Multivariate Analysis of Factors Associated with Serum Lipoprotein(a) Level in Continuous Ambulatory Peritoneal Dialysis Patients / 대한신장학회잡지

Lp(a) is an independent risk factor of atherosclerotic cardiovascular diseases. Marked increase in plasma lipoprotein(a)[Lp(a)] was reported in conti- nuous ambulatory peritoneal dialysis(CAPD) patients. Serum albumin, parameters of nutritional status and parameters of dialysis have been reported to be related with Lp(a) concentration. Eighty nine patients(age 52 +/- 13, M: F 61: 28) undergoing CAPD were included in this study. We measured Lp(a) concentration, apolipoprotein(a) [apo(a)] phenotype, serum albumin, parathyroid hormone (PTH), Creactive protein(CRP), fibrinogen, 24 hour peritosol protein ancl albumin, 24 hour urine protein and albumin, total albumin clearance, residual renal function(RRF), and parameters of nutritional status such as prealbumin, triceps skin fold(TSF), mid-arm muscle area(MAMA), and normalized protein cata- bolic rate(nPCR). Peritoneal equilibration test(PET) and weekly Kt/V,. were also measured to evaluate relationship of Lp(a) and the adequacy of dialysis. The median serum Lp(a) was 48.9mg/dl(29.1-73.5 mg/dl) (quartiles). Higher Lp(a) level was observed in the low molecular weight apo(a) subgroup. There was no significant difference in serum Lp(a) levels between male and female, diabetic and non-diabetic patients, smokers and non-smokers. Serum albumin was negatively correlated(r=-0.28, p<0.01), while total albumin clearance was positively correlated with Lp (a)(r=0.20, p<0.05). 4)gLp(a) was not correlated with age, duration of dialysis, prealbumin, fibrinogen, RRF, weekly Kt/V, PET, PTH, CRP, TSF, MAMA, nPCR, 24hour peritosol protein and albumin and 24hour urine protein and albumin. Multivariate analysis using apo(a) phenotype, serurn albumin, total albumin clearance as independent variables revealed that serum albumin and apo(a) phenotype were significantly related with logLp(a)(p<0.05). Apo(a) phenotype and serum albumin were the factors that were independently associated with se- rum Lp(a) concentration in CAPD patients.

A Case of Simultaneous Bilateral Emphysematous Pyelonephritis and Cystitis / 대한내과학회지

Since the first clinical observation by Kelly and MacCallum, gas-forming infection of the urinary tract has been extensively studied. It is characterized by gas production within the urinary tract. The gas may often pass outside the urinary tract. Patients with this disorder invariably have uncontrolled diabetes mellitus and pos sibly associated obstructive uropathy. It is usually caused by aerobic bacteria, most commonly Escherichia coli. In the literature, the majority of cases were emphy sematous pyelonephritis alone or emphysematous cystitis separately. Bilateral renal involvement associated with emphysematous cystitis is very rarely seen and no case was reported yet in Korea. We report a case of bilateral emphysematous pye lonephritis and emphysematous cystitis which occured in 48-year-old diabetic patient simultaneously. It was caused by E. coli. The patient was cured by medical management alone.