Metabolism of Reactive Oxygen Species in Neutrophils from Patients with End-Stage Renal Disease / 대한신장학회잡지

BACKGROUND: The present study was aimed to know the cause of impaired bactericidal activity, especially the metabolism of oxygen free radicals in neutrophils from patients with end-stage renal disease (ESRD). METHODS: We measured the amount of superox ide anion, the activity of three antioxidant enzymes, myeloperoxidase, copper ion level, zinc ion level and the amount of malondialdehyde in neutrophils from patients with ESRD before and after hemodialysis. Reverse transcription-polymerase chain reaction (RT-PCR) for superoxide dismutase (SOD) was also done. RESULTS: The malondialdehyde level, the amount of superoxide anion, catalase, and myeloperoxidase levels in the neutrophils from the patients with ESRD were higher than those from healthy controls. SOD activity, hydrogen peroxide level and zinc level were lower in ESRD patients. On the RT-PCR, the relative index, which is defined the ratio of the band densities for SOD to glyceraldehyde 3-phosphate dehydrogenase, was decreased in neutrophils from patients with ESRD. Glutathione peroxidase activity in the neutrophils from ESRD patients did not show any significant change. CONCLUSION: These results indicate that there are some alterations in metabolism of oxygen free radicals including lower levels of hydrogen peroxide which exerting a direct germicidal ability, due to decreased gene expression and mineral levels. And these alterations might be one of the major mechanisms of impaired microbicidal activity in patients with ESRD.

Rapidly Progressive Glomerulonephritis -A Review of 26 Cases- / 대한신장학회잡지

OBJECTIVES: Rapidly progres s ive glomerulonephritis (RPGN) is a clinico- pathologic entity characterized by extens ive crescent formation(usually involving 50% or more of glomeruli) as the principal his tologic finding and a rapid deterioration of kidney function, which can lead to end s tage renal disease within a few weeks. T he etiology and incidence of RPGN has been well defined in Europe and North America, however, there has been no report of a large series in Korea. T he aim of the present s tudy was to analyze the etiology and clinico- pathologic features of 26 patients with RPGN, seen during 1983-1997. METHODS: T wenty-six patients with RPGN(crescents in > 50% of glomeruli) were obs erved during a period of las t 14 years. Male to female ratio was 1:1.4, and the mean age was 30(6-75) years. Mean time from the initial symptoms to the ESRD was 3.1 months . RESULTS: The incidence of RPGN in our series was 2.1% of primary glomerulonephritis. Immunecomplex mediated disease was presented in 14 cases (54%), including 6 sys temic lupus erythematos us, 3 post- streptococcal glomerulonephritis, 3 Henoch- Schonlein purpura, and 2 IgA nephropathy. Pauci- immune disease was presented in 12 cases (46%), including 3 Wegener' s granulomatos is, one necrotizing crescentic glomerulonephritis, and 8 idiopathic crescentic glomerulonephritis. However, there was none of anti-GBM- mediated disease in our s tudy. ANCA were found in 6 patients. All 3 patients with WG were C- ANCA pos itive, whereas one patient with PSGN, necrotizing cres centic GN, and idiopathic crescentic GN were P- ANCA pos itive, respectively. Initial clinical and laboratory features included edema(80%), hypertens ion(72%), oliguria(68%), a decreased renal function(serum creatinine > 5mg/dL, 35%), and gros s hematuria(36%). Renal biopsy showed large crescents more than 80% of the glomeruli in 14 cases (54%) which were predominantly fibrocellular. Fifteen patients (58%) were treated with prednis olone alone, and 12 of them received puls e doses of corticosteroids. Five patients were treated with prednisolone and cyclophos phamide IV pulse. Two cases received plasma exchange. During the mean follow-up of 31+/-37 months, 18 patients (69%) developed inexorable progression of renal failure, three(12%) showed recovery of renal function, and two(8%) showed partial improvement, which is followed by varying degrees of renal insufficiency. During follow-up, three patients died : two from res piratory failure with severe pulmonary hemorrhage and one from opportunistic pulmonary infection during immunosuppressive therapy. Poor prognos is is as sociated with hypertension, increased serum creatinine level at the time of diagnosis, large crescents more than 85% of glomeruli, and glomerular scleros is . CONCLUSION: We conclude that an earlier diagnos is including kidney biopsy and the more aggressive treatment are essential in the management of RPGN.

Effect of Cu Zn Levels on Superoxide Dismutase Activity in Erythrocytes from Patients with end Stage Renal Disease / 대한신장학회잡지

Suppressed superoxide dismutase activity, which is responsible for the dismutation of superoxide anion to hydrogen peroxide, is known to be one of the factors leading to lipid peroxidation in the erythrocyte membrane structures in the patients with end stage renal disease. In this study, copper and zinc levels were determined in the erythrocytes and plasma from 14 hemodialysis patients to explain the decreased activity of superoxide dismutase in erythrocytes. Before dialysis, superoxide dismutase, copper and zinc levels in erythrocytes were lower than those from healthy controls. Superoxide dismutase activity was normalized perfectly after hemodialysis. Copper level in the erythrocytes was normalized after hemodialysis, but its level was still lower than that in healthy controls. Zinc level in the erythrocytes was not changed after hemodialysis. Before hemodialysis, copper and zinc levels in plasma were higher than those from healthy controls. Copper level in the plasma was higher after hemodialysis than before hemodialysis. Zinc level in the plasma was not changed after hemodialysis. It is suggested that copper levels in erythrocytes from patients with hemodialysis affects partially to the superoxide dismutase activity, and superoxide dismutase activity is influenced more by copper levels than by zinc levels during hemodialysis.

Post-Biopsy Arterio-Venous Fistula: Color Doppler Sonography in Evaluation of Its Incidence and Evolution / 대한신장학회잡지

Arteriovenous fistulae(AVF) are well documented complications of percutaneous renal biopsy. Between August 1995 and April 1997, we prospectively studied 280 consecutive ultransound-guided percutaneous renal biopsies to evaluate the incidence of post-biopsy AVF and its natural course. All biopsies patients were monitored through a routine follow-up echo-color popple sonography at post-biopsy 1, 7, 14 and 30 days. The 28 patients(10%) out of 280 consecutive percutaneous renal biopses were diagnosed to have AVF. There was no differences in the incidence of AVF between native and transplanted kidney biopsy. Most AVF were small(<2cm) and caused minimal or no symptoms. AVF was accompanied with large hematoma(thickness above 2cm) was observed in 9 cases(53%) of 17 native kidneys and none in 10 transplanted kidneys. This difference was statistically significant(P=0.008). At follow-up, AVF resolved spontaneously in 24 cases(87%). In two patients(7.1%) required superselective arterial embolization, one develoved spontaneous rupture of AVF, and one had persistence of AVF over 12 months. We concluded that color Doppler sonography provides a good, non-invasive and safe method for diagnosis and follow up of post-biopsy AVF.

Three Cases of Lupus enteritis: Response to Steroid Therapy / 대한류마티스학회지

Systemic lupus erythematosus is a systemic disorder which has frequent involvement of gastrointestinal tract. Non specific symptoms such as anorexia, nausea, diarrhea and abdominal pain are well known symptoms when the gastrointestinal tract is involved. The most feared gastrointestinal complication of systemic lupus erythematosus is lupus enteritis. The pathological change in lupus enteritis is usually a result of mesenteric vasculitis. Major complications such as intestinal bleeding and perforation may occur and sometimes result in sugery. Because of high mortality rate in case of major complications, early diagnosis and appropriate treatment is very important. We experienced three patients with lupus enteritis who presented with severe abdominal pain and dirrhea. They were diagnosed by characteristic radiographical findings of small bowel series and barium study. All radiographical findings has been resolved completely with the steroid therapy. Conclusively we can induce complete remission by steroid therapy alone, if we diagnose lupus enteritis in the early period of disease course.