Altered Regulation of Water Channels and Sodium Transporters in Fasting-induced Polyuria in Rat Kidney / 대한신장학회잡지

PURPOSE: Starvation causes impairment in the urinary concentration ability. However, the molecular basis for the impaired urinary concentration and polyuria remains undefined. We examined the effects of food deprivation on the water handling by the kidney and it's regulatory mechanism. METHODS: Sprague-Dawley rats were used. They were placed in metabolic cages and deprived of food but had free access to water for 24 hours. Control rats had free access to both water and food. Protein expression of aquaporin-2 (AQP2) and Na+-K+-2Cl- cotransporter (NKCC2) was determined in the kidney by Western blot analysis. Protein expression of type VI adenylyl cyclase and prostaglandin E2 synthase (PGES) was determined. Urinary PGE2 excretion was also determined by radioimmunoassay. RESULTS: Food deprivation (FD) resulted in impaired urinary concentration associated with decreased tubular water reabsorption and increased urine output. The expression of AQP2 proteins was significantly decreased in the inner stripe of the outer medulla (ISOM). The expression of NKCC2 was not affected in ISOM. The adenylyl cyclase VI expression was increased in ISOM in FD rats. The protein expression of PGES was decreased in the cortex/OSOM and ISOM. The 24 hr urinary excretion of PGE2 was significantly decreased in FD rats compared with controls. CONCLUSION: These findings indicate that FD-induced urinary concentration defect may related to a reduced abundance of AQP2 in the kidney. It is also suggested that the primary impairment in the pathway to the activation of AQP2 in food deprivation is independent of vasopressin/cAMP or prostaglandin activity.

Successful systemic thrombolysis of both the inferior vena cava and a renal vein thrombi that complicated nephrotic syndrome / 대한내과학회지

Nephrotic syndrome has been considered a hypercoagulable state because thromboembolic events of the venous or the arterial circulations occur on occasion. There are various risk factors for thromboembolism in patients with nephrotic syndrome (membranous nephropathy, severe hypoalbuminemia, hemoconcentration and medications such as steroid and diuretics). As thromboembolism is often fatal, early detection and proper management are important. Although anticoagulation is the preferred therapy, thrombolysis may be considered for an extensive thrombosis, for inferior vena cava (IVC) thrombosis, for recurrent pulmonary thromboembolism and for bilateral renal vein thrombosis in conjunction with acute renal failure. We report here on a case of renal vein and IVC thrombosis in a 24-year-old male with nephrotic syndrome, and this patient was treated with intravenous thrombolytics rather than anticoagulation and local thrombolytic infusion. He complained of left flank pain and his CT scan revealed left renal vein thrombosis and IVC thrombosis. After urokinase infusion, his thrombi were resolved successfully without bleeding complications.

Impact of Early Nephrology Referral on Factors Correlated with Hemodialysis Patients' Survival / 대한신장학회잡지

BACKGOUND: The late referral to nephrologist was founded as independent risk factor of poor survival in hemodialysis patients. Patients referred lately are prone to initiate dialysis urgently through temporary catheter and the use of catheter increase the incidence of catheter related complications. But patients' survival may be influenced by multiple and more complex factors beside referral pattern and use of catheter. So we planed to evaluate the effect of referral pattern on patients' survival and related factors. METHODS: This analysis included 629 incident hemodialysis patients in single center. Demographical, clinical, laboratory data were collected retrospectively. Early referral was defined as first nephrology visit over 3 months prior to initiation of dialysis. Clinical characteristics were compared between early (ER) and late referral groups (LR). Survival analysis and Cox models were performed to assess the relationship of referral pattern and mortality. Significant differences were defined as p value less than 0.05. RESULTS: ER included 269 patients and their mean age, male proportion were not different from those of LR. In ER, pre-dialysis education program and nutritional counseling were offered much more than LR and lesser catheter usage, higher serum albumin at the initiation of dialysis. ER survived longer but in Cox models, only older age, presence of diabetes, lower serum albumin at the initiation of dialysis were independent risk factor for death (odds ratio 1.047, 1.547, 0.615, respectively) CONCLUSION: Although early referral decrease catheter use at the initiation and urgent hemodialysis, classical risk factors such as old age, presence of diabetes, nutritional status at the initiation are more important in patients prognosis.

Clinical Characteristics of Uremic Pruritus in Chronic Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: Pruritus is a common, unpleasant symptom in patients on maintenance hemodialysis (HD), however its pathogenesis remains unclear. The aim of this study was to evaluate the prevalence of pruritus in chronic renal failure patients on hemodialysis and to correlate its presence with several clinical and laboratory parameters. METHODS: One hundred seventy patients on maintenance HD were enrolled, Some relevant clinical and laboratory parameters (age, sex, duration of dialysis, type of membrane, underlying renal disease, medications, erythropoietin (EPO) and laboratory findings including hematocrit, creatinine, urea, calcium, phosphorus, parathyroid hormone (PTH), erythrocyte sediment rate (ESR), albumin, beta2-microglobulin (beta2MG) and lipid profile as well as parameters of adequate dialysis (Kt/Vurea, URR) were evaluated. RESULTS: Total 170 patients (80 males) were enrolled and pruritus was found in 60 patients (Group I, M:F=29:31). One hundred ten patients did not complain pruritus (Group II, M:F=51:59). Mean age was significantly higher in Group I (59.6+/-14.8 vs. 54.3+/-13.6 years, p<0.05). There was no difference in sex, type of membrane, primary renal disease, serum beta2MG, ESR, EPO dose, duration of dialysis and serum albumin level. The mean value of Kt/V was higher in Group II (1.39+/- 0.36 vs. 1.51+/-0.27, p<0.035). CONCLUSION: Pruritus was more common in older patients and low Kt/V, but other clinical characteristics and laboratory findings were not correlated with uremic pruritus.

Clinical Characteristics of Uremic Pruritus in Chronic Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: Pruritus is a common, unpleasant symptom in patients on maintenance hemodialysis (HD), however its pathogenesis remains unclear. The aim of this study was to evaluate the prevalence of pruritus in chronic renal failure patients on hemodialysis and to correlate its presence with several clinical and laboratory parameters. METHODS: One hundred seventy patients on maintenance HD were enrolled, Some relevant clinical and laboratory parameters (age, sex, duration of dialysis, type of membrane, underlying renal disease, medications, erythropoietin (EPO) and laboratory findings including hematocrit, creatinine, urea, calcium, phosphorus, parathyroid hormone (PTH), erythrocyte sediment rate (ESR), albumin, beta2-microglobulin (beta2MG) and lipid profile as well as parameters of adequate dialysis (Kt/Vurea, URR) were evaluated. RESULTS: Total 170 patients (80 males) were enrolled and pruritus was found in 60 patients (Group I, M:F=29:31). One hundred ten patients did not complain pruritus (Group II, M:F=51:59). Mean age was significantly higher in Group I (59.6+/-14.8 vs. 54.3+/-13.6 years, p<0.05). There was no difference in sex, type of membrane, primary renal disease, serum beta2MG, ESR, EPO dose, duration of dialysis and serum albumin level. The mean value of Kt/V was higher in Group II (1.39+/- 0.36 vs. 1.51+/-0.27, p<0.035). CONCLUSION: Pruritus was more common in older patients and low Kt/V, but other clinical characteristics and laboratory findings were not correlated with uremic pruritus.

Two Cases of Systemic Lupus Erythematosus Presenting Earlier as Retinal Microangiopathy / 대한류마티스학회지

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease of unknown etiology, which affects skins, joints and other parts of body. Retinopathies associated SLE occur in 3.3% to 28% of cases, the incidence rising with the severity of systemic disease, and generally are found late in the disease. The most common findings described are cotton wool spots, retinal hemorrhages, and optic disc edema. We report two cases of SLE who had retinopathies as early manifestation of disease.

Comparison of Safety and Efficiency of Hemodialysis Using Heparin-bound Hemophan with those of Saline Flushing Hemodialysis and Hemodialysis Using Low Dose Heparin in Patients at Risk of Bleeding / 대한신장학회잡지

OBJECTIVE: Although hemodialysis using heparin bound Hemophan (HBH-HD) has been reported to be a possible modality in patients at risk of bleeding, the efficiency and safety of HBH-HD is not certain. Therefore, we prospectively compared the safety and efficiency of HBH-HD with those of saline flushing HD (SF-HD) and HD using low dose heparin (LDH-HD) in 13 HD patients at risk of bleeding in a cross-over design. METHODS: The safety and efficiency were evaluated by measuring activated partial prothrombin time (aPTT) before and during HD, hemostasis time after needle removal, total blood compartment volume (TBCV) loss of dialyzer, urea clearance (K) and Kt/V. RESULTS: There was no difference in compression time needed to achieve hemostasis at puncture site after needle removal between HBH-HD, SF-HD and LDH-HD. During HBH-HD, there was a slight increase in aPTT at 15 min (50.6+/-4.5 sec), compared to predialysis levels (40.9+/-4.7 sec). In this cross- over study, aPTT during dialysis session was markedly higher in LDH-HD than those in HBH-HD or SF-HD (p<0.05). The loss of TBCV of the dialyzer was greater in SF-HD than HBH-HD or LDH-HD (17.4+/-1.9% vs. 12.4+/-1.4% vs. 10.1+/-1.8%). However, there was no difference in K (212.0+/-30.7 vs. 217.2+/-36.9 vs. 221.6+/- 29.5 mL/min) and Kt/V (1.22+/-0.12 vs. 1.24+/-0.16 vs. 1.26+/-0.18). CONCLUSION: We concluded that the safety and efficiency of HBH-HD are not different compared to SF-HD or LDH-HD and HBH-HD could an alternative hemodialysis method in patients at risk of bleeding.

Clinical Utility of Random Spot Urine Protein to Creatinine Ratio Modified by Estimated Daily Creatinine Excretion / 대한신장학회잡지

BACKGROUND: The urinary protein to creatinine ratio in a single voided random urine sample has been widely used as an estimation of 24 hour urine protein excretion because of inconvenience and frequent collection errors during timed collection of 24 hour urine. But the protein to creatinine ratio also showed frequent estimating error, overestimation or underestimation. We thought that protein to creatinine ratio adjusted by daily creatinine excretion estimated by Cockroft-Gault equation can be more accurate than protein to creatinine ratio and compared them as follows. METHODS: This study consisted of 81 patients whose 24 hour urine protein excretion and random spot urine protein to creatinine ratio were measured concomitantly. There was no significant change of body weight or serum creatinine change around the study day. The modified protein to creatinine ratio could be estimated from the measured protein to creatinine ratio in a random spot urine sample by multiplying the ratio by the expected daily creatinine excretion estimated by Cockroft-Gault equation. These results were compared with well collected 24 hour urine protein. RESULTS: The difference between protein to creatinine ratio and 24 hour urine protein was 0.87+/-1.13, on the other hand, the difference between modified protein to creatinine ratio and 24 hour urine protein was 0.52+/-0.65 (p<0.05). Correlation coefficients between protein to creatinine ratio, modified protein to creatinine ratio and 24 hour urine protein were 0.877, 0.957 respectively. CONCLUSION: The protein to creatinine ratio modified by the expected daily creatinine excreation rate calculated by Cockfort-Gault equation was more accurate than simple protein to creatinine ratio.

A Case of Systemic Vasculitis with Intraperitoneal Aneurysmal Rupture / 대한신장학회잡지

Though systemic vasculitidis are a group of diseases with extremely low incidence and prevalence, vessels with diverse size from aorta to capillaries are involved. It has been argued how to classify and define systemic vasculitidis, especially how to discriminate poly arteritis nodosa (PAN) and microscopic polyangiitis (MPA). Since there are lots of overlapping between them, clinical manifestations, antineuclear cytoplasmic antibody (ANCA) and angiographic findings besides pathologic findings should be considered altogether. We report a case of systemic vasculitis in which crescentic necrotizing glomerulonephritis with positive perinuclear-type ANCA occurred with intraperitoneal aneurysmal rupture simultaneously. Our case can be a typical one that shows definite overlapping between PAN and MPA.

Estimation of GFR Using Iohexol Plasma Clearance in Korean without Renal Disease / 대한신장학회잡지

BACKGROUND: Plasma clearance of iohexol (Omnipaque(r)) which used widely in radiologic procedure is considered as useful method for estimation of GFR because iohexol is neither reabsorbed nor secreted from tubule after filtered as inulin and its extrarenal clearance is negligible. Plasma clearance of iohexol can be calculated from two compartment model or one compartment model with Brochner-Mortensen (B-M) modification which convenient and reliable. But there were controversies about sufficient sampling numbers and times for B-M modification of iohexol clearance. METHODS: Nineteen healthy Korean without renal disease underwent measurement of iohexol clearance. Iohexol was given as a single iv dose, and 14 blood sample were drawn up to 300 min. A reference GFR was iohexol clearance calculated from two-compartment model using 14 samples (CL-T). From 8, 3 and 2 samples clearances were calculated by B-M modification (CL-M8, 3 and 2 respectively). The accuracy of estimates was evaluated as percent of estimates falling within 10% above or below the reference GFR. Accuracy of CCr and equations for GFR estimation were also compared. RESULTS: CL-T, CL-M8, CL-M3 and CL-M2 were not different (101.9+/-24.0, 101.9+/-18.7, 101.7+/-18.6, 101.9+/-19.5 mL/min/1.73 m2 respectively). Accuracy of CL-M8, 3 and 2 were not different (74%, 84% and 79% respectively, p>0.05). MDRD equation had higher accuracy (47%) compared with other equations. CONCIUSION: These results indicate that sampling number for measuring iohexol plasma clearance using simplified method might be reduced to only two without accuracy loss in Korean without renal disease.

Randomized Trial of Tacrolimus Versus Cyclosporine in Steroid Withdrawal in Living Donor Renal Transplant Recipients / 대한신장학회잡지

BACKGROUND: The introduction of new immunosuppressants has prompted several trials of steroid withdrawal immunosuppression. However, several groups have reported a higher incidence of rejection. METHODS: We conducted a randomized two-arm, parallel group, open label, prospective study to compare steroid withdrawal (at 6 months post-transplant) regimens: tacrolimus+mycophenolate mofetil (MMF) (FK group) vs cyclosporine+MMF (CyA group). Entry criteria were: first living donor transplant recipient, no diabetes mellitus (DM), no congestive heart failure, no chronic liver disease, and no acute rejection by 6 months post-transplant. The primary endpoint was a biopsy-proven acute rejection episode or treatment failure within 1 year post- transplant. RESULTS: While eighty-seven recipients were assigned to FK (n=43) and CyA group (n=44) before transplantation, seventy-six recipients (FK 39, CyA 37) could taper off steroid at 6 months post-transplant since eleven were excluded due to acute rejection within 6 months post-transplant (FK 2, CyA 3), protocol violation (FK 2, CyA 1), drug change due to side effect (CyA 2) and follow-up loss (CyA 1). After steroid withdrawal, acute rejection episode was 0% in FK group and 13.5% in CyA group (p0.05 in every variable). CONCLUSION: These data suggest that steroid withdrawal are successful in first living donor renal transplant recipients and tacrolimus may be more effective than cyclosporine significantly in preventing acute rejection after steroid withdrawal.

A Case of Spontaneous Renal Artery Dissection Secondary to Fibromuscular Dysplasia and Treatment by Renal Arterial Stenting / 대한신장학회잡지

Isolated spontaneous renal artery dissection (SRAD) associated with fibromuscular dysplasia (FMD) is a rare condition that can result in renal infarction. Treatment and long-term management of patients with this condition is controversial. We report the case of a patient with SRAD secondary to FMD who was treated by renal arterial stenting. A previous healthy 50-year-old white male presented to the emergency department with acute right flank pain. Blood pressure was 150/90 mmHg and serum creatinine was 1.6 mg/dL. A CT scan of the abdomen showed multifocal right renal infarction. The patient was started on anticoagulant regimen of heparin. Renal angiography showed the dissection of right renal artery and stenosis of mid-segment of right main renal artery and intrarenal branches. We decided to perform percutaneous balloon angioplasty and stenting for the purpose of dilating the stenotic renal artery, preventing recurrence of the disease and controlling hypertension and elevated creatinine. A dissected intimal flap was closed successfully by renal artery stenting and stenotic renal artery was dilated by stenting and balloon angioplasty. Five days after the procedure, he was discharged with warfarin. Three months later, he had normal renal function and blood pressure without antihypertensive medication was mildly elevated at 145/104 mmHg. Conclusively, stent implantation to renal artery dissection can be effective, reliable and feasible and can be an alternative to surgical treatment.

Hemodialysis Using Heparin Bound Hemophan Hemodialysis in ESRD Patients at High Risk for Bleeding: A Seven-Year Experience / 대한신장학회잡지

OBJECTIVE: Positively charged N, N-diethyl-aminoehtyl groups on Hemophan enable negative charged heparin to be bound with the dialyzer membrane and hemodialysis using heparin bound Hemophan (HBH- HD) could be a hemodialysis modality in patients at risk of bleeding. We designed simplified heparin binding technique and evaluated the bleeding risk and efficiency of HBH-HD in chronic renal failure patients at risk of bleeding. METHODS: During the period from April 1995 through April 2002, 159 patients at high bleeding risk received 1057 HBH-HD (dialyzer: GFS plus 11, Gambro). The duration of each HBH-HD was standardized to 4 hours at blood-flow rate of 200-250 mL/min. To evaluate safety of HBH-HD, we measured serum heparin concentration (HC) and activated partial thromboplastin time (aPTT) at baseline, 15, 60, 120 minutes and endpoint (240 minutes) (n= 40). To evaluate the dialysis efficiency, HBH-HD and routine hemodialysis with systemic heparinization (R-HD) were compared for total blood compartment volume (TBCV) loss, dialyzer urea clearance (K) and Kt/V in same study group patients (n=20). RESULTS: Clotting of dialyzer necessitating termination of dialysis occurred in 11 (1.0%) out of 1, 057 dialyses at 150 minutes, and clotting requiring change of blood line occurred in 64 dialyses (6.1%) between 150 and 230 minutes. There was a slight increase in the aPTT (mean+/-SD, 49.8+/-10.5 sec) and HC (0.14+/-0.06 U/mL) at 15 min, compared to predialysis levels of 44.3+/-12.9 sec and 0.11+/-0.06 U/ mL, respectively (p>0.05). But no increase in aPTT, HC was observed in measurements at 60 min, 120 min, and at the endpoint. TBCV loss was significantly higher in HBH-HD (mean+/-SD, 17.2+/-9.6%), compared to R-HD (2.8+/-1.2%) (p0.05). CONCLUSION: HBH-HD could be a safe and efficient HD technique in patients at high risk of bleeding. Extracorporeal clotting, however, should be observed carefully during HBH-HD.

A Case of Light Chain Deposition Disease without Significant Proteinuria / 대한신장학회잡지

A 67-year-old male was admitted to the hospital for evaluation of incidentally detected anemia and mild azotemia. Urinalysis showed no abnormal finding and 24 hr urine protein amount was clinically insignificant (270 mg/day). Urine and serum protein electrophoresis were negative for a monoclonal spike. However, urine and serum immunoelectrophoresis demonstrated the presence of monoclonal free kappa light chains. Renal biopsy showed the features of chronic tubulointerstitial disease and on the immunofluorescence studies, kappa light chain was in a linear pattern in basement membranes of glomeruli and tubules. Work-up for multiple myeloma including bone marrow biopsy showed results compatible with multiple myeloma. Treatment was started with vincristine, adriamycin and doxorubicin at monthly interval for three months followed by autologus peripheral blood stem cell transplantation. At follow-up 5 months after autologus peripheral blood stem cell transplantation, the patient is well with a serum creatinine of 2.3-2.6 mg/dL and 24 hr urine protein of 200-350 mg.

A Case of Postinfectious Glomerulonephritis Following Meningococcal Meningitis / 대한신장학회잡지

A 21-year-old male was presented with sudden headache, fever, petechiae and neck stiffness. The diagnosis of meningococcal meningitis was confirmed by examination of cerebrospinal fluid. The clinical symptoms of the illness were improved after treatment of antibiotics. However the patient developed generalized edema, oliguria, azotemia, and heavy proteinuria in the recovery phase of illness. Low serum C3 level was also noted. A kidney biopsy was performed and showed the features of postinfectious glomerulonephritis and typical subepithelial humps on electron-microscopic examination. His symptoms and laboratory findings were improved, and C3 level returned to normal range after conservative treatment. We suggest that a complement deficiency should be ruled out in patients of glomerulonephritis developed during the recovery phase of meningococcal meningitis. C3 nephritic factor detection and renal biopsy should be carefully considered in these patients.

Primary Sjogren's Syndrome with Renal Pseudolymphoma Featuring Interstitial Nephritis / 대한신장학회잡지

A 65 year-old woman with Sjogren's syndrome was found to have renal mass and acute renal failure. Immunopathologic analysis of renal biopsy specimens showed polyclonal lymphocytic interstitial infiltration. Gene rearrangement study of T cell receptor showed a polyclonal pattern. The degree of azotemia and the size of pseudolymphoma diminished dramatically with steroid therapy. This is a case of proven pseudolymphoma that was found as renal mass in Sjogren's syndrome.

Peritoneopleural Leakage in Continuous Ambulatory Peritoneal Dialysis : Successful Treatment with Video-Assisted Thoracoscopic Talc Pleurodesis / 대한신장학회잡지

Continuous ambulatory peritoneal dialysis (CAPD) is an effective renal replacement therapy for end- stage renal disease. Hydrothorax secondary to leakage of dialysate via pleuroperitoneal communication is a rare complication of CAPD. Earlier treatments of CAPD-induced hydrothorax have included pleurodesis with tetracycline, talc, fibrin, or autologous blood and surgical treatment. These procedure have made many patients switch to hemodialysis, because of the high relapse rate of the former and the invasiveness and morbidity of the latter. The talc pleurodesis with video-assisted thoracic surgery (VATS) allows not only direct visualization of potential diaphragmatic defect but also direct application of the talc to the visceral or parietal pleura. This procedure is less invasive than thoracotomy and can perform more accurate poudrage of talc than conventional methods. We have recently managed a patient CAPD-induced massive hydrothorax using thoracoscopic talc pleurodesis. This patient was successfully returned to CAPD.

Peritoneopleural Leakage in Continuous Ambulatory Peritoneal Dialysis : Successful Treatment with Video-Assisted Thoracoscopic Talc Pleurodesis / 대한신장학회잡지

Continuous ambulatory peritoneal dialysis (CAPD) is an effective renal replacement therapy for end- stage renal disease. Hydrothorax secondary to leakage of dialysate via pleuroperitoneal communication is a rare complication of CAPD. Earlier treatments of CAPD-induced hydrothorax have included pleurodesis with tetracycline, talc, fibrin, or autologous blood and surgical treatment. These procedure have made many patients switch to hemodialysis, because of the high relapse rate of the former and the invasiveness and morbidity of the latter. The talc pleurodesis with video-assisted thoracic surgery (VATS) allows not only direct visualization of potential diaphragmatic defect but also direct application of the talc to the visceral or parietal pleura. This procedure is less invasive than thoracotomy and can perform more accurate poudrage of talc than conventional methods. We have recently managed a patient CAPD-induced massive hydrothorax using thoracoscopic talc pleurodesis. This patient was successfully returned to CAPD.

A Prospective Study on Changes of Serum Leptin and Its Expression in CAPD Patients / 대한신장학회잡지

The ob gene product leptin is thought to be an adipostatic hormone through the regulation of food intake and energy expenditure. There are many reports that serum leptin concentration was increased in CRF patients, especially CAPD patients. The causes of elevated serum leptin concentration in CRF are believed to be multifactorial. Increased body fat mass, decreased residual renal function, active inflammation and hyperinsulinemia all are suggested to influence serum leptin concentration in CAPD patients. In this study, in order to investigate the pathogenic mechanism of increased serum leptin level in CAPD patients, we observed the changes of serum leptin concentration, leptin expression in the abdominal subcutaneous fat tissue, body fat composition, residual renal function, serum insulin concentration and CRP. Thirteen patients(7 men and 6 women, mean age 53+/-14 years) were enrolled in this study. Serum leptin concentration was measured by RIA before start of CAPD(baseline data), 5 days and 1, 3 months after start of CAPD. Simultaneously, fat tissues were aspirated from the abdominal subcutaneous fat tissues for analysis of ob gene expression. Ob mRNA expression was measured by semiquantitative RT-PCR method. The changes of serum insulin concentration, C-reactive protein, residual renal function were measured. All studies were done immediately before starting CAPD, 5 days, 1 month and 3 months after starting CAPD. Total body fat was estimated by dual energy X-ray absorptiometry and abdominal visceral and parietal fat area measured by computed tomography were done at 1-3 days(baseline data), 1 month, 3 months after start of CAPD. Serum leptin concentration increased significantly as early as 5 days after start of CAPD and maintained high up to 3 months(4.3+/-2.6->8.2+/-7.6->7.4+/-6.5->10.8+/-13.8ng/mL), while leptin expression in the abdominal subcutaneous fat tissue did not change during the study period(0.24+/-0.06->0.25+/-0.08->0.20+/-0.07->0.34+/-0.21ng/mL). No significant changes of body fat composition, residual renal function and serum insulin concentration were observed during the study period. These results suggest that increase of serum leptin concentration after CAPD may be due to increase of local leptin production, especially from the peritoneum, as has also been suggested by several reports of relatively higher dialysate leptin.

Estimation of Kidney Size by Ultrasonography in Normal Korean Adults / 대한신장학회잡지

BACKGROUND: The kidney size is important in differentiating many renal diseases. Some studies have been reported about the normal kidney size in the foreign countries. However, no studies were performed by using ultrasonography in Korea. Therefore, we investigated the normal kidney length, the factors affecting the kidney length and the relationship of each other. METHODS: One thousand three hundred eighty eight healthy Koreans were scanned for the kidney length by ultrasonography and were measured for their body index(height, weight, body surface area, total body water, and fat free mass). We analyzed the association between kidney length and body index. RESULTS: Eight hundred four male and five hundred eighty four female were involved in this study and their mean age was 47.8+/-10.3 in male, 48.1+/-9.5 in female. 1) The average value of left and right kidney was 10.65+/-0.80cm, 10.50+/-0.78cm respectively, and the left kidney was greater than right one(P<0.01). 2) The difference between male and female was 10.77+/-0.79cm, 10.49+/-0.78cm respectively in the left kidney and 10.66+/-0.76cm, 10.27+/-0.75cm in the right kidney(P<0.01). 3) The aging process nearly does not affects the kidney size from 4th decade to 7th decade. However, the kidney size is getting smaller after 8th decade. 4) The correlation coefficient between the kidney size and height, weight, body surface area, total body water, fat free mass was 0.37, 0.41, 0.43, 0.37, 0.38(P<0.01) respectively. CONCLUSION: The kidney length showed normal distribution in normal Korean adult and the length greater than 12.36cm, smaller than 8.76cm means out of its range of normal(+/-2SD) irrespective of sex and position. The body surface area has the largest correlation with kidney size in both sex(r=0.38/0.44; left/right, P<0.01).