Intracapsular infection of polycystic kidney disease and renal transplantation / 器官移植

Autosomal dominant polycystic kidney disease (ADPKD) is a common monogenic hereditary kidney disease, which can progress into end-stage renal disease (ESRD). Patients with ADPKD constantly suffer from recurrent intracapsular infection. The drug resistance caused by antibiotic treatment is becoming increasingly prominent. The pattern of renal transplantation should be selected according to the infection of polycystic kidney disease. In this article, the origin of renal cyst, classification and source of cystic fluid, type and drug resistance of bacteria in the cystic fluid, and intracapsular infection of patients with renal transplantation- associated ADPKD were reviewed, aiming to provide reference for the diagnosis and treatment of intracapsular infection of patients with ADPKD.

Serodiagnosis of Echinococcosis by ELISA Using Cystic Fluid from Uzbekistan Sheep

According to increase of travel, the cases of imported echinococcosis have been increasing in Korea. The present study was undertaken to develop a serodiagnostic system for echinococcosis in Korea. For diagnosis of echinococcosis, the fluid of Echinococcus granulosus hydatid cysts was collected from naturally infected sheep in Uzbekistan. Also serum samples of infected patients who were surgically confirmed were collected in a hospital in Tashkent, Uzbekistan. According to the absorbance of 59 echinococcosis positive and 39 negative control serum samples, the cut-off value was determined as 0.27. The sensitivity and specificity of ELISA with hydatid fluid antigen were 91.5% and 96%, respectively. The antigen cross-reacted with the serum of some cysticercosis or clonorchiasis patients. However, immunoblot analysis on the cystic fluid recognized antigenic proteins of 7-, 16-, and 24-kDa bands in their dominant protein quantity and strong blotting reactivity. In conclusion, the present ELISA system using hydatid cyst fluid antigen from Uzbekistan sheep is sensitive and specific for diagnosis of echinococcosis cases.

Cytokine Profile in the Aspirated Cystic Fluids in Autosomal Dominant Polycystic Kidney Disease (ADPKD) Patients / 대한신장학회잡지

BACKGROUND: The pathogenesis of ADPKD is still unknown but the proliferation of cystic epithelia and the fluid secretion to cystic lumen are thought to be important. Cytokines play a pivotal role in growth, differentiation, and apoptosis in general, but there were few reports about the cytokine profile in ADPKD cysts. METHODS: In this study, we measured cytokine content in aerobic culture-negative cystic fluids from 23 patients with symptomatic normal to end-stage (n=3) ADPKD in order to elucidate the possibility that cytokines are related to the development and progression of disease. Enzyme-linked immunosorbent assays (ELISAs) were used to detect IL-1beta, IL-2, IL-4, IL-6, IL-10, and IFN-gamma with commercial kits. RESULTS: Male to female ratio was 6 : 17 and the median age at examination was 52 years (range 36 to 78). IL-1beta was present in 18 of 23[78%] (11 to 173 pg/mL), IL-2 in 18 of 23[78%] (5 to 159 pg/ mL), IL-4 in 9 0f 23[39%] (8 to 156 pg/mL) and IL-6 in 10 of 23[43%] (16 to 1498 pg/mL). IL-10, and IFN-gamma were not detected. IL-1beta concentrations correlated directly with those of IL-2 (r=0.7671). IL- 6 levels in patients with azotemia (n=7) [288.4+/-26.2 (mean+/-S.D.)] were significantly higher than those of normal renal function group (98.3+/-413.9)(p<0.01). Such difference was not found in other cytokines. Cytokine concentrations did not correlate with sodium concentrations, nor with cystic fluid osmolality, indicating that differences in concentrations among fluids could not be explained by differences in water content. And, there was no significant correlation between the intracystic concentrations of these cytokines and the corresponding cyst diameters. CONCLUSION: These data identify proinflammatory cytokines as possible mediators to the morbidity of ADPKD. Especially, IL-6 levels of cystic fluid were elevated in the azotemic ADPKD patients.

Thoracolumbar Intramedullary Astrocytoma of the Spinal Cord: Report of 1 Case

The intramedullary glioma of spinal cord has occupied 22.5% of intraspinal neoplasm, and is the most common among the intramedullary spinal cord tumor, and the first successful operative removal was performed in 1907 by Elsberg. The intramedullary astrocytoma has frequent incidence in the thoracic and cervical region of the spinal cord, which has more frequent grade I astrocytoma. We experienced a case of intramedullary grade II astrocytoma of the thoracolumbar region which has associated a paraplegia as neurological deficit. A 26 year old Korean female has admitted to our clinic because of paraplegia with incontinence for 2 years. On admission, the neurological examination revealed a paraparesis below T12 level with urinary and fecal incontinence and then local tenderness from T10 to L1 level. The simple X-ray film of the thracolumbar spine has showed erosion of both pedicle, widening of interpeduncular distance and scalloping change of posterior vertebral margin from T12 to L1, which were similar to the picture of intramedullary spinal cord tumor. We performed a myelography by pantopaque through the lumbar and cisternal puncture for accurate site of lesion, and found a complete block at L1 level and T10 level on myelogram. Then the immediate total laminectomy from T8 to L1 was applied. The operative finding was a intramedullary mass with cystic fluid, which has compressed the spinal cord. After aspiration of cystic fluid, we removed the tumor mass incompletely because of intermingling with spinal cord but the decompression was enough. The neurological defict was improved gradually for post-operative 4 weeks, thereafter improvement was stopped and remained the paraparesis. The post-operative pathological diagnosis was grade II astrocytoma, which composed of anaplastic cell and radiotherapy has followed.