Estimating the urinary sodium excretion in patients with chronic kidney disease is not useful in monitoring the effects of a low-salt diet

BACKGROUND: Several epidemiologic studies have suggested that the urine sodium excretion (USE) can be estimated in lieu of performing 24-hour urine collection. However, this method has not been verified in patients with chronic kidney disease (CKD) or in an interventional study. The purpose of this study was to evaluate the usefulness of estimating USE in a prospective low-salt diet education cohort (ESPECIAL). METHODS: A new formula was developed on the basis of morning fasting urine samples from 228 CKD patients in the ESPECIAL cohort. This formula was compared to the previous four formulas in the prediction of 24-hour USE after treatment with olmesartan and low-salt diet education. RESULTS: Most previously reported formulas had low predictability of the measured USE based on the ESPECIAL cohort. Only the Tanaka formula showed a small but significant bias (9.8 mEq/day, P < 0.05) with a low correlation (r = 0.34). In contrast, a new formula showed improved bias (−0.1 mEq/day) and correlation (r = 0.569) at baseline. This formula demonstrated no significant bias (−1.2 mEq/day) with the same correlation (r = 0.571) after 8 weeks of treatment with olmesartan. Intensive low-salt diet education elicited a significant decrease in the measured USE. However, none of the formulas predicted this change in the measured urine sodium after diet adjustment. CONCLUSION: We developed a more reliable formula for estimating the USE in CKD patients. Although estimating USE is applicable in an interventional study, it may be unsuitable for estimating the change of individual sodium intake in a low-salt intervention study.

Plasma endocan level and prognosis of immunoglobulin A nephropathy

BACKGROUND: Endocan, previously called endothelial cell–specific molecule-1, is a soluble proteoglycan that is secreted from vascular endothelial cells. Elevated plasma endocan levels were shown to be associated with poor cardiovascular outcomes in patients with chronic kidney disease (CKD). We investigated the clinical relevance of plasma and urine endocan levels in patients with immunoglobulin A nephropathy (IgAN). METHODS: Sixty-four patients with IgAN and 20 healthy controls were enrolled in this study. Plasma and urine endocan levels were measured. Clinical parameters, pathologic grades, and renal outcomes were compared among subgroups with different plasma and urine endocan levels. RESULTS: Both plasma and urine endocan levels were significantly higher in patients with IgAN than in controls. Elevated serum phosphorus and C-reactive protein were independent determinants for plasma endocan, and elevated C-reactive protein was also an independent determinant for urine endocan levels in multivariate analysis. Plasma endocan level was not significantly different across CKD stages, but patients with higher plasma endocan levels showed adverse renal outcome. Urine endocan levels were also elevated in patients with poor renal function. Cox proportional hazard models showed that high plasma endocan was an independent risk factor for CKD progression after adjusting for the well-known predictors of outcome in patients with IgAN. CONCLUSION: This study suggested that plasma endocan might be useful as a prognostic factor in patients with IgAN.

A case of Ramsay Hunt syndrome diagnosed after kidney transplantation

We report the first case of Ramsay Hunt syndrome (RHS) diagnosed after kidney transplantation in Korea. RHS is a disease caused by latent varicella-zoster characterized to involve geniculate ganglion of the seventh cranial nerve. Patients who have undergone kidney transplantation can be easily affected by viral infections because of their immune-compromised status. A 35-year-old man with hypertensive end-stage renal disease underwent kidney transplantation. Two months after surgery, the recipient was diagnosed with RHS and treated with antivirals and steroids. However, after using the antiviral agents for the recommended duration, facial paralysis occurred as a new presentation and he required further treatment. Otalgia and periauricular vesicles improved, but the facial palsy remained.

Transforming growth factor-beta receptor 2 gene polymorphisms are associated with end-stage renal disease

BACKGROUND: Transforming growth factor-beta (TGF-beta) is a multifunctional cytokine involved in immune disorders, cancer, asthma, lung fibrosis, and chronic kidney disease, and its signal pathways are considered crucial mediators of a variety of cellular processes. In addition, several recent studies have reported that TGF-beta receptor (TGF-betaR) gene polymorphism is associated with chronic kidney disease. However, the association between end-stage renal disease (ESRD) and the TGF-beta gene polymorphism has not been sufficiently investigated. In this study, we hypothesized that polymorphisms of the TGF-beta ligands or their receptors may be related to ESRD. METHODS: We assessed the relationship between four single-nucleotide polymorphisms (SNPs) in the TGF-betaR2 and TGF-beta2 genes and ESRD, in 312 patients with ESRD and 258 controls. RESULTS: Compared with the control participants, the frequencies of the TGF-betaR2 (rs764522*C) and TGF-betaR2 (rs3087465*G) alleles were significantly higher in the patients with ESRD. Genotyping analysis demonstrated that two SNPs in TGF-betaR2 of the four SNPs included in the study were significantly associated with ESRD in the codominant 1 [rs764522, odds ratio (OR)=1.65; rs3087465, OR=1.63], dominant (rs764522, OR=1.63; rs3087465, OR=1.57), and log-additive (rs764522, OR=1.54; rs3087465, OR=1.39) models after adjusting for age and sex. CONCLUSION: We suggest that TGF-betaR2 polymorphisms (rs764522 and rs3087465) increase the risk of development of ESRD.

Terrible Stent Thrombosis Induced by a Treadmill Test Performed Three Days after Percutaneous Coronary Intervention / 전남의대학술지

Generally, early exercise after coronary stenting is considered safe, but isolated cases of acute stent thrombosis have been associated with the performance of a treadmill exercise test after percutaneous coronary intervention (PCI). The treadmill exercise test is often used to noninvasively assess the functional result of PCI. In this report, we describe a case of terrible stent thrombosis related to an exercise test performed 3 days after stenting, and the patient died as the result of an intractable thrombus.

Terrible Stent Thrombosis Induced by a Treadmill Test Performed Three Days after Percutaneous Coronary Intervention / 전남의대학술지

Generally, early exercise after coronary stenting is considered safe, but isolated cases of acute stent thrombosis have been associated with the performance of a treadmill exercise test after percutaneous coronary intervention (PCI). The treadmill exercise test is often used to noninvasively assess the functional result of PCI. In this report, we describe a case of terrible stent thrombosis related to an exercise test performed 3 days after stenting, and the patient died as the result of an intractable thrombus.

Clinical Characteristics of Elderly Patients Undergoing Coronary Angiography for Chest Pain

BACKGROUND: Elderly persons are rapidly increasing in Korea. Atherosclerotic cardiovascular disease is the leading cause of morbidity and mortality in this age group. In this research, we evaluated the clinical characteristics of the elderly patients presenting chest pain. METHODS: A total of 471 patients who visited cardiovascular center of Kyung Hee University Hospital at Gangdong for chest pain were reviewed and divided by three groups, via age; under 40, from 40 to 69 and over 70 years old. RESULTS: The number of patients over 70 years was 142 (30.1%). The proportion of patients diagnosed as having significant, multivessel coronary diseases was higher than that of younger patients (p=0.0002). The rate of atypical chest discomfort presenting as a cardiac symptom was not higher than in the middle-aged group (4.8% vs. 2.1%, p=0.255). CONCLUSION: In elderly patients, the proportion of female patients and significant multivessel diseases were more common than younger patients.

Endoscopic Treatment of Benign Hypopharyngeal Tumors / 대한소화기내시경학회지

During endoscopy, most endoscopists insert endoscopes into the esophagus without visual aid in order to minimize the discomfort to patients. However, studies have shown that visual guided insertion imposes little discomfort, is safe and can increase the diagnostic rate of abnormal pathology of the throat. As for the treatment of hypopharyngeal lesions, cases of endoscopic treatment are rare and any guidelines have not been clearly defined yet. However, endoscopic treatment may be feasible in selected cases. Several procedures, such as endoscopic mucosal resection with cap (EMR-C) and saline injection polypectomy can be applied. We experienced seven patients who had benign hypopharyngeal masses that were removed endoscopically without serious complications. Compared to surgical treatment, endoscopic removal of the benign hypopharyngeal tumors does not require general anesthesia; it is simple, less invasive and less costly. Therefore, endoscopy should be regarded as a treatment option. However, further studies are required before widespread application of endoscopic removal for the definitive treatment of hypopharyngeal masses, including malignancies.