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.

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.

Clinical Usefulness of the Serum Anion Gap

The anion gap in the serum is useful in the interpretation of acid-base disorders and in the diagnosis of other conditions. In the early 1980s, ion-selective electrodes for specific ionic species were introduced for the measurement of serum electrolytes. This new method has caused a shift of the anion gap from 12+/-4 mEq/L down 6+/-3 mEq/L. It is worthy for clinicians to understand the range of normal anion gap and the measuring methods for serum sodium and chloride in the laboratories that support their practice. While an increase in the anion gap is almost always caused by retained unmeasured anions, a decrease in the anion gap can be generated by multiple mechanisms.

D-Lactic Acidosis in Humans: Review of Update

D-Lactic acidosis has been well documented in ruminants. In humans, D-lactic acidosis is very rare, but D-lactic acidosis may be more common than generally believed and should be looked for in a case of metabolic acidosis in which the cause of acidosis is not apparent. The clinical presentation of D-lactic acidosis is characterized by episodes of encephalopathy and metabolic acidosis. The entity should be considered as a diagnosis in a patient who presents with metabolic acidosis accompanied by high anion gap, normal lactate level, negative Acetest, history of short bowel syndrome or malabsorption, and characteristic neurologic manifestations. Low carbohydrate diet, bicarbonate treatment, rehydration, and oral antibiotics would be helpful in controlling symptoms.

Expression of Platelet Derived Growth Factor-A, C and Platelet Derived Growth Factor Receptor-alpha in the Ischemia Reperfusion Renal Failure Model / 대한신장학회잡지

BACKGOUND: Platelet-derived growth factor (PDGF) is a widely expressed growth factor with both mitogenic and chemotactic activities in many connective tissue cell types. There are four members of PDGF family; PDGF-A, PDGF-B, PDGF-C, PDGF-D. Their biological effects are mediated via two tyrosine kinase receptors, PDGF receptor-alpha and PDGF receptor-beta, and PDGF-mediated signaling is critical for development of many organ systems and acquired disease. The aims of this study were to determine the changes of PDGF-A, PDGF-C and PDGF receptor (PDGFR)-alpha expression in ischemia reperfusion acute renal failure model. METHODS: We examined the expression and localization of PDGF-A, PDGF-C and PDGF receptor-alpha protein using Western blot analysis and immunohistochemistry and PDGF-C mRNA using RNase protection assay after ischemia reperfusion renal failure model. RESULTS: PDGF-A expression showed no change after ischemia reperfusion injury. Proliferating cell nuclear antigen expression increased at day 2 after ischemia reperfusion injury. PDGF-C expression increased at day 2 after ischemia reperfusion injury, and was localized in tubular epithelial cells of outer medulla. PDGFR-alpha increased at day 2 after ischemia reperfusion injury, and was localized in tubular interstitium of outer medulla. CONCLUSION: These results indicated that PDGF-C and PDGF receptor-alpha may have an important role in the renal regeneration after ischemia reperfusion renal injury.

The Kidney Knows the Answers to the Hidden Messages in Body Water

No abstract available.

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.

Update on pathogenesis of uric acid nephrolithiasis / 대한내과학회지

No abstract available.

A Case of Lupus Nephritis Associated with Transiently Decreased C1 Inactivator Activity and Angioedema / 대한신장학회잡지

C1 esterase inhibitor deficiency with consequent angioedma is an uncommon condition. Nonhereditary C1 inhibitor deficiency includes underlying disorders; lymphoproliferative disorder, autoimmune disease, hypereosinophilia, drug-induced, allergic, and idiopathic forms. The as sociation of hereditary C1 esterase inhibitor deficiency with systemic lupus erythematosus has been previously described. We experienced a case with transiently decreased C1 inactivator activity and angioedema in lupus nephritis. This present case is a previously healthy 22-year-old woman, who developed intermittent facial angioedema and decreased urine amount. After steroid treatment, the C1 inactivator activity was recovered and angioedema was disappeared.

The Expressions of PDGF-C, PDGF-D and PDGF Receptors in Renal Development Model / 대한신장학회잡지

BACKGROUND: Four platelet derived growth factor (PDGF) family members have been identified; the classical PDGFs, PDGF-A and PDGF-B, and the novel PDGFs, PDGF-C and PDGF-D, which were only recently discovered. METHODS: The present study was designed to determine the changes of the platelet derived growth factor (PDGF) subtypes (C & D) and their receptors (PDGFR)-alpha & beta expression in kidneys during pre- and postnatal development. RESULTS: All the protein levels of PDGFR-alpha and -beta and the mRNA levels of PDGF-C and D were high in kidneys during the prenatal period and decreased differently during the postnatal period. PDGFR-alpha was expressed in the interstitial space at embryo day 18. PDGFR-beta protein were expressed in metanephric blastema at embryo day 18. PDGF-C mRNA was expressed in metanephric blastema, developing glomerulus at embryo 18 day and in collecting duct at postnatal day 7. PDGF-D mRNA was expressed in the parietal and vesceral epithelial cells during pre and postnatal period. CONCLUSION: These results indicate that the PDGF subtypes (C & D) and their receptors (PDGFR-alpha & -beta) are differently expressed in the kidney during the prenatal and postnatal period.

Two Cases of Severe Hyperkalemia with Atypical Electrocardiographic Manifestations

No abstract available.

Renal Transport of Urate

All urate transport occurs across the renal epithelial cells of the proximal tubule. Most of the filtered urate is reabsorbed in the S1 segment of the early proximal tubule. This is followed by tubular secretion in the S2 segment of the proximal tubule and approximately 50% of the filtered urate flows back into the tubular lumen. Most of the secreted urate undergoes postsecretory reabsorption that occurs predominantly in the last S3 segment of the proximal tubule. Recently, four proteins that transport urate have been identified at the molecular level. These proteins are an electrogenic urate uniporter, urate transporter/channel (UAT), two members of the organic anion transporter (OAT) family, OAT1 and OAT3, and a protein with some homology to OAT4, designated URAT1.

The Study on the Expression of Angiopoietin-1, Angiopoietin-2, and Tie2 in Mouse Kidney Maturation / 대한신장학회잡지

BACKGROUND: The Angiopoietin-1 (Ang1), Angiopoietin-2 (Ang2) and Tie2 have essential role in angiogenesis in development. Ang1 and Ang2 are ligands which binds to their receptor, Tie2. METHODS: Expression of these proteins was sought during mouse kidney maturation from embryonic day 16 (E16) to 28 days postnatal (P28). RESULTS: Using RNase protection assay and Western blot, these three molecules were expressed throughout the experimental period with peak levels at P28 (Ang1), P14 (Ang2) and P7 (Tie2). By immunohistochemical analysis, Ang1 protein was found to localize to condensing renal mesenchymal cells, and tubules. Ang2 proteins were detected in differentiating outer medullary tubules and the vasa recta bundle area. Tie2 protein was detected in a portion of glomerular tufts and cortical interstitium, and medulla including vessels in the vasa recta. CONCLUSIONS: These data suggest that Ang1, Ang2 and Tie2 proteins are expressed in renal development.

Essential Hypertension and renal role: Low renin hypertension / 대한내과학회지

No abstract available.

A case of multiple symmetric lipomatosis with acute renal failure due to pulmonary thromboembolism / 대한내과학회지

Multiple symmetric lipomatosis (MSL) is a rare disease characterized by the presence of diffuse, non-tender, symmetric deposits of adipose tissue on the neck, back and upper part of the trunk. It has been reported that this disease could be associated with various metabolic abnormalities such as impaired glucose tolerance, hyperuricemia, alcohol consumption, type 4 hyperlipidemia, renal tubular acidosis and thyroid disorder. We present a case of type 2 MSL with pulmonary thromboembolism. He suffered sudden dyspnea and decreased urine output. The causes of dyspnea and acute renal failure (ARF) in this case were dehydration and hemodynamic disturbance due to pulmonary thromboembolism. After thrombolytic and fluid therapy, his condition was improved. He was discharged on warfarin medication and has remained asymptomatic for 12 months.

A Case of Hydrochloric Acid Induced Hyperkalemia / 대한신장학회잡지

Significant disturbances of potassium homeostasis may cause considerable morbidity and mortality. Prompt recognition and appropriate treatment of these disturbances after acid ingestion could be life- saving. The administration of the mineral acid, HCl to experimental animal is associated with elevation in plasma potassium concentration which have been attributed to shift of the cation from the intracellular to the extracellular space. Authors experienced a case of hyperkalemia after ingestion of 10% HCl 400 mL for suicide in 51-year-old male.

The Antiapoptotic Effect of Vascular Endothelial Growth Factor and Angiopoietin-1 on Glomerular Endothelial Cells in Adriamycin or Cisplatin-induced Apoptosis / 대한신장학회잡지

BACKGROUND: Because glomerular endothelium play a pivotal role in the renal diseases, damage of glomerular endothelial cells lead to progression of glomerular sclerosis and decrement of renal function. Apoptotic damage of cells is an important mechanism in renal disease. Therefore, several growth factors that have antiapoptotic effect may have a protective role in maintaining a renal function in apoptotic cell injury. METHODS: The present study evaluated whether cisplatin or adriamycin induce apoptosis in glomerular endothelial cells. We also evaluated the antiapoptotic effect of angiopoietin-1 and VEGF in cisplatin or adriamycin- induced apoptosis. RESULTS: Cisplatin or adriamycin induced apoptosis in glomerualr endothelial cell in dose dependent manner. Angiopoietin-1 and VEGF produced antiapoptotic effect in cisplatin or adriamycin-induced apoptosis in a dose dependent manner. The antiapoptotic effect of angiopoietin-1 was more potent than that of VEGF in glomerualr endothelial cells. Wortmannin, a phosphatidylinositol 3'-kinase inhibitor decrease the angiopoietin-1 or VEGF-induced antiapoptotic effect. CONCLUSION: These results suggest that angiopoietin-1 and VEGF may be a strong survival factor for the glomerular endothelial cells in the cisplatin or adriamycin-induced apoptosis through phosphatidylinositol 3'-kinase/Akt. Therefore, pretreatment of angiopoietin-1 and VEGF could play a beneficial role for maintaining normal glomerular endothelial cell integrity before and during systemic cisplatin or adriamycin therapy.

A Case of Mesangial IgM Nephropathy without Proteinuria / 대한신장학회잡지

An 51-year-old woman presented with microscopic hematuria without protenuria for long time. Laboratory studies demonstrated the presence of red blood cells in urine, a normal serum IgM level, the absence of antinuclear antibodies, and a normal complement level. Renal biopsy revealed that some glomeruli are enlarged with endocapillary cell proliferation and a few glomeruli exhibit prominent vascular pole of the tufts and segmental increase in mesangial cell and matrix. Immunofluorescence studies demonstrated segmental granular deposits for IgM. Electron microscopy showed well-preserved foot process associated with focal effacement. Biopsy findings were consistent with IgM nephropathy. We present this case to promote understanding of the pathogenesis of IgM nephropathy.

Mannitol-Induced Metabolic Alkalosis / 대한신장학회잡지

Mannitol is an osmotic diuretic as a useful agent in the treatment of a variety of clnical conditions. In persons with normal renal function, the mannitol is almost excreted by kidney. Although various studies of the effectiveness of mannitol for the cerebral edema have been reported, but there are still few reports on acid-base disorder. This study is based on acid-base and electrolyte changes after the intravenous infusion of hypertonic mannitol for the purpose of preventing cerebral edema. Mannitol were intravenously infused with 300-900 mL for 90-minutes (group A), 1,200-2,600 mL for 24-hours(group B) and 3,200-4,900 mL for over 24-hours(group C) each. Each blood sample was drawn for gas analysis, and electrolytes through arterial line before and after mannitol infusion. In group A, blood pH is increased significantly from baseline level 7.43+/-0.07 to 7.46+/-0.04, and plasma HCO3- 25.3+/-2.1 mEq/L to 28.9+/-2.9 mEq/ L each, but plasma K is decreased significantly from baseline level 4.3+/-0.6 mEq/L to 3.7+/-0.8 mEq/L. In group B, blood pH is increased significantly from baseline level 7.42+/-0.02 to 7.47+/-0.06, and plasma HCO3- 25.2+/-1.8 mEq/L to 29.1+/-2.9 mEq/L each, but plasma K is decreased significantly from baseline level 4.2+/-0.3 mEq/L to 3.8+/-0.5 mEq/L. In group C, blood pH is increased significantly from baseline level 7.41+/-0.01 to 7.52+/-0.04, and plasma HCO3- 24.9+/-1.2 mEq/L to 27.7+/-2.5 mEq/L each, but plasma K is decreased significantly from baseline level 4.2+/-0.1 mEq/L to 3.9+/-0.2 mEq/L. These results clinically used intravenous infusion of mannitol could induce metabolic alkalosis associated with hypokalemia, regardless of its dosage.

The Changes of Growth Hormone, Insulin-like Growth Factor-1 and Insulin-like Growth Factor Binding Protein-3 Levels after Long-Term Dialysis Therapy / 대한신장학회잡지

The insulin-like growth factor-I(IGF-I) is a hormone that has growth stimulation and metabolic effects. Insulin-like growth factor binding proteins (IGFBPs) were known to be the most important factors that affect bioavailability of IGF. Thereby, the changes of IGFBPs may affect the bioavailability of IGF-I. Because growth hormone/IGF system may be affected by dialysis therapy, the changes of GH, IGF-1, IGFBPs levels after dialysis therapy can affect the bioavailability of IGF. To evaluate the changes of serum levels of IGF-I and IGFBP-3 after long-term dialysis therapy, we measured the serum IGF-I and IGFBP-3 levels in the patients on hemodialysis and on peritoneal dialysis. Eight patients undergoing peritoneal dialysis, 10 patients undergoing hemodialysis, and age-matched 10 normal control patients were studied. In patients on hemodialysis, the mean serum level of IGF-I before hemodialysis was 90.6+/-9.0 nanogram/mL, and after long-term hemodialysis was 130.9+/-31.0 nanogram/milliliter. The mean serum level of IGFBP-3 before hemodialysis was 14,549+/-7,815 microgram/liter, and after long-term hemodialysis was 5,726+/-883 microgram/liter. There were no significant changes of serum IGF-I and IGFBP-3 levels after long-term hemodialysis therapy. In patients on peritoneal dialysis, the mean serum level of IGF-I before peritoneal dialysis was 169.8+/-20.5 nanogram/milliliter, and after long-term peritoneal dialysis was 242.6+/-37.6 nanogram/mL. The mean serum level of IGFBP- 3 before peritoneal dialysis was 10,272+/-885 microgram/liter, and after ling-term peritoneal dialysis was 8,604+/-1,721 microgram/liter. There were no significant changes of serum IGF-I and IGFBP-3 levels after long-term peritoneal dialysis. We found that the level of IGF-1 before hemodialysis was lower then that of normal control group and the level of IGFBP-3 before hemodialysis or peritoneal dialysis was higher then that of normal control group. Our results suggested that the blood levels of growth hormone, IGF-I and IGFBP-3 may not be significantly affected by long-term dialysis therapy.