A case of microscopic polyangiitis combined with pulmonary silicosis / 대한내과학회지

Microscopic polyangiitis (MPA) is a distinct type of systemic small vessel vasculitis affecting small sized vessels with few or no immune deposit and no granulomatous inflammation. Cause or pathogenetic mechanism of MPA has been unknown but association with silicon or silica exposure or pulmonary silicosis has been reported rarely and supports hypothesis that environmental factors are important modulating or triggering factors of the vasculitis in the indivisual who may be genetically predisposed. We report a case of microscopic polyangiitis with underlying pulmonary silicosis in 43 year-old male. He was admitted due to hemoptysis, dyspnea, fever and bilateral pulmonary infiltration with underlying small nodular densities in whole lung field and egg-shell calcification of both hilar areas. Laboratory findings showed hematuria, proteinuria and rapid deterioration of renal function. Renal biopsy revealed focal segmental necrotizing glomerulonephritis with early cellular crescents accompanied with membranous glomerulonephropathy and perinuclear-antineutrophil cytoplasmic antibody was positive. Under the diagnosis of MPA, he has been managed with high dose steroid, cyclophosphamide and hemodialysis. Chest infiltration decreased and hemoptysis and hypoxia was improved but renal function was not recoverd and he needed regular hemodialysis continuously.

Effects of Dialyzer Reuse on Clearances of Blood Urea Nitrogen and beta2-Microglobulin in the Three Different Membranes / 대한신장학회잡지

BACKGROUND: We performed the study on the changes of beta2-microglobulin(beta2M) clearance and urea reduction ratio after reuse of dialyzers with three different membranes. METHODS: 9 patients who had received regular hemodialysis more than five years were enrolled. Three kinds of dialyzer membrane were used; i.e. : Two of them were high-flux and the other was low-flux. Dialyzer reprocessing was performed by an automated machine using glutaraldehyde and bleach. Each dialyzer was reused 10 times. Solute clearance was determined for each dialyzer after the 1st, 5th, 8th and 10th reuse. RESULTS: Urea clearance was well maintained after reuse with both high-flux and low-flux membrane but beta2M clearance was significantly greater with high-flux dialyzers than low-flux dialyzer. Effects of each dialyzer reuse on beta2M clearance showed no significant decrease until the 10th reuse and no significant difference in beta2M clearance between the two high-flux dialyzers(polyamide vs PEPA membrane, p= 0.197). CONCLUSION: Reuse of dialyzers was cost-effective. After reuse of dialyzer, clearance of solute was maintained in both small and large solutes until the 10 th reuse. Further study is needed regarding the maintenance of solute clearance with increased number of reuses.

A Case of Acute Renal Failure due to Rhabdomyolysis Associated with Dermatomyositis in Breast Cancer / 대한신장학회잡지

Dermatomyositis is a clinical syndrome of unknown etiology characterized by a nonpurulent inflammatory myopathy involving striated skeletal muscle associated with rheumatoid arthritis, or systemic lupus erythematosus, sometimes underlying malignancy. A few cases of acute renal failure due to rhabdomyolysis in dermatomyositis has been reported. But, no case combined with breast cancer have been reported. We experienced a case of acute renal failure due to rhabdomyolysis associated with dermatomyositis. The patient was admitted to the our hospital due to breast cancer. After breast cancer operation, she complained of progressive muscle weakness. The heliotrope rash involved the eyelid, bridge of nose and forehead. And eczematoid dermatitis involved the lower abdomen and both forearm and hands. The laboratory findings revealed LDH 2,944IU/L, CPK 2,244IU/L and SGOT 214IU/L. Serum myoglobin and aldolase were increased, and antinuclear antibody was 1:40(positive, homogenous pattern). Electromyogram revealed myopathic findings compatible with dermatomyositis. Then, the patient developed acute renal failure requring hemodialysis. After acute hemodialysis, acute renal failure resolved. But, the patient died on the 113th hospital day due to sepsis. Here, we report a case of acute renal failure due to nontraumatic rhabdomyolysis associated with dermatomyositis in breast cancer.