Scrub typhus infection in a kidney transplant recipient: a case report / 고신대학교의과대학학술지

Scrub typhus is a febrile disease that is endemic to Asia and the Pacific region. Its clinical manifestations include fever, myalgia, lymphadenopathy, and a characteristic eschar. The main manifestations of this disease are difficult to differentiate from those of other febrile illnesses; thus, a careful clinical examination and a high index of suspicion are crucial for an early diagnosis. Our case involved a 55-year-old female renal transplant recipient who presented with fever and sore throat in November. Her clinical symptoms did not improve after oral amoxicillin/clavulanate administration for 7 days, after which proteinuria and acute kidney injury were identified. After hospitalization, an eschar was found and immunoglobulin M antibodies against Orientia tsutsugamushi were detected by indirect immunofluorescence. She received oral doxycycline for 7 days and showed improvement in renal function and proteinuria. This is the first case report of scrub typhus infection in a kidney transplant patient in Korea. It is meaningful to report that the renal abnormalities associated with scrub typhus improved in a renal transplant patient through treatment of the disease. This case highlights the importance of examining the social history and symptoms of patients suspected of having scrub typhus in endemic areas. Early diagnosis and treatment are crucial in kidney transplant patients to preserve graft function and prevent fatal complications.

Nutcracker Syndrome with Thin Basement Membrane Disease: A Case Report / 대한내과학회지

Nutcracker syndrome is caused by external compression of the left renal vein and is characterized by various symptoms, such as hematuria and left flank pain. However, long-standing gross hematuria is uncommon. We report the case of a 23-year-old woman who had had painless gross hematuria for several months. Kidney biopsy revealed thin basement membrane disease, but this did not explain the gross hematuria with proteinuria. Renal venography and Doppler ultrasonography showed increased diameter and velocity ratios between the left renal vein and inferior vena cava. Cystoscopy revealed that the hematuria originated from the left ureteral orifice. These results indicate coexisting Nutcracker syndrome. Nutcracker syndrome with thin basement membrane disease should be considered in the differential diagnosis of a patient who has long-standing gross hematuria.

Clinical features and outcomes in kidney transplant recipients with renal cell carcinoma: a single-center study

BACKGROUND: Previous studies have recommended a 2- to 5-year waiting time prior to kidney transplantation (KT) in patients with end-stage renal disease (ESRD) and symptomatic renal cell carcinoma (RCC) and no delay for incidental early-stage RCC. Data on Asian KT recipients are unavailable.METHODS: This is a Korean single-center retrospective study on 35 KT recipients with ESRD and RCC. Patients were classified into two groups: early KT (KT performed within 1 year after nephrectomy for RCC, including KT with simultaneous nephrectomy) and delayed KT (KT performed over than 1 year after nephrectomy for RCC). Patient survival, graft survival, and cancer recurrence were compared between both groups.RESULTS: There were no statistically significant differences in patient survival (P = 0.388), graft survival (P = 0.317), or graft rejection rate (P = 0.207) between the early and delayed KT groups. Additionally, there were no differences in pathological characteristics or RCC stage other than cancer histology: acquired cystic disease-associated RCC (47.4%) was the most common RCC type in the early KT group, whereas clear cell type (62.5%) was the most common RCC type in the delayed KT group. No RCC recurrence was observed.CONCLUSION: Patients with early-stage and asymptomatic RCC do not require a mandatory observational period prior to KT after curative nephrectomy

Outcomes of living donor kidney transplantation in diabetic patients: age and sex matched comparison with non-diabetic patients

BACKGROUND/AIMS: Kidney transplantation (KT) reportedly provides a significant survival advantage over dialysis in diabetic patients. However, KT outcome in diabetic patients compared with that in non-diabetic patients remains controversial. In addition, owing to recent improvements in the outcomes of KT and management of cardiovascular diseases, it is necessary to analyze outcomes of recently performed KT in diabetic patients. METHODS: We reviewed all diabetic patients who received living donor KT between January 2008 and December 2011. Each patient was age- and sex-matched with two non-diabetic patients who received living donor KT during the same period. The outcomes of living donor KT were compared between diabetic and non-diabetic patients. RESULTS: Among 887 patients, 89 diabetic patients were compared with 178 non-diabetic patients. The incidence of acute rejection was not different between the diabetic and non-diabetic patients. Urinary tract infection and other infections as well as cardiovascular events occurred more frequently in diabetic patients. However, diabetes, cardiovascular disease, and infection were not significant risk factors of graft failure. Late rejection (acute rejection after 1 year of transplantation) was the most important risk factor for graft failure after adjusting for diabetes mellitus (DM), human leukocyte antigen mismatch, rejection and infection (hazard ratio, 56.082; 95% confidence interval, 7.169 to 438.702; p < 0.001). Mortality was not significantly different between diabetic and non-diabetic patients (0 vs. 2, p = 0.344 by log-rank test). CONCLUSIONS: End-stage renal disease patients with DM had favorable outcomes with living donor kidney transplantation.

Microvascular Pulmonary Tumor Embolism Detected by Perfusion Images of Dual-Energy Computed Tomography / 결핵및호흡기질환

Although advances in multi-detector computed tomography (CT) technique make it possible to evaluate peripheral subsegmental pulmonary arteries, several studies have reported that small peripheral embolisms may still be missed. Recently, some reports demonstrated that dual-energy CT improved the capability to detect peripheral pulmonary embolism. We report a case of lymphoma presenting as disseminated microvascular pulmonary tumor embolism, detected by perfusion images using dual energy CT.

Proteasome-Inhibitor-Based Primary Therapy for Antibody-Mediated Rejection in a Renal Transplant Recipient / 대한내과학회지

Donor-specific anti-human leukocyte antigen antibodies (DSA) following kidney transplantation predict the evolution of humoral rejection and reduced graft survival. Rapid, complete elimination of DSA during antibody-mediated rejection (AMR) is rarely achieved with traditional antihumoral therapies. We report the case of a 39-year-old female who was admitted for increasing azotemia and diagnosed with AMR based on diffusely positive histological changes on C4d immunostaining. In this case, bortezomib reversed the histological changes and induced a reduction in DSA. Proteasome-inhibitor-based combination therapy is a potential means for rapid DSA elimination in antibody-mediated rejection in renal transplant recipients.

Proteasome-Inhibitor-Based Primary Therapy for Antibody-Mediated Rejection in a Renal Transplant Recipient / 대한내과학회지

Donor-specific anti-human leukocyte antigen antibodies (DSA) following kidney transplantation predict the evolution of humoral rejection and reduced graft survival. Rapid, complete elimination of DSA during antibody-mediated rejection (AMR) is rarely achieved with traditional antihumoral therapies. We report the case of a 39-year-old female who was admitted for increasing azotemia and diagnosed with AMR based on diffusely positive histological changes on C4d immunostaining. In this case, bortezomib reversed the histological changes and induced a reduction in DSA. Proteasome-inhibitor-based combination therapy is a potential means for rapid DSA elimination in antibody-mediated rejection in renal transplant recipients.

Neurotoxicity Induced by Cefepime in a Patient with Minimal Change Disease / 대한신장학회지

A 71-year-old woman with minimal change disease visited our clinic complaining of pleuritic chest pain. Cefepime was given under the impression that she had pneumonia. Three days after cefepime administration, she became unconscious. A brain MRI scan was non-revealing and an EEG showed triphasic waves. As there was no evidence of septic, uremic or hepatic encephalopathy, we suspected cefepime-induced neurotoxicity. Cefepime was stopped and she underwent hemodialysis to decrease the blood levels of the drug. Following hemodialysis, she regained consciousness.