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Treatment Strategy for Pediatric Patients with Nephrotic Syndrome with Microscopic Hematuria at the Onset: A Retrospective Study of the Need for Kidney Biopsy
Get PDFNephrotic syndrome (NS) in children responds well to steroid therapy, therefore kidney biopsy before treatment is often avoided. However, the indications for kidney biopsy in children with NS with microscopic hematuria are controversial. In the present study, the indications for pretreatment kidney biopsy at the onset of pediatric patients with NS with microscopic hematuria were evaluated. Clinicopathologic correlations were retrospectively examined from patients enrolled in a database from January 2005 to December 2018. Fifty-nine pediatric patients with NS were enrolled. Among them, 6 with hypocomplementemia, gross hematuria, or onset at less than 1 year of age were excluded. Of the 53 enrolled patients, 38 without hematuria were assigned to Group A, and 15 patients with microscopic hematuria comprised Group B. There was a significant difference in the renal biopsy rate between Group A (n = 19, 50%) and Group B (n = 13, 87%) (P = 0.01). Two patients in Group B avoided biopsy. Pathology results for patients in Group B included 4 patients with minimal change disease, 2 with focal segmental glomerulosclerosis, 6 with mesangial proliferative glomerulonephritis (non-IgA), and 1 with membranous lupus nephritis (LN). The first three are commonly found in pediatric patients with NS, and all are treated with steroid therapy. LN could be diagnosed by kidney biopsy at the time of steroid resistance. LN presenting with nephrotic syndrome is also treated with steroids. Thus, the treatment strategy would not have changed even if the kidney biopsy had been performed before treatment. These results suggest that renal biopsy is not always mandatory during the initial stage for pediatric patients with NS with microscopic hematuria.journal articl
A Case of Inflammatory Demyelinating Disease of the Central Nervous System Presenting with Clinical Manifestation of Multiple Sclerosis Following SARS-CoV-2 mRNA Vaccination
Get PDFA 57-year-old woman presented with abnormal sensations and muscle weakness in the left upper and lower limbs and difficulty in walking four days after coronavirus disease 2019 (COVID-19) vaccination. The patient had deep sensation deficits and increased tendon reflexes in the left upper and lower limbs. Her head and cervical spinal cord magnetic resonance imaging showed a ring-shaped contrast-enhancing lesion. Cerebrospinal fluid examination showed a mildly elevated cell count, myelin basic protein, and IgG index, and positive oligoclonal bands. The patient was diagnosed as inflammatory demyelinating diseases of the central nervous system (IDDCNS) due to vaccination and was treated with pulse steroids. Her symptoms improved to a greater degree compared to previously reported cases of IDDCNS after COVID-19 vaccination. The disease course of this case was monophasic, but was more similar to multiple sclerosis than to acute disseminated encephalomyelitis (ADEM) according to their diagnostic criteria. Careful long-term observation is necessary because vaccination, as in this case, may lead to relapses in multiple sclerosis (MS) patients who have not received disease-modifying drugs.journal articl
