ABSTRACT
The aims of our study were to identify the risk factors for an increased aortic pulse wave velocity (AoPWV) and to assess the impact of the AoPWV on the cerebro-cardiovascular (CV) outcomes of hemodialysis (HD) patients. Seventy two HD patients were included, and the AoPWV, the echocardiography and the biochemical parameters were measured. After dividing the patients into tertiles according to the AoPWV values, we defined the low, the middle and the high AoPWV groups. The patients in the high AoPWV group showed a significantly higher age and high-sensitivity C-reactive protein level, a greater prevalence of diabetes and statin use, left ventricular hypertrophy, average pulse pressure (PP), AoPWV and left ventricular mass index and a lower serum albumin level than those in the low AoPWV group (p<0.05). On multivariate regression analysis of the AoPWV, age and the average PP were independently related to the AoPWV (p<0.05). On the multivariate Cox analysis for CV outcomes, the AoPWV and the average PP remained significant independent predictors of CV events. Our data suggest that an increased AoPWV is an independent predictor for the CV outcomes of HD patients.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Albumins/metabolism , Aorta/pathology , C-Reactive Protein/metabolism , Echocardiography/methods , Heart Rate , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Kidney Failure, Chronic/complications , Pulse , Renal Dialysis/methodsABSTRACT
Postoperative rhabdomyolysis with acute renal failure (ARF) is a rare complication of laparoscopic urologic surgery. It is associated with lateral decubitus surgical position, long operative time, and increased body mass. We report a case of a 49-year-old-man with right renal cell carcinoma who underwent a laparoscopic right radical nephrectomy for 7 hours in left decubitus position and was complicated by ARF due to postoperative rhabdomyolysis. Laparoscopic renal surgery is performed in many surgical renal diseases and heightened suspicion may help early recognition of postoperative rhabdomyolysis. Vigorous hydration and hemodialysis are also helpful in treating ARF secondary to rhabdomyolysis
Subject(s)
Acute Kidney Injury , Carcinoma, Renal Cell , Laparoscopy , Nephrectomy , Operative Time , Renal Dialysis , RhabdomyolysisABSTRACT
The gene responsible for nail-patella syndrome, LMX1B, has recently been identified on chromosome 9q. Here we present a patient with nail-patella syndrome and an autosomal dominant pattern of inheritance. A 17-year-old girl visited our clinic for the evaluation and treatment of proteinuria. She had dystrophic nails, palpable iliac horns, and hypoplastic patellae. Electron microscopy of a renal biopsy showed irregular thickening of the glomerular basement membrane. A family history over three generations revealed five affected family members. Genetic analysis found a change of TCG to TCC, resulting in a synonymous alteration at codon 219 in exon 4 of the LMX1B gene in two affected family members. The same alteration was not detected in an unaffected family member. This is the first report of familial nail-patella syndrome associated with an LMX1B in Korea mutation, However, we can not completely rule out the possibility that the G-to-C change may be a single nucleotide polymorphism as this genetic mutation cause no alteration in amino acid sequence of LMX1B.
Subject(s)
Adolescent , Female , Humans , Homeodomain Proteins/genetics , Mutation , Nail-Patella Syndrome/genetics , Transcription Factors/geneticsABSTRACT
Infectious aneurysms in hemodialysis patients are very rare. It is assumed that injuries on atherosclerotic vessel walls are involved in the development of aneurysms associated with septicemia. Rupture of infectious aneurysms carries a high mortality rate because it often leads to hemorrhagic shock. Here we report the case of a hemodialysis patient with rupture of an abdominal aortic infectious aneurysm secondary to Staphylococcus aureus septicemia. A 72 year-old male hemodialysis patient presented with diarrhea and fever. Staphylococcus aureus was identified in his blood culture. On the sixth day after admission, he developed sudden abdominal pain, distension and hypotension, so we assumed hypovolemic shock due to intraabdominal hemorrhage. On abdominal CT, he was found to have a ruptured, 2.4x2 cm infrarenal abdominal aortic aneurysm with a large amount of retroperitoneal hemorrhage. His final diagnosis was rupture of an infectious aneurysm based on the presence of Staphylococcal bacteremia. He underwent a percutaneous stent graft in the infrarenal aorta successfully. However, two weeks later, he developed septic shock due to a newly developed intestinal perforation and died of multiorgan failure.
Subject(s)
Humans , Male , Abdominal Pain , Aneurysm , Aorta , Aortic Aneurysm , Aortic Aneurysm, Abdominal , Bacteremia , Diarrhea , Fever , Glycosaminoglycans , Hemorrhage , Hypotension , Intestinal Perforation , Renal Dialysis , Rupture , Sepsis , Shock , Shock, Hemorrhagic , Shock, Septic , Staphylococcus , Staphylococcus aureus , Stents , TransplantsABSTRACT
We describe a patient with hyponatremia induced by the use of angiotensin-converting enzyme (ACE) inhibitor; imidapril HCl. Although the mechanism of severe hyponatremia due to ACE inhibitor is not clear, it is conceivable that ACE inhibitor therapy may complicate the syndrome of inappropriate secretion of antidiuretic hormone and induce hyponatremia. In addition, the possibility should be considered that hyponatremia in our patient is a presumptive interaction between oxcarbazepine and imidapril HCl.
Subject(s)
Humans , Angiotensins , Hyponatremia , Peptidyl-Dipeptidase AABSTRACT
BACKGROUND: The plasma concentration of atrial natriuretic peptide (ANP) has been shown to be a volume marker and be useful to predict cardiovascular disease in hemodialysis patients, so we investigate the association between 24-hour ambulatory blood pressure monitoring (ABPM) parameters and the plasma concentrations of ANP. METHODS: Plasma concentrations of ANP of 52 CAPD patients were measured and the patients were divided into the high ANP (>40 pg/mL) and the low ANP (<40 pg/mL) groups. We analyzed the association between the 24-hour ABPM parameters and the plasma concentrations of ANP of both groups. RESULTS: On a 24-hour ABPM record, a daytime mean systolic (167.1+/-22.4 vs. 142.2+/-23.5 mmHg, p<0.01) and diastolic (100.2+/-14.5 vs. 87.9+/-19.2 mmHg, p<0.05) blood pressure and a nighttime mean systolic (162.5+/-31.1 vs. 136.1+/-33.2 mmHg, p<0.01) and diastolic (94.3+/-16.8 vs. 84.3+/-14.9 mmHg, p<0.05) pressure were significantly increased in the high ANP group. In a simple linear regression analysis, daytime mean diastolic pressure was best correlated with the plasma concentrations of ANP (r=0.53, p<0.05). In peritoneal equilibrium test, a daytime mean systolic (168.7+/-18.1 vs. 128.4+/-11.8 mmHg, p=0.024) and diastolic (99.3+/-11.5 vs 80.3+/-8.3 mmHg, p=0.028) pressure were significantly increased in high transporter group. CONCLUSION: A 24-hour ABPM parameters are correlated with the concentrations of plasma ANP, so the plasma concentration of ANP may be useful for the assessment of the volume status and the treatment of hypertension in CAPD patients.
Subject(s)
Humans , Atrial Natriuretic Factor , Blood Pressure , Blood Pressure Monitoring, Ambulatory , Cardiovascular Diseases , Hypertension , Linear Models , Peritoneal Dialysis, Continuous Ambulatory , Plasma , Renal DialysisABSTRACT
BACKGROUND: Tsutsugamushi disease is one of the acute febrile illness frequently developed in Korea. Unless it is cared properly in acute stage, it can be progressed to severe status associated with complication such as acute renal failure (ARF). But there has been little reported about tsutsugamushi disease associated with ARF. METHODS: We investigated patients records with tsutsugamushi disease associated with ARF, who were admitted at Our Lady of Mercy's Hospital and Uijeongbu St. Mary's Hospital from 1994 to 2003. 6. RESULTS: The incidence rate for ARF was 14.1% (23/163). Most patients have fever but eschar which is one of the most important findings, appeared less than half patients. Hypotension during developed more frequently in severe ARF group than mild ARF (p<0.05). Platelet count at admission and lowest platelet count was significantly lower in severe ARF group (p<0.05). The mortality rate was 3/23. All of them are in severe ARF group (p<0.05). The highest creatinine level was positively correlated with AST (p<0.01) and ALT (p<0.01). CONCLUSION: Tsutsugamushi disease is an acute febrile illness which is not rare in Korea. With proper and early management, it can be cured. But as it can be progressed to severe state with complication such as ARF and death in some cases, it is important to diagnose early and manage carefully.
Subject(s)
Humans , Acute Kidney Injury , Creatinine , Fever , Hypotension , Incidence , Korea , Mortality , Platelet Count , Scrub TyphusABSTRACT
BACKGROUND: Dialysis-induced hypotension is a very common but difficult complication to manage. Amezinium methylsulfate is a newly developed sympatho-mimetic agent which has been reported as effective in postural hypotension. We studied the preventive effect of amezinium methylsulfate on dialysis-induced hypotension in chronic hemodialysis patients. METHODS: Twenty-five hemodialysis(HD) patients who were maintaining on hemodialysis longer than 3 months and had frequent episodes of dialysis hypotension were enrolled in this study. After 4 weeks of observation period, patients received one tablet of ameziniurn 30 minutes prior to every hemodialysis session for 4 weeks. We com mean arterial pressure(MAP), number of hypotensive episodes and number of nursing interventions(defined as position change, bolus injection of saline or 50% dextrose in water, need to decrease transmembrane pressure or discon- tinuation of dialysis) between observation and medication period in each patient. RESULTS: The number of nursing interventions (mean, 2.5+/-0.9 interventions vs. 1.4+/-0.9 interventions, p<0.05) and hypotensive episodes(mean, 1.7+/-0.7 episodes per session vs. 0.9+/-0.7 episodes per session; p<0.05) decreased significantly in the medication period and the nadir MAP(57+/-13mmHg vs 70+/-15mmHg; p<0.05), mid-HD MAP(65+/-15mmHg vs. 79+/-15mmHg; p<0.05) and post-HD MAP(66+/-14mmHg vs 78+/-16 mmHg ; p<0.05) are higher in the medication period compared with observation period. CONCLUSION: These results show that amezinium methylsulfate is useful to prevent dialysis-induced hypotension in chronic hemodialysis patients.
Subject(s)
Humans , Dialysis , Glucose , Hypotension , Hypotension, Orthostatic , Nursing , Renal Dialysis , WaterABSTRACT
The status of renal replacement therapy in Korea as follows ; 1) The response rate to questionaire was 57.9% of the 226 hemodialysis centers in Korea and data file was sent in the 62.4% of responder. 2) The number of dialysis center was 226 and the number of hemodialysis machine was 3,507 and annual increasing rate were 8,7%, 14.0%, respectively. 3) The total number of ESRD patients was 20,244 and prevalance and incidence of ESRD were 431.9 and 101.1 patients per million population(ppm). 4) The proportion of renal replacement therapy was hemodialysis(HD) 53.3%, peritoneal dialysis(PD) 17.196, renal transplants(KT) 29.5%. 5) The proportion of long-term and elderly patients was markedly increased comparing 1985 (long term dialysis 20% vs. 2%, over 60 year old patients 26.2% vs. 13.8%. 6) The primary cause of renal disease was diabetic nephropathy 34.09o, chronic glomerulone-phritis 20.8%, hypertensive nephropathy 15.7%. 7) The mean BMI(body mass index,' kg/M)in over 18 year old patients was 20.7+/-2.7 kg/M in the HD and 22.23.0 kg/M in the PD. 71.9M of HD patients and 73.2% of PD were in the normal range (18.5-24.9). 8) The fistula survival rate was 6 month 93.4%, 1 yr 91.7%, 3 yr 87.6%, 5 yr 84.7%. 9) The cause of death were cardiac disease 31.8%, miscellaneous 23.5%, vascular disease 17.2%, infection 14.2%, liver disease 1.2%, social cause 5.9%.
Subject(s)
Adolescent , Aged , Humans , Middle Aged , Electronic Data Processing , Cause of Death , Diabetic Nephropathies , Dialysis , Fistula , Heart Diseases , Incidence , Kidney Failure, Chronic , Korea , Liver Diseases , Reference Values , Renal Dialysis , Renal Replacement Therapy , Survival Rate , Vascular DiseasesABSTRACT
No abstract available.
Subject(s)
Biopsy , Cytoplasm , Follow-Up Studies , Glomerulonephritis , Kidney TransplantationABSTRACT
No abstract available.
Subject(s)
Arachnoid , Arachnoiditis , Magnetic Resonance Imaging , TuberculosisABSTRACT
No abstract available.