Factors associated with Endothelial Dysfunction in Hemodialysis Patients / 대한신장학회지

PURPOSE: Endothelial dysfunction is an event in the atherosclerotic process usually considered reversible at its early stage. Early detection, therefor, may improve the prognosis in the cardiovascular disease. The aim of this study was to investigate the vascular function in hemodialysis (HD) patients and to explore its relation to other various parameters with a specific emphasis on systemic inflammatory reaction (SIR), nutritional status and the presence of ischemic heart disease (IHD). METHODS: Flow-mediated endothelium-dependent vasodilatation (FMD) was measured, using Doppler sonogram, in 37 stable HD patients, 11 healthy people and 24 hypertensive controls. Nitroglycerine- induced endothelium-independent vasodilatation (EIV) and peak reaction time (PT) of each FMD and EIV were also measured. RESULTS: FMD in HD patients was decreased compared to healthy group whereas it was comparable in HD patients and hypertensive control. EIV in HD patients was significantly decreased compared to healthy and hypertensive controls. PT of each FMD and EIV was significantly delayed in HD patients. Each FMD and EIV showed a negative correlation with serum hsCRP level, but no significant correlations of FMD with other parameters were noted. Both FMD and EIV were further decreased in HD patients with IHD than non-IHD group. CONCLUSION: Our study confirmed a characteristic pattern of vascular dysfunction in HD patients: the impaired endothelial and smooth muscle function with a delayed reaction time. Importantly, SIR was one of the important factors determining vascular dysfunction in HD patients. Further studies will be necessary to define the causative role of SIR on endothelial dysfunction and the effect of inflammation- modulating therapy.

The Effect of FR167653, p38 Mitogen-Activated Protein Kinase (MAPK) Inhibitor, on the Expression of Slit Diaphragm-Associated Proteins in Experimental Diabetic Nephropathy / 대한신장학회지

PURPOSE: This study was undertaken to investigate the effect of a p38 mitogen-activated protein kinase (p38 MAPK) inhibitor, FR167653, on urinary albumin excretion and on the expression of slit diaphragm-associated proteins in diabetic rats. METHODS: Thirty-two Sprague-Dawley rats were injected with diluent [control (C), N=16] or streptozotocin intraperitoneally (DM, N=16). Eight rats from each group were treated with 5 mg/kg/day FR 167653 (C+FR, DM+FR) for 6 weeks. At the time of sacrifice, 24-hour urinary albumin excretion was determined by ELISA. Glomerular nephrin, P-cadherin, and ZO-1 mRNA and protein expression were determined by real-time PCR and Western blot, respectively, with sieved glomeruli. RESULTS: Urinary albumin excretion was significantly higher in DM compared to C rats, and this increase in albuminuria was significantly inhibited by the administration of FR167653 in DM rats. Glomerular phospho-p38 MAPK protein expression was significantly increased in DM rats compared to C rats, and FR167653 treatment significantly attenuated the increase in phospho-p38 MAPK expression in DM glomeruli. Nephrin mRNA and protein expression were higher in 6-week DM compared to C glomeruli, and these increases were significantly abrogated with FR167653 treatment in DM rats. In contrast, FR167653 had no effects on the decrease in P-cadherin expression and the increase in ZO-1 expression observed in DM glomeruli. CONCLUSION: These findings suggest that FR167653, a p38 MAPK inhibitor, reduce the amount of albuminuria in early diabetic nephropathy, and this anti-proteinuric effect seems to be related with the change of glomerular nephrin expression.

The Effect of Monocyte Chemoattractant Protein-1 (MCP-1) on Epithelial-Mesenchymal Transition in Human Peritoneal Mesothelial Cells / 대한신장학회지

PURPOSE: This study was undertaken to elucidate whether CC chemokine receptor 2 (CCR2) exists in human peritoneal mesothelial cells (HPMCs) and whether monocyte chemoattractant protein-1 (MCP-1) has direct effects on epithelial to mesenchymal transition (EMT) and fibronectin expression in HPMCs. METHODS: HPMCs were isolated from a piece of human omentum and were incubated with M199 media containing 5.6 mM glucose (LG), 5.6 mM glucose+94.4 mM mannitol (LG+M), LG+10 ng/mL recombinant human MCP-1 (LG+MCP-1), or 100 mM glucose (HG) with or without a specific inhibitor of CCR2, 1.0 micrometer RS102895, for 4 days. Levels of secreted MCP-1 in culture media were determined by ELISA. Western blot was performed to determine fibronectin, E-cadherin, alpha-smooth muscle actin (alpha-SMA) and CCR2 protein expression. RESULTS: MCP-1 protein levels were significantly increased in HG-conditioned media compared to LG media (p<0.05). CCR2 protein was expressed in HPMCs, but there was no difference between LGand HG-stimulated cells. alpha-SMA protein expressions in HG and LG+MCP-1 groups were significantly higher relative to LG cells, while E-cadherin protein expressions were decreased in HG and LG+ MCP-1 groups compared to LG cells (p<0.05). In addition, there were significant increases in fibronectin mRNA and protein expression in HG and LG+MCP-1 groups (p<0.05). These HG-induced changes were significantly abrogated upon pre-treatment with RS102895. CONCLUSION: HG and MCP-1 directly induce EMT and enhance fibronectin expression in HPMCs, and these HG-induced changes were attenuated by the inhibition of MCP-1/CCR2 system, suggesting that increased MCP-1 levels by HG may contribute to the development of peritoneal fibrosis.

Two Cases of Nephrolithiasis Following Administration of Cyclosporine / 대한신장학회지

Cyclosporine is one of the most useful immunosuppressants for many diseases including nephrotic syndrome, glomerulonephritis, organ transplantation, and other autoimmune diseases. However, cyclosporine is known to cause renal tubular acidosis (RTA) due to a decrease in urinary ammonium excretion. Cyclosporine also can lead to significant hypocitraturia due to a higher proximal tubular reabsorption of citrate and increase the risk for nephrolithiasis. Citrate excretion is essential for the prevention of urinary supersaturation and hypocitraturia is a major risk factor for nephrocalcinosis and nephrolithiasis. Now we report two cases of nephrolithiasis treated with cyclosporine. The first patient is a renal transplantation recipient and the second patient has membranous glomerulonephritis. Therefore, these two cases lead us to conclude that patients treated with cyclosporine have to be regularly followed up for nephrolithiasis caused by cyclosporine-induced tubular dysfunction.

Analysis of Erroneous Overestimation of Blood Glucose in Patients on Continuous Ambulatory Peritoneal Dialysis with Icodextrin / 대한신장학회잡지

PURPOSE: Icodextrin in peritoneal cavity is absorbed via the lymphatics to the blood and metabolized to maltose and maltriose which may interfere with correct measurement of glucose. In an attempt to evaluate the effects of icodextrin on the erroneous results of blood glucose, we measured blood glucose by different methods. METHODS: Peripheral capillary blood and venous blood were obtained from 12 patients using icodextrin and from 12 patients not using icodextrin. Venous blood glucose was measured by using the laboratory technique (glucose oxidase method), and capillary blood glucose was measured by using a Surestep (glucose oxidase method) and an Acucheck (GDH-PQQ method). To estimate icodextrin and its metabolites indirectly, we calculated osmolal gap. We measured blood icodextrin and its metabolites with amyloglucosidase in icodextrin group. RESULTS: In icodextrin group, glucose was overestimated in the results of the GDH-PQQ method (delta= GDH-GOD=56.2+/-30 mg/dL [vein] 58+/-32 mg/dL [capillary]), but in the control group, there were no significant differences in the results between the glucose oxidase method and the GDH-PQQ method. There was a correlation between the osmolal gap and the differences in the results (delta=GDH-GOD) (r=0.741, p=.006 [vein], r=0.671, p=.017 [capillary]). Blood icodextrin and its metabolites were related with the differences in the results (delta=GDH-GOD) (p=.026, r=0.635), but there was no significant correlation between the osmolal gap and the icodextrin and its metabolites (p=0.086, r=0.515). CONCLUSION: Icodextrin and its metabolites may lead to erroneously high blood glucose levels when measured by GDH-PQQ method. It is necessary to be aware of this factor in order to prevent overlooking dangerous hypoglycemia.

Methylenetetrahydrofolate Reductase (MTHFR) Polymorphism in Korean Chronic Renal Failure Patients: Impacts on Hyperhomocysteinemia and Peripheral Atherosclerosis / 대한신장학회지

PURPOSE: Recently, many studies have investigated that Methylenetetrahydrofolate Reductase (MTHFR) polymorphism may be not a only cause for hyperhomocysteinemia, but also an independent risk factor for cardiovascular disease or atherosclerosis in renal failure patients. In this study, we analyzed MTHFR polymorphisms in chronic renal failure (CRF) patients, and investigated relationship between MTHFR polymorphism and peripheral atherosclerosis. METHODS: One hundred twenty eight CRF patients with GFR < 30 mL/min were enrolled. We analyzed their MTHFR polymorphism by standard PCR/restriction fragment length polymorphism and measured their ankle brachial index (ABI) using blood pressure cuff and Doppler stethoscope. Plasma homocysteine, vitamin B12, and folic acid levels were measured. 170 healthy peoples were enrolled for control group. RESULTS: The distribution of MTHFR 677 polymorphism of CRF patients was as follows: CC genotype, 33.6%; CT, 47.7% and TT 18.7%. Plasma homocysteine concentration was higher in TT group than in CC group (p < 0.05). The distribution of MTHFR 1298 polymorphism of CRF patients was as follows: AA type, 63.78%; AC, 33.07% and CC 18.7%. The distributions of MTHFR polymorphisms in control group were not different from patients group, respectively. There was no definite correlation between ABI and plasma homocysteine concentration. A trend of lower ABI in TT type compared with CC type within CRP patients group, but no statistical significance was shown. CONCLUSIONs: No difference of the distribution of MTHFR polymorphism was noted between CRF patients and healthy population. In CRF patients, MTHFR C677T mutation was closely associated with hyperhomocysteinemia, but both did not significantly influence to peripheral arterial disease.

Markers of Inflammation in the Stenosis of Hemodialysis Vascular Access / 대한신장학회잡지

BACKGROUND: Histologically, vascular access stenosis is similar to the atherosclerotic lesion such as neointimal hyperplasia. However, the pathogenesis is not completely understood. The development of Inflammation and atherogenesis in hemodialysis population has been well recognized and is known as the malnutrition-inflammation-atherosclerosis (MIA) syndrome. We, therefore, examined the relationship between the vascular access stenosis and proinflammatory molecules in hemodialysis patients METHODS: Seventy-two regularly dialyzed patients were observed and the serum levels of the proinflammatory cytokines (IL-6, TNF-alpha and INF-gamma) were measured by ELISA. Patients were followed until the earliest date of death, modality change or loss to follow up. RESULTS: Vascular access stenosis was developed in thirty-five patients, and their mean duration of access survival was 22.7+/-37.6 months. In thirty-seven patients, vascular access remained patent during the study period (mean follow up; 70.9+/-46.6 months). In patients with autologous AV fistula, multivariate Cox regression analysis showed a significant contribution of INF-gamma to vascular access stenosis (Hazard ratio 1.024, p=0.044). In patients with AV graft, there was no significant relation between inflammatory cytokines and graft stenosis. There were positive correlations between the level of TNF-alpha and ferritin, and between transferrin and albumin. CRP and ferritin were negatively correlated with albumin and transferrin. CONCLUSIONS: Markers of inflammation were significantly associated with nutrition. And INF-gamma, one of the inflammatory cytokines, was related to the vascular access stenosis.

Effects of Short-Term Partial Correction of Anemia in End-Stage Renal Disease (ESRD) Patients on Maintenance Hemodialysis : Changes of Amino-Terminal Pro B-type Natriuretic Peptide (NT-pro BNP) and Echocardiographic Parameters / 대한신장학회잡지

BACKGROUND: Anemia is known to be one of the important risk factors in the development and the aggravation of cardiovascular diseases. This study was undertaken to evaluate the effect of anemia correction on blood NT-pro BNP level and echocardiographic parameters in ESRD patients on hemodialysis. METHODS: Recombinant human erythropoietin (rHuEPO) was administered in 20 hemodialysis patients (median age 51.5, M:F=2.3:1) with a target hemoglobin>12.0 g/dL for 3 months. All patients were subjected to a serial follow-up of hemoglobin, hematocrit, and NT-pro BNP. Echocardiographic examination was also performed before and after 3 months of therapy. RESULTS: Hemoglobin was increased at 3 months [12.3 g/dL (11.8-13.6)] compared with baseline [9.8 g/dL (9.1-10.4)] (p<0.01), and NT-pro BNP was significantly decreased at 3 months [3415 pg/mL (2717- 8160)] compared with baseline [6371 pg/mL (2338- 18269)] (p<0.05). Echocardiographic examination revealed no significant changes in left ventricular ejection fraction and left ventricular mass index. In Doppler imaging, however, there was significant decrease in E velocity [62.5 cm/sec (52.8-83.5) vs. 57.0 cm/sec (45.0-60.0), p<0.05], thereby decrement in E/E' [15.6 (13.4-25.7) vs. 14.3 (11.5-22.2), p<0.05]. CONCLUSION: Partial correction of anemia with rHuEPO in ESRD patients on hemodialysis results in the reduction of blood NT-pro BNP level and the decrease of E velocity and E/E'.

Markers of Inflammation in the Stenosis of Hemodialysis Vascular Access / 대한신장학회잡지

BACKGROUND: Histologically, vascular access stenosis is similar to the atherosclerotic lesion such as neointimal hyperplasia. However, the pathogenesis is not completely understood. The development of Inflammation and atherogenesis in hemodialysis population has been well recognized and is known as the malnutrition-inflammation-atherosclerosis (MIA) syndrome. We, therefore, examined the relationship between the vascular access stenosis and proinflammatory molecules in hemodialysis patients METHODS: Seventy-two regularly dialyzed patients were observed and the serum levels of the proinflammatory cytokines (IL-6, TNF-alpha and INF-gamma) were measured by ELISA. Patients were followed until the earliest date of death, modality change or loss to follow up. RESULTS: Vascular access stenosis was developed in thirty-five patients, and their mean duration of access survival was 22.7+/-37.6 months. In thirty-seven patients, vascular access remained patent during the study period (mean follow up; 70.9+/-46.6 months). In patients with autologous AV fistula, multivariate Cox regression analysis showed a significant contribution of INF-gamma to vascular access stenosis (Hazard ratio 1.024, p=0.044). In patients with AV graft, there was no significant relation between inflammatory cytokines and graft stenosis. There were positive correlations between the level of TNF-alpha and ferritin, and between transferrin and albumin. CRP and ferritin were negatively correlated with albumin and transferrin. CONCLUSIONS: Markers of inflammation were significantly associated with nutrition. And INF-gamma, one of the inflammatory cytokines, was related to the vascular access stenosis.

Effects of Short-Term Partial Correction of Anemia in End-Stage Renal Disease (ESRD) Patients on Maintenance Hemodialysis : Changes of Amino-Terminal Pro B-type Natriuretic Peptide (NT-pro BNP) and Echocardiographic Parameters / 대한신장학회잡지

BACKGROUND: Anemia is known to be one of the important risk factors in the development and the aggravation of cardiovascular diseases. This study was undertaken to evaluate the effect of anemia correction on blood NT-pro BNP level and echocardiographic parameters in ESRD patients on hemodialysis. METHODS: Recombinant human erythropoietin (rHuEPO) was administered in 20 hemodialysis patients (median age 51.5, M:F=2.3:1) with a target hemoglobin>12.0 g/dL for 3 months. All patients were subjected to a serial follow-up of hemoglobin, hematocrit, and NT-pro BNP. Echocardiographic examination was also performed before and after 3 months of therapy. RESULTS: Hemoglobin was increased at 3 months [12.3 g/dL (11.8-13.6)] compared with baseline [9.8 g/dL (9.1-10.4)] (p<0.01), and NT-pro BNP was significantly decreased at 3 months [3415 pg/mL (2717- 8160)] compared with baseline [6371 pg/mL (2338- 18269)] (p<0.05). Echocardiographic examination revealed no significant changes in left ventricular ejection fraction and left ventricular mass index. In Doppler imaging, however, there was significant decrease in E velocity [62.5 cm/sec (52.8-83.5) vs. 57.0 cm/sec (45.0-60.0), p<0.05], thereby decrement in E/E' [15.6 (13.4-25.7) vs. 14.3 (11.5-22.2), p<0.05]. CONCLUSION: Partial correction of anemia with rHuEPO in ESRD patients on hemodialysis results in the reduction of blood NT-pro BNP level and the decrease of E velocity and E/E'.

A Case of Graft Intolerance Syndrome Treated by Percutaneous Renal Artery Embolization / 대한신장학회잡지

In patients with renal transplant failure's the graft can be left in situ when there are no additional complications. Graft intolerance occurs in some failed renal grafts when the immunological treatment is completely withdrawn. We experienced a case of graft intolerance syndrome in a patient with renal graft failure treated by percutaneous renal artery embolization. A 31 year -old man was admitted at nephrology department because of fever and hematuria without other infection focus. He was diagnosed as graft intolerance syndrome and treated by percutaneous embolization of the failed renal allograft. The embolization was successful. He suffered from post-emboization syndrome and treated by sulindac. We report this case with a review of relevant literatures and conclud that percutaneous renal artery embolizaion is a simple, safe and effective technique for the treatment of nonfunctioning renal allograft with clinical intolerance. Surgical nephrectomy should be reserved as a second level of treatment when allograft embolization has been ineffective owing to reappearance of manifestations of clinical intolerance.

A Case of Baclofen-Associated Encephalopathy in a Maintenance Hemodialysis Patient / 대한신장학회잡지

Baclofen, a derivative of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), is used for the treatment of muscle spasm, intractable hiccups and multiple sclerosis. It is mostly excreted by glomerular filtration with a clearance that is proportional to creatinine clearance. Early hemodialysis is a treatment of the choice for baclofen-induced neurologic complication in renal failure patients. We experienced a 57-year-old hemodialysis patient with right arm muscle spasm who developed baclofen-associated encephalopathy by a single dose of oral baclofen (10 mg). He admitted to the hospital with the symptom of stuporous mental status with no specific focal neurologic signs. Brain CT imaging and blood biochemistry showed no specific abnormality. EEG revealed the typical metabolic encephalopathy findings, such as triphasic wave and frontal lobe syndrome with delta wave. After daily hemodialysis for 3 days, there was a complete recovery of an altered mentality. After one month later, the follow-up EEG showed normal finding with the resolution of abnormal waves. We report this case with a review of relevant literature. Baclofen should be used carefully, and rather recommended not to be administered in patients with renal failure.

A Case of Baclofen-Associated Encephalopathy in a Maintenance Hemodialysis Patient / 대한신장학회잡지

Baclofen, a derivative of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), is used for the treatment of muscle spasm, intractable hiccups and multiple sclerosis. It is mostly excreted by glomerular filtration with a clearance that is proportional to creatinine clearance. Early hemodialysis is a treatment of the choice for baclofen-induced neurologic complication in renal failure patients. We experienced a 57-year-old hemodialysis patient with right arm muscle spasm who developed baclofen-associated encephalopathy by a single dose of oral baclofen (10 mg). He admitted to the hospital with the symptom of stuporous mental status with no specific focal neurologic signs. Brain CT imaging and blood biochemistry showed no specific abnormality. EEG revealed the typical metabolic encephalopathy findings, such as triphasic wave and frontal lobe syndrome with delta wave. After daily hemodialysis for 3 days, there was a complete recovery of an altered mentality. After one month later, the follow-up EEG showed normal finding with the resolution of abnormal waves. We report this case with a review of relevant literature. Baclofen should be used carefully, and rather recommended not to be administered in patients with renal failure.

Clinical Implication of Hyperhomocysteinemia in Hemodialysis Patients: Impact of Nutritional Status / 대한신장학회잡지

BACKGROUND: Cardiovascular disease (CVD), especially ischemic heart disease (IHD) and vascular access occlusion (VAO) is the most common morbidity in dialysis patients. Hyperhomocysteinemia (HHcy) is regarded as an independent risk factor of atherosclerosis in general population, however clinical implication of HHcy in dialysis patients is controversial. Nutritional status of dialysis patients is also known to be closely linked to CVD. METHODS: To investigate the impact of the presence of HHcy and malnutrition on cardiovascular events, especially ischemic heart disease (IHD) and vascular access occlusion (VAO). We measured plasma levels of Hcy and other biochemical parameters with an evaluation of nutritional status using subjective global assessment (SGA) in 44 HD patients and gender-matched control subjects of comparable age. RESULTS: Mean plasma Hcy was 18.6 microM/L (range 5-28), which was significantly higher than normal control (8.6+/-2.0 microM/L, p< 0.05). There was no significant correlation between plasma Hcy and the levels of folate or vit B12. Mean Hcy was significantly higher in patients with normal nutritional status compared to mild-to-moderately malnourished patients (22.0+/-3.2 vs. 15.1+/-4.1 microM/L, p<0.05), and there was a significant positive correlation of Hcy level with serum albumin or nPNA. There was no significant difference in plasma Hcy level according to the presence of IHD or VAO. However, interestingly, in HD patients group with lower serum albumin (<3.9 g/ dL), frequency of VAO was significantly correlated with Hcy (r2=0.68, p<0.001) whereas no significant correlation was observed in patients with higher albumin level. CONCLUSION: The clinical implication of HHcy in HD patients may be different from general healthy population. Nutritional status can be one of the important factors influencing plasma Hcy level. And, high plasma level of Hcy in malnourished HD patients has to be carefully followed up in terms of the development of atherosclerotic CVD and VAO.

ABI and Risk Factors of Peripheral Vascular Disease in Maintenance Dialysis Patients: According to the Modality of Dialysis / 대한신장학회잡지

BACKGROUND: PVD is a risk marker for coronary disease, cerebrovascular disease and many other conditions. One of the simplest, noninvasive and most useful parameters to objectively assess PVD is the ankle-brachial index (ABI). The aim of our study was to explore the frequency, severity and the risk factors of peripheral vascular disease in dialysis patients, especially according to dialysis modality. METHODS: We studied 85 maintenance dialysis patients (HD 50 patients, PD 35 patients) and control (n=73) who has normal serum creatinine without DM, hypertension. ABI was tested during about 2 hrs into the hemodialysis by doppler ultrasono (Smartdop 30, HADECO, Japan). The severity of PVD was stratified into 3 groups based upon ABI [normal (0.9 or =55 yrs), duration of dialysis and HD were negatively correlated with ABI: r= -0.309; p<0.01 for HD modality. Multiple regression analysis demonstrated that HD modality (than PD) predicted ABI with an adjusted R2=0.206 and p<0.01. CONCLUSION: We conclude that ABI was significantly decreased in HD pts than PD pts. The frequency of severe PVD was significantly higher in HD pts than PD pts. These findings suggest that dialysis modality may be related to the severity of PVD in the maintenance dialysis patients. Further studies are needed to understand the association between PVD and nutrition factors, inflammation markers and dialysis- or uremia-related factors in maintenance dialysis patients.

A Case of Spontaneous Rupture of the Kidney with Acute Pyelonephritis / 대한신장학회잡지

Spontaneous rupture of the kidney, Wonderlich syndrome, is a rare event but potentially life-threatening condition. The most comman causes are clear cell carcinoma, benign angiomyolipoma and vascular disease. Among this event, acute pyelonephritis is a very unusual cause. A 67-year-old diabetic woman was admitted with high fever and left flank pain due to acute pyelonephritis. She had uterine prolapse for 10 years with both renal hydronephrosis before this event. Abdominal ultrasonography and CT scan showed fluid collection around left kidney with a rupture of renal parenchyme at lower pole. The renal angiography showed displaced capsular artery due to subcapsular hematoma and decreased blood flow at lower pole. The percutaneous needle aspiration revealed blood collection around left kidney, which confirmed spontaneous rupture of the kidney. We report this case with a review of the relevant literature.

Clinical Implication of Hyperhomocysteinemia in Chronic Renal Failure / 대한신장학회잡지

No abstract available.

A Case of Chryseobacterium (Flavobacterium) meningosepticum Peritonitis in a Patient on CAPD / 대한신장학회잡지

Peritonitis remains the leading cause of morbidity and technique failure for patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Chryseobacterium meningosepticum is the most common pathogen for humans among Chryseobacterium species and a few cases of CAPD peritonitis caused by C. meningosepticum were reported in the world. We experienced a case of CAPD peritonitis by C. meningosepticum in Ewha Womans University Hospital, Seoul, Korea. A 52-year-old diabetic woman on CAPD was admitted with turbid peritoneal fluid. She was suffered from three episodes of peritonitis. Effluent was cloudy with a cell count of 1,620 WBC/ mm3 (94% neutrophils, 4% lymphocytes). Effluent cultures obtained on 6th hospital day revealed a mixed growth of C. meningosepticum and P. aeruginosa. Tenckhoff catheter was removed due to persistent cloudy effluent till 9th hospital day. We herein report a case of peritonitis caused by C. meningosepticum and review the literature of similar cases of peritonitis.

A Case of Severe Hypokalemia Induced by Chronic Furosemide Abuse / 대한신장학회잡지

A 46-year-old woman was admitted to emergency room for muscle weakness and repiratory difficulty. She was taking furosemide (4 tablets per day : 160 mg/day) without physician's prescription. Her blood pressure was 90/50 mmHg and her heart rate 74/ min. Her laboratory finding showed a low serum potassium concentration (0.9 mmol/L), CK 368 IU/L, creatine 1.6 mg/dL. The result was rechecked and confirmed. Electrocardiography showed a dip in the ST segment, prolonged QTc, 1st degree AV block and 2 : 1 AV block. Echocardiography was normal. Abdominal CT scan show right lower pole calyceal stones without nephrocalcinosis. Treatment was initiated consisting of intravenous potassium chloride. Hypokalemia was overcome in 3 days. Kidney biopsy showed hypokalemic nephropathy - interstitial nephrosis, vacuolar change of tubule, proliferation of juxtaglomerular apparatus. Paralytic ileus, rebound pleural effusion, glucose intolerance, elevation of CK were associated findings. After correction of hypokalemia, her symptoms and electrocardiographic findings returned to normal.

Production of MCP-1 and RANTES in Cultured Human Peritoneal Mesothelial Cells Stimulated with IL-1beta / 대한신장학회잡지

Human peritoneal mesothelial cells may have a great potential to secrete chemokines, growth factors, adhesion molecules, and various cytokines stimulated with proinflammatory cytokines during peritoneal infection. In the course of peritonitis, rapid neutrophil cell influx and subsequent monocytic cell influx can be observed. It has been demonstrated that human peritoneal mesothelial cells secrete a C-X-C chemokine, IL-8, which contributes to the recruitment of neutrophil influx during peritoneal infection. However, the production and role of C-C chemokines have not been fully defined in human peritoneal mesothelial cells. This study was performed to evaluate the production of MCP-1 and RANTES and their influence on the chemotaxis of monocytes when human peritoneal mesothelial cells were stimulated with IL-1beta. Mesothelial cells obtained by enzymatic digestion of pieces of human omentum and stimulated with a various doses and times of IL-1beta. The expression of MCP-1 and RANTES mRNA was measured by Northern blot assay and the expression of their proteins was analyzed by ELISA. To evaluate their function, monocytes chemotaxis assay was performed using a 48-well chemotactic chamber. Cultured human peritoneal mesothelial cells appeared to be polygonal at confluence using phase contrast microscope. Indirect immunofluorescent staining demonstrated that the mesothelial cells reacted positively with anti-cytokeratin antibody and anti-vimentin antibody. The expression of MCP-1 and RANTES mRNA increased in response to IL-1beta in time and dose dependent manner. The protein levels of MCP-1 and RANTES with stimulation of 1.0ng/mL of IL-1beta for 24 hours were higher than those without(30.0+/-2.22 vs 3.55+/-0.74ng/105cells and 1.53+/-0.41 vs 0.11+/-0.02ng/105cells respectively, p<0.05, n=6). Chemotaxis assay showed that the supernatants from human peritoneal mesothelial cells with stimulation of IL-1beta for 24 hours had significantly higher chemotaxis of monocytes than those without(71+/-3.4% vs 50+/-2.9%, p<0.05, n=6). Coincubation of supernatants with stimulation and antibodies to MCP-1 or RANTES(20 micro L/mL, 10 micro L/mL, respectively) resulted in a significant inhibition of chemotaxis of monocytes by 33% and 12%(47+/-3.1% and 62+/-3.0% respectively, p<0.05, n=6). Human peritoneal mesothelial cells are capable of the expression of MCP-1 and RANTES mRNA and the production of their proteins in response to IL-1beta. Functionally, mesothelial cells derived Mand RANTES may contribute to the recruitment of monocytes and amplify the inflammatory process. Thus, human peritoneal mesothelial cells play an important role during peritoneal infection.