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Renal Lesions in Congenital Rubella MARGARET A. MENSER, S. E.J. ROBERTSON, D. C. DORMAN, AILSA M.the World Wide Web at: http://www.pediatrics.org PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 1967 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275. Downloaded from www.pediatrics.org . Provided by Indonesia:AAP Sponsored on May 7, 2010 " id="pdf-obj-0-2" src="pdf-obj-0-2.jpg">

Renal Lesions in Congenital Rubella

MARGARET A. MENSER, S. E.J. ROBERTSON, D. C. DORMAN, AILSA M.

GILLESPIE and A. M. MURPHY Pediatrics 1967;40;901-904

The online version of this article, along with updated information and services, is located on the World Wide Web at:

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 1967 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

Renal Lesions in Congenital Rubella MARGARET A. MENSER, S. E.J. ROBERTSON, D. C. DORMAN, AILSA M.the World Wide Web at: http://www.pediatrics.org PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 1967 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275. Downloaded from www.pediatrics.org . Provided by Indonesia:AAP Sponsored on May 7, 2010 " id="pdf-obj-0-20" src="pdf-obj-0-20.jpg">

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EXPERIENCE AND REASON-BRIEFLY RECORDED 901 Using the number of infants “at risk” (num- infant. Effect on
EXPERIENCE
AND
REASON-BRIEFLY
RECORDED
901
Using
the
number
of
infants
“at
risk”
(num-
infant.
Effect
on
staphylococcal
carriage
and
infection.
Brit.
Med.
J.
1 :76,
1958.
ber
of
infants
alive
in
the
nursery
at
the
be-
ginning
of
each
period
plus
those
admitted
during
the
period)
as
the
denominator
of
the
death
rates
for
the
period,
the
cumulative
re-
suits
were:
Renal
Lesions
in
Congenital
Rubella
“go vn”-100/395
x
100
=
25%
Gregg1
noted
one
infant
with
renal
and
“no
gown”-72/350
x
100
=
21%.
ureteric
malformations
when
he
first
described
to
agree
on
a
uniform
the
effects
of
congenital
rubella
infection
in
Since
it
was
difficult
1941.
However,
there
are
few
subsequent
re-
definition
of
non-fatal
bacterial
infections,
we
decided
that
generalized
fatal
infections
(espe-
ports
of
renal
abnormalities
in
this
syndrome.
Only
four
children
with
renal
lesions
were
daIly
meningitis)
confirmed
by
postmortem
found
in
Lundstrom’s2
extensive
prospective
examination,
would
serve
as
a
crude
(but
fairly
firm)
marker
in
this
experience.
The
major
survey
of
infants
born
to
mothers
exposed
to
rubella
during
the
1951
epidemic
in
Sweden.
bacterial
infections
were
distributed
as
fol-
Recently,
a
rubella-affected
infant
with
an
lows:
“gown”-meningitis
6,
septicemia
with-
abnormal
kidney
and
double
ureter
was
docu-
out
meningitis
2;
“no
gown”-meningitis
0,
mented
by
Bellanti,
et
ai.
The
present
report
septicemia
without
meningitis
2.
concerns
a
child
with
prolonged
rubella
vir-
COMMENT
una
and
gross
renal
abnormalities.
We
report
this
experience
not
because
we
believe
that
we
have
obtained
proof
that
tra-
CASE
REPORT
This
male
infant
ditional
gowning
precautions
in
neonatal
units
weighed
3.05
kg
when
born
on
August
8,
1965.
No
information
is
available
can
be
safely
abandoned
by
all.
Note,
for
ex-
regarding
his
parents
or
the
course
of
the
preg-
ample,
that
in
our
unit
all
infants
are
housed
nancy.
On
the
second
day
of
life
a
soft
Grade
I-I!
in
rooms
(blower-ventilated
incubators)
with-
mid-systolic
cardiac
murmur
was
audible
over
in rooms
(also
pressure
ventilated),
and
this
the
precordium,
his
chest
x-ray
was
normal,
and
special
circumstance
may
afford
a
measure
cataracts
were
not
detected,
although
the
possi-
of
protection
not
generally
available.
We
cite
bility
of
the
presence
of
small
lesions
was
not
our
experience
only
to
encourage
others
to
excluded.
When
18
weeks
old,
a
mature
cataract
examine
time
honored
practices
which
may
was
present
in
the
left
lens
and
there
was
a
have
the
undesirable
effect
of
keeping
the
smaller
central
posterior
cortical
opacity
in
the
right
lens.
His
head
physician
and
his
high-risk
neonatal
patient
circumference
was
37.5
cm,
and
a
and
to
do
so
cautiously
and
systemati-
severe
degree
of
bilateral
deafness
was
sus-
apart,
pected.
cally.
On
December
14,
1965,
the
infant
was
ad-
A.
M.D.
WILLIAM
SiLVERMAN,
mitted
to
the
hospital
with
acute
bronchitis,
con-
C.
JOHN
SINCLAIR,
M.D.
junctivitis,
and
otitis
externa.
He
was
pyrexic
and
Department
of
Pediatrics
there
was
minimal
proternunia.
A
centrifuged
spec-
College
of
Physicians
and
Surgeons
imen
of
urine
contained
1-2
leucocytes
per
high
Columbia
University
power
field
and
4-6
granular
casts.
Urine
cul-
and
ture
showed
no
bacterial
growth
but
provided
a
rubella
virus
isolate.
Beta-hemolytic
Neonatal
Unit,
Babies
Hospital
streptococcus
was
not
present
in
the
pharyngeal
secretions.
His
Columbia-Presbyterian
Medical
Center
blood
urea
was
80
mg
per
100
ml,
and
the
serum
3975
Broadway
albumin
was
normal.
New
York,
New
York
10032
On
January
24,
1966,
the
right
cataract
was
aspirated
and
1
month
later
the
left
cataract
was
W.
A.
S.
is
a
Career
Investigator
of
the
Health
treated
similarly.
Rubella
virus
was
isolated
from
Research
Council
of
the
City
of
New
York
(Con-
the
cataractous
material
removed
from
both
the
tract
1-181);
J.
C.
S.
is
supported
by
Research
Ca-
right
and
left
lenses
at
operation
(Fig.
1).
reer
Development
Award
of
Public
Health
Service
The
blood
urea
fell
gradually
(Fig.
1)
and
was
(No.
1K3
HD-34,
992-01).
52
mg
per
100
ml
on
February
28,
1966.
In-
REFERENCE
travenous
pyelography
demonstrated
renal
func-
1.
Forfar,
J.
0.
and
MacCabe,
A.
F.:
Masking
tion
on
the
right
side
but
not
on
the
left.
A
cysto-
and
gowning
in
nurseries
for
the
newborn
gram
and
retrograde
pyelogram
(Fig.
2)
showed

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902 CONGENITAL RUBELLA 1UULLA VIRUS + ISOLATION URINI : -+-+ - 1’ + LENS SL000 TITER
902
CONGENITAL
RUBELLA
1UULLA
VIRUS
+
ISOLATION
URINI
:
-+-+
-
1’
+
LENS
SL000
TITER
01
USEA
EU
SE UA
IN
NEUTSALISING
MO.
ANT
SOOT
%
SGI
IN
MONTHS
Fic.
1.
Clinical
progress
of
male
infant
with
congenital
rubella.
free
reflux
up
both
ureters
during
filling
of
the
urine
and
pharyngeal
secretions
until
the
infant
bladder,
some
distension
of
the
right
ureter
and
was
10
months
old
(Fig.
1).
Rubella
virus
was
pelvi-calyceal
system,
but
no
evidence
of
a
pelvis
also
isolated
from
tile
cataractous
material
re-
or
calyces
on
tile
left
side.
A
left
renal
shadow
moved
at
operation
from
both
the
right
and
left
could
not
be
seen.
lenses
but
not
from
specimens
of
conjunctival
Se-
Rubella
viruria
persisted.
The
blood
urea
was
cretion
and
aqueous
humor
collected
at
the
same
51
mg
per
100
ml
when
the
infant
was
8
months
time.
old.
On
May
6,
1966,
2.5
ml
of
pooled
human
Neutralizing
antibody
titers
were
determined
in
gamma-globulin
(Commonwealth
Serum
Labora-
RK13
cultures
using
the
method
described
by
tones#{176}Batch
No.
047
which
has
been
shown4
to
Reid,
et
al.’
Serum
collected
when
the
infant
was
have
a
titer
of
neutralizing
antibody
to
rubella
4
months
old
had
a
titer
of
neutralizing
antibody
virus
of
1: 1024)
were
given
by
intramuscular
in-
to
rubella
virus
of
1: 128;
at
the
age
of
13
months
jection.
Rubella
virus
was
not
isolated
from
urine
the
titer
was
1 :512
(Fig.
1).
or
pharnygeal
secretions
after
the
infant
was
aged
Neutralization
was
found
to
occur
in
similar
dilu-
10
months.
lions
in
a
system
using
the
child’s
serum
against
Full
assessment
of
renal
function
was
carried
one
of
his
own
rubella
virus
isolates.
out
when
the
child
was
13
months
old.
At
this
time
leucocytes
were not
detected
in
the
urine,
COMMENT
there
was
no
proteinuria
and
tests
of
renal
con-
Six
children
have
been
reported
previously
centrating
ability
and
tubular
function
were
nor-
with
renal
lesions
possibly
due
to
congenital
mal.
Random
blood
urea
was
38
mg
per
100
ml
rubella.
Of
these,
two
had
polycystic
kid-
but
this
fell
to
22
mg
per
100
ml
following
in-
neys,
two
had
a
bibbed
kidney
with
duplica-
stitution
of
a
low
protein
diet.
Intravenous
py-
elography
tion
of
the
collecting
system,
and
the
nature
again
failed
to
demonstrate
any
renal
function
on
the
left
side.
Renal
scanning
per-
of
the
abnormality
was
not
described
in
the
formed
on
November
23,
1966
(Fig.
3),
using
remaining
two.
Now,
a
child
with
deafness,
“Hg
showed
no
functioning
renal
tissue
on
the
microcephaly,
bilateral
cataracts,
prolonged
left.
The
right
kidney
had
a
normal
isotope
dis-
rubella
viruria,
and
probable
agenesis
of
the
tribution
and
measured
9
cm
by
5
cm.
left
kidney
is
reported.
It
is
suggested
that
this
renal
lesion
may
be
due
to
congenital
VIROLOGY
rubella
infection.
Specimens
were
collected
in
separate
bottles
Development
of
the
kidney
depends
upon
and
processed
according
to
the
methods
described
formation
of
a
ureteric
bud.
This
bud
differ-
previously’
using
the
RK,,
continuous
line
of
rab-
entiates
caudally
from
the
nephric
duct
at
the
bit
kidney
cells.
end
of
the
first
month
of
gestation.6
As
the
Rubella
virus
was
frequently
isolated
from
bud
elongates
it
ascends
the
posterior
abdomi-
0 Parkville,
Vie.
3052,
Australia.
nal
wall.
In
the
10
to
15
mm
embryo,
primary

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903 EXPERIENCE AND REASON-BRIEFLY RECORDED tubules grow out from the primitive renal pelvis into the surrounding
903
EXPERIENCE
AND
REASON-BRIEFLY
RECORDED
tubules
grow
out
from
the
primitive
renal
pelvis
into
the
surrounding
mesodermal
tissue
where
the
kidney
is
formed.
If
the
primary
tubules
do
not
differentiate,
a
functioning
kid-
ney
fails
to
develop.
Differentiation
would
seem
to
have
arrested
at
this
stage
in
the
present
case,
possibly
due
to
the
presence
of
rubella
virus
111
the
embryo.
It
is
of
interest
that,
ill
Collins’s
series
of
581
patiellts
with
unilateral
renal
agenesis,
the
ureter
was
totally
absent
in
only
51%.
Some
infants
who
are
congenitally
infected
with
rubella
virus
harbor
and
excrete
the
virus
for
many
months
after
birth.
It
is
known
that
persisting
rubella
virus
infection
may
con-
tribute
to
the
pathogenesis
of
further
defects
postnatally.10h1
The
present
infant
had
ru-
bella
vininia
for
at
least
10
months
and,
al-
though
at
first
his
renal
function
appeared
grossly
impaired,
it
gradually
improved
(Fig.
1).
This
improvement
in
function
suggests
that
a
slowly
resolving
lesion
may
have
been
superimposed
upon
the
basic
renal
defect.
Renal
glomeruiar
and
tubular
cell
changes
Fic.
2.
Retrograde
pyelogram.
have
rarely
been
seen
in
conjunction
with
congenital
ruhella3,b0,1214
but
are
well
docu-
mented
in
infectious
hepatitis.15
In
the
present
case,
rubella
virus
may
have
caused
a
ne-
may
represent
a
progressive
improvement
in
phnitic
process,
in
addition
to
gross
structural
his
renal
function
as
the
viral
infection
waned
renal
abnormalities.
The
infant’s
urine
con-
and
the
nephritis
resolved.
tamed
leucocytes
and
granular
casts
but
on
This
is
the
second
infant
to
be
recorded
culture
showed
no
bacterial
growth.
The
fall
with
virologically-proven
congenital
rubella
which
was
observed
in
this
child’s
blood
urea
alld
a
renal
lesion.
As
most
centers
have
not
I
N
‘l
-‘V
R.
R.PMI.
.
DIAGPIOST1C RADKNSOTOP(S.
5
6
7
1
9
.
aI%’i1b
#{149}a ”
sca w
Fic.
3.
Renal
scan
using
1TTHg.

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904 SMALL VESSEL CANNULATION included tests of renal function in the routine additional investigations on prophylaxis
904
SMALL
VESSEL
CANNULATION
included
tests
of
renal
function
in
the
routine
additional
investigations
on
prophylaxis
and
clinical
assessment
of
rubella-affected
infants
treatment
of maternal
rubella.
Acta
Paediat.
and
as
renal-artery
stenosis
has
now
been
re-
( Stockholm)
( Suppl.
133),
51
: 1,
1962.
3.
Bellanti,
J.
A.,
Artenstein,
NI.
S.,
Olson,
L.
C.,
ported
in
three
infants
with
the
rubella
syn-
Buescher,
E.
L.,
Luhrs,
C.
E.,
and
Mil-
drome,16
it
appears
likely
that
renal
and
reno-
stead,
K.
L.
:
Congenital
rubella.
Amer.
J.
vascular
abnormalities
may
have
been
over-
Dis.
Child.,
110:464,
1965.
looked
in
the
past.
Therefore,
it
is
recom-
4.
Murphy,
A.
M.,
and
Reid,
R.
R.
:
Neutraliz-
mended
that
attention
be
paid
to
any
clinical
ing
antibodies
to
rubella
virus
in
gamma
or
laboratory
evidence
of
renal
dysfunction
in
globulin
and
“convalescent”
sera.
Med.
J.
infants
with
congenital
rubella,
that
an
at-
Aust.,
1:369,
1967.
tempt
be
made
to
correlate
such
evidence
5.
Reid,
R.
R.,
Murphy,
A.
M.,
Gillespie,
A.
M.,
with
the
duration
of
activity
of
rubella
virus
Dorman,
D.
C.,
Menser,
M.
A.,
Hertzberg,
R.,
and
Harley,
J.
D.
:
Isolation
of
rubella
in
the
kidney,
and
that
necropsy
and
biopsy
virus
from
congenital
cataracts
removed
at
specimens
be
carefully
evaluated
for
indica-
operation.
Med.
J.
Aust.,
1:540,
1966.
tionsof
rubella
nephritis.
6.
Smith,
D.
W.
:
Dysmorphology
(teratology).
J.
Pediat.,
69:1150,
1966.
SUMMARY
7.
Black,
D.
A.
K.
:
Renal
Disease.
Oxford:
Renal
lesions
have
rarely
been
reported
in
Blackwell
Scientific
Publications,
p.
9, 1963.
congenital
rubella.
A
male
infant
with
classi-
8.
Collins,
D.
C.
:
Congenital
unilateral
renal
cal
rubella
syndrome
defects
and
agenesis
of
agenesia.
Ann.
Surg.,
95:715,
1932.
the
left
kidney
is
described.
Rubella
virus
was
9.
Cooper,
L.
Z.,
and
Krugman,
S.
:
Diagnosis
present
in
his
urine
for
10
months.
His
renal
and
management:
congenital
rubella.
PEDI-
function,
although
poor
initially,
improved
ATRICS,
37:335,
1966.
10.
Naeye,
R.
L.,
and
Blanc,
W.
:
Pathogenesis
progressively.
It
is
suggested
that
congenital
of
congenital
rubella.
J.A.M.A.,
194:1277,
rubella
infection
was
responsible
not
only
for
1965.
his
renal
defect
but
also
for
a
slowly
resolv-
11.
Menser,
NI.
A.,
Harley,
j.
D.,
Housego,
C.
J.,
ing
nephritis.
and
Murphy,
A.
M.
:
Possible
chemical
fac-
A.
M.B.,
M.R.A.C.P.
MARGARET
MEN5ER,
tors
in
the
postnatal
development
of
rubella
Children’s
Medical
Research
Foundation
cataracts.
Lancet,
2:771,
1966.
Royal
Alexandra
Hospital
for
Children
12.
Swan,
C.
:A
study
of
three
infants
dying
from
Post
Office
Box
34
congenital
defects
following
maternal
ru-
Camperdown,
N.S.W.
2050.
Australia
bella
in
the
early
stages
of
pregnancy.
J.
S.
E.
J.
Path.
Bact.,
56:289,
1944.
ROBERTSON,
M.B.,
F.R.A.C.P.
13.
T#{246}ndurv,
G.,
and
Smith,
D.
W.
:
Fetal
ru-
Royal
Alexandra
Hospital
for
Children
bella
pathology.
J.
Pediat.,
68:867,
1966.
D.
C.
DORMAN,
PH.D.
14.
Bayer,
W.
L.,
Sherman,
F.
E.,
Michaels,
AILSA
M.
GILLESPIE,
M.B.
R.
H.,
Szeto,
I.
L.
F.,
and
Lewis,
j.
H.:
Institute
of
Pathology
Purpura
in
congenital
and
acquired
rubella.
Royal
Alexandra
Hospital
for
Children
New
Eng.
j.
Med.,
273:1362,
1965.
A.
M.
MURPHY,
B.Sc.
15.
Conrad,
M.
E.,
Scllwartz,
F.
D.,
and
Young,
Institute
of
Clinical
Pathology
A.
A.
:
Infectious
hepatitis-a
generalised
and
Medical
Research
disease.
A
study
of
renal,
gastrointestinal
Lidcombe,
N.S.W.
2141.
Australia
and
hematologic
abnormalities.
Amer.
J.
Med.,
37:789,
1964.
We
wish
to
thank
Associate
Professor
J.
McRae,
16.
Menser,
M.
A.,
Dorman,
D.
C.,
Reye,
R.D.K.,
Radioisotope
Unit,
Department
of
Medicine,
Uni-
and
Reid,
R.
R.
:
Renal-artery
stenosis
in
versity
of
Sydney,
for
permission
to
publish
the
rubella.
Lancet,
1:571,
1967.
renal
photoscan,
and
Dr.
D.
Arnold
and
Dr.
Lorna
Tannenbaum
for
their
help
with
this
case.
REFERENCES
intravenous
Cutdown-Technical
Aid
1.
Gregg,
N.
McA.
:
Congenital
cataract
follow-
ing
German
measles
in
the
mother.
Trans.
in
Cannulation
of
Small
Vessels
Opthal.
Soc.
Aust.,
3:35,
1941.
The
method
for
performing
intravenous
cut-
2.
Lundstrom,
R.
:
Rubella
during
pregnancy:
Follow-up
study
of
children
born
after
an
down
in
most
institutions
is
usually
stan-
epidemic
of
rubella
in
Sweden,
1951,
with
dardized
up
to
the
point
of
the
actual
insertion

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Renal Lesions in Congenital Rubella

MARGARET A. MENSER, S. E.J. ROBERTSON, D. C. DORMAN, AILSA M.

GILLESPIE and A. M. MURPHY Pediatrics 1967;40;901-904

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