Hematúria macroscópica em equinos associada à infecção por Leptospira interrogans / Macroscopic haematuria in horses associated with Leptospira interrogans infection

Hematúria é uma grave manifestação clínica de doença do sistema urinário, ocorrendo sob as formas micro ou macroscópica. Neste artigo relatam-se dois casos de hematúria macroscópica associada à infecção por Leptospira interrogans sorogrupo Canicola. O exame clínico inicial revelou hematúria macroscópica, taquicardia, taquipneia, febre, elevação do tempo de perfusão capilar, hipomotilidade intestinal, além de icterícia da mucosa oral. Leucocitose, proteinúria, glicosúria, piúria e azotemia foram achados comuns aos dois casos. Teste de Soroaglutinação Microscópica foi realizado para titulação de anticorpos contra Leptospira interrogans. Tratamento incluiu medidas terapêuticas de suporte (fluidoterapia), controle da hematúria e antibioticoterapia. Sete dias após manifestação dos sinais clínicos iniciais, ambos animais receberam alta hospitalar após remissão dos sinais clínicos.

Haematuria is a serious clinical manifestation of urinary system disease, occurring in micro or macroscopic forms. In this article two cases of macroscopic haematuria associated with Leptospira interrogans serogroup Canicolainfection are related. The initial clinical examination revealed macroscopic haematuria, tachycardia, tachypnea, fever, increased capillary perfusion time, intestinal hypomotility, in addition to jaundice of the oral mucosa. Leukocytosis, proteinuria, glycosuria, pyuria and azotemia were common findings in both cases. Microscopic serum agglutination test was performed for titration of antibodies against Leptospira interrogans. Treatment included supportive therapeutic measures (fluid therapy), hematuria control and antibiotic therapy. Seven days after the manifestation of the initial clinical signs, both animals were discharged from the hospital without complications.

Hematúria macroscópica em equinos associada à infecção por Leptospira interrogans / Macroscopic haematuria in horses associated with Leptospira interrogans infection

Hematúria é uma grave manifestação clínica de doença do sistema urinário, ocorrendo sob as formas micro ou macroscópica. Neste artigo relatam-se dois casos de hematúria macroscópica associada à infecção por Leptospira interrogans sorogrupo Canicola. O exame clínico inicial revelou hematúria macroscópica, taquicardia, taquipneia, febre, elevação do tempo de perfusão capilar, hipomotilidade intestinal, além de icterícia da mucosa oral. Leucocitose, proteinúria, glicosúria, piúria e azotemia foram achados comuns aos dois casos. Teste de Soroaglutinação Microscópica foi realizado para titulação de anticorpos contra Leptospira interrogans. Tratamento incluiu medidas terapêuticas de suporte (fluidoterapia), controle da hematúria e antibioticoterapia. Sete dias após manifestação dos sinais clínicos iniciais, ambos animais receberam alta hospitalar após remissão dos sinais clínicos.

Haematuria is a serious clinical manifestation of urinary system disease, occurring in micro or macroscopic forms. In this article two cases of macroscopic haematuria associated with Leptospira interrogans serogroup Canicolainfection are related. The initial clinical examination revealed macroscopic haematuria, tachycardia, tachypnea, fever, increased capillary perfusion time, intestinal hypomotility, in addition to jaundice of the oral mucosa. Leukocytosis, proteinuria, glycosuria, pyuria and azotemia were common findings in both cases. Microscopic serum agglutination test was performed for titration of antibodies against Leptospira interrogans. Treatment included supportive therapeutic measures (fluid therapy), hematuria control and antibiotic therapy. Seven days after the manifestation of the initial clinical signs, both animals were discharged from the hospital without complications.

Analysis of Reported Critical Values and Their Associated Clinical Conditions in a Clinical Chemistry Laboratory of a Tertiary Health Institution in Nigeria

Studies involving critical values in recent time have mainly dwelt on compliance to timely reporting as well as the volumes of the individual reported critical analytes. There is paucity of data however, especially in this environment, on the relationships that exist between reported critical biochemical analytes and the presenting clinical conditions of the patients as at the time of the laboratory investigation. This study therefore sought to investigate such relationships.This study is a retrospective study of data obtained in the year 2018 from the critical value register of the Department of Chemical Pathology, Babcock University Teaching Hospital Ilisan-Remo, Ogun state, Nigeria. Data obtained was analyzed using Statistical Package for Social Sciences (SPSS) version 21.0. Level of statistical significance was set at p < 0.05. Relationship between variables was determined using Chi-square Test.Original ResearchArticleIn the year under review, a total of 270 critical values from various biochemical analytes were obtained; out of which 34.0% waspotassium, representing the highest occurrence. Calcium had the highest proportion of its tests from the year having critical outcomes (2.2%) compared to other biochemical parameters. Kidney disease was the most frequently reported clinical condition (25.1%) with critical values of biochemical analytes. This study also showed a strong statistical association (p = 0.000) between diabetic ketoacidosis and critical levels of hyperkalemia, critical outcomes of hypocalcaemia and infection/sepsis as well as critical level of azotemia and pregnancy related complications.This study has shown potassium as the most reported critical biochemical analyte which occurred mostly as cases of critical hyperkalemia. This was associated with a high burden of kidney diseases among the study population. The study has also drawn attention to the need for immediate and constant check of blood calcium and urea levels in patients that have sepsis and pregnancy related complications respectively.

A Study On Incidence Of Cystic Kidney Disease In Patients On Maintenance Hemodialysis

INTRODUCTION: Cystic kidney disease is a unilateral or bilateral cystic disease characterized by small cysts distributed throughout the renal cortex and medulla of patients with ESRD unrelated to inherited renal cystic diseases. ACKD is a disease of chronic renal failure of any etiology and has to be differentiated from other types of cystic kidney disease. It is defined as more than three macroscopic cysts in each kidney of a patient who does not have a hereditary cause of cystic disease. It can be present at early stages of CKD or more commonly in patients on dialysis & to a lesser extent in native kidneys of renal transplant recipients. Most of them are asymptomatic but rarely complications like infection, rupture, bleeding, spontaneous perinephric hematoma may occur There is increased incidence of renal neoplasms in acquired cystic kidney disease that some authors consider ACKD pre-neoplastic. 1 Its prevalence and severity are higher in men than in women and increases with the duration of azotemia and duration of dialysis as well. With better health care facilities and penetration of nephrology services, the life span of patients on dialysis is increasing. The easy availability & application of imaging services to the above group has led to more frequent diagnosis of acquired cystic kidney disease. AIMS:To study the prevalence of kidney cysts in patients on maintenance hemodialysis. OBJECTIVES: Ÿ To study correlation between duration of dialysis and cystic changes and complications arising out it. Ÿ To study the impact of age and gender on cystic changes. METHODS:The study was done in Maintenance hemodialysis unit of Gandhi Hospital, secunderabad. 140 patients were enrolled over a period of one year from May,2016 to April,2017. Patients who had past history of polycystic kidney disease and had acquired kidney disease on sonography prior to dialysis were excluded. Radiological imaging was done using Computerized tomography KUB to look for acquired renal cysts. Cystic changes were considered as presence of one or more cysts in either or both the kidneys. STUDYDESIGN: prospective cross-sectional observational study. STATISTICALMETHODS: Data analysed using the Statistical Package for Social Science (SPSS) software version 19. ANOVAtest is applied for comparison variables. APvalue of < 0.05 is taken as significant. RESULTS: 22.8% of the incident MHD cohort were found to have cystic changes, of which 78.1% constitute males and 21.8% females. Cystic changes were observed in 46.6%in patients on MHD between 4-5yrs, 57.6% in patients on MHD between 5-6 yrs and to 75%in patients on MHD greater than 6 yrs. CONCLUSION: This study showed that Cystic kidney disease is an important complication of long term HD regardless of etiology of renal failure, more seen in males and relates to duration of hemodialysis. Hence renal surveillance with USG or CT every 3yrs in all dialysis patients and annually in patients with cystic changes.

Increased nitric oxide plasma concentration in dogs with naturally acquired chronic renal disease / Aumento da concentração plasmática de óxido nítrico em cães com doença renal crônica naturalmente adquirida

This study aimed to determine the amount of plasma nitric oxide in clinically stable dogs at different stages of chronic kidney disease (CKD). Five groups of dogs were studied, aged from 4 to 18, comprising of a control group composed of healthy animals (control n=17), group CKD stage 1 (DRC-1, n=12), group CKD stage 2 (CKD-2, n=10) group, CKD stages 3 (CRD-3, n=13) and Group CKD stage 4 (DRC-4, n=10). Dogs with CKD were clinically stable and received no treatment. Two blood samples were collected at 24 hours intervals (repeated measures) to obtain serum and plasma. The serum creatinine values were used to classify dogs as CG, CKD-1, CKD-2, CKD-3 and CKD-4, and were (1.02±0.02mg/dL), (1.07±0.04mg/dL), (1.81±0.03mg/dL), (3.40±0.15mg/dL) and (6.00±0.20mg/dL) respectively. The determination of nitric oxide (NO) was performed by dosing nitrate/nitrite indirectly, and used for measurement of nitrate according to the NO/ozone chemiluminescence. The data were submitted to ANOVA for nonparametric analysis(Kruskal-Wallis) (P<0.05). The concentration of plasmatic NO did not differ significantly among GC (10.81±0.51µM), CKD-1 (15.49±1.97µM) and CKD-2 (19.83±3.31µM) groups. The plasma concentration of CKD-3 (17.02±1.73µM) and CKD-4 (83.56±13.63µM) was significantly higher compared with healthy dogs. In conclusion, the NO plasma concentration can increase in dogs with CKD and become significantly higher in stage 3 and 4 dogs.(AU)

A determinação de óxido nítrico no plasma em cães clinicamente estáveis em diferentes estágios da doença renal crônica (DRC) não foi estudada, constituindo este o objetivo do presente estudo. Foram estudados cinco grupos de cães, com idade variando entre quatro a 18 anos, compreendendo o grupo controle, composto por animais sadios (controle, n=17), grupo com DRC estágio 1 (DRC-1, n=12), grupo com DRC estágio 2 (DRC-2, n=10), grupo com DRC estágio 3 (DRC-3, n=13) e grupo com DRC estágio 4 (DRC-4, n=10). Os cães com DRC estavam com o quadro clínico estável e sem receber qualquer tipo de tratamento. Foram estudados cinco grupo de cães, com idade variando entre quatro a 18 anos, compreendendo o grupo controle, composto por animais sadios (controle, n=17), grupo com DRC estágio 1 (DRC-1, n=12), grupo com DRC estágio 2 (DRC-2, n=10), grupo com DRC estágio 3 (DRC-3, n=13) e grupo com DRC estágio 4 (DRC-4, n=10). Os animais sadios ou com DRC foram submetidos a duas coletas de sangue, com intervalo de 24 horas (amostras repetidas), para obtenção de soro e plasma. Os valores de creatinina sérica, que definiram a classificação dos pacientes do controle, DRC-1, DRC-2, DRC-3 e DRC-4, que foram 1,02±0,02mg/dL; 1,06±0,05mg/dL; 1,80±0,03mg/dL; 3,39±0,21mg/dL e 6,00±0,28mg/dL, respectivamente. A determinação plasmática indireta de óxido nítrico (NO) foi realizada por meio da dosagem de nitrato/nitrito, através da técnia de quimioluminescência NO / ozono. Os dados foram submetidos à ANOVA para análise não paramétrica (Kruskal-Wallis) (P <0,05). Os resultados das concentrações plasmáticas de NO não diferiram significativamente quando comparados os dados do controle (10,81±0,51µM), DRC-1 (15,49±1,97µM), DRC-2 (19,82±3,31µM). No entanto, o NO plasmático do grupo DRC-3 (17,01±1,73µM) e DRC-4 (83,55±13,63µM), foi significativamente maior, em relação às médias dos cães sadios. Concluímos que a concentração plasmática de NO pode aumentar em cães com DRC e torna-se significativamente mais elevada nos estágios 3 e 4 da doença.(AU)

A Case of Severe Hypercalcemia Causing Acute Kidney Injury: An Unusual Presentation of Acute Lymphoblastic Leukemia

Severe hypercalcemia is rarely encountered in children, even though serum calcium concentrations above 15-16 mg/dL could be life-threatening. We present a patient having severe hypercalcemia and azotemia. A 14-year-old boy with no significant past medical history was referred to our hospital with hypercalcemia and azotemia. Laboratory and imaging studies excluded hyperparathyroidism and solid tumor. Other laboratory findings including a peripheral blood profile were unremarkable. His hypercalcemia was not improved with massive hydration, diuretics, or even hemodialysis, but noticeably reversed with administration of calcitonin. A bone marrow biopsy performed to rule out the possibility of hematological malignancy revealed acute lymphoblastic leukemia. His hypercalcemia and azotemia resolved shortly after initiation of induction chemotherapy. Results in this patient indicate that a hematological malignancy could present with severe hypercalcemia even though blast cells have not appeared in the peripheral blood. Therefore, extensive evaluation to determine the cause of hypercalcemia is necessary. Additionally, appropriate treatment, viz., hydration or administration of calcitonin is important to prevent complications of severe hypercalcemia, including renal failure and nephrocalcinosis.

Epidemiologia e distribuição de lesões extrarrenais de uremia em 161 cães / Epidemiology and distribution of extrarenal lesions of uremia in 161 dogs

Com o objetivo de determinar a epidemiologia e as características morfológicas, incluindo a localização anatômica, das lesões extrarrenais de uremia, bem como determinar as principais lesões do sistema urinário associadas à ocorrência de uremia, foram revisados os protocolos de necropsias de cães realizadas no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria de janeiro de 1996 a dezembro de 2012 (17 anos). Nesse período foram necropsiados 4.201 cães, sendo que 161 (3,8%) apresentaram lesões extrarrenais de uremia. Em 134 cães (83,2%) foram descritos sinais clínicos associados à uremia. As lesões extrarrenais mais frequentes, em ordem decrescente, foram: gastrite ulcerativa e hemorrágica (56,5%), mineralização de tecidos moles (55,9%), edema pulmonar (47,2%), estomatite e/ou glossite ulcerativa (30,4%), endocardite/trombose atrial e aórtica (28,6%), hiperplasia das paratireoides (9,3%), osteodistrofia fibrosa (8,1%), anemia (6,2%), laringite ulcerativa (5%), enterite ulcerativa/hemorrágica (3,7%), esofagite fibrinonecrótica (1,9%) e pericardite fibrinosa (1.9%). Na maioria dos casos as lesões extrarrenais de uremia foram decorrentes de azotemia prolongada por lesões renais graves, sendo as mais prevalentes a nefrite intersticial e a glomerulonefrite.

The aim of this study was to determine the epidemiology and the morphological characteristics (including the anatomic localization) of the extrarenal uremic lesions, as well as to describe the main lesions of the urinary system associated with the occurrence of uremia, through analysis of the protocols of necropsies performed in dogs from January 1996 to December 2012 (17 years) at the Laboratório de Patologia Veterinária of the Universidade Federal de Santa Maria. A total of 4,201 dogs were necropsied and 161 (3.8%) had extrarenal uremic lesions. In 134 dogs (83.2%) clinical signs associated with uremia were reported. The extrarenal lesions more often observed, in descending order of prevalence, were ulcerative and hemorrhagic gastritis (56.5%), soft-tissue mineralization (55.9%), pulmonary edema (47.2%), ulcerative stomatitis and/or glossitis (30.4%), endocarditis/atrial and aortic thrombosis (28.6%), parathyroid hyperplasia (9.3%), fibrous osteodystrophy (8.1%), anemia (6.2%), ulcerative laryngitis (5%), ulcerative and hemorrhagic enteritis (3.7%), fibrinonecrotic esophagitis (1.9%), and fibrinous pericarditis (1.9%). In most of the cases, the extrarenal lesions of uremia were due to prolonged azotemia secondary to severe renal lesions, such as interstitial nephritis and glomerulonephritis (the most prevalent ones).

Nephroprotective and Curative Assessment of an Aqueous Seed Extract of Parkia clappertoniana Keay in Gentamicin-induced Renal Damage in Sprague-dawley Rats.

Aim: To assess the nephroprotective and curative effects of an aqueous seed extract of Parkia clappertoniana on gentamicin-induced renal damage (GIRD) in Sprague-Dawley rats. Study Design: Experimental Place and Duration of Study: Department of Medical Laboratory, University of Cape Coast, Ghana between September, 2012 and May 2013. Methodology: In assessing nephro protective effect, rats were pretreated (10 days) with P. clappertoniana aqueous seed extract (1-2 g kg-1; p.o) prior to induction of renal damage by treatment with gentamicin (0.08g kg-1; p.o, for 8 days. Serum biochemical markers (Creatinine, Urea, Na+ and K+) and urine parameters (leukocyte, protein, specific gravity and pH) of renal damage were determined and compared with baseline values. In a curative study, GIRD in rats was treated with Normal Saline (2 ml kg-1; p.o), Losartan (0.05 g kg-1; p.o), or extract (1-2 g kg-1; p.o) for 14 days and serum and urine parameters determined for all treatments. Histopathology and changes in kidney weights for normal and treated rats in both studies were assessed. The extract was screened for DPPH radical scavenging activity. Results: The extract significantly (P ≤ .001) reduced elevated serum creatinine and urea secondary to GIRD (P ≤ .05) and significantly (P ≤ .05) reduced elevated serum Na+ but had no effect on K+. Elevated urine proteins and leucocytes secondary to GIRD was significantly (P ≤ .05) reduced; but had no significant effect on urine pH and specific gravity. Elevated kidney weights associated with GIRD was significantly (P≤ .01) reduced. Histopathological assessment revealed healing effect by extract to GIRD. Effects of the extract were similar to Losartan. Pretreatment with extract however had no significant effect on GIRD as serum and urine parameters, as well as kidney weights were significantly (P≤ .01) elevated on induction of renal damage. Conclusion: The aqueous seed extract of Parkia clappertoniana has curative but no nephroprotective effect on gentamicin-induced renal damage in Sprague-Dawley rats.

Probiotic dietary supplementation in a dog with chronic kidney disease / 동물의과학연구지

A 7-year-old spayed female English Cocker Spaniel dog presented with polyuria (PU), polydipsia (PD), intermittent vomiting, and weight loss. Physical examination revealed pale, tacky mucous membranes and severe emaciation. Hematological and biochemical examinations revealed moderate normocytic normochromic non-regenerative anemia and moderate azotemia. Abdominal ultrasonography demonstrated bilaterally small lumpy-bumpy kidneys with hyperechoic parenchyma as well as loss of renal corticomedullary junction. Based on clinical history and examinations, the dog was diagnosed with chronic kidney disease (CKD). The dog was treated with supportive care including fluid therapy, phosphate-binding agent, and histamine H2-receptor antagonist. Darbepoetin Alfa was administered to control renal secondary non-regenerative anemia. Prescribed diet with low-protein and low-phosphorus was fed to alleviate CKD signs. Further, dietary probiotics were supplemented. This case demonstrates that oral probiotic supplementation helped reduce blood urea-nitrogen (BUN) levels. This case indicates that dietary probiotics can be a potential alternative therapeutic agent for management of renal failure.

Clinical Differences in Acute Kidney Injury between Unilateral Acute Pyelonephritis and Bilateral Acute Pyelonephritis / 대한내과학회지

BACKGROUND/AIMS: Acute pyelonephritis (APN) can involve a single kidney or both kidneys. The aim of this study was to define the clinical characteristics of unilateral and bilateral APN and compare their differences in acute kidney injury (AKI). METHODS: This was a retrospective study of patients admitted to Konyang University Hospital from January, 2006 to December, 2010 with APN diagnosed by the presence of definitive APN lesions on abdominal CT. Patients with a history of renal disease or anatomical predisposing factors were excluded. The patients were divided into two groups: unilateral and bilateral APN. BUN, creatinine, MDRD eGFR, and FENa were evaluated. RESULTS: Of the 177 patients, 130 had unilateral APN and 47 had bilateral APN. Significant differences were noticed in BUN, creatinine, and MDRD eGFR between the two groups. According to RIFLE criteria, 51 patients were at "risk" and six were in "failure." Compared with unilateral APN, bilateral APN patients had lower eGFR (65.2 vs. 61.7, p = 0.042) and higher FENa (0.81 vs. 1.43, p = 0.04), and "failure" was more frequent (4 vs. 2, p = 0.044). CONCLUSIONS: Our study showed a significant correlation between bilateral APN and decreased renal function. AKI in bilateral APN was more likely than AKI in unilateral APN to result in severe renal dysfunction. The pathophysiology of AKI may differ between unilateral and bilateral APN.

Acesso vascular para hemodiálise com cateter temporário de duplo lúmen em cães com insuficiência renal aguda / Hemodialysis vascular access with temporary double-lumen catheter in dogs with acute renal failure

A hemodiálise é uma modalidade terapêutica que pode sustentar a vida do paciente com insuficiência renal aguda (IRA), enquanto este recupera a função renal. Para sua realização, é necessário estabelecer circulação extracorpórea, para que seja realizada a filtração do sangue, impondo a necessidade de um acesso vascular viável e eficiente. O objetivo deste estudo foi avaliar a eficiência e as complicações do acesso vascular para hemodiálise (HD), com cateter temporário de duplo lúmen inserido na veia jugular externa. Foram estudados 10 cães com IRA induzida por gentamicina, submetidos a sessões diárias de HD, com duração de uma hora, até a recuperação da função renal ou óbito. Foram realizadas 104 sessões de HD nos animais estudados, observando-se necessidade de troca do cateter em sete sessões (6,7 por cento), devido à obstrução do lúmen do cateter em seis sessões (5,8 por cento) ou por saída acidental do mesmo em uma sessão (1,0 por cento). Não se observou migração do cateter, infecção, hemorragia ou hematoma no local de entrada do cateter na pele, obtendo-se fluxo sanguíneo patente em 90,4 por cento das sessões. Concluiu-se que o acesso vascular na veia jugular externa com cateter temporário de duplo-lúmen mostrou-se viável, com ocorrência de poucas complicações, sendo, portanto, indicado como forma de acesso para a circulação extracorpórea para HD em cães com IRA.

Hemodialysis is a therapeutic procedure that can sustain the patient's life in acute renal failure (ARF), during the renal function recover. To perform hemodialysis (HD), an extracorporeal circulation is established to blood filtration, imposing the need of a viable and efficient vascular access. The aim of this study was to evaluate the effectiveness and complications of the HD vascular access with temporary double-lumen catheter inserted into the external jugular vein. Ten mongrel dogs with ARF, induced by gentamicin administration, were submitted to daily hemodialysis for one hour, until renal function recover or death. A total of 104 HD sessions were performed. Catheter replacement was accomplished in seven sessions (6.7 percent), due to catheter lumen mechanical obstruction in six sessions (5.8 percent) or accidental catheter output in one session (1.0 percent). No catheter migration, infection, bleeding or haematoma around the catheter insertion site was found. Effective blood flow rates were observed in 90.4 percent HD sessions. In conclusion, the vascular access in jugular external vein with temporary double-lumen catheter was valuable, with few complications, and should be indicated to vascular access in extracorporeal circulation to HD in ARF dogs.

The Preoperative Risk Factors that Influence the Postoperative Renal Function in Living Donor Nephrectomy: The Impact of Dominant Kidney Nephrectomy / 대한비뇨기과학회지

PURPOSE: We wanted to investigate the effect of dominant kidney nephrectomy on the postoperative renal function and we wanted to determine the preoperative risk factors that influence the postoperative renal function in living donor nephrectomy. MATERIALS AND METHODS: A total of 297 living kidney donors(159 males and 138 females) who underwent nephrectomy were included in this study. Renal function was measured by the serum creatinine levels and (99m)Tc-diethylenetriamine penta-acetic acid(DTPA) renal scanning. Using univariate and multivariate analyses, the following independent variables were evaluated to predict a postoperative serum creatinine level 1.5mg/dl or higher: removal of a functionally dominant kidney or a larger kidney according to the DTPA renal scan or CT, age, gender, body mass index (BMI), comorbidity, preoperative serum creatinine and the preoperative glomerular filtration rate(GFR). RESULTS: Of the 297 subjects, 134(55%) underwent donor nephrectomy on the left side, and 163(45%) underwent donor nephrectomy on the right side. Univariate analysis showed that gender and the preoperative creatinine level were significantly associated with postoperative serum creatinine elevation(1.5mg/dl or higher)(p<0.05). Multivariate analysis showed that the preoperative creatinine level(p<0.001), the preoperative GFR (p=0.015) and removal of a functionally dominant kidney(p=0.049) were significant factors. The cut-off values from the receiver operating characteristics(ROC) curves were 1.0mg/dl for the preoperative creatinine level, 90.24ml/min/1.73m2 for the preoperative GFR, and 10.94% for the difference of the relative renal function on DTPA. CONCLUSIONS: The preoperative serum creatinine level and the preoperative GFR are critical predictive factors for renal function after living donor nephrectomy. The impact of removing a functionally dominant kidney on the postoperative renal function should be cautiously interpreted in patients where the function of the nondominant kidney is favored.

Renal manifestation in patients with rheumatoid arthritis / 대한내과학회지

BACKGROUND/AIMS: Although renal manifestations are often involved in patients with rheumatoid arthritis (RA), the causal relationship between RA and renal manifestations has not been clearly defined. The prevalence and causes of renal manifestations in patients with RA were investigated in this study. METHODS: The clinical data from 457 patients with RA and who were admitted to Hanyang University Hospital between 2001 and 2005 were retrospectively analyzed. Renal manifestations were defined as proteinuria (> or =300 mg/day) or azotemia (serum creatinine > or =1.7 mg/dL), with or without hematuria. RESULTS: Renal manifestation was present in 82 (17.9%) out of 457 RA patients. Among them, proteinuria was observed in 81 (17.7%), azotemia in 37 (8.1%) and hematuria with either proteinuria or azotemia in 35 (7.7%). For the cases with proteinuria, the amount of preteinuria was 1353+/-207 (mean+/-SD) mg/day. There was no significant correlation between the degree of proteinuria and the duration of RA. For the cases with azotemia, the serum creatinine was 3.98+/-0.35 mg/dL. The presence of azotemia had no significant association with the duration of RA (14.4+/-1.5 vs. 11.6+/-1.2 years, respectively). When the etiology of the renal manifestation was classified into primary and secondary renal disease, the latter included diabetic nephropathy in 13 (15.9%), hypertensive nephrosclerosis in 8 (9.8%), drug induced chronic tubulointerstitial disease in 11 (13.4%) and AA amyloidosis in 2. Renal biopsy revealed 10 cases of primary glomerulopathy, including IgA nephropathy in 3, membranous nephropathy in 2, mesangial proliferative glomerulonephritis in 1, focal segmental glomerulosclerosis in 1 and chronic sclerosing glomerulonephritis in 3. CONCLUSIONS: The prevalence of chronic kidney disease in patients with RA is high, although direct renal invasion by RA is very rarely encountered. Renal biopsy would be of great help to identify the various causes of renal manifestations in patients with RA.

A Case of Light Chain Deposition Disease without Significant Proteinuria / 대한신장학회잡지

A 67-year-old male was admitted to the hospital for evaluation of incidentally detected anemia and mild azotemia. Urinalysis showed no abnormal finding and 24 hr urine protein amount was clinically insignificant (270 mg/day). Urine and serum protein electrophoresis were negative for a monoclonal spike. However, urine and serum immunoelectrophoresis demonstrated the presence of monoclonal free kappa light chains. Renal biopsy showed the features of chronic tubulointerstitial disease and on the immunofluorescence studies, kappa light chain was in a linear pattern in basement membranes of glomeruli and tubules. Work-up for multiple myeloma including bone marrow biopsy showed results compatible with multiple myeloma. Treatment was started with vincristine, adriamycin and doxorubicin at monthly interval for three months followed by autologus peripheral blood stem cell transplantation. At follow-up 5 months after autologus peripheral blood stem cell transplantation, the patient is well with a serum creatinine of 2.3-2.6 mg/dL and 24 hr urine protein of 200-350 mg.

An Ultrastructural Study of Renal Tissues with Experimenta Crush Syndrome in Rabbits / 第三军医大学学报

Experimental crush syndrome was inflicted to the kidneys of rabbits and specimens of renal tissues were studied with electron microscope. It was found that apart from the damage to the renal tubules, the ultrastructural alterations of the glomeruli were also prominent and were characterized as follows:(1) Hypertrophy and hyperplasia of the glomerular cells resulting in narrowing and/or obliteration of the capillary loops.(2) Retrogressive changes of the glomerular cells in varying degrees such as mitochondrial swelling, dilatation of ER, vacuole formation, etc.On the basis of the morphological findings of the renal tissues in association with the clinical manifestations of acute renal failure (ARF), it is proposed that in addition to the damage of the renal tubules, a reduction of the glomerular filtration rate, which is the result of the altered hemodynamics in the renal vessels and the ultrastructural changes of the glomerular cells also play an important role in the pathogenesis of ARF.