A Case of Rhabdomyolysis and Acute Renal Failure Associated with Salmonella Enteritidis / 대한신장학회지

Rhabdomyolysis varies from transient elevation of muscular enzyme to reduction of circulating volume and development of acute kidney injury (AKI). The majority is related to trauma, excessive exercise, alcohol and seizure disorders. Systemic infections associated with salmonellosis were rarely reported. Most of Salmonella infections are caused by Salmonella Typhi. Most common manifestations are typhoid fever and gastroenteritis. Sometimes serious complications such as gastrointestinal bleeding, intestinal perforation, and encephalopathy occur. However, AKI-associated rhabdomyolysis is rarely reported in salmonellosis even though it is not considered to be a major complication. Unfortunately, the precise pathogenetic mechanisms responsible for rhabdomyolysis with Salmonella Enteritidis infection are poorly understood due to the rarity of reported cases. In this presentation, we describe a patient with Salmonella Enteritidis (serogroup D) bacteremia complicated by disseminated intravascular coagulation, rhabdomyolysis and AKI. The blood culture and stool culture from the patient yielded Salmonella Enteritidis. Rhabdomyolysis and AKI should be considered as potentially fatal complications in patients with Salmonella Enteritidis infection.

Crohn's Disease in a Patient Undergoing Hemodialysis Caused by IgA Nephropathy / 대한신장학회지

IgA nephropathy is usually localized to the kidney, however, it can accompany systemic disease, including gastrointestinal disease, skin disease, connective tissue disease, and malignant tumor. In some patients with IgA nephropathy which manifested as an extraintestinal symptom of Crohn's disease, recovery of renal function was achieved following treatment of Crohn's disease. The pathophysiology of each disease remains unclear. According to some studies, however, immunological, genetic, and environmental factors may be involved in a complex manner. In patients receiving renal replacement therapy for treatment of renal dysfunction due to IgA nephropathy, occurrence of Crohn's disease as an extrarenal symptom has not been reported. We experienced a case of Crohn's disease which developed in a patient receiving hemodialysis for treatment of end-stage renal disease due to IgA nephropathy.

Secondary Amyloidosis in Patient with Spinal Cord Injury: Renal and Thyroid Amyloidosis / 대한신장학회잡지

Amyloidosis is an acquired or inherited disorder with protein folding and degradation characterizing the deposition of the proteinaceous material in the extracellular matrix of one or several organs. Secondary amyloidosis resulting from the deposition of serum amyloid A protein, occurs 1-5% during the lifetime of patients with chronic inflammatory disorders such as rheumatoid arthritis and ankylosing spondylitis. In addition, chronic pyelonephritis and pressure sores in patient with spinal cord injury are documented as risk factors of secondary amyloidosis. Thus, the efforts to treat and prevent the development of secondary amyloidosis and to preserve the renal function should focus on avoiding the chronic inflammatory state and a pathologic study of doubtful organs for early diagnosis should be performed. We have experienced one case of secondary amyloidosis in patient with spinal cord injury which involves with kidney and thyroid gland.

Clinical Significance of B-type Natriuretic Peptide Levels and Impedance Cardiography in Maintenance Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: The risk for cardiovascular morbidity and mortality is higher in hemodialysis (HD) patients than in general population. Early diagnosis, treatment and prevention of cardiovascular disease (CVD) are the best way to reduce the most important cause of death. However, cardiac geometric and/or functional alterations including left ventricular hypertrophy, atherosclerosis and/or systolic and diastolic dysfunction are not easily known to nephrologist in the sense that diagnostic procedure is limited because cardiac angiography and echocardiography are frequently needed. METHODS: To evaluate the cardiac alteration by non-invasive tools, we measured pre- and post-HD B-type natriuretic peptide levels and performed impedance cardiography (ICG) in 40 HD patients and 10 healthy adults as control. RESULTS: Pre- and post-HD BNP level, cardiac index (CI), cardiac output (CO), stroke volume (SV), systemic vascular resistance index (SVRI), systemic vascular resistance (SVR), acceleration index (ACI), velocity index (VI) and thoracic fluid content (TFC) in patients were significantly higher than those in normal control group (p<0.05). Pre-HD BNP level, stroke index (SI), SV and TFC were significantly different after HD (p<0.05). There were significant differences in pre-HD BNP level, SI, SV and VI between diabetes and non-diabetes groups (p<0.05). Pre-HD BNP level correlated significantly with post- HD BNP level, systolic blood pressure, diastolic blood pressure, CO, SVRI, SVR and TFC (p<0.05). In multiple linear regression analysis, SVR and TFC were positively associated with pre-HD BNP level (R2=0.289). The area under the ROC curve for cardiac alterations was 0.749 for pre-HD BNP level. A cut-point of 560 pg/mL for pre-HD BNP level was 80% sensitive and 72% specific in determining cardiac alterations. CONCLUSION: Even though cardiac alterations of patients were heterogeneous in our study, plasma BNP level and some parameters (SVR, TFC) of ICG seem to be available to nephrologist for detecting and monitoring cardiac conditions in HD patients.

Listeria monocytogenes Meningitis in Hemodialysis Patient: a Case Report / 대한신장학회잡지

Since it has been named as Listeria monocytogenes after its detection in 20th century, listeriosis has been known as a microorganism to parasitize and proliferate in cytoplasm of eucaryotic cell in many researches. As listeriosis has been occurred frequently in malignancy, leukemia, alcoholism, pregnant women, neonates and patients who has been administered immunosuppressants, a declined cell- mediated immune system of these patients has gotten the clinical attention as a common pattern. Infections by listeria have been rarely reported in end stage renal disease patients with a reduction in cell- medicated immune system. Through our experience, we'd like to report a meningitis by Listeria monocytogenes which has not been submitted in Korea yet.

Stenting for Bilateral Renal Artery Occlusion with a Distal Embolic Protection Device / 대한신장학회잡지

Renal artery disease is one of the significant factors that lead to compromise renal function and/or aggravate hypertension in the elderly population. Since the non-surgical treatment of renal artery stenosis, percutaneous transluminal renal angioplasty, is available, it is possible to cure the decreased renal function and exacerbated hypertension. However, bilateral renal artery occlusion (BRAO) that brings about anuria and azotemia is rare. In this communication, we'd like to describe a patient who developed acute renal failure due to BRAO. His renal function was completely recovered after successful implantation of stents into both renal arteries. We are unaware of prior reports documenting the beneficial effect of a distal embolic protection device, the PercuSurge GuardWire system (Medtronic, Minneapolis, MN, USA), in a clinical setting as described here. The GuardWire arm, a device for transient distal balloon occlusion during angioplasty or stent placement, allows recovery of any liberated plaque by aspiration before restoration of antegrade flow, and thereby performs a double service. We'd like to strongly recommend that stent implantation with adjunctive distal protection is essential to obtain a complete restoration of distal blood flow although there is sufficient collateral blood flow in elderly patients with BRAO and azotemia.

Clinical Significance of Thrombopoietin Levels in Maintenance Hemodialysis Patients with Thrombocytopenia / 대한신장학회잡지

BACKGROUND: Thrombopoietin (TPO) is a major cytokine which plays a critical role in the regulation of thrombopoiesis and megakaryopoiesis. Since the kidney is one of the TPO-producing organs, it is hypothesized that TPO deficiency in end stage renal disease can give rise to thrombocytopenia. However, serum TPO levels and their clinical significance in maintenance hemodialysis patients with thrombocytopenia are not completely evaluated. The aim of the present study was to compare the percentage of reticulated platelets and serum TPO levels between non-thrombocytopenic group (platelet count > or =150x109/L, non-T group) and thrombocytopenic group (platelet count <150x109/L, T group) and to investigate the local and/or systemic effect of the TPO on the platelet count in hemodialysis patients. METHODS: We measured the percentage of reticulated platelets and serum TPO levels in samples obtained from venous returns of arteriovenous fistula (AVF) and contralateral peripheral veins in 44 hemodialysis patients. Serum reticulated platelets were measured by flow cytometry and serum TPO levels were determined with a commercially available ELISA kit. Patients with a history of HBV/HCV infection and hepatobiliary disease were excluded. RESULTS: Reticulated platelets of T group (4.57+/-2.32%) were significantly lower than non-T group (7.79+/-3.62%) (p<0.05). Serum TPO levels obtained from venous return of AVF in T group (78.37+/-15.48 pg/mL) were lower than non-T group (98.15+/-35.05 pg/mL) (p<0.05). Serum TPO levels obtained from contralateral peripheral veins in T group (77.20+/-17.28 pg/mL) were lower than non-T group (104.73+/-38.45 pg/mL) (p<0.01). There were no statistically significant difference of serum TPO levels between venous return of AVF and contralateral peripheral veins in T group. CONCLUSION: Decreased circulating reticulated platelets and serum TPO levels despite low platelet counts in comparison with normal platelet counts in hemodialysis patients, suggesting that the feedback mechanism, the TPO producing organ and bone marrow is not working with effect in the regulation of thrombopoiesis. An alteration in the production and regulation of TPO level is not influenced by local factor like an AVF endothelium.