ABSTRACT
We report one case of renal PV infection after renal allograft transplantation leading to graft dysfunction. According to prior reports, PV induced interstitial nephritis might be a cause of graft loss. Pathologic findings show varying degrees of interstitial infiltration and tubular degenerative changes, which resemble acute cellular rejection. Therapeutic strategies have not yet been developed. Case ; A 23 years old male underwent renal transplantation from his HLA haploidentical 25 year old sister. His renal function had been good with cyclosporin, steroid and azathioprine until 9 months after transplantation, when his serum creatinine level rose to 2.2mg/dl. The renal biopsy revealed diffuse lymphocyte infiltration in the interstitium and feature of the tubulitis. Also, giant tubular epithelial cells with large, hyperchromic nuclei were present. Despite steroid pulsing and OKT3, renal function progressively de- teriorated. After 10 days of OKT3 therapy, the patient suffered from high fever, dyspnea and general aches. A chest X-ray revealed interstitial infiltration in both lung fields and the cytomegalovirus PCR (polymerase chain reaction) test of serum and blood was positive. Intravenous ganciclorvir was administered and immunosuppressants were tapered. 4 months after admission, he lost his graft function and underwent hemodialysis. The aforementioned renal biopsy was retested immunohistochemically. Nuclear inclusions in renal tubular epithelial cells were shown and these inclusions were reacted positively with PV monoclonal antibodies.
Subject(s)
Adult , Humans , Male , Young Adult , Allografts , Antibodies, Monoclonal , Azathioprine , Biopsy , Creatinine , Cyclosporine , Cytomegalovirus , Dyspnea , Epithelial Cells , Fever , Immunosuppressive Agents , Intranuclear Inclusion Bodies , Kidney Transplantation , Lung , Lymphocytes , Muromonab-CD3 , Nephritis, Interstitial , Polymerase Chain Reaction , Renal Dialysis , Siblings , Thorax , TransplantsABSTRACT
Renal transplantation is the optimal treatment for end stage renal disease and it has been improved through the development of operative methods and immunosuppressants. However some patients must receive dialysis or undergo retransplantation after a loss of the primary graft due to rejection or other causes. Recently the frequency of retransplantation has begun to increase gradually. Some articles have reported that retransplantation results do not significantly differ in comparison with initial transplantation results when living related donor kidneys are used. Our study focused on the outcome of 445 first transplantation and 12 retransplantation cases. The sex distribution of retransplanted patients was 11 male and 1 female. The mean age (yrs) for recipients was 32.3 at the first transplantation and 39.1 at the retransplantation. The underlying causes of end stage renal disease were presumed to be chronic glomerulonephritis in all retransplantion patients; the mean duration of graft survival (mo) for first transplantation was 77.92. The causes of previous graft failure were as follows: 10 due to chronic rejection, 1 due to recurrent glomerulonephritis, 1 resulted from a graft rupture due to a motorcar accident. The interval (mo) between graft failure and retransplantation averaged 6.7 and 9 out of 12 patients underwent regrafting within 1 year of their previous graft loss. Recipient-donor relationships in first transplantations were as follows: 9 were living related and 3 were living non-related. Recipient-donor relationships in second transplantations were as follows: 4 were living related and 8 were living non-related. Acute rejection within 1 month of transplantation occurred in 4 primary transplantation patients and 2 retransplantation patients. The incidence of acute rejection within 1 month was as follows: 23% of 445 first renal transplantation patients, 16.7% of 12 second transplantation patients. The 1 year and 2 year graft survival rate was 100% and the mean survival duration (mo) was 33 for retransp
Subject(s)
Female , Humans , Male , Dialysis , Glomerulonephritis , Graft Survival , Immunosuppressive Agents , Incidence , Kidney Failure, Chronic , Kidney Transplantation , Kidney , Rupture , Sex Distribution , Tissue Donors , TransplantsABSTRACT
Increasingly aggressive chemotherapy regimens, advances in transplantation technology, and the acquired immunodeficiency syndrome have resulted in a growing number of immunocompromised patients. Infections are a major cause of morbidity and mortality in this population. One of the most ominous complications is the development of typhlitis in this immunocompromised patients. Treatment of this process is controversial, and no consensus has emerged. We report a case of typhlitis who complicated agranulocytosis after exposure to drugs to treat "flu" like illness and recovered completely after two operations of appendectomy and ileocolectomy. Reviewing articles and this case, the favorable outcome seemed to be related to following three factors recognition of the acute surgical abdomen by abdominal CT scan, a prompt return of normal circulating white cells by the use of Granulocyte Colony Stimulating Factor and discontinuation of causative drugs, and an appropriately timed surgical intervention.
Subject(s)
Abdomen , Acquired Immunodeficiency Syndrome , Agranulocytosis , Appendectomy , Colony-Stimulating Factors , Consensus , Drug Therapy , Granulocytes , Immunocompromised Host , Mortality , Tomography, X-Ray Computed , TyphlitisABSTRACT
OBJECTIVES: Protein-calorie malnutrition has been shown to be prevalent among patients on chronic dialysis, And assessment of nutritional status of continuous ambulatory peritoneal dialysis(CAPD) patients has assumed greater importance because of the association of protein-calorie malnutrition with increasing morbidity and mortality. So we observed the incidence and clinical effect of protein-calorie malnutrition, and we compared the indices of nutrition with dialysis adequacy utilizing urea kinetic modeling and cretinine clearance in CAPD patients. METHODS: We performed a cross-sectional study in which eight parameters, based on anthropometry, blood chemistry and subjective symptoms, were scored according to the degree of abnormalities in 82CAPD patients. A malnutrition index was derived from these scores. We also performed comparative analysis to identify significant correlations of the indices of urea kinetic modeling and creatinine clearance with the other parameters of nutritional status. RESULTS: The malnutrition index classified 47(57%) patients as normal, 30(37%) intermediately malnourished, and 5(6%) as severely malnourished. Malnutrition index showed a significant correlation with the body mass index(BMI), triceps skinfold thickness(TSF), mid-arm circumference(MAC), mid-arm muscle area (MAMA), duration of CAPD, subjective symptoms, serum albumin, transferrin, cholesterol, and triglyceride. The malnutrition index also showed a significant correlation with residual renal function(RRF), and standardized creatinine clearance(SCCr). The TWR-Kt/V(total Kt/Vurea per week with consideration of residual renal urea clearance) was significantly lower in the severely malnourished group than in the normal group. Serum alkaline phosphatase and BUN levels were higher in the severely malnourished group than in the normal and inter-mediate groups. CONCLUSION: In assessing the nutrition status of CAPD patients, body weight, TSF, MAC, MAMA, subjective symptoms, serum albumin, transferrin, cholesterol, triglyceride, urea nitrogen, and alkaline phosphatase were considered useful parameters. There was a trend of increased BUN and decreased TWR-Kt/V in severely malnourished patients, and the value of SCCr was significantly lower in malnourished patients. However, no meaningful relationships between TW-Kt/V and malnutrition index or between NPCR(normalized protein catabolic rate) and malnutrition index were found m this cross-sectional study. As the number of patients with longer duration of CAPD or negligible RRF has increased in the malnourished patients, regular monitoring of these parameters, especially TWR-Kt/V and SCCr, may be helpful to assess dialysis adequacy to keep good nutritional status of each CAPD patient.
Subject(s)
Humans , Alkaline Phosphatase , Anthropometry , Body Weight , Chemistry , Cholesterol , Creatinine , Cross-Sectional Studies , Dialysis , Incidence , Malnutrition , Mortality , Nitrogen , Nutritional Status , Peritoneal Dialysis, Continuous Ambulatory , Protein-Energy Malnutrition , Serum Albumin , Transferrin , Triglycerides , UreaABSTRACT
No abstract available.
Subject(s)
Kidney Transplantation , Urinary Tract Infections , Urinary TractABSTRACT
No abstract available.
Subject(s)
Humans , Hepatitis B Vaccines , Hepatitis B , Hepatitis , Histocompatibility Antigens , Histocompatibility , Kidney Failure, Chronic , Kidney , Survival Rate , TransplantsABSTRACT
No abstract available.
Subject(s)
Humans , Anemia , Peritoneal Dialysis, Continuous Ambulatory , Renal DialysisABSTRACT
Arotinolol, a new alpha and beta receptor antagonist, was administered in 27 essential hypertensive patients for 8 weeks in order to evaluate the antihypertensive effect and side effects. The dose were 10mg to 15mg given twice a day. The results are as follows : 1) Before medication, systolic and diastolic blood pressure in sitting, supine and erect position were 173.1+/-3.2/105.8+/-1.8, 171.1+/-3.6/86.7+/-2.0 and 169.3+/-2.6/97.2+/-2.1mmHg. 2) After 8 weeks treatment moderated to marked antihypertensive effect was observed in 74.0%(in systolic blood pressure) and 81.4%(in diastolic blood pressure) respectively in sitting position. 3) There was a significant reduction of pulse rate from 73.0+/-2.5 beats per minute on the beginning of the treatment to 63.4+/-5.2 beats per minute after 8 weeks of medication. 4) There was no significant change in hematocrit, WBC, serum lipid, GOT, GPT, BUN and creatinine. But fasting blood sugar was reduced from 95.3mg% to 81.5mg% with treatment. 5) The side effects of arotinolol were gastrointestinal symptoms(15%), fatigue(11%), dizziness(7%) and insomnia(3%). But these side effects were not severe enough to discontinue medication. In summary, arotinolol seemed to be an effective antihypertensive drug in treating mild to moderate hypertension without significant side effects.
Subject(s)
Humans , Blood Glucose , Blood Pressure , Creatinine , Fasting , Heart Rate , Hematocrit , HypertensionABSTRACT
In 22 end-stage renal disease patients on regular hemodialysis, echocardiographic study including 2-D Doppler echocardiogrphy was performed to evaluate the effect of hemodialysis on cardiac performance and the degree of valvular regurgitation. After hemodialysis, there were significant improvement of ventricular contractility and reduction of circulating volume in accordance with the reduction of degree of valvular regurgitation in comparison with before hemodialysis. We postulate that the reduction of valvular regurgitation after hemodialysis is caused by relief of hypervolemic state.
Subject(s)
Humans , Echocardiography , Echocardiography, Doppler , Kidney Failure, Chronic , Renal DialysisABSTRACT
To investigate long term effects of CAPD on the left ventricular function in end-stage renal disease patients, M-mode echocardiographic studies and measurement o fsystolic time intervals were performed in 20 CAPD cases, 28 hemodialysis cases and 29 uremic controls. Compared to the uremic control grup, the patients on CAPD treatment revealed significant improvement of ventricular contractility and reduction of volume. On the other hand in hemodialysis group, even though there was improvement of ventricular contractility, volume control was not adequate. In the systolic time interval measurement, it is postulated that increase of PEP/LVET ratio in CAPD group probably results from reduction of volume(preload) rather than from deranged ventricular function.
Subject(s)
Humans , Echocardiography , Hand , Kidney Failure, Chronic , Peritoneal Dialysis, Continuous Ambulatory , Renal Dialysis , Systole , Ventricular Function , Ventricular Function, LeftABSTRACT
Respiratory effects of acute coronary embolism were studied in mongrel dogs. Coronary embolism was produced by Agress's method and respirtory effects were observed for two hours. In the experimental group, in which coronary embolism was produced, there were relative decreases in respiratory rate and arterial oxygen saturation along with relative increases in tidal volume, minute ventilation, ventilation equivalent and arteriovenous oxygen difference compared to those in the control group. However, differences in these various measurements between tow groups, those in tidal volume and arterial oxygen saturation, have greatly diminished in two hours. These facts suggest that changes in respiratory rate, minute ventilation, ventilation equivalent and arteriovenous oxygen difference in the experimental group are early but short-lasting responses to acute coronary embolism, whereas changes in tidal volume and arterial oxygen saturation occur early and last longer.
Subject(s)
Animals , Dogs , Embolism , Oxygen , Respiratory Rate , Tidal Volume , VentilationABSTRACT
Renal blood flow was measured by single injection technique of HippuranI13 in 13 patients with chronic glomerulonephritis and 11 control subjects. There was a significant decrease in renal blood flow in chronic glomerulonephritis particulary in those with elevated blood urea nitrogen. Renal blood flow was inversely proportionate to renal vascular resistance but no correlation was noted between renal blood flow and creatinine clearance.
Subject(s)
Humans , Blood Urea Nitrogen , Creatinine , Glomerulonephritis , Renal Circulation , Vascular ResistanceABSTRACT
A clinical study was made on 14 cases of coronary sinus rhythm and 17 cases of left atrial rhythm seen at the Kyungpook University Hospital during the past 13 years. The incidence of coronary sinus rhythm among 23, 137 electrocardiograms was 0.07% and that of left atrial rhythm was 0.08%. Among the various types of left atrial rhythm as diagnosed by Mirowski's criteria, type III, posterior type and inferior type were far more common than others. The most common underlying diseases were heart diseases in both coronary sinus rhythm and left atrial rhythm: five cases out of 14 in the former and 11 cases out of 17 in the latter were cardiac cases, respectively.