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Journal of the Korean Society of Pediatric Nephrology 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
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ABSTRACT
Purpose : To report the decreasing indicence 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 groups. 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 cases 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 nephrophthy | Children | Clinical manifestation
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