The Effect of High Sodium Dialysate(HSD) on Blood Pressure in Hemodilaysis / 대한신장학회잡지

Hypotensive episode is one of the serious complication during hemodialysis. HSD has used for relief of this problem, but sometimes increased interdialytic weight gain or exacerbation of hypotension are happened. To evaluate the effect of HSD, 7 non- diabetic normotensive uremic patients were hemodialyzed with different sodium level of dialysate (stage A : Na 138mEq/L for 4hrs, stage B : Na 148mEq/L for 4hrs, stage C : initially Na 148mEq/L for 3hrs and Na 138mEq/L for 1hrs), and each stages were continued for 2 weeks. Ultrafiltration was performed to maintain the patient's estimated dry weight constantly. Interdialytic weight gain(stage A : 2.9+/-1.2kg, stage B : 3.2+/-1.1kg, stage C : 3.1+/-0.8kg) and presystolic systolic and diastolic blood pressure were not different in each stage. The incidence of hypotension (systolic BP<90mmHg) during hemodialysis was significantly lower in stage B and stage C(24%, 21%) than stage A(54%)(P<0.01). During hemodialysis the incidence of thirst was higher in stage B(40%) than stage A and stage C(11%, 12%) (P<0.05) significantly but there are no difference in headache and itching during hemodialysis between the each stage. Pre-dialysis and post-dialysis serum sodium and osmolality were not different in each stage but at 2 hrs after initiation of hemodialysis serum sodium and osmolality were higher in stage B(145.6+/-2.1mEq/L, 306+/-6.7mOsm/kg) and stage C (146.1+/-2.1mEq/L, 306+/-13.1mOsm/kg) than stage A (140.1+/-2.5mEq/L, 292+/-8.7mOsm/kg)(P<0.05). The ANP levels of pre-dialysis and post-dialysis were not different in each stage. In conclusion, HSD improved hypotenive episode. In spite of sodium load, increased interdialytic weight gain and elevation of pre-dialysis blood pressure were not developed and sodium modeling during hemodialysis attenuate some adverse effect of HSD.

Relationship between IgA nephropathy and Histocompatibility Antigens (HLA) in Korean Population / 대한내과학회지

OBJECTIVES: Primary IgA nephropathy(IgAN), currently recognized as the most prevalent form of glomerular disease in the world, has tendency toward end stage renal failure at a rate of 20-30% in patients after a long-term follow-up of more than 20 years. But its etiology and pathophysiology is not fully understood. This study was designed to evaluate the pattern of histocompatibility antigens(HLA) and its association with poor prognostic factors in patients with IgAN. METHODS: Study population comprised the 69 patients with IgAN which was diagnosed by clinical and pathological findings, and control groups were 202 healthy Korean people. We evaluated the HLA class I serologic typing by standard microlymphocytotoxic technique and the HLA class II genotypes by the two-step polymerase chain reaction. RESULTS: 1. HLA-A was not associated with IgAN. 2. The phenotype frequency of HLA-B55 was 6.1% in patient group and 1.7% in normal control group. HLAB55 was associated with IgAN(relative risk 3.47, P<0.05). 3. HLA-DQB1*04 was also associated with IgAN (relative risk 3.57, P<0.05). 4. There was no significant difference in the distribution of HLA in IgAN patients according to histologic grading, blood pressure, renal function and proteinuria. CONCLUSIONS: Frequencies of HLA-B55, HLA-DQB1 *04 are higher in Korean patients with IgAN compared to general population. But we could not observe the significant relationships between HLA type and poor prognostic factors. Further study using larger population with IgAN may be necessary to identify the association of HLA locus with poor prognostic factors and progress decline in renal function in patients with IgAN.

Clinical Features of Long Term Confined Patients Due to a Building Collapse Disaster / 대한신장학회잡지

Following the department store building collapse disaster on June 29, 1995, more than 140 people were brought to emergency care center of the Catholic medical center. Among them three starvated people due to long term confined in the collapsed building and one severe crush injured patient developed to prerenal azotemia and ARF. Case 1, 21- year-old man had been confined in the collapsed building debris for 11 days, he had been able to drink water and showed only mild dehydration on admission. Case 2, 3, 18-year-old woman and 19- year-old woman had been confined for 13 and 17 days even without water intake. They were severely dehydrated, hypotensive and hypernatremia on admission. Case 4, 39-year-old man was crushed by building debris and rescued 22 hours later and was diagnosed as ARF due to traumatic rhabdomyolysis. Case 1, 2 and 3 improved immediately only with fluid therapy. Case 4 progressed to acute tubular necrosis, in spite of therapy, and required hemodialysis. Severe dehydration due to long term starvation in young healthy person over 17 days did not progressed to acute tubular necrosis only with adequate fluid therapy. To prevent acute tubular necrosis in crush injured patient, needs more immediate and intensive fluid therapy at the rescue and careful correction of hypernatremia.

Myelodysplastic Syndrome in a Renal Transplant Recipient Treated with Long-term Azathioprine / 대한신장학회잡지

A 39-year-old renal transplant recipient was admitted for evaluation of pancytopenia which developed gradually 10 months ago. He received renal transplantation 10 years ago and maintained relatively good renal function. Since 1 year before admission, he showed progressive decline of hematocrit, WBC count and platelet. Initial bone marrow biopsy showed erythroid hypoplasia, and second bone marrow biopsy revealed myelodysplasia. Clinical course was fatal. In conclusion, if patients with long term azathioprine treatment show progressive pancytopenia, one should suspect the possibility of myelodysplastic syndrome.