Ciliary metaplasia in a patient with antineutrophil cytoplasmic autoantibody-associated pauci-immune glomerulonephritis

No abstract available.

Isolated Spontaneous Celiac Artery Dissection as a First Manifestation of Systemic Lupus Erythematosus / 전남의대학술지

No abstract available.

Frequency and Severity of Hypoglycemia in Type 2 Diabetes Mellitus Patients Treated with a Sulfonylurea-Based Regimen at University-Affiliated Hospitals in Korea: The Naturalistic Evaluation of Hypoglycemic Events in Diabetic Subjects Study / 가정의학회지

BACKGROUND: We assessed the frequency and severity of hypoglycemia in type 2 diabetes mellitus patients treated with sulfonylurea monotherapy or sulfonylurea+metformin. METHODS: We conducted a retrospective, observational, cross-sectional study in 2011 and 2012 including patients with type 2 diabetes mellitus aged ≥30 years who were treated with ≥6 months of sulfonylurea monotherapy or sulfonylurea+metformin at 20 university-affiliated hospitals in Korea. At enrollment, glycated hemoglobin (HbA1c) was assessed; participants completed self-reported questionnaires describing hypoglycemia incidents over the past 6 months. A review of medical records up to 12 months before enrollment provided data on demographics, disease history, comorbidities, laboratory results, and drug usage. RESULTS: Of 726 enrolled patients, 719 were included (55.6% male); 31.7% and 68.3% were on sulfonylurea monotherapy and sulfonylurea+metformin, respectively. Mean±standard deviation age was 65.9±10.0 years; mean HbA1c level was 7.0%±1.0%; 77.8% of patients had hypertension (89.4% used antihypertensive medication); 60.5% had lipid disorders (72.5% used lipid-lowering medication); and 52.0% had one or more micro- or macrovascular diseases. Among patients with A1c measurement (n=717), 56.4% achieved therapeutic goals (HbA1c <7.0%); 42.4% (305/719) experienced hypoglycemia within 6 months of enrollment; and 38.8%, 12.9%, 12.7%, and 3.9% of patients experienced mild, moderate, severe, and very severe hypoglycemia symptoms, respectively. Several reported hypoglycemia frequency as 1–2 times over the last 6 months. The mean number of very severe hypoglycemia episodes was 3.5±5.5. CONCLUSION: Among type 2 diabetes mellitus patients treated with sulfonylurea-based regimens, glycemic levels were relatively well controlled but hypoglycemia remained a prevalent side effect.

Safety and Efficacy of Tolvaptan in Korean Patients with Hyponatremia Caused by the Syndrome of Inappropriate Antidiuretic Hormone

BACKGROUND: The aim of this multicenter study was to evaluate the safety and efficacy of tolvaptan (TLV) in Korean patients with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). METHODS: Of 51 enrolled patients with SIADH, 39 patients (16 female patients, aged 70.8 ± 11.3 years) were included in an intention to treat analysis. All patients received 15 mg/day as the initial dose, and the dose was then increased up to 60 mg/day (as needed) until day 4. RESULTS: Serum sodium increased significantly from baseline during the first 24 hours (126.8 ± 4.3 vs. 133.7 ± 3.8 mmol/L, P < 0.001), rose gradually between days 1 and 4 (133.7 ± 3.8 vs. 135.6 ± 3.6 mmol/L, P < 0.05), and then plateaued until day 11 (136.7 ± 4.5 mmol/L). The correlation between the change in serum sodium for the first 24 hours and initial serum sodium concentration was significant (r = −0.602, P < 0.001). In severe hyponatremia (< 125 mmol/L), the change was significantly higher (11.1 ± 4.8 mmol/L) than in moderate (6.4 ± 2.5 mmol/L, P < 0.05) or mild hyponatremia (4.3 ± 3.3 mmol/L, P < 0.01). In addition, logistic regression analysis showed that body weight (odds ratio [OR], 0.858; 95% confidence interval [CI], 0.775–0.976; P = 0.020) and body mass index (BMI) (OR, 0.692; 95% CI, 0.500–0.956; P = 0.026) were associated with rapid correction. No serious adverse events were reported, but in 13% of patients hyponatremia was overcorrected. CONCLUSION: TLV is effective in correcting hyponatremia and well-tolerated in Korean patients with SIADH. However, those with low body weight, low BMI or severe hyponatremia, could be vulnerable to overcorrection with the initial dose of 15 mg TLV.

A Case of Acute Tubulointerstitial Nephritis Associated with Rifampin Therapy Presenting as Fanconi-like Syndrome / 전남의대학술지

No abstract available.

A Case of Acute Tubulointerstitial Nephritis Associated with Rifampin Therapy Presenting as Fanconi-like Syndrome / 전남의대학술지

No abstract available.

Crystals in a patient with asymptomatic proteinuria

No abstract available.

Thrombotic microangiopathy resulting from neglected blood pressure control

Hypertensive nephrosclerosis is usually associated with chronic hypertension, which increases the risk of progressive renal disease. Among the causes of malignant hypertension, thrombotic microangiopathy is complicated and is associated with renal dysfunction at the time of diagnosis. In this case, a young man with hypertension presented with renal failure and thrombocytopenia in the emergency department. This case emphasizes the importance of early recognition of renal failure and thrombocytopenia among patients with uncontrolled hypertension.

Decreased serum level and increased urinary excretion of vascular endothelial growth factor-C in patients with chronic kidney disease

BACKGROUND: Interstitial tonicity increases vascular endothelial growth factor-C (VEGF-C), a lymphangiogenic factor in salt-induced hypertension. Therefore, it can be assumed that changes of serum VEGF-C level may be associated with increasing blood pressure. However, there is no report about the changes of serum VEGF-C levels in patients with chronic kidney disease (CKD). The aims of this study were to investigate the changes of serum and urine VEGF-C levels in patients with CKD stage 3-4 and to evaluate the relationship between blood pressure and serum VEGF-C levels in the patients with CKD stage 5 and hemodialysis. METHODS: Glomerular filtration rate (GFR) was assessed by the Modification of Diet in Renal Disease equation. Blood pressure and VEGF-C levels (serum and urine) were measured by enzyme-linked immunosorbent assay (ELISA) in nine patients with stage 3-4 CKD, 41 hemodialysis patients, and eight healthy individuals. RESULTS: The median serum level of VEGF-C in patients with stage 3-4 CKD and stage 5 hemodialysis significantly decreased in comparison with healthy individuals. Urinary VEGF-C excretion increased in patients with stage 3-4 CKD compared with healthy control patients. For 41 hemodialysis patients, the serum level of VEGF-C in patients with stage 1 or stage 2 hypertension with hemodialysis did not significantly increase when compared with prehypertension hemodialysis patients. CONCLUSION: We demonstrated that circulating levels of VEGF-C were decreased in patients with CKD, and the decrease of VEGF-C in patients with stage 3-4 CKD coincided with an increase in the urinary excretion of VEGF-C.

Serial MR Imaging of Magnetically Labeled Humen Umbilical Vein Endothelial Cells in Acute Renal Failure Rat Model

PURPOSE: To evaluate the usefulness of in vivo magnetic resonance (MR) imaging for tracking intravenously injected superparamagnetic iron oxide (SPIO)-labeled human umbilical vein endothelial cells (HUVECs) in an acute renal failure (ARF) rat model. MATERIALS AND METHODS: HUVECs were labeled with SPIO and poly-L-lysine (PLL) complex. Relaxation rates at 1.5-T MR, cell viability, and labeling stability were assessed. HUVECs were injected into the tail vein of ARF rats (labeled cells in 10 rats, unlabeled cells in 2 rats). Follow-up serial T2*-weighted gradient-echo MR imaging was performed at 1, 3, 5 and 7 days after injection, and the MR findings were compared with histologic findings. RESULTS: There was an average of 98.4+/-2.4% Prussian blue stain-positive cells after labeling with SPIO-PLL complex. Relaxation rates (R2*) of all cultured HUVECs at day 3 and 5 were not markedly decreased compared with that at day 1. The stability of SPIO in HUVECs was maintained during the proliferation of HUVECs in culture media. In the presence of left unilateral renal artery ischemia, T2*-weighted MR imaging performed 1 day after the intravenous injection of labeled HUVECs revealed a significant signal intensity (SI) loss exclusively in the left renal outer medulla regions, but not in the right kidney. The MR imaging findings at days 3, 5 and 7 after intravenous injection of HUVECs showed a SI loss in the outer medulla regions of the ischemically injured kidney, but the SI progressively recovered with time and the right kidney did not have a significant change in SI in the same period. Upon histologic analysis, the SI loss on MR images was correspondent to the presence of Prussian blue stained cells, primarily in the renal outer medulla. CONCLUSION: MR imaging appears to be useful for in vivo monitoring of intravenously injected SPIO-labeled HUVECs in an ischemically injured rat kidney.

Masked Hydronephrosis

No abstract available.

Hemorrhagic fever with renal syndrome and coexisting hantavirus pulmonary syndrome

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease with fever, hemorrhage and renal failure caused by hantavirus infection. Hantavirus induces HFRS or hantavirus pulmonary syndrome (HPS). HPS progression to a life-threatening pulmonary disease is found primarily in the USA and very rarely in South Korea. Here, we report a case of HFRS and coexisting HPS.

An Overlooked Cause of Impaired Consciousness in a Hemodialysis Patient

No abstract available.

Acute Dermal Capillary Rupture in a Patient with Diabetic Nephropathy / 대한신장학회지

A 46-year-old diabetic woman visited our hospital with generalized edema and high blood pressure. An appropriately sized noninvasive blood pressure cuff was placed on her right arm above the elbow to measure blood pressure. While we were checking her blood pressure, we noticed small red petechial spots distal to the cuff involving her entire right forearm. Her blood pressure was 170/96 mmHg. The laboratory findings showed no abnormality of anticoagulation. The rest of the patient's extremities were not affected. The petechiae on the right arm resolved spontaneously after ten days. The most likely explanation for these petechiae is acute dermal capillaryrupture, which is called the Rumpel- Leede phenomenon. Acute dermal capillary rupture appears as petechiae in an area following application of vascular constriction such as application of tourniquet to draw blood specimen or use of blood pressure cuff due to capillary fragility or abnormal platelets in numbers or in function. This situation has been reported previously in the literature as the Rumpel-Leede phenomenon in association with prolonged noninvasive BP monitoring. In the patient described herein, increased venous pressure from blood pressure measurement and capillary fragility associated with diabetes mellitus may have increased the risk of acute dermal capillary rupture.

Periprocedural Hemoglobin Drop and Contrast-Induced Nephropathy in Percutaneous Coronary Intervention Patients

BACKGROUND AND OBJECTIVES: The development of contrast-induced nephropathy (CIN) is associated with an increased risk of death and late cardiovascular events after percutaneous coronary intervention (PCI). The relationship between CIN and hemoglobin drop has been controversial. The aim of this study was to evaluate the clinical usefulness of periprocedural hemoglobin drop as a nontraditional risk factor for CIN. SUBJECTS AND METHODS: Five-hundred thirty-seven patients who underwent PCI were divided into 2 groups: Group I (486 patients: patients who did not develop CIN) and Group II (51 patients: patients who developed CIN). All patients were administered iodixanol as contrast media during coronary angiography. CIN is defined as a rise in serum creatinine of > or =25% or > or =0.5 mg/dL above the baseline value within 48 hours after contrast administration. RESULTS: Baseline clinical and cardiovascular risk factors were not significantly different between the two groups, except for low abdominal circumference (Group I : Group II=87.9+/-9.0 cm : 81.2+/-15.1 cm, p=0.024), body weight (Group I : Group II=63.5+/-10.6 kg : 59.7+/-9.2 kg, p=0.008), body mass index (BMI) (Group I : Group II=24.4+/-3.4 kg/m2 : 23.4+/-2.8 kg/m2, p=0.032), pre-PCI hemoglobin (Group I : Group II=13.2+/-2.0 g/dL : 12.3+/-2.0 g/dL, p=0.003), and post-PCI hemoglobin (Group I : Group II=12.4+/-1.9 g/dL : 11.5+/-1.8 g/dL, p=0.001). Multiple logistic regression analysis showed that a periprocedural drop in hemoglobin (>1 g/dL) was an independent predictor of CIN, like other known risk factors. CONCLUSION: A periprocedural drop in hemoglobin of more than 1 g/dL is another important independent predictor for CIN, even in patients administered the lowest nephrotoxic contrast agent, iodixanol, during PCI.

The Anti-apoptotic Effect of Adrenomedullin on Vascular Endothelial Cells in Radiocontrast Media-induced Apoptosis / 대한신장학회지

PURPOSE: Because vascular endothelial cells play a pivotal role in the vascular diseases, damage of vascular endothelial cells lead to progression of vascular disease. Apoptotic damage of cells is an important mechanism in vascular disease. Therefore, several growth factors that have antiapoptotic effect may have a protective role in maintaining a cell function in apoptotic cell injury. In this study, we examined the effects of adrenomedullin on apoptosis in iopromide-induced endothelial cell injury. METHODS: Human umbilical vein endothelial cells were incubated with nonionic radiocontrast agent, iopromide and/or adrenomedullin. Apoptosis was assessed quantitatively using FACScan after annexin V-FITC and propidium iodide staining, and by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) stain. Signaling pathway was evaluated by Western blot analysis of phospho-Akt and Akt. RESULTS: Iopromide-induced apoptosis in human umbilical vein endothelial cells was increased in a dose-dependent manner. Adrenomedullin prevented iopromide-induced apoptosis in human umbilical vein endothelial cells in a dose dependent manner. Wortmannin, phosphatidylinositol 3-kinase inhibitor, decrease the adrenomedullin-induced antiapoptotic effect. CONCLUSION: These results suggest that adrenomedullin protects vascular endothelial cells from iopromide-induced apoptosis by regulating the activity of Akt.

Renal infarction resulting from traumatic renal artery dissection

Renal artery dissection may be caused by iatrogenic injury, trauma, underlying arterial diseases such as fibromuscular disease, atherosclerotic disease, or connective tissue disease. Radiological imaging may be helpful in detecting renal artery pathology, such as renal artery dissection. For patients with acute, isolated renal artery dissection, surgical treatment, endovascular management, or medical treatment have been considered effective measures to preserve renal function. We report a case of renal infarction that came about as a consequence of renal artery dissection.

Renal Subcapsular Hematoma: A Consequence of Reperfusion Injury of Long Standing Renal Artery Stenosis

Renal artery stenosis is a cause of secondary hypertension which can be cured by surgical or radiological intervention such as percutaneous transluminal renal artery stent placement. In this case we present a subcapsular hematoma of the kidney, a complication following percutaneous transluminal stent placement in the renal artery. Reperfusion injury to the kidney may be a possible mechanism of subcapsular hematoma of the kidney. Long standing severe renal artery stenosis and high pre- and post- procedure pressure gradient might contribute to the complication.

Changes in Urine Osmolar Composition seen in Different Age Groups in the Local Korean Population

Due to their unique living conditions and dietary habits, the Koreans' renal function model may be different from that of the Western people. About 40 years ago, a researcher reported that two thirds of the urine osmolality in Koreans was contributed by NaCl, while less than 1/3 by urea. It is known that the Koreans' daily consumption of NaCl is higher while their protein intake is lower, compared to that of the Westerners. Now-a-days, the Korean's dietary habit is changing to a westernized life style. In this study, we investigated whether there were changes in urine composition and osmolality according to age. The subject of study were 215 Koreans (128 male, 142 female, age 7-68 years) living in the Chonbuk and Chonnam province in Korea. We performed routine physical examinations and analyses of the urine Na+, K+, Cl-, urea, NH3, creatinine, and osmolality on their 24 hour urine samples. In the case of the male, total body water, Na and Cl excretion, urine ammonia excretion were significantly changed between groups. In the case of the female, total body water and urine creatinine excretion were significantly changed between groups. We calculated the urine osmolar contribution of NaCl and urea. Our results showed that NaCl composed 63.6 % of total urine osmolality and Urea composed 36.4% of total urine osmolality. In conclusion, urine osmolar composition is similar to the 1960's, but further studies are required to elucidate the change of urine composition in this population for another 50 years.

Mannitol-induced Metabolic Alkalosis

Mannitol is an osmotic diuretic agent useful in a variety of clinical conditions. This study is based on acid-base and electrolyte changes seen after the intravenous infusion of hypertonic mannitol for the prevention of cerebral edema. The study subjects were divided into 3 groups: for group A, an amount of 300-900 mL 15% mannitol was intravenously infused over the period of 60 to 90 minutes; for group B, 1,200-2,600 mL over 12 to 24 hours; and for group C, 3,200-4,900 mL over more than 24 hours. In group A, blood pH is increased from 7.43+/-0.07 to 7.46+/-0.04, and plasma HCO3- from 25.3+/-2.1 to 28.9+/-2.9 mEq/L, but plasma K+ is decreased from 4.3+/-0.6 to 3.7+/-0.8 mEq/L. In group B, blood pH is increased from 7.42+/-0.02 to 7.47+/-0.06, and plasma HCO3- from 25.2+/-1.8 to 29.1+/-2.9 mEq/L, but plasma K+ is decreased from 4.2+/-0.3 to 3.8+/-0.5 mEq/L. In group C, blood pH is increased from 7.41+/-0.01 to 7.52+/-0.04, and plasma HCO3- from 24.9+/-1.2 to 27.7+/-2.5 mEq/L, but plasma K+ is decreased from 4.2+/-0.1 to 3.9+/-0.2 mEq/L. These results showed that intravenous infusion of mannitol could induce metabolic alkalosis and hypokalemia, regardless of its dose. The mannitol induced metabolic alkalosis may be due to increased renal HCO3- production.