A case of hydrothorax caused by peritoneal dialysate leakage diagnosed using the reaction between icodextrin and povidone-iodine / 대한내과학회지

Hydrothorax occurs as a complication of peritoneal dialysis in about 2% of cases. When a pleural effusion occurs, the effusion should be analyzed as part of the differential diagnosis. A hydrothorax due to peritoneal dialysate leakage can be suspected based on higher glucose and lower protein content compared with serum. Computed tomography (CT) peritoneography, peritoneal scintigraphy, and magnetic resonance peritoneography are safe, accurate, and reliable methods for diagnosing hydrothorax. Here, we report a case of hydrothorax associated with dialysate leakage that could not be confirmed using standard CT peritoneography. We confirmed the leakage by observing the change in color to black in a test that involved adding povidone-iodine to the pleural fluid obtained by thoracentesis after a cycle of peritoneal dialysis with icodextrin solution. We propose using the icodextrin-povidone reaction as a test for hydrothorax caused by dialysate leakage.

A case of hydrothorax caused by peritoneal dialysate leakage diagnosed using the reaction between icodextrin and povidone-iodine / 대한내과학회지

Hydrothorax occurs as a complication of peritoneal dialysis in about 2% of cases. When a pleural effusion occurs, the effusion should be analyzed as part of the differential diagnosis. A hydrothorax due to peritoneal dialysate leakage can be suspected based on higher glucose and lower protein content compared with serum. Computed tomography (CT) peritoneography, peritoneal scintigraphy, and magnetic resonance peritoneography are safe, accurate, and reliable methods for diagnosing hydrothorax. Here, we report a case of hydrothorax associated with dialysate leakage that could not be confirmed using standard CT peritoneography. We confirmed the leakage by observing the change in color to black in a test that involved adding povidone-iodine to the pleural fluid obtained by thoracentesis after a cycle of peritoneal dialysis with icodextrin solution. We propose using the icodextrin-povidone reaction as a test for hydrothorax caused by dialysate leakage.

A Case of Fabry Disease, Pathologically Revealed as Focal Segmental Glomerulosclerosis / 대한신장학회지

Fabry disease is an X-linked recessive lysosomal storage disease that is caused by deficient activity of the lysosomal enzyme alpha-galactosidase A. This deficiency results in progressive lysosomal accumulation of glycosphingolipid with particular globotriaosylceramide which accumulates in the heart, kidneys, and the nervous system. The classic Fabry diease affects males, who typically experience an early onset of neuropathic pain, angiokeratoma, and anhydrosis or hypohydrosis. The introduction of enzyme replacement therapy necessitates early awareness of Fabry disease and knowledge of disease- related complications. We experienced a man presenting with acroparesthesia, anhydrosis and proteinuria, who had no residual alpha-galactosidase A activity on leukocytes and mutation analysis demonstrated thiamine deletion at position 1077, exon 7 of GLA gene. He was initially diagnosed as focal segmental glomerulosclerosis without electron microscopic examination three years ago. Now he is being treated with recombinant alpha-galactosidase A via intravenous administration for 1 month.

A Case of Granulocytic Sarcoma Relapsed in Both Breasts After Complete Remission of Acute Myelogeous Leukemia / 대한진단검사의학회지

Granulocytic sarcoma (GS) is a localized tumor composed of immature granulocytic cells. GS can involve any site in the body. The common sites are periosteum, bone, soft tissue, lymph node, and skin; the breast is an unusual site for GS. They can be present at the time of diagnosis, at relapse, and sometimes preceding the diagnosis. We describe a 49-year-old woman with acute myelogenous leukemia, FAB AML M2, who was diagnosed with granulocytic sarcoma in both of her breasts at months after complete remission.

Clinical characteristics of rapidly progressive glomerulonephritis / 대한내과학회지

BACKGROUND: Rapidly progressive glomerulonephritis (RPGN) is microscopically characterized by formation of crescents in more than 50% of glomeruli observed. The patients usually move on rapidly to renal failure and the prognosis is not favorable. But there was only a few study because of the rarity in incidence. METHODS: We reviewed and analyzed the records of 15 patients diagnosed as crescentic glomerulonephritis (CrGN) by renal biopsy from March 1990 to December 2003. RESULTS: Fifteen out of 1055 biopsy cases were CrGN including 6 (40%) of pauci-immune glomerulonephritis (PIGN) and 9 (60%) of immune complex glomerulonephritis (ICGN). Underlying diseases of PIGN were: unknown 2, Wegener's granulomatosis 2, focal segmental glomerulosclerosis 1, and rectal cancer 1. For ICGN were: IgA nephropathy 3, lupus nephritis class IV 3, Henoch-Schonlein purpura 2, and HBV-associtated membranoproliferative glomerulonephritis type I. The incidence of major manifestation in PIGN vs. ICGN was respectively: hypertension 50% vs. 22.2%, nephrotic syndrome 50% vs. 88.9%, percents of crescents 73.9% vs. 57.3%. The levels of BUN (mg/dL) and serum creatinine (mg/dL) were higher in PIGN as 76.8 +/- 14.3 and 6.6 +/- 1.2 vs. 26.9 +/- 8.9 and 1.6 +/- 0.3 in ICGN. With methylprednisolone pulse, 5 out of 7 patients showed some improvement in their renal function. A case of Wegener's granulomatosis taken oral prednisolone and another case of lupus nephritis given cyclophosphamide pulse also had relatively favorable course. At the end of follow-up, the more crescents they had the higher creatinine level (r=0.711, p<0.01). CONCLUSION: RPGN manifested nephrotic syndrome commonly and many of them progressed to the chronic kidney disease or even developed end stage renal disease. But appropriate immunosuppre- ssive treatment could help to preserve renal function. When considering the proportion of crescentic glomeruli, it was related to the worse prognosis. It is necessary to make an effort to diagnose early and treat vigorously.