Hypercalciuria and Hyperuricosuria in Adults with Microscopic Hematuria / 대한신장학회잡지

PURPOSE: We investigated the prevalence of hypercalciuria and hyperuricosuria in adults with microscopic hematuria and whether specific underlying diseases were associated with it. METHODS: A total of 36 patients with microscopic hematuria were divided into hypercalciuria or normocalciuria and hypercalciuria or normouricosuria and compared between groups in their clinical characteristics and laboratory findings. RESULTS: Of the 36 patients, 27 patients (75%) had normocalciuria but 9 (25%) had hypercalciuria. Twenty-eight patients (78%) had normouricosuria but 8(22%) had hyperuricosuria. All 8 patients in the hyperuricosuric group were male but 6 were male and 3 female in the hypercalciuric group. Other basal parameters and clinical characteristics were comparable between hypercalciuric and normocalciuric groups as well as between hyperuricosuric and normouricosuric groups except for significantly higher proteinuria in the latter. Underlying or associated diseases were hypertension (11), nephrolithiasis (5), simple renal cysts (3), hepatitis B carrier (3), diabetes mellitus (2), poststreptococcal glomerulonephritis (1), and membranous nephropathy (1). The degrees of calciuria and uricosuria were not different between patients with or without specific underlying or associated diseases but relative hypercalciuria in diabetic patients and hyperuricosuria in hepatitis B carriers were noted. CONCLUSION: We found a high prevalence of hypercalciuria and hyperuricosuria in adults with microscopic hematuria. In view of relatively higher proteinuria in hyperuricosuric patients in addition to some differences in clinical characteristics of patients with hypercalciuria or hyperuricosuria, a simple cost- effective examination of the degree of calciuria and uricosuria would be helpful in the clinical evaluation of microscopic hematuria.

The Study of Plasma D-lactate Level and Acid-base Imbalance in Cirrhotic Patients / 대한신장학회잡지

PURPOSE: D-lactate, optical isomer of L-lactate is not a human metabolite. Once the D-lactate enters the human body, it is mainly metabolized in liver. The metabolism of D-lactate can be changed in patients with decompensated liver cirrhosis with the exposure of antibiotics and the frequent trial of lactulose, if neccessory. The aim of this study is to analyze blood D-lactate level in cirrhotic patients and it's relationship with the degree of hepatic insufficiency and acid-base imbalance. METHODS: Plasma L-lactate and D-lactate levels were measured in 40 cirrhotic patients classified by Child-Pugh system with L-LDH and D-LDH with comparison of their changes before and after the use of antibiotics and lactulose(n=14). Also, acid-base disorders were analyzed in 35 cirrhotic patients, and plasma L, D-lactate levels were determined in each acid-base disorder. RESULTS: Plasma D-lactate level was not significantly elevated in cirrhotic patients compared to the control group(2.34+/-.48 mmol/L vs. 1.63+/-.26 mmol/ L, p=NS), but some patients(n=4, 10%) revealed abnormally elevated D-lactate level. The plasma L, D- lactate levels were not different in subgroups classified by Child-Pugh system as well as by underlying causes of liver cirrhosis, and plasma D-lactate level was not sugnificnatly different before and after the exposure of antibiotics and lactulose. Plasma D-lactate level was significantly increased in 3 patients with respiratory alkalosis and metabolic acidosis(12+/-.98 mmol/L) compared to others(p<0.05). CONCLUSION: These results suggest that, regardless of its decompensated degree and exposure to drugs, a subset of patients with liver cirrhosis can develop elevation of D-lactate in blood, particularly when metabolic acidosis is accompanied.

Upregulation of Renal Renin-Angiotensin System in Rats with Adriamycin-Induced Nephrosis

The present study was aimed to investigate whether the adriamycin-induced nephrosis is associated with an altered regulation of local renin-angiotensin system (RAS) in the kidney. Rats were subjected to a single injection of adriamycin (2 mg/kg body weight, IV) and kept for 6 weeks to allow the development of nephrosis. They were then divided into two groups, and supplied with and without cilazapril, an angiotensin converting enzyme (ACE) inhibitor, in drinking water (100 mg/l) for additional 6 weeks. Another group without adriamycin-treatment served as control. The mRNA expression of renin, ACE, type 1 and type 2 angiotensin II receptors (AT1R, AT2R), and transforming growth factor (TGF) -beta1 was determined in the cortex of the kidney by reverse transcription-polymerase chain reaction. Adriamycin treatment resulted in heavy proteinuria. Accordingly, the mRNA expression of renin, ACE, and AT1R was increased in the renal cortex, while that of AT2R was decreased. Co-treatment with cilazapril attenuated the degree of proteinuria. While not affecting the altered expression of renin, cilazapril decreased the expression of ACE to the control level. Cilazapril further increased the expression of AT1R, while it restored the decreased expression of AT2R. The expression of TGF-beta1 was increased by the treatment with adriamycin, which was abolished by cilazapril. An altered expression of local RAS components may be causally related with the development of adriamycin-induced nephrosis, in which AT1R is for and AT2R is against the development of nephrosis.

The Analysis of Causes and Treatments of Hyperkalemia / 대한신장학회잡지

BACKGROUND: Hyperkalemia is a common, potentially life-threatening disorder. We studied the causes and treatments of hyperkalemia in korean with and without dialysis. We also sought to analyze how to treat and prevent hyperkalemia. METHODS: we reviewed medical records of 60 patients with serum or plasma; potassium levels more than 6.0 mEq/L. Twenty of them had been on maintenance dialysis. We analyzed causes of hyperkalemia and studied the sequence of it's treatment. RESULTS: The causes of hyperkalemia were mostly related to noncompliance(55%) and diet(35%) in patients with dialysis. In contrast, acute renal failure (72.5%) and drugs(15%) were the leading causes in patients without dialysis. Drugs causing hyperkalemia included angiotensin-converting enzyme inhibitor, NSAID and potassium-sparing diuretics. Sequence of various treatments were in order intravenous calcium, dialysis, insulin and calcium polystyrene sulfonate in patients with dialysis but intravenous calcium, insulin, calcium polysyrene sulfonate with dialysis. There was no case of death by arrhythmia caused hyperkalemia. CONCLUSION: The prevention of hyperkalemia in korean included dietary potassium restriction and compliance on dialysis in patients with dialysis, and careful selection of drugs especially in patients with chronic renal failure without dialysis.

Pseudohyperkalemia on Maintenance Hemodialysis / 대한신장학회잡지

BACKGROUND: The serum to plasma potassium [K] difference in patients(n=42) on maintenance hemodialysis more than one year was analyzed to evaluate the prevalence of pseudohyperkalemia among them. METHODS: In all 42 hemodialysis patients, the following predialysis serum and plasma K concentration frequencies were as followed : serum K-normal (3.5-5.5 mEq/L) 24, high(>or=5.6 mEq/L) 18, low(

The Survey for Correlation of ECG Findings to Prognosis in Hyperkalemia / 대한신장학회잡지

BACKGROUND: Hyperkalemia, one of life threatening medical emergencies, has had its prognosis and treatment determined clinically based on the findings of EKG. To date, there hasn't been enough data on the effect of very early EKG features of hyperkalemia on the long-term outcome of treatment. Therefore, we have conducted this study to suggest possible treatment guideline for hyperkalemia by analyzing the correlations between initial parameters, treatment methods and treatment outcomes. METHODS: We reviewed retrospectively the medical records of 58 patients with hyperkalemia who visited the Hanyang University Kuri Hospital from May 1995 to April 2000. We examed underlying diseases, electrolytes, regular hemodialysis, hemodialysis trials, clinical and ECG findings(at initial and recovery state). RESULTS: High systolic pressure seems to be significantly correlated with high recovery rate. Subjects with unique EKG finding of hyperkalemia were more likely to have higher serum potassium level and death rate than those without unique EKG finding. However, this group has shown improved recovery rate after undergoing hemodialysis. Serum potassium level of hyperkalemia phase does not correlate with final outcomes and EKG findings. Over 80 percent of the hyperkalemic subjects are accompanied with renal failure, and there was significant improvement in the survival rate in renal failure subjects whom had undergone hemodialysis. CONCLUSION: In hyperkalemia, the EKG has the importance in diagnosis, severity classification and treatment choice. However, prognosis of the hyperkalemia does not rely solely on the EKG itself but rather on the appropriate individualized treatment including hemodynamic stabilization and hemodialysis. Therefore, prompt and adequate treatment based on early speculation upon possible etiologic candidates, EKG, and general condition may lead to recovery from the hyperkalemia, including critical conditions such as conduction disorder and severe arrhythmia.

The Survey for Correlation of ECG Findings to Prognosis in Hyperkalemia / 대한신장학회잡지

BACKGROUND: Hyperkalemia, one of life threatening medical emergencies, has had its prognosis and treatment determined clinically based on the findings of EKG. To date, there hasn't been enough data on the effect of very early EKG features of hyperkalemia on the long-term outcome of treatment. Therefore, we have conducted this study to suggest possible treatment guideline for hyperkalemia by analyzing the correlations between initial parameters, treatment methods and treatment outcomes. METHODS: We reviewed retrospectively the medical records of 58 patients with hyperkalemia who visited the Hanyang University Kuri Hospital from May 1995 to April 2000. We examed underlying diseases, electrolytes, regular hemodialysis, hemodialysis trials, clinical and ECG findings(at initial and recovery state). RESULTS: High systolic pressure seems to be significantly correlated with high recovery rate. Subjects with unique EKG finding of hyperkalemia were more likely to have higher serum potassium level and death rate than those without unique EKG finding. However, this group has shown improved recovery rate after undergoing hemodialysis. Serum potassium level of hyperkalemia phase does not correlate with final outcomes and EKG findings. Over 80 percent of the hyperkalemic subjects are accompanied with renal failure, and there was significant improvement in the survival rate in renal failure subjects whom had undergone hemodialysis. CONCLUSION: In hyperkalemia, the EKG has the importance in diagnosis, severity classification and treatment choice. However, prognosis of the hyperkalemia does not rely solely on the EKG itself but rather on the appropriate individualized treatment including hemodynamic stabilization and hemodialysis. Therefore, prompt and adequate treatment based on early speculation upon possible etiologic candidates, EKG, and general condition may lead to recovery from the hyperkalemia, including critical conditions such as conduction disorder and severe arrhythmia.

Factors Affecting on Treatment of Hyponatremia in Hyponatremic Patients / 대한신장학회잡지

Hyponatremia, well known as a serious medical condition, is the most frequent electrolyte disorder in clinical medicine. The aim of this study is to bring to readers affecting factors in hyponatremia treatment and to suggest effective treatment guideline. We studied general characteristics, associated serum potassium change, relationship of sodium concentration in urine, and affecting factors on serum sodium correction in 76 hyponatremic patients who had admitted Hanyang University Kuri Hospital. These 73 hyponatremic patients were divided into 10 groups according to cause and treatment by retrospective analysis(1 group : G-I origin, 2 group : CRF, 3 group : CHF, 4 group: LC, 5 group : adrenal origin, 6 group : diuretics use, 7 group : CHF with di- uretics use, 8 group : LC with diuretics use, 9 group : polydypsia, 10 group : SIADH). Serum sodium were 124.2+/-6.9mEq/L in initial diagnosis, 125.6 +/-7.7mEq/L after 48 hour, and 129.8+/-6.3mEq/L in final evaluation. Among these hyponatremic patients, thirty patients' (41.1%) sodium correction rate were below 0.5mEq/L/hr during initial 48 hour and fifteen patients(20.5%) were corrected above 135mEq/l in serum sodium Initial serum potassium was average 4,07mEq/L, and 15 patients in 73 hyponatremic patients were hypokalemic feature. Eight patients of 15 hypokalemic patients were corrected to normal potassium level and in addition, four patients of 8 corrected patients were corrected to normal sodium level above 135mEq/L. The disease frequency were highest in GI origin (31.5%), followed by SIADH(20.5%) and LC(12.3%). In our study, hyponatremia correction was not related to patient sex, age, and initial serum sodium concentration. In conclusion, Hyponatremia prognosis was not related to initial serum sodium concentration and corection rate, but related to treatment of underlying disease. And hypokalemia acompanied by hyponetremia was corrected after correction of hyponatremia.

The Pathophysiologic Difference Between Idiopathic and Self-induced Edema on Chronic Furosemide Abuse / 대한신장학회잡지

Patients suffering from idiopathic or self-induced edema are uniformly characterized by chronic use of furosemide, which leads to vicious cycle of edema. Among chronic furosemide users who don't have any other specific edema forming diseases, 9 patients from the outpatient clinic(OC) and 6 patients examined at the emergency room(ER) used it mainly for weight reduction and for cyclical edema, respectively. All of the ER group patients were presented with severe hypokalemia(2.04+/-0.2mEq/L; range 1.3 to 2.7 mEq/L) and alkalosis(748+/-0.01; range 7.44 to 7.51) but none from the OC group showed such results. Other baseline parameters including Plasma renin activity(PRA) and aldosterone level on recumbency, and FEn(2)were similar in both groups. In contrast, daily working hours(6.1+/-0.5 vs 10+/-0.6hr, p<0.01), average body weight gain between AM and PM(0.4+/-0.1 vs 0.9+/-0.lkg, p<0.01), peak weight gain interval(9+/-0.8 vs 5+/-0.1day, p<0.05), PRA(7.6+/-1.5 vs 23.5+/-7.2ng/ml/h, p<0.05) and aldosterone level(22.1+/-4.2 vs 64.8+/-10.4 ng/dl, p<0.01) on ambulation, and FEk. on normokalemia(ll+/-2A vs 36+/-7.7%, p<0.01) were statistically different between the two groups. In comparison to the OC group, both the amout of urine(617+/-39 vs 358+/-26ml, p<0.01) and the percent change of PRA(-14+/-4 vs -3+/-2%, p<0.05) and al-dosterone level(-17+/-5 vs -4+/-3%, p<0.05) after saline loading(lL over 1hr, IV) following ambulation were smaller in the Elt group. Moat of the ER group patients(5/6) required aldosterone antagonist (spironolactone) added to K+ supplement, but all of the OC group patients were managed to maintain an edema-free status with conservative treatment. In conclusion, patients with idiopathic edema seem to have more fluid transudation out of intravascular space during orthostasis with a prominent degree of deranged renin-aldosterone axis and K+ metabolism than those with self-induced edema.

Comparison of Free Ionized Calcium Levels by Direct Measurement and Those Calculated from Total Calcium, Albumin, and pH in Chronically Ill Patients / 대한신장학회잡지

This study was aimed to assess the free calcium status with or without its direct measurement in patients on hemodialysis(HD: n=27) and malnourished ones from extrarenal diseases(MN: n=14). It was performed by the comparison of measured free calcium (Ca++m) levels by gas analyzer and calculated free calcium(Ca++c) levels based on those of total calcium (TCa), albumin, and pH with the modified algorithm invented by Moore(J Clin Invest. 49:318, 1970). Of 27 HD pts, 14(5296) had low[Ca++m] below 1.05mmol/L despite only 2(796) with low [TCa] below 2.05mmoV L, whereas 14 MN pts had similar numbers between low[Ca++m] and low[TCa]. Compared to MN pts, HD pts showed significantly lower mean levels(SE) of pH(7.37 0.01 vs. 7A4 0.01, p<0.01), higher[TCa](2.33 0.04 vs. 1.83 0.08mmol/L, p<0.01), and higher albumin (4.33 0.06 vs. 2.59 0.17mg/dL, p<0.01).However, [Ca++m] between 2 groups did not reveal any significant difference. Furtherrnore, in total 41 pts of 2 groups, no similarity was observed between the values of [Ca++ml and [Ca++c] but with their significant difference(p<0.05). Only[TCa] was significantly corre- lated with albumin level(r=0.73, p<0.01). Furthermore, multiple regression analysis between [Ca++m] and other factors including pH and albumin didn't show any correlation. In conclusion, this data suggests that relatively high prevalence of low values of physiologically important free ionized calcium in chronically ill pts, especially on maintenance HD, could be missed when predicted on total calcium level, and pH without its direct measurement.