The Association of Serum Cystatin C with Glycosylated Hemoglobin in Korean Adults

BACKGROUND: Cystatin C has been known to be associated not only with early renal impairment but also with the incidence of diabetic conditions (prediabetes plus diabetes). However, it is not clear whether cystatin C levels are associated with the prevalence of diabetic conditions in Asian populations. We evaluated this association using glycosylated hemoglobin (HbA1c) levels as the definition of diabetes in Korean adults. METHODS: We analyzed data from 1,559 Korean adults (937 men and 622 women) with available serum cystatin C and HbA1c values. RESULTS: The serum cystatin C levels in subjects with prediabetes and diabetes were significantly increased (0.91+/-0.14 mg/L in prediabetes and 0.91+/-0.17 mg/L in diabetes vs. 0.88+/-0.13 mg/L in patients with normal glucose levels, P=0.001). At increasing cystatin C levels, the prevalence of subjects with prediabetes (30.2% vs. 14.6%, P<0.001) and those with diabetes (10.6% vs. 8.0%, P<0.001) significantly increased in the group with the highest cystatin C levels. The group with the highest cystatin C levels had a significantly increased odds ratio (OR) for the presence of diabetic conditions compared to the group with the lowest values in total subjects (OR, 2.35; 95% confidence interval [CI], 1.54 to 3.58; P<0.001) and in women (OR, 4.13; 95% CI, 1.97 to 8.65; P<0.001), though there was no significant increase after adjusting for multiple variables. CONCLUSIONS: Higher levels of serum cystatin C are associated with an increased prevalence of diabetic conditions in Korean adults. Our findings may extend the positive association of cystatin C with diabetes incidence to an Asian population.

A Case of Seizure and Metabolic Acidosis Due to Renal Adjustment Dosage of Isoniazid in an Elderly Woman / 고신대학교의과대학학술지

Isoniazid is one of the most commonly used antituberculosis drug. Acute into xication is characterized by repetitious convulsions, high anion gap metabolic a cidosis and coma. The basis of theraphy consists of parental pyridoxine admi nistration in a dose equivalent to that of isoniazid ingested. Here we present a case of seizure and metabolic acidosis due to only renal adjustment dosage of Isoniazid in an elderly woman.

A Case of Renal Tubular Acidosis Associated With Graves' Disease

Renal tubular acidosis (RTA) is a metabolic acidosis caused by impaired excretion of hydrogen ions or reabsorption of bicarbonate. Disorders caused by impairment of bicarbonate reabsorption in the proximal tubule are classified as proximal RTA, whereas those resulting from impairment of hydrogen ion secretion at the distal tubule are called distal RTA. The most common causes of distal renal tubular acidosis in adults are autoimmune disorders including Sjogren syndrome, systemic lupus erythematosis, rheumatoid arthritis, and autoimmune thyroiditis. Of the thyroiditis states, Graves' disease-associated RTA is a rare disease. We experienced and managed one case of hypokalemic muscle weakness associated with Graves' disease and distal renal tubular acidosis.

Myxedema Coma Successfully Treated by Low Dose Oral Levothyroxine

Myxedema coma is a severe life-threatening form of hypothyroidism that is associated with a high mortality rate. It is known to be common in the elderly, and is mainly accompanied with cardiogenic shock, respiratory failure, central nervous system dysfunction, and body temperature regulation defects. Thus, immediate management is required in order to prevent fatal complications in myxedema coma. However, early detection is difficult and further, it is easily misdiagnosed due to its low incidence rate and nonspecific symptoms. We report a case of myxedema coma which was misdiagnosed for heart failure. The patient was successfully treated with intensive care and oral low dose levothyroxine.

A Case of Glomerulonephritis Associated with Klinefelter' Syndrome / 고신대학교의과대학학술지

Klinefelter' syndrome is a disorder of sexual differentiation in males, characterized by the presence of two or more X-chromosomes, hypogonadism, and lack of secondary sexual characteristics. The association between Klinefelter' syndrome and glomerulonephritis has been reported, while cases of glomerulonephritis associated with Klinefelter' syndrome are rare. We report the Korean case: a 31-year-old man with Klinefelter' syndrome who developed glomerulonephritis. The patient's urine analysis shows microscopic hematuria and the result of kidney biopsy was minimal change disease. The onset and course of his disease might have been influenced by the sex hormone imbalance.

Percutaneous Retrieval of an Intravascular Catheter Embolus / 대한내과학회지

Intravascular catheter embolism is common and the most important complication of subclavian catheterization. The catheter fragment can lead to pulmonary embolism, vascular perforation, sepsis, arrhythmia, and even death. The intravascular foreign body can be removed using surgical or non-surgical methods. With technological advances, the percutaneous retrieval of intravascular foreign bodies has become a relatively common procedure. A commonly used method for retrieving intravascular foreign bodies is the loop snare. Sometimes biopsy forceps can be used. We experienced a case of non-surgical retrieval of an intravascular foreign body. We used the standard loop snare technique to remove a 5-cm catheter fragment from the left pulmonary artery.

The 46C/T Polymorphism of Coagulation Factor XII in Healthy Korean Population and in Patients with Ischemic Cerebrovascular Disease / 대한진단검사의학회지

BACKGROUND: In Orientals, the levels of the plasma coagulation factor XII (FXII) were only half of those in Caucasians. Recently, nucleotide polymorphism of the 46C to T substitution in the 5'-untranslated region was reported and this led to lower levels in plasma FXII. Some inherited FXII deficiencies were reported to show thromboembolic predisposition. We investigated the interaction of this polymorphism with FXII activity and the association of this polymorphism among ischemic cerebrovascular disease (CVD) patients among Koreans. METHODS: Blood was obtained from 334 healthy Korean adults and 163 patients. We measured FXII activities by the aPTT method. Molecular analysis using the allele-specific restriction with endonuclease Hga I was performed. RESULTS: Genotype frequencies of our controls were 7.8%, 47.3%, and 44.9% for C/C, C/T, and T/T. There were no significant differences in genotype frequencies between the controls and the patients (P=0.800). FXII activities of our controls were strongly dependent on the genotype: C/C, 129.4%; C/T, 92.4%; T/T, 50.2% (P60 years old), the prevalence of the T/T genotype increased significantly in the old-age category of patients (P=0.046). CONCLUSIONS: Koreans had a 69% frequency of T alleles with low levels of FXII activity. We could not prove any association between this polymorphism and ischemic CVD, but the prevalence of the T/T genotype in old-age patients was significantly higher than in the age-matched controls. This finding suggests that the 46C/T polymorphism of FXII might have an influence on the morbidity of ischemic CVD in the old-age group.