The Incidence of Hyperparathyroidism in Renal Allograft Recipients with Stable Renal Function / 대한신장학회잡지

The hyperparathyroidism which causes renal osteodystrophy is a common complication in patients with end stage renal diseases. It is usually normalized after successful renal transplantation, but it remains in some renal transplant recipients. It is not well known whether hyperparathyroidism decreases bone mineral density in renal allograft recipients or not. To evaluate the incidence and predictive marker for hyperparathyroidism in renal allograft recipients and to describe the impact of hyperparathyroidism on the bone mineral density, we measured intact parathyroid hormone(iPTH) in 193 renal allograft recipients with stable renal and hepatic function. The mean age of patients was 42+/-12(13-76) years old and male female ratio was 1.9. The patients were on pre-transplant dialysis for 14.4+/-15.6(0-130) months and were followed up for 43.8+/-35.7(2-204) months after transplantation. Of the total 193 patients, 13 patients(6.7%) had high iPTH level. All patients showed normal serum calcium and phosphorous levels. iPTH levels were positively correlated to pre- and post-transplant serum alkaline phosphatase levels(vs. pre-transplant r=0.32, P<0.001, vs post- transplant r=0.63, P<0.001). There was no difference in pre- and post-transplant serum calcium, phosphorus, post-transplant serum creatinine and hemoglobin levels between the patients. There were no statistical differences in age, sex, duration of pre-transplant dialysis, duration of post-transplant follow-up, number of transplantation, donor type, primary renal disease and episodes of acute rejection. Of the total 193 patients, bone mineral density was studied in 37 patients. Bone mineral densities did not correlated to iPTH levels. In conclusion, the incidence of hyperparathyroidism in renal allograft recipients with stable renal function was 6.7%. Pre- and post-transplant serum alkaline phosphatase levels might be used as a useful marker for hyperparathyroidism. Serum iPTH level was not correlated to bone mineral density.

Two Cases of Pneumocystis Carinii Pneumonia in Renal Allograft Recipients / 대한신장학회잡지

Renal allograft recipients are at risk for Pneumocystis carinii pneumonia (PCP) within the first year following transplantation and during treatment for graft rejection. We experienced two cases of PCP in renal allograft recipients. The first case was a 39-year-old female who had received renal allograft 7 years before. At the time of traosplantation, she was a carrier of hepatitis B surface (HBs) antigen. After transplantation, she had been received the rnaintenance dose of cyclosporine and oral prednisolone. Three months before adrnission, dosage of prednisolone was increased because of the increased serum creatinine level and gene-ralized edema. A week before admission, syrnptom of exertional dyspnea, dry cough, and fever was developed. Chest X-ray film showed streaky interstitial infiltration in both lung fields and chest CT showed diffuse ground-glass appearance. Rroncho- alveolar lavage revealed positive Grocott's methenamine silver stain for numerous clumps of pneumocystis carinii cysts. Despite the aggressive treatment, she died of respiratory and hepatic failure and GI bleeding. Another case was a 40-year-old male who had received renal allograft S years before. He had been received maintenance immune suppressive therapy with cyclosporine and oral prednisolone. He was admitted for evaluation of hypertension and elevated serum creatinine level. After several days of admission, he complained fever, dry cough and dyspnea. X-ray film showed pneumonic infiltration and the bronchial brushing and washing fluid revealed the Pneumocystis carinii cysts that were stained by methenamine silver. He was treated with the full dose of trimethoprim-sulfamethoxazole and clindamycin. Sacrificing the renal allograft, he recovered from Pneumocystis carinii pneumonia.

The Comparison of Clinical Efficacy and Side Effects of Once Daily Versus Divided Doses of Gentamicin in Acute Pyelonephritis / 감염

BACKGROUND: Once daily dose of aminoglycoside has been used recently in the gram-negative infection for the purpose of improving efficacy. The clinical efficacy and side effects of once daily versus divided doses of gentamicin were compared in acute pyelonephritis. METHOD: Gentamicin (3-5mg/kg/day) was administered into 3 divided doses intravenously in 15 patients of the divided dose group, and the same dose was administered at a time in 19 patients of the once daily dose group. The duration of treatment was 6-14 days. RESULTS: The clinical outcome of all patients was favorable, and nephrotoxicity or ototoxicity was not detected in any patients. E. coli were isolated from 12 patients in the divided dose group, and 15 patients in the once daily dose group. They were all eradicated after treatment. The mean peak serum concentrations of gentamicin were 5.33+/-1.99;g/mL in the divided dose group, and 14.79+/-5.71g/mL in the once daily dose group. The trough concentrations were not different significantly between two groups(0.69+/-0.58;g/mL in the divided dose group vs. 0.35+/-0.45g/mL in the once daily dose group). The number of patients with peak concentration over 5.0g/mL was 8 out of 15 in the divided dose group. CONCLUSION: The once daily dose of gentamicin was as effective as the divided dose, and the nephrotoxicity or ototoxicity was not observed in both groups.