Clinicopathologic Characteristics of IgA Nephropathy with Crescents / 대한신장학회지

PURPOSE: In IgA nephropathy (IgAN), crescent formation appears to represent a nonspecific response to severe injury to the glomerular capillary wall. This study was performed to evaluate the clinicopathological manifestations of the crescents and their effects on the clinical courses of IgAN. METHODS: The patients diagnosed IgAN were included and the information about their renal biopsies, chemistries and immunohistochemistry findings were collected retrospectively. Some patients that have similar renal function and protenuria were followed up for 12 months to examine the effects of crescents on the renal prognosis. RESULTS: 38 patients with crescents and 177 patients without crescents were enrolled. The patients with IgAN with crescents showed significantly lower renal function (MDRD eGFR 58.5 vs 88.4 ml/min/1.73m2), higher blood pressure, larger amount of proteinuria and more severe hematuria than those patients without crescents. In pathologic findings, HS Lee grades were higher (2.9 vs 1.9). When we selected patients with mildly decreased renal function (serum creatinine <2.5 mg/dL, PCR 0.5-8 g/gCr), the patients with crescents presented lower renal function and higher proteinuria but no statistical significance. After 12 months of treatment, the patients with crescents showed significantly lower renal function (MDRD eGFR 78.6 vs 96.5 ml/min/1.73m2) and higher proteinuria (0.9 vs 0.6 g/gCr). CONCLUSION: The patients with IgAN with crescents showed more deteriorated clinicopathological findings than those without crescents. Despite aggressive treatments, they presented a significantly decreased renal function and larger amount of proteinuria after 1 year. So crescents are supposed to have poor effects on the clinical course.

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.

Herpes Simplex Virus and Varicella Zoster Virus Infections in Adult Kidney Transplant Recipients: Incidence and Risk Factor Analysis / 대한신장학회지

PURPOSE:Enhanced immunosuppression for preventing acute rejection, But infection is an inevitable complication. This study was performed to evaluate the risk factors of herpes simplex virus (HSV) and varicella zoster virus (VZV) infection which are frequent and serious complication of renal transplant recipients. METHOD:We evaluated the incidence and risk factors for post-transplant HSV and VZV infection in three hundred and twenty three adult renal transplant recipients. RESULTS:The averaged period of infection was 37.8 months and 42% of infection occurred within six month after transplantation. Prevalence of HSV and VZV infection in diabetes patients are higher than that of non-diabetes patients (p=0.01). The other factors such as age, sex, acute rejection and immunosuppressive regimens, antibody induction didnt affect HSV and VZV infections in renal transplant recipients. CONCLUSION:As diabetic condition suggested more susceptibility to HSV and VZV infections, it is necessary to evaluate the possible occurrence of HSV and VZV infections carefully in transplant recipients with diabetes.

A Case of Imipenem Resistance Acinetobacter baumannii Peritonitis Successfully Treated with Colistin Therapy / 대한신장학회지

Peritonitis in continuous ambulatory peritoneal dialysis (CAPD) is a major cause of technical failure in peritoneal dialysis. The major pathogen is gram positive bacteria, and other main pathogens include gram negative bacteria, mixed microorganisms and fungi. The case of imipenem resistance Acinetobacter baumannii (IRAB) peritonitis are not common. We report a case of peritonitis by IRAB that was not responsive to the empirical antibiotics for CAPD-associated peritonitis. A 56-year-old male with a CAPD catheter inserted 2 weeks before visited our hospital for abdominal pain and turbid peritoneal fluid. He had been diagnosed as having an end stage renal disease (ESRD) about a month before. White blood cell and neutrophil count were elevated at the initial peritoneal fluid analysis, so we diagnosed him as having CAPD-associated peritonitis. Antibiotic therapy was initiated with intraperitoneal injections of ceftazidime/cefamezine which were soon changed to vancomycin/ceftazidime. However, vancomycin/ceftazidime regimen proved ineffective. On the fifth and sixth hospital day, IRAB was cultured from the CAPD catheter exit site swab and peritoneal fluid sampled on the first visiting day. Accordingly, we changed the antibiotics to colistin and removed the CAPD catheter, which led to clinical and laboratory improvement. In the cases of CAPD associated peritonitis in patients who have a history of ICU stay, exposure to the 3rd generation cephalosporin or imipenem, or who are elderly, we must suspect unusual pathogen or multi-drug resistance pathogen such as IRAB.

Association of Polymorphisms in Monocyte Chemoattractant Protein-1 Promoter with Diabetic Kidney Failure in Korean Patients with Type 2 Diabetes Mellitus

Monocyte chemoattractant protein-1 (MCP-1) is suggested to be involved in the progression of diabetic nephropathy. We investigated the association of the -2518 A/G polymorphism in the MCP-1 gene with progressive kidney failure in Korean patients with type 2 diabetes mellitus (DM). We investigated -2518 A/G polymorphism of the MCP-1 gene in type 2 DM patients with progressive kidney failure (n=112) compared with matched type 2 DM patients without nephropathy (diabetic control, n=112) and healthy controls (n=230). The overall genotypic distribution of -2518 A/G in the MCP-1 gene was not different in patients with type 2 DM compared to healthy controls. Although the genotype was not significantly different between the patients with kidney failure and the diabetic control (p=0.07), the A allele was more frequent in patients with kidney failure than in DM controls (42.0 vs. 32.1%, p=0.03). The carriage of A allele was significantly associated with kidney failure (68.8 vs. 54.5%, OR 1.84, 95% CI 1.07-3.18). In logistic regression analysis, carriage of A allele retained a significant association with diabetic kidney failure. Our result shows that the -2518 A allele of the MCP-1 gene is associated with kidney failure in Korean patients with type 2 DM.

The Polymorphisms of PPAR-gamma Coactivator 1alpha Gly482Ser (PGC-1alpha Gly482Ser) are Associated with the Nephropathy of Korean Patients with Type 2 Diabetes Mellitus / 대한신장학회잡지

BACKGROUND: We investigated the effects of the common polymorphisms in the peroxisome proliferator- activated receptor gamma2 (PPAR-gamma2 Pro12Ala) and in PPAR-gamma coactivator 1alpha (PGC-1alpha Gly482Ser) genes on the association with the nephropathy of Korean patients with type 2 diabetes mellitus. METHODS: A total of 113 patients with type 2 diabetes and 123 patients with diabetic nephropathy were enrolled in this study. The Pro12Ala polymorphism of the PPAR-gamma2 gene and the Gly482Ser polymorphism in the PGC-1alpha gene were determined with the polymerase chain reaction amplification, BstU-I and Msp I enzyme digestion, and gel electrophoresis. RESULTS: The genotype and allelic frequency of PPAR-gamma2 Pro12Ala gene were not different statistically between the diabetic nephropathy and the control. The genotype of PGC-1alpha Gly482Ser in diabetic nephropathy was also not different from those in control. The allelic frequency and carriage rate of Ser allele in PGC-1alpha Gly482Ser were significantly higher in patients with diabetic nephropathy than those in control (respectively, p<0.05). CONCLUSION: The polymorphisms of the PGC-1alpha Gly482Ser gene are significantly associated with the nephropathy in Korean patients with type 2 diabetes mellitus.

The Polymorphisms of PPAR-gamma Coactivator 1alpha Gly482Ser (PGC-1alpha Gly482Ser) are Associated with the Nephropathy of Korean Patients with Type 2 Diabetes Mellitus / 대한신장학회잡지

BACKGROUND: We investigated the effects of the common polymorphisms in the peroxisome proliferator- activated receptor gamma2 (PPAR-gamma2 Pro12Ala) and in PPAR-gamma coactivator 1alpha (PGC-1alpha Gly482Ser) genes on the association with the nephropathy of Korean patients with type 2 diabetes mellitus. METHODS: A total of 113 patients with type 2 diabetes and 123 patients with diabetic nephropathy were enrolled in this study. The Pro12Ala polymorphism of the PPAR-gamma2 gene and the Gly482Ser polymorphism in the PGC-1alpha gene were determined with the polymerase chain reaction amplification, BstU-I and Msp I enzyme digestion, and gel electrophoresis. RESULTS: The genotype and allelic frequency of PPAR-gamma2 Pro12Ala gene were not different statistically between the diabetic nephropathy and the control. The genotype of PGC-1alpha Gly482Ser in diabetic nephropathy was also not different from those in control. The allelic frequency and carriage rate of Ser allele in PGC-1alpha Gly482Ser were significantly higher in patients with diabetic nephropathy than those in control (respectively, p<0.05). CONCLUSION: The polymorphisms of the PGC-1alpha Gly482Ser gene are significantly associated with the nephropathy in Korean patients with type 2 diabetes mellitus.

Two cases of occupational asthma induced by 7-ACA and ACT / 천식및알레르기

7-ACA(7-aminocephalosporanic acid) and ACT(aminocephalosporanic thiazine) are basic materials for development of 2nd and 3rd generation cephalosporin. Occupational asthmas(OA) induced by these materials have been very rarely reported. We had experienced 2 cases of OA by them. One was 26 year-old male laboratorian involving 7ACA manufacturing directly. The other case was 40 year-old male asthmatics working at the ware house keeping 7ACA and ACT, not directly making these. The result of skin prick test with 55 common inhalant allergens and 7ACA, ACT and several cephalosporins including Cefazolin, Cefuroxime, Ceftazidime, Cefotaxime, Ceftriaxone and Cefotetan. First case revealed positive reactions to 7ACA and Ceftriaxone, but second case, only positive to ACT. In first case, bronchial challenge with 7ACA only showed positive, but in second, those with 7ACA and ACT both showed positive, though negative to 7ACA in skin test.