Seoul National University College of Medicine
6Department of Pediatrics, Seoul National University College of Medicine
7Department of Pediatrics, Seoul National University College of Medicine
8Department of Pediatrics, Seoul National University College of Medicine
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ABSTRACT
Purpose : The long term disease course and prognostic factors were evaluated in childhood Henoch-$Sch{ddot{o}}nlein$ puruura nephritis(HSPN).
Methods : A total of 75 children(44 boys and 31 girls) with HSPN were included in this study. The onset age was $8.0{pm}3.1$ years(2.3-l5.3 years), and the follow-up period was $4.3{pm}3.6$ years(1.0-17.1 years). Kidney biopsy was done in 24 children(32$%$). Initial clinical and laboratory findings were evaluated. In addition, polymorphisms of the renin angiotensin system(RAS) genes(insertion/deletion in intron 16 of ACE gene, M235T in AGT gene, and A1166C in AGTR gene) were analysed. The initial and last clinical states were classified into 4 groups as follows A, normal; B, minor urinary abnormalities; C, active renal disease (nephrotic-range proteinuria and/or hypertension with serum creatinine $leq$1.5 mg/dL); D, renal insufficiency.
Results : At the onset, the clinical states of the patients were B in 26(35$%$), C in 46(61$%$), and D, in 3(4$%$). The distribution of the RAS gene polymorphism of HSPN were not different from that of 100 healthy control subjects. At the last follow-up, the clinical states of the patients were A in 23(31$%$), B in 38(50$%$), C in 9(12$%$), and D in 5(7$%$). A multiple logistic regression identified age at the onset and initial urine protein excretion as significant prognostic factors. Analysis of genotypes of the 3 RAS genes as prognostic values revealed no statistical significance.
Conclusion : Older age at onset and severe proteinuria were identified as poor prognostic factors of childhood HSPN. Implication of the RAS gene polymorphism In HSPN could not be validated in this small-scale retrospective study. (J Korean Soc Pediatr Nephrol 2005;9:183-192)
Key words: Renin angiotensin system(RAS) gene polymorphism
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