Clinical characteristics and outcomes of new uremic patients with extreme azotemia in southern Taiwan.

Serum creatinine (SCr) had been considered to be an important predictor of mortality in end-stage renal disease (ESRD) patients at the start of renal replacement therapy (RRT). However, the data were limited about initially extreme azotemia (EA), exclusively defined as blood urea nitrogen (BUN) > or = 300 mg/dL, SCr > or = 30 mg/dL, or both. This retrospective study was conducted to clarify the characteristics and outcome in our EA patients. We had 1682 new ESRD patients from July 1988 to December 1996. With frequency match for age, gender, and starting RRT in the same period, 20 EA patients and 60 controls were included. Fifty percent of our EA patients had unknown etiology. The EA patients had significantly lower prevalence of underlying diabetic nephropathy, and comorbid hypertension. All the EA patients had late referral to nephrologists within 4 weeks before the initiation of RRT, and 90% of them had taken Chinese herbals. The EA group had significantly higher BUN, SCr, and iron storage as well as a higher prevalence of severe anemia, hyperkalemia, hypocalcemia, and acidemia. However, the similar prevalence of cardiomegaly and left ventricular hypertrophy as well as the similar early mortality rate and long-term survival were noted. Age over 40 years, comorbid diabetes mellitus, and hypoalbuminemia were independent predictors of poor survival. Our EA patients had different initial presentations from other uremic ones at the start of RRT. However, the short-term and long-term mortality rates were similar. The lower prevalence of underlying diabetic nephropathy and comorbid hypertension among the EA patients might contribute to their fair outcome.

Designing a molecularly imprinted polymer as an artificial receptor for the specific recognition of creatinine in serums.

In this study, molecularly imprinted polymers (MIP) synthesized from two different functional monomers, beta-cyclodextrin (beta-CD) and 4-vinylpyridine (4-Vpy), were prepared. The crosslinkers used for these two monomers were epichlorohydrin (EPI) and divinylbenzene (DVB), respectively. It was attempted to adsorb the target molecule, creatinine, from its mixture solutions. A proper molar ratio of monomer/crosslinker for the preparation of the imprinted poly(beta-CD) was 1:10. Between both polymers mentioned above, the affinity of the imprinted poly(4-Vpy-co-DVB) towards creatinine was comparably superior. The imprinted poly(4-Vpy-co-DVB) for creatinine could reach a specific binding ratio of 3.11. The imprinted poly(4-Vpy-co-DVB) was further utilized to bind creatinine from human serum samples. The binding capacity of the imprinted poly(4-Vpy-co-DVB) for creatinine from the serum samples was plotted against the creatinine concentration. From the correlation, the feasibility of the imprinted poly(4-Vpy-co-DVB) thus prepared for the target analyte, creatinine, was experimentally confirmed.

Clinical features of thin basement membrane disease and associated glomerulopathies.

BACKGROUND: Thin basement membrane disease (TBMD) occurs in 5-11% of renal biopsy series, and can be associated with other glomerulopathies (GNs). Data on the prevalence, clinical features, and prognosis of TBMD with other GNs are limited. METHODS AND RESULTS: From June 1990 to May 2001, findings from 658 native kidney biopsies were retrospectively studied. The overall prevalence of TBMD was 7.9% (52 of 658). The mean glomerular basement membrane (GBM) thickness was 206 +/- 30 nm. Clinicopathological features were compared for patients with TBMD only (n = 14) and in those with TBMD and GN (n = 38). Focal segmental glomerulosclerosis, mesangial proliferative GN, and minimal change disease were the most common GNs associated with TBMD. After a mean follow-up period of 44.9 +/- 42.5 months, the group who only had TBMD revealed a relatively benign disease with microscopic haematuria and trivial proteinuria, a low prevalence of hypertension, and no renal progression. In the group who had both TBMD and GN, heavy proteinuria (6.1 +/- 5.2 g/day), hypoalbuminaemia (26 +/- 12 g/L) and renal insufficiency (76 +/- 25 mL/min) might develop. CONCLUSION: We suggested that the TBMD is a developmental abnormality of little or no significance and that it is the underlying associated GN rather than TBMD, which has the relevance to the outcome of renal disease.

Renal cell carcinoma complicated by emphysematous pyelonephritis in a non-diabetic patient with renal failure.

A 72-year-old non-diabetic uremic woman underwent right nephrectomy for urolithiasis at the age of 50. Because pyuria, fever, chilliness and left flank pain developed during preparing for arteriovenous fistula, she was admitted to National Cheng Kung University Hospital. Renal cell carcinoma (RCC) complicated with emphysematous pyelonephritis (EPN) was diagnosed and immediately treated with antibiotics and CT-guided percutaneous catheter drainage. Cultures of pus and blood yielded Escherichia coli. She received left radical nephrectomy later for the control of persistent sepsis and removal of left renal tumor. The pathology of the tumor was composed of a glandular arrangement of granular cells with the occasional atypism, and renal parenchyma had been totally replaced by RCC. The non-tumor part of the kidney showed chronic pyelonephritis. Five months later, multiple metastases developed. We reported this first uremic case with EPN and RCC, but without diabetes mellitus and urinary tract obstruction. The gas formation may be due to large RCC, which caused impaired tissue perfusion and E. coli infection.