Transcatheter Arterial Embolization Therapy for a Massive Polycystic Liver in Autosomal Dominant Polycystic Kidney Disease Patients

Polycystic liver is the most common extra-renal manifestation associated with autosomal dominant polycystic kidney disease (ADPKD), comprising up to 80% of all features. Patients with polycystic liver often suffer from abdominal discomfort, dyspepsia, or dyspnea; however, there have been few ways to relieve their symptoms effectively and safely. Therefore, we tried transcatheter arterial embolization (TAE), which has been used in treating hepatocellular carcinoma. We enrolled four patients with ADPKD in Seoul National University Hospital, suffering from enlarged polycystic liver. We embolized the hepatic arteries supplying the dominant hepatic segments replaced by cysts using polyvinyl alcohol particles and micro-coils. The patients were evaluated 12 months after embolization for the change in both liver and cyst volumes. Among four patients, one patient was lost in follow up and 3 patients were included in the analysis. Both liver (33%; 10%) and cyst volume (47.7%; 11.4%) substantially decreased in two patients. Common adverse events were fever, epigastric pain, nausea, and vomiting. We suggest that TAE is effective and safe in treating symptomatic polycystic liver in selected ADPKD patients.

The Bilirubin Level is Negatively Correlated with the Incidence of Hypertension in Normotensive Korean Population

Reactive oxygen species have been known to be an important factor in the pathogenesis of hypertension. Bilirubin, one of the metabolites of heme degraded by heme oxygenase, is a potent anti-oxidant. We verified the effect of serum bilirubin level on the incidence of hypertension in normotensive subjects. We grouped 1,208 normotensive subjects by the criterion of the highest quintile value of serum bilirubin, 1.1 mg/dL. The incidence of hypertension was higher in group 1 with bilirubin less than 1.1 mg/ dL than in group 2 with bilirubin 1.1 mg/dL or more (186/908 vs. 43/300, p=0.018). The relative risk for hypertension was 0.71 (95% confidence interval, 0.51-0.99), p=0.048 in group 2 compared to group 1 by Cox's proportional hazard model. Among the groups stratified by gender, smoking, and liver function status, the group 2 showed a lower risk of hypertension in females and in non-smokers. In conclusion, a mild increase within the physiological range of serum bilirubin concentration was negatively correlated with the incidence of hypertension. The effect of bilirubin on the development of hypertension was more evident in females and in non-smokers.

The impact of uric acid and metabolic syndrome on the incidence of hypertention in a Korean population / 대한내과학회지

BACKGROUNDS: Uric acid has been proposed as an important risk factor for the development of primry hypertension. Many factors related to the serum uric acid level also influence the prevalence and incidence of hypertension. Especially, hyperuricemia is considered a secondary phenomena of metabolic syndrome. We evaluated the impact of uric acid and metabolic syndrome on the development of hypertension, with exclusion of the possible effects of confounding factors on both the uric acid level and the incidence of hypertension. METHODS: We included 2,390 subjects without hypertension who had undergone multiple health check-ups at the Seoul National University Hospital during the last 10 years. We selected the JNC VII criteria for hypertension and the modified ATP III criteria for metabolic syndrome. RESULTS: During the mean follow-up period of 54.3 months, hypertension was developed in 32.2% of the subjects. The incidence of hypertension in the high uric acid group was higher than that in the low uric acid group. Metabolic syndrome was an independent risk factor for hypetension and it was closely related to the prevalence of high uric acid level. Uric acid was also an independent risk factor for hypertension in each gender. The relationship between uric acid and hypertension was evident for the subjects without metabolic syndrome. CONCLUSIONS: Serum uric acid was a risk factor for hypertension in each gender regardless of the absence of metabolic syndrome. Metabolic syndorme also contributed to the development of hypertension.

The Prevalence and the Associated Disorders of Chronic Kidney Disease in Subjects with Health Check-Up / 대한신장학회지

PURPOSE: The prevalence of chronic kidney disease (CKD) is increasing in Korea. Considerable resources have been consumed for patients with CKD. This study investigated the prevalence, the associated disorders, and the awareness of CKD and the current status of appropriate control for blood pressure and blood sugar in subjects with CKD. Methods: We included 14,856 subjects who underwent a health check-up in Seoul National University Bundang Hospital during the last 2 years. We selected K/DOQI guideline of CKD. We used the modified MDRD equation to estimate the glomerular filtration rate (eGFR). RESULTS: The mean eGFR was 83.3 mL/min/1.73m(2) and it decreased with aging at the rate of 5 (mL/ min/1.73m(2))/10 years. The prevalences of CKD stage 1, stage 2, and stage more than 3 were 3.2%, 9.4%, and 3.5%, respectively. The prevalence of CKD was higher in subjects with hypertension or diabetes mellitus than in subjects without it. The CKD was associated with disorders of hypertension, cardiovascular diseases, hyperuricemia, hyperphosphatenemia, hyperkalemia, and hypertriglyceridemia. The prevalence of reported kidney disease was only 6.5% in subjects with eGFR less than 60 mL/min/1.73m(2). The frequency of adequate control of blood pressure and blood sugar in subjects with CKD was lower than in subjects without CKD. Conclusion: The subjects were rarely aware of CKD whereas the frequencies of CKD and the associated diseases were considerably high. We have to pay more attention to diagnose and treat the CKD.