ABSTRACT
Arteriovenous graft for hemodialysis vascular access is a widely used technique with many advantages. However, it has crucial complications with graft thrombosis and infection. We recently experienced an unusual case of arteriovenous graft complication involving graft thrombosis related to fistula formation between the graft and the natural vein with infection. We diagnosed this condition using Doppler ultrasound and computed tomography angiography. Successful surgical treatment including partial graft excision and creation of a secondary arteriovenous fistula using an inadvertently dilated cephalic vein was performed. The dialysis unit staff should keep this condition in mind and try to prevent this complication.
Subject(s)
Angiography , Arteriovenous Fistula , Dialysis , Fistula , Renal Dialysis , Thrombosis , Transplants , Ultrasonography , VeinsABSTRACT
BACKGROUND/AIMS: The Oxford classification of immunoglobulin A nephropathy (IgAN) is a pathology-based prognostic classification system. However, further study is needed to determine its validity. We studied the relationships between the Oxford classification and established prognostic factors and renal survival. We also examined associations between electron microscopy findings and these parameters. METHODS: We reviewed and reclassified 213 patients who were diagnosed with IgAN from 1997 to 2007 using the Oxford and World Health Organization (WHO) classification systems. The patients were also categorized by a pathologist using electron microscopy findings, including foot process fusion, glomerular basement membrane thickness, and electron-dense deposits. We examined the correlations between light and electron microscopy data and known prognostic factors (e.g., age, sex, proteinuria, serum creatinine, estimated glomerular filtration rate [eGFR], and blood pressure). The same procedure was applied to renal survival. RESULTS: Patient age increased with the grades of segmental sclerosis (S) and tubular atrophy/interstitial fibrosis (T) (P < 0.05). eGFR decreased significantly with increasing mesangial hypercellularity (M) (p = 0.0034), S (p = 0.0003), endocapillary hypercellularity (E) (p = 0.0411), and T (P < 0.0001). MSET differed significantly by sex (P < 0.0001). The 24-h urine protein/creatinine ratio increased significantly with the degrees of S (p = 0.036), E (p = 0.0155), and T (p = 0.015). The serum creatinine level was significantly higher in patients with T2 than T1 or T0 (P < 0.0001). At the time of biopsy, the degree of tubular atrophy/interstitial fibrosis affected the doubling of serum creatinine or end-stage renal disease. However, the electron microscopy findings did not predict the renal outcome. CONCLUSIONS: Our study suggests that tubular atrophy/interstitial fibrosis is significantly associated with proteinuria and renal progression in IgAN.
Subject(s)
Humans , Biopsy , Classification , Creatinine , Fibrosis , Foot , Glomerular Basement Membrane , Glomerular Filtration Rate , Glomerulonephritis, IGA , Kidney Failure, Chronic , Microscopy, Electron , Pathology , Prognosis , Proteinuria , Sclerosis , World Health OrganizationABSTRACT
Nocardia is an opportunistic pathogen that can cause disseminated disease in serious immunosuppressive patients with organ transplantation, advanced HIV infection, malignancy or long-term corticosteroid use. Cerebral nocardiosis constitutes the most severe form of Nocardial infection. Early detection and treatment of cerebral abscess of Nocardia is important because the mortality is three times higher than that of other bacterial cerebral abscesses. We report a case of N. farcinica brain abscess in a focal segmental glomerulosclerosis (FSGS) patient after steroid treatment.
Subject(s)
Humans , Brain , Brain Abscess , Glomerulosclerosis, Focal Segmental , HIV Infections , Nocardia , Nocardia Infections , Organ Transplantation , Steroids , TransplantsABSTRACT
Rhabdomyolysis varies from transient elevation of muscular enzyme to reduction of circulating volume and development of acute kidney injury (AKI). The majority is related to trauma, excessive exercise, alcohol and seizure disorders. Systemic infections associated with salmonellosis were rarely reported. Most of Salmonella infections are caused by Salmonella Typhi. Most common manifestations are typhoid fever and gastroenteritis. Sometimes serious complications such as gastrointestinal bleeding, intestinal perforation, and encephalopathy occur. However, AKI-associated rhabdomyolysis is rarely reported in salmonellosis even though it is not considered to be a major complication. Unfortunately, the precise pathogenetic mechanisms responsible for rhabdomyolysis with Salmonella Enteritidis infection are poorly understood due to the rarity of reported cases. In this presentation, we describe a patient with Salmonella Enteritidis (serogroup D) bacteremia complicated by disseminated intravascular coagulation, rhabdomyolysis and AKI. The blood culture and stool culture from the patient yielded Salmonella Enteritidis. Rhabdomyolysis and AKI should be considered as potentially fatal complications in patients with Salmonella Enteritidis infection.
Subject(s)
Humans , Acute Kidney Injury , Bacteremia , Disseminated Intravascular Coagulation , Epilepsy , Gastroenteritis , Hemorrhage , Intestinal Perforation , Rhabdomyolysis , Salmonella , Salmonella enteritidis , Salmonella Infections , Salmonella typhi , Typhoid FeverABSTRACT
OBJECTIVES: Exercise and physical activity may increase bone mineral density (BMD), especially in premenopausal women. However, previous studies have concentrated on postmenopausal women. This study was conducted to evaluate the independent associations of exercise and physical activity with BMD in premenopauseal women. MATERIAL & METHODS: One hundred premenopausal women were recruited from outpatient clinics and a health promotion center in a university hospital located in Seoul. We measured the BMD of lumbar spine and hip using dual energy X-ray absoptiometry. Data on sociodemographic characteristics and exercise status were obtained from self-reported questionnaires. The Stanford questionnaire was used to assess physical activity. RESULTS: Age and body mass index-adjusted ANCOVA revealed that the mean BMD at the spine and hip was not significantly associated with exercise time. The mean BMD at the spine was significantly higher in women who exercised regularly > or =3 a week than in women who exercised or =3 times every week had significantly higher spine BMDs. The increase in physical activity was significantly associated with higher BMD at the spine and femur neck.
Subject(s)
Female , Humans , Ambulatory Care Facilities , Bone Density , Femur Neck , Health Promotion , Hip , Motor Activity , Premenopause , Surveys and Questionnaires , SpineABSTRACT
Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal disorder of the hematopoietic stem cells characterized by chronic intravascular hemolysis, venous thrombosis, deficient hematopoiesis. Kidney involvement is usually benign and secondary to chronic deposition of hemosiderin. However, acute kidney injury may rarely occur in association with a hemolytic crisis or thrombotic complication. Hemolytic crisis is precipitated by nonspecific factors, such as infection, surgery and transfusion. A 35-year-old woman, who developed hemolytic crisis and acute kidney injury was admitted to our hospital presenting with acute gastroenteritis. After being treated by hemodialysis and oral low dose steroid, she was discharged with recovered renal function. Renal biopsy demonstrated acute tubular necrosis with considerable hemosiderin deposition without evidence of vascular thrombosis. A review of Korean cases showed that most of the cases featured severe renal dysfunction to such an extent to require a hemodialysis although there were no definite etiologies other than the deposition of blood iron due to massive hemolysis unlike the foreign cases. It also showed that the disease duration was longer. It can therefore be inferred that the early diagnosis and active treatment will be mandatory for the treatment of Korean patients with PNH. We reported a case of PNH with acute kidney injury and hemolytic crisis and documented by renal biopsy with review of Korean literature.
Subject(s)
Adult , Female , Humans , Acute Kidney Injury , Biopsy , Early Diagnosis , Gastroenteritis , Hematopoiesis , Hematopoietic Stem Cells , Hemoglobinuria, Paroxysmal , Hemolysis , Hemosiderin , Iron , Kidney , Korea , Necrosis , Renal Dialysis , Thrombosis , Venous ThrombosisABSTRACT
IgA nephropathy is usually localized to the kidney, however, it can accompany systemic disease, including gastrointestinal disease, skin disease, connective tissue disease, and malignant tumor. In some patients with IgA nephropathy which manifested as an extraintestinal symptom of Crohn's disease, recovery of renal function was achieved following treatment of Crohn's disease. The pathophysiology of each disease remains unclear. According to some studies, however, immunological, genetic, and environmental factors may be involved in a complex manner. In patients receiving renal replacement therapy for treatment of renal dysfunction due to IgA nephropathy, occurrence of Crohn's disease as an extrarenal symptom has not been reported. We experienced a case of Crohn's disease which developed in a patient receiving hemodialysis for treatment of end-stage renal disease due to IgA nephropathy.