KP Index at the Initiation of Dialysis for Patients with End-stage Renal Disease

BACKGROUND: The time at which renal replacement therapy (RRT) is initiated in patients with end-stage renal disease (ESRD) has a great influence on the prognosis of the patient; however, there are currently no accurate guidelines for the initiation of RRT. Traditionally, nephrologists usually initiate RRT on the basis of the observation of the uremic symptoms and changes in the laboratory parameters, such as the serum creatinine concentration and/or glomerular filtration rate (GFR). DOQI guidelines suggest a weekly Kt/Vurea 2.0 and KP index 2.0 group, while there were no significant differences between the groups in the serum albumin concentration, serum creatinine concentration, FFEFBM and RRF. Also, there was a statistically significant higher rate of incidence of patients starting RRT in the KP index 2.0 group. There was a significant correlation between the KP and other indices in all patients. When comparing the number of patients starting RRT, the weekly Kt/Vurea index demonstrated no significant differences between the 1.5 < weekly Kt/Vurea < 2.0 and 2.0 < weekly Kt/Vurea < 2.5 groups, but the number of patients starting RRT in the 1.5 < KP index < 2.0 group was significantly higher than that in the 2.0 < KP index < 2.5 group. CONCLUSION: The KP index is considered a clinically useful index in ESRD patients for determining an appropriate time for the initiation of RRT. Also, the timing of the initiation of RRT should be fixed with regard to the various other indices and clinical features for a desirable prognosis of the patients. In addition, further studies will be required to determine accurate guidelines for an appropriate time for RRT initiation.

A case of bear's gall induced rhabdomyolysis / 대한내과학회지

We report a case of rhabdomyolysis in a 29-year-old man, presenting pain on neck and shoulder and dark urine, which developed after taking Bear's gall and swimming. Laboratory studies revealed serum creatinine 0.9 mg/dL, creatinine kinase 83,045 IU/L, serum myoglobin 794.6 ng/mL, urine myoglobin 220.2 ng/mL. Tc-99m MDP whole bone scan showed diffuse increased uptake confined to the soft tissue of upper chest. The condition resolved spontaneously when consumption of the product ceased, he was recovered with normal creatine kinase. Generally, the Bear's gall is termed gall bladder of bear dried under the air-flow, which has been applied as versatile treatment in oriental medcine. Rhabdomyolysis is a well known complication of HMG-CoA inhibitor therapy, the Bear's gall has not yet been reported as a cause of rhabdomyolysis. We postulate that the Bear's gall may result in muscle injury.

KP index at the timing of initiation of dialysis for patients with end-stage renal disease / 대한내과학회지

BACKGROUND: An initiating time of renal replacement therapy (RRT) for patients with end-stage renal disease (ESRD) has great influence on prognosis of the patients, however, there are currently no accurate guidelines for initiation of renal replacement therapy. Traditionally, nephrologists usually initiate RRT on the basis of observation of uremic symptoms and changes of laboratory parameters, such as serum creatinine concentration and/or glomerular filtration rate (GFR). DOQI guidelines suggest weekly Kt/Vurea 2.0 and KP index 2.0, while no significant differences between the groups were in serum albumin concentration, serum creatinine concentration, FFEFBM and RRF. And the frequency of patients starting RRT was significantly higher in the group of KP index 2.0 in statistics. There was a significant correlation between KP index and other indices in all patients. In comparing and analyzing the number of patients starting RRT, weekly Kt/Vurea index did not demonstrate significant differences between two groups of 1.5 < weekly Kt/Vurea < 2.0 and 2.0 < weekly Kt/Vurea < 2.5, but the frequency of patients in the group of 1.5 < KP index < 2.0 was significantly higher than that in the group of 2.0 < KP index < 2.5. CONCLUSION: It is considered that KP index is an index clinically useful for ESRD patients to determine an appropriate timing for the initiation of RRT, and that the timing should be fixed with regard for other various indices and clinical features for advisable prognosis of the patients. In addition, accurate guideline to determine such an appropriate time needs to be suggested by further new studies.

Effects of 2,3,7,8-tetrachlorodibenzo- p-dioxin(TCDD) on Glomerular Mesangial and Tubular Epithelial Cell Activation / 대한신장학회잡지

BACKGROUND: 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), a prototype compound of polyhalogenated aromatic hydrocarbons, produces diverse biologic effects. Although nephrotoxicity of aromatic hydrocarbons such as benzo[a]pyrene(BP) is well known, little is known about the effects of TCDD on renal function. Thus, the present study examined the effects of TCDD on cell viability, proliferation, and extracellular matrix(ECM) synthesis by glomerular mesangial cells, LLC-PK1 cells representing proximal tubular epithelial cells, and MDCK cells representing distal epithelial cells and compared with the effects of BP. METHODS: Quiescent cells were incubated with serum free media containing different concentrations of TCDD(1-100 nM) and BP(3 and 30 micro M) for 24- 96 hours. Cell viability and proliferation were assessed by lactate dehydrogenase(LDH) release and [3H]-thymidine incorporation, respectively. Secreted fibronectin was measured by Western blot analysis. RESULTS: When cells were continuously exposed to TCDD, LDH release significantly increased in MMC, LLC-PK1, and MDCK in a dose- and a time- dependent manner. [3H]-Thymidine incorporation was increased in MMC and LLC-PK1 but decreased in MDCK by TCDD. Contrary to TCDD, 30 micro BP significantly inhibited [3H]-thymidine incorporation in MMC and MDCK but not in LLC-PK1. Both TCDD and BP increased fibronectin secretion by MMC, LLC-PK1, and MDCK cells, suggesting that TCDD and BP may cause renal fibrosis leading to loss of renal function. CONCLUSION: These data provide experimental evidence that TCDD can alter cell viability and proliferation and increase ECM synthesis by renal cells which may lead to renal injury.

A case report of Churg-Strauss syndrome / 천식및알레르기

The characteristic features of Churg-Strauss syndrome are vasculitis, both intra- and extravascular granuloma formation with eosinophilic tissue infiltration, and strong association with asthma and peripheral eosinophilia. Churg-Strauss syndrome with pleural effusion is relatively common and only a few cases have previously been reported in Korea. We report a case of Churg-Strauss syndrome with pleural effusion confirmed by VATS.

Proteinuria / 대한내과학회지

No abstract available.

A Case Report of Esophageal and Ileocecal Valve Involvement in Behcet's Disease / 대한소화기내시경학회지

Behcet's disease characterized by recurrent oral and genital ulceration and ocular inflammation has been recognized as a multi-system disorder with numerous manifestations including gastrointestinal tract. Terminal ileum and cecum are the most frequently involved portions of the gastrointestinal tract in Behcet's disease and esophageal involvement is very uncommon. We experienced a case of Behcet's disease involved esophageal and ileocecal region which had been diagnosed by endoscopy. A 20-year-old male was admitted by dysphagia and substernal discomfort. There was a history of recurrent aphthous stomatitis and genital ulcers. The large geographic ulcers surrounded with edematous mucosa were found at mid esophagus and the huge ulcer with exudate was noted on ileocecal valve area in endoscopic examination. The microscopic finding of endoscopic biopsy showed chronic nonspecific inflammation with necrotic inflammatory exudate. Pathergy test was positive. So he was diagnosed as Behcet's disease, and his symptoms and signs were resolved after steroid treatment.

Study on Circulating Factor(s) in Patient with Recurrent Focal Segmental Glomerulosclerosis / 대한신장학회잡지

BACKGROUND: Although a significant number of studies were done on focal segmental glomerulosclerosis(FSGS), its pathogenesis has not been sufficiently established yet. Recent studies suggested certain types of circulating factor(s) played an important role in development and recurrence after renal transplantation of FSGS by modifying the glomerular permeability of albumin. The purpose of this study performed on animals and through molecular-biological experiments is to certify the role of circulating factor (s), which cause proteinuria, by manipulating plasma of a FSGS patient who showed massive of proteinuria and wide effacement of glomerular epithelial foot processes in histologic examination after renal transplantation. also, whose massive proteinuria decreased significantly after plasma exchange. METHODS: The patient's plasma prior to(plasma A) or post to(plasma B) plasma exchange were injected into tail veins of two groups of male Sprague-Dawley rats, six in each. The ratio of 24 hour urine protein and urine creatinine(Uprt/Ucr) was calculated for each case. The 2D gel electrophoresis was performed in plasma A and plasma B. The pattern of 2D gel electrophoresis of plasma A was compared to those of plasma B and healthy human serum. RESULTS: Compared to control group, there was no significant differences in 24-hour Uprt/Ucr afer injecting 1, 2, 3, 5 mL of plasma A(p>0.05). There was no significant difference in 24-hour Uprt/Ucr between the injecting groups of plasma A and plasma B(p>0.05). We were not able to observe any new protein which did not appear in plasma B or healthy human serum in 2D gel electrophoresis. CONCLUSION: These results suggest that the proteinuria developed in a few hours after renal transplantation and is related to wide effacement of glomerular epithelial foot processes, and that it may be induced by a certain factor which is eliminated by the plasma exchange or restrained by the immunosuppressive agents. However, we were not able to find certain circulating factor(s) which rapidly changes albumin permeability in the patient's plasma with FSGS.

A Case of Bilateral Reexpansion Pulmonary Edema After Pleurocentesis / 결핵

Acute bilateral reexpansion pulmonary edema after pleurocentesis is a rare complication. In one case, bilateral reexpansion pulmonary edema after unilateral pleurocentensis in sarcoma was reported. Verious hypotheses regarding the mechanism of reexpansion pulmonary edema include increased capillary permeability due to hypoxic injury, decreased surfactant production, altered pulmonary perfusion and mechanical stretching of the membranes. Ragozzino et al suggested that the mechanism leading to unilateral reexpansion pulmonary edema involves the opposite lung when there is significant contralateral lung compression. Here we report a case of bilateral reexpansion pulmonary edema and acute respiratory distress syndrome after a unilateral pleurocentesis of a large pleural effusion with contralateral lung compression and increased interstitial lung marking underlying chronic liver disease.