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| 소아 낭창성 신염의 임상양상에 대한 연구 |
| 노혜옥 , 배기수 , 김기혁 , 이재승 , 김병길 , 정현주 , 최인준 |
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| Abstract |
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In childhood systemic lupus erythematosus patients, renal involvement was closely related to mortality and morbidity of the disease. Therefore early diagnosis and treatment by pathologic classification through percutaneous renal biopsy are essential to improving prognosis. During last 12 years, 19 cases of lupus nephritis were diagnosed in the pediatric department. The clinicopathologic observation was performed. The male to female ratio was 1:2.8 and the mean age of diagnosis was 9.8 years old. At the time of diagnosis, fever (84%), skin rash (84%), and bleeding tendency (68%) were the main clinical features. Hematuria (100%), positivity of ANA (94%) and decreased C, and C, levels were common in lupus nephritis patients. Renal biopsies were performed in 12 cases and the results were as follows; there was 1 case of mesangial proliferative glomerulonephritis, 4 cases of focal proliferative glomerulonephritis (FGN), 6 cases of dif- fuse proliferative glomerulonephritis (DGN) and 1 with membranous lupus nephritis (MGN). Nephrotic syndrome developed in 9 patients, 6 cases of them were biopsied. There were 2 cases of FGN, 3 cases of DGN and 1 case of MGN. Any of the clinical findings such as age, 24 hours urine protein excretion or blood urea nitrogen level did not provide a significant predictor for the development of renal failure in children. Pathologic findings such as activity index or chronicity index also did not provide a significant predictor. We treated steroid in all the patients, with azathioprine in 9 cases and plasmapheresis in 3 cases. Of the 19 cases of SLE nephritis, there were 5 cases of motality during the follow-up period. The mean follow up period was 48 montha The cause of death were uremia in 2, pneumonia after methylprednisolone pulse therapy in 1, pulmo- nary hemorrhage in 1, and central nervous system involvement in 1 case. |
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