A Case Report of MPO-ANCAAssociated Vasculitis Following Heterologous mRNA1273 COVID-19Booster Vaccination

Despite that clinical trials have been examining the safety profile of coronavirus disease 2019 (COVID-19) vaccines, there are concerns about long-term side effects as the number of vaccinations increases. Herein, we report a case of new-onset renal-limited antimyeloperoxidase (MPO) antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis after booster vaccination with the mRNA 1273 (Moderna) vaccine. A 72-year-old woman with no specific past history, and who had a normal renal function, developed ANCAassociated vasculitis following heterologous booster with mRNA1273 (Moderna) vaccine.After a kidney biopsy, she was diagnosed with ANCA-associated pauci-immune crescentic glomerulonephritis. Her renal function and constitutional symptoms have been improved with treatment with plasmapheresis, intravenous cyclophosphamide and steroid pulse therapy (intravenous 500 mg of methylprednisolone sodium succinate for 3 days) followed by a reduced steroid regimen.

Influencing Factors Affecting Successful Organ Donation and Families' Consent to Donate after Drain Death / 대한이식학회지

BACKGROUND: This study was conducted to identify the factors influencing successful organ donation and families' consent to donate after brain death. METHODS: Medical records and data regarding organ donation counseling with the families of 107 brain-dead potential donors between September 2012 and March 2016 at a single tertiary medical center were retrospectively reviewed. RESULTS: The final consent rate was 57.9% (62/107), and successful donation was performed in 40.2% (43/107) of cases. Univariate and multivariate analyses revealed that the independent factors associated with successful organ donation were age <60 years (odds ratio [OR], 3.384; 95% confidence interval [CI], 1.350 to 8.484; P=0.009), systolic blood pressure ≥90 mmHg (OR, 6.261; 95% CI, 1.418 to 27.653; P=0.015), and serum sodium level ≥150 mEq (OR, 4.215; 95% CI, 1.655 to 10.733; P=0.003). Family's consent to donate was significantly associated with head trauma (OR, 3.538; 95% CI, 1.104 to 11.334; P=0.033) and serum sodium level ≥150 mEq (OR, 3.392; 95% CI, 1.404 to 8.194; P=0.007). CONCLUSIONS: Successful organ donation was associated with patient age, systolic blood pressure and serum sodium level. Family's consent to donate was associated with head trauma and serum sodium level.

Renoprotective effects of febuxostat compared with allopurinol in patients with hyperuricemia: A systematic review and meta-analysis

BACKGROUND: Hyperuricemia is reported to be related to rapid progression of renal function in patients with chronic kidney disease (CKD). Allopurinol, a uric acid lowering agent, protects renal progression. However, it is not widely used in patients with CKD because of its serious adverse event. Febuxostat can be alternatively used for patients who are intolerable to allopurinol. We aimed to determine renoprotective effect and urate-lowering effect between the two drugs. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials to assess the effects of febuxostat compared to allopurinol in patients with hyperuricemia. MEDLINE, Embase, and Cochrane Library databases were searched to identify research publications. RESULTS: Four relevant publications were selected from among 3,815 studies. No significant differences were found in the changes in serum creatinine from baseline between the febuxostat and allopurinol groups. Changes in estimated glomerular filtration rate (eGFR) were observed between the two groups at 1 month (mean difference 1.65 mL/min/1.73 m², 95% confidence interval [CI] 0.38, 2.91 mL/min/1.73 m²; heterogeneity χ² = 1.25, I² = 0%, P = 0.01); however, the changes in eGFR were not significantly different at 3 months. A significant difference did exist in the changes in albuminuria levels from baseline between the febuxostat and allopurinol groups (mean difference −80.47 mg/gCr, 95% CI −149.29, −11.64 mg/gCr; heterogeneity χ² = 0.81, I² = 0%, P = 0.02). A significant difference was also observed in the changes in serum uric acid from baseline between the febuxostat and allopurinol groups (mean difference −0.92 mg/dL, 95% CI −1.29, −0.56 mg/dL; heterogeneity χ² = 6.24, I² = 52%, P < 0.001). CONCLUSION: Febuxostat might be more renoprotective than allopurinol.

Efficacy of a Modified Pharmacomechanical Thrombolysis Technique for Endovascular Treatment of Thrombosed Prosthetic Arteriovenous Grafts

OBJECTIVE: We applied a modified pharmacomechanical thrombolysis (PMT) technique to endovascular treatment of thrombosed arteriovenous (AV) grafts without the use of any mechanical thrombectomy devices. The aim of this study was to evaluate the efficacy of the PMT technique in the treatment of thrombosed AV grafts by analyzing the long-term patency. MATERIALS AND METHODS: Eighty-two patients with thrombosed AV grafts were treated with the PMT technique. AV graft surveillance to detect failing/failed access was followed by endovascular treatment. RESULTS: The technical and clinical success rates were 95% and 95%, respectively. The total number of thrombolysis sessions was 279. A post-intervention primary patency rate was 45% and 22% at 12 and 24 months, respectively. The secondary patency rate was 96% and 91% at 12 and 24 months, respectively. No major complications were noticed. CONCLUSION: The modified PMT technique is effective in endovascular treatment of thrombosed AV grafts.

Plasma leptin concentrations are greater in type II diabetic patients and stimulate monocyte chemotactic peptide-1 synthesis via the mitogen-activated protein kinase/extracellular signal-regulated kinase pathway

BACKGROUND: Leptin is an adipokine that is recently reported to be a biomarker of systemic inflammation. Although atherosclerosis causes cardiovascular diseases, it is not clear whether leptin contributes to the acceleration of this process. In this study, we investigated whether alterations of plasma leptin levels were related to diabetic nephropathy and systemic inflammation. In addition, we examined the physiologic action of leptin in cultured vascular smooth muscle cells (VSMCs). METHODS: A total of 126 type 2 diabetic participants and 37 healthy controls were studied. The diabetic participants were divided into three groups according to stage of nephropathy. We investigated whether leptin induced monocyte chemotactic peptide-1 (MCP-1) synthesis through the mitogen-activated protein kinase (MAPK) pathway using cultured VSMCs. RESULTS: Plasma leptin concentrations were significantly higher in the diabetic group than in the controls. Plasma leptin levels were positively correlated with body mass index, fasting and postprandial blood glucose, hemoglobin A1c, total cholesterol, urinary albumin excretion, high-sensitivity C-reactive protein (hsCRP), and MCP-1 plasma levels, and negatively correlated with creatinine clearance values. In cultured VSMCs, leptin increased MCP-1 production in a dose-dependent manner, and this stimulating effect of leptin on MCP-1 expression was reversed by the MAPK (MEK) inhibitor PD98059. In addition, leptin stimulated the phosphorylation of MEK, extracellular signal-regulated kinase, and E26-like transcription factor, which are components of the MAPK pathway. CONCLUSION: Overall, these findings suggest that activation of leptin synthesis may promote MCP-1 activation in a diabetic environment via the MAPK pathway in VSMCs and that it possibly contributes to the acceleration of atherosclerosis.

Phosphodiesterase Inhibitor Improves Renal Tubulointerstitial Hypoxia of the Diabetic Rat Kidney

BACKGROUND/AIMS: Renal hypoxia is involved in the pathogenesis of diabetic nephropathy. Pentoxifyllin (PTX), a nonselective phosphodiesterase inhibitor, is used to attenuate peripheral vascular diseases. To determine whether PTX can improve renal hypoxia, we investigated its effect in the streptozocin (STZ)-induced diabetic kidney. METHODS: PTX (40 mg/kg, PO) was administered to STZ-induced diabetic rats for 8 weeks. To determine tissue hypoxia, we examined hypoxic inducible factor-1alpha (HIF-1alpha), heme oxygenase-1 (HO-1), vascular endothelial growth factor (VEGF), and glucose transporter-1 (GLUT-1) levels. We also tested the effect of PTX on HIF-1alpha in renal tubule cells. RESULTS: PTX reduced the increased protein creatinine ratio in diabetic rats at 8 weeks. HIF-1alpha, VEGF, and GLUT-1 mRNA expression increased significantly, and the expression of HO-1 also tended to increase in diabetic rats. PTX significantly decreased mRNA expression of HIF-1alpha and VEGF at 4 and 8 weeks, and decreased HO-1 and GLUT-1 at 4 weeks. The expression of HIF-1alpha protein was significantly increased at 4 and 8 weeks in tubules in the diabetic rat kidney. PTX tended to decrease HIF-1alpha protein expression at 8 weeks. To examine whether PTX had a direct effect on renal tubules, normal rat kidney cells were stimulated with CoCl2 (100 microM), which enhanced HIF-1alpha mRNA and protein levels under low glucose conditions (5.5 mM). Their expressions were similar even after high glucose (30 mM) treatment. PTX had no effect on HIF-1alpha expression. CONCLUSIONS: PTX attenuates tubular hypoxia in the diabetic kidney.

Comparison of the Long-Term Outcome of Coronary Artery Bypass Grafting between Percutaneous Coronary Intervention in End Stage Renal Disease Patients / 대한신장학회지

PURPOSE: Coronary artery disease is the main cause of morbidity and mortality in dialysis patients. Some observational studies proposed that coronary artery bypass graft (CABG) might provide higher survival benefit than percutaneous coronary intervention (PCI) in dialysis patients. There were not many studies of the comparison between the methods of coronary artery reperfusion therapy. Therefore, we compared the long term survival between PCI and CABG groups in dialysis patients. METHODS: We selected 104 patients with end stage renal disease (ESRD) who had PCI (N=75) or CABG (N=29) in Ilsan-Paik Hospital from December 1999 to February 2010. We collected data from medical records and performed a retrospective analysis in ESRD patients hospitalized for the first coronary revascularization procedure. RESULTS: There was no difference in the basic characteristics between the two groups. However, the frequency of more than 3-vessel lesions or less than 30% ejection fraction was higher in the group of CABG than that of PCI. One and three-year survival rates were higher in the PCI group than those in the CABG group. However, there was no difference in the 5 year survival rate between the groups. In subgroup analysis for severe patients with 3-vessel coronary diseases or less than 30% of ejection fraction, there were no statistical differences in the 1, 3 and 5 year survival rates between the groups. In subgroup analysis for the patients maintaining dialysis more than three months, 1, 3, and 5 year survival rates were not statistically different. CONCLUSION: In ESRD and dialysis patients, there was no difference in the long-term survival between PCI and CABG.

A Perirenal Abscess Recurring with Methicillin-Resistant Staphylococcus Aureus and Mycobacterium Tuberculosis Co-Infection after Treatment of Escherichia Coli Infection: A Case Report / 대한신장학회지

Renal and perirenal abscesses are disease entities caused by infections in or around the kidneys. As imaging modalities have improved in quality and convenience, diagnosing these diseases has become easier. Some cases are refractory to conventional treatment and require surgical correction, although most patients can be cured by antibiotic treatment and percutaneous drainage. We here report the case of a patient with a perirenal abscess that recurred twice after appropriate antibiotic treatment and percutaneous drainage. Although Gram-negative bacilli are the most common pathogenic cause of these diseases, we isolated methicillin-resistant Staphylococcus aureus and Mycobacterium tuberculosis in our patient. Thus, poor responses to appropriate treatment in patients with a perirenal abscess can result not only from antimicrobial resistance or a co-infection but also from the 2 conditions existing concomitantly.

Relapsing Kocuria varians Peritonitis in a Continuous Ambulatory Peritoneal Dialysis Patient / 대한신장학회지

Kocuria species are the normal flora of skin, mucosa and oropharynx, and can be the causative organisms of complications associated with intravenous catheterization, ambulatory peritoneal dialysis, and ventricular shunt. We report a case of relapsing peritonitis by Kocuria varians in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD). A 62 year old woman was admitted to the hospital with a complaint of abdominal pain and a turbid peritoneal dialysate. The patient was treated with a combination of intraperitoneal antibiotics. A culture of the peritoneal dialysate revealed K. varians, and the patient was discharged after she showed improvement with the treatment. Although the organism was sensitive to the administered antibiotics, the patient experienced 2 episodes of peritonitis. This continuing recurrence could be attributed to an insufficient treatment period or biofilm formation. Therefore, the patient underwent further treatment with intraperitoneal antibiotics and showed no recurrence for 1 year thereafter. This is the first report of relapsing peritonitis by K. varians. Although peritonitis caused by rare pathogens has been described recently, K. varians is known to have a low pathogenecity and occurs rarely. The findings in this case emphasize the importance of careful consideration on the rare pathogen and administration of the appropriate antibiotics for a sufficient duration.

A Case of Tumoral Calcinosis in a Hemodialysis Patient with Secondary Hyperparathyroidism / 대한신장학회지

Tumoral calcinosis is a periarticular calcific lesion and rare complication in patients with maintenance hemodialysis. The pathogenesis of tumoral calcinosis is poorly understood but may be due to elevated serum phosphorus, a high calcium phosphorus (Ca x P) product or secondary hyperparathyroidism in hemodialysis patients. A 30-year-old man presented with pain and palpable mass of left shoulder. He had been on maintenance hemodialysis with high flux dialyzer for 10 years. Laboratory finding showed hyperphosphatemia and elevated intact PTH concentration. A shoulder X-ray and CT scan demonstrated a massive calcification. Following partial resection, pain was relieved. Here we report a case of tumoral calcinosis of shoulder in a hemodialysis patient with untreated hyperphosphatemia and secondary hyperparathyroidism.

Pseudo-Renal Failure; Urinary Ascites and Uremia due to Bladder Rupture / 대한신장학회지

The main feature of acute renal failure is a decline in the glomerular filtration rate. However, urine leakage into the peritoneal cavity due to bladder rupture may cause pseudo-renal failure. This is a situation in which renal function is normal, along with the presence of elevated serum creatinine. A 47-year-old woman presented with abdominal distension and pretibial pitting edema on both lower extremities. She had no traumatic history. She did not complain of abdominal pain, and exhibit neither oliguria nor anuria. Her blood urea nitrogen (BUN) and serum creatinine was 105 and 11.2 mg/dL. Ascites showed that urea nitrogen and creatinine were 160 and 29 mg/dL, respectively. We confirmed bladder rupture by an abdominal CT scan and retrograde cystography. She underwent an emergency laparotomy to repair the ruptured bladder. Azotemia was normalized 2 days after the operation. Here we present a rare case of uremia due to bladder rupture.

A Case of Bilateral Xanthogranulomatous Pyelonephritis with Renal Failure / 대한신장학회지

Xanthogranlomatous pyelonephritis is a rare chronic inflammatory renal disease. Its clinical and radiological findings resemble other renal parenchymal diseases, such as a renal abscess or renal cell carcinoma. Only a histologic examination can confirm xanthogranulomatous pyelonephritis. It usually presents unilaterally and displays relatively normal renal function. Bilateral xanthogranulomatous pyelonephritis is extremely rare. The renal function of bilateral xanthogranulomatous pyelonephritis is usually normal at the time of diagnosis, but progresses to end stage renal failure as the disease progresses. We experienced a case of bilateral xanthogranulomatous pyelonephritis, and its initial manifestation was renal failure. We report this case with a review of the literatures.

A Case of Vivax Malaria with Seizure and Shock

Vivax malaria reemerged in the Republic of Korea in 1993. Vivax malaria is generally a benign disease with few severe complications. Even in the worldwide literature, there is only a small number of case reports on severe complications in vivax malaria. We report a unique case of P. vivax infection complicated by seizure and shock. A 58 year-old male showed generalized tonic-clonic seizure and shock after P. vivax infection. The species of malarial parasite was identified using peripheral blood film examination and polymerase chain reaction (PCR). He successfully recovered after treatment with hydroxychloroquine.

A Case of Vivax Malaria with Seizure and Shock

Vivax malaria reemerged in the Republic of Korea in 1993. Vivax malaria is generally a benign disease with few severe complications. Even in the worldwide literature, there is only a small number of case reports on severe complications in vivax malaria. We report a unique case of P. vivax infection complicated by seizure and shock. A 58 year-old male showed generalized tonic-clonic seizure and shock after P. vivax infection. The species of malarial parasite was identified using peripheral blood film examination and polymerase chain reaction (PCR). He successfully recovered after treatment with hydroxychloroquine.

Pure Red Cell Aplasia (PRCA) due to Parvovirus B19 Infection after Kidney Transplantation / 대한이식학회지

The patient was a 39-year-old male with anemia persistent after a living-related renal transplantation. He was diagnosed to have pure red cell aplasia (PRCA) due to parvovirus B19 infection on the 6th week after the renal transplantation. Serum Parvovirus B19 DNA polymerase chain reaction (PCR) and anti-Parvovirus B19 IgM were positive and bone marrow aspiration biopsy showed giant pronormoblasts including prominent intranuclear inclusions. He has been receiving immunosuppressive therapy including oral cyclosporine A, prednisolone, mycophenolate mofetil (MMF). After diagnosis of pure red cell aplasia, we reduced the dose of cyclosporine A and maintained prednisolone, mycophenolate mofetil. We used intravenous immunoglobin(IVIG) 0.4 g/kg/ day for 5 days. Patient's serum reticulocyte count increased a week after the treatment from 0.1% to 3.8%, and patient's serum hemoglobin level normalized on the 4th week of the treatment. Presently, 20 weeks following the initiation of IVIG, his hemoglobin remains normal without recurrent symptom. We are planning to follow up the serum anti-parvovirus B19 IgM/IgG and parvovirus B19 DNA PCR examination.

A Case of Rhizobium Radiobacter Peritonitis Cured without Removal of the PD Catheter in a Patient on CAPD / 대한신장학회지

Rhizobium radiobacter has been recognized as a rare pathogen affecting debilitated patients and usually associated with indwelling foreign body. Rhizobium radiobacter is a rare pathogen of peritonitis in patients on peritoneal dialysis. It is assumed that a cure can hardly be expected without removal of a peritoneal dialysis catheter. We experienced a case of Rhizoboum radiobacter peritonitis in a patient on CAPD successfully cured without removal of the peritoneal dialysis catheter. The patient was 42-year-old male and maintained on CAPD for 2 months. He visited with cloudy peritoneal dialysate effluent and showed mild abdominal tenderness. 650 leucocytes/microL were counted and Rhizobium radiobacter was isolated in the peritoneal dialysate effluent. His peritonitis was completely resolved with 3 weeks course of intraperitoneal ceftazidime and oral ciprofloxacin. He has maintained on CAPD without recurrence of peritonitis for 12 months.

Combination Treatment with Retinoid and Peroxisome Proliferator-Activated Receptors (PPAR)-gamma Agonist on Streptozotocin-Induced Diabetic Nephropathy / 대한신장학회지

PURPOSE: An inflammatory mechanism has been suggested to contribute to the progression of diabetic nephropathy. Both retinoid and PPAR-gamma agonist, known anti-inflammatory agents, have been reported to be beneficial in diabetic nephropathy. Because they form heterodimer for transcription within the nucleus, we investigated the effect of a combination treatment with them in streptozotocin (STZ)-induced diabetic rats. METHODS: STZ-induced diabetic rats were treated with retinoid and PPAR-gamma agonist. The effects were determined by measuring urinary monocyte chemoattractant peptide (MCP)-1, proteinuria, and intrarenal ED-1 expression. RESULTS: Blood glucose concentration was higher in diabetic rats than in control rats. Retinoid and PPAR-gamma agonist did not affect blood glucose concentration. Urinary protein excretion (8.6+/-0.69 vs. 22.1 mg/mgCr, p<0.01) and urinary MCP-1 (19.8+/-3.4 vs. 61.5+/-6.1 pg/mgCr, p<0.01) were significantly higher in diabetic rats at four weeks after the induction of diabetes compared with controls. Proteinuria in the group with retinoic acid (16.9+/-1.4, mg/mgCr, p<0.05) and PPAR-gamma agonist (14.6+/-1.5 mg/mgCr, p<0.05) were decreased. Retinoic acid (42.2+/-2.7 pg/mgCr, p<0.05) and PPAR-gamma agonist (40.5+/-pg/ mgCr, p<0.05) significantly suppressed MCP-1 level in diabetic rats. However, combination treatment was not effective to proteinuria and urinary MCP-1 concentration. Urinary protein excretion was significantly correlated with MCP-1 (r=0.9, p<0.01). Immunohistochemistry revealed a significant increase in staining for ED-1 protein in the diabetic kidneys. Both retinoid and PPAR-gamma agonist significantly suppressed intrarenal ED-1 synthesis. However combination treatment didn't show any additional beneficial effects. CONCLUSION: Both retinoic acid and PPAR-gamma agonist suppressed proteinuria and inflammatory changes in diabetic rats. However, there were no additional effects of the combination treatment present. Further research is needed to determine the effect of the combination treatment on diabetic nephropathy.

Serum Cystatin C Concentration Compared with Serum Creatinine Concentration as a Marker of Glomerular Filtration Rate / 대한신장학회잡지

BACKGROUND: Several studies have shown serum cystatin C to be a better parameter for glomerular filtration rate (GFR) than serum creatinine (sCr). It is also known to be more sensitive in detecting of early renal impairment. METHODS: Serum samples were obtained from 518 subjects with various renal functions for GFR determination and cystatin C measurement. GFRs were estimated by Modification of Diet in Renal Disease (MDRD) formula and classified 5 stages according to KDOQI CKD classification. The relationships between the levels of serum cystatin C or sCr and the stages of GFR were determined. RESULTS: The mean levels of serum cystatin C in stage 1 (normal renal function) subjects were not different in stage 2 (mild renal impairment) subjects (0.9+/-0.3 vs. 0.9+/-0.3 (mg/L), p>0.05). The mean levels of sCr in stage 1 subjects also were not different from the ones in stage 2 subjects (0.7+/-0.1 vs. 1.0+/-0.2 (mg/dL), p>0.05). The levels of cystatin C in stage 3 (moderate renal impairment) were significantly higher than those in stage 2 subjects. The difference of serum levels of cystatin C between stage 2 and stage 3 was more significant than the difference of sCr (0.9+/-0.3 vs. 1.2+/-0.6, p=0.007: 1.0+/-0.2 vs. 1.3+/-0.3, p=0.02). The levels of cystatin C and sCr were increased as GFR decreased after stage 2. The correlation of cystatin C with GFR was similar to that of sCr (-0.675 vs. -0.670) CONCLUSION: Serum cystatin C is not better than sCr for detecting of early renal impairment, but, gives a good assessment of GFR change during the follow-up.

Serum Cystatin C Concentration Compared with Serum Creatinine Concentration as a Marker of Glomerular Filtration Rate / 대한신장학회잡지

BACKGROUND: Several studies have shown serum cystatin C to be a better parameter for glomerular filtration rate (GFR) than serum creatinine (sCr). It is also known to be more sensitive in detecting of early renal impairment. METHODS: Serum samples were obtained from 518 subjects with various renal functions for GFR determination and cystatin C measurement. GFRs were estimated by Modification of Diet in Renal Disease (MDRD) formula and classified 5 stages according to KDOQI CKD classification. The relationships between the levels of serum cystatin C or sCr and the stages of GFR were determined. RESULTS: The mean levels of serum cystatin C in stage 1 (normal renal function) subjects were not different in stage 2 (mild renal impairment) subjects (0.9+/-0.3 vs. 0.9+/-0.3 (mg/L), p>0.05). The mean levels of sCr in stage 1 subjects also were not different from the ones in stage 2 subjects (0.7+/-0.1 vs. 1.0+/-0.2 (mg/dL), p>0.05). The levels of cystatin C in stage 3 (moderate renal impairment) were significantly higher than those in stage 2 subjects. The difference of serum levels of cystatin C between stage 2 and stage 3 was more significant than the difference of sCr (0.9+/-0.3 vs. 1.2+/-0.6, p=0.007: 1.0+/-0.2 vs. 1.3+/-0.3, p=0.02). The levels of cystatin C and sCr were increased as GFR decreased after stage 2. The correlation of cystatin C with GFR was similar to that of sCr (-0.675 vs. -0.670) CONCLUSION: Serum cystatin C is not better than sCr for detecting of early renal impairment, but, gives a good assessment of GFR change during the follow-up.

Aldosterone Receptor Blockade Prevents Inflammatory Reaction on Type 2 Diabetic Nephropathy / 대한신장학회잡지

BACKGROUND: Aldosterone induces renal injury independent of angiotensin II. This harmful effect might be mediated via inflammatory reaction. Aldosterone receptor blockade can retard renal damage in various renal diseases including diabetic nephropathy. However, it is not clear which mechanism is related to the beneficial effect of aldosterone receptor blockade in diabetic nephropathy. Therefore, we investigated whether aldosterone receptor blockade, spironolactone, inhibited inflammatory changes in Otsuka Long-Evans Tokushima Fatty (OLETF) rats, a model of type 2 diabetes. METHODS: To determine the inflammatory effects, urinary MCP-1 protein was measured by ELISA, and intrarenal MCP-1 mRNA and ED-1 expression were examined by RT-PCR and immunohistochemistry, respectively. RESULTS: Blood glucose concentration were higher in diabetic rats than in control rats. Urinary protein excretion was significantly higher in diabetic rats compared with controls since twenty weeks, and proteinuria of the diabetic rats was decreased by spironolactone treatment. Urinary excretion of monocyte chemoattractant peptide-1 (MCP-1) was rapidly increased at the early period in diabetic rats. Spironolactone suppressed urinary level of MCP-1 compared to untreated diabetic rats. Immunohistochemistry revealed a significant increase in ED-1 staining in the diabetic kidney, and spironolactone treatment significantly suppressed intrarenal ED-1 expression in diabetic rats. CONCLUSION: Aldosterone receptor blockade, spironolactone, suppressed proteinuria and inflammatory changes in diabetic rats. These results suggest that spironolactone may have an anti-inflammatory effect in diabetic nephropathy.