Development of Anthropometry-Based Equations for the Estimation of the Total Body Water in Koreans

For developing race-specific anthropometry-based total body water (TBW) equations, we measured TBW using bioelectrical impedance analysis (TBW(BIA)) in 2,943 healthy Korean adults. Among them, 2,223 were used as a reference group. Two equations (TBW(K1) and TBW(K2)) were developed based on age, sex, height, and body weight. The adjusted R2 was 0.908 for TBW(K1) and 0.910 for TBW(K2). The remaining 720 subjects were used for the validation of our results. Watson (TBW(W)) and Hume-Weyers (TBW(H)) formulas were also used. In men, TBW(BIA) showed the highest correlation with TBW(H), followed by TBW(K1), TBW(K2) and TBW(W). TBW(K1) and TBW(K2) showed the lower root mean square errors (RMSE) and mean prediction errors (ME) than TBW(W) and TBW(H). On the Bland-Altman plot, the correlations between the differences and means were smaller for TBW(K2) than for TBW(K1). On the contrary, TBW(BIA) showed the highest correlation with TBW(W), followed by TBW(K2), TBW(K1), and TBW(H) in females. RMSE was smallest in TBW(W), followed by TBW(K2), TBW(K1) and TBW(H). ME was closest to zero for TBW(K2), followed by TBW(K1), TBW(W) and TBW(H). The correlation coefficients between the means and differences were highest in TBW(W), and lowest in TBW(K2). In conclusion, TBW(K2) provides better accuracy with a smaller bias than the TBW(W) or TBW(H) in males. TBW(K2) shows a similar accuracy, but with a smaller bias than TBW(W) in females.

A case of systemic amyloidosis involving liver, kidney and peritoneum after cholecystectomy / 대한내과학회지

Amyloidosis is a heterogenous group of often fatal disorders characterized by extracellular deposition of a proteinaceous material with a unique fibrillar form in various tissues and organs. Deposition of amyloid may cause widespread dysfunction of the involved organs. Recently, we experienced a case of 40-year-old male patient with nephrotic syndrome, uncontrolled ascites and jaundice, which developed after cholecystectomy. We confirmed systemic amyloidosis involving kidney, liver and peritoneum by kidney and liver and peritoneum biopsy. The case that, having about a month of incubation period after cholecystectomy, amyloidosis occurred in a healthy man before the operation, and that amyloid was deposited in the peritoneum site incised during the operation provides grounds that amyloidosis may be triggered by cholecystectomy. Given the rarity of this case, the following is a report of this case and a review of the relevant literatures.

Relationships between Climate Factors and Peritonitis In CAPD Patients / 대한신장학회잡지

Peritonitis is one of the major complication of continuous ambulatory peritoneal dialysis (CAPD) and the most common cause of hospital admission and for termination of peritoneal dialysis. We retrospectively analyzed the incidences and causative organisms of CAPD peritonitis according to season/month of the year under the hypothesis that climate factors, increased temperature and humidity, may changes the incidences and causative organisms of peritonitis. There were a few studies about this issue and in most cases the result was inconclusive because of the limitation in the limited range of climate factors such as temperature and humidity. Wide annual differences of temperature (-3.4-25.4 degrees C) and humidity (61-81%) may affect the rate of peritonitis episode in the area where the current study was performed. Data from 80 patients(49 male, 31 female), with a mean age 48.3+/-14.5 years and mean CAPD period 14.0+/-9.0 months, followed from September 1996 to July 1999, were reviewed. Fifty-three cases of peritonitis were found in 1,123 patient-months, a rate of 0.56 episode/patients- year, and 0.047 episode/patient-month. The months in which the incidence of peritonitis above average was March (5.05%), May(7.96%), July (10.8%), August (6.25%), September (6.06%). The incidence of peritonitis was the lowest in November (1.31%). The incidence in hot season (May-September : average temperature for three years 21.9degrees C, humidity 74%) was 0.065 episodes/patient-month, which was significantly higher than in cold season (October-February : 5.9degrees C, 64.4%)(p<0.05). Average temperature for three years in the study area was 13.2degrees C with maximal temperature of 25.4degrees C (August) and minimal of -3.4 degrees C (January). Average humidity for three years in the study area was 68.4% with maximal humidity of 81% (July) and minimal of 61% (April). The incidence of peritonitis paralleled with temperature and humidity, highest in July (0.080/pt-month) and lowest in November (0.013/pt-month) and were directly correlated with temperature (r=0.53, p<0.05) and humidity (r=0.59, p<0.05). Among 53 episodes of peritonitis, gram positive peritonitis, gram negative peritonitis and culture negative peritonitis were 36.9%, 15.0% and 45.2%, respectively. From March to August, gram positive peritonitis was 50% and culture negative peritonitis was 42.4%. From September to February, culture-negative peritonitis was 52.9% and gram negative peritonitis organisms was 29.4%. In contrast to gram positive organisms which showed increased in hot weather, gram negative organisms showed uniform distribution throughout the year. There were no significant monthly differences in peritoneal fluid WBC count on admission and negative conversion period of that. Our data suggest that high temperature and humidity can adversely affect the incidence of CAPD peritonitis and may change the distribution of causative organisms.

Effect of peritoneal glucose load on plasma leptin concentration in continuous ambulatory peritoneal dialysis patients

This study was performed to investigate the effect of peritoneal glucose load on plasma leptin concentrations in the continuous ambulatory peritoneal dialysis (CAPD) performed on 13 non-diabetic ESRD patients. Plasma leptin and insulin concentrations were measured for 2 hours during a single 2 liter exchange of 1.5% glucose-based dialysate (SPD, n = 6), for 7 days of daily peritoneal dialysis (DPD, n = 7). In DPD, standard full volume (2,000 ml x 4 times/day) exchange was performed immediately after operation. In SPD, plasma leptin and insulin concentrations remained unchanged during the study. In DPD, the plasma leptin concentration increased significantly after CAPD on the first day (PD1) (11.2 +/- 5.4 to 17.0 +/- 6.0 ng/mL, p < 0.05) and this elevation seemed to persist until 7 days after operation. After CAPD, there was no significant day-to-day variation in peritoneal glucose absorption (391-465 cal). Oral intake seemed to decrease on operation day (PD0) and PD1 and then increased slowly. Plasma insulin and glucose concentrations did not significantly change after CAPD. Changes of leptin concentration were significantly correlated with the changes of peritoneal glucose absorption at PD1. In conclusion, continuous peritoneal glucose load may affect plasma leptin concentrations in CAPD patients.

Nandrolone Decanoate-Induced Transient Ultrafiltration Failure in End Stage Renal Disease Patients Undergoing Dialysis / 대한신장학회잡지

Nandrolone decanoate(ND), one of the anabolic steroids, has been used by athletes to build muscle mass and enhance weight-lifting performance and has also shown to be useful in malnourished ESRD patients. However, ND has several adverse effects including edema. After we experienced a case of severe edema and transient ultrafiltration failure(TUF) requiring more frequent number of dialysis during ND treatment, we prospectively studied the incidence and clinical characteristics of TUF during ND treatment. Among 30 ND-treated patients, 7 patients developed TUF. All TUF+ patients were female and had sigificantly higher number of patients with congestive heart failure, more use of minoxidil and moderate to severe malnutrition than TUF- patients. There were no significant differences in age, duration of dialysis, and number of diabetics between TUF+ and TUF- group. In ND-treated male patients, the number of patients with CHF and moderate to severe malnutrition and with use of minoxidil were significantly lower than TUF+ ones. Body weight and serum albumin concentrations were significantly increased 2-3 months after ND treatment in TUF+ patients. But there were no differences in body weight and serum albumin in TUF-patients. In TUF+ patients, frequency of HD increased from 3 times to 4 to 6 times a week. CAPD patients with TUF+ had more frequently used 4.25% dialysate and number of exchanges were increased. In most TUF+ patients, severe edema and TUF were disappeared about 2 weeks after treatment. Most TUF+ patients returned to previous schedle of dialysis. In conclusion, ND seems to induce TUF in ESRD patients who had risk for volume regulation such as CHF, hypoalbuminemia, or the use of minoxidil.

Prospective Analysis of Factors that Affect Change of Lipoprotein(a) in Hemodialysis Patients During 2 Years / 대한신장학회잡지

Lipoprotein(a) [Lp(a)] is an independent risk factor for cardiovascular disease that is a major cause of death in dialysis patients. It has been described to be increased in chronic renal failure patients on conservative treatment or dialysis. It has also been suggested that high concentration of Lp(a) correlates to malnutrition of hemodialysis patients, but this has unproven. The aim of our study was the evaluation of factors that affect changes of Lp(a) concentration through follow up in hemodialysis patients. We assessed the serum concentrations of lipoprotein(a), serum albumin, nPCR, various biochemical parameters and Kt/V as adequacy of dialysis in 25 hemodialysis patients over a 48-months period. The mean serum concentrations of Lp(a) were 40.0+/-21.3mg/dL at basal level, 39.2+/-16.6mg/dL after 48 months, respectively. Significant correlation was found between basal and follow up Lp(a) levels(r=0.76, p=0.0001). Moreover, a significant inverse correlation was observed between changes of serum Lp(a) level and changes of serum albumin level(r=-0.507, p=0.027). However no significant correlation was found between changes of serum Lp(a) level and changes of lipid profiles, nPCR, URR and Kt/V. Our data suggests the possibility of the influence of nutritional status(changes of serum albumin) on changes of serum Lp(a) level in hemodialysis patients. Further prospective studies are warranted to clarify the influence of nutritional status on the Lp(a) in hemodialysis patients.

A case of living-related kidney transplantation in Bartter's syndrome

Bartter's syndrome is a renal tubular disorder characterized by hypokalemia, metabolic alkalosis, increased urinary excretion of potassium and prostaglandins, a relative vascular resistance to the pressor effects of exogenous angiotensin II, and hyperplasia of the juxtaglomerular apparatus. In most patients, the glomerular filtration rate is normal and chronic renal failure does not develop. We report here on a case of living-related kidney transplantation in Bartter's syndrome, in which a non-steroidal anti-inflammatory drug is suspected to be the cause of the end-stage renal disease.

Relationship between Clinical Factors of Atherosclerosis and Carotid Artery on High Resolution B-mode Ultrasonography in End-stage Renal Disease Patients / 대한신장학회잡지

Atherosclerotic cardiovascular disease(AVD) is a major cause of the mortality and morbidity in end-stage renal disease(ESRD) patients undergoing chronic dialysis therapy. The factors such as lipopretein metabolism abnormality, diabetes, hypertension, hyperhomocysteinemia and oxidative stress have been implicated as underlying causes related AVD. Malnutrition, chronic inflammation, increased oxidative stress, hyperparathyroidism and its related lipoprotein abnormalities are suggested to accelerate AVD in ESRD patients. High-resolution B-mode ultrasono-graphy has been used to evaluate atherosclerotic change in carotid artery in a number of epidemiologic or clinical studies because of its non-invasive advantage and proven effects in predicting AVD or cardiovascular mortality. Using high-resolution B-mode sonography, we evaluated the presence of plaque and carotid intima-media area(cIM area), which is known to be a good predictor of athero-sclerosis. We compared and analyzed those sonographic findings according to a number of selected clinical and laboratory factors. Study subjects were 27 stable ESRD patient receiving hemodialysis(HD) or chronic ambulatory peritoneal dialysis(CAPD) at least over 24 months. The patients with present or past coronary, cerebral or peripheral vascular disease, history of anti-platelet agents or age over 70 years were excluded. Nine HD and 18 CAPD patients were included and mean age was 52.1+/-2.6 years and number of male and female patients were sixteen and eleven. Among many factors, sex, age, dialysis duration, diabetes, smoking history, blood pressure, body mass index, albumin, creatinine, high-density lipoprotein, triglyceride, C-reactive protein, total calcium, phosphorus, intact-parathyroidid hormone were selected and analyzed for their correlation with carotid sonograpic findings. 1) Mean cIM area of all patients was 15.4+/-0.7 mm2. cIM area was significantly increased in CAPD patients compared to HD patients(16.5+/-1.2 vs 14.9+/- 0.9mm2, p<0.05). Atherosclerotic plaques were found in 48.1% and bilateral lesion was found in 18.5% of all patients. The incidence of the plaque was 42.1% in HD and 55.6% in CAPD patients. 2) cIM area was more significantly increased in male than female(16.7+/-0.8 vs 13.6+/-1.2mm2, in diabetes than non-diabetes(16.4+/-0.8 vs 14.7+/-l.lmm2) and in smoker than non-smoker(18.8+/-0.7 vs 12.8+/-0.7mm2, p<0.05). It was also significantly inereased in patients with body mass index more than 2.3kg/ m(18.3+/-1.1 vs 14.6+/-0.8mm), systolic blood pres-sure more than 14mmHg(16.6+/-0.7 vs 13.0+/-1.2mm) and C-reactive pretein more than 0.5 mg/dL(18.9+/-1.5 vs 14.2+/-0.77mm2p<0.05). Among those factors, age, systolic blood pressure, body mass index and C-reactive protein were proven to positively correlate to cIM area with statistical significance(p<0.05). Even though cIM area was increased in patients with high serum parathyroid hormone, high total cholesterol and triglyceride and low high-density lipoprotein level, no statistical significances were found in these factors. 3) In comparison of each factor according to the presence of the plaque, age and the presence of diabetes were proven to be significantly different between patients without the plaque and with the plaque(45.7+/-2.7 vs 59.5+/-3.8 year, 33.3% vs 53.8%, respectively, p<0.05). Systolic blood pressure and C-reactive protein were increased in patients with the plaque but no statistical significance was shown. In conclusions, we found that old age, male sex, presence of diabetes, smoking history, high systolic blood pressure, increased body mass index and increased C-reactive protein were significantly related to increased cIM area and the plaque was more frequent in old age and diabetes patients using high resolution B-mode ultrasonography. It can be assumed that inflammatory state as reflected by C-reactive protein would be more related with atherosclerosis in ESRD patients than such as nutritional state, parathyroid hormone or lipoprotein metabolism based on these results. Fusing prospective analysis demonstrating causeeffect relationship or analyzing inflammatory index such as TNF-a or interleukin would be necessary to prove this assumption.

Effect of Initiaion of Hemodialysis and Continuous Ambulatory Peritoneal Dialysis on Blood Pressure Control in Patients with End-Stag Renal Disease / 대한신장학회잡지

Studies describing the effects on blood pressure control by hemodialysis(HD) or continuous amulatory peritoneal dialysis(CAPD) have yielded conflicting results with respect to 24 hour blood pressure control, diurnal variation and blood pressure loads. The aim of the study was to investigate the effect of beginning with HD or CAPD on blood pressure control, diurnal variation and blood pressure loads using ambulatory blood pressure monitoring(ABPM). Twen-ty-seven end-stage renal disease(ESRD) patients(12 on HD and 15 on CAPD) were enrolled into the study. Patients with cardiovascular diseases, erythro-poietin therapy, or severe edema were excluded. ABPM were performed two times before and after the initiation of dialysis. Mean duration of interval between pre- and post-dialysis ABPM were 17+/-4 days on HD and 13+/-3 days on CAPD. Daytime and nighttime were defined as the time from 6:00 AM to 10:00 PM and from 10:00 PM to 6:00 AM of the next day. Systolic and diastolic loads were defined as the percentage of the incidence of systolic and diastolic blood pressure over l% and 90mmHg. Dipper meaning the presence of normal diurnal difference were defined as the differences of daytime- nighttime mean arterial pressure more than 5mmHg. In HD patients, mean systolic and diastolic blood pressure and mean arterial pressure were significantly decreased after dialysis during 24 hour, day- time and nighttime. In CAPD patients, those were also significantly decreased after dialysis during 24 hour, daytime and nighttime(p<0.05). Diurnal differences were increased after CAPD(3.3+/-9.4 vs 5.4+/-6.8mmHg) but decreased after HD(4.3+/-6.2 vs 2.4+/-10.8mmHg) and the differences of diurnal difference between two groups were significantly different(+2.1+/-9.0 vs 1.9+/-8.4mmHg, p<0.05). Proportions of dipper among patients were increased from 16.7 to 66.7% in HD and from 33.3% to 60% in CAPD without statistical significance between two groups. Systolic and diastolic loads were significantly decreased after HD(from 75.0+/-38.0 to 37.5+/-43.8%, from 45.2+/-29.7 to 12.5+/-12.8%, respectively, p<0.05) and after CAPD(from 63.1+/-30,1 to 32.3+/-27.1%, from 43.4+/-36.2% to 12.2+/-16.9%, respectively, p<0.05). Systolic and diastolic loads of daytime and nighttime were significantly decreased after each dialysis modality except nighttime diastolic pressure load in HD. In conclusions, both HD and CAPD improve BP control in ESRD patients. CAPD has more benefit to control of diurnal variations in ESRD patients.

Comparison of Myocardial Fractional and Coronary Flow Reserve after Revascularization in Acute Myocardial Infarction

BACKGROUND AND OBJECTIVE: The aim of this study was to compare the residual diameter stenosis after PTCA with fractional flow reserve (FFR) and coronary flow reserve (CFR), and investigate the correlation between FFR and CFR in patients with acute myocardial infarction (AMI). MATERIALS AND METHOD: The study population consisted of twenty seven patients with myocardial infarction. Baseline and hyperemic average peak velocity (APV) were measured using Doppler wire 15 minutes after restoration of infarct-related artery (IRA). CFR was obtained by the ratio of distal hyperemic APV to baseline APV. Distal coronary arterial pressure (Pd) was measured with advancing the wire distal to the lesion of IRA. Simultaneous proximal aortic pressure (Pa) was measured using guiding catheter. Myocardial FFR was obtained by the ratio of hyperemic Pd to hyperemic Pa. RESULTS: Post-interventional CFR and FFR were 0.85+/-0.44, 0.91+/-0.09. CFR did not show significant correlation with luminal diameter stenosis (%ST). There was no significant correlation between FFR and CFR with a correlation coefficient of 0.29 (p=.25). But, significant correlation was found between %ST and FFR, %ST and hyperemic PG (hPG) with correlation coefficient of -0.70 (p=.0012) and 0.68 (p=.0018). CONCLUSION: In AMI patients, %ST has a significant correlation with FFR and hPG after PTCA. But, there was no significant correlation between FFR and CFR.

A retrospective study, with emphasis on endoscopic findings / 대한소화기내시경학회지

BACKGROUND/AIMS: Generally, candida esophagitis has a low incidence of occurrence, but the prevalence of candida esophagitis was found to be higher in cases involving patients with impaired immunity due to an underlying disease and thereby using immunosupressive drugs. This study was designed to evaluate the relation of symptoms, endoscopic findings, and pathologic findings of each patient. METHODS: Between January 1993 and August 1996, 14,090 upper digestive tract endoscopies were done in Inha hospital. Among those patients, 20 cases of candida esophagitis (0.14%) were confirmed by an endoscopic biopsy. During these same endoscopic sessions, retrospectively reviews were conducted.

Relationship between Serum TSH Level and Nutritional Status in Maintenance Hemodialysis Patients / 대한신장학회잡지

Nutrition influences thyroid function. To investigate the association of malnutrition with thyroid function(especially serum TSH level), we performed cross-sectional study in 47 clinically stable HD patients. Thyroid function test[TSH and free T4 (FT4), anthropometry[triceps skinfold thickness (TSF), midarm muscle circumference MAMC), BMI, and fractional deviation from ideal weight(FW)], and biochemical parameters[serum albumin(SA), insulin- like growth factor-1(IGF-I) and lymphocyte count (LC)] were measured. All patients were euthyroid state(TSH 0.89+/-0.52, 0.19-2.82microU/ml; FT4 0.99+/-0.25, 0.38-1.89ng/dl). Patients were divided into two groups according to mean TSH level: group I(>0.89U/ml, n=24) and group II(<0.89U/ml, n=23). Malnourished patients were significantly more(79.2 vs. 47.8%) and SA(4.0+/-0.5 vs. 4.4+/-0.3g/dl), IGF-I (174.5+/-76.7 vs. 229.3+/-89.6ng/ml), and BMI (20.8+/-2.5 vs. 22.3+/-2.1kg/m2) were significantly(p<0.05) lower in group I than in II. The proportions of patients with SA of <4.0g/dl and LC of <1200/mm3 (33.3 vs. 4.3%) and F delta W of <-0.10(29.2 vs. 4.3%) were significantly more in group I. Group I seemed to have longer duration of HD(53.3+/-37.2 vs. 36.0+/-28.7 months), lower FT4 (0.52+/-0.19 vs. 1.05+/-0.28ng/ dl) and LC(1239.3+/-455.6 vs. 1498.1+/-557.4 cells/ mm3), and more DM(20.8 vs. 4.3%) and number of patients with TSF(45.8 vs. 13.0%) and MAMC (41.7 vs. 17.4%) of <5 percentile of normal Korean value. TSH showed significantly negative correlation with SA(r=-0.34) and IGF-I(r=-0.35). In conclusion, inadequate HD and malnutrition seem to affect serum TSH level to minimize the energy expenditure in long-term HD patients.

The Effect of Anabolic Steroid on Body Composition and Protein Metabolism in Malnourished CAPD Patients / 대한신장학회잡지

To evaluate the effect of anabolic steroid(AS) on body composition and protein metabolism in malnourished CAPD patients, 7 CAPD patients who were proved to be malnourished by subjective global assessment received 200mg of AS, nandrolone decanoate, by intramuscular route monthly for 5 months. We analyzed the body composition, biochemical nutritional markers, plasma and dialysate amino acids(AA) before and after administration of AS. The mean age was 53.6+/-11.5 years, the sex ratio was 2:5, and the duration of CAPD was 28.5+/-18.7 months. Two patients were diabetics. Five months after AS administration, %lean body mass seemed to increase from 52.6+/-11.7 to 57.3+/-11.0%(P>0.05), but there were no significant changes in body weight and body mass index. Serum insulin-like growth factor-I (172.4+/-88.5 vs. 204.1+/-85.8ng/ml, P<0.05) and transferrin(213.6+/-55.4 vs. 239.0+/-55.3mg/dl, P<0.05) were significantly increased, and serum total CO2(31.1+/-4.5 vs. 25.9+/-2.5mM/L, P<0.05) were significantly decreased. Urea nitrogen appearance(4.0+/-2.0 vs. 3.6+/-1.6g/ day) seemed to be decreased. Both plasma essential AA(EAA) level(738.3+/-206.5 vs. 492.5+/-187.2micromol/L, P<0.05) and peritoneal EAA loss(565.0+/-186.1 vs. 377.4+/-113.9micromol/day, P<0.05) decreased significantly after administration. Plasma total and non- essential amino acids(NEAA) level tended to be increased and peritoneal total and NEAA loss seemed to be decreased without statistical significance. In conclusion, AS seems to have anabolic effect and be useful in the correction of malnutrition in CAPD patients.

A Case of Bilateral Renal Angiomyolipoma Associated with Tuberous Sclerosis / 대한신장학회잡지

Renal angiomyolipoma is a rare entity, usually associated with tuberous sclerosis. Until a few years ago it was almost impossible to arrive at a correct diagnosis preoperatively, and most of the case underwent nephrectomy with the wrong diagnosis of renal carcinoma. Recently, abdominal computerized tomography and renal sonography have made it possible to reach the correct preoperative diagnosis in many cases, and thus to avoid unnecessary nephrectomies. We herein present a case of bilateral renal angiomyolipoma with tuberous sclerosis which was preoperatively diagnosed by abdominal ultrasound and CT. A 54 years old woman was admitted with pain on the left flank since 4 months ago. She has had multiple erythematous papules on the face, a small nodule like fibroma on the right third toe. Laboratory findings were normal range. Abdominal ultrasound revealed multiple, variable sized homogenous hyperechogenic mass in the both kidney. Abdominal CT scan showed multiple, variable sized low dense mass in both kidney. Biopsy specimens of the mass of the left kidney revealed fibronecrotic material and blood clots, in which was no evidence of malignancy. Biopsy specimen from the face revealed adenoma sebaceum.