Coronary Artery Bypass Surgery in Patients with End-Stage Renal Disease / 대한흉부외과학회지

BACKGROUND: As cardiac disorders, especially coronary artery disease is increasing in end-stage renal disease patients, the indications for coronary artery bypass surgery are increasing now. They have high risks for postoperative morbidity and mortality after coronary artery bypass surgery. MATERIAL AND METHOD: Between March of 1996 and May of 2000, medical records of 25 patients with end-stage renal disease who underwent coronary artery bypass surgery at Asan medical center were reviewed retrospectively. We reviewed the short-term results of preoperative risk factors, preoperative renal function, perative methods, operation results, hospital course, postoperative morbidity and mortality. RESULT: Preoperative creatinine clearance was 12.68+/-5 ml/min and serum creatinine level was 6.18+/-3 mg/dL(range 1.7-14. 4). Preoperatively, 11 patients(44%) received dialysis and the others(14 patients, 56%) were not supported by dialysis due to adequate urine output. Of the non-dialysis patients(14 cases), 8 patients were newly supported by dialysis, perioperatively. Of the preoperative hemodialysis patients(9 cases), two patients changed dialysis method postoperatively to peritoneal dialysis. Operative mortality occured in 2 patients(8%) and the causes of death were sepsis from aspiration pneumonia and mediastinitis, and postoperative bleeding and mediastinitis, respectively. Postoperative complications were developed in 14 patients(56%). There were 2 cases(8%) late mortalities and the cause of death was catheter-induced peritonitis. The actuarial survival rates in hospital survivals at 4 years was 82+/-13%. CONCLUSION: The coronary artery bypass surgery of end-stage renal disease patients were performed with acceptable mortality(8%). However , because the morbidity and mortality from morbidity were very frequent, perioperative prevention of infectious complications and careful patient management are very important.

The Clinical Outcomes of Coronary Stenting and Coronary Artery Bypass Grafting in ESRD Patients with Ischemic Heart Disease / 대한신장학회잡지

The purpose of this study was firstly, to evaluate the efficacy of coronary stenting in ESRD patients compared with non uremic patients and secondly, to compare the perioperative mortality of coronary artery bypass grafting(CABG) in ESRD patients with that in non-uremic patients exhibiting a similar degree of left ventricular function. We examined the clinical restenosis of coronary stenting and 30 day mortality rate after CABG in this retrospective, case-controlled study. The case histories of twenty-five ESRD patients with ischemic heart disease(IHD) and twenty-five non-uremic IHD patients matched for age, sex, ejection fraction and number of implanted stents, who had undergone first, elective, primarily successful coronary stenting were reviewed. The case of histories of another sixteen ESRD patients with IHD and sixteen non-uremic IHD patients matched for age, sex, ejection fraction and number of grafted vessels, who had undergone first elective CABG were also reviewed. Clinical restenosis developed in nine of the twenty-five ESRD patients and in eight of the twenty-five non-uremic patients after coronary stenting within follow up periods of 16.9+/-14.5 months and 17.6+/-14.6 months, respectively. There was no significant difference in the cumulative clinical restenosis free curves between the two groups(p=0.79). Three out of sixteen for the ESRD patients and one out of sixteen for the non-uremic patients died in 30 days after CABG, follow up periods being 11.3+/-9.6 months and 11.1+/-8.9 months, respectively. The perioperative mortality did not differ between the two groups(p=0.28). We conclude that coronary stenting in ESRD patients is as effective as in non-uremic patients regarding initial coronary revascularization and perioperative mortality rate of CABG in ESRD patients is not significantly higher compared with non-uremic patients when Left ventricular function is matched.

A Case of Idiopathic Fibrillary Glomerulonephritis / 대한신장학회잡지

A 17-year-old girl was admitted to our hospital due to mild generalized edema. Laboratory tests revealed a serum creatinine was 0.7mg/dL, protein/albumin 6.7/3.5g/dL, cholesterol 190mg/dL, hemoglobin 10.0g/dL, and 24 hour urinary protein 4,40mg/day. Chest X-ray and renal ultrasound were normal. There were no clinical or serologic evidences of paraproteinemia, cryoglobulinemia, light chain disease or systemic lupus erythematosus. Renal biopsy showed membranoproliferative glomerulonephritis-like pattern with lobular accentuation, hypercellularity and diffuse GBM thickening by light microscope. Congo red staining was negative. Granular IgG and C3 deposits were found along the glomerular capillary wall and mesangium by immunofluorescence microscope. Ultrastructurally, abundant subendothelial and mesangial fibrillary deposits were found associated with thickening and wrinkling of GBM. These fibrils, measured about 20-30nm in diameter, were nonbranching and randomly arranged without either periodicity or an organized structure. These findings were compatible with those of fibrillary glomerulonephritis. Thus we report a case of idiopathic fibrillary glomerulonephritis, which is a rare cause of nephrotic syndrome.