Effects of Methylprednisolone on TGF-beta, Apoptosis and Renal Scarring in Experimental Acute Pyelonephritic Weaning Rats

PURPOSE: Acute pyelonephritis of growing kidneys may result in renal scarring. TGF-beta, inflammatory cytokine, has been suggested to play an important role in promoting renal scarring through apoptosis, suppression of cellular proliferation and fibrosis. We observed the effects of a potent anti-inflammatory agent, methylprednisolone on apoptosis and renal scarring in experimentally induced acute pyelonephritic weaning rats. MATERIALS AND METHODS: To induce ascending pyelonephritis a saline solution containing Escherichia coli type ATCC No. 25922, pili-form (107 bacteria/mL) was infused into the bladder through the 16-guage silicone cannula for 48 hours to 102 three-week-old Sprague-Dawley rats (50-60g). Experimental groups were divided into three groups according to the treatment protocols, group I (ceftriaxone only, n=31), group II (methylprednisolone+ceftriaxone n=28), control group (n=43) was not treated. Histopathologic scores of inflammatory changes, fibrosis and tubular atrophy, the apoptosis index and TGF-beta1 expression score were observed at post-infection 1 and 3 week. Datas were analysed using ANOVA test and P value below 0.05 was interpreted as significant. RESULTS: The mortality rate (21.4%) of group II was not different to the control group (41.9%) and group I (32.3%). The inflammatory score of group II (0.8+/-0.87) at week 1 was significantly lower than those of the control group (2.3+/-0.87) and Group I (1.7+/-0.79) (P<0.05). Apoptosis index of group II (2.9+/-2.15) at week 1 was significantly lower than (10.0+/-0.95) and group 1 (8.3+/-2.53) (P<0.05). TGF-beta1 expression score of group II (0.8+/-0.72) at week 1 was significantly lower than those of the control group (1.9+/-0.68) and group I (1.8+/-0.60) (P<0.05). The fibrosis score of group II (1.1+/-0.10) at week 3 was significantly lower than that of the group I (1.8+/-0.83) (P<0.05). CONCLUSION: Combined treatment with methylprednisolone and ceftriaxone reduced inflammation, fibrosis, apoptosis and TGF-beta expression in acute pyelonephritic weaning rats, compared to ceftriaxone alone. Anti-inflammatory agent supplemented to antibiotics could prevent renal scarring more effectively.

Therapeutic Effect of Nocturnal Water Restriction in Children with Primary Nocturnal Enuresis

PURPOSE : Treatment of primary nocturnal enuresis (PNE) includs folk remedies and various treatments based on pathogenesis. We assessed the therapeutic effect of nocturnal water restriction as the primary treatment of PNE. MATERIALS AND METHODS : From October 1998 to June 1999, 41 children with PNE (>3 wet nights per week) who visited Ewha Womans University Mokdong hospital and who had good compliances to nocturnal water restriction for 2 months were included. Before and during nocturnal water restriction, daily fluid intake and urine volume were recorded for 2 days every 2 weeks. Responses to nocturnal water restriction were classified according to the decrease of wet nights as complete (>90%), partial (50-90%) and no (<50%) response. Predictors such as age, sex, daytime voiding dysfunction, fluid intake, urine volume, maximum urine volume per void and fasting urine osmolality were evaluated. RESULTS : The response rate to nocturnal water restriction for 2 month was 82.9% (34/41) [complete response : 39.0% (16/41), partial response : 43.9% (18/41)]. The response rate to nocturnal water restriction was significantly higher in monosymptomatic PNE than polysymptomatic PNE and more effective in PNE with er nocturnal fluid intake, nocturnal urine volume, and maximum urine volume than lower nocturnal fluid intake, nocturnal urine volume and maximum urine volume per void (p<0.05). Nocturnal urine volume, maximum urine volume per void and fasting urine osmolality after nocturnal water restriction has significantly increased higher in complete response and partial response group than in no response group (p<0.05). CONCLUSION : The nocturnal water restriction was effective in monosymptomatic PNE with nocturnal polydypsia, nocturnal polyuria and high bladder capacity.

Predictive Factors of Saline Reduction under Ultrasound-guidance in Patients with Intussusception

PURPOSE: The purpose of this study was to investigate the predictive factors of saline reduction under ultrasound-guidance in patients with intussusception. METHODS: Ultrasound-guided saline enema reductions were performed in 105 patients with intussusception from September 1993 to April 1996 at Ewha Womans University Mok-dong Hospital. Clinical characteristics and ultrasonographic findings were analyzed as the predictive factors of ultrasound-guided saline enema reduction in 15 patients(14.3%) who were not reduced by saline enema reduction compared to 90 patients(85.7%) who were reduced. RESULTS: The mean age of the not-reduced group was 8.9+/-5.8 months old which was significantly younger than 14.5+/-15.4 months old of the reduced group(P0.05). Among the ultrasonographic findings, the thickness of the hypoechoic outer rim in the not-reduced group was 10.5+/-3.3mm which was significantly thicker than 7.4+/-1.8mm of the reduced group(P<0.05). In stepwise logistic regression analysis, hypoechoic outer rim thickness over 8mm contributed significantly as the predictive factor for the failure of ultrasound-guided saline enema reduction(P<0.05). CONCLUSION: The thickness of the hypoechoic outer rim over 8mm on ultrasonogram was the predictive factor for the failure of saline reduction.

Reference Values of Hematologic and Biochemical Parameters of Nutrition around Weaning Period

PURPOSE: To determine the reference values of hematologic and biochemical parameters of nutrition around the weaning period. METHODS: From February 1996 to March 1997, several nutritional laboratory values were evaluated in 130 healthy babies and 120 inpatients in the recovery stage of acute illness at six general hospitals. RESULTS: Reference values in 9-month-old healthy babies(range : 6-12 months) were hemoglobin 11.8+/-0.9g/dL, hematocrit 30.9+/-0.7%, serum ferritin 25.7+/-15.4ng/mL, total protein(TP) 6.5+/-0.5g/ dL, albumin 4.6+/-0.5g/dL, prealbumin 15.6+/-3.9mg/L, cholesterol 154.7+/-22.4mg/dL, calcium 10.1+/-0.5mg/dL, phosphorus 6.1+/-0.9mg/dL, alkaline phosphatase(ALP) 235.1+/-66.4U/L. Reference values in 15-month-old healthy babies(range : 13-18 months) were hemoglobin 12.3+/-1.0g/dL, hematocrit 30.9+/-0.4%, serum ferritin 20.4+/-11.2ng/mL, TP 6.8+/-0.6g/dL, albumin 4.7+/-0.5g/dL, prealbumin 18.1+/-4.6mg/L, cholesterol 163.1+/-24.2mg/dL, calcium 9.3+/-1.0mg/dL, phosphorus 6.0+/-0.8mg/dL and ALP 254.5+/-64.0U/L. Most reference values were significantly lower in inpatients than the healthy babies, except for serum ferritin level which was the opposite. There were no significant differences in reference values according to feeding and weaning practices. Incidence of anemia(hemoglobin200mg/dL) was 8.6% in 15-month-old healthy babies. CONCLUSION: This study presented the reference values of hemoglobin, hematocrit, serum ferritin, total protein, albumin, prealbumin, cholesterol, calcium, phosphorus and alkaline phosphatase around the weaining period. The current nutritional status of Korean babies around the weaning period was appropriate except for borderline iron deficiency.

Reference Values of Hematologic and Biochemical Parameters of Nutrition around Weaning Period

PURPOSE: To determine the reference values of hematologic and biochemical parameters of nutrition around the weaning period. METHODS: From February 1996 to March 1997, several nutritional laboratory values were evaluated in 130 healthy babies and 120 inpatients in the recovery stage of acute illness at six general hospitals. RESULTS: Reference values in 9-month-old healthy babies(range : 6-12 months) were hemoglobin 11.8+/-0.9g/dL, hematocrit 30.9+/-0.7%, serum ferritin 25.7+/-15.4ng/mL, total protein(TP) 6.5+/-0.5g/ dL, albumin 4.6+/-0.5g/dL, prealbumin 15.6+/-3.9mg/L, cholesterol 154.7+/-22.4mg/dL, calcium 10.1+/-0.5mg/dL, phosphorus 6.1+/-0.9mg/dL, alkaline phosphatase(ALP) 235.1+/-66.4U/L. Reference values in 15-month-old healthy babies(range : 13-18 months) were hemoglobin 12.3+/-1.0g/dL, hematocrit 30.9+/-0.4%, serum ferritin 20.4+/-11.2ng/mL, TP 6.8+/-0.6g/dL, albumin 4.7+/-0.5g/dL, prealbumin 18.1+/-4.6mg/L, cholesterol 163.1+/-24.2mg/dL, calcium 9.3+/-1.0mg/dL, phosphorus 6.0+/-0.8mg/dL and ALP 254.5+/-64.0U/L. Most reference values were significantly lower in inpatients than the healthy babies, except for serum ferritin level which was the opposite. There were no significant differences in reference values according to feeding and weaning practices. Incidence of anemia(hemoglobin200mg/dL) was 8.6% in 15-month-old healthy babies. CONCLUSION: This study presented the reference values of hemoglobin, hematocrit, serum ferritin, total protein, albumin, prealbumin, cholesterol, calcium, phosphorus and alkaline phosphatase around the weaining period. The current nutritional status of Korean babies around the weaning period was appropriate except for borderline iron deficiency.

Random Urine Ca/Cr Ratio in Healthy Neonates

PURPOSE: Recently, in high risk preterm infants, we experienced high incidence of hypercalciuria, nephrolithiasis & nephrocalcinosis. To screen hypercalciuria, we need the normal value of random urine Ca/Cr ratio in healthy neonates according to gestational age, postnatal age, milk and calcium intake. METHODS: Random urine Ca/Cr ratio was checked in 260 healthy full-term infants at the 2-7th day, and in 40 preterm infants at the 3-16th day when they started formula feeding at Ewha Universaity Mok-dong Hospital from March 1995 to October 1995. We calculated calcium amount in formulas and we excluded the neonates who needed extra calcium supplement. RESULTS: There were no significant relationships between random urine Ca/Cr ratio and body weight or gestational age. There were significant logistic positive relationships between random urine Ca/Cr ratio and postnatal age (r=0.47, P<0.05) or calcium intake (r=0.52, P<0.05). The velocity of increase in random urine Ca/Cr ratio in term and preterm infants is not significantly different. The normal values of random urine Ca/Cr ratio in healthy term and preterm infants were 0.026 0.013 (Max. 0.052) at the early neonatal period with low calcium intake, and 0.075 0.0310 (Max. 0.137) at the late neonatal period with adequate calcium intake. CONCLUSION: Random urine Ca/Cr ratio was very low in healthy neonates and increase in a logistic line according to calcium (milk) intake. New normal value of random urine Ca/Cr ratio in neonates according to calcium (milk) intake is suggested to screen hypercalciuria.

A Clinical Study of Mother's Understanding About Children's Fever

One hundred mothers bringing their children to a pediatric outpatient deparment of Ewha Womans University Hospital were surveyed about their understanding of fever and method of fever therapy. Most mothers(91%) were unduly worried about low to moderate grade fever with the temperature of 39degrees C or less. They didn't know the thermoregulatory mechanism and thought that fever can rise to the temperature above 42degrsse C. Most mothers(80%) believed that fever has harmful effects such as brain damage and convulsion and only a few mothers(20%) know vaguely about the beneficial effects of fever . Hence, most mothers treated fever aggressively. 39% started fever therapy at the temperature of 37.5degrsse C or less and 65% gave antipyretic medication before the temperature reached 39.5degrsse C. From these results, it becomes clear that health education to counteract mother's overconcern about fever should be a part of routine pediatric care. A review of literature confirmed the beneficial effect of fever and only two serious rare harmful effects of fever, anmely, status epilepticus and heat stroke. Some guidelines to fever therapy are represented.