Best surrogate marker for insulin resistance in middle aged non-diabetic Korean: Chungju metabolic syndrome study / 대한내과학회지

BACKGROUND: To investigate the best surrogate marker for insulin resistance in the non-diabetic middle-aged population in Korea. METHODS: This study was performed from February to April 2003-2005 in adults over 40 years of age living in Chungju City, South Korea, selected by stratified random cluster sampling. We analyzed the data from a total 6,149 non-diabetic subjects that completed a survey consisting of anthropometric measurement and blood chemistry. We defined the highest quartile of the homeostasis model for insulin resistance (HOMA-IR) as the insulin resistant group in our study population. We also analyzed the correlation of various anthropometric (body mass index, waist circumference, waist to hip ratio, waist to height ratio) and biochemical parameters (total cholesterol to HDL cholesterol ratio, non-HDL cholesterol level, triglycerides to HDL cholesterol ratio and level of triglycerides) with insulin resistance using simple and multiple regression analysis for detecting the insulin resistance group. RESULTS: By simple regression analysis, among the anthropometric parameters including the body mass index, waist circumference, waist to hip ratio, waist to height ratio, and the biochemical parameters, including the total cholesterol to HDL cholesterol ratio, non-HDL cholesterol level, triglyceride to HDL cholesterol ratio and triglycerides level, the body mass index was the best surrogate marker for insulin resistance (95% CI 1.215-1.262). The cut-off value of the body mass index was 24.6 kg/m2 (male; 24.7, female; 24.6 kg/m2), with a sensitivity of 62.6% and specificity of 66.9%. Multiple logistic regression analysis for insulin resistance also gave the same results. Furthermore, the cut-off value of the body mass index for the metabolic syndrome as defined by NCEP-ATP III was also 24.1 kg/m2 (male; 24.0, female; 24.2 kg/m2). CONCLUSIONS: Our study results suggest that the body mass index was the best surrogate marker for insulin resistance of a non-diabetic population and its cut-off value was approximately 24 kg/m2.

The Clinical Features of Acute Renal Failure Caused by Alcohol Induced Rhabdomyolysis / 대한신장학회잡지

Alcohol can cause rhabdomyolysis by either direct toxicity or associated metabolic abnormality such as hypophosphatemia and hypokalemia. It can also predispose to or cause trauma, seizures, or coma- induced ischemic pressure necrosis. In order to investigate the clinical features of acute renal failure caused by alcohol induced rhabdomyolysis, we reviewed the medical records of the 12 patients. All patients had been drinking much amounts of alcohol for several years. All patients showed elevation of muscle enzyme such as creatine phosphokinase, lactic dehydrogenase, aspartate transaminase and blood urea nitrogen and serum creatinine. Predisposing factors of rhabdomyolysis were ischemic compression due to unconsciousness and dehydration(2 cases), and hypophosphatemia and dehydration(1 case), seizure and dehydration(1 case), and only severe dehydration(3 cases). Initial symptoms were painful swelling at lesion site(5 cases), abdominal pain(2 cases), general ache(2 cases), leg pain without swelling(1 case), dyspnea(1case), and lethargy(1 case). Seven patients developed delirium tremens during recovery stage. Eight patients showed oliguric acute renal failure and 8 patients were treated with hemodialysis. Complications were disseminated intravascular coagulation(DIC)(3 cases), compartment syndrome(2 cases), capillary leak syndrome and DIC(1 case). One of 12 patients died of disseminated intravascular coagulation and other patients showed complete recovery of renal function.

Successful Angioplasty using Gadopentetate Dimeglumine in a Patient with Chronic Renal Insufficiency / 대한신장학회잡지

Iodinated contrast-induced acute renal failure is estimated to occur in 0.15 to 2% of all patients undergoing contrast imaging studies. Incidence is higher in patients with renal insufficiency, diabetes mellitus, dehydration, multiple myeloma, congestive heart failure, advanced age. We here report successful vascular interventional procedure by using gadopentetate dimeglumine(Gd-DTPA) as a contrast agent in a patient with chronic renal insufficiency and right superficial femoral artery stenosis. The patient had a history of iodinated contrast-induced acute renal failure. Gd-DTPA(0.17mmoVkg) diluted 1: 1 with 0.9% norrnal saline was used as contrast agent for the interventional procedure. Percutaneous transluminal angioplasty was successfully performed and there was no evidence of contrast material- induced acute renal failure after the procedure. Gd- DTPA is an alternative contrast agent for patients with chronic renal insufficiency.

A case of acute interstitial nephritis associated with cimetidine therapy / 대한내과학회지

Although cimetidine causes a transient rise in serum creatinine without reduction of renal function, acute renal failure due to acute interstitial nephritis is rare in patients after cimetidine treatment. We here present a case of acute renal failure and acute interstitial nephritis that occurred during cimetidine treatment. A 38-year old woman was referred to our hospital because of nausea and general weakness. She had been taking cimetidine for 3 weeks because of epigasric discomfort. On admission, serum creatinine was 3.9 mg/dL and urinalysis showed mild proteinuria and hematuria. There was no history of pyelonephritis, diabetes mellitus, hypertension, toxin exposure. Renal biopsy showed severe interstitial infiltration of lymphocytes without definite glomerular change. After withdrawal of cimetidine, renal function completely recovered.

A case of acute interstitial nephritis associated with cimetidine therapy / 대한내과학회지

Although cimetidine causes a transient rise in serum creatinine without reduction of renal function, acute renal failure due to acute interstitial nephritis is rare in patients after cimetidine treatment. We here present a case of acute renal failure and acute interstitial nephritis that occurred during cimetidine treatment. A 38-year old woman was referred to our hospital because of nausea and general weakness. She had been taking cimetidine for 3 weeks because of epigasric discomfort. On admission, serum creatinine was 3.9 mg/dL and urinalysis showed mild proteinuria and hematuria. There was no history of pyelonephritis, diabetes mellitus, hypertension, toxin exposure. Renal biopsy showed severe interstitial infiltration of lymphocytes without definite glomerular change. After withdrawal of cimetidine, renal function completely recovered.

A Case of Furosemide Induced Acute Interstitial Nephritis / 대한신장학회잡지

Drug-induced acute interstitial nephritis is characterized by renal interstitial inflammatory cell infiltration and commonly presents as acute renal failure. This is caused mainly by methicillin, non-steroidal antiinflammatory drugs, sulfonamide diuretics such as thiazide, but cases induced by furosemide are rare. We report a patient with acute interstitial nephritis causing reversible acute renal failure and dermatitis while she was taking furosemide. A 37-year old woman was referred to our hospital because of generalized skin rash and non-oliguric acute renal failure. She had peripheral eosinophilia (1,577/mm3) and serum creatinine level of 6.8mg/dL. Skin biopsy showed leukoclastic vasculitis and percutaneous renal biopsy showed severe interstitial infiltration of lymph ocyte and mild interstitial fibrosis with focal tubular atrophy. After withdrawal of furosemide, renal function and skin lesions were completely recovered.