Pyeloduodenal Fistula Successfully Treated By Endoscopic Ligation without Surgical Nephrectomy: Case Report

A 74-yr-old woman presented with fever and abdominal discomfort. She was in a septic condition caused by urinary tract infection. Her computed tomogram of the abdomen revealed features of hydronephrosis with ureteral stones in both kidneys. During percutaneous nephrostomies, right pyeloduodenal fistula (PDF) was diagnosed. Elective surgery was originally planned but the patient was in a poor condition to undergo surgery. Instead, 2 times endoscopic clipping and ligation by endoloop were applied with parenteral antibiotics for the fistula lesion. On admission day 30, she was discharged from the hospital after confirmation of no more contrast leakage on fistulography. We reviewed the literature and discuss the etiologies, clinical presentations, diagnosis, and treatment of PDF.

Corrigendum: Use of low-dose sulodexide in IgA nephropathy patients on renin-angiotensin system blockades Volume 31, Issue 3, September 2012, Pages 163-169

The authors regret that, in the above article, one of the co-authors' names was incorrectly printed. It is now reproduced correctly above.

Use of low-dose sulodexide in IgA nephropathy patients on renin-angiotensin system blockades

BACKGROUND: Despite using renin-angiotensin system (RAS) blockades, some of the patients with immunoglobulin A (IgA) nephropathy often had persistent proteinuria of more than 500mg/d. They need to be managed further by alternative methods to halt the progression of the disease; these methods could also be applied safely over a long period of time. In this context, sulodexide has been studied for the management of diabetic nephropathy. METHODS: A retrospective review was carried out involving 20 patients with IgA nephropathy who had been taking sulodexide (50mg daily) as an add-on therapy together with an optimal dose of RAS blockades during 2008-2009. We evaluated the proteinuria reduction rates and renal function changes. RESULTS: During 11.1+/-72.7 months of follow-up duration, urinary protein-to-creatinine ratio (UPCR) decreased for 1.57+/-0.6 to 1.17+/-0.7 g/g (P=0.032). Twenty-five percent of the patients showed a greater than 50% reduction of UPCR, and 40% had a UPCR of less than 1.0g/g at their final observations. The analysis of the factors contributing to the effect found that a higher pretreatment UPCR showed a significant correlation with the UPCR decrease (r=0.45, P=0.047). Neither the adverse effects nor the renal function impairments were documented during the management. CONCLUSION: Low-dose sulodexide has an additional modest antiproteinuric effect on IgA nephropathy undergoing RAS blockade therapy.

Factors determining renal function in Korean patients with autosomal dominant polycystic kidney disease / 대한내과학회지

BACKGROUND/AIMS: Previous studies of autosomal dominant polycystic kidney disease (ADPKD) in Koreans have been predominantly cross-sectional and insufficient to elucidate factors determining renal function. METHODS: We retrospectively reviewed the medical records of 60 patients who were diagnosed with ADPKD in our hospital from 1995 to 2005. We surveyed the basal characteristics, symptoms, signs, blood and urine laboratory findings, radiologic extrarenal abnormalities, and kidney length through ultrasonography, and these measures were analyzed to identify their relationship to decreased renal function. RESULTS: The clinical characteristics, such as symptoms and signs, were similar to those reported previously. Following t-tests and simple regression analyses, the statistically significant variables related to renal function deterioration were as follows: hypertension (with decreased renal function, 2.5 mL/min/1.73 m2/year more rapidly than the no-hypertension group, p=0.006), hypercholesterolemia (p=0.007), hypernatremia (p=0.011), mean kidney length (beta=0.378, p=0.029), and albumin (beta=-2.067, p=0.003). The multiple regression analysis revealed that the significant factors were hypertension (beta=0.261, p=0.016), mean kidney length (beta =0.211, p=0.047), and hypernatremia (beta=0.244, p=0.024). CONCLUSIONS: The independent risk factors for deteriorating renal function in Korean patients with ADPKD were hypertension, hypernatremia, and mean kidney length.

Acute Kidney Injury due to Menstruation-related Disseminated Intravascular Coagulation in an Adenomyosis Patient: A Case Report

The authors report a case of acute kidney injury (AKI) resulting from menstruation-related disseminated intravascular coagulation (DIC) in an adenomyosis patient. A 40-yr-old woman who had received gonadotropin for ovulation induction therapy presented with anuria and an elevated serum creatinine level. Her medical history showed primary infertility with diffuse adenomyosis. On admission, her pregnancy test was negative and her menstrual cycle had started 1 day previously. Laboratory data were consistent with DIC, and it was believed to be related to myometrial injury resulting from heavy intramyometrial menstrual flow. Gonadotropin is considered to play an important role in the development of fulminant DIC. This rare case suggests that physicians should be aware that gonadotropin may provoke fulminant DIC in women with adenomyosis.

A Case of Metastatic Gastric Calcification in Acute Renal Failure / 대한신장학회지

In end stage renal disease, the precise mechanism of metastatic calcification remains unclear, except that it occurs with hyperphosphatemia, increased Ca x P product, and secondary hyperparathyroidism. It involves various organs such as lung, eye, stomach, kidney, and so on. A 62-year-old male patient, who had acute renal failure (ARF), developed gastric calcification in our institution. The ARF had been result of membranoproliferative glomerulonephritis (MPGN), and the metastatic calcification seemed to be caused by increased Ca x P product and hyperphosphatemia. This case shows that metastatic calcification could arise even in ARF.

Post-treatment Effects of Erythropoietin and Nordihydroguaiaretic Acid on Recovery from Cisplatin-induced Acute Renal Failure in the Rat

5-Lipoxygenase inhibitor and human recombinant erythropoietin might accelerate renal recovery in cisplatin-induced acute renal failure rats. Male Sprague-Dawley rats were randomized into four groups: 1) normal controls; 2) Cisplatin group-cisplatin induced acute renal failure (ARF) plus vehicle treatment; 3) Cisplatin+nordihydroguaiaretic acid (NDGA) group-cisplatin induced ARF plus 5-lipoxygenase inhibitor treatment; 4) Cisplatin+erythropoietin (EPO) group-cisplatin induced ARF plus erythropoietin treatment. On day 10 (after 7 daily injections of NDGA or EPO), urea nitrogen and serum Cr concentrations were significantly lower in the Cisplatin+NDGA and Cisplatin+EPO groups than in the Cisplatin group, and 24 hr urine Cr clearances were significantly higher in the Cisplatin+EPO group than in the Cisplatin group. Semiquantitative assessments of histological lesions did not produce any significant differences between the three treatment groups. Numbers of PCNA(+) cells were significantly higher in Cisplatin, Cisplatin+NDGA, and Cisplatin+EPO groups than in normal controls. Those PCNA(+) cells were significantly increased in Cisplatin+NDGA group. These results suggest that EPO and also NDGA accelerate renal function recovery by stimulating tubular epithelial cell regeneration.

Effects of Celecoxib and Nordihydroguaiaretic Acid on Puromycin Aminonucleoside-Induced Nephrosis in the Rat

The selective cyclooxygenase-2 (COX-2) and 5-lipoxygenase (LOX) inhibitors might inhibit prostaglandin synthesis and reduce proteinuria. The present study was designed to investigate the anti-proteinuric effects of nordihydroguaiaretic acid (NDGA) as compared with celecoxib in puromycin aminonucleoside (PAN) nephrosis rats. Fifty five male Sprague-Dawley rats were divided into 4 groups; A, normal control; B, PAN group; C, PAN+COX-2 inhibitor (celecoxib) group; and D, PAN+5-LOX inhibitor (NDGA) group. After induction of PAN nephrosis through repeated injections of PAN (7.5 and 15 mg/100 g body weight), rats were treated with celecoxib, NDGA, or vehicle for 2 weeks. Twenty four hour urine protein excretions were significantly lower in PAN+celecoxib and PAN+NDGA groups than in PAN group. Serum creatinine (SCr) concentrations and 24 hr urine creatinine clearances (CCr) were not significantly different in the four groups. Electron microscopy showed that podocyte morphology was changed after the induction of PAN nephrosis and was recovered after celecoxib or NDGA administration. Celecoxib significantly recovered the expressions of nephrin, CD2AP, COX-2, and TGF-beta. NDGA also recovered TGF-betaexpression, but did not alter the expressions of nephrin, CD2AP and COX-2. The present study suggested that celecoxib and NDGA might effectively reduce proteinuria in nephrotic syndrome without impairing renal function.

15-Deoxy-Delta(12,14)-Prostaglandin J2 and Proinflammatory Cytokines in IgA Nephropathy / 대한신장학회지

PURPOSE: This study was performed to demonstrate a correlation among urinary 15d-PGJ2, proinflammatory cytokines (i.e. IL-23, IL-6, and TGF-beta1), and CRP, and to determinate the contributors to prognostic score and proteinuria in IgAN patients. METHODS: Fifty-four patients with biopsy-proven IgAN were enrolled. For comparison with IgAN, five MCD patients were also enrolled. Immunohistochemical staining for PPAR-gamma in kidney tissue and measurements of urinary IL-6, IL-23, TGF-beta1, 15d-PGJ2 and serum CRP were performed RESULTS: There was no difference according to PPAR-gamma staining. 15d-PGJ2 was negatively correlated with urinary IL-23, TGF-beta1, and CRP. Among proinflammatory cytokines and CRP, there were positive relationships with each other except for IL-23 and CRP. TGF-beta1 in the group having proteinuria more than 3 g/day was statistically higher than that in the sole hematuria group. However, in multivariate regression analysis, not a single relation was found between TGF-beta1 and proteinuria. Prognostic score was correlated with IL-6, IL-23, TGF-beta1, CRP, 15d-PGJ2, and 24hr proteinuria. 24hr proteinuria was correlated with IL-6 and 15d-PGJ2. In multivariate regression analysis, CRP, 15d-PGJ2, and 24hr proteinuria contributed to prognostic score, and only 15d-PGJ2 contributed to 24hr proteinuria. Last, urinary 15d-PGJ2 in IgAN was higher than that in MCD. CONCLUSION: Endogenous 15d-PGJ2 was associated with inflammation and might be considered as a material which could delay the damage of kidney in IgAN. In the future, larger cohort and long-term follow-up studies are needed to demonstrate the role of 15d-PGJ2 as prognostic indicator or marker of kidney damage.

'Rescue Therapy' with Mycophenolate Mofetil in Non-transplant Renal Disease Patients Experienced Conventional Immunosuppressive Treatments : Clinical Observation / 대한신장학회지

PURPOSE: Mycophenolate mofetil (MMF) is thought to have not only low frequency of adverse side effects but also have equal efficacy to other conventional immunosuppressants (CIS). But It's hard to conclude that CIS may be replaceable with MMF. So we inquired into another aspect of MMF as 'Rescue therapy' in non-transplant renal diseases. METHODS: Twenty nine patients with non-transplant renal diseases received MMF therapy between January 2000 and April 2007. Eighteen patients who had received MMF more than 6 months were included. Sixteen of the 18 patients included were resistant to CIS and two were patients who maintained complete remission (CR) with MMF because of the adverse side effects of CIS. Treatment outcome was evaluated by dip-stick urine test. CR was defined by negative or trace, partial remission (PR) by 1 positive and treatment failure (TF) by more than 1 positive. RESULTS: Eleven of the resistant 16 patients had shown CR (69%) and maintained CR. Two of maintenance therapy with MMF had kept CR more than 12 months. The proportions of the patients who had shown decreased proteinuria in each treatment duration were 69% for 3 months (p=0.005), 81% for 6 months (p=0.001), 86% for 9 months (p=0.002) and 91% for 12 months (p=0.004), respectively. There were few adverse effects. CONCLUSION: We observed the efficacy of MMF in decreasing proteinuria and maintaining CR as 'Rescue therapy' for previously treated non-transplant renal disease patients with CIS. Large controlled clinical trials are expected for defining this effect.

A comparative study of the clinical features and hematobiochemical indices between the lung-uptake group and the non-lung-uptake group of malarial patients undergoing liver scanning / 대한내과학회지

BACKGROUND: Lung uptake during liver scanning has been considered as a passing phenomenon related to several diseases, and especially infectious diseases and malignancy. Some reports have shown diffuse lung uptake during liver scanning of malarial patients. Therefore, we tried to determine the relationship between the abnormalities of the clinical features, including the hematobiochemical indices and the lung uptake during liver scanning, by analyzing the information of the malarial patients. METHODS: We performed 99mTechnethium(Tc)-sulfur colloid liver scanning on 20 of the 45 malarial patients who were admitted from 1999 to 2004. We divided them into two groups, the Lung-Uptake (LU) group and the Non-Lung-Uptake (NLU) group. We analyzed the hematobiochemical indices and clinical features, including the respiratory symptoms, between the two groups. RESULTS: 10 of the 20 malarial patients showed lung uptake on the liver scan. The mean platelet counts were 74,000/L and 165,000/L, respectively, in the LU group and the NLU group (p=0.012). Also, the mean total cholesterol levels were 80.3 mg/dL and 105.7 mg/dL, respectively, in the LU group and the NLU group (p=0.033). The scores ofthe bone marrow (BM) uptake in the LU group were higher than those in the NLU group (p=0.008). Yet the other values such as Hb, ALT, albumin and total bilirubin were not statistically significant, nor were the peak body temperatureand other features. CONCLUSIONS: Half of the patients had lung uptake on the liver scanning, and this may be considered as a characteristic of vivax malaria. The BM uptake during liver scanning in the LU group was more increased, and this is supposed to be a consequence of hyperstimulated reticuloendothelial system, which was accompanied by thrombocytopenia and a lower level of total cholesterol in malarial patients.