The presence of simple renal cysts is associated with an increased risk of albuminuria in young adults.

BACKGROUND/AIMS: The prevalence of simple renal cysts increases with age; however, they are occasionally found in adults aged < 40 years. This cross-sectional study evaluated the clinical significance of simple cysts in young adults, focusing on their associations with hematuria and albuminuria. METHODS: Adults aged < 40 years who underwent comprehensive medical examination between January 2005 and December 2013 were included. Simple renal cysts were identified by ultrasonography. RESULTS: Renal cysts were found in 276 of the 5,832 subjects (4.7%). Subjects with medullary sponge kidney (n = 1) or polycystic kidney disease (n = 5) were excluded. A single cyst and multiple cysts were found in 234 (4.0%) and 42 (0.7%) subjects, respectively. Age, high systolic blood pressure, and history of hypertension were independent risk factors for the presence of simple cysts. Simple cysts were not associated with an increased prevalence of hematuria. However, subjects with cysts showed a higher prevalence of albuminuria than those without (11.3% vs. 4.5%, p < 0.001). Multivariate analysis revealed that the existence of simple renal cysts was associated with a 2.30-fold increased prevalence of albuminuria (95% confidence interval, 1.512 to 3.519; p < 0.001) independent of other risk factors. CONCLUSION: In young adults, the presence of simple renal cysts was independently associated with an increased prevalence of albuminuria. The causal relationship needs to be elucidated in further studies.

Psychometric properties of the EQ-5D-5L in the general population of South Korea.

PURPOSE: The EQ-5D-5L was developed to compensate for a high ceiling effect and lack of descriptive richness of the EQ-5D-3L. We evaluated psychometric properties of EQ-5D-5L in the general population. METHODS: Six hundred of adults were sampled from the general population in South Korea using a multistage stratified quota sampling method. Participants completed the EQ-5D-5L, EQ-5D-3L, and SF-36v2. One hundred participants were resurveyed for reliability evaluation. The ceiling effect, known-groups construct validity, convergent and discriminant validity, and reliability of EQ-5D-5L were evaluated. RESULTS: A smaller proportion of participants answered 'no problem' to all dimensions of EQ-5D-5L (61.2 %) than EQ-5D-3L (65.7 %, p < 0.01), indicating a reduced ceiling effect. Female, elderly, low-educated, and low-income participants reported health problems more frequently, indicating known-groups construct validity. The mobility dimension of EQ-5D-5L was better correlated with the physical component score (|r| = 0.48) than the mental component score (|r| = 0.25) of the SF-36v2, and the anxiety/depression dimension was better correlated with mental component score (|r| = 0.45) than physical component score (|r| = 0.34), indicating convergent and discriminant validity. The intraclass correlation coefficient of EQ-5D-5L index was 0.75. CONCLUSIONS: The EQ-5D-5L has a smaller ceiling effect than the EQ-5D-3L and is a valid and reliable instrument to measure health-related quality of life in the general population.

Clinical aspects of pulmonary hypertension in patients with systemic lupus erythematosus and in patients with idiopathic pulmonary arterial hypertension.

Clinical aspects and pathology of pulmonary hypertension (PH) in patients with systemic lupus erythematosus (SLE) have been reported to be similar to those in patients with idiopathic pulmonary arterial hypertension (IPAH). To determine whether PH in these patients is similar, we compared the clinical characteristics, hemodynamics at diagnosis, and survival in groups of patients with SLE-PH and IPAH. We reviewed the case records of 20 patients with SLE-PH and 34 patients with IPAH, who had been assessed by echocardiography or right cardiac catheterization at Asan Medical Center, Seoul, Korea, from January 1995 to October 2003. Clinical features, laboratory data, chest X-rays, electrocardiogram results, pulmonary function tests, pulmonary perfusion scans, echocardiographic findings, serologic profiles, and survival were compared in the two groups of patients. The mean follow-up period was 18.1+/-20.6 months for patients with SLE-PH and 33.0+/-23.4 months for patients with IPAH. During follow-up, 12 SLE-PH (60%) and 11 IPAH (32%) patients died. For SLE-PH, the 3-year survival rate was 44.9% and the 5-year survival rate was 16.8%. For IPAH, the 3-year survival rate was 73.4% and the 5-year survival rate was 68.2% (p=0.02). There were no other significant differences in clinical characteristics and laboratory data between the two groups. In contrast to previous reports that the prognosis of patients with pulmonary arterial hypertension associated with collagen vascular disease was better than that of patients with IPAH, we found that the prognosis of patients with SLE-PH was much worse than that of patients with IPAH.

Effects of disease-modifying antirheumatic drugs and antiinflammatory cytokines on human osteoclastogenesis through interaction with receptor activator of nuclear factor kappaB, osteoprotegerin, and receptor activator of nuclear factor kappaB ligand.

OBJECTIVE: To demonstrate the effects of disease-modifying antirheumatic drugs and antiinflammatory cytokines on human osteoclastogenesis through their effects on receptor activator of nuclear factor kappaB (RANK), osteoprotegerin (OPG), and RANK ligand (RANKL). METHODS: Peripheral blood mononuclear cells (PBMCs) and rheumatoid arthritis (RA) fibroblast-like synoviocytes (FLS) were cocultured in the presence of macrophage colony-stimulating factor, 1,25-dihydroxyvitamin D(3), and various concentrations of methotrexate (MTX), sulfasalazine (SSZ), hydroxychloroquine (HCQ), anti-tumor necrosis factor alpha monoclonal antibody (infliximab), interleukin-4 (IL-4), and IL-10. Osteoclast formation was assayed by counting cells after staining for tartrate-resistant acid phosphatase. RANKL expression in RA FLS and RANK expression in PBMCs were assayed by Western blotting, reverse transcription-polymerase chain reaction (RT-PCR), and real-time PCR. OPG expression was measured by enzyme-linked immunosorbent assay, RT-PCR, and real-time PCR in cultures of RA FLS. RESULTS: MTX, SSZ, infliximab, and IL-4, but not IL-10 and HCQ, each inhibited osteoclast formation in a dose-dependent manner. We observed no evidence of synergistic inhibition of osteoclast formation by IL-4 and IL-10. High doses of infliximab suppressed the expression of RANK in PBMCs. MTX, SSZ, infliximab, and IL-4 each inhibited the expression of RANKL in RA FLS in a dose-dependent manner, and also increased the secretion of OPG in RA FLS supernatants. CONCLUSION: MTX, SSZ, infliximab, and IL-4 inhibit human osteoclastogenesis by modulating the interaction of RANKL, RANK, and OPG. These results are indicative of the underlying mechanisms of the antiresorptive effects of these 4 agents.

Does the anti-beta2-glycoprotein I antibody provide additional information in patients with thrombosis?

OBJECTIVE: To investigate whether the anti-beta(2)-glycoprotein I (anti-beta(2)GPI) antibody may provide additional information in patients with thrombosis in conjunction with the lupus anticoagulant (LAC) or anticardiolipin (aCL) antibody. METHODS: We selected 235 patients whose plasma were tested for the presence of all three antiphospholipid (aPL) antibodies (LAC, aCL, and anti-beta(2)GPI) and were positive for at least one aPL antibody from January 2000 to December 2001. The LAC test was performed using dilute activated thromboplastin time reagent (dAPTT) and dilute Russell viper venom time reagent (dRVVT). ACL (IgG/IgM) and anti-beta(2)GPI (IgG/IgM) were detected by enzyme-linked immunosorbent assay (ELISA). Clinical data were collected and analysed in all patients with aPL antibody. RESULTS: Of the 235 patients with aPL, thrombosis was detected in 76 patients (28.0%). Of the 76 patients with thrombosis, 29 were positive for LAC, 9 for aCL, 7 for anti-beta(2)GPI, 3 for LAC+aCL, 9 for aCL+anti-beta(2)GPI, 11 for LAC+anti-beta(2)GPI, and 8 for LAC+aCL+anti-beta(2)GPI. The rate of thrombosis was significantly different (p=0.01) among single positive patients (45/163, 27.6%), double positive patients (23/60, 38.3%), and triple positive patients (8/12, 66.7%). In single positive patients, the rate of thrombosis was highest in LAC positive patients (29/85, 34.1%). In double positive patients, the LAC+anti-beta(2)GPI positive group (11/24, 45.8%) and aCL+anti-beta(2)GPI positive group (9/22, 40.9%) had higher rates of thrombosis than the LAC+aCL positive group (3/14, 21.4%). CONCLUSION: Single positivity for anti-beta(2)GPI explained 9.2% of thrombotic events in the absence of LAC or aCL. Double or triple positivity for aPLs were associated with a higher rate of thrombosis than single positivity for aPL. Our results suggest that anti-beta(2)GPI provides additional information in patients with thrombosis in conjunction with LAC or aCL.