Relapsing Peritonitis Caused by Bordetella bronchiseptica in Continuous Ambulatory Peritoneal Dialysis Patient: A Case Report

Bordetella (B) bronchiseptica is a common veterinary pathogen, but has rarely been implicated in human infections. Most patients with B. bronchiseptica infections are compromised clinically such as in patients with a malignancy, AIDS, malnutrition, or chronic renal failure. We experienced a case of relapsing peritonitis caused by B. bronchiseptica associated with continuous ambulatory peritoneal dialysis (CAPD). A 56-yr-old male, treated with CAPD due to end stage renal disease (ESRD), was admitted with complaints of abdominal pain and a turbid peritoneal dialysate. The culture of peritoneal dialysate identified B. bronchiseptica. The patient was treated with a combination of intraperitoneal antibiotics. There were two further episodes of relapsing peritonitis, although the organism was sensitive to the used antibiotics. Finally, the indwelling CAPD catheter was removed and the patient was started on hemodialysis. This is the first report of a B. bronchiseptica human infection in the Korean literature.

Clinical characteristics of p-ANCA (anti-neutrophil cytoplasmic antibody)-related nephritis: a single center experience / 대한내과학회지

BACKGROUND/AIMS: We evaluated the clinical characteristics and prognostic value of the clinical, laboratory, pathologic features, at time of diagnosis, and the renal survival of patients with ANCA (anti-neutrophil cytoplasmic antibody)-related nephritis. METHOD: We retrospectively analyzed 17 patients who were diagnosed with ANCA-related nephritis at a single center. The risks of progression to ESRD or death according to the clinical parameters, the ANCA pattern and the renal pathologic findings were evaluated. RESULTS: The major symptoms were hematuria (100%), proteinuria (100%), uremic symptoms (41.2%), edema (35.5%), upper respiratory symptoms (29.4%) and oliguria (23.5%), which were not correlated with renal survival. All the patients showed a p-ANCA pattern. The BUN level (p=0.032) and GFR (p=0.023) at the time of diagnosis were different between the improved and the progressed patients in terms of renal function. The pathology indices were not predictive factors of both renal and patient survival. Eight patients (47.1%) were treated with steroid IV pulse, 4 (23.5%) with steroid IV pulse and cyclophosphamide IV pulse, 2 (11.8%) with steroid IV pulse, cyclophosphamide IV pulse and plasma exchange, and 2 (11.8%) with steroid IV pulse and plasma exchange. Fourteen patients (82.4%) needed hemodialysis. There were 3 (17.6%) disease-related deaths, 13 patients (76.5%) reached ESRD and 4 (23.5%) showed recovery of renal function. The mean percent of patients who survived was 80.2% and the mean percent of renal survival was 33.3% at the 1st and 3rd year, respectively. CONCLUSIONS: Poor renal function at presentation was associated with a high risk for disease progression, but age, gender, the clinical patterns of presentation and the pathologic findings were not associated with the prognosis. Early diagnosis and treatment seems to be essential to improve the renal outcomes.

The Preventive Effects of Practical Training on the Spot for Peritoneal Dialysis Related Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients / 대한신장학회지

PURPOSE: Peritoneal dialysis related peritonitis remains one of the most common causes of hospitalization and discontinuation of peritoneal dialysis. Patient education and the individual environment play a significant role in improving the clinical outcomes. Therefore, this study focused on the preventive effects of practical training on the spot for peritoneal dialysis related peritonitis in continous ambulatory peritoneal dialysis (CAPD) patients. METHODS: Fifty-eight patients who were started on CAPD were as the primary intended treatment modality. The patients were given to a questionnaire regarding their gender, age, place of residence, level of education, economic status, sterile technique, knowledge of personal hygiene, placing a correct region for exchanging a fluid bag, and their duration of CAPD. During a home visit, the patients were instructed in how to sterilize the region of dialysis and maintain sterility in dialysis. RESULTS: Seventy four cases of peritonitis from 35 patients were identified over the 2 year's period. In the rural residences where there is a lower socio-economic status, the rates of peritonitis decreased in those patients who had received training on the spot within 6 months from the start of peritoneal dialysis compared with the patients after the 6 month period. Lower rates of peritonitis were noted in the patients who received training earlier (r=0.19, p=0.03). CONCLUSION: Ongoing and repetitive individualized education is needed to prevent peritoneal dialysis related peritonitis. The incidence of peritoneal dialysis related peritonitis can be reduced by educating these patients individually.

Crystal-induced Acute Renal Failure due to Acyclovir in a Renal Transplant Patient / 대한이식학회지

Several medications are associated with the production of crystals that are insoluble in human urine. Intratubular precipitations of these crystals can lead to acute renal insufficiency. Many patients who require treatment with these medications have additional risk factors, such as volume depletion, underlying renal insufficiency and immunocompromised state that increase the risk of drug induced intrarenal crystal deposition. We experienced a case of crystal-induced acute renal failure due to acyclovir in a 44 year-old male renal allograft recipient. He was diagnosed as Varicella Zoster at 12 days after transplantation, and treated with intravenous (IV) acyclovir (IV infusion of acyclovir 250 mg mixed with normal saline 100 mL within several minutes three times a day, total seven times). Two days after initiation of IV acyclovir, serum BUN was increased up to 160 mg/dL, serum creatinine was increased up to 9.9 mg/dL and urine output was decreased to anuria. With discontinuation of acyclovir, hemodialysis was started as treatment of renal insufficiency. Renal function was restored after discontinuation of acyclovir.

The Suppression of Peritoneal Advanced Glycosylation End Product Formation by Intraperitoneal Aminoguanidine / 대한신장학회잡지

BACKGOUND: The purpose of the study was to evaluate the effect of aminonguanidine on the inhibition of advanced glycosylation end product (AGE) formation and the expression of peritoneal vascular endothelial growth factor (VEGF). Then we analyzed the functional and morphological alterations of peritoneal membrane during long-term PD in rats. METHODS: Male Sprague-Dawley rats were randomly divided into 3 groups:group I (n=6), control rats with PD catheter but not dialyzed; group II (n=9), rats dialyzed with 4.25% glucose solution for all exchanges; group III (n=9), rats dialyzed with 4.25% glucose solution containing aminoguanidine (25 mg/kg) for all changes. Dialysis changes were performed 3 times a day with 25 mL/each exchange for 12 weeks. Immunostaining was performed using a monoclonal anti-AGE antibody and a polyclonal anti-VEGF antibody. One-hour peritoneal equilibration test were performed at every 4-week for the comparison of peritoneal transport characteristics. RESULTS: Expressions of peritoneal AGE and VEGF in dialyzed groups (group IIand III) were higher compared to control group. The level of AGE immunostaining in group III was significantly lower than in the group II. But peritoneal VEGF expression did not differ between the dialyzed groups. In dialyzed groups, D/DO glucose was significantly lower whereas D/P urea was significantly higher than in the control group. On linear regression analysis, peritoneal AGE and VEGF accumulation were directly correlated with D/DO glucose and D/P urea nitrogen. But there was no statistical significance in D/DO glucose and D/P urea nitrogen between the dialyzed groups. CONCLUSION: Peritoneal accumulation of AGE and VEGF increased with time on CAPD in dialyzed groups. Intraperitoneal aminoguanidine was greatly suppressed peritoneal AGE accumulation but no attenuated long-term dialysis related peritoneal hyperpermeability. The VEGF formation may be one of the several mediators resulting the functional deterioration of the peritoneal membrane in long-term peritoneal dialysis.

Altered Expression of Peritoneal Aquaporin-in Response to Osmotic Stimuli and Glucocorticoid / 대한신장학회잡지

BACKGROUND: To examine the changes of peritoneal aquaporin-1 (AQP-1) expression and peritoneal transport in rats in response to continuous exposure of same osmotic stimuli which was induced by either mannitol or glucose in dialysis solution or glucocorticoids co-reatment. METHODS: Twenty-eight male Sprague-awley rats were divided into three groups:group I (n=10) rats were dialyzed with 5% mannitol solution (0.27 M); group II (n=9) rats were dialyzed with 5% glucose solution (0.28 M): and group III (n=9) rats were dialyzed with 5% glucose solution (0.28 M) accompanied by daily injection of dexamethasone (2 mg/kg, im) for the last 7 days of the 1 month dialysis period. Dialysis exchanges were performed 2 times a day for 1 month with 25 mL per exchange. Immunohistochemistry was performed using a polyclonal anti AQP-1 antibody. The peritoneal membrane (PM) function was assessed by one-hour PET for comparing transport characteristics. PM transport rates were assessed by D/P of urea nitrogen and D/Do of glucose. Water transport of peritoneal membrane was assessed by D/P of sodium at 1 month. RESULTS: The immunolabeling intensity of peritoneal AQP-1 was markedly increased and the most prominent in rats dialyzed with 5% glucose solution accompanied by injection of dexamethasone (group III). Consistent with this, D/P of sodium in rats of group III was significantly decreased (p<0.05), indicating an increased water permeability and ultrafiltration. In contrast, peritoneal AQP-1 labeling intensity was weaker in PD groups dialyzed with mannitol (group I) and glucose (group II) solution having an identical osmolality and was not different between the groups. Rats in group I exhibited significantly lower D/Do of glucose and increased D/P of urea nitrogen, suggesting high PM transport. CONCLUSION: These results indicate that the change of peritoneal AQP-1 expression is not specific to the glucose itself, but rather it could be altered in response to the changes of osmolality per se in PD solution. Moreover, corticosteroid up-egulates peritoneal AQP-expression, which is paralleled by an increased water permeability.

Expression of p27(Kip1) in gastric cancers and precancerous lesions / 대한내과학회지

BACKGROUND: The cyclin-dependent kinase inhibitor p27(Kip1) is a negative regulator of cell cycle progression at G1/S transition. Recently, the expression level of p27(Kip1) was decreased in many cancers such as breast, pituitary gland, colon and stomach. We studied the expression of p27(Kip1) in gastric cancers, precancerous lesions and normal gastric tissues and analysed its correlation to clinicopathologic data including tumor differentiation, tumor depth, nodal and distant metastasis in gastric cancers. METHODS: p27(Kip1) were immunohistochemically stained in the tissue specimens of 62 resected cancers, 110 corresponding adjacent non-neoplastic tissues, 22 gastric adenomas and 10 normal gastric tissues. Adjacent non-neoplastic tissues consisted of 32 chronic gastritis, 29 intestinal metaplasia and 49 transitional mucosa. RESULTS: Gastric cancers showed significantly decreased expression level of p27(Kip1) when compared with non-neoplastic lesions and adenomas. Labeling index of p27(Kip1) were more decreased in chronic gastritis, intestinal metaplasia and transitional mucosa than in normal mucosa. Early gastric cancers showed significantly decreased expression level of p27(Kip1) when compared with advanced gastric cancers. In gastric cancers, p27(Kip1) labeling index was significantly decreased in diffuse type and presence of nodal metastasis however did not show relationship with distant metastasis and tumor depth of advanced gastric cancers. CONCLUSION: We suggest that p27(Kip1) may be decreased in the early stage of gastric carcinogenesis and play an important role in the progression and differentiation of gastric cancers. More further studies are thought to be necessary in order to evaluate its prognostic factor in gastric cancers.

A case of syndrome of inappropriate antidiuretic hormone secretion (SIADH) in small cell cancer of lung combined with squamous cell cancer of lung / 대한내과학회지

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the term applied to arginine vasopressin (AVP) excess associated with hyponatremia without edema in the absence of physiologic or pharmacologic stimuli to AVP secretion. SIADH is associated with various conditions such as malignant tumors, infection, central nervous system disorders, and different pharmacological agents. The patient was 73-year-old female. She was admitted to the hospital because of persistent cough, dizziness, general weakness and confusion. On admission, her serum osmolality was 253 mOsm/kg, urine osmolality was 416 mOm/kg, and urine Na concentration was 159 mEq/L. Her Chest X-ray and CT scan of lung showed about 4x3.5 cm sized mass at posterior basal segment of left lower lobe of the lung, and CT-guided percutaneous needle aspiration revealed small round cell with clusters of malignant squamous cells. She was treated by salt restriction, hypertonic saline infusion and demeclocycline. We planned chemotherapy for advanced combined lung cancer, but she was discharged because of poor general condition and associated pneumonia without cancer chemotherapy. We report a rare case of SIADH in small cell cancer of lung combined with squamous cell cancer of lung.