Development of a Perirenal Hematoma after Hula-Hooping

The development of a perirenal hematoma is rare and primarily the result of trauma, malignancy, or a connective tissue disease. Infrequently, a continuous or even mild trauma can cause a perirenal hematoma. Here, we report a case involving the development of a perirenal hematoma after excessive hula-hooping in the absence of a major trauma history.

Relationship of malnutrition-inflammation score with atherosclerosis in maintenance hemodialysis patients / 대한내과학회지

BACKGROUND: Malnutrition-inflammation complex syndrome (MICS) is common in maintenance hemodialysis (MHD) patients and may be related to a poor outcome. However, there is little evidence showing MICS to be a risk factor for atherosclerosis. The aim of this study was to determine if MICS is associated with the atherosclerotic markers such as abdominal aortic calcification (AAC) and pulse wave velocity (PWV) in MHD patients. METHODS: Eighty MHD patients were selected in Kangbuk Samsung Hospital (male: female=50:30, age 58+/-14 years). The nutritional status was assessed by the Subjective Global Assessment (SGA), biochemical measurement and the normalized protein equivalent of the total nitrogen appearance (nPNA). The presence of inflammatory reaction was assessed by the C-reactive protein (CRP). The malnutrition-Inflammation Score (MIS) was used to assess MICS. A lateral lumbar radiogram was used to evaluate the AAC index. Brachial-ankle (ba) PWV using automatic device was performed. RESULTS: Malnourished patients had a higher MIS than the well nourished patients (8.7+/-3.6 vs. 4.0+/-1.8, p<0.001). Patients with inflammation (CRP3 mg/L) showed a higher MIS than patients without inflammation (7.6+/-4.6 vs. 5.7+/-3.3, p=0.045). There was no correlation between the MIS and the AAC index (r=0.157, p=0.191) and baPWV (r= 0.144, p=0.323). CONCLUSION: These results suggest that the MIS is a useful marker of MICS in MHD patients. However, the MIS was not directly related to the AAC index and baPWV. This report highlights the importance of assessing the MICS and atherosclerosis in MHD patients.

Evaluation of Glomerular Filtration Rate by Prediction Equation in the Elderly / 대한신장학회잡지

BACKGROUND: The glomerular filtration rate (GFR) is considered the best overall index for the level of renal function and is estimated commonly by the creatinine-based, Cockcroft-Gault (CG) equation or the Modification of Diet Disease Study (MDRD) equation indirectly. Recently, cystatin C has been reported as a new endogenous marker of GFR. To predict the decrease of renal function in the elderly, we measured standard GFR (EDTA-GFR) by (51)Cr- EDTA and attempted to compare the result with CG, MDRD, and cystatin C equation for accuracy. METHODS: Sixty-three elderly persons (28 men, 35 women:mean age 70, range 65-78) who underwent health screening, were measured for plasma creatinine, cystatin C and EDTA-GFR. RESULTS: The CG and MDRD equations performed better than the cystatin C equation with an accuracy of within 30% (68 and 67%, respectively, versus 37%) and 50% (98 and 94%, respectively, versus 72%) of EDTA-GFR. The coefficient of determination (R2) of each estimated equation was 0.08 (p=0.03) in CG, 0.06 (p=0.04) in MDRD, and 0.07 (p=0.04) in cystatin C equation. Analysis of ROC curves with EDTA-GFR 60 mL/min/1.73m2 showed that each estimated equation was inadequate for the diagnosis of chronic kidney disease (sensitivity and specificity, 73% and 65% in CG, and 68% and 65% in MDRD, respectively). CONCLUSION: In the elderly, CG or MDRD equation was more accurate than cystatin C equation. Nevertheless, problems remain in the assessment of GFR using these equations and caution is particularly necessary in the diagnosis of chronic kidney disease with calculated estimates of GFR<60 mL/ min/1.73m2 in the elderly.

Evaluation of Glomerular Filtration Rate by Prediction Equation in the Elderly / 대한신장학회잡지

BACKGROUND: The glomerular filtration rate (GFR) is considered the best overall index for the level of renal function and is estimated commonly by the creatinine-based, Cockcroft-Gault (CG) equation or the Modification of Diet Disease Study (MDRD) equation indirectly. Recently, cystatin C has been reported as a new endogenous marker of GFR. To predict the decrease of renal function in the elderly, we measured standard GFR (EDTA-GFR) by (51)Cr- EDTA and attempted to compare the result with CG, MDRD, and cystatin C equation for accuracy. METHODS: Sixty-three elderly persons (28 men, 35 women:mean age 70, range 65-78) who underwent health screening, were measured for plasma creatinine, cystatin C and EDTA-GFR. RESULTS: The CG and MDRD equations performed better than the cystatin C equation with an accuracy of within 30% (68 and 67%, respectively, versus 37%) and 50% (98 and 94%, respectively, versus 72%) of EDTA-GFR. The coefficient of determination (R2) of each estimated equation was 0.08 (p=0.03) in CG, 0.06 (p=0.04) in MDRD, and 0.07 (p=0.04) in cystatin C equation. Analysis of ROC curves with EDTA-GFR 60 mL/min/1.73m2 showed that each estimated equation was inadequate for the diagnosis of chronic kidney disease (sensitivity and specificity, 73% and 65% in CG, and 68% and 65% in MDRD, respectively). CONCLUSION: In the elderly, CG or MDRD equation was more accurate than cystatin C equation. Nevertheless, problems remain in the assessment of GFR using these equations and caution is particularly necessary in the diagnosis of chronic kidney disease with calculated estimates of GFR<60 mL/ min/1.73m2 in the elderly.

Serum Osteoprotegerin Levels and the Extent of Aortic Calcification in Hemodialysis Patients / 대한신장학회잡지

BACKGOUND: Vascular calcification is highly correlated with cardiovascular disease mortality, especially in patients with end-stage renal disease (ESRD). Recent experimental research has implicated osteoprotegerin (OPG) in medial arterial calcification. The present study aims to examine whether serum OPG level is associated with the extent of aortic calcification in hemodialysis patients. METHODS: We studied 57 ESRD patients (59.5+/-14.1 years) on maintenance hemodialysis. Serum OPG level was measured by enzyme-linked immunosorbent assay. Abdominal aortic calcific deposits index (AAC index) was analysed with lateral lumbar radiograms. Patients were classified into tertile groups according to their AAC index: group I (0, n= 18), group II (1-4, n=18) and group III (5-18, n=21). Brachial ankle pulse wave velocity (baPWV) was also measured. RESULTS: Serum OPG level was greater in patients with higher AAC index than in those with lower AAC index but it was not statistically significant (group I: 409.8+/-343.5 pg/mL, group II: 575.9+/-723.3 pg/mL and group III: 660.8+/-593.5 pg/mL, p=0.399). There was a trend that serum OPG level was positively associated with AAC index, but it was not statistically significant (r=0.089, p=0.511). Serum OPG level showed positive correlation with age and pulse pressure. AAC index positively related with age and baPWV. CONCLUSION: Serum OPG levels seems to be positively related to AAC index by lateral lumbar radiograms, but it was not statistically significant. We suggest more extended studies to determine that serum OPG is helpful clinical marker for the extent of vascular calcification in maintenance hemodialysis patients.

The Clinical Significance of Serum and Urinary Neopterin Levels in Several Renal Diseases

Neopterin is a pyrazino-pyrimidine compound, and is known to be a marker associated with cell-mediated immunity in various diseases. We hypothesized that the levels of serum and urine neopterin would be elevated in renal disease, and would correlate with certain clinical parameters. We evaluated serum and urinary neopterin levels in patients with several renal diseases, including nephrotic syndrome (NS, n=19), chronic renal failure (CRF, n=8), end stage renal disease (ESRD, n=64) and controls (n=22). Serum neopterin was elevated in patients with CRF and ESRD, as compared to controls. Urinary neopterin levels were also found to be elevated in patients with CRF and ESRD, as compared to controls. Serum neopterin levels showed significant positive correlation with age, serum BUN and creatinine levels, and inverse correlation with WBC, hemoglobin, hematocrit, serum albumin and total iron binding capacity. Urine neopterin levels exhibited positive correlation with age and serum creatinine levels, and inverse correlation with WBC, hemoglobin, hematocrit, BUN and serum albumin. In conclusion, increased serum and urinary neopterin levels were found in some patients with renal disease and were correlated with certain clinical parameters.

Apoptosis in Autosomal Dominant Polycystic Kidney Disease / 대한신장학회잡지

BACKGROUND: Apoptosis is one of the major histopathologic features of autosomal dominant polycystic kidney disease (ADPKD) and may be causally related to the cystogenesis and the progressive deterioration of the renal function in this population. The purpose of this study is to determine whether transforming growth factor-beta1 (TGF-beta1)-Smad2/3 signal pathway, antiapoptotic Bcl-2 proteins are involved in apoptotic pathway in the pathogenesis of ADPKD. METHODS: Human polycystic kidneys were collected from four ADPKD patients with end stage renal disease who were taken renal transplantation. We evaluated TdT-mediated dUTP nick end labeling (TUNEL) assay to detect apoptotic DNA fragmentation in polycystic kidneys compared to normal kidneys. Expression of TGF-beta1, Smad2/3 and Bcl-2 proteins was also detected by immunohistochemistry. RESULTS: The number of apoptotic nuclei in polycystic kidneys was markedly increased, as compared with normal kidneys. Apoptotic cells in tubules expressed as a percentage of total tubular cells within 10 random high power fields (x400) were significantly increased in ADPKD group than in normal group (9.01+/-1.85%, 0.36+/-0.10%, p=0.020). Apoptotic nuclei were detected not only in cells lining the expanded cystic wall but also in the noncystic tubular epithelial cells. Apoptotic nuclei were also demonstrated in the interstitium occasionally but rarely observed in the glomeruli. Immunohistochemical findings of polycystic kidneys showed increased expression of TGF-beta1 proteins and Smad2/3 proteins, and decreased expression of Bcl-2 proteins in cystic and noncystic tubular epitheial cells as opposed to other parts of the kidney, as compared with normal kidneys. CONCLUSION: Upregulation of TGF-beta1-Smad2/3 signal pathway and decreased anti-apoptotic Bcl-2 protein seem to be involved in apoptotic pathway of ADPKD.

A decrease in glomerular filtration rate with aging: the effect of smoking and obesity / 대한내과학회지

BACKGROUND: The kidney function with aging is the dramatic changes of human organ system. Recent studies have suggested that many risk factors such as smoking and obesity could contribute to the progression of chronic kidney disease, though there is a little evidence in the literature showing this relationship in the general population prospectively. We aimed to identify the change of calculated glomerular filtration rate (GFR) with aging in healthy adults and to evaluate the effect of prior risk factors to the change of GFR after 5 years follow-up. METHODS: This study included 3,928 healthy adults who participated in health screening examinations in 1997 and 2002. Average age was 42 +/- 5 years in 2002 (2,955 males, 973 females). The study population had no diabetes, hypertension, renal disease and other major diseases. The clinical and laboratory monitoring were performed each on 1997 and 2002; 5 years follow-up. In this study population, GFR was calculated using the MDRD (Modification of Diet in Renal Disease) equation: calculated GFR = 186 X Scr(-1.154) X age(-0.203) X (0.742 if female). We evaluated the change of calculated GFR with aging and compared the change of calculated GFR after 5 years follow-up according to smoking and obesity. RESULTS: The decreased GFR in adults was associated with aging. The mean calculated GFR (mean +/- SD) was 82.2 +/- 9.7 mL/min/1.73 m2 at 1997, 76.2 +/- 9.1 mL/min/1.73 m2 at 2002, respectively, so decrease is 6.0 mL/min/1.73 m2/yr (1.2 mL/min/1.73 m2/yr). The change of calculated GFR was more decreased in smoking group (5.2 vs 5.0 mL/min/1.73 m2) and obesity group (6.4 vs 5.7 mL/min/1.73 m2), but not statistically significant(p>0.05). CONCLUSION: Aging is an important factor of decrease in renal function. The mean decrease in calculated GFR was 1.2 mL/min/1.73 m2/yr. We suggest that smoking and obesity had some effects on decrease in renal function. These changes in renal function should be confirmed by a prospective study for a long period and in a large number of subject.

The Relationship of the Hypertension, Insulin Resistance, and Metabolic Syndrome in the Serum Uric Acid Level

BACKGROUND AND OBJECTIVE: The relationship between serum uric acid and metabolic syndrome variables has not been reported in Korea. Therefore, whether the circulating levels of serum uric acid are independently related to hypertension, insulin resistance and the variables of metabolic syndrome were assessed. SUCJECTS AND METHODS: A total of 53,477 health screen examinees were enrolled and divided into four groups (Quartile 1:6.29 mg/dL) according to their serum uric acid level. The blood pressure, lipid profiles, fasting plasma glucose, waist circumference, HOMA, high sensitivity CRP and apolipoprotein were compared between the four groups. RESULTS: There was a positive association between blood pressure and the serum uric acid level (p<0.001). After adjustment for covariates the prevalence of hypertension due to uric acid was 1.192 (95% CI, 1.038-1.368 p=0.013), and 1.408 (95% CI, 1.221-1.623 p<0.001) times higher in subjects in the third and fourth uric acid level quartiles, respectively, compared to the subjects in the first quartile. Insulin resistance and metabolic syndrome variables were positively correlated with the serum uric acid level. The number of metabolic syndrome variables was also increased with an elevated serum uric acid level. CONCLUSION: Our study suggests that serum uric acid levels were independently associated with hypertension, insulin resistance and the variables of metabolic syndrome in the Korean population. Although the serum uric acid level was normal value, the risk of metabolic syndrome was increased with an elevated serum uric acid level. However, because of the cross-sectional nature of our study, these findings should be confirmed in prospective cohort studies.

Hepatitis B virus infection and its relation to cardiovascular risk factors such as lipid profile, hsCRP in Korean adults / 대한내과학회지

BACKGROUND: Among the recent advances in understanding atherogenesis, the "infection hypothesis" is one of the most compelling but remains controversial. Recent experimental and epidemiologic findings suggest that some infectious agents play a role in the development and promotion of atherosclerosis. But very few data are available on the relation between HBV infection and atherosclerosis. We have investigated the possible association between hepatitis B virus surface antigen (HBsAg) positivity and cardiovascular risk factors including hsCRP in healthy Korean adults. METHODS: In 48,423 healthy subjects, the proportion of seropositive subjects for HBsAg and its association with cardiovascular disease risk factors were evaluated in participants in health screening program. Hepatitis B virus infection status was tested with HBsAg test with IRMA (immunoradiometric method) and serum lipid profiles, hsCRP were tested. RESULTS: Of the 48,423 study subjects, 4.5% were positive for HBsAg, indicating that they were hepatitis B virus carriers. In male, HBsAg positive group showed higher mean values for high density lipoprotein (HDL) and lower values for triglycerides, low density lipoprotein (LDL), total cholesterol. They were statistically significant (p<0.001). In female, HBsAg positive group showed higher mean values for high density lipoprotein (HDL) and lower values for triglycerides (p<0.001). In multivariate analysis of covariance (MANCOVA), adjusted by age and other variables, triglyceride, total cholesterol and low density lipoprotein were inversly associated with HBsAg seropositivity in male while only triglyceride and total cholesterol were inversly associated in female. HBsAg seropositivity and other risk factors including hsCRP level which is markers for inflammation were not correlated(p=0.055, p=0.074). CONCLSUION: The result of this study suggest no significant association between hepatitis B infection and hsCRP which is markers for inflammation but possible association with some cardiovascular risk factors such as triglyceride, total cholesterol, HDL, and LDL. Relationship between HBV infection and atherosclerosis has no definitive answer and is disputed issue therefore should stimulate the initiation of further studies to determine whether hepatitis B virus is indeed a causative factor in atherogenesis.

Thyroid dysfunction and their relation to cardiovascular risk factors such as lipid profile, hsCRP, waist hip ratio in Korea / 대한내과학회지

BACKGROUND: Thyroid abnormalities affect a considerable portion of the population. Overt hypothyroidism is associated with an elevated risk of cardiovascular disease and adverse changes in blood lipids. Subclinical hypothyroidism is also associated with an increase risk of cardiovascular disease. So we performed the study to investigate the prevalence of overt and subclinical thyroid disorders and their association between cardiovascular risk factors. METHODS: This study was performed in 66,260 subjects (43,588 men, 22,672 women ; between 20~80 years of age, mean age 41.5+/-9.6). Serum free thyroxine (FT4), thyroid stimulating hormone (TSH), total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) were measured with RIA using commercial kits. High sensitivity C-reactive protein (hsCRP) were measured with nephelometry. RESULTS: The prevalence of overt thyrotoxicosis, subclinical thyrotoxicosis, overt hypothyroidism and subclinical hypothyroidism was 5/1000 (334 subjects), 6.4/1000 (426 subjects), 1.6/1000 (108 subjects), 6.4/1000 (375 subjects) population. Mean plasma total cholesterol and LDL-C were elevated in overt hypothyroidism than normal (202.1 mg/dL and 121.8 mg/dL versus 197.1 mg/dL and 120.1 mg/dL)(p < 0.05). Also in subclinical hypothyroidism, mean total cholesterol and LDL-C level were elevated compared to normal group (201.9 mg/dL and 123.7 mg/dL)(p=0.015, p=0.047). Waist-to-hip ratio (WHR) was lower in overt thyrotoxicosis and was higher in hypothyroidism. CONCLUSION: The prevalence of thyroid dysfunction was not significantly different from those of other countries. It was also age dependent and higher in women but it was lower than expected. Patients with hypothyroidism exhibit higher levels of waist-to-hip ratio as index of obesity. Patients with subclinical hypothyroidism exhibited increased levels of the atherogenic parameters (Total cholesterol, LDL-C). Therefore screening and treatment for subclinical hypothyroidism may be warranted due to the adverse effects on lipid metabolism.

Thyroid dysfunction and their relation to cardiovascular risk factors such as lipid profile, hsCRP, waist hip ratio in Korea / 대한내과학회지

BACKGROUND: Thyroid abnormalities affect a considerable portion of the population. Overt hypothyroidism is associated with an elevated risk of cardiovascular disease and adverse changes in blood lipids. Subclinical hypothyroidism is also associated with an increase risk of cardiovascular disease. So we performed the study to investigate the prevalence of overt and subclinical thyroid disorders and their association between cardiovascular risk factors. METHODS: This study was performed in 66,260 subjects (43,588 men, 22,672 women ; between 20~80 years of age, mean age 41.5+/-9.6). Serum free thyroxine (FT4), thyroid stimulating hormone (TSH), total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) were measured with RIA using commercial kits. High sensitivity C-reactive protein (hsCRP) were measured with nephelometry. RESULTS: The prevalence of overt thyrotoxicosis, subclinical thyrotoxicosis, overt hypothyroidism and subclinical hypothyroidism was 5/1000 (334 subjects), 6.4/1000 (426 subjects), 1.6/1000 (108 subjects), 6.4/1000 (375 subjects) population. Mean plasma total cholesterol and LDL-C were elevated in overt hypothyroidism than normal (202.1 mg/dL and 121.8 mg/dL versus 197.1 mg/dL and 120.1 mg/dL)(p < 0.05). Also in subclinical hypothyroidism, mean total cholesterol and LDL-C level were elevated compared to normal group (201.9 mg/dL and 123.7 mg/dL)(p=0.015, p=0.047). Waist-to-hip ratio (WHR) was lower in overt thyrotoxicosis and was higher in hypothyroidism. CONCLUSION: The prevalence of thyroid dysfunction was not significantly different from those of other countries. It was also age dependent and higher in women but it was lower than expected. Patients with hypothyroidism exhibit higher levels of waist-to-hip ratio as index of obesity. Patients with subclinical hypothyroidism exhibited increased levels of the atherogenic parameters (Total cholesterol, LDL-C). Therefore screening and treatment for subclinical hypothyroidism may be warranted due to the adverse effects on lipid metabolism.