Effects of Rosiglitazone on Heat Shock Protein and the Endothelin System in Deoxycorticosterone Acetate-Salt Hypertensive Rats

The deoxycorticosterone acetate (DOCA)-salt rat is known as a model of volume dependent hypertension and characterized by increased cardiac endothelin-1 (ET-1) content. Recently, it has been reported that rosiglitazone (RGT), a peroxisome proliferator-activated subtype gamma receptor agonist, shows blood pressure lowering effect. We investigated whether DOCA-salt hypertension is associated with altered expression of heat shock proteins (HSP) and ET-1 in the heart, aorta, and kidney, and whether RGT changes HSP expression and ET-1 in association with its blood pressure lowering effect. Two weeks after the silastic DOCA (200 mg/kg) strips implantation, DOCA-salt rats were randomly divided to receive control diet with or without RGT (10 mg/kg/day) for another 2 weeks. The mRNA expression of ET-1 was determined by real time polymerase chain reaction. The expression of HSP was determined by semiquantitative immunoblotting. In DOCA-salt rats, systolic blood pressure was markedly increased, while creatinine clearance decreased. RGT treatment attenuated high blood pressure and decreased creatinine clearance in DOCA-salt rats. The mRNA expression of ET-1 was increased in DOCA-salt rats compared to controls, which was counteracted by RGT treatment. The protein expression of HSP70, HSP32, and HSP25 was increased in the kidney and heart in DOCA-salt rats, which was attenuated by RGT treatment in the kidney, but not in the heart. In conclusion, increased expression of ET-1 may play a role in the pathogenesis of hypertension in DOCA-salt rats, which was counteracted by the treatment of RGT. Up-regulation of HSP70, HSP32, and HSP25 in the kidney and heart may play a role in organ protection against a variety of stresses.

Continuous renal replacement therapy for the treatment of acute kidney injury

BACKGROUND/AIMS: Continuous renal replacement therapy (CRRT) has been widely used for treating critically ill patients with acute kidney injury (AKI). Whether CRRT is better than intermittent hemodialysis for the treatment of AKI remains controversial. We sought to identify the clinical features that can predict survival for the patients who are treated with CRRT. METHODS: We analyzed the data of 125 patients who received CRRT between 2005 and 2007. We identified the demographic variables, the underlying diagnoses, the duration of CRRT, the mean arterial blood pressure (ABP) and the Simplified Acute Physiology Score (SAPS) II. The classification/staging system for acute kidney injury (AKI) was applied to all the patients, who were then divided into stage 1-3 subgroups. RESULTS: The average age of the patients was 61.414.3 years and the mortality rate was 60% (75 of 125 patients). The survivors had a significantly higher mean ABP and a higher mean serum bicarbonate level, which were measured the day after CRRT, than the nonsurvivors (86.723.7 vs. 69.224.6 mm Hg, respectively, 21.43.5 vs. 16.45.4 mmol/L, respectively,; p<0.05 for each). The stage 3 AKI patients showed the worst parameters for the SAPS II score and the serum levels of creatinine and blood urea nitrogen. The mortality rate was higher for the stage 3 subgroup than the other groups (70.5%, p<0.05). CONCLUSIONS: The patients with AKI and who require CRRT continue to have a high mortality rate. A higher mean ABP and a higher serum bicarbonate level measured the day after CRRT may predict a more favorable prognosis. The staging system for AKI can improve the ability to predict the outcomes of CRRT patients.

A Case of Horseshoe Kidney with Focal Segmental Glomerulosclerosis / 대한신장학회지

An 18-year-old man presented as marked proteinuria on urinalysis. Abdominal ultrasonography and computed tomography indicated the presense of horseshoe kidney without any other abnormalities. A percutaneous computed tomography (CT) guided renal biopsy was done. Of 6 glomeruli obtained, global sclerosis was found in 2. Some segments of affected glomerulus showed peripheral solidifications and focal hyalinosis, which are Periodic acid-Schiff and Masson Trichrome stain positive. The diagnosis of horseshoe kidney with focal segmental glomerulosclerosis (FSGS) was made by clinical and pathological findings. The authors report here a case of FSGS occurring in horseshoe kidney which has not yet been reported in Korea.

PAX2 Gene Assay in a Family of Ocular Coloboma with Bilateral Renal Hypoplasia / 대한신장학회지

We report one family with bilateral renal hypoplasia and ocular coloboma in two consecutive generations. Ophthalmological examination revealed optic disc coloboma and decreased visual acuity. Fragments spanning exon 1-12 of the PAX2 gene were amplified from genomic DNA using PCR primers. The PCR products were purified and directly sequenced. No definite mutation was detected in the PAX2 genes in these patients, but two coding region single nucleotide polymorphisms were identified. This result suggests that the optic disc coloboma with bilateral renal hypoplasia might be genetically heterogenous or other genes could be responsible.

Altered Regulation of type 3 Na+/H+ exchanger, type 1 Na+/HCO3- cotransporter, and Na+,K+-ATPase in the Kidney of Rats with Experimental Rhabdomyolysis

Metabolic acidosis was shown to correlate with deterioration of renal function in patients with rhabdomyolysis. The present study was aimed to investigate whether the changes of type 3 Na+/H+ exchanger (NHE3), type 1 Na+/HCO3- cotransporter (NBC1), and Na+,K+-ATPase alpha1 subunit may play a role in the pathogenesis of metabolic acidosis in glycerol-induced experimental rhabdomyolysis. Male Sprague-Dawley rats were deprived of fluid intake for 24 hours, and then were injected with 50% glycerol in normal saline (10 mL/kg, intramuscularly). At 24 hours after the glycerol injection, rats were sacrificed by decapitation. Control rats were injected with normal saline. The protein expression of NHE3, NBC1 and Na+,K+-ATPase alpha1 subunit was determined in the cortex of the kidney by immunoblotting and immunohistochemistry. Following the treatment of glycerol, creatinine clearance was significantly decreased, and high anion gap metabolic acidosis developed. In the experimental group, the expression of Na+,K+-ATPase alpha1 subunit was significantly decreased in the cortex of the kidney. On the contrary, the expression of NHE3 and NBC1 was significantly increased. Immunohistochemical analyses confirmed the immunoblotting data. In conclusion, the coordinate up-regulation of NHE3 and NBC1 may play an adaptive role against the metabolic acidosis in glycerol-induced rhabdomyolysis.

Altered Regulation of Water Channels and Sodium Transporters in Fasting-induced Polyuria in Rat Kidney / 대한신장학회잡지

PURPOSE: Starvation causes impairment in the urinary concentration ability. However, the molecular basis for the impaired urinary concentration and polyuria remains undefined. We examined the effects of food deprivation on the water handling by the kidney and it's regulatory mechanism. METHODS: Sprague-Dawley rats were used. They were placed in metabolic cages and deprived of food but had free access to water for 24 hours. Control rats had free access to both water and food. Protein expression of aquaporin-2 (AQP2) and Na+-K+-2Cl- cotransporter (NKCC2) was determined in the kidney by Western blot analysis. Protein expression of type VI adenylyl cyclase and prostaglandin E2 synthase (PGES) was determined. Urinary PGE2 excretion was also determined by radioimmunoassay. RESULTS: Food deprivation (FD) resulted in impaired urinary concentration associated with decreased tubular water reabsorption and increased urine output. The expression of AQP2 proteins was significantly decreased in the inner stripe of the outer medulla (ISOM). The expression of NKCC2 was not affected in ISOM. The adenylyl cyclase VI expression was increased in ISOM in FD rats. The protein expression of PGES was decreased in the cortex/OSOM and ISOM. The 24 hr urinary excretion of PGE2 was significantly decreased in FD rats compared with controls. CONCLUSION: These findings indicate that FD-induced urinary concentration defect may related to a reduced abundance of AQP2 in the kidney. It is also suggested that the primary impairment in the pathway to the activation of AQP2 in food deprivation is independent of vasopressin/cAMP or prostaglandin activity.

SIADH Associated with Prostate Cancer

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common disease leading to hyponatremia, and it is characterized by an inappropriately elevated serum ADH level relative to serum osmolality. This syndrome may occur in a variety of clinical settings including malignancies. However, it is rarely observed in association with prostate cancer. Moreover, its pathogenesis and clinical characteristics have not been completely understood. We report a case of SIADH associated with prostate cancer in a 64-year-old male patient with a literature review.

Ectopic Kidney Associated with Malrotation and Dual Arterial Supply in an Adult with Microscopic Hematuria / 대한신장학회잡지

A 52-year-old man presented as an intermittent right flank pain and microscopic hematuria on urinalysis. Abdominal ultrasonography showed that the left kidney was normally positioned but the right kidney was not observed in the normal position. The ectopic kidney was 7 cm sized and its pelvis was rotated anteriorly. To further evaluate the urinary system, angiography with urography by computed tomography (CT) was carried out. The ectopic kidney was received blood supply from two arteries which directly arose from the abdominal aorta. There was no detectable abnormality on distal urinary system. The authors report here a rare adult case of ectopic kidney associated with rotation anomaly and aberrant arterial supply presenting as an intermittent flank pain and microscopic hematuira.

Relationship between decreased renal function and hemoglobin / 대한내과학회지

BACKGROUND: The goal of this study is to define the relationship between the decreased renal function and anemia, and also to determine whether this relationship is different in male and female patients. METHODS: We conducted a retrospective study of 289 patients (male:female=157:132) who were followed at the department of internal medicine at Chonnam National University Hospital. General linear models were used to analyze the relationship between the hemoglobin concentration and Modification of Diet in the Renal Disease formula estimated Glomerular Filtration Rate (mL/min/1.73 m2). RESULTS: Among all patients, the mean hemoglobin concentration and hematocrit of the men with a Glomerular Filtration Rate of 50~59 mL/min/1.73 m2 was an absolute change of 0.8 g/dL (p=0.021) and it was 2.6% (p=0.011) lower than those of the patients with a Glomerular Filtration Rate> or =90 mL/min/1.73 m2 and continued to decrease further as the Glomerular Filtration Rate decreased, respectively (Hgb.: r=0.635, Hct.: r=0.640, all p or =90 mL/min/1.73 m2 and continued to decrease as the Glomerular Filtration Rate decreased, respectively (Hgb.: r=0.698, Hct: r=0.689, all p or =90 mL/min/1.73 m2 and continued to decrease further as the Glomerular Filtration Rate decreased, respectively (Hgb.: r=0.672, Hct.: r=0.687, all p<0.001). CONCLUSIONS: A decrease in the hemoglobin concentration was statistically significant in the patients of both genders, along with a moderately decreased Glomerular Filtration Rate (< or =60 mL/min/1.73 m2).

A Case of Huge Infected Adrenal Pseudocyst associated with Acute Pyelonephritis and E. coli Bacteremia / 대한신장학회지

A 61-year-old woman was presented with fever and pain in both flanks. Computed tomography (CT) revealed a septated heterogenous giant mass suggesting a huge suprarenal cyst. Percutaneous drainage was performed. Escherichia coli was cultured in blood, urine and aspirated fluid from the cyst. Therefore, it was initially diagnosed as infected renal cyst with acute pyelonephritis. However, follow-up CT after drainage of the cyst and surgical findings revealed the cyst grew not from the kidney but from the adrenal gland. Postoperative finding and pathologic study confirmed it was originated from adrenal. We describe a case of E.coli infected huge adrenal pseudocyst misunderstood as an infected renal cyst because of indistinct anatomical boundary and association with acute pyelonephritis.

Increased Expression of Endothelin-1 and CYP11B2 in Gentamicin-Induced Nephropathy in Rat Kidney / 대한신장학회지

PURPOSE: An altered activity of vasoactive hormones as well as aldosterone synthase (CYP11B2) in the kidney may involve the pathogenesis of gentamicin-induced nephropathy. The present study was designed to investigate whether there are changes of local renin-angiotensin-aldosterone system (RAAS) and endothelin (ET) in the kidney of gentamicin-induced nephropathy in rats. METHODS: Male Sprague-Dawley rats (180-200 g) were intramuscularly injected with gentamicin (100 mg/kg per day) for 5 days. Vehicle was given for the control rats. The mRNA expression of local renin-angiotensin system, aldosterone synthase (CYP11B2), ET system and transforming grow factor-beta1 (TGF-beta1) was determined in the kidney by real-time polymerase chain reaction. The protein expression of TGF-beta in the kidney was determined by immunoblotting and immunohistochemistry. RESULTS: Following the gentamicin treatment, a renal failure was noted as evidenced by increased serum concentrations of creatinine along with a decrease of its clearance. TGF-beta1 expression was significantly increased in the kidney in gentamicin treated rats compared with that in controls. The abundance of ET-1 mRNA was significantly increased. The endothelin type A receptor expression was decreased while endothelin type B receptor was not changed. The expression of angiotensin converting enzyme 1 (ACE1) and ACE2 was decreased, whereas renin expression was not changed. The CYP11B2 expression was significantly increased in gentamicin treated rats, while mineralocorticoid receptor expression was not changed. CONCLUSION: The expression of ET-1 and CYP11B2 was up-regulated which may play a role in the pathogenesis of gentamicin-induced nephropathy.

Effects of Tempol on Blood Pressure and Tissue Oxidative Stress in DOCA-alt and L-AME-nduced Hypertension / 대한신장학회잡지

BACKGROUND: Effects of oxidative stress on the development of deoxycorticosterone acetate (DOCA)-salt or N(G)-nitro-L-arginine (L-NAME) hypertension were examined. METHODS: Male Sprague-awley rats were treated with DOCA (200 mg/kg, subcutaneous)-salt or L-NAME (40 mg/L in daily drinking water) for 4 weeks. To reduce the oxidative stress, 4-hydroxyl-2,2,6,6-tetramethylpiperidine-1-oxyl (Tempol, 3 mM/L) was cotreated in drinking water. The expression of endothelial nitric oxide synthase (eNOS) and nitrotyrosine proteins was determined in the renal cortex and thoracic aorta. RESULTS: Tempol prevented the development of DOCA-salt hypertension, whereas it was without effect on L-NAME hypertension. In DOCA-salt hypertension, the eNOS expression in the renal cortex was increased, the degree of which was attenuated by Tempol. The renal expression of nitrotyrosine was decreased, which was further decreased by Tempol. In the aorta, the expression of both eNOS and nitrotyrosine was decreased, which was not further affected by Tempol. In L-NAME hypertension, the renal expression of eNOS was significantly increased, which was blocked by Tempol. The expression of eNOS in the aorta was slightly decreased, and was not further affected by Tempol. The renal expression of nitrotyrosine was not significantly altered. However, its expression was significantly decreased in the aorta, and was further reduced by Tempol. CONCLUSION: The blockade of oxidative stress may attenuate the development of hypertension and provide tissue protection in DOCA-salt hypertension. The blockade of oxidative stress may also contribute to a tissue protection in L-NAME hypertension.

Clinical Characteristics of Uremic Pruritus in Chronic Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: Pruritus is a common, unpleasant symptom in patients on maintenance hemodialysis (HD), however its pathogenesis remains unclear. The aim of this study was to evaluate the prevalence of pruritus in chronic renal failure patients on hemodialysis and to correlate its presence with several clinical and laboratory parameters. METHODS: One hundred seventy patients on maintenance HD were enrolled, Some relevant clinical and laboratory parameters (age, sex, duration of dialysis, type of membrane, underlying renal disease, medications, erythropoietin (EPO) and laboratory findings including hematocrit, creatinine, urea, calcium, phosphorus, parathyroid hormone (PTH), erythrocyte sediment rate (ESR), albumin, beta2-microglobulin (beta2MG) and lipid profile as well as parameters of adequate dialysis (Kt/Vurea, URR) were evaluated. RESULTS: Total 170 patients (80 males) were enrolled and pruritus was found in 60 patients (Group I, M:F=29:31). One hundred ten patients did not complain pruritus (Group II, M:F=51:59). Mean age was significantly higher in Group I (59.6+/-14.8 vs. 54.3+/-13.6 years, p<0.05). There was no difference in sex, type of membrane, primary renal disease, serum beta2MG, ESR, EPO dose, duration of dialysis and serum albumin level. The mean value of Kt/V was higher in Group II (1.39+/- 0.36 vs. 1.51+/-0.27, p<0.035). CONCLUSION: Pruritus was more common in older patients and low Kt/V, but other clinical characteristics and laboratory findings were not correlated with uremic pruritus.

Clinical Characteristics of Uremic Pruritus in Chronic Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: Pruritus is a common, unpleasant symptom in patients on maintenance hemodialysis (HD), however its pathogenesis remains unclear. The aim of this study was to evaluate the prevalence of pruritus in chronic renal failure patients on hemodialysis and to correlate its presence with several clinical and laboratory parameters. METHODS: One hundred seventy patients on maintenance HD were enrolled, Some relevant clinical and laboratory parameters (age, sex, duration of dialysis, type of membrane, underlying renal disease, medications, erythropoietin (EPO) and laboratory findings including hematocrit, creatinine, urea, calcium, phosphorus, parathyroid hormone (PTH), erythrocyte sediment rate (ESR), albumin, beta2-microglobulin (beta2MG) and lipid profile as well as parameters of adequate dialysis (Kt/Vurea, URR) were evaluated. RESULTS: Total 170 patients (80 males) were enrolled and pruritus was found in 60 patients (Group I, M:F=29:31). One hundred ten patients did not complain pruritus (Group II, M:F=51:59). Mean age was significantly higher in Group I (59.6+/-14.8 vs. 54.3+/-13.6 years, p<0.05). There was no difference in sex, type of membrane, primary renal disease, serum beta2MG, ESR, EPO dose, duration of dialysis and serum albumin level. The mean value of Kt/V was higher in Group II (1.39+/- 0.36 vs. 1.51+/-0.27, p<0.035). CONCLUSION: Pruritus was more common in older patients and low Kt/V, but other clinical characteristics and laboratory findings were not correlated with uremic pruritus.

Blockade of Nitric Oxide Synthesis Further Diminishes Aquaporin Water Channels in Rat Kidney Subjected to Ischemia/reperfusion Injury / 대한신장학회잡지

BACKGOUND: The present study examined whether a blockade of nitric oxide (NO) synthesis affects the regulation of aquaporin (AQP) water channels in rats subjected to renal ischemia/reperfusion (I/R). METHODS: Renal I/R was experimentally induced by clamping the left renal artery for 60 minutes in rats. The rats were kept for 7 days thereafter, during which they were supplied with tap water containing NG-nitro-L-arginine methyl ester (L-NAME, 100 mg/L). The expression of AQP1-3 was determined in the kidney by Western blot analysis. RESULTS: In renal I/R injury, the expression of AQP2 was significantly decreased. The treatment with L-NAME further diminished the expression of AQP2. Although the expression of either AQP1 or AQP3 was not significantly altered in the kidney subjected to I/R, it was also significantly decreased by the treatment with L-NAME. CONCLUSION: It is suggested that endogenous NO system should play a role in the regulation of AQP water channels in rat kidney subjected to I/R injury.

A Case of Hemolytic Uremic Syndrome Caused by Escherichia coli O104:H4

A 29-year-old woman presented with bloody diarrhea, abdominal pain, hemolytic anemia, thrombocytopenia, and acute renal failure. She was diagnosed with Escherichia coli O104:H4-associated hemolytic-uremic syndrome (HUS) and treated with plasmapheresis and hemodialysis for 3 weeks. She recovered without sequelae. To the best of our knowledge, this is the first report of Escherichia coli O104:H4-associated HUS in Korea. We recommend that Escherichia coli O104:H4, as well as the more common O157:H7, be considered in the diagnosis of bloody diarrhea-associated HUS.

Effects of Nitric Oxide Synthesis Inhibition on Indomethacin-Induced Downregulation of Renal Aquaporins in Rats / 대한신장학회잡지

BACKGROUND:The present study aimed to determine whether there is a regulatory mechanism exerted by endogenous nitric oxide (NO) in the regulation of aquaporin (AQP) water channels in the kidney. METHODS:Male Sprague-Dawley rats were used. They were divided into 4 groups: 1) L-NAME group was treated with N(G)-nitro-L-arginine methyl ester (L-NAME, 100 mg/L drinking water) for 1 week, 2) indomethacin group was treated with indomethacin (5 mg/kg, twice a day, i.p.) for 2 days, 3) L-NAME/ indomethacin group was treated with L-NAME for 1 week in which indomethacin was cotreated for the last two days, and 4) control group was kept untreated. The abundance of AQP2 and AQP3 proteins was determined in the inner medulla of the kidney. RESULTS:The expression of AQP2 and AQP3 proteins was significantly decreased by indomethacin. L-NAME abolished the indomethacin-induced decreases of AQP channels, although it did not significantly affect the expression of AQP channels by itself. CONCLUSION:These results suggest that endogenous NO system, when stimulated, may downregulate the expression of AQP2 and AQP3 channels in the kidney.

A Case of Ganglioneuroma in a Patient with Gross Hematuria / 대한신장학회잡지

Ganglioneuroma is a rare benign neoplasm that originates from the neural crest tissue and is characterized histologically by the composition of mature ganglion cells and Schwann's cells. Its definitive diagnosis is achieved by histological examination and most ganglioneuromas arise in the posterior mediastinum followed by the retroperitoneum. Due to the slow growth of the tumor, it may be incidentally detected in imaging studies for unrelated reasons and most of them are clinically silent. Recently a 18-year-old man visited Chonnam National University Hospital because of intermittent gross hematuria. We tentatively diagnosed him as renal cyst or retroperitoneal benign cystic tumor by abdominal CT and MRI, however biopsy result of surgically resected tumor showed that it contained Schwann's cells and mature ganglion cells, thus we confirmed the diagnosis of retroperitoneal ganglioneuroma. To our best knowledge, this is the first reported case of retroperitoneal ganglioneuroma with gross hematuria in Korea, so we report the case with reviews of other literatures.

Increased Expression of Sodium Transporters in Rats Chronically Inhibited of Nitric Oxide Synthesis

The present study was done to determine whether endogenous nitric oxide (NO) plays a role in the regulation of sodium transporters in the kidney. Male Sprague-Dawley rats were treated with NG-nitro-L-arginine methyl ester (L-NAME, 100 mg/L drinking water) for 4 weeks. Control rats were supplied with tap water without drugs. Expression of Na, K-ATPase, type 3 Na/H exchanger (NHE3), Na/K/2Cl cotransporter (BSC1), and thiazide-sensitive Na/Cl cotransporter (TSC) proteins was determined in the kidney by Western blot analysis. Catalytic activity of Na,K-ATPase was also determined. The treatment with L-NAME significantly and steadily increased the systemic blood pressure. Total and fractional excretion of urinary sodium decreased significantly, while creatinine clearance remained unaltered. Neither plasma renin activity nor aldosterone concentration was significantly altered. The alpha1 subunit expression and the catalytic activity of Na, K-ATPase were increased in the kidney. The expression of NHE3, BSC1 and TSC was also increased significantly. These results suggest that endogenously-derived NO exerts a tonic inhibitory effect on the expression of sodium transporters, including Na, K-ATPase, NHE3, BSC1, and TSC, in the kidney.

Changes in serum and dialysate levels of Cancer Antigen 125 (CA125) in continuous ambulatory peritoneal dialysis patients / 대한내과학회지

BACKGROUND: Peritoneal mesothelial cells are the most important intraperitoneal cells quantitatively and have the capability to secret different types of substances. It may therefore be essential to have information on the mesothelial cell mass during peritoneal dialysis. Cancer Antigen 125 (CA125) is a 22KDa glycoprotein which is a clinically useful tumor marker of non-mucinous epithelial ovarian carcinoma. Recently, other cells including pleural and peritoneal mesothelial cell have been proved to express CA125. This study was undertaken to determine whether CA125 can be used as a marker of mesothelial cell mass in clinically stable 39 CAPD patients. METHODS: We checked serum and peritoneal dialysate CA125 level, D/P creatinine and D/Do glucose after 4 hours dwell in 39 stable continuous ambulatory CAPD patients. RESULTS: No statistically significant correlation was seen among the patient's age, sex, serum and dialysate levels of CA125. The dialysate CA125 levels correlated with the duration of CAPD, negatively (r=-0.345, p=0.039) and a significant positive correlation was seen between the duration of CAPD and D/Do glucose at 4 hours (r=0.523, p=0.001). But there were not a correlation between the dialysate CA125 levels and D/P creatinine after 4 hours dwell nor between the dialysate CA125 levels and D/Do glucose after 4 hours dwell. CONCLUSION: Although the duration of CAPD affects CA125 levels in dialysate, no specific alteration in peritoneal membrance transport properties can be detected or predicted by changes in dialysate concentration of CA125. However longitudinal follow-up of changes in concentration of dialysate CA125 may be useful in evaluating mesothelial cell mass in stable CAPD patients.Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.