The Use of Single-pass Albumin Dialysis to Correct Severe Hyperbilirubinemia in Acute Hepatitis A: A Case Report / 대한신장학회지

In cases of acute liver failure or acute or chronic liver failure, extracorporeal albumin dialysis utilizing a Molecular Adsorbent Recirculating System has been used to treat liver failure and to reduce serum total bilirubin concentrations as a bridge therapy until either liver transplantation or spontaneous recovery. However, the procedure is expensive and is not easily administered in clinical practice. Recently, single pass albumin dialysis (SPAD) using continuous renal replacement therapy was introduced, but information is scarce regarding its efficacy in controlling serum bilirubin. The authors report a case of acute hepatitis A, in which SPAD was performed to correct severe hyperbilirubinemia.

Effect of Anti-embolism Stocking on Intrasession Hemodynamic Variables in Hemodialysis Patients / 대한신장학회지

PURPOSE: There is no data about the effect of anti-embolism stockings on intrasession hemodynamics in end stage renal disease patients on hemodialysis (HD). We investigated whether it affects the hemodynamic changes during HD or not. METHODS: We performed 2 HD sessions, before (stocking negative, SN) and after (stocking positive, SP) putting on thigh-high anti-embolism stockings in 11 ESRD patients on HD. In each session, cardiac output (CO), stroke volume (SV), central blood volume (CBV), and peripheral resistance (PR) were measured by ultrasound velocity dilution method at 1 and 3 hours of HD. Ultrafiltration (UF) amount was matched during study. Hemodynamic variables were compared between SN and SP. RESULTS: Mean ages were 51+/-14 years, female was 8, diabetes mellitus was 4, and duration of HD was 56.9+/-28.9 months. There were no differences in pre- and post-HD SBP and DBP, UF amount at 1 hr and 3 hr of HD, and total UF amount between SN and SP. At 1 hr of HD, CBV was greater in SP than in SN (0.85+/-0.32 L vs. 0.93+/-0.32 L, p=0.003). CO (5.56+/-1.22 L/min vs. 5.14+/-1.35 L/min, p=0.075) and SV (73.77+/-19.11 mL vs. 68.95+/-22.21 mL, p=0.05) tended to be increased in SP than in SN. However, there were no differences in TPR between 2 groups. At 3 hr of HD, there were no differences in all hemodynamic variables bewteen SP and SN. CONCLUSION: At early phase of HD, anti-embolism stockings seem to increase CBV, but this effect seems to be attenuated at later phase.

A Case of Hemoperitoneum after Transplant Kidney Biopsy / 대한신장학회지

Percutaneous transplant kidney biopsy has become the most important tool for diagnosing allograft dysfunction. However, renal biopsy has various complications. Among them, hemoperitoneum is a rare complication and has not been reported in Korea. We experienced a case of hemoperitoneum after transplant kidney biopsy. A 43-year-old man, 3 years after renal transplantation, was presented with elevated serum creatinine. Percutaneous renal biopsy was executed by real-time ultrasound guidance and 14-gauged spring loaded automated biopsy gun at upper pole of transplanted kidney. Renal biopsy was completed after 5 trials due to poor visualization of biopsy needle tip. After 2 hours, the patient complained of acute right side abdominal pain and dizziness. Abdominal pelvis CT showed moderate amount of hemoperitoneum. The patient underwent emergency laparotomy. Hematoma was seen in the omentum with minor vessel bleeding. Ligation was done. The patient was discharged after 15 days.

A Case of Massive Intra-Abdominal Hematoma Due to Inferior Epigastric Artery Rupture During Peritoneal Dialysis Catheter Insertion / 대한신장학회지

With the development of the Tenckhoff catheter and subsequent Trochar device for percutaneous placement, a bed-side approach for peritoneal dialysis (PD) catheter insertion has been frequently used by nephrologists. Bleeding complications resulting from PD catheter placement are infrequent and massive bleeding by the rupture of inferior epigastric artery is very rare. We report a case of massive intra-abdominal hematoma caused by traumatic rupture of inferior epigastric artery during percutaneous placement of PD catheter.

A Case of Idiopathic Nodular Glomerulosclerosis Related to Hypertension and Smoking / 대한신장학회지

A 39-year-old man with a history of hypertension for 10 years and 10 pack-years smoking, was admitted with dyspnea and generalized edema. On admission, renal insufficiency accompanied with nephrotic syndrome was diagnosed. Even on careful examination including history, blood chemistry test, and fundoscopic examination, no clinical evidence of diabetes was found. Renal biopsy findings, which strongly resembled that of diabetic nodular glomerulosclerosis in microscopic features, showed glomerular hypertrophy and nodular mesangeal sclerosis. Additional immunohistochemistry and ultrastructural investigations excluded other possible diseases that should be differentiated; membranoproliferative glomerulonephritis, thrombotic microangiopathy, amyloidosis, monoclonal immunoglobulin deposition disease, fibrillary glomerulonephritis, and immunotactoid glomerulopathy. Idiopathic nodular glomerulosclerosis is histopathologically similar to nodular diabetic glomerulosclerosis but is unusually developed in persons with hypertension and smoking history. Though there were three reports about cases of nodular glomerulosclerosis in the Korean literature, the cases were related to hepatitis B virus or diabetic retinopathy without overt diabetes. We report a rare case of idiopathic nodular glomerulosclerosis that was related to hypertension and smoking without other medical history.

A Case of Cryptococcal Pneumonia in a Rheumatoid Arthritis Patient after Tumor Necrosis Factor-alpha Antagonist Therapy / 대한류마티스학회지

Tumor necrosis factor-alpha (TNF-alpha) plays a important role in the pathogenesis of rheumatoid arthritis and Crohn's disease, TNF-alpha antagonist has been widely used for these disease, but it also plays a major role in cell mediated immunity. Cryptococcus neoformans, an encapsulated, ubiquitous environmental yeast, is pathogenic for humans, primarily those with compromised immune function. Cryptococcus neoformans is believed to be a facultative intracellular pathogen. We report a case of pulmonary cryptococcosis after chimeric anti-TNF monoclonal antibody therapy. No case has been reported in Korea for the best of our knowledge. A 66-year old woman was admitted because of severe cough. She was diagnosed to have rheumatoid arthritis 4 years ago and taken prednisolone and methotrexate. She was started on infliximab and received ten doses, the last dose being administered 6 weeks prior to above symptom. Chest PA and computed tomography of chest revealed multifocal consolidative lesions in both lungs. Pulmonary cryptococcosis confirmed by thoracoscopic lung biopsy tissue stained with Grocott-Gomori methenamine-silver (GMS). Initially the lung lesion responded to amphotericin B but leukopenia developed after 12 days of treatment. It was changed to fluconazole, then leukopenia and the pneumonia also improved. Physicians should remind pulmonary cryptococcosis in patients receiving TNF-alpha antagonist therapy.

One Case of Primary Malignant Mixed M llerian Tumor of the Ovary / 대한산부인과학회잡지

Malignant mixed m llerian tumor (MMMT) of the ovary is very rare neoplasm consisting of both a sarcomatous and carcinomatous component and represent is fewer than 1% of all ovarian malignancies. Characteristically, ovarian MMMTs follow an aggressive clinical course, and long-term survival is unusual. Almost all MMMTs are found in postmenopausal women, often with low parity and usually in an advanced stage. Stage has been recognized as the single most important prognostic factors. However, a major improvement in prognosis for this rare malignancy has not yet been achieved. The authors have experienced one case of primary malignant mixed m llerian tumor of the ovary and report our experience with a brief review of literature.