A Case of Crescentic IgA Nephropathy with Positive ANCA Serology / 대한신장학회지

Immunoglobulin A (IgA) nephropathy in patients with the clinical findings of rapidly progressive glomerulonephritis usually demonstrate crescentic glomerulonephritis (CrGN). It is characterized by mesangial immune complex deposits containing IgA and is rarely associated with ANCA. The following case report illustrates a CrGN with mesangial & capillary wall IgA deposits by immunofluorescence (IF) and mesangial & endocapillary electron dense deposits by electron microscopy (EM) in patient with positive ANCA serology. A 54-year-old male visited due to the discomfort of right flank. Blood pressure was 150/90 mmHg. BUN and serum Creatinine was 40 mg/dL, 4.4 mg/dL respectively. Urinalysis revealed protein 2+, >30 RBC's/ HPF (dysmorphic), 24hr urine protein 1,612 mg/day and creatinine clearance 19 mL/min/1.73m2. Serological P-ANCA was positive by indirect immunofluorescence & ELISA. The histologic findings showed global scleorsis and fibrocelluar crescent without hypercellularity on LM, mesangial IgA deposition on IF, mesangial and subendothelial electrone dense material depositions on EM. After treatment (Methylprednisolon 500 mg/day for 3 days and then prednisolone 60 mg/day), Serum creatinin level, proteinuria and ANCA titer were decreased.

Experimental Study on Optimal Duration of Intermittent Hepatic Vascular Clamping / 한국간담췌외과학회지

BACKGROUND/AIMS: During partial liver resection, intermittent hepatic pedicle clamping results in less hepatocyte damage than continuous clamping. However, the optimal duration of ischemia and reperfusion during the intermittent hepatic vascular clamping has not been determined. So, this study aimed to determine the optimal duration of ischemia and reperfusion. METHODS: Using partial ischemia(70%) rat model, the maximum limit of ischemic time and minimum limit of reperfusion time were evaluated. To assess the maximum limit of ischemic time, rats were divided into three groups for 15, 20, and 30 minutes of ischemia followed by 60 minutes reperfusion. To assess the minimum limit of reperfusion time, reperfusion following 15-minute ischemia was repeated 10 times in three groups for 5, 10, and 15 minutes of reperfusion. In the ischemic experiments, hepatic blood flow and ATP levels were serially measured. In the reperfusion experiments, serum liver enzyme, 1-month survival rates, as well as, hepatic blood flow and ATP level were serially measured and then, the 1-month survival rate was compared between the continuous ischemic group and intermittent ischemic groups. RESULTS: (1) In the 15- minute ischemic group, the hepatic blood flow and ATP levels returned to preischemic values after 1 hour of reperfusion. But in the 20- or 30-minute ischemic groups, the hepatic blood flow and ATP levels did not return to preischemic values. (2) In the 15-minute reperfusion group, the survival rate and hepatic function, such as hepatic blood flow and ATP levels, were better than the 5- or 10-minute reperfusion groups. CONCLUSION: In 70% partial ischemic rat model, the maximum limit of ischemic time was 15 minutes. In cases of intermittent ischemia and reperfusion, there was less liver damage in the 15-minute reperfusion group compared to the 5- or 10-minute reperfusion groups.