Clinical Presentation of Diabetes Mellitus after Kidney Tansplantation / 대한신장학회잡지

BACKGROUND: Incidence rate of diabetes mellitus (DM) after renal transplantation has been reported variably, ranging from 2.5% to 45%. The new diagnostic criterion of diabetes presented by American Diabetes Association and use of new immunosuppressants may increase the incidence of post-transplant DM. METHODS: We investigated the incidence of post- transplant DM in 135 patients, who underwent kidney transplantation at Hanyang University Hospital between March, 1998 and February, 2003. The association of risk factors (age, sex, types of immunosuppressive agents, presence of acute rejection, and relationship with donor) with post-transplant DM was retrospectively evaluated using multivariate analysis. RESULTS: The incidence of post-transplant DM was 19.3%, and the significant risk factors were age over 40 years and male sex. Presence of acute rejection and relationship between donor and recipient were not significantly associated with the occurrence of post-transplant DM. Notably, the frequencies of post-transplant DM between cyclosporine and low- dose tacrolimus were not significantly different. CONCLUSION: The incidence of post-transplant DM is higher than that of DM in general population. Blood glucose should be frequently monitored in older male patients, considering their significant risk for post-transplant DM. Low-dose tacrolimus regimen dose not seem to increase the risk for post-transplant DM compared with cyclosporine.

A Case of Fanconi's Syndrome Due to Chinese Herb Nephropathy: Differences between European and Asian CHN / 대한신장학회잡지

We encountered one case of Chinese Herb Nephropathy in Korea. But clinical feature of our case was different from those of CHN in Belgium. The purpose of this case report was clarified the features of CHN in Asia. The subjects consisted of a patient diagnosed as interstitial nephritis in Hanyang University Hospital and of those reported in the literature in Asia and Belgium. We investigated the clinical and histological features of CHN patients in Asia and compared them with the Belgian cases. The remarkable differences were as follows; (1) relatively high prevalence in males compared with Belgian cases, (2) digestion with multiple object and mode in Asia, (3) Most of renal failure in Asia were improved or were in stable status. (4) Fanconi's syndrome was found in most cases of Asia. In conclusion, CHN in Asia has some characteristics distinguished from Belgian Chinese Hreb Nephropathy. These findings could indicate that susceptibility to aristolochic acid may be different among races. Furthermore, it is likely that different components of AA could cause different features, that the amount of ingested AA, mode in digestion, or interaction with other components except nephrotoxic agent such as AA might reflect clinical pictures. Other hypothesis may be some other toxic substances affecting the clinical findings although they are not identified at present. Further studies must be undertaken to clarify these differences.

Seasonal Variation of Interdialytic Weight Gain in Korean Hemodialysis Patients / 대한신장학회잡지

PURPOSE: Observational results on seasonal variation of interdialytic weight gain in patients with end-stage renal disease treated with hemodialysis are controversial till now. There has been no report about it for Korean patients. The relation of interdialytic weight gain and climatic factors was studied in one region of Korea. METHODS: From Jan. 2002 to Dec. 2002, fifty patients receiving conventional and regular hemodialysis three times a week in Hanyang University Hospital, Seoul, Korea, where there is distinct seasonal variation in monthly temperature, relatively humidity, and duration of sunshine, were analyzed. For each patient, body weight and blood pressure were measured before and after each dialysis treatment three times per week for one year. The monthly mean values for interdialytic weight gain and blood pressure in relation to the monthly values for climatic factors were then analyzed. RESULTS: The seasonal pattern of interdialytic weight gain was evident throughout the one-year period. The monthly mean temperature was highest in July and lowest in January and mean monthly interdialytic weight gain was lowest in July and highest in December. The difference of mean interdialytic weight gain between July and January was significant (p< 0.05). Interdialytic weight was inversely correlated with monthly mean temperature, mean maximal temperature, and mean minimal temperature(r= -0.721 with p=0.008, r=-0.714 with p=0.009, and r= -0.717 with p=0.009, respectively) but not with mean relatively humidity and duration of sunshine. Mean predialysis systolic and diastolic blood pressure were not related to changes in temperature, relative humidity, and duration of sunshine. CONCLUSION: Interdialytic weight gain in patients with end-stage renal disease treated on hemodialysis was correlated with seasonal variation in temperature, with higher values in the winter and lower values in the summer. It would be better to consider this finding to treat hemodialysis patients.

A Case of Henoch-Schonlein Purpura with Portal Vein and Mesenteric Vein Thrombosis / 대한혈액학회지

Henoch-Schonlein purpura is an immunologically mediated systemic leukocytoclastic vasculitis of small vessels that is characterized by symmetric nontraumatic, nonthrombocytopenic, painless palpable purpura on the lower extremities and buttock, arthralgias on usually the knees and ankles, gastrointestinal symptoms and glomerulonephritis. Although the jejunum and ileum are most frequently affected, any portion of gastrointestinal tracts may be involved. Generally, gastrointestinal manifestations of Henoch-Schonlein purpura are the edematous wall of involved bowel, submucosal hemorrhage and erosion. We experienced a 56-year-old man with Henoch-Schonlein purpura who initially presented acute abdominal pain with portal vein and superior mesenteric vein thrombosis.