Clinical Risk Factors for Bacteremia in Patients with Acute Pyelonephritis / 대한신장학회지

PURPOSE: Acute pyelonephritis (APN) is among the most common infectious diseases. Most APN occurs in young women and easily treated. Bacteremia has been associated in approximately 20-30% of those with APN. But recent documents demonstrated that blood cultures provide no useful information toward the clinical management of acute pyelonephritis. Thus we compared demographic and clinical characteristics as related to the bacteremic status, and investigated the risk factors for bacteremia. METHODS: One hundred sixty five patients, who visited myongji hospital for APN from January, 2004 to December, 2006 were included. Retrospective data were analyzed by medical record review. RESULTS: Bacteremic patients (N=51, 30.9%) were significantly older than those in nonbacteremic group (p<0.0001), had elevated serum creatinine (p=0.008), decreased platelet counts (p=0.029), lower serum protein (p=0.010), and lower serum albumin (p=0.011) than those without bacteremia. Hematuria was more severe in bacteremic patients (p<0.0001). The bacteremic cases were observed more frequently in patients with complicated APN patients than uncomplicated patients (46.7% vs. 21.4%, p=0.001). No significant difference existed between the bacteremic and non-bacteremic patients in the prevalence of resistance to quinolone of E. coli. In multivariate logistic regression analysis, serum albumin (p= 0.023), hematuria (p=0.003), and age (p=0.003) at presentation were found to be independent risk factors for bacteremia in acute pyelonephritis. CONCLUSION: Our study reveals that patients with bacteremia have different clinical characteristics compared to those without bacteremia. It is recommended to concern about the presence of bacteremia in the treatment of APN.

A Case of Membranoproliferative Glomerulonephritis with False-Positive Reaction for Anti-GBM Antibody / 대한신장학회지

Anti-glomerular basement membrane (Anti-GBM) nephritis is an autoimmune disorder characterized by rapidly progressive crescentic glomerulonephritis (RPGN). The treatment of anti-GBM nephritis with plasmapheresis, steroids and immunosuppressant has improved outcomes. An early diagnosis is essential for the survival of patients and a recovery of renal function. The diagnosis of anti-GBM disease has been traditionally based on the demonstration of linear deposits of immunoglobulins along the glomerular basement membrane by immunofluorescence (IF) microscopy. However, a kidney biopsy cannot always be easily performed in such ill patients. Recent development of specific enzyme immunoassays for anti-GBM antibody in the serum has made possible a provisional diagnosis without a kidney biopsy. A 46-year-old male patient with hypertension and hepatitis B presented with generalized edema and general weakness. Laboratory findings were compatible with acute renal failure and nephrotic syndrome with positive serum anti-GBM antibodies. After plasmapheresis with steroid pulse therapy, renal biopsy was performed and diagnosed as membranoproliferative glomerulonephritis (MPGN) with granular deposit of Ig G and C3. Follow-up antibody titers were negative. This case demonstrates the possibility of false-positive anti-GBM antibody in the serum. Therefore, enzyme immunoassay for anti-GBM antibody should be used only as a screening or follow-up test in patients that have been confirmed positive by IF microscopy.

Tc-99m MDP-induced Acute Hepatitis in a Hemodialysis Patient / 대한신장학회지

Bone scan is one of the most frequently performed studies in nuclear medicine with few adverse reactions for the examination of pathologic conditions of bone. Diffuse liver uptake of Technetium-99m methylene diphosphonate (Tc-99m MDP) is a rare occurrence with only a few reports in the literature. Furthermore, there is no report of Tc-99m MDP-induced liver injury. Here we report a case of acute hepatitis with diffusely increased uptake of Tc-99m MDP in a hemodialysis patient.

Recurrent Acute Uremic Encephalopathy Associated with Reversible Bilateral Basal Ganglia Lesion / 대한신장학회지

Uremic encephalopathy is a well-known complication in uremia and rarely occurs with involuntary movements which represent basal ganglia lesion. We experienced a cases of recurrent acute uremic encephalopathy associated with reversible bilateral basal ganglia lesion. A 49-year-old man with end stage renal disease due to diabetic nephropathy on continuous ambulatory peritoneal dialysis (CAPD) treatment for the last 2 months was admitted for mental change. His blood sugar was 60 mg/dl, and his mentality was recovered after glucose solution infusion. Five days after admission, he suddenly developed dysarthria and chorea. Brain magnetic resonance imaging (MRI) demonstrated low and high signals on bilateral basal ganglia in T1-weighted and T2-weighted images, respectively. After intensified CAPD treatment, his neurologic manifestations were resolved. One month after discharge, follow-up brain MRI showed decreased size of low attenuation on the basal ganglia. Two months later, he repeatedly developed dysarthria and involuntary movement of extremities. Newly developed bilateral symmetric T1 low and T2 high signal lesion on the basal ganglia was repeatedly observed on brain MRI. At that time, (his) Kt/V was 1.33. So we decided on him to switch from CAPD to hemodialysis, after then his symptoms disappeared.

A Case of Classic Polyarteritis Nodosa Presented with Acute Renal Failure / 대한신장학회잡지

Classic polyarteritis nodosa (c-PAN), first described by Kussmaul and Maier in 1866, is a systemic illness characterized by necrotizing inflammation of medium- sized arteries. Rapid progressive renal failure is very rare in c-PAN in contrast to microscopic polyangiitis (MPA). We report a case of c-PAN presented with rapidly progressive renal failure. A 58 year-old male was referred to our hospital for evaluation of asthenia and right visual loss. An increase in serum creatinine level was developed in the 6th day of hospitalization and acute renal failure was aggravated rapidly. Renal biopsy showed the transmural fibrinoid necrosis of small and medium sized arteries with few glomerular crescents. P-ANCA was detected in serum, and all clinical and laboratory findings supported the diagnosis of c-PAN. He was treated with pulse methylprednisolone, followed by oral corticosteroid and cyclophosphamide, and received temporary hemodialysis. After the treatment, he recovered and was discharged but his visual defect was irreversible despite the treatment.