P2-087 Nephrology P2-088 NephrologyPROTECTIVE EFFECTS <strong>OF</strong> ADIPONECTINAGAINST RENAL ISCHEMIA-REPERFUSIONINJURY VIA PROSTACYCLIN -PPARΑ- HEMEOXYGENASE-1 SIGNALING PATHWAYVESICOURETERAL REFLUX (VUR) TREATEDWITH DEXTRANOMER/HYALURONIC ACID(DEFLUX) IN CHILDREN: EXPERIENCE IN ASOUTHERN TAIWAN MEDICAL CENTERChing-Feng Cheng 1, 2 Wei-Shiung Lian 2 , Heng Lin 31 Department of Pediatrics and Medical Research, Tzu Chi General Hospitaland Tzu Chi University, Hualien, Taiwan; 2 Institute of Biomedical Sciences,Academia Sinica, Taipei, Taiwan; 3 Graduate Institute of Pharmacology &Toxicology, Tzu Chi University, Hualien, TaiwanAdiponectin (APN), a circulating adipose-derivedhormone that regulates inflammation and energymetabolism, has beneficial effects on the cardio- andcerebro-vascular disorders. Serum APN levels arelower in patients with coronary artery disease andtype II diabetes, while hyper-adiponectinemia isfound in patients with chronic kidney disease.However, the precise role and molecular mechanismof APN in acute reno-vascular disease is not clear.Results of the present study show that the serumconcentration of APN decreased after ischemia/reperfusion (I/R) injury in mice. In addition,I/R-induced renal dysfunction (elevated serumcreatinine and urea levels), inflammation (number ofinfiltrating neutrophils, myeloperoxidase activity,induction of IL-6 and P-selectin) and apoptoticresponses (apoptotic cell number and caspase-3activation) were attenuated in APN-treated comparedto control mice. Molecular and biochemical analysisrevealed that APN up-regulates heme oxygenase-1(HO-1) via peroxisome-proliferatoractivated-receptor-α(PPARα) dependent pathwaywhich is mediated through the enhancement ofCOX-2 and 6-keto PGF1α expression. Chromatinimmune-precipitation assay demonstrated that APNincreases the binding activity of PPARα to the PPREregion of HO-1 promoter. Furthermore, APN inducedHO-1 expression only in wild type but not in PPARαgene deleted mice. This provides in vivo evidencethat APN mediated HO-1 expression depends onPPAR signaling pathway. In conclusion, our resultsprovide a novel APN mediated prostacyclin-PPARα-HO-1 signaling pathway that mediates its protectiveeffects on renal I/R injury.[Keywords] adiponectin, renal ischemic repurfusion injury, HO-1Chih-Chong Lin 1 , Sin-Yi Lee 2 , Jia-Fu Hong 1 ,You-Lin Tain 11 Division of Pediatric Nephrology and 2 Pediatric Surgery, Chang GungMemorial Hospital-Kaohsiung Medical Center, Chang Gung University, TaiwanBACKGROUND: Vesicoureteral reflux (VUR) is acommon genitourinary anomaly in children. Managementof VUR is crucial because reflux nephropathy accounts for~20 % of pediatric chronic kidney disease. Endoscopicinjection of dextranomer/hyaluronic acid (Deflux) at theureterovesical junction is an established alternative tolong-term antibiotic prophylaxis and ureteralreimplantation. We intended to survey the feasibility ofDeflux injection as a suitable option for VUR in ourhospital.MATERIALS AND METHODS: We retrospectivelyreviewed the records of children with documented primaryVUR between 2005 and 2009. Deflux injection wasperformed if VUR graded 2 or above and grade 1 VUR wasexcluded. Injections of Deflux on the right and left sideswere regarded as independent events. Success of Defluxinjection was defined by complete resolution of VUR onpost-operative voiding cystourethrogram (VCUG). Seconddose of Deflux was suggested if follow-up VCUG graded ≥2 three months later. The first 33 Deflux injections on 19ureters were selected as the learning curve (L) group andthe injections thereafter were classified as mature (M)group. The success rate of the L and M groups werecompared. Success rate of high grade (≥ 4) and low grade(2 or 3) groups were also analyzed.RESULTS: A total of 87 children with documented VURreceived Deflux injection and underwent post-operativeVCUG. The median age at entry was 29 months (7months-15 years); 46% of the patients were boys and 31%were high grade. A total of 168 Deflux injections wereperformed on 131 ureters. The success rate of the procedurewas 26% (5/19) for the first injection and 73% (14/19) forthe second injection in the L group. In the M group, thesuccess rate was increased to 68% (76/112) for the firstinjection and 79% (88/112) for the second injection.Especially, the success rates in the high grade group were ashigh as 74% (22/31) and 80% (25/31) following the firstand second injection, respectively.CONCLUSIONS: Our observations demonstrate thatDeflux injection is a suitable treatment option for VUR.The success rate can be increased with a second dose ofDeflux injection. Once the operator can overcome thelearning curve, Deflux injection should be considered as analternative to ureteral reimplantation for VUR.[Keywords] VUR, Deflux, success rate298
P2-089 Nephrology P2-090 NephrologySHORT TIME FOR FULL DOSE <strong>OF</strong> STEROIDPLUS HIGH-DOSE ALTERNATE DAYPREDNISONE IN TREATMENT <strong>OF</strong>CHILDHOOD NEPHROTIC SYNDROMETHE UTILIZATION <strong>OF</strong> THE THREE-MEDIADIPSLIDE CULTURE TEST TO DIAGNOSEURINARY TRACT INFECTION IN PEDIATRICPATIENTS IN CARDINAL SANTOS MEDICALCENTERHui ZhangPediatrics, West China Second University Hospital, ChinaOBJECTIVE: There are conflicting evidences regardinglongtime full dose of steroid in routine therapy ofchildhood nephrotic syndrome, which could be associatedwith the development of steroid resistance. Thereby weproposed a new steroid regimen in treatment of childhoodnephrotic syndrome.METHODS: We administered a questionnaire to 323children who have been diagnosed as nephrotic syndromeand received regular steroid therapy in West China SecondUniversity Hospital. 236 cases were followed up after 6months since the first questionnaire survey. All the patientswere clasified to two groups according to clinicalmanagement. Group A received new steroid regimen(dexamethasone pulse followed by two-week oral full doseof prednisone and high-dose alternate day prednisone);Group B received the routine moderate-long coursetherapy of prednisone recommended widely in China. Thetherapeutic effects and adverse effects of two groups wereobserved and compared.RESULTS: 1. It was much more rapidly for urinaryprotein to disappear in group A than that in group B (P
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