KP Index at the Initiation of Dialysis for Patients with End-stage Renal Disease

BACKGROUND: The time at which renal replacement therapy (RRT) is initiated in patients with end-stage renal disease (ESRD) has a great influence on the prognosis of the patient; however, there are currently no accurate guidelines for the initiation of RRT. Traditionally, nephrologists usually initiate RRT on the basis of the observation of the uremic symptoms and changes in the laboratory parameters, such as the serum creatinine concentration and/or glomerular filtration rate (GFR). DOQI guidelines suggest a weekly Kt/Vurea 2.0 and KP index 2.0 group, while there were no significant differences between the groups in the serum albumin concentration, serum creatinine concentration, FFEFBM and RRF. Also, there was a statistically significant higher rate of incidence of patients starting RRT in the KP index 2.0 group. There was a significant correlation between the KP and other indices in all patients. When comparing the number of patients starting RRT, the weekly Kt/Vurea index demonstrated no significant differences between the 1.5 < weekly Kt/Vurea < 2.0 and 2.0 < weekly Kt/Vurea < 2.5 groups, but the number of patients starting RRT in the 1.5 < KP index < 2.0 group was significantly higher than that in the 2.0 < KP index < 2.5 group. CONCLUSION: The KP index is considered a clinically useful index in ESRD patients for determining an appropriate time for the initiation of RRT. Also, the timing of the initiation of RRT should be fixed with regard to the various other indices and clinical features for a desirable prognosis of the patients. In addition, further studies will be required to determine accurate guidelines for an appropriate time for RRT initiation.

KP index at the timing of initiation of dialysis for patients with end-stage renal disease / 대한내과학회지

BACKGROUND: An initiating time of renal replacement therapy (RRT) for patients with end-stage renal disease (ESRD) has great influence on prognosis of the patients, however, there are currently no accurate guidelines for initiation of renal replacement therapy. Traditionally, nephrologists usually initiate RRT on the basis of observation of uremic symptoms and changes of laboratory parameters, such as serum creatinine concentration and/or glomerular filtration rate (GFR). DOQI guidelines suggest weekly Kt/Vurea 2.0 and KP index 2.0, while no significant differences between the groups were in serum albumin concentration, serum creatinine concentration, FFEFBM and RRF. And the frequency of patients starting RRT was significantly higher in the group of KP index 2.0 in statistics. There was a significant correlation between KP index and other indices in all patients. In comparing and analyzing the number of patients starting RRT, weekly Kt/Vurea index did not demonstrate significant differences between two groups of 1.5 < weekly Kt/Vurea < 2.0 and 2.0 < weekly Kt/Vurea < 2.5, but the frequency of patients in the group of 1.5 < KP index < 2.0 was significantly higher than that in the group of 2.0 < KP index < 2.5. CONCLUSION: It is considered that KP index is an index clinically useful for ESRD patients to determine an appropriate timing for the initiation of RRT, and that the timing should be fixed with regard for other various indices and clinical features for advisable prognosis of the patients. In addition, accurate guideline to determine such an appropriate time needs to be suggested by further new studies.

Three Cases of Amyloidosis Diagnosed by Endoscopic Biopsy of Stomach / 대한소화기내시경학회지

Since amyloidosis is usually diagnosed later in the disease process, a high index of suspicion is therefore necessary for earlier diagnosis. Confirmative diagnosis rests on a biopsy of the involved organ. Gastrointestinal amyloidosis causes a variety of symptoms including intestinal obstruction, ulcers, malabsorption, hemorrhaging, protein loss, diarrhea, anorexia, nausea, vomiting, and dysphagia. We confirmed amyloid deposits in the stomach in three patients with epigastric pain through a biopsy of erosive gastritis documented on a gastrofiberscopy. One patient with primary amyloidosis which had invaded his kidney, stomach, and heart, expired, although aggressive treatment with a pacemaker insertion, peritoneal dialysis, and ventilator care was performed. Another patient with multiple myeloma died on the 38th day, after having started systemic chemotherapy. The other patient with secondary amyloidosis due to rheumatoid arthritis, is currently receiving colchicine at our out patient clinic.

Two Cases of Anomalous Termination of the Common Bile Duct and the Pancreatic Duct into the Duodenal Bulb / 대한소화기내시경학회지

Many examples of congenital anomalies of the pancreatobiliary ductal system are now being found due to the development of new diagnostic techniques. Recently, despite the improvement in diagnosis and management of pancreatobiliary lesions, a lack of knowledge and understanding of these variations is undoubtedly responsible for many problems in medical and surgical management. In particular, drainage of the common bile duct and pancreatic duct at sites other than the second portion of the duodenum is an anatomieal curiosity. We report two cases in this study, of anomalous termination of the common bile duct and the pancreatic duct into the duodenal bulb, diagnosed by an ERCP and a gastroscopy.

Left Atrial Dissection after Mitral Valve Replacement Demonstrated by Transesophageal Echocardiography

Left atrial dissection is one of extremely rare complications associated with mitral valve surgery. We reported a case of left atrial dissection, which was developed after mechanical mitral valve replacement and was demonstrated by transesophargeal echocardiography. The cause of dissection was due to excessive traction of left atrial endocardial layer during surgery.