Relative Risk Factors of Prognosis in IgA Nephropathy Patients with Depressed Renal Functions / 대한신장학회지

PURPOSE: This study was aimed at finding clinical factors to be associated with a progressive course of IgA nephropathy. METHODS: We investigated the association between the prognosis of IgA nephropathy and clinical and laboratory findings including age, sex, hypertension, diabetes mellitus, 24-hour urine protein, macroscopic hematuria, hematuria duration, serum uric acid, serum creatinine, GFR, upper respiratory infection, pathological observation, and treatment protocols. One hundred seventy seven patients were followed up for more than 2 years at Kyung Hee university medical center from January 1997 through December 2006. Kidney size and echogenicity were measured by abdominal ultrasonography. Resistive index was calculated by doppler ultrasonography. RESULTS: Long hematuria duration, increased uric acid, elevated creatinine of chronic renal failure group were distinguished from those of normal and acute renal failure group statistically. Using multivariate analysis, three factors, elevated serum uric acid, decreased GFR, ACE inhibitor or ARB and steroid combination treatment proved to be independent prognostic indicators of acute renal failure of IgA nephropathy. Heavy proteinuria, long hematuria duration, and severe histopathologic findings by Haas' classification were associated with significant risk factors for developing chronic renal failure. CONCLUSION: At diagnosis of IgA nephropathy, hematuria continuation and histological damage in Haas' classification were related with the reduction of renal function.

A case of idiopathic granulomatous hepatitis in an HIV-infected patient / 대한내과학회지

Patients infected with human immunodeficiency virus (HIV) may develop various liver diseases, including viral hepatitis, granulomatous inflammation, malignancies, vascular disease, drug-induced hepatitis and, sometimes, diseases of unknown origin. In this case, a 35-year-old HIV-infected man presented with fatigue, myalgia, elevated liver enzymes, and multiple skin lesions for 3 months. Since the abdominal computed tomography (CT) and viral marker tests failed to explain the cause of his symptoms and signs, a liver biopsy was performed. This revealed a granuloma consisting of epithelioid cells without necrosis. His symptoms, skin lesions, and abnormal liver enzymes improved without changing his management, including the anti-retroviral agents. He was diagnosed with idiopathic granulomatous hepatitis based on the pathologic findings of the liver and clinical course. Aggressive diagnostic methods, such as a liver biopsy, should be considered for HIV-infected patients with liver disease.

Carotid Artery Intima-Media Thickness According to the Stage of Chronic Kidney Disease / 대한신장학회지

PURPOSE: Carotid artery intima-media thickness (cIMT) has been reported as the predictive factor of mortality of cardiovascular disease in dialysis patients but only a few reports are available on the patients with earlier stages. We compared cIMT according to the stage of chronic kidney disease, and analyzed the data in association with cardiovascular risk factors. METHODS: Study subjects were 88 patients with chronic kidney disease less than 60 ml/min/1.73m2 of glomerular filtration rate. cIMT was measured by means of high- resolution B-mode ultrasonography. Cardiovascular risk factors and cIMT were analyzed and compared with 30 subjects with normal renal function. RESULTS: cIMT was significantly increased with the stage of chronic kidney disease. When the stage was increased from 3 to 5, cIMT was increased (p=002). cIMT was further increased in all stages of chronic kidney disease than in patients with normal kidney function. But association of diabetic chronic kidney disease with non-diabetic chronic kidney disease was not significant (p=0.127). Multiple regression analysis showed that cIMT in patients with chronic kidney disease was significantly correlated to age, glomerular filtration rate, and the stage of chronic kidney disease. CONCLUSION: We suggest that carotid atherosclerosis could increase in no dialysis patients with early stage of chronic kidney disease. Carotid artery intima-media thickness was correlated with age, glomerular filtration rate, and the stage of chronic kidney disease.

A Case of Wegener's Granulomatosis with Delayed Diagnosis due to Clinical Features of Henoch-Schonlein Purpura / 결핵및호흡기질환

Wegener's granulomatosis is a systemic vasculitis of the medium and small arteries, as well as of the venules, arterioles, and occasionally large arteries, and primarily involves the upper and lower respiratory tracts and the kidneys. Renal symptoms of Wegener's granulomatosis are indistinguishable from those of vasculitis such as Henoch-Schonlein purpura and microscopic polyangiitis. This case, though initially diagnosed as Henoch-Schonlein purpura, was confirmed as Wegener's granulomatosis from a lung biopsy fifteen years after the initial diagnosis. We report this case with a review of the literature.

A Case of Wegener's Granulomatosis with Delayed Diagnosis due to Clinical Features of Henoch-Schonlein Purpura / 결핵및호흡기질환

Wegener's granulomatosis is a systemic vasculitis of the medium and small arteries, as well as of the venules, arterioles, and occasionally large arteries, and primarily involves the upper and lower respiratory tracts and the kidneys. Renal symptoms of Wegener's granulomatosis are indistinguishable from those of vasculitis such as Henoch-Schonlein purpura and microscopic polyangiitis. This case, though initially diagnosed as Henoch-Schonlein purpura, was confirmed as Wegener's granulomatosis from a lung biopsy fifteen years after the initial diagnosis. We report this case with a review of the literature.