Beneficial Effects of Omega-3 Fatty Acids on Low Density Lipoprotein Particle Size in Patients with Type 2 Diabetes Already under Statin Therapy

Beyond statin therapy for reducing low density lipoprotein cholesterol (LDL-C), additional therapeutic strategies are required to achieve more optimal reduction in cardiovascular risk among diabetic patients with dyslipidemia. To evaluate the effects and the safety of combined treatment with omega-3 fatty acids and statin in dyslipidemic patients with type 2 diabetes, we conducted a randomized, open-label study in Korea. Patients with persistent hypertriglyceridemia (> or =200 mg/dL) while taking statin for at least 6 weeks were eligible. Fifty-one patients were randomized to receive either omega-3 fatty acid 4, 2 g, or no drug for 8 weeks while continuing statin therapy. After 8 weeks of treatment, the mean percentage change of low density lipoprotein (LDL) particle size and triglyceride (TG) level was greater in patients who were prescribed 4 g of omega-3 fatty acid with statin than in patients receiving statin monotherapy (2.8%+/-3.1% vs. 2.3%+/-3.6%, P=0.024; -41.0%+/-24.1% vs. -24.2%+/-31.9%, P=0.049). Coadministration of omega-3 fatty acids with statin increased LDL particle size and decreased TG level in dyslipidemic patients with type 2 diabetes. The therapy was well tolerated without significant adverse effects.

A Case of Latent Autoimmune Diabetes in Adults Developed after Surgical Cure of Growth Hormone Secreting Pituitary Tumor

Acromegaly is generally caused by a benign growth hormone (GH)-secreting pituitary adenoma. It is characterized by a wide range of complications; cardiovascular, respiratory, bone and joint, and metabolic complications. Among them, impaired glucose tolerance and diabetes mellitus, due to GH-induced insulin resistance, has been reported in approximately 16-46% and 19-56%. They are usually improved following the treatment of acromegaly, surgical or medical therapy. We report a first case of 36-year-old man who was paradoxically diagnosed with GAD antibody positive latent autoimmune diabetes in adults (LADA) after the surgical cure of acromegaly.

A Case of IgA Nephropathy associated with Acute Hepatitis A / 대한신장학회지

IgA nephropathy is the most common type of glomerulonephritis worldwide. Although primary IgA nephropathy receives the most attention, many other diseases are also associated with IgA nephropathy. Among these, chronic liver diseases such as alcoholic liver disease or hepatitis B or C have been reported as secondary causes of glomerular IgA deposits. Recently, as the prevalence of hepatitis A virus (HAV) infection is increasing in Korea, HAV-associated renal diseases occur frequently. Acute kidney injury (AKI) is one of the most common complications of HAV infection, mainly due to acute tubular necrosis or interstitial nephritis. However, unlike hepatitis B and C, glomerular involvement is extremely rare in acute HAV infection. Here, we report a case of biopsy-proven IgA nephropathy with serologically documented HAV infection. The patient presented moderate degree of proteinuria without evidence of AKI. Renal biopsy revealed mesangial IgA deposits but tubular or interstitial inflammation was not observed. This report suggests that HAV infection may be a secondary cause of IgA nephropathy. However, further studies are required to elucidate a causal link between hepatitis A and mesangial IgA deposits.

A Case of Cold Agglutinin Disease Accompanied by Bacterial Pneumonia That Was Treated with Rituximab / 대한수혈학회지

Cold agglutinin disease (CAD) is a small group of disorders that is characterized by cold-reactive autoantibodies that bind to erythrocyte carbohydrate antigens, and this causes hemagglutination and complement-mediated hemolysis. Autoimmune hemolytic anemia (AIHA) is an immune disorder that is mediated via auto-antibodies produced by lymphoid B cells against red blood cells. The disorder may be a primary (idiopathic) or secondary disease with an underlying autoimmune disease, a lymphoproliferative disorder or infection. The mainstay of initial treatment is immunosuppression with glucocorticosteroids. For those who do not have satisfactory response to initial glucocorticosteroids or they have a relapse after initially successful treatment, splenectomy or other immunosuppressive agents such as azathioprine, cyclosporine and intravenous immunoglobulin (IVIG) could be the next available options. More recently, rituximab, which is a human-murine chimeric monoclonal antibody specific for the CD20 antigen found on the surface of B lymphocytes, is also available. We report here on the successful use of rituximab for the treatment of a Korean elderly patient with CAD and the patient presented with recurrent AIHA.

Bilateral Anterior Ischemic Optic Neuropathy with Sudden Sensorineural Hearing Loss in a Long term Hemodialysis Patient / 대한신장학회지

Anterior ischemic optic neuropathy (AION) is rarely reported in end stage renal disease. In particular, AION combined with sudden sensorineural hearing loss (SNHL) has not been reported in domestic and international journals. Here we report the first case of this combined condition. A 58-year-old male patient in end-stage renal disease presented on painless bilateral visual and hearing deterioration. Clinical findings and imaging studies were compatible with a diagnosis of AION and SNHL. Despite of high-dose steroid therapy, vision and hearing were not significantly recovered. Uremic patients often have coexisting pathology such as hypotension during dialysis, atherosclerosis and anemia, predisposing to AION and SNHL. We describe a patient of dialysis for 10 years who presented with bilateral visual and hearing loss due to complications of long-term dialysis. Our case suggests that nephrologists have to know and treat more carefully this rare but emergent complications of dialysis.