Lupus Membranous Nephropathy with Atypical Serology / 대한신장학회잡지

Glomerulonephritis is the common manifestation of SLE and occurs in approximately 60-75% of patients. However, renal involvement as an initial presentation of SLE is not frequent finding. Serum complement levels and anti-ds DNA titer are useful tests in assessing the activity of lupus nephritis, but the level of anti-ds DNA is often normal in patients with pure membranous disease. With the above characteristics, this case shows atypical serology that is positive anti-La/SSB which is related with the absence of nephritis.

Clinical Significance of Bone-Specific Alkaline Phosphatase as a Marker of Bone Turn-Over In Hemodialysis Patients: Impact of Metabolic Acidosis on Various Bone Markers / 대한신장학회잡지

Renal osteodystrophy is a leading cause of morbidity in patients with end stage renal disease(ESRD), including a diverse clinical spectrum and histologic lesions. Since the invasiveness and practical limitations of bone biopsy to diagnose the exact nature of bone disease in ESRD patients, many attempts have been made to investigate the biologic markers of bone disease. Bone-specific alkaline phosphatase(bAP) is localized in the plasma membrane of osteoblast to be involved in bone formation and skeletal mineralization. This study was undertaken to evaluate the value of bAP in the diagnosis of renal osteodystrophy and to examine the correlation between bAP (Immunoassay, Metra, U.S.A.) and other known markers of bone turn-over, total alkalilne phosphatase (tAP), intact parathyroid hormone(iPTH) and osteocalcin in 49 HD patients(M:F 29:20, mean age 51 years, mean HD duration 57 months). We also evaluated the impact of metabolic acidosis, which is known to stimulate the osteoclastic activity and bone resorption, on plasma levels of these bone markers. The median value of bAP in HD patients was 30.1ng/ml with a distribution of 8.8-140.1ng/ml (normal 12-23ng/ml). There was a significant positive correlation between the duration of HD and plasma levels of tAP, bAP, iPTH and osteocalcin. Significant positive correlaton was also observed between iPTH and other markers of bone turn- over-bAP, tAP and osteocalcin. bAP was correlated better with iPTH(r=0.8483, P<0.001) than tAP(r= 0.7588, P<0.01). In the patients group whose arterial blood bicarbonate below 20mEq/L(30 cases), plasma iPTH and bAP were significantly higher compared to the patients with arterial bicarbonate higher than 20mEq/L(19 cases). In conclusion, high bAP can be an useful marker of increased bone turn-over in HD patients. Increased concentrations of iPTH and bAP in patients with metabolic acidosis(arterial bicarbonate below 20 mEq/L) may reflect an increased bone resorption with resultant increase in osteoblast activity. However, a prospective study with alkali supplementation and bone biopsy will be necessary to define the exact role of metabolic acidosis in the development and progression of renal osteodystrophy.

Primary Bilateral B-cell Renal Lymphoma: A Case Report and Review of the Literature / 대한내과학회지

Primary lymphoma of the kidney is rare, and in most cases is attributable to lymphomatous renal infilitration of systemic non-Hodgkin's lymphoma or an extension from an adjacent site of the disease. Since the renal parenchyma is not a lymphoid organ, the mechanism by which renal lymphoma occur remains poorly understood. We report here a case of primary bilateral B-cell renal lymphoma in 26-year-old man who was treated successfully with combination chemotherapy.

A Case of Bronchial Mucoepidermoid Carcinoma / 결핵

Mucoepidermoid carcinoma developed in tracheobronchjal tree is one of rare lung tumor. It is histologically divided into low grade malignancy of relatively benign course versus high grade malignancy of fatal course. In low grade malignancy, it can be curative with a surgical resection. We experienced a case of mucoepidermoid carcinoma in a 28-year-old woman who complained sudden dyspnea and presented right total lung collapse on chest roentgenogram. It was diagnesed as a low grade mucoepidermoid carcinoma and removed by the surgical excision.