Clinicopathologic Characteristics of Poststreptococcal Glomerulonephritis in Elderly Patients / 대한신장학회잡지

PURPOSE: Acute poststreptococcal glomerulonephritis(PSGN) is a disease that affects primarily children, and is caused by immune complex-mediated injury after streptococcal infection. The retrospective study was carried out to characterize the clinicopathologic features of PSGN in elderly patients. METHODS: The twenty five patients were enrolled; who had been diagnosed as PSGN clinically and pathologically from 1995 to 1999 in Pusan National University Hospital. They were divided up into 2 groups according to age; younger group being 16 to 29 years old(n=16) and elderly group being 30 years or older(n=9). The age-related characteristics were analyzed by the paired T-test RESULTS: Renal functional impairments and decreased GFR were developed more frequently in elderly group. The pathological severity was more advanced in elderly group. But there was no difference in BUN, serum creatinine, serum albumin, 24-hour urine total protein, ASO, C3, IgG, IgA, IgM. CONCLUSION: Elderly patients with PSGN had a high incidence of renal functional impairment. Early recognition of PSGN in elderly patients with nephrotic syndromes or nephritis, thought to be the key role to improve the renal function.

A study of central venous hemodialysis catheter colonization and peripheral bacteremia in patients undergoing hemodialysis / 대한내과학회지

BACKGROUND: Central venous hemodialysis is often used and is respectively safe in hemodialysis patients. But, many complications have been reported. Peripheral bacteremia after insertion of central venous hemodialysis catheter is a major cause of morbidity. We undertook a prospective study to investigate the colonization of central venous hemodialysis catheter and subsequent related episodes of peripheral bacteremia. METHODS: Twenty-nine patients were enrolled ; who had been in hemodialysis program from July, 1999 to June, 2000 in Pusan National University Hospital. Blood cultures were taken from the catheter weekly after insertion. When the result of blood cultures through the central venous catheter became positive, indicating the colonization in the central venous catheter, peripheral venous blood cultures were taken before starting dialysis to detect the peripheral bacteremia. The data were analyzed by Mann-Whitney test. RESULTS: The mean age of patients was 53 years old and a prospective study of 29 central venous hemodialysis catheter was performed. Seven catheters (24%) became colonized on their instrumental surface. The mean time to colonization was 21 days after insertion. The colonizing organisms were Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus. Four catheters (13%) developed peripheral bacteremia with the same organism of colonization in the central venous catheter. The mean time to bacteremia was 19 days after insertion. The organisms of peripheral bacteremia were Staphylococcus epidermidis (n=2), Staphylococcus aureus (1), Enterococcus (1). Bacteremia only occured when blood drawn through the catheter cultured more than 1000 colony forming units per mL. The risk of subsequent bacteremia is not related to time left in. CONCLUSION: Bacterial colonization in the central venous catheter often led to bacteremia in hemodialysis patients. The risk of subsequent bacteremia is not related to time left in situ but to degree of colonization. In future, prospective study is needed in more patients.

The changes in cardiac dimensions and function in patients with end stage renal disease undergoing hemodialysis / 대한내과학회지

BACKGROUND: It is absolutely necessary to evaluate cardiac function at starting and during hemodialysis in patients with end stage renal disease. In this study, we tried to determinate the changes of cardiac function associated with hemodialysis. METHODS: Twenty patients with end stage renal disease were enrolled , who had been in hemodialysis program from February, 1997 to August, 1999 in Pusan National University Hospital. They were examined with echocardiography and gated blood pool scintigraphy at starting hemodialysis and after follow-up. The data were analyzed by paired T-test. RESULTS: The patients were 46.2+/-16.8 years old and male to female ratio was 8 : 12. The underlying diseases were diabetes mellitus(n=10), hypertension(7), glomerulonephritis (2) and others(1). The duration of symptoms associated with end stage renal dis- ease and underlying diseases was 3.4+/-2.6 years, and the duration of hemodialysis was 13.8+/-7.0 months. The LVEDID, LVESID and RVC decreased significantly (-6.10, -7.80 and -20.00%, respectively, p0.05). In ten cases associated with diabetes, LVEDID decreased (-7.90%, p<0.05). In twelve cases associated with cardiac diseases, LVEDID and LVESID decreased (-8.60 and -10.50%, respectively, p<0.05). In four cases associated with diabetes without cardiac diseases, LAD decreased (-5.10%, p<0.05). And in four cases associated with cardiac diseases without diabetes, there were no significant changes in cardiac dimensions and EF. In seven cases associated with diabetes and cardiac diseases, LVEDID decreased (-10.50%, p<0.05). The EF on gated blood pool scintigraphy decreased (-0.9%, p<0.05) as a whole, while increased (5.90%, p<0.05) in the cases associated with diabetes and cardiac diseases. CONCLUSION: During the early hemodialysis stage of end stage renal disease, we found a change of concentric left ventricular hypertrophy and relatively preserved left ventricular function. Furthermore we can expect that adequate hemodialysis -with dry-weight as low as possible - may prevent progression to eccentric left ventricular hypertrophy and dilated cadiomyopathy.

Clinical Characteristics and Prognostic Factors of Bacteremia and Sepsis / 대한내과학회지

OBJECTIVES: In spite of the improvement in therapeutic strategy, the mortality rate from sepsis is still high. The purpose of this study was to examine the clinical characteristics and prognostic factors of sepsis to get help in treatment and estimation of prognosis of sepsis. METHODS: We analyzed the clinical and bacteriologic data of 313 admitted patients with bacteremia at Pusan National University Hospital from Jan., 1996 to Dec., 1997 retrospectively and all patients were categorized into 4 groups (bacteremia, sepsis, severe sepsis, septic shock) by the definition from American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference, 1992. RESULTS: 1) Male to female ratio was 1.22: 1 and mean age was 52 years. 2) The overall mortality rate was 32.3% and the mortality rates of bacteremia, sepsis, severe sepsis and septic shock were 14.9%, 22.8%, 52.0%, and 95.2%, respectively. 3) Underlying diseases predisposing to bacteremia were diabetes mellitus(14.4%), solid cancer (13.1%), hematologic malignancy(10.2%) and liver cirrhosis(9.9%), but the most common was no underlying disease. 4) Among the total 80 species of isolated microorganisms, gram-positive organisms were responsible in 169 cases, gram-negative organisms in 218 cases. E. coli was isolated most frequently, followed by S. aureus, S. epidermidis, K. pneumoniae, Enterococcus spp., Enterobacter spp., Str. viridans group, CNS, P. aeruginosa and S. typhi. 5) Although the source of bacteremia could not be identified in 28.8% of the patients, the others had the primary site of infections ; skin(17.9%), gastrointestinal tract(16.9%), respiratory tract(12.5%), urinary tract(9.9%) and biliary tract(7.3%). 6) The mortality rate in patients with gram-positive bacteremia was 39.4%, with gram-negative bacteremia was 20.9% and with polymicrobial bacteremia was 33.3%. MRSA sepsis showed the highest mortality rate(58.8%), followed by Enterococcus spp.(50.0%), K. pneumoniae (35.0%), P. aeruginosa(27.3%) and E. coli(18.8%). 7) There was significant relation between etiologic organisms of bacteremia and the primary site of infections. 8) Using logistic regression analysis, mortality was predicted by disseminated intravascular coagulation, severity of sepsis and severity of underlying diseases. CONCLUSION: Sepsis occurred in 16 patients among 1,000 adult admitted patients and overall mortality rate was 32.3%, still high. The mortality rate had positive correlation with the severity of sepsis. Among 16 evaluated risk factors of mortality, mortality was predicted by disseminated intravascular coagulation, severity of sepsis and severity of underlying disease.

Clinical Significance of Antiphospholipid Syndrome / 대한내과학회지

OBJECTIVES: Antiphospholipid syndrome (APS) is characterized by arterial or venous thrombosis, recurrent fetal loss, many neurological deficits, and presence of anticardiolipin antibody (ACA) or lupus anticoagulant (LA). This study was done to know the clinical and serological characteristics of antiphospholipid syndrome. METHODS: Clinical and laboratory features of 18 patients with APS who had antiphopholipid antibodies and histories of obstetric events and thrombosis were studied. RESULTS: Of the 18 patients, 4 were male, and 14 were female, and the ages ranged from 19 to 64 years. 11 patients were primary APS. 17 patients had ACAs: 11 had IgG ACA; 2 had IgM ACA; 3 had both IgG and IgM; 1 had both IgG and IgA; 1 patient had LA. Antinuclear antibodies were positive (>1:40) in 15 patients, and anti-ds-DNA (>1:10) were present in 8 patients. Hemolytic anemia was noted in 4 patients with positive in only direct Coomb's test, and all were secondary APS. Thrombocytopenia (<150,000/mm3) was observed in 14 patients, 9 patients ranged between 100,000/mm3 and 150,000/mm3. Initial presentation were deep vein thrombosis in 7 patients, pulmonary embolism in 3, arterial occlusion in 3, leg ulcer in 1, spontaneous abortion in 2, preeclampsia in 1, preterm labor in 1. Combined diseases were SLE, Sj gren syndrome, idiopathic thrombocytopenic purpura, hypertension. In 7 patients associated with cardiac abnormalities, 3 were mitral regurgitation, 4 were pericardial effusion, 1 was dilated cardiomyopathy. Venous thrombosis were present in 11 patients, 6 had deep vein thrombosis only, 3 had both deep vein thrombosis and pulmonary embolism. Arterial occlusion were present in 4 patients, 3 had small multiple cerebral infarction, 1 had right common femoral arterial occlusion. Obstetric complications were present 5 patients of 14 female patients: 3 had spontaneous abortion, preeclampsia was present in 1 and preterm labor was present in 1. CONCLUSIONS: The clinical and serological features of APS in this study were similar to those of previous reports (Oeffinger et al.,1994: Edelman et al., 1995). Treatment with prednisolone, anticoagulants and antiplatelet agents was used. Of the 10 follow-up patients, none had recurrence of thrombotic events.

A Case Of Non-traumatic Rhabdomyolysis In Doxylamine Overdose / 대한신장학회잡지

Because doxylamine is an antihistamine commonly used as over-the counter sleep preparation, it may bring out overdose. The usual clinical course of the overdose is dominated by the anticholinergic effect of these agents; it include significant autonomic and central nervous system effect. The most frequent symptom included impaired consciousness, seizure, tachycardia, mydriasis and a psychosis similar to that in catatonic stupor. A serious complications may be rhadbomyolysis with subsequent impairment of renal function and acute renal failure. Though the exact mechaism is not clear yet, it seems likely that doxylamine has a direct toxic effect on striated muscle. We report a case of a 22-year-old man who was complicated by rhabdomyolysis and impairment of renal function after doxylamine overdose. He was transported due to reddish urine from other hospital. According to transfer note, when he arrived at emergency room, he had slight drowsy mental state without tonic clonic seizure. He developed a elevated muslce enzyme and showed generalized, multiple uptake in damages muscle with the image of 99MTc-MDP bone scan. He was managed with hydration, urine alkalinization and supportive care during hospitalization. If doxylamine overdose are suspected, we should obtain creatine kinase level. Recognition of the potential for rhabdomyolysis and institution of vigorous treatment may prevent acute renal failure in patients who have taken an overdose of the drug.

A case of myocardial infarction in the minimal change nephrotic syndrome / 대한내과학회지

The authors report the case of a 25 year old woman with a chronic corticosteroid-refractory nephrotic syndrome complicated by myocardial infarction. The thromboembolism, especially acute myocardial infarction, is the most serious complication of nephrotic syndrome. Until now many mechanisms have been studied about thromboem bolism including coronary artery disease in nephrotic syndrome, but not clear. Hypercoagulability and prolonged hyperlipidemia are known as the principal contributing factors in this complication. In addition, use of steroid as therapeutic trial and hypovolemic state induced by vigorous diuretics will affect the thromboembolism, too. In this case, several coagulation abnormality and prolonged hyperlipidemia are observed. On admission day, this patient had deep vein thrombosis and then was complicated by pulmonary thromboembolism. Despite of anticoagulant and thrombolytic therapy, she experienced acute myocardial infarction on fourth day after admission. After onset of myocardial infarction, by thrombolytics and prolonged anticoagulant therapy, this nephrotic patient was relieved and discharged without other serious complication. We recommend anticoagulant and antiplatelet agent therpy in risky patient of nephrotic syndrome. We present this case with review of literature.

Distal renal tubular acidosis in sjogren syndrome with rheumatoid arthritis / 대한신장학회잡지

No abstract available.