A Case of Systemic Lupus Erythematosus Associated with Marked Intracranial Calcification / 대한류마티스학회지

Systemic lupus erythematosus (SLE)is a disease of unknown etiology in which tissues and cells are damaged by pathogenic autoantibodies and immune complexes.The central nervous system may be involved in 25~75%of patients. Neuropsychiatric manifestations of SLE include psychosis,affective disease, seizure,stroke.The main brain CT and MRI findings consisted of diffuse brain atrophy,infarction,hemorrhage.Intracranial calcification in a patient with SLE has been rarely reported.We experienced a patient with SLE who present marked intracranial calcification.

A Case of Acute Renal Failure Caused by Toxic Epidermal Necreolysis Combined with Rhabdomyolysis in A Patient with Idiopathic Hypoparathyroidism / 대한신장학회잡지

Idiopathic hypoparathyroidism is extremely rare disease. We experienced an interesting case of idiopathic hypoparathyroidism associated with acute renal failure caused by toxic epidermal necrelysis combined with rhabdomyolysis. This 36-years-old male patient was suffered from bullous erythematous scalding skin lesion on lower extremity, back, and chest. After 10 days, he was admitted with the chief complaints of generalized seizure, carpopedal spasm, stuporous mentality. Skin biopsy showed edematous change with extravasated erythrocytes in upper dermis and several individually necrotic keratinocytes. On laboratory finding, marked decreased serum PTH level were demonstrated. Increased muscle uptake of technetium-99m MDP were noticed on bone scan. Prolonged Q-T interval on electrocardiogram was also noted. We could diagnose his disease as severe hypocalcemia(hypocalcemic crisis) developed associated with acute renal failure caused by toxic epidermal necrolysis combined with rhabdomyolysis in patient with idiopathic hypoparathyroidism. He was treated by hydration, urine alkalinization, 2 times of hemodialysis and supplementary calcium, vitamin D during the admission.

Analysis of Risk Factors and Prediction of Mortality in Acute Renal Failure / 대한내과학회지

OBJECTIVES: Over the last 30 years, despite the increasing sophistication in medical care, the mortality of acute renal failure(ARF) has remained virtually unchanged at 40-50%, but the reasons remain unknown. This study intend to identify prognostic risk factors influencing survival and predict the mortality in ARF patients. METHODS: We retrospectively analyzed 152 patients with ARF who required renal replacement therapy, or whose serum creatinine level above 5 mg/dl, from Jan. 1988 to May. 1995. Multiple factors which may influence mortality were evaluated by univariate and multivariate analysis. RESULTS: 1) Of the 152 patients, 97 were male and 55 were female. The mean age was 47 years and the overall mortality was 36.8%. 2) Based on the univariate analysis, age>60 years, cause of ARF, APACHE II score, number of failing organs, peak serum creatinine level, PaO2, coma, hypotension, ARDS, GI bleeding, ventilatory support, need for antiarrhythmics, DIC, cardiovascular failure, pulmonary failure, neurological failure, and gastrointestinal failure were all significant factors discriminating between survivors and nonsurvivors(p<0.05) 3) By multivariate analysis, hypotension, coma, ventilatory support, and age over 60 years were significant independent predictors influencing survival in ARF patients and logistic equation and logit score were as follows : z=-2.04+1.32(age over 60)+2.18(hypotension)+2.88 (ventilatory support) + 3.28(coma) P=ez/(1+ ez) 4) In ROC(receiver-operating characteristic)curve, when the cutoff point was 0.2, maximum sensitivity was 75% and maximum specificity was 82%. CONCLUSION: In ARF, prognostic risk factors for mortality were age over 60 years, hypotension, assisted ventilation and coma. The logit score by multiple analysis is a reliable predictor of mortality in ARF patients, however the further studies are required to confirm these results.