Clinical relevance of postoperative proteinuria for prediction of early renal outcomes after kidney transplantation

Proteinuria is associated with poor allograft and patient survival in kidney transplant recipients. However, the clinical relevance of spot urine protein-to-creatinine ratio (PCR) or albumin-to-creatinine ratio (ACR) as predictors of renal outcomes during the early postoperative period following kidney transplantation (KT) has not been determined. Methods: This single-center retrospective cohort study included 353 kidney transplant recipients who underwent KT between 2014 and 2017 and were followed up for more than 3 years. Among them, 186 and 167 recipients underwent living donor KT and deceased donor KT, respectively. The PCR and ACR were measured during the immediate postoperative period (within 7 days postoperatively), before discharge (2–3 weeks postoperatively), and 3–6 months postoperatively. Results: The median age of the patients was 51 years (interquartile range, 43–59 years), and 62.9% were male. An immediate postoperative PCR of ≥1 mg/mg was associated with old age, diabetes mellitus, high systolic blood pressure, delayed graft function, and donor factors (deceased donor KT, old age, and high serum creatinine concentrations). The PCR and ACR 3 to 6 months posttransplant were inversely associated with the estimated glomerular filtration rate at 1 year posttransplant. Deceased donor KT recipients with immediate postoperative PCR of ≥3 mg/mg showed a greater incidence of delayed graft function and lower estimated glomerular filtration rate before discharge than those with immediate postoperative PCR of <3 mg/mg. Conclusion: Early postoperative proteinuria is a useful biomarker to predict early renal outcomes after KT.

Korean Society of Nephrology hemodialysis unit accreditation report (2016–2020) and future directions

Patients receiving hemodialysis have various complications with a high mortality rate and require specialized treatment at an institution equipped with an appropriate workforce, equipment, and facilities. The Korean Society of Nephrology (KSN) is conducting hemodialysis unit accreditation to manage the quality of hemodialysis institutions, present standard treatment guidelines, and establish a network between regional medical institutions for the safe treatment of hemodialysis patients. This study aimed to summarize the previous accreditation results and discuss future directions. Methods: After the proposal of hemodialysis unit accreditation in 2009, pilot projects were undertaken for hemodialysis units and dialysis subspecialist training hospitals in the metropolitan area for 5 years. Since 2016, five hemodialysis unit accreditation projects have been conducted. Results: The cumulative number of participating units was 599, and the number of accredited units was 473 (average accreditation rate, 79.0%). The participating units consisted of clinics (58.6%), non-university hospitals (28.2%), and university hospitals (13.2%). Overall, 92.4% of university hospitals, 81.2% of clinics, and 68.0% of non-university hospitals were accredited. Over 5 years, new units were added annually to apply for accreditation, and the rate of previous participants applying for reaccreditation was high (77.7%). However, considering that the total number of member institutions of the KSN is 637, the number of units with valid accreditation as of 2020 was low (267 [41.9%]). Conclusion: The efforts of the KSN and its members, as well as institutional support from the government, are required for quality management of hemodialysis units through hemodialysis unit accreditation.

The presence of simple renal cysts is associated with an increased risk of albuminuria in young adults

Background/Aims@#The prevalence of simple renal cysts increases with age; however, they are occasionally found in adults aged < 40 years. This cross-sectional study evaluated the clinical significance of simple cysts in young adults, focusing on their associations with hematuria and albuminuria. @*Methods@#Adults aged < 40 years who underwent comprehensive medical examination between January 2005 and December 2013 were included. Simple renal cysts were identified by ultrasonography. @*Results@#Renal cysts were found in 276 of the 5,832 subjects (4.7%). Subjects with medullary sponge kidney (n = 1) or polycystic kidney disease (n = 5) were excluded. A single cyst and multiple cysts were found in 234 (4.0%) and 42 (0.7%) subjects, respectively. Age, high systolic blood pressure, and history of hypertension were independent risk factors for the presence of simple cysts. Simple cysts were not associated with an increased prevalence of hematuria. However, subjects with cysts showed a higher prevalence of albuminuria than those without (11.3% vs. 4.5%, p < 0.001). Multivariate analysis revealed that the existence of simple renal cysts was associated with a 2.30-fold increased prevalence of albuminuria (95% confidence interval, 1.512 to 3.519; p < 0.001) independent of other risk factors. @*Conclusions@#In young adults, the presence of simple renal cysts was independently associated with an increased prevalence of albuminuria. The causal relationship needs to be elucidated in further studies.

Association between extract from fruit of Opuntia ficus-indica and streptozotocin-induced diabetic rats

Opuntia ficus-indica has traditionally been used in prevention and treatment of various diseases such as diabetes mellitus. The current study was performed to determine whether Opuntia ficus-indica is associated with diabetes. Diabetic rat models were induced with streptozotocin (STZ). This study divided rats into 1 day (short-term) and 4 consecutive weeks (long-terms) of daily administration. These groups were subdivided into four groups each other for assessment of blood glucose level as follows: Group 1, untreated rats given distilled water; Group 2, untreated rats given Opuntia ficus-indica; Group 3, STZ-induced diabetic rats given distilled water; Group 4, STZ-induced diabetic rats given Opuntia ficus-indica. Blood glucose level was measured for one day and four weeks. In addition, serum markers of alanine aminotransferase (ALT), aspartate transaminase (AST), cholesterol, and creatinine were determined, and total protein triglycerides were measured at four weeks. Blood glucose level was highest in both groups (Group 3 and Group 4) at 30 minutes and two weeks and gradually decreased in a time-dependent manner. The difference in blood glucose among the four groups was significant (p < 0.05). Additionally, the levels of ALT, AST and triglycerides were significantly decreased by Opuntia ficus-indica.

Depiction of the Periosteum Using Ultrashort Echo Time Pulse Sequence with Three-Dimensional Cone Trajectory and Histologic Correlation in a Porcine Model

Objective@#To evaluate the signal intensity of the periosteum using ultrashort echo time pulse sequence with threedimensional cone trajectory (3D UTE) with or without fat suppression (FS) to distinguish from artifacts in porcine tibias. @*Materials and Methods@#The periosteum and overlying soft tissue of three porcine lower legs were partially peeled away from the tibial cortex. Another porcine tibia was prepared as three segments: with an intact periosteum outer and inner layer, with an intact periosteum inner layer, and without periosteum. Axial T1 weighted sequence (T1 WI) and 3D UTE (FS) were performed. Another porcine tibia without periosteum was prepared and subjected to 3D UTE (FS) and T1 WI twice, with positional changes. Two radiologists analyzed images to reach a consensus. @*Results@#The three periosteal tissues that were partially peeled away from the cortex showed a high signal in 3D UTE (FS) and low signal on T1 WI. 3D UTE (FS) showed a high signal around the cortical surface with an intact outer and inner periosteum, and subtle high signals, mainly around the upper cortical surfaces with the inner layer of the periosteum and without periosteum. T1 WI showed no signal around the cortical surfaces, regardless of the periosteum state. The porcine tibia without periosteum showed changes in the high signal area around the cortical surface as the position changed in 3D UTE (FS). No signal was detected around the cortical surface in T1 WI, regardless of the position change. @*Conclusion@#The periosteum showed a high signal in 3D UTE and 3D UTE FS that overlapped with artifacts around the cortical bone.

Association between extract from fruit of Opuntia ficus-indica and streptozotocin-induced diabetic rats

Opuntia ficus-indica has traditionally been used in prevention and treatment of various diseases such as diabetes mellitus. The current study was performed to determine whether Opuntia ficus-indica is associated with diabetes. Diabetic rat models were induced with streptozotocin (STZ). This study divided rats into 1 day (short-term) and 4 consecutive weeks (long-terms) of daily administration. These groups were subdivided into four groups each other for assessment of blood glucose level as follows: Group 1, untreated rats given distilled water; Group 2, untreated rats given Opuntia ficus-indica; Group 3, STZ-induced diabetic rats given distilled water; Group 4, STZ-induced diabetic rats given Opuntia ficus-indica. Blood glucose level was measured for one day and four weeks. In addition, serum markers of alanine aminotransferase (ALT), aspartate transaminase (AST), cholesterol, and creatinine were determined, and total protein triglycerides were measured at four weeks. Blood glucose level was highest in both groups (Group 3 and Group 4) at 30 minutes and two weeks and gradually decreased in a time-dependent manner. The difference in blood glucose among the four groups was significant (p < 0.05). Additionally, the levels of ALT, AST and triglycerides were significantly decreased by Opuntia ficus-indica.

Depiction of the Periosteum Using Ultrashort Echo Time Pulse Sequence with Three-Dimensional Cone Trajectory and Histologic Correlation in a Porcine Model

Objective@#To evaluate the signal intensity of the periosteum using ultrashort echo time pulse sequence with threedimensional cone trajectory (3D UTE) with or without fat suppression (FS) to distinguish from artifacts in porcine tibias. @*Materials and Methods@#The periosteum and overlying soft tissue of three porcine lower legs were partially peeled away from the tibial cortex. Another porcine tibia was prepared as three segments: with an intact periosteum outer and inner layer, with an intact periosteum inner layer, and without periosteum. Axial T1 weighted sequence (T1 WI) and 3D UTE (FS) were performed. Another porcine tibia without periosteum was prepared and subjected to 3D UTE (FS) and T1 WI twice, with positional changes. Two radiologists analyzed images to reach a consensus. @*Results@#The three periosteal tissues that were partially peeled away from the cortex showed a high signal in 3D UTE (FS) and low signal on T1 WI. 3D UTE (FS) showed a high signal around the cortical surface with an intact outer and inner periosteum, and subtle high signals, mainly around the upper cortical surfaces with the inner layer of the periosteum and without periosteum. T1 WI showed no signal around the cortical surfaces, regardless of the periosteum state. The porcine tibia without periosteum showed changes in the high signal area around the cortical surface as the position changed in 3D UTE (FS). No signal was detected around the cortical surface in T1 WI, regardless of the position change. @*Conclusion@#The periosteum showed a high signal in 3D UTE and 3D UTE FS that overlapped with artifacts around the cortical bone.

Effects of percutaneous angioplasty on kidney function and blood pressure in patients with atherosclerotic renal artery stenosis

BACKGROUND: Previous randomized controlled trials of revascularization for atherosclerotic renal artery stenosis (ARAS) were not successful. We investigated the effects of percutaneous transluminal angioplasty with stent insertion (PTA/S) on kidney function and blood pressure (BP) control in patients with ARAS. METHODS: From 2000 to 2017, 47 subjects who underwent PTA/S for ARAS were identified. A high-risk group was defined, composed of patients having one or more of the following clinical presentations: pulmonary edema, refractory hypertension, and rapid deterioration of kidney function. Subjects who met the criteria of ‘kidney function improvement’ or ‘hypertension improvement’ after PTA/S were classified as responders. RESULTS: Twenty-one (44.7%) subjects were classified into the high-risk group. Two subjects (8.0%) in the low-risk group (n = 25) and 5 subjects (27.8%) in the high-risk group (n = 18) showed improvement in kidney function after PTA/S (P = 0.110). In patients with rapid decline of kidney function, estimated glomerular filtration rate improved from 28 (interquartile range [IQR], 10–45) mL/min/1.73 m² to 41 (IQR, 16–67) mL/min/1.73 m² at 4 months after PTA/S, although the difference was not significant (P = 0.084). Regarding BP control, 9 (36.0%) and 14 (77.8%) subjects showed improvement after PTA/S in the low- (n = 25) and high-risk (n = 18) groups, respectively (P = 0.007). In patients with refractory hypertension, the systolic BP dropped from 157 (IQR, 150–164) mmHg to 140 (IQR, 131–148) mmHg at 4 months after PTA/S (P = 0.005). Twenty-five subjects were defined as responders and comprised a significant proportion of the high-risk group (P = 0.004). CONCLUSION: PTA/S might improve BP control and kidney function in patients with ARAS presenting with high-risk clinical features. The optimal application of PTA/S should be based on individual assessment of the clinical significance of renal artery stenosis.

Evaluation of BacT/Alert FAN Plus Bottles for the Culture of Peritoneal Dialysate / 대한임상미생물학회지

BACKGROUND: A major complication of peritoneal dialysis (PD) is peritonitis, and bacterial culture of PD effluent in a blood culture bottle is the preferred technique for diagnosis of peritonitis. In this study, we compared dialysate inoculation and culture using the BacT/AlerT® Fastidious Antimicrobial Neutralization Plus blood culture bottles (FAN Plus; bioMérieux, France) to the conventional centrifugation culture method.METHODS: A total of 170 PD effluents were simultaneously processed by the conventional centrifugation culture method and by culture using FAN Plus media with two different inoculation procedures: inoculation after centrifugation and direct bedside inoculation.RESULTS: Of the 52 cultures that were positive on at least one of the culture methods, 27 samples were positive on conventional centrifugation. However, 46 samples showed growth following inoculation into the FAN Plus media after centrifugation, and 47 samples were positive on the direct FAN Plus inoculation method. Using the case definition for PD peritonitis to classify samples, sensitivity of the conventional method was 50.0% (95% CI, 33.7–66.3%), whereas the sensitivity of the FAN Plus media was 78.9% (95% CI, 62.2–89.9%) by inoculation after centrifugation and 86.8% (95% CI, 71.1–95.1%) by direct inoculation. Use of both inoculation methods with FAN Plus media resulted in 92.1% sensitivity (95% CI, 89.2–99.9%).CONCLUSION: Culture using FAN Plus media demonstrated a superior bacterial recovery rate to the conventional centrifugation culture method. A combination of the two inoculation methods with FAN Plus media is recommended for the best diagnostic yield, while direct inoculation alone can be useful due to its simplicity and cost-effectiveness.

Warfarin skin necrosis mimicking calciphylaxis in a patient with secondary hyperparathyroidism undergoing peritoneal dialysis

Warfarin skin necrosis (WSN) is an infrequent complication of warfarin treatment and is characterized by painful ulcerative skin lesions that appear a few days after the start of warfarin treatment. Calciphylaxis also appears as painful skin lesions caused by tissue injury resulting from localized ischemia caused by calcification of small- to medium-sized vessels in patients with end-stage renal disease. We report on a patient who presented with painful skin ulcers on the lower extremities after the administration of warfarin after a valve operation. Calciphylaxis was considered first because of the host factors; eventually, the skin lesions were diagnosed as WSN by biopsy. The skin lesions improved after warfarin discontinuation and short-term steroid therapy. Most patients with end-stage renal disease have some form of cardiovascular disease and some require temporary or continual warfarin treatment. It is important to differentiate between WSN and calciphylaxis in patients with painful skin lesions.

The impact of early and late acute rejection on graft survival in renal transplantation

BACKGROUND: Advances in immunosuppression after kidney transplantation have decreased the influence of early acute rejection (EAR) on graft survival. Several studies have suggested that late acute rejection (LAR) has a poorer effect on long-term graft survival than EAR. We investigated whether the timing of acute rejection (AR) influences graft survival, and analyzed the risk factors for EAR and LAR. METHODS: We performed a retrospective cohort study involving 709 patients who underwent kidney transplantation between 2000 and 2009 at the Samsung Medical Center, Seoul, Korea. Patients were divided into three groups: no AR, EAR, and LAR. EAR and LAR were defined as rejection before 1 year and after 1 year, respectively. Differences in graft survival between the three groups and risk factors of graft failure were analyzed. RESULTS: Of the 709 patients, 198 (30%) had biopsy-proven AR [EAR=152 patients (77%); LAR=46 patients (23%)]. A total of 65 transplants were lost. The 5-year graft survival rates were 97%, 89%, and 85% for patients with no AR, EAR, and LAR, respectively. These differences were significant (P<0.001 for both by log-rank test). In time-dependent Cox regression analysis, EAR (hazards ratio, 3.37; 95% confidence interval, 1.90-5.99) and LAR (hazards ratio, 5.32; 95% confidence interval, 2.65-10.69) were significantly related to graft failure. When we set LAR as standard and compared it with EAR, there was no statistical difference between EAR and LAR (P=0.21). CONCLUSION: AR, regardless of its timing, significantly worsened graft survival. Treatments to reduce the incidence of AR and improve prognosis are needed.

A case of Fanconi syndrome accompanied by crystal depositions in tubular cells in a patient with multiple myeloma

Fanconi syndrome (FS) is a rare condition that is characterized by defects in the proximal tubular function. A 48-year-old woman was admitted for evaluation of proteinuria. The patient showed normal anion gap acidosis, normoglycemic glycosuria, hypophosphatemia, and hypouricemia. Thus, her condition was compatible with FS. The M peak was found behind the beta globulin region in urine protein electrophoresis. Upon bone marrow examination, we found that 24% of cells were CD138+ plasma cells with kappa restriction. From a kidney biopsy, we found crystalline inclusions within proximal tubular epithelial cells. Thereafter, she was diagnosed with FS accompanied by multiple myeloma. The patient received chemotherapy and autologous stem cell transplantation, and obtained very good partial hematologic response. However, proximal tubular dysfunction was persistent until 1 year after autologous stem cell transplantation. In short, we report a case of FS accompanied by multiple myeloma, demonstrating crystalline inclusion in proximal tubular cells on kidney biopsy.

Erratum to: Expression of CD44 in mouse diethylnitrosamine (DEN)- induced hepatic tumors as well as in DEN-treated embryo stem cells and derived hepatic lineage cells / 동물의과학연구지

A corresponding author was incorrectly described in the previous paper.

Prevalence of Anemia and Calcium-Phosphorus Abnormalities in Hemodialysis Patients in Southwestern Seoul / 대한내과학회지

BACKGROUND/AIMS: The number of hemodialysis patients and dialysis centers is increasing each year, but there are no quality standards for facilities. Thus, the Korean Society of Nephrology carried out a pilot project regarding a hemodialysis center accreditation system. This study was aimed at surveying the prevalence of anemia and abnormalities of calcium or phosphorus metabolism in hemodialysis patients in southwestern Seoul. METHODS: We investigated anemia, serum calcium, and phosphorus levels in 1,524 patients in 25 hemodialysis units. The rate of iron injections in patients with iron deficiency was also evaluated. Each item was compared between accredited (n = 12) and non-accredited centers (n = 13). RESULTS: The mean hemoglobin in subjects was 10.5 +/- 1.5 g/dL. The prevalences of anemia and iron deficiency were 27.4% and 25.2%, respectively. The rate of iron injection in patients with iron deficiency was 48.1%. The mean phosphorus level was 5.1 +/- 1.9 mg/dL and the proportion of patients with Ca x P < 55 mg2/dL2 was 70.7%. The prevalence of anemia, iron deficiency, and Ca x P were similar between accredited and non-accredited centers. The rate of iron injection in iron deficiency was higher in accredited (65.6%) than non-accredited centers (30.9%). CONCLUSIONS: Management of anemia and levels of calcium or phosphorus were acceptable in hemodialysis patients in southwestern Seoul, although some facilities should make more efforts to improve iron deficiency. The availability of data from a hemodialysis center accreditation system allowed us a unique opportunity to further explore the relationships between anemia, abnormalities of mineral metabolism, and outcomes.

Prevalence of Anemia and Calcium-Phosphorus Abnormalities in Hemodialysis Patients in Southwestern Seoul / 대한내과학회지

BACKGROUND/AIMS: The number of hemodialysis patients and dialysis centers is increasing each year, but there are no quality standards for facilities. Thus, the Korean Society of Nephrology carried out a pilot project regarding a hemodialysis center accreditation system. This study was aimed at surveying the prevalence of anemia and abnormalities of calcium or phosphorus metabolism in hemodialysis patients in southwestern Seoul. METHODS: We investigated anemia, serum calcium, and phosphorus levels in 1,524 patients in 25 hemodialysis units. The rate of iron injections in patients with iron deficiency was also evaluated. Each item was compared between accredited (n = 12) and non-accredited centers (n = 13). RESULTS: The mean hemoglobin in subjects was 10.5 +/- 1.5 g/dL. The prevalences of anemia and iron deficiency were 27.4% and 25.2%, respectively. The rate of iron injection in patients with iron deficiency was 48.1%. The mean phosphorus level was 5.1 +/- 1.9 mg/dL and the proportion of patients with Ca x P < 55 mg2/dL2 was 70.7%. The prevalence of anemia, iron deficiency, and Ca x P were similar between accredited and non-accredited centers. The rate of iron injection in iron deficiency was higher in accredited (65.6%) than non-accredited centers (30.9%). CONCLUSIONS: Management of anemia and levels of calcium or phosphorus were acceptable in hemodialysis patients in southwestern Seoul, although some facilities should make more efforts to improve iron deficiency. The availability of data from a hemodialysis center accreditation system allowed us a unique opportunity to further explore the relationships between anemia, abnormalities of mineral metabolism, and outcomes.

Two cases of idiopathic membranous nephropathy treated with rituximab

Idiopathic membranous nephropathy is a common cause of nephrotic syndrome, and has been reported as a cause of idiopathic primary glomerulonephropathy in up to 90% of patients. However, the treatment options remain controversial. We report two cases of idiopathic membranous nephropathy that were treated with rituximab. A 54-year-old man and a 64-year old man were admitted for rituximab therapy. They had previously been treated with combinations of immunosuppressive agents including cyclophosphamide, cyclosporine, mycophenolate, and steroids. However, the patients' heavy proteinuria was not resolved. Both patients received rituximab therapy, 2 weeks apart. After several months of follow-up and a second round of rituximab treatment for each patient, their proteinuria decreased and partial remission of disease was achieved in both patients.

Expression of CD44 in mouse diethylnitrosamine (DEN)-induced hepatic tumors as well as in DEN-treated embryo stem cells and derived hepatic lineage cells / 동물의과학연구지

To clarify the role of stem cells in hepatocarcinogenesis, CD44 expression was investigated in mouse livers as well as embryonic cell lineages treated with diethylnitrosamine (DEN). Liver tumors induced by DEN were analyzed by immunohistochemisty for CD44. Liver tissues were sampled at 6, 24, and 48 hr after treatment with saline or DEN. Mouse embryonic stem cells (ESCs), hepatic progenitor cells (HPCs), and hepatocyte like cells (HCs), representing 0, 22, and 40 days of differentiation, respectively, were treated with DEN at four doses (0, 1, 5, and 15 mM, respectively) for 24 hr, after which CD44 expression levels were examined by relative quantitative real-time PCR. CD44 expression was weakly detected in tumor cells as well as in some hepatocytes surrounding the tumor cells. However, CD44 expression was not detected in liver tissue treated with DEN at early time points. The CD44 mRNA expression level was significantly different among cells treated with 5 mM DEN at day 22 (P<0.01) as well as 1, 5, and 15 mM DEN at day 40 (P<0.01) compared with control. Taken together, CD44 expression slightly increased in mouse DEN-induced tumors. Furthermore, expression of CD44 in embryonic cell lineages treated with various doses of DEN significantly differed among embryo stem cells and derived hepatic lineage cells. This suggests that CD44 expression may be modulated in the progeny of stem cells during their differentiation toward hepatocytes, and its expression may increase in the tumor stage but not during early carcinogenesis.

Current status and standards for establishment of hemodialysis units in Korea

The number of hemodialysis patients and dialysis facilities is increasing each year, but there are no surveillance programs validating that the services and equipment of each hemodialysis unit meet specified safety and quality standards. There is a concern that excessive competition and illegal activities committed by some dialysis facilities may violate patients' right to health. Contrastingly, developed countries often have their own survey program to provide initial certification and monitoring to ensure that these clinics continue to meet basic requirements. Because hemodialysis units provide renal replacement therapy to critical patients suffering from severe chronic renal failure, appropriate legal regulation is important for the provision of initial certification and maintenance of facility, equipment, and human resource quality. Therefore, several standards providing minimum requirements for the area of hemodialysis unit, equipment for emergency care, physician and nurse staffs, water purification and quality management are urgently needed.

Patients with Persistent New-Onset Diabetes after Transplantation Have Greater Weight Gain after Kidney Transplantation

The purpose of the present study was to evaluate the difference in BMI pattern between patients with persistent new-onset diabetes after transplantation (P-NODAT) and without new-onset diabetes after transplantation (N-NODAT) in a retrospective matched case-control (1:3) analysis. Thirty-six patients who developed P-NODAT were identified among 186 adult renal transplant recipients with no evidence of pretransplant diabetes mellitus who underwent kidney transplantation from September 1997 to March 2008 and were treated with a triple regimen including tacrolimus. The controls were selected to match the patients for pretransplant BMI, age at transplantation (+/- 5 yr), and date of transplantation (+/- 12 months). Finally, 20 P-NODAT patients and 60 N-NODAT patients were selected. The pre- and posttransplant BMI data were collected every 16 weeks for up to 80 weeks. The clinical characteristics did not differ between the P-NODAT group and N-NODAT group. BMI increased faster in the P-NODAT group than in the N-NODAT group. The mixed-model analysis showed that patients with P-NODAT exhibited a faster increase in BMI. P-NODAT is associated with posttransplant weight gain. The risk of P-NODAT should be considered in patients with rapid weight gain after transplantation.

A Case of Lung Disease and Vertebral Osteomyelitis Due to Nontuberculous Mycobacteria in a Kidney Transplant Recipient / 대한내과학회지

Nontuberculous mycobacteria (NTM) infections in kidney transplant recipients (KTR) are rare. We describe here a 52-year-old female with vertebral osteomyelitis caused by NTM, who received a kidney transplant 5 years earlier. She had been diagnosed with NTM lung disease 1 year prior. NTM therapy was delayed due to esophageal candidiasis. Mycobacterium intracellulare was isolated from sputum and bone tissue. The pattern of drug-susceptibility testing in both specimens was identical. NTM vertebral osteomyelitis due to direct inoculation is rare, and was in this case a disseminated NTM disease. The subjective symptoms resolved after 4 months of NTM treatment. This suggests that early NTM treatment is important for KTRs who have NTM disease during immunosuppressive therapy.