Hepatic Tuberculous Abscess and Miliary Tuberculosis in A Hemodialysis Patient / 대한신장학회잡지

The impairment of host defense mechanisms, particularly of cellular immunity, causes high incidence of mycobacterial infections in the patients with ESRD. Extrapulmonary mycobacterial infections are more frequent in ESRD patients compared to general population. However, there has been rarely reported on the occurrence of hepatic tuberculous abscess as an extrapulmonary mycobacterial infection in ESRD patients. We present a case of ESRD patient manifesting miliary tuberculosis and hepatic tuberculous abscess, which have successfully resolved after anti-tuberculous medications. A 44 years old male admitted with fever, general weakness, night sweating, and cough. Chest X-ray and abdominal CT revealed pulmonary miliary tuberculosis and a solitary tuberculous abscess at S7 of right hepatic lobe with multiple periportal and celiac lymphadenopathy. After the administration of anti-tuberculous medications(isoniazid, rifampicin, ethambutol - eight month, pyrazinamide - two month), miliary tubuculosis disappeared. The size of hepatic tuberculous abscess and lymphadenopathy were reduced in abdominal CT six month later. The patient is followed in outpatient without noticeable symptoms after eight month treatment.

Nandrolone Decanoate-Induced Transient Ultrafiltration Failure in End Stage Renal Disease Patients Undergoing Dialysis / 대한신장학회잡지

Nandrolone decanoate(ND), one of the anabolic steroids, has been used by athletes to build muscle mass and enhance weight-lifting performance and has also shown to be useful in malnourished ESRD patients. However, ND has several adverse effects including edema. After we experienced a case of severe edema and transient ultrafiltration failure(TUF) requiring more frequent number of dialysis during ND treatment, we prospectively studied the incidence and clinical characteristics of TUF during ND treatment. Among 30 ND-treated patients, 7 patients developed TUF. All TUF+ patients were female and had sigificantly higher number of patients with congestive heart failure, more use of minoxidil and moderate to severe malnutrition than TUF- patients. There were no significant differences in age, duration of dialysis, and number of diabetics between TUF+ and TUF- group. In ND-treated male patients, the number of patients with CHF and moderate to severe malnutrition and with use of minoxidil were significantly lower than TUF+ ones. Body weight and serum albumin concentrations were significantly increased 2-3 months after ND treatment in TUF+ patients. But there were no differences in body weight and serum albumin in TUF-patients. In TUF+ patients, frequency of HD increased from 3 times to 4 to 6 times a week. CAPD patients with TUF+ had more frequently used 4.25% dialysate and number of exchanges were increased. In most TUF+ patients, severe edema and TUF were disappeared about 2 weeks after treatment. Most TUF+ patients returned to previous schedle of dialysis. In conclusion, ND seems to induce TUF in ESRD patients who had risk for volume regulation such as CHF, hypoalbuminemia, or the use of minoxidil.

Prospective Analysis of Factors that Affect Change of Lipoprotein(a) in Hemodialysis Patients During 2 Years / 대한신장학회잡지

Lipoprotein(a) [Lp(a)] is an independent risk factor for cardiovascular disease that is a major cause of death in dialysis patients. It has been described to be increased in chronic renal failure patients on conservative treatment or dialysis. It has also been suggested that high concentration of Lp(a) correlates to malnutrition of hemodialysis patients, but this has unproven. The aim of our study was the evaluation of factors that affect changes of Lp(a) concentration through follow up in hemodialysis patients. We assessed the serum concentrations of lipoprotein(a), serum albumin, nPCR, various biochemical parameters and Kt/V as adequacy of dialysis in 25 hemodialysis patients over a 48-months period. The mean serum concentrations of Lp(a) were 40.0+/-21.3mg/dL at basal level, 39.2+/-16.6mg/dL after 48 months, respectively. Significant correlation was found between basal and follow up Lp(a) levels(r=0.76, p=0.0001). Moreover, a significant inverse correlation was observed between changes of serum Lp(a) level and changes of serum albumin level(r=-0.507, p=0.027). However no significant correlation was found between changes of serum Lp(a) level and changes of lipid profiles, nPCR, URR and Kt/V. Our data suggests the possibility of the influence of nutritional status(changes of serum albumin) on changes of serum Lp(a) level in hemodialysis patients. Further prospective studies are warranted to clarify the influence of nutritional status on the Lp(a) in hemodialysis patients.

Effect of 1.5 and 4.25% Dialysate on Gastric Myoelectrical Activity in CAPD Patients / 대한신장학회잡지

Gastric motility is controlled by gastric myoelectrical activity, which propagates from the proximal body to the distal antrum at a frequency of 3 cycles per minute(cpm). Peritoneal infusion of dialysate may influence on gastric motility in continuous ambulatory peritoneal dialysis(CAPD) patients. To investigate the concentration of dialysate affects the gastric myoelectrical activity in CAPD patients, we performed electrogastrographic studies(EGG) in 13 non-diabetic CAPD patients. EGG was measured noninvasively using abdominal surface electrodes at the fasting state at empty and 2 hours after 1.5% and 4.25% 2,000mL dialysate, respectively. The dominant power (DP) and the percentage of normal slow-wave frequency(NSWF) had significantly decreased after 4.25 % infusion than the baseline. Tachygastria had significantly increased after 4.25% infusion. Changes in the gastric myoelectrical activity after 1.5% was less prominent than that of 4.25%. In conclusion, peritoneal dialysis may influence on gastric myoelectrical activity and higher osmolar solution may more aggrevate gastric myoelectrical activity than lower one.