Clinical Characteristics of Tuberculosis in Kidney Transplantation Patients / 대한이식학회지

PURPOSE: Infection is a important cause of morbidity and mortality in renal transplantation recipients, and the prevalence of tuberculosis (Tb) is high in our country. To evaluate the clinical characteristics of tuberculosis in renal transplantation, we retrospectively analysed of 552 renal recipients. METHODS: We retrospectively analyzed the 22 cases of mycobacterial infection in renal transplants carried out in our Unit of Renal Transplantation from 1986 to 2002. Diagnosis was made with acid-fast bacilli (AFB) stain, biopsy and chest X-ray. RESULTS: We found 22 patients (3.6%) to have post-transplantation tuberculosis. Among these, 7 patients (32%) had history of previous tuberculosis or scar of tuberculosis in chest X-ray. The mean time interval between transplantation and TB diagnosis was 65 +/- 45.9 (range) months, 59 +/- 41.3 months in primary infection and 78 +/- 56.2 months in reactivation. The difference of duration in primary infection and reactivation is not significant. The diagnosis was made by positive AFB smear in eight patients, tissue biopsy in 3 patients and typical radiologic appearance on chest X-ray in 11 patients. Immunosuppressive regimens included cyclosporine+azathioprine+steroid in 15 patients, cyclosporine+mycophenolate mofetil+steroid in 4 patients, cyclosporine+steroid in 2 patients and azathioprine+steroid in 2 patients. None of recipients died by tuberculosis or its complication. CONCLUSION: One third of tuberculosis developed in renal transplant recipients is reactivation. By this reason, we should carefully examine patients with history of previous tuberculosis or findings of old tuberculosis in chest X-ray.

Defect of Acid-base Transporters in Distal Renal Tubular Acidosis / 대한신장학회잡지

The purpose of this study was to elucidate whether the molecular defect of acid-base transporters in renal tubules is related to the functional defect of urinary acidification in distal renal tubular acidosis(RTA). We performed NH4Cl, furosemide, or bicarbonate loading test to evaluate renal acidification function, and immunohistochemistry using antibodies to H+- ATPase, Cl-/HCO3- exchanger(band-3 protein), and Na+/K+-ATPase in kidney tissue in 6 patients with RTA and renal cell carcinoma patients as normal controls. Kidney tissue was obtained either by percutaneous needle biopsy(RTA) or nephrectomy(NC). The results were as follows; 1) In all six RTA patients, proton secretory defect of distal acidification was shown by a failure to lower the urine pH after NH4Cl loading or furosemide test or abnormally low urine-blood pCO2 difference during bicarbonate loading. In two patients with RTA, proximal acidification defect was combined, which was demonstrated by increased fractional excretion of bicarbonate. 2) In normal control, intense H+-ATPase and band-3 protein staining was observed in collecting ducts. 3) In distal RTA patients, H+-ATPase and band- 3 protein staining was not demonstrable or markedly decreased in the intercalated cells of distal nephron. 4) In two patients who had both proximal and distal RTA, H+-ATPase staining was markedly decreased in the brush border of proximal tubules as well as the distal nephron. In conclusion, the defect of acid-base transporters in renal tubule was related with the functional defect of urinary acidification in distal RTA.

Ischemic Stroke After Acute Myocardial Infarction

BACKGROUND: The relationship between the anterior site of acute myocardial infarction(MI) and occurrence of stroke has become a recent subject of much debate in the relevant literature. The object of this study was to examine the incidence of ischemic stroke during the hospitalization after an acute MI and to identify predictors of MI-related stroke. METHOD: We performed retrospective analysis of 452 patients with acute MI admitted to department of Neurology or Cardiology from January 1990 to August 1997. Patients with a stroke during hospitalization after acute MI were recruited for this study. RESULT: Thirteen cases were recorded. Seventy-seven percent (10/13) of the strokes occurred within 4 days after onset of MI. Multivariate analysis identified the following as independent predictors of stroke : History of hypertension(OR. 2.6: CI, 1.1 to 5.9), previous stroke(OR, 22.3: CI, 5.9 to 84.9) and congestive heart failure (CHF)(OR, 15.4: CI, 2.2-108.6). Transthoracic echocardiography(TTE) was performed in 349/452(77%) during hospitalization. The incidence of left ventricular thrombosis(LVT) in patients with anterior MI who received thrombolytic and anticoagulant therapy was not significantly different from that in patients with anterior MI who didn't(2.6% vs 6.1%, p=0.265). Stroke developed in only one of these patients with LVT. Thrombolytic and anticoagulant therapy were more frequently used in patients without stroke compared with stroke.(p<0.05). CONCLUSION: The incidence of stroke after acute MI is 2.9% and more frequent within the 4 days after MI. History of hypertension, previous stroke and congestive heart failure (CHF) were the factors independently favoring the occurrence of stroke, but there is no relation between the occurrence of stroke and anterior site of MI. Although intravenous thrombolytics followed by full anticoagulation treatment appeared to provide protection against ischemic stroke, it has no effect in the incidence of left ventricular thrombi in this study.