A Case of Perforated Acute Cholecystitis in CAPD Patient who Returned to CAPD after Laparoscopic Cholecystectomy / 대한신장학회지

We experienced a 59 year-old female diabetic CAPD patient with severe peritonitis due to perforated acute cholecystitis. Because of heart failure due to old myocardial infarction and cerebral infarction she had been treated with CAPD for 5 years in bed-ridden state. Initial presentation was dark brown colored peritoneal dialysate effluent (changed greenish bile color later) and septic shock. We diagnosed perforated acute cholecystitis by computerized tomography three days after improvement of sepsis. She was received laparoscopic cholecystectomy and continuous venovenous hemodiafiltration for two weeks and returned to peritoneal dialysis without complication. Secondary CAPD peritonitis with cholecystitis or bowel disease should be carefully considered in patients with specific dialysate color, which could be cured with laparoscopic surgery, and then patients can be returned to CAPD again without complication.

A Case of Congenital Nephrogenic Diabetes Insipidus with Bilateral Hydronephrosis and Hydroureter / 대한신장학회잡지

We describe a case of congenital nephrogenic diabetes insipidus with severe dilatation of bilateral urinary tracts without anatomical obstructions. Functional obstruction can be occurred when polyuria surpasses the transporting ability of urine in the urinary tract. The patient was admitted to our hospital due to decreased mentality developed after traffic accident. On radiologic study, bilateral hydronephrosis and hydroureter were noted. Because the patient excreted copious dilute urine, we performed water deprivation test and the result was consistent with nephrogenic diabetes insipidus. We are presenting this case in an attempt to describe strong association between congenital diabetes insipidus and nonobstructive hydronephrosis in which polyuria is responsible for the hydronephrosis.

Prevalence and Correlating Factors of Secondary Hyperparathyroidism in Hemodialysis Patients / 대한내과학회지

OBJECTIVES: Renal osteodystrophy has been recognized as one of the major complications in long-term hemodialysis patients. Bone histomorphology is the definite method for diagnosis but plasma intact PTH level has predictive value for diagnosis of renal osteodystrophy. We performed this study to evaluate the prevalence and correlating factors of secondary hyperparathyroidism in ESRD patients. METHODS: we analyzed the intact PTH level (normal value: 12-72 pg/ml) and clinical parameters in 309 maintance hemodialysis patients retrospectively. RESULTS: The causes of ESRD were chronic glomerulonephritis (32%) diabetic nephropathy (25%) and hypertensive nephropathy (13%). In hemodialysis patients, the mean duration were 48+/-43 months, the serum phosphorus levels were 5.0+/-1.8 mg/dl, and the serum albumin levels were 3.9+/-0.6 gm/dl. The intact PTH levels were 175+/-266 pg/ml. The incidence of hypercalcemia (>10.5 mg/dl) in patients was 4.6% and the incidence of hypocalcemia (<8.5mg/dl) was 26.4%. Twenty-five percent of the patients had iPTH level more than three times normal. Another 42% had a less than normal iPTH level. In multiple regression, serum calcium (r=-0.24), age (r=-0.17) and duration of dialysis (r=0.15) correlated significantly with iPTH level. The iPTH levels between diabetic (82+/-139 pg/ml) and nondiabetic (229+/-320 pg/dl) patients were significantly different (P<0.01). But there are no significant correlation between sugar control and iPTH level. CONCLUSION: We conclude that the iPTH levels were significantly correlated with the age, durations of hemodialysis and the serum calcium levels. Level of intact iPTH in diabetic group were significantly lower than nondiabetes in hemodialysis.