Treatment of Lupus Nephritis: A 21 Year, Single Center Experience / 대한신장학회지

PURPOSE:Renal disease is the major cause of mortality and morbidity in systemic lupus erythematosus. The aim of this study was to examine the therapeutic outcome of patients with lupus nephritis (LN) for 21 years. METHODS:We conducted a retrospective study of 100 patients with biopsy proven LN who were admitted at Keimyung University Dongsan Hospital between 1985 and 2006, and were followed with a mean of 73 months. We diagnosed renal pathology according to WHO 1995 classification, and analyzed the therapeutic and long-term outcome of patients with LN treated with steroid alone or steroid with intravenous cyclophosphamide (CYC). RESULTS:The mean age at the time of renal biopsy was 28. 3 years and male to female ratio was 1:9.9. The initial therapy consisted of steroid alone in 69 patients and steroid with intravenous CYC in 31 patients. The proportion of diffuse proliferative LN and titer of anti ds-DNA were significantly higher in patients treated with steroid and CYC than in patients with steroid alone. The percentage of patients with clinical response was significantly higher in patients with steroid and CYC than in patients with steroid alone (p=0.018). The patients who experienced clinical response had an excellent long term outcome compared with those who had no clinical response. CONCLUSION:The clinical response was significantly higher in CYC combination regimen than steroid alone. The response to therapy in LN was an important factor for long-term prognosis. The early diagnosis and aggressive treatment with immunosupppressive agents are valuable for better outcome in patient with LN.

Continuous Renal Replacement Therapy (CRRT) in Intensive Care Unit (ICU) Patients with Acute Renal Failure / 대한신장학회지

PURPOSE: The mortality rate in critically ill patients with acute renal failure (ARF) remains unacceptably high, despite numerous advances in dialysis techniques and intensive care medicine. We evaluated clinical characteristics and prognostic factors in ICU patients with ARF requiring continuous renal replacement therapy (CRRT). METHODS: We retrospectively reviewed the medical records of all ICU patients who received CRRT at the Keimyung University Dongsan Hospital from September 2002 to October 2007. RESULTS: Total number of patients who required CRRT in ICU was 58. The mean age was 58.3+/-14.8 years. The treatment duration of CRRT was 63.5+/-40.7 hours. The mechanical ventilation rate was 82.8%, vasoactive drug 79.3%, sepsis 39.7%. APACHE II score was 25.2+/-7.9, SAPS II score 48.1+/-15.1, CCF score 9.3+/-3.6, the number of organ dysfunction 2.1+/-1.3. Overall mortality rate was 48%. When we compared sepsis group with non-sepsis group, the number of organ dysfunction and severity of illness were significantly higher in sepsis group than that of non-sepsis group. A mortality rate of sepsis group was significantly higher than non-sepsis group (82.6% vs 31.3%, p<0.001). In univariate analysis, significant risk factors for mortality were the number of organ dysfunction, severity of illness, MAP, platelet count, serum albumin level, and a type of hemofilter. Significances of all these factors were lost in multiple linear regression analysis. CONCLUSION: A large scaled, prospective randomized multi-center trials are needed to confirm the beneficial effect of CRRT in patient with ARF in ICU.

A Case of Emphysematous Pyelitis in a Renal Transplant Recipient / 대한이식학회지

Emphysematous pyelitis (EP) is a rare complication of urinary tract infection, which has been defined as isolated gas production inside the excretory system. Contrary to emphysematous pyelonephritis, which is more severe, necrotizing infection of the renal parenchyma, EP is a benign entity. To our knowledge, it has not been reported in the Korean literature, particularly in renal transplant recipients. Herein we report a case of EP in a living renal transplant recipient. A 32-year-old man received a living related renal transplant 4 years earlier for end-stage renal disease secondary to chronic glomerulonephritis. The patient presented with a sudden onset of chills, nausea, vomiting and pain on graft area. He was diagnosed as EP by computerized tomography. Immunosuppressive agents were modified and he was successfully treated with parenteral antibiotics with complete disappearance of air in the renal pelvis.

An Analysis of 3,000 Cases of Percutaneous Renal Biopsy: Single Center Study / 대한신장학회지

PURPOSE: The incidence of glomerular diseases varies according to population characteristics and time period. METHODS: A total of 3,000 renal biopsies were performed over the 29 years' period from 1978 to 2007. We reviewed the patient records of all patients who underwent renal biopsies at our institution. The patients were grouped for analysis in three time intervals: before 1990, 1991 to 2000, and after 2001. RESULTS: There were 2,377 cases of native kidney biopsies and 623 cases of allograft kidneys. The principal long-term changes were an increase in the mean age of patients with undergoing biopsy and an increase in the percentage of asymptomatic urinary abnormalities as an indication for biopsy. In the primary glomerulonephritis (GN), the most common pathologic diagnosis was IgA nephropathy (IgAN, 26.6%), followed by minimal change disease (MCD, 21.4%), membranous nephropathy (8.9%), focal segmental glomerulosclerosis (7.7%). The major changes noted in primary GN were a marked increase in the frequency of IgAN and decrease in the frequency of MCD. Major causes of secondary GN were lupus nephritis (37.9%), and hepatitis associated GN (28.9%). In allograft biopsies, acute rejection (42.3%) and chronic rejection (19.4%) were the two most common diagnoses. Documented complications of renal biopsies included perirenal hematoma (25.1%), but the rate of serious complications that required surgical intervention or embolization was very low (1.0%). There was no death or nephrectomy case in our study. CONCLUSION: IgAN was the most common primary GN in this study. The multi-center studies are needed to evaluate the distribution and changing trends of renal disease in Korea.

Peritonitis by Chryseobacterium indologenes and Sphingomonas paucimobilis in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) / 대한신장학회지

Bacterial peritonitis is a well-recognized complication of continuous ambulatory peritoneal dialysis (CAPD) in patients with end-stage renal failure. Chryseobacterium indologenes is a non-fermentative Gram-negative bacillus that is a rare pathogen in humans and Sphinomomas paucimobilis has rarely been reported as an opportunistic human pathogen. We present a case of peritonitis due to unusual pathogens, C. indologenes and S. paucimobilis, unresponsive to the standard antibiotics therapy. A 51-year-old diabetic man undergoing CAPD for 45 days developed the first peritonitis due to C. indolegenes. Although he had received intraperitoneal antibiotics with good in vitro activity against organism, the signs of peritonitis persisted. S. paucimobilis was isolated from dialysate sample. The Tenckhoff catheter was finally removed on 19th day of hospitalization and the fever and abdominal pain subsided.

Change of Parathyroid Hormone and Markers of Bone Metabolism after Renal Transplantation / 대한신장학회지

PURPOSE: The aims of this retrospective study were to evaluate the sequential changes of parathyroid hormone (iPTH) and calcium metabolism after renal transplantation (RTP) and to identify risk factors for hypertension (HPT). METHODS: Biochemical bone parameters were reviewed in 264 patients at pre-transplant, 6, 12, 36 and 60 months after RTP. RESULTS: iPTH levels fell significantly during the first six months after RTP and remained substantially stable thereafter. The mean total serum calcium level showed significant increase during the first six months and progressive and significant decline after the first year. The mean serum phosphorus level returned to the normal range during the first six months and remained normal thereafter. The serum alkaline phosphatase (ALP) level increased during the first year and gradually decreased after then. The prevalence of persistent HPT was 17.8%. Patients with persistent HPT had significantly elevated serum levels of iPTH at the time of RTP and had spent a longer time on dialysis. Significant positive correlations were observed between the serum iPTH levels on the one hand and the pre-transplant iPTH, serum ALP, and creatinine levels on the other hand. CONCLUSION: The prevalence of persistent HPT after RTP is not uncommon. The patients with long duration of dialysis showing high serum level of iPTH at the time of transplantation are at risk for persistent HPT.

Long-term Prognosis of IgA Nephroapthy / 대한신장학회잡지

BACKGROUND: IgA nephropathy (IgAN) is the most frequent primary glomerulonephritis in the world. Despite 20 years of research into this condition, much remains unknown about its pathogenesis and therapy. One major problem is that the prognostic evaluation and renal survival of IgAN is unreliable. METHODS: A retrospective study was performed to clarify the prognostic factors and the long-term renal survival rates of this disease. RESULTS: One hundred fifty-two patients with IgAN who followed-up at least 3 years after renal biopsy were included in this study. During a mean followed-up of 9.3 years after their renal biopsy (range:36-215 months), 33 of them (21.7%) had progressed to end-stage renal disease (ESRD). The actuarial renal survival rate was 97% at 5 years, and 85% at 10 years. Using univariate analysis, 5 risk factors for developing ESRD were identified:male sex, hypertension, heavy proteinuria, renal insufficiency at the time of biopsy, severe histopathologic findings such as subclass IV/V lesions by Haas' subclassification were associated with significant risk factors for developing ESRD. In multivariate regression analysis, only Haas' subclass IV/V lesions and renal insufficiency at the time of biopsy were the independent prognostic factors of IgAN. CONCLUSION: In conclusion, further long-term prospective study with larger number of patients would be necessary to assess the prognostic factors in IgAN.

A case of secondary renal amyloidosis complicating Crohn's disease / 대한내과학회지

Secondary amyloidosis is characterized by accumulation of an amorphous proteineous material in the various tissue and orgrans with infectious or inflammatory disease. Renal amyloidosis in Crohn's disease is a rare condition with proteinuria in the most cases and serious clinical complication due to the unfavorable prognosis. We are reporting a case of secondary renal amyloidosis in a 30-year old man with Crohn's disease presenting with nephrotic syndrome and renal failue.