The Risk Factors and Natural History of Chronic Kidney Disease in Liver Transplant Recipients / 대한신장학회잡지

BACKGROUND: With the increasing success of liver transplantation, more patients are developing renal dysfunction. The goal of the current study was to assess the natural history of renal dysfunction and to identify patients at risk for the development of chronic kidney disease in liver transplant recipients. METHODS: Cumulative incidence of chronic kidney disease (defined as a sustained decrease in estimated glomerular filtration rate of <60 mL/min/m2 for at least 3 months) was determined using the Kaplan - Meier method. Cox regression analysis was used to test the independent effect of potential risk factors on time to development of chronic kidney disease. In addition, mycophenolate mofetil was introduced in conjuncion with rapid reduction of calcineurin inhibitors (CNI) in some cases of patients with renal dysfunction, and the change of renal function was analyzed. RESULTS: The cumulative incidence of chronic kidney disease was 28.7% and the incidence of severe renal dysfunction was 2.3%. Pre - transplant renal dysfunction and older age are risk factors of chronic kidney disease. Renal dysfunction at 3 months after transplantation was a significant predictor for the development of chronic kidney disease. A significant improvement of renal function was seen in patients with rapid reduction of CNI. CONCLUSION: We have identified risk factors and the natural history of chronic kidney disease in liver transplant recipients. These observations may be useful in the development of less - nephrotoxic immunosuppressive regimens for liver transplant recipients at high - risk of renal dysfunction.

Tuberculous Pyomyositis in a Renal Transplant Patient / 대한신장학회잡지

Tuberculosis infection of skeletal muscle is rare, even in countries where tuberculosis is relatively prevalent. Because tuberculosis of muscle is usually secondary to underlying tuberculosis of the bone or adjacent joint, isolated tuberculosis of skeletal muscle is very rare. Moreover, tuberculosis pyomysitis shows nonspecific symptoms even in immuno-compromised hosts. Recently we experienced an isolated tuberculosis pyomysitis in renal allograft recipient and report here. A 57-year-old woman presented with pain and edema on right calf area. Sonographic imaging of right calf muscle showed large elongated fluid collection. Operative debridement was done and the histopathology of calf muscle showed granulomas surrounded by Langhans' giant cells. We diagnosed her as tuberculous polymyositis combining the data of histology and positive result of polymerase chain reaction for mycobacterium tuberculosis. We treated her with the anti-tuberculosis medication. After surgical debridement and medical management, calf muscle tuberculous polymyositis showed fair improvement.