Development of a Zinc Database to Estimate the Zinc Intake Levels in the Korean Toddlers and Preschool Children / 대한지역사회영양학회지

Objectives@#The objective of this study was to develop a zinc database (DB) to estimate the intake levels of zinc in Korean toddlers and preschool children using the data from the Korea National Health and Nutrition Examination Survey (KNHANES). @*Methods@#A total of 3,361 food items for the DB representing the usual diet of Korean toddlers and preschool children were selected based on KNHANES (2009~2013) and the food composition table of Rural Development Administration (RDA). The existing values of zinc in foods were collected from the latest food composition tables of RDA (9th revision) and the US Department of Agriculture (legacy release). The zinc contents were filled preferentially with these collected values. The missing values were replaced with the calculated values or imputed values using the existing values of similar food items from the data source. The zinc intake levels of Korean toddlers and preschool children were estimated using KNHANES and zinc DB @*Results@#A total of 1,188 existing values, 412 calculated values, and 1,727 imputed values were included in the zinc DB. The mean intake levels of zinc for 1-2-year-old children and 3-5-year-olds were 5.17 ± 2.94 mg/day and 6.30 ± 2.84 mg/day, respectively.There was no significant difference in the zinc intake levels between boys and girls in each group. @*Conclusions@#This newly developed zinc DB would be helpful to assess the zinc nutritional status and investigate the association between the zinc intakes and related health concerns in Korean toddlers and preschool children.

Development of a Zinc Database to Estimate the Zinc Intake Levels in the Korean Toddlers and Preschool Children / 대한지역사회영양학회지

Objectives@#The objective of this study was to develop a zinc database (DB) to estimate the intake levels of zinc in Korean toddlers and preschool children using the data from the Korea National Health and Nutrition Examination Survey (KNHANES). @*Methods@#A total of 3,361 food items for the DB representing the usual diet of Korean toddlers and preschool children were selected based on KNHANES (2009~2013) and the food composition table of Rural Development Administration (RDA). The existing values of zinc in foods were collected from the latest food composition tables of RDA (9th revision) and the US Department of Agriculture (legacy release). The zinc contents were filled preferentially with these collected values. The missing values were replaced with the calculated values or imputed values using the existing values of similar food items from the data source. The zinc intake levels of Korean toddlers and preschool children were estimated using KNHANES and zinc DB @*Results@#A total of 1,188 existing values, 412 calculated values, and 1,727 imputed values were included in the zinc DB. The mean intake levels of zinc for 1-2-year-old children and 3-5-year-olds were 5.17 ± 2.94 mg/day and 6.30 ± 2.84 mg/day, respectively.There was no significant difference in the zinc intake levels between boys and girls in each group. @*Conclusions@#This newly developed zinc DB would be helpful to assess the zinc nutritional status and investigate the association between the zinc intakes and related health concerns in Korean toddlers and preschool children.

Constipation is Closely Associated with Depression in Patients with End-Stage Renal Disease Undergoing Hemodialysis or Peritoneal Dialysis / 대한신장학회지

PURPOSE: Constipation is a frequent complaint among dialysis patients. However, factors that contribute to constipation in these patients have not been evaluated rigorously. The aim of study was to assess the prevalence and factors that contribute to constipation in patients with End-Stage Renal Disease (ESRD) undergoing hemodialysis (HD) or peritoneal dialysis (PD). METHODS: Patients undergoing HD or PD for more than six months in the six dialysis centers were asked to complete a self-administered questionnaire that is designed to assess constipation by Rome- III criteria. Beck depression inventory (BDI) were assessed. A total of 146 patients (HD 91, PD 55) completed the study. RESULTS: The prevalence of constipation was 33% in 91 HD patients and 31% in 55 PD patients. Prevalence of constipation was 32% and did not differ by dialysis mode. Older age, unemployed state, high cumulative illness rating scale and high BDI were associated with constipation. In multivariate analysis, BDI was an independent factor associated with constipation. The prevalence of constipation was 18% and 50% for patients with BDI or =15, respectively. The odd ratio for constipation in patients with BDI > or =15 was 3.4 (95% CI, 1.4-8.1). CONCLUSION: Careful psychogenic attention must be paid to ESRD patients with constipation.

A case of lithium poisoning with a maintenance dose treated by hemodialysis / 대한내과학회지

Lithium is a commonly prescribed drug for bipolar disorder. Because of the narrow therapeutic range, lithium intoxication continues to be prevalent. Drugs that alter renal function such as ACEI, ARB, NSAIDS, and thiazide can increase the risk of chronic lithium toxicity even to stable patients. A 65-year old woman was admitted for hand tremor, cognitive impairment, and lethargy. A medical history included major depressive disorder, mitral stenosis, atrial fibrillation, and hypertension. Her prescription included lithium, quetiapine, digoxin, furosemide, and warfarin. She recently received Atacand Plus (candesartan plus thiazide) for hypertension. At the time of admission, the patient was drowsy and confused. The serum lithium level was 4.25 mEq/L. The patient received hydration. Due to neurologic complications and the degree of lithium toxicity, a total of three sessions of hemodialysis were performed, and the post-dialysis serum lithium level was 0.54 mEq/L. The neurologic symptoms recovered completely after a third dialysis session.

A case of acute interstitial nephropathy and toxic hepatitis after short-term herbal medication / 대한내과학회지

There are many kinds of herbal medication available in Korea, and some of them have been reported to be related with renal failure. However, the simultaneous occurrence of toxic hepatitis and acute renal failure associated with herbal medicine has rarely been reported. A 26-year-old male was admitted with a sudden onset of jaundice and generalized weakness after taking two doses of herbal medication. A physical examination revealed no abnormalities other than scleral icterus. The patient's blood chemistry demonstrated a blood urea nitrogen level of 91 mg/dL, a creatinine level of 13 mg/dL, an AST of 212 IU/L, an ALT of 1,528 IU/L and a bilirubin level of 8.5 mg/dL. Renal biopsy showed interstitial edema and an infiltration of neutrophils and lymphocytes with preserved glomeruli and vascular structure; these findings were consistent with administering medical supportive care without renal replacement therapy. He was discharged on the 8th hospital day. This case provides the possibility of development of hepatitis and renal failure due to herbal medication. We propose that a meticulous history taking for determining the herbal medications a patient has taken should be done for those cases of simultaneous toxic hepatitis and renal failure that are without any obvious cause in Korea.

Vitamin D Receptor Genotype is Associated with Secondary Hyperparathyroidism in Hemodialysis Patients / 대한신장학회지

PURPOSE: It is known that secondary hyperparathyroidism in end stage renal disease (ESRD) patients is associated with vitamin D receptor (VDR) gene polymorphism, but there is no consensus on its genotype. There is lack of data in Ca, P, calcitriol and VDR polymorphism. METHODS: We measured serum Ca, P, alkaline phosphatase, parathyroid hormone (PTH), and 1,25 (OH)2D3 of the 53 hemodialysis patients. The genotypes of VDR were classified BB, Bb, bb according to restriction patterns in PCR of the patients' DNA using Bsm I restriction enzyme. RESULTS: The patients with BB, Bb, bb type were 0 (0%), 15 (28.3%), 38 (71.7%) respectively. Serum PTH levels were 70.0+/-63.3 pg/mL and 146.9+/-184.9 pg/mL in Bb, bb type respectively, and showed significant statistical difference (p<0.05). Serum 1,25 (OH)2D3 levels were 7.68+/-3.41 pg/mL and 6.59+/-2.67 pg/mL in Bb and bb genotype respectively without statistical significance. And there was no significant statistical differences among the serum levels of calcium, phosphorus, alkaline phosphatase. CONCLUSION: Vitamin D receptor gene polymorphism is associated with secondary hyperparathyroidism in hemodialysis patients, and the b allelle is suggestive of poorer bone mineral metabolism.

Two Cases of Patchy Renal Vasoconstriction without Antecedent Anaerobic Exercise / 대한신장학회잡지

Patchy renal vasoconstriction is one of the reversible renal vasoconstrictions, which usually occur in healthy young men following strenuous anaerobic exercise. Analgesics, viral infection, dehydration were known to be the causes of patchy renal vasoconstriction. We experienced two cases of patchy renal vasoconstriction without antecedent anaerobic exercise. The first case is a 54-year-old woman admitted to a hospital with severe loin pain. On admission, serum creatinine was elevated to 2.2 mg/dL. Patchy areas of delayed contrast enhancement in both kidneys were observed on immediate post-contrast CT and 14 hours delayed image. This severe loin pain was initiated without anaerobic exercise. On the 4th day, her loin pain was relieved and on the 12th day of her illness, serum creatinine was normalized with supportive care. The second case is an 18- year-old man presented with pain in the both flanks. Five days earlier, operation had been performed for treatment of gynecomastia. There had been no preceding anaerobic exercise before the flank pain occurred. On admission to the hospital, laboratory studies revealed a serum creatinine 2.3 mg/dL. Computed tomography showed multiple patchy areas of enhancement in the renal parenchyma. On 12 hours delayed image, there were delayed contrast enhancement. On the sixth day, serum creatinine decreased to 1.4 mg/dl and the loin pain was subsided. Patchy renal vasoconstriction can occur without exercise, and we suggest that patchy renal vasoconstriction should be suspected in the patients suffering from acute renal failure with severe loin pain even without strenuous exercise.

The Mathematical Model for Predicting the Probability of Minimal Change Nephrotic Syndrome Using Clinical Parameters / 대한신장학회잡지

PURPOSE: We retrospectively investigated to find out the equation of calculating the probability of minimal change nephrotic syndrome (MCNS) using clinical parameters. We prospectively investigated to determine the usefulness of the mathematical model. METHODS: We retrospectively examined 56 patients with nephrotic syndrome (NS) (30 MCNS and 26 non-MCNS) diagnosed by kidney biopsy. A mathematical model for calculating the probability of MCNS was obtained through multiple logistic analysis in SAS statistics package. In addition, we prospectively studied 28 patients with NS. Clinical MCNS and non-MCNS were classified according to the probability of 85% in the mathematical model. Kidney biopsy was performed, and serum albumin and urinalysis were measured after 2 weeks of steroid treatment. RESULTS: In the retrospective study, the mathematical model was P=ea/(1+ea), a=17.2507 - 5.5777xON - 4.2256xALB-0.000579x24PROT - 1.2569xUBL+2.1703xUAL. The mode of onset (ON), 24 hours urine protein (24PROT), serum albumin concentration (ALB), the grade of hematuria (UBL) and proteinuria (UAL) were included as clinical parameters. At the probability of 85%, the sensitivity and specificity for predicting MCNS was 73.3% and 100% respectively. In the prospective study, the result of kidney biopsy was consistent with clinical MCNS and non-MCNS according to a mathematical model. All clinical MCNS showed negative proteinuria on urinalysis and a significant increase in serum albumin after 2 weeks treatment (1.85+/-0.30 g/dL to 2.88+/-0.26 g/dL, p<0.05). CONCLUSION: We conclude that the mathematical model for predicting the probability of MCNS may be useful in diagnosis of the MCNS.

Changes in Flow-Mediated Vasodilation after a Single Session of Hemodialysis / 대한신장학회잡지

BACKGROUND: The cardiovascular morbidity and mortality are much higher in the patients who undergo hemodialysis than normal population. Atherosclerotic vascular disease is one of the most important causes of cardiovascular disease, and it is thought to be related to endothelial function. It is known that endothelial function in the end-stage renal disease (ESRD) patients is decreased, but it is not clear the hemodialysis can improve the endothelial function or not. Hemodialysis can remove uremic toxins and improve endothelial function, but it also can cause oxidative stress to vascular endothelial cell. The purpose of this study is to determine whether hemodialysis could improve endothelial function compared with simple ultrafiltration in the same patient. METHODS: We prospectively evaluated endothelial function of hemodialysis patients by flow-mediated vasodilation (FMD) method in the patient's right brachial artery. Total thirteen patients were enrolled in this study, and their right brachial artery diameters were measured by 7 MHz echocardiography probe, and calculated by enlarged scan image. FMD were measured before and after hemodialysis, and measured before and after simple ultrafiltration in the same patient, same four hours of each session. RESULTS: The mean brachial artery diameters were 4.18+/-1.11 mm in pre-hemodialysis and 4.25+/-1.15 mm in pre-ultrafiltration respectively, and there was no statistic difference. Average percent change of brachial artery diameter before and after hemodialysis were 2.20+/-1.67 and 1.35+/-1.22% (p<0.05). The same of ultrafiltration were 2.13+/-1.99 and 2.72+/-1.79% (p=0.431). CONCLUSION: In summary, flow mediated vasodilation after a single session of hemodialysis, in contrast with simple ultrafiltration, could be diminished significantly.

Clinical Significance of Urinary G1 Cells in the Differentiation of Hematuria / 대한신장학회잡지

BACKGROUND: Recently, G1 cells, characterized by distinctive doughnut-like shape with blebs have been reported as a reliable marker for glomerular hematuria. We investigated the validity of the urinary G1 cells in distingushing glomerular from non-glomerular hematuria. In addition, we evaluate the influence of urine osmolality, pH and proteinuria on dysmorphic erythrocytes and G1 cells. METHODS: One hundred and twenty patients with hematuria including 60 glomerular (GH) and 60 non- glomerular hematuria (NGH) were examined. The percentage of urinary dysmorphic erythrocytes and G1 cells using phase-contrast microscopy was determined. Urine osmolality, pH, and spot urine protein/ creatinine ratio were examined. RESULTS: The proportion of G1 cells differed significantly between the two group (7.8+/-16.0% in GH vs. 0% in NGH, p<0.05). At the cut-off value of 50 % dysmorphic erythrocytes, the sensitivity and specificity for the detection of GH was 88.3% and 93.3%, respectively. At the cut-off value of 1% G1 cells, sensitivity and specificity were 60.0% and 100%, respectively. When both of 50% dysmorphic erythrocytes and 1% G1 cells were considered as the cut-off value, the sensitivity and specificity were 91.0% and 100%, respectively. There was a significant difference in the percentage of dysmorphic erythrocytes and G1 cells at different urine pH. There was a significant correlation between urine osmolality and dysmorphic erythrocytes (r=0.41, p< 0.05), but not for G1 cells. No significant correlations were observed between G1 cells and proteinuria or pH. CONCLUSION: Evaluation of both urinary G1 cell and dysmorphic erythrocytes at the same time could improve the diagnostic value for differentiating glomerular hematuria.

A Case of Acute Renal Failure Caused by Cresol Ingestion / 대한신장학회잡지

Cresol, a commonly used disinfectant, is an extremly toxic material and can cause systemic effects such as respiratory, neurological, gastrointestinal, hepatic and renal damage. Cresol intoxication can be caused by inhalation, cutaneous adsorption or oral ingestion. Cresol denatures and precipitates cellular proteins, thus exer ts their toxic effects directly on all cells. There is only one case of cresol intoxication in Korea, but a case of chemical burn. We report a case of acute renal failure caused by cresol ingestion. A 39-year-old male attempted suicide by ingesting 200 mL of 50% cresol solution. Acute renal failure developed, but he recovered by only supportive care. It was reported that the lethal dose of saponated cresol solution is approximately 60-120 mL and the lethal blood level is 71-190 microgram/mL. The amount of cresol ingested by the patient far exceeded the reported lethal dose. This is the first case of acute renal failure caused by cresol ingestion successfully treated with only supportive care in Korea.

A Case of Multiple Renal Arteries Presented with the Manifestations of Renovascular Hypertension / 대한신장학회잡지

In 17-30% of subjects, at least one kidney is supplied by more than one artery arising from the aorta. Subjects with multiple renal arteries have been reported to suffer more frequently from hypertension, But the precise association between hypertension and multiple renal arteries was not yet defined. A 20- year old woman presented clinical manifestations of renovascular hypertension. Basal renin activity was elevated, and time-activity curves showed delayed peak time at captopril renal scan. Angiography showed multiple renal arteries with 2 right and left 3 arteries. There was neither stenosis nor inflammation. We strated angiotensin-receptor blocker, calcium channel blocker, and beta-blocker. The patient currently remains normotensive in an outpatient unit. In general, accessory renal arteries are narrower and longer than main artery. As a results, the renal segments supplied by accessory vessels might have lower levels of blood pressure than the remainder of the parenchyma, thereby increasing the renin secretion. So hypertension associated with multiple renal arteries might be involved in renin-angiotensin-aldosterone system activation.

Relationship between Initial Leukocyte Count and the Extent of Myocardial Injury in Patients with Acute Myocardial Infarction Who Received Reperfusion Therapy

BACKGROUND AND OBJECTIVES: The presence of leukocytosis in patients with acute myocardial infarction (AMI) has been reported to be related to the extent of MI and with the prognosis. However, whether the leukocytosis itself is a cause or result of the myocardial injury has not been determined. The relationship between the leukocyte count and the extent of myocardial injury was investigated in patients with AMI that had undergone reperfusion therapy. SUBJECTS AND METHODS: Patients with AMI that had undergone thrombolysis (n=60) or primary PCI (n=36) were included. The initial leukocyte counts were analyzed with regard to the peak and initial CK-MB levels. The relationship between leukocytosis and the time elapsed from the onset of symptoms, infarct related coronary arteries and the proximity of the lesions were also investigated. RESULTS: In both groups, the initial leukocyte count did not show a significant relationship with the initial CK-MB level or the time elapsed from symptoms onset, which could be an indication of the extent of early myocardial injury. Furthermore, no significant relationship was shown with the infarct related coronary artery or proximity of the lesion. However, a relationship was shown with the maximum CK-MB level, which could be an indication of the extent of myocardial injury following reperfusion therapy in both groups (p<0.01). CONCLUSION: This study suggests that the initial leukocyte count in patients with AMI might is an important prognostic factor that determines the extent of myocardial injury following reperfusion therapy, rather than being a simple indicator of the extent of early myocardial injury.

A Case of Sclerosing Peritonitis Successfully Treated with Corticosteroid Therapy / 대한신장학회잡지

Sclerosing peritonitis is a rare but fatal complication of peritoneal dialysis (PD). Management of sclerosing peritonitis includes cessation of PD, total parenteral nutrition, and surgery. Recently, a few reports have indicated immunosuppression might be beneficial in sclerosing peritonitis. In these reports, all of patients had the combination therapy of steroid and immunosuppressant. A 37-year old man develped sclerosing peritonitis 3 months after switching from PD to hemodialysis because of uncontrolled peritonitis. An abdominal computed tomography (CT) scan demonstrated massive ascites with multilocuated fluid collection and extensive enhancement of the peritoneum. A peritoneal biopsy showed proliferation of fibrous collagenous tissue with infiltration of lymphocytes. We started corticosteroid for one month. A follow-up CT scan showed complete resolution with absence of peritoneum thickness and fluid collection 16 months after corticosteroid therapy. The patient currently remains free of symptoms in an outpatient hemodialysis unit. To our knowledge, this is the first case of sclerosing peritonitis successfully treated with corticosteroid therapy alone in Korea.