Retrospective Analysis of Factors Related with Renal Outcomes in Elderly Type 2 Diabetic Patients Including Advanced Diabetic Nephropathy / 대한신장학회잡지

BACKGROUND: Recently, the prevalence of diabetes mellitus in elderly people is increasing in Korea because of an increase in longevity. With advancing age, also a greater proportion of end-stage renal disease (ESRD) patients with complex medical co-morbidity contributes to the higher mortality seen in patients receiving dialysis. Diabetic nephropathy has become the most important cause of ESRD worldwide. More intensive therapeutic manipulation is needed to prevent the progression of diabetic nephropathy, but there are few studies about this subject in type 2 diabetes. The aim of this study is to predict renal outcomes of elderly people with type 2 diabetes and investigate risk factors related with the deterioration of renal function and the development of ESRD. METHODS: Study subjects were 67 elderly patients (over 65 years old) with type 2 diabetes. We retrospectively analyzed risk factors for the end points of doubling of serum creatinine or the development of ESRD (dialysis or transplantation). RESULTS: 17 patients (26.4%) reached the end points during the follow-up period. 16 patients of 43 patients with decreased renal function reached the end points and only one of 24 patients with preserved renal function reached the end points. A univariate analysis revealed significant correlations between renal outcomes and duration of diabetes, anemia, hypoalbuminemia, BUN, baseline serum creatinine, GFR, serum calcium, phosphorus, uric acid levels and the degree of proteinuria. In our multivariate analysis, proteinuria and baseline serum creatinine level were significantly independent risk factors. The risk of doubling of serum creatinine or development of ESRD among patients with baseline urinary protein excretion rate >or=1g/24h was six times higher compared with the risk among those with urinary protein excretion rate <1g/24h. CONCLUSION: Proteinuria and the degree of baseline kidney dysfunction are significant risk factors that contribute to the deterioration of renal function and the development of ESRD in elderly patients with type 2 diabetes. Proteinuria is the most powerful independent predictor of renal outcomes.

A Case of Abdominal Actinomycosis Complicated by Hydronephrosis / 감염과화학요법

Actinomycosis is a chronic suppurative and granulomatous disease caused by Actinomyces species, which normally colonize the mouth, colon, and vagina. Actinomycosis affects any organ and it is histologically characterized by sulfur granule. Most of abdominal actinomycosis develop following appendicitis, diverticulitis or perforated viscus. Abdominal actinomycosis is commonly misdiagnosed as other diseases of intestine because the clinical presentation is non-specific and the radiologic findings mimic tumor. We report a case of abdominal actinomycosis, which initially presented as hydronephrosis and finally diagnosed after laparotomy. Histological findings showed sulfur granules, chronic granulomatous inflammation, and acute inflammatory cells. In our knowledge, this is the first report in Korea of the abdominal actinomycosis associated with appendicitis and complicated with hydronephrosis.

A Case of Abdominal Actinomycosis Complicated by Hydronephrosis / 감염과화학요법

Actinomycosis is a chronic suppurative and granulomatous disease caused by Actinomyces species, which normally colonize the mouth, colon, and vagina. Actinomycosis affects any organ and it is histologically characterized by sulfur granule. Most of abdominal actinomycosis develop following appendicitis, diverticulitis or perforated viscus. Abdominal actinomycosis is commonly misdiagnosed as other diseases of intestine because the clinical presentation is non-specific and the radiologic findings mimic tumor. We report a case of abdominal actinomycosis, which initially presented as hydronephrosis and finally diagnosed after laparotomy. Histological findings showed sulfur granules, chronic granulomatous inflammation, and acute inflammatory cells. In our knowledge, this is the first report in Korea of the abdominal actinomycosis associated with appendicitis and complicated with hydronephrosis.

A Case of Acute Ethanol Intoxication Complicated with Sciatic Neuropathy Treated with Hemodialysis / 대한신장학회잡지

A 20-year-old man presented with semicoma due to severe ethanol intoxication. Initially, his blood ethanol level was markedly elevated to 73 mmol/L. The patient's level of consciousness did not change for 6 hours with conservative treatment. In an attempt to expedite his recovery, hemodialysis was started using a femoral vein catheter. After an initial session of hemodialysis, his blood ethanol level was decreased to 19 mmol/L, and his mental status showed improvement. Subsequent hemodialysis further reduced his blood ethanol concentration to 3 mmol/L and improved his consciousness level. The patient was treated conservatively for additional complications caused by ethanol toxicity including liver failure, rhabdomyolysis and peripheral polyneuropathy. Most commonly, peripheral polyneuropathy is related with chronic ethanol intoxication and it is extremely rare in acute ethanol intoxication. We report a case of peripheral polyneuropathy related with acute ethanol intoxication and suggest that hemodialysis should be considered in patients with severe ethanol intoxication for life preservation and prevention of complications.

A case of primary synovial sarcoma of the pleura / 대한내과학회지

Synovial sarcoma is a malignant soft tissue tumor originated from primitive mesenchymal cell and displays epithelial differentiation. Synovial sarcoma most commonly occurs in the peri-articular regions of the extremities in adolescents and young adults. But primary synovial sarcoma of the pleura is extremely rare. The present report describes a case of primary synovial sarcoma of the pleura in a 35-year-old male who showed unilateral spontaneous hemothorax as initial manifestation. The tumor mass was removed by open thoracotomy. The tumor was composed of oval to spindle cells with abundant vascular structures. Some of the spindle-shaped tumor cells express cytokeratin. A diagnosis of monophasic fibrous synovial sarcoma was made by histologic and immunologic features. The patient received chemotherapy postoperatively and showed no evidence of recurrence or tumor at other sites 1 year after surgery.

Long-term Chelation Therapy in Patients with Chronic Lead Nephropathy by Excessive Body Lead Burden / 대한신장학회잡지

BACKGROUND: Although chelation therapy with calcium disodium ethylenediamine tetraacetic acid (CaNa2EDTA) reduces body burden of lead and improves clinical side effects from lead, it is unclear whether long-term repeated chelation is safe for chronic lead poisoning with nephropathy. We described the consequential changes of renal function and clinicopathological findings during one to two years of monthly administration of CaNa2EDTA in patients with chronic lead nephropathy and excessive body lead burden. METHODS: Three patients diagnosed as chronic lead nephropathy received 1 g/day of intravenous CaNa2EDTA for a 3-5 day/cycle. A total of 48-86 g CaNa2EDTA was administered. Midtibial bone lead, chelatable lead, and blood lead levels were assessed. Renal function was determined in each chelation, and renal biopsies before and after chelation were conducted and compared for microscopic and immunofluorescence changes. RESULTS: Cortical bone lead levels showed a high burden of lead (>200 microgram Pb/g bone mineral). During CaNa2EDTA treatment, blood lead level and renal function were in steady state. No evidence of progression of renal pathology was observed in both renal biopsies, showing similar interstitial fibrosis and glomerular sclerosis. CONCLUSION: Our results suggest that long-term repeated chelation therapy with CaNa2EDTA is safe and effective for patients who have suffered from severe chronic lead poisoning, even though renal pathologic change has started.

Rhabdomyolysis in a Cyclosporine-treated Renal Transplant Recipient Who Received Atorvastatin as Replacement for Fluvastatin / 대한신장학회잡지

Statin-induced rhabdomyolysis is a frequent complication in renal transplant recipients receiving cyclosporine, but incidences are different between different types of statins. Statins have different pharmacokinetic properties. Atorvsatatin, simvastatin, lovastatin, and cerivastatin are all metabolized by the cytochrome P450 isoenzyme 3A4 and co-administration of cyclosporine which may inhibit cytochrome P450 isoenzyme 3A4, increases statin levels and therefore increases the risk of rhabdomyolysis. Fluvastatin is metabolized by cytochrome P450 isoenzyme 2C9 and no clinically significant interactions with cyclosporine have been reported. Atorvastatin with co-administration of cyclosporine in renal transplant patients may induce drug interactions, therefore we recommend the routine monitoring of muscle enzymes, in these cases. Here, we reported a case of rhabdomyolysis in a patient who received atorvastatin and cyclosporine with the review of the literature.