A Case of Bile Peritonitis with Acute Cholecystitis in a Continuous Ambulatory Peritoneal Dialysis Patient / 대한신장학회지

Peritonitis is the most common complication of CAPD (continuous ambulatory peritoneal dialysis). Major cause of peritonitis is bacterial infection by septic manipulation and catheter exit infection. In patients with CAPD, bile peritonitis by acute cholecystitis is rare. A 80-year-old female patient who had been treated with CAPD for 18 months visited our hospital for abdominal pain and change of dialysate color. These symptoms suggested peritonitis. Although we administered intraperitoneal antibiotics, abdominal pain did not subside. Therefore, we checked abdomen computerized tomography. CT findings showed gall bladder stone with distension, wall thickening and pericholecystic fluid collection. Acute cholecystitis with microperforation was suspected. She underwent percutaneous transhepatic gall bladder drainage and systemic antibiotics therapy. After conservative treatment, abdominal pain was subsided and peritoneal fluid came out clear. The patient was discharged and maintained on CAPD When CAPD patients visit hospital due to abdominal pain and dialysate color change (dark brown color or greenish color), physicians should consider bile peritonitis and early treatment.

A Case of Acute Renal Infarction with Protein S Deficiency / 대한신장학회지

Acute renal infarction is an uncommon disease that is often misdiagnosed initially because of its nonspecific presentation. Cardiovascular disease is the major cause of thromboembolic event, but renal infarction can also occur in patient with special conditions such as hypercoagulable states. Protein S deficiency is a rare cause of the hypercoagulable states and induces both venous and arterial thrombosis. Protein S are a vitamin K dependent plasma protein that serves as a cofactor for the anticoagulant effects of activated protein C. Patients deficient in protein S is prone to recurrent thromboembolic disease. We reported a case of acute renal infarction that was associated with type II protein S deficiency in a 38-year old patient without underlying cardiovascular disease.

A Case of Myelodysplastic Syndrome in a Renal Transplant Recipient / 대한신장학회잡지

A 44-year-old man treated with azathioprine, cyclosporine and prednisolone for 7.5 years after allogeneic renal transplantation was admitted because of exertional dyspnea, fatigue and pancytopenia which were found 3 months ago. He had been on hemodialysis for renal failure of unknown cause for 8 months before the renal transplantation. Bone marrow examination showed hypercellularity, erythroid hyperplasia and 7% of myeloblast, consistent with the diagnosis of myelodysplastic syndrome. Cytogenetic study showed chromosomal abnormalities:deletion of chromosome 5, monosomy 7, trisomy 8, monosomy 14 and deletion of chromosome 17. Immunosuppressive agents were discontinued and he was treated with transfusion, G-CSF, and combination chemotherapy including topotecan and Ara-C. Graft kidney function was normal before and after the treatment, but the clinical course was fatal because of leukemic transformation and eventually sepsis. Although therapy induced myelodysplastic syndrome was rare in renal allograft recipients, thorough evaluations including bone marrow biopsy and cytogenetic study are recommended in patients with anemia of unknown etiology.