Erratum: Bone scan appearance and biochemical markers of the bone metabolism in hemodialysis patients / 대한내과학회지

No abstract available.

Bone scan appearance and biochemical markers of the bone metabolism in hemodialysis patients / 대한내과학회지

BACKGROUND: The gold standard for a diagnosis of ROD is performing a bone biopsy. We need other non-invasive diagnostic techniques because of this procedure's invasiveness. In this study, we evaluated the value of a radionucleotide bone scan and the various biochemical markers for determining the bone metabolism in hemodialysis patients . METHODS: This study evaluated 118 hemodialysis patients who underwent 99mTc-MDP bone scanning and blood tests for such biochemical markers as osteocalcin and c-terminal telopeptide of type I collagen. Two nuclear medicine physicians read the bone scan images semi-quantitatively for six bone areas and the soft tissue, and they assigned a score of 0, 1 or 2 to the findings. RESULTS: The patients were categorized into 3 classes: iPTH or =200 pg/mL. For the group with a iPTH > or =200 pg/mL, the Ca, P product, alkaline phophatase and osteocalcin levels were increased, and the serum aluminum level was decreased compared to the other groups. When the bone scans were analyzed, the sum of the bone uptake scores was higher in the group with an iPTH > or =200 pg/mL while the soft tissue uptake score was higher in the group with an iPTH <50 pg/mL. The most common type of patient was a patient with an iPTH <50 pg/mL, and adynamic bone disease may be the most prevalent type of ROD. CONCLUSIONS: The bone scan findings correlated with the iPTH level in hemodialysis patients. Bone scans can provide additional information if this is combined with other biological markers. We stillneed to confirm its usefulness by conducting a comparative study with using bone biopsy.

A Case of Idiopathic Sigmoid Colonic Perforation in a Hemodialysis Patient / 대한신장학회잡지

Many hemodialysis patients, because of low fiber diet, water restriction, phosphate binder and endocrine-metabolic disturbance, suffer from chronic constipation. In a state of chronic constipation, a large amount of hard fecal mass often results in fecal impaction. Megacolon, urinary obstruction and perforation of the large bowel rarely develop as a complication of fecal impaction. The authors experienced a case of idiopathic sigmoid colonic perforation, with fecal impaction, in a 66-year-old woman having undergone hemodialyis of 6 years duration. The clinical features of the case are presented, with a review of the literatures.

Clinical Characteristics in Patients with HELLP Syndrome Complicated with Acute Renal Failure / 대한신장학회잡지

BACKGROUND: The aim of this study was to exam the clinical features and the renal outcome of HELLP syndrome complicated with ARF. METHODS: Thirty-nine patients with HELLP syndrome were retrospectively analyzed on the basis of medical records. A serum creatinine level of >1.3 mg/dL was used as a criterion to define ARF for at least 48 hours. RESULTS: Of the 39 patients, HELLP syndrome with ARF developed in 17 patients. The ARF group had a higher incidence of primigravida (p<0.05) and a longer gestational age at the onset of HELLP syndrome (p<0.05) than those in the non-ARF group. The recovery time of HELLP syndrome in the ARF group was much longer than that in the non-ARF group (p<0.05). In the ARF group, the serum aspartate aminotransferase (AST) concentration was higher (p<0.05) and the nadir blood platelet counts were lower (p<0.05). The incidence of disseminated intravascular coagulation (DIC) was significantly higher in the ARF group than in the non-ARF group (p<0.01). There was no significant difference in the incidence of pulmonary edema, abruptio placenta, preeclampsia, and fetal death between the two groups. Only one patient in the ARF group required hemodialysis. In all ARF patients, the renal impairment fully recovered within a median of 5 days (range: 2-32 days) after the onset of ARF. CONCLUSION: The clinical factors associated with ARF in HELLP syndrome were primigravida, gestational age, serum AST level, blood platelet counts, and DIC. The ARF in HELLP syndrome fully recovered without progression to permanent renal impairment.

A Case of Aloe-nduced Acute Interstitial Nephritis / 대한신장학회잡지

We report a case of aloe induced acute interstitial nephritis in a 66-year old man. He had been taken aloe as a healthy foodstuff for 6 weeks prior to admission. He complained poor oral intake and developed nonoliguric acute renal failure. Renal biopsy revealed focal tubular atrophy and interstitial infiltration of neutrophils, and lymphocytes. After discontinuation of aloe and high dose prednisolone therapy, acute renal failure of the patient improved and serum creatinine level decreased.

A Case of Anti-glomerular Basement Membrane Disease which Presented with Fever of Unknown Origin / 대한신장학회잡지

Anti-glomerular basement membrane disease is an autoimmune disorder characterized progressive renal failure and/or lung hemorrhage. Most of patients present with acute renal failure or acute nephritic feature such as hematuria, proteinuria, and leukocyturia in urinalysis. A part of patients present with pulmonary hemorrhage, anemia, tachypnea, and cyanosis. It is accompanied with transient fever and myalgia but fever of unknown origin (FUO) is very rare condition. We report the atypical case of anti-glomerular basement membrane mediated rapidly progressive glomerulonephritis which presented with FUO and shock after methylprednisolone pulse therapy.

Is the Angiodysplasia Significant as the Cause of Upper Gastrointestinal Hemorrhage in Patients with Chronic Renal Failure? / 대한신장학회잡지

PURPOSE: The role of angiodysplasia as a main cause of upper gastrointestinal hemorrhage (UGH) in patients with chronic renal failure (CRF) is controversial. We investigated the sources of UGH and the clinical characteristics of UGH in patients with CRF. METHODS: We reviewed the medical and endoscopic records of 574 patients who were admitted to Gil Medical Center from November 1999 to November 2004. UGH was defined as hematemesis, or nasogastric aspirate showing fresh or old blood, or melena associated with acute drop in hematocrit. CRF was defined as a serum creatinine clearance < or =59 mL/min for at least 3 months before and after the bleeding episode or the patients who have undergone dialysis or received renal transplantation. RESULTS: Thirty-two of 574 patients were CRF group. 19 of the CRF patients have received dialysis (18 paitents-hemodialysis; 1 patient-peritoneal dialysis). The mean age of CRF group was 56+/-13.65 years old and 16 patients were male. The causes of UGH in CRF patients, in order of frequency, was duodenal ulcer (37.5%), gastric ulcer (34.4%), unknown (12.5%). No angiodyplasia was found in CRF group. The sources of bleeding did not differ significantly between the two groups. The prevalence of taking ulcerogenic drugs in CRF patients was higher than that in control group (59.4% vs 29.7%, p=0.001). The prevalence of Helicobacter pylori (H. pylori) infection in CRF patients with peptic ulcer and gastritis was lower than that in control group (16.7% vs 42.3%, p=0.017). The mean length of hospital stay and the mean numbers of blood transfusions required were higher in the CRF group than control group. However, no differences were seen between the two groups in mortality, recurrent bleeding and surgery for control of bleeding. CONCLUSION: The common cause of UGH in patients with CRF was peptic ulcer disease and no angiodysplasia was found.

Analysis of factors affecting the delivered dose of hemodialysis in patients on conventional fixed dialysis regimen / 대한내과학회지

BACKGROUND: Although adequate removal of small solutes are essential for effective hemodialysis, many patients are suffering from inadequate delivery of hemodialysis, especially with the conventional fixed regimen of dialysis for 4 hours three times per week. We tried to evaluate actual delivered dose of hemodialysis in patients receiving 4 hours of low-flux hemodialysis, and to analyze factors affecting inadequate delivery of hemodialysis. METHODS: 97 stable maintenance hemodialysis patients who were undergoing 4 hours of hemodialysis thrice weekly were included for analysis. Prescribed dose of dialysis was calculated by Kt/V where K was in vitro urea clearance of dialyzer membrane and V was estimated according to the Watson's formula. Delivered dose of dialysis was calculated according to the Daugirdas equation. To find factors that may impair adequate delivery of hemodialysis, various clinical and technical parameters were analyzed. RESULTS: Prescribed dose of hemodialysis was 1.37+/-0.21, while delivered dose was 1.23+/-0.27, and thus, there was a significant difference (p <0.03). In 45% of the patients, delivered dose was less than 1.2. They were heavier and prescribed dose was low. delta Kt/V (Prescribed dose-Delivered dose) was significantly greater in patients who did not use heparin therapy compared to patients who used heparin. Other parameters such as hypotension, missed treatment, sex, type of vascular access and degree of recirculation were not associated with impaired delivery of hemodialysis.