Changes in plasma sclerostin level associated with use of a medium cut-off dialyzer in end-stage renal disease

Background@#Larger middle molecules are important substances associated with cardiovascular complications in end- stage renal disease. Unfortunately, larger middle molecules are not reliably removed by a high-flux dialyzer. A medium cut-off (MCO) membrane could effectively remove larger middle molecules. This study aimed to identify the long -term effect of the MCO membrane for changes of larger middle molecules. @*Methods@#Thirty-four patients were prospectively analyzed for 12 months. The enrolled patients were divided into control and MCO groups. We measured the plasma levels of growth differentiation factor 15, sclerostin, and fibroblast growth factor 23 in larger middle molecules and those of biomarkers including small solutes. Single-pool Kt/V (spKt/V) and reduction ratios also were evaluated. @*Results@#Plasma sclerostin did not increase significantly in patients using the MCO dialyzer (135.3 [–637.7 to 908.3], p = 0.715). And there was a significant difference in change of plasma sclerostin level between the two groups (–1,646.9 [–3,015.2 to –278.7], p = 0.033). Furthermore, a negative association between calcium and sclerostin was not observed in the MCO group (r = –0.142, p = 0.587). Solute clearance of larger middle molecules in the MCO group was significantly higher. Moreover, spKt/V values for patients in the MCO group were significantly increased without albumin loss. Values are presented as mean (95% confidence interval [CI]) or adjusted mean (95% CI). @*Conclusion@#The MCO dialyzer can increase dialytic adequacy and suppress the increase in plasma sclerostin level without significant albumin loss in patients with end-stage renal disease.

Changes in plasma sclerostin level associated with use of a medium cut-off dialyzer in end-stage renal disease

Background@#Larger middle molecules are important substances associated with cardiovascular complications in end- stage renal disease. Unfortunately, larger middle molecules are not reliably removed by a high-flux dialyzer. A medium cut-off (MCO) membrane could effectively remove larger middle molecules. This study aimed to identify the long -term effect of the MCO membrane for changes of larger middle molecules. @*Methods@#Thirty-four patients were prospectively analyzed for 12 months. The enrolled patients were divided into control and MCO groups. We measured the plasma levels of growth differentiation factor 15, sclerostin, and fibroblast growth factor 23 in larger middle molecules and those of biomarkers including small solutes. Single-pool Kt/V (spKt/V) and reduction ratios also were evaluated. @*Results@#Plasma sclerostin did not increase significantly in patients using the MCO dialyzer (135.3 [–637.7 to 908.3], p = 0.715). And there was a significant difference in change of plasma sclerostin level between the two groups (–1,646.9 [–3,015.2 to –278.7], p = 0.033). Furthermore, a negative association between calcium and sclerostin was not observed in the MCO group (r = –0.142, p = 0.587). Solute clearance of larger middle molecules in the MCO group was significantly higher. Moreover, spKt/V values for patients in the MCO group were significantly increased without albumin loss. Values are presented as mean (95% confidence interval [CI]) or adjusted mean (95% CI). @*Conclusion@#The MCO dialyzer can increase dialytic adequacy and suppress the increase in plasma sclerostin level without significant albumin loss in patients with end-stage renal disease.

Peritoneal Dialysis Catheter-Related Infection due to Mycobacterium abscessus Confused with Rhodococcus

No abstract available.

Granulomatosis with Polyangiitis Presenting as Cholangitis and Acute Kidney Injury / 전남의대학술지

No abstract available.

Obturator hernia in autosomal dominant polycystic kidney disease

No abstract available.

Human CD36 overexpression in renal tubules accelerates the progression of renal diseases in a mouse model of folic acid-induced acute kidney injury

BACKGROUND: Acute kidney injury (AKI) is a risk factor for progression to chronic kidney disease, with even subclinical AKI episodes progressing to chronic kidney disease. Several risk factors such as preexisting kidney disease, hyperglycemia, and hypertension may aggravate renal disease after AKI. However, mechanisms underlying the progression of AKI are still unclear. This study identified the effect of human cluster of differentiation 36 (CD36) overexpression on the progression of folic acid-induced AKI. METHODS: Pax8–rtTA/tetracycline response element–human CD36 transgenic mice were used to elucidate the effect of human CD36 overexpression in the proximal tubules on folic acid-induced AKI. RESULTS: Results of histological analysis showed severely dilated tubules with casts and albuminuria in folic acid-treated transgenic mice overexpressing human CD36 compared with folic acid-treated wild-type mice. In addition, analysis of mRNA expression showed a significant increase in the collagen 3a1 gene in folic acid-treated transgenic mice overexpressing human CD 36 compared with folic acid-treated wild type mice. CONCLUSION: Human CD36-overexpressing transgenic mice showed severe pathological changes and albuminuria compared with wild-type mice. Moreover, mRNA expression of the collagen 3a1 gene increased in folic acid-treated transgenic mice. These results suggest that human CD36 overexpression is a risk factor of AKI and its progression to chronic kidney disease.

Minimal Change Disease Associated with Ingestion of Poison Sumac / 전남의대학술지

No abstract available.

Renal Involvement in Rheumatic Diseases

Most rheumatic diseases are chronic inflammatory diseases. Kidney-related symptoms of rheumatic diseases are often present, which increase mortality and morbidity of patients with rheumatic diseases. When patients with rheumatic diseases show signs or symptoms of renal involvement, management for primary rheumatic diseases should be more aggressive. In general, the risk and severity of renal involvement in patients with rheumatic diseases depend on the type of primary rheumatic diseases. Rheumatic disease itself, chronic use of immunosuppressive agents and non-steroidal anti-inflammatory drugs, and comorbidities, such as diabetes, hypertension, and cardiovascular complications, are the main causes of renal involvement in patients with rheumatic diseases. Many studies have reported the predominant features of renal involvement in most rheumatic diseases. We have attempted to summarize the relationships between rheumatic diseases and renal diseases, and clinical or pathophysiological features of renal involvement resulting from primary rheumatic diseases except systemic lupus erythematosus. Review for renal involvement, particularly in relation to early diagnosis and management of renal involvement in rheumatic diseases, is clinically significant because renal involvement in rheumatic diseases generally implies a bad prognosis.

Staphylococcal infection-associated crescentic immunoglobulin A nephropathy

No abstract available.

Heart Failure Secondary to Pazopanib for Treatment of Metastatic Renal Cell Carcinoma / 대한내과학회지

A 78-year-old man was diagnosed with renal cell carcinoma, and left nephrectomy was performed. He started pazopanib. One month later, he visited our hospital because of general weakness and dyspnea. His oxygen saturation was low. A chest X-ray showed pulmonary edema and bilateral pleural effusion. An echocardiogram showed a larger left ventricle and lower ejection fraction than observed at the previous examination. The patient discontinued pazopanib and started diuretics and digoxin. His symptoms improved and a follow-up X-ray showed improvement in the pulmonary edema with bilateral pleural effusion.

Spontaneous renal artery dissection in Ehlers-Danlos syndrome / 영남의대학술지

Primary dissection of the renal artery is rare. Spontaneous renal artery dissection can be associated with diseases such as medial degeneration, neurofibromatosis, syphilitic arteritis, tuberculosis, polyarteritis nodosa, Marfan syndrome, fibromuscular dysplasia, or Ehlers-Danlos syndrome (EDS). Among these causes, EDS related renal artery dissection is very rare worldwide and has not been previously reported in Korea. EDS are a group of heritable connective tissue disorders characterized by fragility of the skin and hypermobility of the joints. We describe the case history of a young man who presented with left side flank pain, hypermobility of the hand joints and showed left renal artery dissection on computed tomography and angiography that turned out to be the first complication of vascular type EDS.

Valacyclovir-Induced Neurotoxicity in a Maintenance Hemodialysis Patient

Valacyclovir is an oral antiviral agent used in the treatment of herpesvirus infection. Although neuropsychiatric symptoms may accompany the use of this drug, valacyclovir is increasingly used to treat herpes zoster, as it is more effective when orally administered. This paper reports one case of neurotoxicity of valacyclovir in patients with end stage renal disease who were undergoing maintenance hemodialysis. Valacyclovir can induce life-threatening neurotoxicity, especially in end stage renal disease patients despite the appropriate dose reduction. Furthermore, Valacyclovir-induced neurotoxicity can be effectively managed by intensive hemodialysis.

Effects of Angiotensin-Converting Enzyme Polymorphism on Soluble Receptor for Advanced Glycation End-Products in Maintenance Hemodialysis Patients / 대한내과학회지

BACKGROUND/AIMS: Advanced glycation end-products (AGEs) exert various toxic effects through the receptor for AGEs (RAGE). Soluble RAGE (sRAGE) is a naturally occurring inhibitor of AGE-RAGE. Recent studies have suggested that inhibition of angiotensin-converting enzyme (ACE) reduces the accumulation of AGEs in diabetes partly by increasing the production and secretion of sRAGE into the plasma. This report describes the relationship between sRAGE and ACE polymorphism in maintenance hemodialysis patients. METHODS: The levels of sRAGE and advanced oxidation protein products (AOPPs) were assessed by enzyme-linked immunosorbent assay (ELISA), and ACE polymorphism was detected by PCR amplification. RESULTS: The distributions of ACE genotypes in 105 hemodialysis patients were as follows: II, 56 (35.9%); ID, 29 (18.6%); and DD, 20 (12.8%). According to the ACE genotypes, the study group consisted of II (n = 56) and ID + DD group (n = 49). sRAGE was correlated with age (r = -0.24; p = 0.013). There were significant differences in sRAGE, AOPP, age, duration of dialysis, C-reactive protein, or 24-h urine volume between two genotype groups. There were no significant differences in sRAGE levels, even though the effect of age was treated as a covariate. CONCLUSIONS: Our findings suggested that sRAGE may be affected only by age, and not by ACE polymorphism in maintenance hemodialysis patients.

Effects of Angiotensin-Converting Enzyme Polymorphism on Soluble Receptor for Advanced Glycation End-Products in Maintenance Hemodialysis Patients / 대한내과학회지

BACKGROUND/AIMS: Advanced glycation end-products (AGEs) exert various toxic effects through the receptor for AGEs (RAGE). Soluble RAGE (sRAGE) is a naturally occurring inhibitor of AGE-RAGE. Recent studies have suggested that inhibition of angiotensin-converting enzyme (ACE) reduces the accumulation of AGEs in diabetes partly by increasing the production and secretion of sRAGE into the plasma. This report describes the relationship between sRAGE and ACE polymorphism in maintenance hemodialysis patients. METHODS: The levels of sRAGE and advanced oxidation protein products (AOPPs) were assessed by enzyme-linked immunosorbent assay (ELISA), and ACE polymorphism was detected by PCR amplification. RESULTS: The distributions of ACE genotypes in 105 hemodialysis patients were as follows: II, 56 (35.9%); ID, 29 (18.6%); and DD, 20 (12.8%). According to the ACE genotypes, the study group consisted of II (n = 56) and ID + DD group (n = 49). sRAGE was correlated with age (r = -0.24; p = 0.013). There were significant differences in sRAGE, AOPP, age, duration of dialysis, C-reactive protein, or 24-h urine volume between two genotype groups. There were no significant differences in sRAGE levels, even though the effect of age was treated as a covariate. CONCLUSIONS: Our findings suggested that sRAGE may be affected only by age, and not by ACE polymorphism in maintenance hemodialysis patients.

Cyclophosphamide-induced Posterior Reversible Encephalopathy Syndrome in a Patient with Lupus Nephritis

Posterior reversible encephalopathy syndrome (PRES) is a neurologic condition characterized by vasogenic edema on neuroimaging and is associated with the setting of severe hypertension, eclampsia, autoimmune disease, malignancy, and immunosuppressive drugs. We report on a 42 year-old female systemic lupus erythematous patient who presented altered consciousness, seizure, and visual disturbance after cyclophosphamide pulse therapy. Magnetic resonance imaging (MRI) showed multi-focal high signal intensity lesions in the parieto-occipital cortex bilaterally and in the subcortical white matter. Her condition was improved and her MRI lesions were resolved after aggressive blood pressure control and high-dose steroid treatment. It is possibly the first reported case of PRES in a patient with lupus, treated with cyclophosphamide pulse therapy during a nephritis flare in Korea.

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.

The Factors Influencing Level of Advanced Oxidation Protein Products (AOPP) in Hemodialysis Patients / 대한신장학회지

PURPOSE: Advanced oxidation protein products (AOPP) has long been considered as a useful marker to estimate oxidative stress in the hemodialysis (HD) patients. However, it has not been clarified what clinical factors can affect the plasma level of AOPP in the HD patients. Based on these, We investigated the correlation between plasma AOPP level and clinical factor, known to be associated with oxidative stress, in the maintenance HD patients. METHODS: Two groups (50 of normal healthy persons and 105 of stable HD patients) were independently subjected in this study, and statistical correlation between plasma AOPP level and several clinical factors were analyzed. RESULTS: Plasma level of AOPP in the maintenance HD patients were higher than those in normal healthy group (52.11+/-16.08 micrometerol/L vs. 40.25+/-12.23 micrometerol/L, p<0.001). Plasma AOPP level of maintenance HD patients were significantly correlated with duration of hemodialysis, MDRD-GFR and daily urine volume. However, plasma level of AOPP in the maintenance HD patients were not affected by sex, diabetes, smoking, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and those were not correlated with age, CRP and serum ferritin. It was demonstrated by multiple regression analysis that daily urine volume was the most important clinical factor which could affect the plasma level of AOPP (beta=-0.255, p=0.017). CONCLUSION: These results suggest that maintenance of daily urine volume is likely to be critical to reduce oxidative stress in the maintenance HD patients.

A Case of Chylothorax Associated with Idiopathic Stenosis of Left Subclavian Vein in a Patient Undergoing Maintenance Hemodialysis / 대한신장학회지

Chylothorax is defined as the accumulation of chyle-containing lymphatic fluid within the pleural space. The causes of chylothorax are various and usually attributable to 1 of 4 categories: malignancy, trauma (including surgery), miscellaneous disorders, and idiopathy. Occurrence of chylothorax in patients on hemodialysis is very uncommon and it may have resulted from multiple iatrogenic vascular trauma conducive to venous thrombosis and stenosis when hemodialysis catheters required frequent changes or long term indwelling. Local thrombosis and stenosis may increase the venous hydrostatic pressure and hinder the discharge of thoracic duct lymph into the venous system. Hence, chylous lymphatic fluid leak into the pleural space. Treatment of chylothorax may range from nonoperative management to elective surgery. We report a case of a patient on hemodialysis who developed chylothorax secondary to a subclavian vein stenosis without any other symptoms such as arm edema and successfully treated with nonoperative management.

Clinical Characteristics of Renal Insufficiency Patients with Clostridium difficile-Associated Pseudomembranous Colitis / 대한신장학회지

PURPOSE:Clostridium difficile-associated diarrhea (CDAD) is a potentially life-threatening illness which has been shown to be more common and more severe in patient with chronic renal failure. The aim of this study was to investigate clinical characteristics of renal insufficiency patients with clostridium difficile-associated pseudomembranous colitis. METHODS:We reviewed charts of fifty-six patients with clostridium difficile-associated pseudomembranous colitis, who have clostridial toxin A assay in stool and a diagnosis made on histology of colonic biopsies. RESULTS:There was no difference in age, serum albumin, C-reactive protein (CRP) and negative incidence of clostridial toxin A between patients who had renal insufficiency with serum creatinine more than 1.5 mg/dL and those who did not. But duration of antibiotic use administered prior to development of the clostridium difficile infection was more shorter in patients with impaired renal function than in patients with normal renal function. CONCLUSION:These data suggest that it may take a short period to development of the clostridium difficile infection in patients with impaired renal function, and histologic evaluation by sigmoidoscopy should be performed to make a diagnosis in CDAD-suggested patients, who have impaired renal function and even negative clostridial toxin A.

Cerebral sinovenous thrombosis associated with nephrotic syndrome / 대한내과학회지

Nephrotic syndrome is associated with proteinuria, hypoalbuminemia, edema, hyperlipidemia, and thromboembolic complications. Thromboembolic complications of nephrotic syndrome are common, especially in the renal vein, while cerebral venous thrombosis is a less frequent complication of minimal change nephrotic syndrome. The pathophysiology remains unclear, but various changes in coagulant and anticoagulant factors may be responsible. We report a case of cerebral venous thrombosis associated with nephrotic syndrome. A 19-year-old man was admitted with a headache and nausea. Cerebral thrombosis was diagnosed on brain computed tomography and magnetic resonance imaging. He recovered gradually after treatment with anticoagulants and achieved control of the nephrotic syndrome. A discussion of this case, coupled with a review of the literature, emphasizes that an early diagnosis is essential for anticoagulation therapy and a successful outcome.