Serum and urine soluble HLA class I antigen concentrations are increased in patients with hemorrhagic fever with renal syndrome

OBJECTIVES: In order to evaluate the association between the Hantaan virus-induced cellular-immune response and clinical severity in patients with hemorrhagic fever with renal syndrome (HFRS). METHODS: We serially measured the serum (n = 16) and urine (n = 6) concentrations of soluble HLA class 1 antigen (sHLA-l) and clinical powameters in patients with HFRS. RESULTS: Serum sHLA-I concentrations in patients with HFRS were significantly higher than those in controls throughout all clinical phases (p < 0.01). The highly elevated Serum sHLA-I concentrations peaked in the oliguric phase and declined gradually through the phases of HFRS. Serum sHLA-l concentrations in patients with hypotensive episode were higher than in those without the episode (5,85 +/-2,184 vs. 2,389 +/- 860 ng/ml in oliguric phase, 4.11 +/- 1,952 vs. 1,502 +/- 592 ng/ml in diuretic phase, p < 0.05), and serum sHLA-l levels showed a significant correlation with blood WBC count (r = 0.75 in the febrile and hypotensive phase, p < 0.01) and serum creatinine concentrations (r = 0.64 in the oliguric phase, p< 0.01), respectively, Urine sHLA-I levels in the oliguric phase were significantly higher than those in the diuretic phase (390 +/- 155 vs. 214 +/- 45 ng/mg Cr, p < 0.05) and urine sHLA-I levels are associated with severe illness in patients with HFRS. The higher serum sHLA-I are associated with severe illness in patients with HFRS. The persistent elevation of serum sHLA-I during all phases of HFRS might be related to increased production due to prolonged cellular immunologic stimulation by the Hantaan virus rather than decreased excretion of sHLA-I through the kidney. CONCLUSION: We suggest that the serum and urine sHLA-I concentrations can be used as a stable and objective parameter for monitoring clinical severity and renal dysfunction in patients with HFRS.

A Case of Bilateral Renal Artery Thrombosis Associated with Oral Contraceptives / 대한신장학회잡지

Oral contraceptives cause a number of serious side effects in young woman. Prominent among these is an increased incidence of thromboembolic events. Although these thromboemboli almost invariably occur on the venous side of the circulation, there have been reports describing the occurrence of arterial thromboses. Spontaneous thrombosis of the renal artery is a rare event. When reported, it has usually superimposed on an underlying anatomic abnormality of the renal artery after trauma, or very rarely in the setting of systemic disease such as polycythemia vera or thromboangiitis obliterans. Since isolated renal artery thrombosis in the absence of these underlying conditions has been rarely described, wewish to bring attention to the diagnosis of this disorder in a young woman taking oral contraceptives and without any other predisposing abnormality.

A Case of Type I Renal Tubular Acidosis Associated with Graves' Disease and Sjogren' s Syndrome / 대한신장학회잡지

Classic distal renal tubular acidosis(type 1 RTA) is a hypokalemic, hyperchloremic metabolic acidosis due to selective defect in distal acidification. Type 1 RTA may be associated with genetic(usually autosomal dominant) or autoimmune disease, drugs and toxin and various tubulointerstitial diseases. This case report describes a 27 year-old female patient with distal RTA, Sjogren' s syndrome and Graves' disease the first case. She had been suffered from muscle weakness and peripheral numbness and was found to have low serum potassium(1.6mEq/L). She was revealed to have 1) distal RTA by NaHCO3 loading test 2) Sjogren' s syndrome by Schirmer' s test and palate biopsy and 3) Graves' disease by exophthalmometry and autoantibody test, thyroid function test. This is the first case as far as I search that report the association of distal RTA, Sjogren' s syndrome, and Graves' disease caused by autoimmune mechanism.