The Impact of Intima-media Thickness of Radial Artery on Early Failure of Radiocephalic Arteriovenous Fistula in Hemodialysis Patients

This study was performed to investigate the impact of intima-media thickness (IMT) of radial artery on early failure of radiocephalic arteriovenous fistula (AVF) in hemodialysis (HD) patients. Ninety uremic patients undergoing radiocephalic AVF operation were included in this study. During the operation, 10-mm long partial arterial walls were removed with elliptical form for microscopic analysis. Specimens were stained with trichrome and examined by a pathologist blinded to the clinical data. And then AVF patency was followed up for 1 yr after the operation. Of the total 90 patients, 31 patients (34%) had AVF failure within 1 yr after the operation. Mean IMT was thicker in failed group (n=31) than in patent group (n=59) (486+/-130 micrometer vs. 398+/-130 micrometer, p=0.004). The AVF patency rate within 1 yr after the operation was lower in patients with IMT > or = 500 micrometer (n=26) than in patients with IMT <500 micrometer (n=64) (p=0.017). Age was an independent risk factor of IMT. Diabetes mellitus tended to be independent risk factor but not statistically significant. Our data suggest that increased radial artery IMT is closely associated with early failure of radiocephalic AVF in HD patients.

A Case of ANCA-positive Crescentic Glomerulonephritis after Propylthiouracil Treatment in Graves' Disease / 대한신장학회잡지

Propylthiouracil (PTU) therapy is commonly used in the treatment of Graves' disease, but often accompanies several side effects, including a mild increase in liver enzymes, leukopenia, skin rash, and arthralgia. ANCA-positive vasculitis and crescentic glomerulonephritis have been rarely reported in patients suffering from (with) Graves' disease and treated with PTU. We experienced a rare case of ANCA-positive crescentic glomerulonephritis presenting rapid progressive renal failure in a 30-year-old woman, suffering from Graves' disease and treated with PTU for 6 years. She was admitted with dyspnea for 1 day and fever, gross hematuria, arthralgia and sore throat for several days. Her chest X-ray revealed moderate cardiomegaly, bilateral pulmonary edema, and bilateral pleural effusion. She had a palpable, firm, diffuse goiter. Anti-myeloperoxidase (anti-MPO) antibody and anti-protease 3 (anti-PR3) antibody were both positive by ELISA. A percutaneous renal biopsy showed crescentic golmerulonephritis showing active cellular crescent formation with some inflammatory cell infiltration and mesangial cell proliferation. Cellular crescents were present in 2 of 3 glomeruli. Immunofluorescence stain showed weak granular deposits of IgG, IgM and C3 in the mesangium and capillary wall. ANCA-positive crescentic glomerulonephritis associated with PTU was diagnosed. The patient was started on intravenous methylprednisolone 250 mg 2 times daily, and then oral prednisolone 100 mg every other day and PTU was discontinued. Her renal function was recovered gradually and anti-MPO antibody and anti-PR3 antibody subsequently fell. Second biopsy, 7 months after first biopsy, showed focal global glomerulosclerosis. 16 months after first biopsy. she had stable renal function with mild renal insufficiency and euthyroid state.

A Case of Idiopathic Nodular Glomerulosclerosis Presenting Rapid Progressive Renal Failure / 대한신장학회잡지

Idiopathic nodular glomerulosclerosis is an unusual entity with histopathologic features resembling nodular diabetic glomerulosclerosis but occurs in non diabetic patients and predominantly in older males with smoking and long standing hypertension. It is characterized histologically by nodular mesangial sclerosis, glomerular basement membrane thickening, and arteriolosclerosis in the absence of immune-type deposit, and clinical presentations typically include renal insufficiency and severe proteinuria with relatively poor prognosis. We experienced a rare case of idiopathic nodular glomerulosclerosis presenting rapid progressive renal failure in a 42-year-old man without clinical evidence of diabetes. He was admitted with peripheral edema and renal insufficiency. He had a history of hypertension for 2 years and chronic hepatitis B for 5 years. Funduscopy and renal ultrasound were normal. HbA1c and oral glucose tolerance test were normal and on serum and urine electrophoresis, M-spike was not found. Light microscopic examination demonstrated the characteristic features of lobular glomerulonephritis showing glomerular hypertrophy and nodular mesangial sclerosis. Immunofluorescence was negative for immune-type deposits. Electron microscopy showed marked increase of mesangial matrix, mesangial cell proliferation, moderate effacement of foot processes, and glomerular basement thickening without electron-dense deposits or other specific fibrils. Idiopathic nodular glomerulosclerosis was diagnosed. After discharge, he continued smoking and his blood pressure was not controlled. Three months after first biopsy, second biopsy was performed because of increasement of serum creatinine and specimens showed progression of tubulointerstitial change and nodular mesangial sclerosis. Subsequent serum creatinine was progressively increased and hemodialysis was started 13 months after diagnosis.

Long-term Effect of Prostaglandin E Analog(Misoprostol) on Blood Pressure, Cyclosporine Dosage and Allograft Function / 대한신장학회잡지

Prostaglandin(PG) E has been shown to affect renal function by influencing renal blood flow and perfusion pressure and to have immunosuppressive properties. Positive effects of PG-E on kidney allograft hemodynamics and function have previously been, but not without controversy. This study was therfore designed to evaluate the long-term effect of misoprostol on blood pressure, CsA level, graft survival, renal function and histological change in first- time renal transplant recipients treated with cyclosporine. Eighty kidney transplant(KT) recipients were randomly se parated into three groups according to the duration of misoprostol treatment. Group C(n=50) was control; group M1(n=13) recieved misoprostol for less than 6 months and group M2(n=17) for more than 6 months after KT. The results were as follows. 1)Serum CsA levels at 24 months after KT were not significantly different among the three groups [groupC 167+/-58ng/ml; group M 163+/-75ng/ml (group M1 171+/-70ng/ml, group M2 155+/-81ng/ml)]. Group M2 required higher dosage of CsA than group C or M1 to maintain the proper serum levels (group M2 4.27+/-1.07mg/kg/day vs. group C 4.04+/-0.90mg/ kg/day or group M1 4.08+/-1.03mg/kg/day). But these results were not statistically significant. 2) Mean arterial pressures at 24 months after KT were not different among the groups[group C 101+/-11 mmHg; group M 103+/-10mmHg(group M1 108+/-11 mmHg, group M2 100+/-7mmHg)]. 3) Incidence of acute rejection was no different between group C(10 cases; 20%) and group M(12 cases; 40%). 4) Serum creatinine levels at 24 months after KT were not significantly different among the groups [group C 1.30+/-0.37mg/dl; group M 1.43+/-0.41mg/dl (group M1 1.51+/-0.47mg/dl, group M2 1.36+/-0.37mg/ dl)]. 5) Routine biopsy of transplanted kidney performed at 2 weeks after KT showed more abnormal findings in group C(9 cases; 49%) than group M(4 cases; 28.5%), but there was no statistical significance. In conclusion, long-term misoprostol treatment in renal transplant recipients was not effective in preventing the acute rejection, maintaining the renal fucntion, and decreasing blood pressure. Still, studies in patients receiving CsA are needed to determine the effect of misoprostol in CsA bioavaility and the histologic change of graft kidney.

Relationship between IgA nephropathy and Histocompatibility Antigens (HLA) in Korean Population / 대한내과학회지

OBJECTIVES: Primary IgA nephropathy(IgAN), currently recognized as the most prevalent form of glomerular disease in the world, has tendency toward end stage renal failure at a rate of 20-30% in patients after a long-term follow-up of more than 20 years. But its etiology and pathophysiology is not fully understood. This study was designed to evaluate the pattern of histocompatibility antigens(HLA) and its association with poor prognostic factors in patients with IgAN. METHODS: Study population comprised the 69 patients with IgAN which was diagnosed by clinical and pathological findings, and control groups were 202 healthy Korean people. We evaluated the HLA class I serologic typing by standard microlymphocytotoxic technique and the HLA class II genotypes by the two-step polymerase chain reaction. RESULTS: 1. HLA-A was not associated with IgAN. 2. The phenotype frequency of HLA-B55 was 6.1% in patient group and 1.7% in normal control group. HLAB55 was associated with IgAN(relative risk 3.47, P<0.05). 3. HLA-DQB1*04 was also associated with IgAN (relative risk 3.57, P<0.05). 4. There was no significant difference in the distribution of HLA in IgAN patients according to histologic grading, blood pressure, renal function and proteinuria. CONCLUSIONS: Frequencies of HLA-B55, HLA-DQB1 *04 are higher in Korean patients with IgAN compared to general population. But we could not observe the significant relationships between HLA type and poor prognostic factors. Further study using larger population with IgAN may be necessary to identify the association of HLA locus with poor prognostic factors and progress decline in renal function in patients with IgAN.

The Relationship between Sleep c-fos Protein in Hypothalamus in Chronic Uremic Rats / 대한신장학회잡지

The activation of c-fos protein (FOS) in ventrol- ateral preoptic neuron (VLPO) induces sleep (Science 271; 216-219, 1996). Although sleep disturbance are very common in patients with chronic renal failure, its mechahanism of sleep disturbance is not clear. The purpose of this study was to evaluate sleep dissturbance and expression of FOS in VLPO of chronic uremic rats. Chronic uremic rats were induced by 5/6 nephrectomized rnodel. After 4 weeks, blood urea nitrogen and serum creatinine in uremic rats (n=14 were higher than in control (n=17) (blood urea nitrogen; 73.6+/-24.8 mg/dl vs. 23.3+/-2.9 mg/dl, P<0.001 serum creatinine', 1.49+/-0.42 mg/dl vs. 0.66+/-0.12 mg/dl, P<0.001). General activity was counted with infrared during day time (08:00-20:00) and night time (20:00-08:00). Rats were killed at 10:00 or 16:00 during day time (uremic rats 7, control 9) and at 22:00 during night time (uremic rats 7, control 7). The expression of FOS in VLPO was examined with immunohistochernical method. The number of day tirne general activity in uremic rats was significantly higher than in control (458+/-185 vs. 222+/-41, P<0.001), and the number of night time general activity in uremic rats was lower than in control (949+/- 430 vs. 1618+/-261, P<0.001). During day time, the number of FOS immunoreactive cell in uremic rats was lower than in control (18.4+/-5.3 vs. 42.8+/-6.3, P<0.001), but there was no difference between 2 groups at night time (10.8+/-8.4 vs 12.5+/-5.1, P=0.62). There was strong negative correlation between the number of activity and the number of FOS immunoreactive cell in control (r= -0.93, P<0.001), but there was no correlation in uremic rats. This study shows that sleep disturbance in chronic uremic rats might be related to decrease of expression of FOS in VLPO.