Effects of Dialysate Calcium Concentration and Calcitriol on Bone Metabolism in Hemodialysis Patients / 대한내과학회지

BACKGROUND/AIMS: Whereas higher dialysate calcium (Ca) levels may pose a risk of hypercalcemia, lower levels may induce a negative Ca balance. We evaluated the effect of lowering dialysate Ca levels from 1.75 to 1.5 mmol/L and explored the appropriate use of calcitriol to regulate bone metabolism in hemodialysis patients. METHODS: The dialysate Ca levels of 36 patients were reduced from 1.75 to 1.5 mmol/L. They were divided into three groups according to basal intact parathyroid hormone (iPTH) level (group 1, iPTH 300 pg/mL, n = 8). Data were collected at 3-month intervals for 1 year. RESULTS: Throughout the study period, no significant difference in phosphate binders, serum Ca, phosphorus (P), or Ca x P products was observed among groups. However, iPTH, alkaline phosphatase (AP), and calcitriol dosage patterns differed among groups. In group 1, iPTH and AP increased significantly over 12 months (p = 0.01). In group 2, iPTH and AP showed no significant changes. In group 3, iPTH and AP declined significantly over 12 months (p = 0.02). Calcitriol dosage did not change in groups 1 and 2, but increased significantly in group 3 (p = 0.001). CONCLUSIONS: After converting hemodialysate Ca levels from 1.75 to 1.5 mmol/L, the initially different iPTH concentrations converged to a modestly elevated level. The use of 1.5 mmol/L hemodialysate Ca may thus be appropriate for both high- and low-turnover bone disease if phosphate binders and calcitriol are combined appropriately.

Effects of Dialysate Calcium Concentration and Calcitriol on Bone Metabolism in Hemodialysis Patients / 대한내과학회지

BACKGROUND/AIMS: Whereas higher dialysate calcium (Ca) levels may pose a risk of hypercalcemia, lower levels may induce a negative Ca balance. We evaluated the effect of lowering dialysate Ca levels from 1.75 to 1.5 mmol/L and explored the appropriate use of calcitriol to regulate bone metabolism in hemodialysis patients. METHODS: The dialysate Ca levels of 36 patients were reduced from 1.75 to 1.5 mmol/L. They were divided into three groups according to basal intact parathyroid hormone (iPTH) level (group 1, iPTH 300 pg/mL, n = 8). Data were collected at 3-month intervals for 1 year. RESULTS: Throughout the study period, no significant difference in phosphate binders, serum Ca, phosphorus (P), or Ca x P products was observed among groups. However, iPTH, alkaline phosphatase (AP), and calcitriol dosage patterns differed among groups. In group 1, iPTH and AP increased significantly over 12 months (p = 0.01). In group 2, iPTH and AP showed no significant changes. In group 3, iPTH and AP declined significantly over 12 months (p = 0.02). Calcitriol dosage did not change in groups 1 and 2, but increased significantly in group 3 (p = 0.001). CONCLUSIONS: After converting hemodialysate Ca levels from 1.75 to 1.5 mmol/L, the initially different iPTH concentrations converged to a modestly elevated level. The use of 1.5 mmol/L hemodialysate Ca may thus be appropriate for both high- and low-turnover bone disease if phosphate binders and calcitriol are combined appropriately.

Risk Factors for New Onset Diabetes after Transplantation among Renal Transplant Recipients Treated with Tacrolimus / 대한신장학회지

PURPOSE: This study was conducted to identify risk factors for new onset diabetes after transplantation (NODAT) among renal transplant recipients treated with tacrolimus-based immunosuppressant. METHODS: We selected renal transplant recipients who underwent surgery at Samsung Seoul Hospital between May 2001 and July 2009. Exclusion criteria were as follows: recipients years: RR=4.36, 95% CI 2.00-9.49), family history of DM (RR=1.62, 95% CI 1.12-2.34) and polyomavirus infection (RR=1.40, 95% CI 1.08-1.81). CONCLUSION: The risk factors for NODAT among renal transplant recipients treated with tacrolimus-based regimen were age (>45 years old), family history of DM and polyomavirus infection.

Crohn's Disease Associated with IgA Nephropathy / 대한소화기학회지

Crohn's disease is a condition of chronic inflammation potentially involving any location of the alimentary tract from mouth to anus. Numerous extraintestinal manifestations can also be present. Urologic complications of inflammatory bowel disease are seen in up to 25% of patients, but renal parenchymal disease has been rarely reported. IgA nephropathy is recognized worldwide as a most common form of primary glomerulonephritis. Clinical manifestations vary, ranging from microscopic hematuria to nephrotic syndrome. Recently, IgA nephropathy associated with systemic diseases has been reported. We describe a case of a 22 year-old man with Crohn's disease associated with IgA nephropathy. At the age of 8 years, microscopic hematuria appeared. After fourteen years, he presented with melena, mild fever, recurrent oral ulcer, microscopic hematuria and proteinuria. Colonoscopic examination revealed characteristic features of Crohn's disease such as multiple ulcers. Microscopic findings showed superficial ulceration with small noncaseating granulomas. Renal biopsy revealed IgA nephropathy. The patient was treated with oral prednisolone, olsalazine, and metronidazole followed by maintenance therapy with sulfasalazine and azathioprine resulting in clinical improvement of Crohn's disease and IgA nephropathy.

Infliximab Therapy in Korean Patients with Ankylosing Spondylitis / 대한류마티스학회지

OBJECTIVE: Infliximab, a monoclonal antibody to tumor necrosis factor-alpha, is effective in patients with ankylosing spondylitis (AS), who have not responded to conventional therapy. There were no data on the efficacy and side effect of infliximab in patients with AS in Korea. The objective of this study is to observe the efficacy and adverse effect of infliximab retrospectively in Korean patients with AS. METHODS: We reviewed the medical records of thirty-three AS patients. The patients were enrolled to fulfill the modified New York criteria of AS and be in active disease state and resist to conventional therapy. Patients were given 3~5 mg/kg of infliximab infusions at weeks 0, 2, 8 and 16. Information on C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and antinuclear antibody (ANA) test was collected at each infusion. The paired t-test was used for comparison between the visits. RESULTS: There were 29 male and 4 female patients. The mean age at first infliximab treatment was 34.6+/-9.8 years. All patients were HLA-B27 positive. ESR and CRP decreased significantly from baseline to 16 weeks after treatment (p<0.001, respectively). The mean ESR was 76.1+/-36.5 mm/h at baseline and 21.3+/-31.6 mm/h at 16 weeks. The mean CRP was 6.4+/-4.8 mg/dL at baseline and 1.3+/-2.1 mg/dL at 16 weeks. Only 1 out of 33 patients got worse. All patients were tested negative for ANA at baseline. After 16 weeks of therapy, the induction of ANA was observed in 8 patients, but no patients have lupus-like symptoms. CONCLUSION: Infliximab is an effective therapy with non-specific adverse effect in AS non-responsive to conventional therapy in Korea.

A Case of Intramuscular Abscess Caused by Nocardia farcinica in a Patient with Lupus Nephritis Concurrent with Pulmonary Tuberculosis / 대한류마티스학회지

Nocardiosis is usually a subacute infection, which can occur as an opportunistic infections in patients with systemic lupus erythematosus. There are rare cases of nocardiosis concurrent with Mycobacterium tuberculosis. We report a case of intramuscular nocardial abscess concurrent with pulmonary tuberculosis in a patient with lupus nephritis. She has received cyclophosphamide pulse therapies and is receiving oral steroid therapy 3 months ago. After Nocardia farcinica and Mycobacterium tuberculosis were confirmed by PCR and PCR-RFLP, we initiated trimethoprim/ sulfamethoxazole and antituberculous agents. After then, patient was improved and discharged, maintaining the medications.

Rituximab Treatment for the Patient with Refractory Lupus Nephritis / 대한류마티스학회지

OBJECTIVE: To determine preliminary evidence for the safety and efficacy of B lymphocyte depletion therapy in refractory systemic lupus erythematosus (SLE). METHODS: Four female lupus nephritis patients who had been refractory to steroid and one or more immunosuppressive therapy were treated on an open-label basis. During a 4-week period, each patient received two 500-mg infusions of rituximab and two 750-mg infusions of cyclophosphamide. RESULTS: Patient 1, 2, and 3 were responded with rituximab treatment with improvements in SLEDAI and laboratory parameters such as C3/C4 and 24 hour urine protein. However, patient 4 had not improved with rituximab. The variation in the level of anti-double-stranded DNA antibody was different in individual patients. No significant adverse events were observed during follow-up. CONCLUSION: This study provides an evidence for the safety and possible efficacy of B lymphocyte depletion therapy in refractory lupus nephritis. However a further randomized trial is needed to confirm the efficacy and durability of remission.