Effects of Angiotensin-Converting Enzyme Polymorphism on Soluble Receptor for Advanced Glycation End-Products in Maintenance Hemodialysis Patients / 대한내과학회지

BACKGROUND/AIMS: Advanced glycation end-products (AGEs) exert various toxic effects through the receptor for AGEs (RAGE). Soluble RAGE (sRAGE) is a naturally occurring inhibitor of AGE-RAGE. Recent studies have suggested that inhibition of angiotensin-converting enzyme (ACE) reduces the accumulation of AGEs in diabetes partly by increasing the production and secretion of sRAGE into the plasma. This report describes the relationship between sRAGE and ACE polymorphism in maintenance hemodialysis patients. METHODS: The levels of sRAGE and advanced oxidation protein products (AOPPs) were assessed by enzyme-linked immunosorbent assay (ELISA), and ACE polymorphism was detected by PCR amplification. RESULTS: The distributions of ACE genotypes in 105 hemodialysis patients were as follows: II, 56 (35.9%); ID, 29 (18.6%); and DD, 20 (12.8%). According to the ACE genotypes, the study group consisted of II (n = 56) and ID + DD group (n = 49). sRAGE was correlated with age (r = -0.24; p = 0.013). There were significant differences in sRAGE, AOPP, age, duration of dialysis, C-reactive protein, or 24-h urine volume between two genotype groups. There were no significant differences in sRAGE levels, even though the effect of age was treated as a covariate. CONCLUSIONS: Our findings suggested that sRAGE may be affected only by age, and not by ACE polymorphism in maintenance hemodialysis patients.

Effects of Angiotensin-Converting Enzyme Polymorphism on Soluble Receptor for Advanced Glycation End-Products in Maintenance Hemodialysis Patients / 대한내과학회지

BACKGROUND/AIMS: Advanced glycation end-products (AGEs) exert various toxic effects through the receptor for AGEs (RAGE). Soluble RAGE (sRAGE) is a naturally occurring inhibitor of AGE-RAGE. Recent studies have suggested that inhibition of angiotensin-converting enzyme (ACE) reduces the accumulation of AGEs in diabetes partly by increasing the production and secretion of sRAGE into the plasma. This report describes the relationship between sRAGE and ACE polymorphism in maintenance hemodialysis patients. METHODS: The levels of sRAGE and advanced oxidation protein products (AOPPs) were assessed by enzyme-linked immunosorbent assay (ELISA), and ACE polymorphism was detected by PCR amplification. RESULTS: The distributions of ACE genotypes in 105 hemodialysis patients were as follows: II, 56 (35.9%); ID, 29 (18.6%); and DD, 20 (12.8%). According to the ACE genotypes, the study group consisted of II (n = 56) and ID + DD group (n = 49). sRAGE was correlated with age (r = -0.24; p = 0.013). There were significant differences in sRAGE, AOPP, age, duration of dialysis, C-reactive protein, or 24-h urine volume between two genotype groups. There were no significant differences in sRAGE levels, even though the effect of age was treated as a covariate. CONCLUSIONS: Our findings suggested that sRAGE may be affected only by age, and not by ACE polymorphism in maintenance hemodialysis patients.

The Factors Influencing Level of Advanced Oxidation Protein Products (AOPP) in Hemodialysis Patients / 대한신장학회지

PURPOSE: Advanced oxidation protein products (AOPP) has long been considered as a useful marker to estimate oxidative stress in the hemodialysis (HD) patients. However, it has not been clarified what clinical factors can affect the plasma level of AOPP in the HD patients. Based on these, We investigated the correlation between plasma AOPP level and clinical factor, known to be associated with oxidative stress, in the maintenance HD patients. METHODS: Two groups (50 of normal healthy persons and 105 of stable HD patients) were independently subjected in this study, and statistical correlation between plasma AOPP level and several clinical factors were analyzed. RESULTS: Plasma level of AOPP in the maintenance HD patients were higher than those in normal healthy group (52.11+/-16.08 micrometerol/L vs. 40.25+/-12.23 micrometerol/L, p<0.001). Plasma AOPP level of maintenance HD patients were significantly correlated with duration of hemodialysis, MDRD-GFR and daily urine volume. However, plasma level of AOPP in the maintenance HD patients were not affected by sex, diabetes, smoking, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and those were not correlated with age, CRP and serum ferritin. It was demonstrated by multiple regression analysis that daily urine volume was the most important clinical factor which could affect the plasma level of AOPP (beta=-0.255, p=0.017). CONCLUSION: These results suggest that maintenance of daily urine volume is likely to be critical to reduce oxidative stress in the maintenance HD patients.

A Case of Chylothorax Associated with Idiopathic Stenosis of Left Subclavian Vein in a Patient Undergoing Maintenance Hemodialysis / 대한신장학회지

Chylothorax is defined as the accumulation of chyle-containing lymphatic fluid within the pleural space. The causes of chylothorax are various and usually attributable to 1 of 4 categories: malignancy, trauma (including surgery), miscellaneous disorders, and idiopathy. Occurrence of chylothorax in patients on hemodialysis is very uncommon and it may have resulted from multiple iatrogenic vascular trauma conducive to venous thrombosis and stenosis when hemodialysis catheters required frequent changes or long term indwelling. Local thrombosis and stenosis may increase the venous hydrostatic pressure and hinder the discharge of thoracic duct lymph into the venous system. Hence, chylous lymphatic fluid leak into the pleural space. Treatment of chylothorax may range from nonoperative management to elective surgery. We report a case of a patient on hemodialysis who developed chylothorax secondary to a subclavian vein stenosis without any other symptoms such as arm edema and successfully treated with nonoperative management.

Spontaneous fracture of a silicone peritoneal catheter / 대한내과학회지

Major peritoneal catheter-related complications include pericatheter leaks, outflow failure, and infection of the exit site or tunnel. We experienced a rare spontaneous fracture of a silicone peritoneal catheter. A 39-year-old man undergoing continuous ambulatory peritoneal dialysis (CAPD) developed peripheral edema and peritoneal outflow failure. He had no signs of exit-site infection, trauma, or peritonitis. The kidney-ureter-bladder radiograph suggested a fractured peritoneal catheter. We removed the catheter in an emergency operation and inserted a new peritoneal catheter. No obvious reason could explain why the catheter had broken, although the patient's nephew was known to frequently jump on his abdomen Based on this case, mechanical stress should be avoided in CAPD patients with increased intra-abdominal pressure.

Lymphocytic infundibuloneurohypophysitis presenting with central diabetes insipidus: a case report and review of previous Korean cases / 대한내과학회지

Lymphocytic infundibuloneurohypophysitis is a neuroendocrine disorder characterized by autoimmune inflammation of the pituitary stalk and neurohypophysis. Clinical findings such as acute onset central diabetes insipidus and the regression of characteristic magnetic resonance imaging (MRI) findings allow for the possible diagnosis of this disease. Three cases of lymphocytic infundibuloneurohypophysitis have been previously reported in Korea. Here we report a case in a 66-year-old woman, along with a review of previously reported occurrences in Korea. A woman presented with abrupt-onset central diabetes insipidus. Sella MRI showed thickening of the pituitary stalk and loss of high T1 signals that are associated with a normal neurohypophysis. Basal pituitary hormone levels were normal with the exception of growth hormone, which was low. The patient refused transsphenoidal pituitary biopsy and we thus chose to continue close clinical and radiologic follow-up after desmopressin nasal spray application. The need for desmopressin decreased slightly over time and MRI obtained after 6 months showed regression of the pituitary stalk lesion.

A Case of Acute Interstitial Nephritis Complicated with Continuous Rifampin Therapy / 대한신장학회지

Acute renal failure caused by rifampin typically occurs on intermittent administration or reintroduction of the drug. However, acute kidney injury (AKI) due to rifampin has been rarely reported to occur in patients receiving a continuous rifampin therapy. We have experienced a case of acute interstitial nephritis during the first course of standard anti-tuberculous therapy, including continuous rifampin therapy in daily dose. Forty-five-year-old male, who had been being treated with anti-tuberculous medication including rifampin (600 mg/day), was admitted to our hospital because of generalized edema and dyspnea by acute renal failure. His past medical history was unremarkable. Since the creatinine level was still elevated in 10 days after cessation of rifampin, we performed renal biopsy. The renal pathologic findings revealed acute interstitial nephritis. After that, the patient symptom was relieved and serum creatinine level was decreased without specific therapy. The renal function was recovered at 1 month after withdrawal of rifampin. We report a case of acute interstitial nephritis complicated with the first daily rifampin therapy, along with the review of literature.

A Case of the Pedunculated Angiomyolipoma Attached to Renal Cortex / 대한신장학회지

A renal angiomyolipoma is uncommon congenital mixed tumor like formations consisting of blood vessel, smooth muscle cells and adipose tissue. We report a case of retroperitoneal hemorrhage from spontaneous rupture of renal angiomyolipoma in a 37 year-old woman that appeared unilateral and pedunculated attached to renal cortex. The patient presented with a clinical feature of flank pain and shock because of massive hemorrhage. Because the patient suffered from flank pain regardless of selective renal embolization, laparoscopic surgery was necessary to remove angiomyolipoma from renal cortex.

Coexistence of the Renal Fibromuscular Dysplasia and Familial Adenomatous Polyposis / 대한신장학회지

Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory vascular disease that most commonly affects the renal and internal carotid arteries. A Familial adenomatous polyposis (FAP) is characterized by hundreds of adenomatous colorectal polyps, with an almost inevitable progression to colorectal cancer. A 19-year-old woman with history of total colectomy as a result of familial adenomatous polyposis presented with high blood pressure incidentally. Abdominal CT scan showed "string of beads" appearance of right renal artery. Percutaneous transluminal renal angioplasty was performed and then hypertension was improved. To our knowledge, there has been no previous case report of secondary renovascular hypertension resulting from fibromuscular dysplasia in patients with FAP. Here, we report a patient with a review of the literature.