The effect of intravenous ascorbic acid in hemodialysis patients with normoferritinemic anemia

BACKGROUND: Hemodialysis (HD) patients with functional iron deficiency often develop resistance to recombinant human erythropoietin (rhEPO). Recent studies have shown that intravenous ascorbic acid (IVAA) administration could override rhEPO resistance in HD patients. This study was undertaken to test the effects of IVAA in HD patients with normoferritinemic functional iron deficiency accompanied by EPO-hyporesponsive anemia. METHODS: Fifty-eight HD patients with normoferritinemic anemia (between 100 and 500 microg/L) were included and divided into the control (N=25) and IVAA (N=33) groups. IVAA patients received 500 mg of IVAA with each dialysis session for 3 months and an additional 4-month follow-up after the end of the therapy. RESULTS: Twenty patients had a response to IVAA with a significant increase in hemoglobin level (Hgb4>1.0 g/dL) and reduction of weekly rhEPO dosage compared with the control group after 3 months of treatment (P<0.05). Compared with non-responders, transferrin saturation (TSAT) was significantly decreased in the responders group (26+/-11 vs. 35+/-14%, P<0.05) on baseline data. There was a significant increase in serum iron and TSAT (baseline vs. 3 months, serum iron 57+/-22 vs. 108+/-22 microg/dL, TSAT 26+/-11 vs. 52+/-7%, P<0.05) and a decrease in serum ferritin (377+/-146 vs. 233+/-145 ng/mL, P<0.05) in the responders group (N=20), but no significant changes in the control and non-responders groups (N=13) at 3-month treatment. CONCLUSION: IVAA can be a potent and effective adjuvant therapy for HD patients with rhEPO-resistant normoferritinemic anemia. In addition, IVAA can reduce the dosage of rhEPO for anemia correction.

Complete Recovery of Renal Function in Bilateral Renal Cortical Necrosis: A Case Report / 대한신장학회지

Acute bilateral renal cortical necrosis (BRCN) is a rare cause of renal failure. It has been reported that contrast-enhanced computed tomography provides characteristic findings of BRCN which correlates well with the histopathology making it an important non-invasive diagnostic modality during early phase of BRCN, improving survival rate and prognosis with early diagnosis and treatment. This report presents a case of 73-year old woman with BRCN due to hemolytic uremic syndrome. The patient recovered from anuria and showed complete recovery to normal renal function of her age and serum creatinine level after early initiation of hemodialysis. Furthermore, a normal radiologic finding of kidney was obtained after 52 days from onset of the disease by contrast-enhanced computed tomography. At present, she is preserved within the normal range renal function without renal replacement therapy.

A Case of Acute Fatty Liver of Pregnancy with Renal Subcapsular Hemorrhage / 대한신장학회지

Wunderlich syndrome is a spontaneous rupture of the kidney. It is a rare but potentially life-threatening event. The causes are tumor, vascular disease, infection and preeclampsia. Subcapsular hepatic and renal hematoma are rare complications of pregnancy associated with preeclampsia or HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Acute fatty liver of pregnancy (AFLP) is rare, but is a fatal complication of the third trimester of pregnancy. The clinical picture consists of liver failure with coagulopathy, encephalopathy and hypoglycemia. Early recognization of the disorder, rapid termination of pregnancy, and intensive supportive care have improved the prognosis. AFLP should be distinguished from HELLP syndrome. AFLP is usually not associated with renal subcapusular hemorrhage. In this report, we describe a 36-year-old nullipara with twin male fetus at 35 weeks of gestation who had developed renal subcapsular hemorrhage in AFLP.

A case of carbamazepine induced acute interstitial nephritis / 대한내과학회지

Acute interstitial nephritis often caused by drugs and infection. Interstitial nephritis by drugs is a kind of idiosyncratic reaction and is caused independently of dosage. This disease developed within several days or weeks after taking medicine but improved if discontinue medication. Adrenocortical hormone may shorten the period of disease if renal dysfunction continued. Acute interstitial nephritis by carbamazepine that is used for epilepsy cure is rarely reported. A 49-year-old male was admitted to our hospital because of skin rash and decreased urine volume which developed 10 days ago. Patient was diagnosed intracranial hemorrhage 6 months ago and was taking carbamazepine because of tingling sensation to lower extremity before 2 months. At admission, blood pressure 120/80 mmHg, hemoglobin 12.6 g/dL, WBC 232,000/mm3, eosinophil count 2,790/mm3, platelet 166,000/mm3. Urine findings indicated protein 1+, blood 2+ and eosinophil was observed in microscopic examination. Abdominal sonography showed increase of both kidney size, shade of renal cortex and Resistance index (RI). Renal biopsy showed inflammatory cell consisted of lymphocyte, eosinophil in parenchyme was seen with tubular necrosis partially. Renal function was improved after carbamazepine withdrawal and adrenocortical hormone medication.

A case of nephrocalcinosis with primary aldosteronism / 대한내과학회지

Primary aldosteronism is defined as hypertension, hypokalemia, increased serum aldosteron, decreased serum renin activity. It has been known that prolonged hypokalemia, renal cyst formation and impairment of renal function. However, nephrocalcinosis associated with primary aldosteronism is rarely reported. A 31-year-old male was admitted to our hospital because of abdominal pain and uncontrolled hypertention which developed 2 years earlier. At admission, blood pressure 180/100 mmHg. Biochemical findings indicated sodium 146 mEq/L, potassium 2.3 mEq/L, BUN 8.2 mg/dL, creatinine 1.1 mg/dL, calcium 10.7 mg/dL, phosphate 5.7 mg/dL, magnesium 1.8 mg/dL. Twenty-four hour urine collection indicated sodium 108 mEq, potassium 32 mEq, calcium 75 mg, phosphate 72 mg, magnesium 8.0 mg. The hormone study revealed PTH 22.7 pg/mL (normal: 9~55 pg/mL), ACTH 8 pg/mL (normal: 6~56.7 pg/mL), aldosterone 51.0 ng/dL (normal: 1~16 ng/dL), plasma renin activity below 0.01 ng/mL/hr (normal: 0.15~233 ng/mL/hr). Abdominal sonography showed homogenous increased medullary echoes and multiple calcification. The abdomen CT showed adrenal mass (1 x 1 cm) consistent with adrenal tumor. Adrenalrectomy was performed on the 16th hospital day and clinical symptoms, blood pressure and hypokalemia improved shortly after operation.

Chronic hyponatremia of Sheehan's syndrome / 대한내과학회지

Sheehan's syndrome has been attributed to ischemic damage of the pituitary gland or hypothalamic-pituitary stalk during the peripartum period. Well-described clinical features of Sheehan`s syndrome include hypothyroidism, growth hormone deficiency, hypogonadism, hypoprolactinemia, adrenal insufficiency, and different sodium and water disturbance. The occurrence of sodium and water disturbances associated with Sheehan`s syndrome depends on the degree of pituitary damage, time of onset since the initial pituitary insult, and concurrent medical conditions that also may play a role in sodium and water balance. Chronic hyponatremia is the most common presentation of altered sodium levels in patients with Sheehan`s syndrome. The chronic nature of the presenting hyponatremia suggests more subtle changes of panhypopituitarism or better adaptive mechanism. Although controversial, another mechanism proposed for hyponatremia in the chronic setting involves alternation in the renin-angiotensin/aldosterone system with resulting sodium wasting. We presented a patient with Sheehan`s syndrome associated with hyporeninemic hypoaldosteronism and hyponatremia 53 years old women, who had 4th baby delivery with severe blood loss about 25 years ago, was admitted to hospital because of general weakness. The patient was diagnosis Sheehan`s syndrome with hyponatremia. In addition, we performed hormonal study to find cause of hyponatremia. The results were hypopituitarism and hyporeninemic hypoaldosteronism. Hyponatremia was corrected by hormonal therapy (glucocorticoid,synthyroid,estrogen). The patient felt well-being sensation and was followed up the out-patient department.