The Effects of Low Sodium Dialysate in Hemodialysis Patients / 대한신장학회지

PURPOSE: Hypertension is a common problem in maintenance hemodialysis (HD) patients. We assessed the effects of low sodium dialysate on changes of blood pressure in maintenance HD patients. METHODS: Forty HD patients were enrolled in this cross-over study. All the patients underwent nine consecutive HD sessions with the dialysate contained 138 mEq/L sodium (conventional sodium HD), then concentrations of sodium were switched to match the patients average pre-HD plasma sodium measured during the conventional sodium phase (135 mEq/L for patients with sodium levels less than 137, 137 for patients with sodium levels over 137). Dry weight and dialysis prescription were not modified during the six weeks of the study. RESULTS: There was a significant decrease in the interdialytic weight gain (2.4+/-0.9 kg vs. 2.0+/-0.7 kg, p<0.001) and the interdialytic thirsty in low sodium HD sessions compare to conventional sodium HD sessions. Pre-HD systolic and diastolic blood pressure (BP), post-dialysis systolic BP was similar in both periods of the study. The use of low sodium dialysate is associated with significantly lower systolic BP in patients with uncontrolled hypertension (n=10,157.1+/-3.6 mmHg vs. 148.0+/-9.4 mmHg, p=0.011), but not in those with controlled hypertension. Cardio-thoracic ratio was significant decrease in low sodium dialysate HD (0.53+/-0.08 vs. 0.51+/-0.07, p=0.002). The episodes of intradialytic hypotension and related symptoms were not more frequent in low sodium dialysate HD. CONCLUSION: Low dialysate sodium concentration based on predialysis sodium levels of patients could reduce the pre-HD systolic BP, interdialytic thirsty and interdialytic weight gain in maintenance HD patients.

A Case of Combining Intravenous Immunoglobulin and Leflunomide for BK Nephropathy / 대한내과학회지

BK virus nephropathy has emerged as an important cause of renal allograft dysfunction. It affects 1-10% of renal transplant patients and results in significant graft dysfunction in more than 50% of cases. A reduction in the amount of immunosuppressants is not an appropriate treatment option for advanced stage BK nephropathy; therefore, other treatment strategies need to be considered such as cidofovir, leflunomide, and intravenous immunoglobulin (IVIG) in combination with reduced immunosuppression. The use of IVIG may be a valuable treatment option in patients with BK virus nephropathy. We report our experience with IVIG rescue therapy in a patient and the progression of BK nephropathy despite leflunomide therapy.

Role of IL-1alpha in Cisplatin-Induced Acute Renal Failure in Mice

BACKGROUND/AIMS: For unknown reasons, caspase-1 -/- mice, protected against cisplatin-induced acute renal failure (ARF), are deficient in interleukin (IL)-1alpha. We thus asked whether IL-1alpha deficiency underlies the mechanism of protection against cisplatin-induced ARF in these mice. METHODS: Cisplatin (30 mg/kg) was injected intraperitoneally into wild-type C57BL/6 mice to produce a cisplatin-induced model of ARF. IL-1alpha was measured in control vehicle- and cisplatin-treated wild-type animals. We also examined whether IL-1alpha -/- mice were similarly protected against cisplatin-induced ARF. Additionally, infiltration of CD11b- and CD49b-positive cells, as markers of macrophages, natural killer, and natural killer T cells (pan-NK cells), was investigated in wild-type and IL-1alpha -/- mice. RESULTS: Compared with vehicle-treated mice, renal IL-1alpha increased in cisplatin-treated wild-type mice beginning on day 1. IL-1alpha -/- mice were shown to be protected against cisplatin-induced ARF. No significant difference in the infiltration of neutrophils or CD11b- and CD49b-positive cells were observed between wild-type and IL-1alpha -/- mice. CONCLUSIONS: Mice deficient in IL-1alpha are protected against cisplatin-induced ARF. The lack of IL-1alpha may explain, at least in part, the protection against cisplatin-induced ARF observed in caspase-1 -/- mice. Investigation of the protective mechanism (s) in IL-1alpha -/- mice in cisplatin-induced ARF merits further study.

Isolated Pancreatic Tuberculosis in a Patient with End-Stage Renal Disease / 대한신장학회지

Tuberculosis (Tb) is a common disease in the developing world and its incidence is slowly increasing in developed countries, where a resurgence has occurred subsequent to the acquired immunodeficiency syndrome epidemic. In addition, patients with end-stage renal disease who are on maintenance hemodialysis carry a high risk for Tb; reported incidence varies from 6-16 times that of the general population. Extrapulmonary Tb constitutes a major part of Tb in dialysis patients. Isolated pancreatic Tb is a very rare occurrence in the setting of extrapulmonary Tb. It usually occurs as a complication of miliary Tb in immunodeficient individuals, particularly those with human immunodeficiency virus infection. There is no isolated pancreatic Tb in patients with end-stage renal disease. We recently experienced a case of isolated pancreatic Tb diagnosed by acid fast bacilli culture, Tb polymerase chain reaction from ultrasound-guided fine needle aspiration, and an excellent response after anti-Tb treatment in a 72-year-old patient with end-stage renal disease.

A case of splenic infarction developed during acute pancreatitis combined with celiac artery stenosis / 대한내과학회지

Prevalence of splenic infarction developed during acute pancreatitis is extremely rare. However, we recently experienced a case of 42-year-old woman who developed splenic infarction during acute alcoholic pancreatitis. There were sustained subjective symptoms and no resolution of image despite of conservative management, so we performed angiography to confirm whether vascular lesion existed or not. We found the significant celiac artery stenosis due to compression by median arcuate ligament and no visible thrombus. We report an unusual case of splenic infarction developed during acute recurrent pancreatitis possibly related with celiac artery stenosis.

A Case of Rhabdomyolysis and Acute Renal Failure Associated with Mitochondrial Myopathy / 대한신장학회잡지

Mitochondrial myopathies are diseases caused by defects in metabolic pathway of mitochondria. Mitochondrial myopathy is known as one of the causes of recurrent myoglobinuria, while clinically, rarely causes acute renal failure requiring medical treatments. We report a case of rhabdomyolysis and acute renal failure associated with mitochondrial myopathy. A 58-year-old male was presented with dyspnea and hypotensive shock. The patient had a history of recurrent dark colored urine and cramping leg pain after prolonged fasting. Laboratory findings showed hyperkalemia, azotemia, metabolic acidosis, and elevated AST, ALT, and creatinine kinase. He had no history of trauma or medication. Muscle biopsy showed "ragged red fibers" in modified Gomori staining. On electron microscope, increased number of mitochondria and abnormal mitochondria were seen. He received hemodialysis and his renal function recovered after 1 month.

A case of acute respiratory distress syndrome (ARDS) due to endobronchial tubercubsis / 대한내과학회지

Endobronchial tuberculosis is defined as a specific inflammation of the trachea or major bronchi caused by the tubercle bacillus. It is recognized as one of the most common and serious complication of pulmonary tuberculosis. A diagnosis of endobronchial tuberculosis is difficult due to the diversity of radiological patterns. But, it is still relatively common disease in korea. Endobronchial tuberculosis as a cause of the acute respiratory distress syndrome (ARDS) is quite rare. The mortality rate of ARDS is still high in korea. The detection and early elimination of the causes for ARDS at the initial stage can result in a more favorable prognosis. So, patients with ARDS, especially due to endobronchial tuberculosis or other form of tuberculosis, should be treated with antituberculous drugs as soon as possible. We experienced a young female with complaints of sudden onset dyspnea, mild fever. In this case the clinical features, laboratory data and radiologic findings allowed an initial presentation of ARDS. The ARDS was defined by the American-Europian Consensus Conference 19921-3). The cause of ARDS was revealed endobronchial tuberculosis. We started antituberculosis medication and steroid injection quickly, which resulted in good prognosis. We emphasize the prognosis depends mainly on the early recognition and treatment of endobronchial tuberculosis.

A Case of Dengue Shock Syndrome Imported from Myanmar

Dengue fever/dengue shock syndrome is an acute febrile illness caused by a Flaviviridae virus. Dengue virus infection can cause a wide spectrum of illness, and disease is characterized by sudden onset of high fever, chill, severe headache, skin rash, general malaise and thrombocytopenia with hemoconcentration. Dengue fever is endemic in most tropical areas of world, including the Caribbean, Central and South America, Africa, and Southeast Asia. Tourists to these areas are liable to infection. We experienced a Korean female who returned to Korea from Myanmar in severely ill state. She was confirmed serologically to be inblieted with Dengue shock syndrome. In spite of intensive medical care, she died of Dengue shock syndrome. We emphasize that favorable prognosis depends mainly on the early recognition and treatment of shock.

A Case of Dengue Shock Syndrome Imported from Myanmar

Dengue fever/dengue shock syndrome is an acute febrile illness caused by a Flaviviridae virus. Dengue virus infection can cause a wide spectrum of illness, and disease is characterized by sudden onset of high fever, chill, severe headache, skin rash, general malaise and thrombocytopenia with hemoconcentration. Dengue fever is endemic in most tropical areas of world, including the Caribbean, Central and South America, Africa, and Southeast Asia. Tourists to these areas are liable to infection. We experienced a Korean female who returned to Korea from Myanmar in severely ill state. She was confirmed serologically to be inblieted with Dengue shock syndrome. In spite of intensive medical care, she died of Dengue shock syndrome. We emphasize that favorable prognosis depends mainly on the early recognition and treatment of shock.

A Case of Adult-Onset Minimal Change Nephrotic Syndrome Relapsed after 15-year of Complete Remission / 대한신장학회잡지

We report an unusual case of adult minimal change nephrotic syndrome relapsed after 15-year of complete remission. In this case, the disease had occurred to the patient for the first time when he was 52 years old; relatively high age, and had been remitted with steroid therapy. After 15 years of complete remission, he visited our hospital with the symptoms of the generalized edema and the pitting edema of both lower extremities that occurred 15 days ago. Massive proteinuria(15, 865 mg/day) and hypoalbuminemia(1.7 g/dL) were detected. The pathologic evaluation of the biopsied specimen of the kidney showed the global sclerosis in 19% of glomeruli in light microscopic finding and the fusion of epithelial foot processes in electron microscopic finding. He was treated with pulse steroid therapy (methylprednisolone 500 mg/day iv for 3 days) and then, with oral prednisolone (60 mg/day). Generalized edema and proteinuria disappeared after 14 days of treatment, and there has been no relapse ever since. Adult-onset minimal change nephrotic syndrome relapses within 4 years after complete remission in 90 % of relapsed patients. The relapse after more than 5 years of complete remission, like this case, is very rare, especially in the case of late-onset disease. However, the possibility of relapse of the minimal change nephrotic syndrome after several years of its remission should be considered constantly and the long-term follow-up more than 10 years may be needed.