The Clinical Profiles and Risk Factors and Outcome of CAPD Peritonitis : A Single Center Study / 대한신장학회잡지

Peritonitis remains the leading cause of the patient dropout in CAPD in many developing countries. In Korea, 71% of CAPD patients dropout is caused by peritonitis. To elucidate an adequate guideline for treating peritonitis in our country, we analyzed clinical and bacteriologic profiles of peritonitis(1995. 1. 1- 1999. 12. 31). Two hundred and twenty eight episodes of peritonitis were developed in 127/247 patients. The incidence of peritonitis was 0.41/patient-year in general, which was decreased to 0.24/patient-year in 1999. The incidence of causative organisms were as follows; 82(36.0%) by Gram positive organisms, 38 (16.2%) by gram negative organisms, 16 cases(7.0%) by mixed organsisms, and 5 cases(2.2%) by fungus. During study period, the incidence of peritonitis by gram positive organsism was decreased while the incidence of peritonitis by gram negative organism was not changed. Recurrent infection/relapse was noted in 58 patients(45%). Peritonitis were eradicated only in 66% of the cases by initial antibiotics(cefazolin+aminoglycoside); and another 17% responded by second line antibiotics. Peritoneal catheters were removed in 38 episodes(16.7%). Patients with exit infection were more frequent in removal of catheter. Risk factor analysis was performed in 146 patients, who were newly started CAPD. There were 60 initial episodes of peritonitis(mean duration of follow up was 16.7 patient months). Sixty-five percent were free of peritonitis at the end of first year, 54% at the end of second year and 45% at the end of third year (Kaplan-Meier). Factors such as age, sex, underlying DM, were not risk factor for CAPD peritonitis. In conclusion, we observed that the incidence of peritonitis decreased every year. It was revealed however that only 66% of peritonitis can be successfully treated by first line antibiotics. Second line antibiotics such as ceftazidime may need to be introduced in early phase of CAPD peritonitis. Up to one third of patients had recurrent infection/relapse, which raised the incidence of peritonitis. Continuing education as well as better exit care is needed to improve technical survival of CAPD patients in Korea.

The Prognostic Factors in the Survival of Adult CAPD Patients / 대한신장학회잡지

As a single CAPD center in Korea, we, at the department of internal medicine, Seoul National University Hospital, conducted a retrospective study in CAPD patients for the causes of death, patient survival rate, technique success rate, and risk factors. We enrolled in our study 167 patients who had began CAPD as an initial replacement therapy for end stage renal disease from March 1992 to July 1997 and survived for more than 2 months. As the prognostic factors of patient survival and technique success, we analyzed demographic features, clinical features including comorbid conditions at the beginning of CAPD, and laboratory findings at the beginning and 6 months after the start of CAPD. The mean age of patients was 49.8 12.5, and sex ratio was 1.4: 1(M: F). The mean follow-up period was 24.0 +/- 14.4 months. Cerebrovasular accident(CVA), the patient giving up on the treatment, cardiac dis- eases and peritonitis were the main causes of death in CAPD patients. Among the causes of death, although CVA and the patient giving up on the treatment were relatively important, the most im- portant causes of death were cardiovascular diseases. The 2 year survival rate and 4 year survival rate of CAPD patients were 89.4% and 55.579o respectively ; the 2 year technique success rate and 4 year technique success rate of CAPD were 87.37% and 63.18% respectively ; and the mean survival period and technique success period were 50.57 +/- 2.42 and 49.37 +/- 2.85 rnonths, respectively. We determined the independent prognostic factors for patient survival to be diabetes mellitus(p=0.0004, relative risk=5.9263) and liver cirrhosis(p=0.0032, RR=5.3211) using multivariate analysis with Cox proportional hazard model. Although the results were statistically insignificant, the patients with cardiac diseases(p=0.0961, RR= 2.0116) and older patients who were over 60 years old(p=0.1312, RR=1.8431) had a poor prognosis. The probable prognostic factors for 2 year survival of patients, considered marker of risk factors for early death, were DM, liver cirrhosis, and cardiac diseases, though statistically insignificant, and they were similar to prognostic factors for the patient survival during the entire period. The independent prognostic factor of technique failure of CAPD was DM(p= 0.0150, RR=2.6762). The patient survival rate and technique success rate of CAPD patients were similar to the outcomes reported in other countries. However, the fact that liver cirrhosis was included as one of the independent prognostic factors seems to reflect a disease characteristic of Korean population in whom chronic liver diseases are prevalent. Due to ever increasing pro- portions of DM, cardiac diseases, and older patients in CAPD patients and the prevalence of liver cirrhosis in Korea, more intensive management is necessary for CAPD patients with these disorders/ conditions.

A Case of Community-Acquired Respiratory Syncytial Virus Pneumonia in a Peripheral Stem Cell Transplantation Recipient / 감염

Pneumonia is a fatal disease in immunocompromised patients including bone marrow transplantation recipients. Etiological agents include fungi, cytomegalovirus, Pneumocystis carinii, influenza virus and parainfluenza virus. We describe a community-acquired respiratory syncytial virus pneumonia in a patient who received intense chemotherapy followed by peripheral stem cell transplantation for acute leukemia. The patient was treated with intravenous immunoglobulin and ribavirin aerosol. About 1 month later, she was recovered.

Clinicopathological Study on Adult Nephrotic Syndrome / 대한신장학회잡지

We investigated the clinical features of nephrotic syndrome in Korea according to sex, age and pathologic diagnosis under the classification system supported by WHO. Adult nephrotic patients who underwent renal biopsy from 1979 to 1993 at the Department of Internal Medicine, Seoul National University Hospital, with the exception of diabetic nephropathy and multiple myeloma, were analyzed in terms of their clinical manifestations, laboratory data, and pathologic features. 1) The number of our total nephrotic patients was 956 and their mean age was 32.6. Male to female ratio was 1.96:1. 2) Among total nephrotic syndrome patients, there were 736 (77%) primary NS and 220 (23%) secondary NS patients. 3) The pathologic diagnoses of the primary NS were minimal change nephrotic syndrome (41.6%), membraneous nephropathy (20.9%), focal glomerulosclerosis (17.3%), IgA nephropathy (9%), membranoproliferative GN (4.5%), sclerosing GN (2.4%), and mesangial proliferative GN (2.2%). 4) Among primary NS patients with ages between 15 and 40, the percentage of minimal change nephrotic syndrome was highest(47.7%), while among those above 40 of age, membraneous nephropathy was most common(42.1%). 5) The pathologic diagnoses of the secondary NS were hepatitis B virus associated GN (46.8%), lupus nephritis (39.5%), amyloidosis (5.9%), post-infectious GN (2.7%), Henoch-Schoenlein nephritis (2.7%). We had one each case of thrombotic thrombocytopenic purpura, Fabry's disease, mixed essential cryoglobulinemia, light chain disease, and Alport's syndrome. In conclusion, minimal change nephrotic syndrome was the most common disease among the primary NS and hepatitis B virus associated GN was the most common among the secondary NS.