Serum Adiponectin as a Predictor for Cardiovascular Outcomes in Non-Diabetic End-Stage Renal Disease Patients / 대한신장학회지

PURPOSE: Adiponectin (ADPN) has been known to protect against cardiovascular disease (CVD) in metabolic syndrome with normal renal function for its anti-inflammatory and anti-atherogenic property. However, it is still unclear whether ADPN is associated with cardiovascular outcomes in end-stage renal disease (ESRD) patients. METHODS: This study included 80 non-diabetic ESRD patients [mean age, 52.8+/-13.7 years; dialysis duration, 67.1+/-52.0 months; hemodialysis (HD), 35 pts; peritoneal dialysis (PD), 45 pts] who survived for more than 3 months after the start of dialysis, and serum ADPN levels were measured at the beginning of the study. We conducted a longitudinal follow-up to evaluate the association of serum ADPN level with cardiovascular outcomes for 29.3+/-6.7 months. RESULTS: ADPN was inversely correlated with fasting serum insulin (r=-0.309, p=0.006) and HOMA-IR (r=-0.321, p=0.004) in ESRD patients. In a multiple linear regression analysis adjusted for age, gender, waist to hip ratio (WHR), and HDL-cholesterol, HOMA-IR (beta=-0.880, p=0.041) was an independent factor associated with serum ADPN level. Kaplan-Meier analysis revealed that patients with higher ADPN levels (> or =15.8 microgram/mL) had a significantly higher survival rate compared with lowers (<15.8 microgram/mL) (p=0.032). Cox proportional hazard model adjusted for age, WHR, creatinine, CRP, and previous CVD history revealed that serum ADPN level (HR, 0.899; 95% CI, 0.818-0.987; p=0.026) was an independent determinant of cardiovascular outcomes. CONCLUSION: These findings suggest that lower ADPN levels independently predict cardiovascular events in non-diabetic ESRD patients.

Cancer in Patients on Chronic Dialysis in Korea

The study of cancer in patients treated with dialysis in Korea has not been reported. The aim of this study was to investigate the incidence and mortality of cancer among patients on dialysis in Korea. The study subjects were 106 cancer patients (2.3%) out of 4,562 end-stage renal disease (ESRD) patients maintained on hemodialysis (HD) or peritoneal dialysis (PD) at Yonsei University Health System from 1996 to 2005. We excluded patients in whom the diagnosis of cancer preceded dialysis or those who received renal allograft or started dialysis after renal allograft. Seventy- three (69%) of our subjects were male and 33 (31%) were female. The mean age at the time of cancer diagnosis was 57.9+/-11.7 yr. The mean time from the start of dialysis to the diagnosis of cancer was 75.2+/-63.9 months. The most common cancer site was gastrointestinal tract (GIT) (51%) followed by urinary tract (20%), lung (8%), and thyroid (7%). Sixty nine percent of the total mortality was due to cancer. The mean time from diagnosis to death was 2.9+/-2.5 yr. In ESRD patients with cancer, there were no significant differences in mortality rates by dialysis modality. In ESRD patients, the most common cancer was GIT cancer followed by urinary tract cancer. Therefore, careful surveillance of these cancers in ESRD patients is highly recommended.

A comparison study between mycophenolate mofetil and cyclophosphamide for treatment of proliferative lupus nephritis / 대한내과학회지

BACKGROUND/AIMS: Our study aimed to evaluate the efficacy of MMF as compared with intravenous cyclophosphamide as induction therapy for proliferative lupus nephritis in Koreans. METHODS: Forty-three patients who were diagnosed with proliferative lupus nephritis (WHO Class III and IV) between Jan 2000 and Dec 2006 were included in this study. Nineteen patients were treated with oral MMF (initial dose: 1.0 g/day and then it was increased to 2.0 g/day) and 24 patients were treated with 0.75-1.0 g/m2 of monthly intravenous cyclophosphamide (CP) followed by subsequent treatment with oral corticosteroid (initial dose 1 mg/kg/day and then it was slowly tapered down) for 6 months. The demographic and laboratory findings, the response rate and the adverse events were reviewed retrospectively and these were compared between the two groups. RESULTS: A complete response occurred in 7 out of the 19 patients (36.8%) treated with MMF and in 8 out of the 24 patients (33.3%) treated with CP, and the difference was not significantly different between the two groups (p=0.66). A partial response was achieved in 52.6% and 45.8%, respectively. There were no significant differences of the laboratory findings such as serum albumin, C3, C4, the urine protein/creatinine ratio and serum creatinine after treatment for 6 months. In addition, both groups had similar rates of adverse events. CONCLUSIONS: Our study showed that for the treatment of lupus nephritis, MMF was as effective as IV cyclophosphamide with similar adverse events. This finding suggests that MMF could be an alternative treatment for active lupus nephritis as induction therapy.

Idiopathic Retroperitoneal Fibrosis Associated with Hashimoto's Thyroiditis in an Old-aged Man

Idiopathic retroperitoneal fibrosis (IRPF) is a rare disease characterized by a retroperitoneal inflammatory proliferative fibrosing process. Hashimoto's thyroiditis is the most common inflammatory condition of the thyroid gland; and is a frequently-occurring autoimmune disorder manifesting predominantly in middle-aged women. We report a rare association of IRPF with Hashimoto's thyroiditis in a 67-year-old man demonstrating good response to steroid therapy.

Comparison of Various Methods for Estimating Glomerular Filtration Rate in Patients with Chronic Kidney Disease / 대한신장학회지

PURPOSE: Several methods are used to estimate glomerular filtration rate (GFR), but there are limitations in each method. We investigated the variation in GFR measured by different methods in patients with chronic kidney disease (CKD). METHODS: 549 patients with CKD stages 2-5, who underwent creatinine clearance (Ccr) and (99m)Tc-DTPA renal scan, were enrolled. GFR was calculated by using Cockcroft-Gault equation (CG-GFR) and MDRD equation (MDRD-GFR). The correlations between MDRD-GFR and GFR estimated by other methods were analyzed according to CKD stages and age groups ( or = 60 years). RESULTS: The mean age of patients was 55+/-19 year (male 60%). CG-GFR, Ccr, and estimated GFR by (99m)Tc-DTPA renal scan (DTPA-GFR) correlated significantly with MDRD-GFR in all CKD stages and all age groups (p<0.01). Compared to patients with stages 2-4 CKD, however, the possibilities of CGGFR, Ccr, and DTPA-GFR to be within 30% of MDRD-GFR were significantly lower in stage 5 CKD patients (p<0.05). In addition, the ratio of DTPA-GFR/MDRD-GFR in stage 5 CKD patients was 2.24+/-1.40, indicating overestimation of DTPA-GFR in these patients. On the other hand, the accuracy of various GFR-estimating methods was higher in patients aged more than 60 years compared to the others. CONCLUSION: CG-GFR, Ccr, and DTPA-GFR correlated significantly with MDRD-GFR, but there was a wide variation in GFR estimated by various methods. Therefore, a careful interpretation of estimation in GFR is needed according to the stage of CKD and the age of patients.

Changes in Skin Color in Hemodialysis Patients According to Dialysis Modality / 대한신장학회지

PURPOSE: Skin hyperpigmentation in end stage renal disease patients is known to be attributed to the accumulation of middle molecular weight (MMW) substances such as urochromic pigments and carotenoids. Therefore, there is a possibility that hyperpigmentation may be improved by high-flux hemodialysis (HF-HD) and online hemodiafiltration (HDF). This prospective study was undertaken to investigate the quantitative changes in skin color in HD patients according to dialysis modality. METHODS: Eighty-two stable ESRD patients undergoing HD were enrolled and divided into three groups according to their dialysis modality. Melanin index and erythema index of forearm and abdomen (nonsun exposed area), and forehead (sun exposed area) were measured by narrow-band reflectance spectrophotometer at baseline and after 12 months. RESULTS: There were no significant differences in the baseline values of melanin and erythema indices among the three groups. But the changes in forehead melanin index were significantly lower in HDF patients (-1.0+/-2.4%) compared to the LF-HD group (0.3+/-1.6%) (p<0.05), and forehead erythema index was significantly decreased in patients treated by HDF (-1.6+/-2.5%) relative to the lowflux hemodialysis group (-0.1+/-2.5%) (p<0.05). CONCLUSION: The changes in skin color of sun exposed area were reduced by HDF, suggesting that enhanced removal of MMW substances by convective therapy may be of advantage to skin hyperpigmentation in ESRD patients.

A Case of Rapidly Progressive Glomerulonephritis in a Hepatitis B Virus Carrier Successfully Treated with High dose Immunosuppressive Therapy and Prophylactic Lamivudine / 대한신장학회지

A 35-year-old man, previously hepatitis B surface antigen (HBsAg) carrier, presented with gross hematuria and heavy proteinuria that he had been suffering from for 1 month. Serum creatinine was 4.4 mg/dL. Renal biopsy showed pauci-immune crescentic glomerulonephritis. He received plasmapheresis and was treated with high-dose steroids and cyclophosphamide. Lamivudine was started for the prevention of hepatitis B virus (HBV) activation. Serum creatinine and proteinuria were ameliorated one week after the treatment. There was no sign of HBV activation after six months of treatment. We report a case of rapidly progressive glomerulonephritis in a HBV carrier successfully treated with high dose immunosuppressive therapy and prophylactic lamivudine.

Renal Outcome Following Stenting for Renal Artery Stenosis / 대한신장학회지

PURPOSE: Renal artery stenosis (RAS) causes or deteriorates hypertension and/or renal insufficiency, and is known as a progressive disease. The aim of this study is to reveal the change of renal function after stenting for RAS. METHODS: We retrospectively analyzed 66 patients between 1999 and 2005 who had stenting for RAS. Renal function was assessed by modified MDRD equation. According to baseline glomerular filtration rate (GFR), patients were divided into subgroups with group A (n=37, GFR > or =60 mL/min/ 1.73m2) or group B (n=29, GFR <60 mL/min/1.73m2). Clinical parameters were compared between two groups. RESULTS: A total of 66 patients (male:female=37:29) were studied. The mean age was 61+/-12 years old and the mean follow-up duration was 54+/-27 months. Sixty-one (92.4%) patients had hypertension, 20 (30.3%) had diabetes, and 48 (73%) had unilateral RAS. Group B was older than group A (65+/-9 vs. 58+/-14 years old). The mean body mass index of group B was higher than that of group A. In group A, there was a decrease in the MDRD GFR (from 75+/-11 to 70+/-15 mL/min/1.73m2; p=0.038). In contrast, in group B there was no significant change in the MDRD GFR (from 48+/-9 to 48+/-15 mL/min/1.73m2). In group A and group B, renal function has been improved in 3% and 24%, and stabilized in 70% and 52%, respectively. CONCLUSION: Stenting for RAS has renal function preserving effect in patients with renal insufficiency. Therefore, stenting should be considered as a treatment modality in RAS patients even with deteriorated renal function.

The Effect of FR167653, p38 Mitogen-Activated Protein Kinase (MAPK) Inhibitor, on the Expression of Slit Diaphragm-Associated Proteins in Experimental Diabetic Nephropathy / 대한신장학회지

PURPOSE: This study was undertaken to investigate the effect of a p38 mitogen-activated protein kinase (p38 MAPK) inhibitor, FR167653, on urinary albumin excretion and on the expression of slit diaphragm-associated proteins in diabetic rats. METHODS: Thirty-two Sprague-Dawley rats were injected with diluent [control (C), N=16] or streptozotocin intraperitoneally (DM, N=16). Eight rats from each group were treated with 5 mg/kg/day FR 167653 (C+FR, DM+FR) for 6 weeks. At the time of sacrifice, 24-hour urinary albumin excretion was determined by ELISA. Glomerular nephrin, P-cadherin, and ZO-1 mRNA and protein expression were determined by real-time PCR and Western blot, respectively, with sieved glomeruli. RESULTS: Urinary albumin excretion was significantly higher in DM compared to C rats, and this increase in albuminuria was significantly inhibited by the administration of FR167653 in DM rats. Glomerular phospho-p38 MAPK protein expression was significantly increased in DM rats compared to C rats, and FR167653 treatment significantly attenuated the increase in phospho-p38 MAPK expression in DM glomeruli. Nephrin mRNA and protein expression were higher in 6-week DM compared to C glomeruli, and these increases were significantly abrogated with FR167653 treatment in DM rats. In contrast, FR167653 had no effects on the decrease in P-cadherin expression and the increase in ZO-1 expression observed in DM glomeruli. CONCLUSION: These findings suggest that FR167653, a p38 MAPK inhibitor, reduce the amount of albuminuria in early diabetic nephropathy, and this anti-proteinuric effect seems to be related with the change of glomerular nephrin expression.

The Effect of Uric Acid on GFR in Early Period after Kidney Transplantation / 대한신장학회지

PURPOSE: Hyperuricemia is a common complication occurring shortly after kidney transplantation. Although increased uric acid level is a risk factor for cardiovascular disease and mortality, the relationship between uric acid level and graft function after transplantation has been a controversial issue. Therefore, we investigated the effects of uric acid on glomerular filtration rate (GFR) and graft survival in the early periods of kidney transplantation. METHODS: Data were collected from 245 patients who underwent kidney transplantation between 2002 and 2004 at Yonsei University Medical Center. Uric acid level and estimated GFR were measured monthly during the first 6 months and then yearly for 3 years. RESULTS: The mean age of the study population was 40.2+/-11.7 years. The proportion of patients with hyperuricemia (uric acid < or =6.8 mg/dL) showed increment during the 3 year follow up. Increased serum uric acid level showed a negative correlation with estimated GFR during the initial 6 months after transplantation (r=-0.026, p<0.05). In Kaplan-Meier analysis, patients with a mean uric acid level higher than 6.8 mg/dL during the first 6 months showed a lower cumulative graft survival during the consecutive 3 years compared to patients with a uric acid level lower than 6.8 mg/dL (HR 1.7, p=0.003). CONCLUSION: Uric acid levels were associated with the changes of GFR in the initial 6 months of kidney transplantation, and the hyperuricemia during the early stages of transplantation might influence the long term graft survival.

The Prognostic Factors for Long-term Maintenance of CAPD: Importance of Early %lean Body Mass and Peritonitis / 대한신장학회지

PURPOSE: Lower technical survival rate of CAPD compared to hemodialysis is still concerned. We aimed to evaluate the characteristics of long-term CAPD survivors in pre-dialysis and early phase of CAPD for estimating predictive markers for long-term maintenance of CAPD. METHODS: We retrospectively reviewed records of long-term CAPD patients (LT group, >100 months, n=51) and short-term patients (ST group, <50 months, n=102) who were age-sex matched with the LT group in a 2:1 ratio. Clinical characteristics, serial biochemical parameters, Kt/V, and peritoneal equilibrium test (PET) within 1 month and at 1 year of CAPD were analyzed. RESULTS: LT group had lower prevalence of diabetes, higher pre-dialysis serum albumin, creatinine, % LBM at 1 month of CAPD and lower peritonitis rate compared to ST group. However, dialysis adequacy, residual renal function and transport status showed no differences between two groups at 1 month and 1 year of CAPD. In multivariate analysis, diabetes, peritonitis rate and %LBM were independent risk factors for failure of long-term maintenance of CAPD. Moreover, patients with high %LBM were more likely to be in LT group, had longer CAPD maintenance duration, and lower peritonitis rate. In multiple linear regression analysis for risk factors associated with peritonitis, %LBM at 1 month and pre-dialysis serum albumin were independently associated with peritonitis rate. CONCLUSION: The present study revealed that non-diabetic history, higher %LBM and lower peritonitis rate are important predictors of long-term CAPD survival. Also, poor nutritional status assessed by %LBM and serum albumin level was independently associated with high frequency of peritonitis.

A Case of Unilateral Renal Artery Stenosis with Contra-Lateral Focal Segmental Glomerulosclerosis in a Chronic Kidney Disease Patient / 대한신장학회지

We report a case of focal segmental glomerulosclerosis (FSGS) with chronic renal failure in a patient with unilateral renal artery stenosis. A 38-year-old woman presented with malignant hypertension, massive proteinuria and renal insufficiency. MR angiography showed proximal stenosis of the right renal artery and biopsy of the left kidney revealed focal segmental glomerulosclerosis. The patient responded favorably to the angiotensin II receptor antagonist, as the blood pressure and urinary protein decreased. This case showed that FSGS is a pathophysiologic mechanism of renal injury in uncontrolled renovascular hypertension.

Factors associated with Hypokalemia in Continuous Ambulatory Peritoneal Dialysis Patients

Hypokalemia is a frequent problem in patients on continuous ambulatory peritoneal dialysis (CAPD) and is affected by multiple factors. To evaluate factors associated with hypokalemia, we studied 68 patients on maintenance CAPD treatment for at least six months. In univariate analysis, patients with hypokalemia were associated with older age and the presence of diabetes mellitus. Serum albumin, calcium-phosphate product, triglyceride, body mass index, protein nitrogen appearance, and lean body mass assessed by creatinine kinetics were significantly lower as compared to those without hypokalemia. Serum C-reactive protein was significantly higher in the patients with hypokalemia. Multivariate stepwise linear regression analysis revealed that the serum albumin level and the ultrafiltration volume at the peritoneal equilibration test were independent factors associated with hypokalemia. This suggests that the serum potassium level may be an important nutritional marker in CAPD patients. Further longitudinal investigation is needed to clarify this relationship.

The Effect of Cyclosporine on P-cadherin Expression in Experimental Diabetic Nephropathy and Glucose-Stimulated Podocytes / 대한신장학회잡지

PURPOSE: We investigated whether Cyclosporin A (CsA) had the anti-proteinuric effect in diabetic rats and whether it was associated with the alteration of P-cadherin expression. METHODS: Sprague-Dawley rats were injected with diluent (C, N=16) or streptozotocin intraperitoneally (DM, N=16). Eight rats in each group were treated with 10% ethanol or with 1.5 mg/kg/day of CsA (C+CsA and DM+CsA) for 6 weeks. Immortalized mouse podocytes were cultured in media with 5.6 mM glucose (LG), LG+CsA (10-8 M), LG+TGF-beta1, 30 mM glucose (HG), or HG+CsA. Real time-PCR and Western blot were performed for P-cadherin and TGF-beta1 mRNA and protein expression, respectively, with sieved glomeruli and cell lysates. RESULTS: Urinary albumin excretion was significantly higher in DM compared with C rats, and CsA treatment inhibited the increase in albuminuria in DM rats. Glomerular P-cadherin mRNA and protein expression in DM were decreased compared with C rats, and these decreases were significantly inhibited by CsA. Glomerular TGF-beta1 mRNA and protein expression were higher in DM than C rats, and CsA treatment inhibited the increase in TGF-beta1 expression in DM. P-cadherin mRNA and protein expression in HG and LG+TGF-beta1 podocytes were lower than LG cells, and these HG-induced decrements were restored by CsA. CONCLUSION: CsA treatment reduces urinary albumin excretion in DM rats. P-cadherin expression is decreased under diabetic conditions, which is ameliorated by CsA. In addition, inhibition of the increase in glomerular TGF-beta1 expression under diabetic conditions by CsA seems to restore the P-cadherin expression, resulting in the decrease in albuminuria.

Differences in Pathologic Findings and Gene Expressions of Renal Tissue according to Steroid Responsiveness in Adult-Onset Minimal Change Disease / 대한신장학회잡지

PURPOSE: Compared to children, adult MCD patients tend to have a slower response to steroids, however, little is known about the relationships between pathologic findings or the expression of certain gene and the response to steroid treatment in adult-onset MCD. This study was undertaken to investigate the differences in pathologic findings and the mRNA expression of nephrin and glucocorticoid receptor (GCR) in renal tissue according to steroid responsiveness in adult-onset MCD. METHODS: Twenty-eight adult patients who presented with idiopathic nephrotic syndrome at our institution and fulfilled the criteria for MCD clinically and pathologically were chosen for this study. Based on the response to steroid treatment, patients were divided into two groups: early responders (ER) in whom CR was achieved within 4 weeks of steroid treatment; late responders (LR) in whom CR was achieved after 4 weeks of steroid treatment. RESULTS: Of the 28 patients, ER consisted of 20 patients. Time to CR was significantly shorter in ER compared to LR (16.5+/-0.9 vs. 52.0+/-4.9 days, p<0.01). The proportion of patients with minimal IgM deposition on immunofluorescence was significantly higher in LR compared to ER (75.0% vs. 30.0%, p<0.01). On the other hands, the mRNA expression of GCR, assessed by real time-PCR, was significantly lower in LR than that in ER (p<0.005), whereas nephrin mRNA expression was not different between the two groups. CONCLUSION: The presence of glomerular IgM deposition and the amount of GCR in renal tissue may be useful predictors of steroid responsiveness in adult MCD patients.

Blood Eosinophilia in Patients Undergoing Continous Ambulatory Peritoneal Dialysis / 대한신장학회잡지

PURPOSE: The prevalence of blood eosinophilia in patients who are maintained on regular hemodialysis has been well established. Blood eosinophilia in patients initiating peritoneal dialysis has been mentioned, but its prevalence and etiologic factors have not been well delineated. Therefore, we performed this retrospective study to find out prevalence and possible etiologic factors of blood eosinophilia in patients undergoing continuous ambulatory peritoneal dialysis. METHODS: Between May 2001 to May 2004, the patients who began continuous ambulatory peritoneal dialysis at one renal center were included in this study. Patients with allergic history or allergic reaction during observed period were excluded. The routine peripheral WBC counts of 47 patients were reviewed and possible predisposing factors of eosinophilia were investigated. RESULTS: Blood eosinophilia was observed in 17 of 47 patients (35% of all patients). In most patients with blood eosinophilia, the time in which the eosinophil count began to be rise was within 40 days, and duration of eosinophilia was variable (mean+/-SD;74+/-67 days). The mean of the peak eosinophil count was 750+/-257/mm3 (mean+/-SD). Possible predisposing factors included recent parenteral iron therapy, but not statistically significant (p=0.09). CONCLUSION: Our retrospective study showed that the eosinophil counts in patients with end stage renal disease on continuous ambulatory peritoneal dialysis were frequently elevated. Predisposing factors for this eosinophilia were not clear, suggesting that immunologic disturbance by uremia or dialysis itself might have influence on eosinophil homeostasis.

Differential Gene Expression According to the Size of Glomeruli in Experimental Diabetic Nephropathy / 대한신장학회지

PURPOSE: Although a few gene-profiling studies with whole renal tissue have been described in experimental diabetic nephropathy, there is only one microarray study using diabetic glomeruli. Furthermore, hypertrophic glomeruli have not been explored. The purpose of this study is to elucidate gene expression profiles of hypertrophic glomeruli in early diabetic nephropathy. METHODS: Forty-male Sprague-Dawley rats were injected with diluent (N=20) or streptozotocin intraperitoneally (DM, N=20) and were sacrificed at 6- and 12-week. Glomeruli were isolated by sieving technique. Glomeruli from 125 and 75 m sieves were classified into large (hypertrophic, DM-LG) and small glomeruli (DM-SG), respectively. After RNA extraction, hybridization was performed on the Rat cDNA 5K chip in triplicate, and slides were analyzed. The significant genes were selected using significant analysis of microarray. RESULTS: At 6-week, hierarchical clustering revealed that gene expression profiles of DM-LG were different from those of DM-SG, whereas DM-SG and C glomeruli showed similar gene expression pattern. In contrast, gene expression profiles at 12-week were similar between DM-LG and DM-SG, whereas C glomeruli showed different gene expression pattern from DM glomeruli. At 6-week, a total of 207 genes showed greater than 1.5-fold differential expression. 149 genes were upregulated, whereas 58 were downregulated in DM-LG. On the other hand, differential gene expression greater than 1.4-fold was observed in 37 genes at 12-week, upregulated in 26 and downregulated in 11. CONCLUSION: These results suggest that the gene expression profiles of DM-LG are different from DM-SG, and the gene expression patterns change with the progression of diabetic nephropathy.

Risk factors of gastrointestinal bleeding for end-stage renal disease patients / 대한내과학회지

BACKGROUDN: Gastrointestinal bleeding (GIB) is not a rare complication in end-stage renal disease (ESRD) patients on dialysis and the occurrence of GIB has also been associated with higher morbidity and mortality rates. However, reasons for the high incidence of GIB are not clear. This retrospective study was undertaken not only to analyze the clinical features of GIB but also to elucidate the independent risk factors for GIB in Korean ESRD patients. METHODS: One hundred thirty ESRD patients on dialysis at the Severance Hospital of Yonsei University College of Medicine from January 2000 to December 2005 were included in the study. The patients were divided into two groups: 65 patients with GIB (the GIB group) and 65 age-, sex-, and dialysis modality-matched patients without GIB (the C group). Clinical characteristics, medications, and laboratory findings were compared between the two groups. RESULTS: Compared to the C group, congestive heart failure (40.0% vs. 21.5%, p<0.05), coronary arterial occlusive disease (CAOD) (32.3% vs. 4.6%, p<0.005), and nonsteroidal anti-inflammatory drug (NSAID) use (18.4% vs. 1.5%, p<0.01) were significantly more common in the GIB group. The baseline serum albumin levels were significantly lower in the GIB group than in the C group (2.53+/-0.67 g/dL vs. 3.56+/-0.63 g/dL, p<0.005). Using logistic regression analysis, CAOD (OR=23.0), NSAID use (OR=12.5), and lower serum albumin levels (OR=2.9) were identified as independent risk factors for GIB (p<0.05). CONCLUSIONS: Careful attention must be paid to ESRD patients with CAOD, taking NSAIDs, or with low serum albumin levels in view of GIB.

The Uses of Urinary betaig-h3 in Differential Diagnosis of Isolated Microscopic Hematuria / 대한신장학회지

PURPOSE: This study was undertaken to elucidate the usefulness of urinary betaig-h3 concentrations in differential diagnosis of isolated microscopic hematuria patients. METHODS: Seventy-seven patients, in whom renal biopsy was performed due to microscopic hematuria without proteinuria, were enrolled. The patients were divided into two groups, IgAN group (patients with IgA nephropathy, N=37) and NM group (patients with normal or minor change on renal biopsy, N=40), and the clinical characteristics and laboratory findings were compared between the two groups. TGF-beta and betaig-h3 concentrations in urine were determined by ELISA and were compared between the two groups. To establish the optimal cut-off value of betaig-h3/creatinine (Cr) ratio for the diagnosis of IgA nephropathy, a receiver operating characteristic curve was constructed and the sensitivity and specificity were calculated. RESULTS: A comparative analysis revealed no significant differences in age and sex ratio between the two groups. There were no differences in serum IgG, IgA, IgM, C3, and C4 levels between the two groups. The urinary betaig-h3/Cr ratio was significantly higher in the IgAN group compared to the NM group (6.632.6 vs. 4.462.6 ng/mg, p0.05). A cut-off betaig-h3/Cr ratio 4.5 has a sensitivity of 85.0% and a specificity of 77.8%. CONCLUSION: The urinary betaig-h3/Cr ratio was a good predictor for the diagnosis of IgA nephropathy. Therefore, renal biopsy should be considered in isolated microscopic hematuria patients with high urinary betaig-h3/Cr ratio.

The Effect of Pioglitazone on the Expression of Transforming Growth Factor (TGF)-beta and Fibronectin in Diabetic Nephropathy / 대한신장학회잡지

BACKGROUND: Peroxisome proliferator-activated receptor (PPAR)-gamma is a member of the nuclear receptor superfamily. PPAR-gamma plays an important role in numerous cellular processes including adipogenesis, insulin sensitivity, cell cycle progression, cell differentiation, inflammation, and extracellular matrix production. This study investigated the effect of a PPAR-gamma agonist on the progression of diabetic nephropathy in OLETF rats. METHODS: 30 week-old male OLETF rats were treated for 10 weeks as follows:diabetic control (DM), no treatment:pioglitazone therapy (DM+Pio). LETO rats were used as non-diabetic control (control). Body weight, blood pressure, blood sugar, creatinine, total cholesterol, triglyceride, and urinary protein excretion were measured. Histological analysis was taken with light microscope. Glomerular protein and mRNA expression of transforming growth factor (TGF)-beta1 and fibronectin were estimated by Western blot and RT-PCR. Kidney sections were stained for fibronectin by immunohistochemistry. RESULTS: Serum glucose, triglyceride and urinary protein excretion were decreased in DM+Pio rats compared to DM rats (p<0.05). PAS staining showed glomerular hypertrophy, mesangial expansion, nodular sclerosis, and glomerular basement membrane thickening in glomeruli of DM rats, but these changes were attenuated in glomeruli of pioglitazone-treated rats. Treatment with pioglitazone resulted in a significant decrease in TGF-beta1 protein and mRNA expression in diabetic glomeruli (80.6% and 78.4%, respectively). Glomerular expression of fibronectin protein and mRNA were also decreased in pioglitazone treatment group compared with DM group (93.1% and 98.6%, respectively). Immunohistochemical staining for fibronectin showed similar results. CONCLUSION: Increased TGF-beta1 and fibronectin mRNA and protein expressions in diabetic rat glomeruli were significantly ameliorated by pioglitazone treatment. These data suggest that activation of PPAR-gamma may play an important role in prevention and treatment of diabetic nephropathy.