The Prevalence of Coronary Artery Disease in Patients with End Stage Renal Disease at the Initiation of Dialysis and the Accuracy of Noninvasive Tests / 대한신장학회지

PURPOSE: Coronary artery disease (CAD) is a major cause of mortality in chronic dialysis patients, and often occurs within the first year of dialysis. However, there is little evidence based on prospective trials in incident dialysis patients, and nobody knows which noninvasive test is best for screening the CAD in these patients. Therefore, we conducted this study to examine the prevalence of CAD and the accuracy of noninvasive tests that we can easil do for detection of CAD in incident dialysis patients. METHODS: We evaluated the prevalence of CAD using resting ECG, 2D echocardiography, 99m Tc tetrofosmin single photon emission computed tomography(SPECT) and the accuracy of these non-invasive screening tests in all 84 incident dialysis patients from March 2005 to September 2006 at the Hallym University SH Hospital in Korea. RESULTS: Of eighty-four patients, 23 (27.4%) had significant CAD. Fifteen (18.9%) patients had ischemic ECG change, and its positive predictive value and sensitivity were 66.7% and 45.0%, respectively. Resting 2D echocardiography had positive predictive value of 77.3%, sensitivity of 63.6% and lower specificity of 50.0%. 99m Tc tetrofosmin SPECT had positive predictive value of 73.3% and sensitivity of 73.3%. CONCLUSION: The prevalence of CAD in patients at the initiation of dialysis was 27.4%. 99m Tc tetrofosmin SPECT may be helpful for diagnosing CAD with ECG and 2D-echocardiography because of high sensitivity and positive predictive value.

Phase IV Study on the Antihypertensive Effect and Safety of Irbesartan in Patients with Mild to Moderate Hypertension and Renal Disease / 대한신장학회잡지

Irbesartan is a new selective angiotensin II subtype 1 receptor antagonist. We evaluated the efficacy and tolerability of irbesartan in patients with mild to moderate hypertension and renal disease. On 24 hypertensive patients, oral irbesartan 150mg a day was administered. In cases whose seated diastolic blood pressure did not decrease to 85mmHg after treatment for 4 weeks, the dose of irbesartan was increased to 300mg per day. Every 4 weeks, blood pressure, heart rates, and adverse effects were monitored. And we assessed WBC counts, hemoglobin, hematocrits, platelets, creatinine, BUN, total protein, albumin, fasting blood sugar, total cholesterol, AST, ALT, alkaline phosphatase, total bilirubin, sodium, potassium, calcium, uric acid and urine protein/creatinine ratio to evaluate the change of renal and hepatic function and other adverse effects. Seated systolic blood pressure was decreased from 157.1+/-3.1mmHg to 135.5+/-3.7mmHg, and seated diastolic blood pressure was also decreased from 99.2+/-1.7mmHg to 84.3+/-2.5mmHg. Irbesartan was effective in lowering blood pressure in 20 among 24 patients, and the effective rate of this drug was 83.3%. After treatment, a non clinically significant increase of heart rates and statistically significant decrease of total cholesterol level were noted. There was no dose-related adverse effect. We conclude that irbesartan is a safe and effective angiotensin II subtype 1 receptor antagonist for lowering blood pressure in patients with mild to moderate hypertension and renal disease.

The Study on the Mechanism Regulating the Production of Extracellular Matrix in Renal Tubular Epithelial Cells Cultured in High Glucose Concentration / 대한신장학회잡지

Thickening of tubular basement membrane and progressive tubulointerstitial fibrosis has been reported as important components of diabetic nephropathy, In order to investigate the mechanisms of tubulinterstitial changes in diabetic nephropathy, we evaluated the effects of a high concentration of glucose(25mM; 450mg/dL) on glucose transporter GLUT1 level, fibronectin production and tissue inhibitors of metalloproteinases (TIMP)-1 concentration in renal tubular(LLC-PK1) cells. As the effect of high glucose-induced alteration in LLC-PK1 cells, the expression of facilitative glueose transporter, GLUT1 was decreased after longer than 24-hours exposure to 25mM glucose, compared to control(5.6mM). The administration of protein kinase C (PKC) inhibitor GF109203X(10 microM) did not show significant effect on high glucose-induced decrease of GLUT1 level. On western blot analysis of fibronectin production, The exposure of LLC-PK cells to 25mM glucose for 48 hours significantly increasc4 fibro- nectin production, dose-dependently. The addition of GF102903X at the concentration of 10pM induced the significant increase of fibronectin level in LLC-PK1cells under glucose-free condition, whereas there was no significant effect on the high glucose-induced increase of fibronectin production. The addition of anti-TGF-beta antibody at 30 microgram/mL partly inhibited the high glucose-induced increase of fibronectin production. Concerning the changes of tissue inhibitor of metallo-proteinase(TIMP)-1 levels in the presence of high glucose, the exposure to high glucose for 24 and 43 hours increased TIMP-1 levels in culture supernatant of LLC-PK1 cells, dose-dependently. The TIMP-1 levels of 48-hour exposure to 15 and 25mM glucose were also significantly higher than those of 24-hourexposure. The treatment with 10 microM GF102903X or 30 microgram/mL anti-TGF-Beta antibody had no significant effects on TIMP-1 levels measured under the high glucose culture condition. In conclusion, the expression of facilitative glucose transporter, GLUT1 is inhibited and the production of fibronectin is increased in renal tubular cells cultured in the presence of high concentration of glucose, which is partly mediated by TGF-beta. The TIMP-1 level is also increased under high glucose culture condition. The enhanced productions of fibronectin and TIMP-1 of renal tubular cells under high glucose concentration may contribute to tubulointerstitial fibrosis that occurs in diabetic nephropathy.

Clinical Outcome and Prognostic Factors of Biopsy-proven Diffuse Proliferative Lupus Nephritis / 대한신장학회잡지

Lupus nephritis is a major cause of morbidity and mortality arising from systemic lupus erythematous. It is generally acknowledged that the presence of diffuse proliferative lupus nephritis(DPLN) is highly predictive of a poor prognosis in terms of renal and patient out- come on survival. The objective of this study was to evaluate the clinicopathologic characteristics, renal out- come according to therapeutic regimen, and prognostic factors of biopsy-proven diffuse proliferative lupus nephritis. Among the biopsy-proven lupus nephritis patients who were admitted to Yonsei University Medical Center from January 1986 to June 1997, 36 patents who were diagnosed DPLN by renal biopsy and treated for at least 6 months and regularly followed-up for at least 12 months were included. We retrospec-tively reviewed the medical recorders. Patients were treated with steroid regimen with or without cyclo-phosphamide. According to the therapeutic response, patients were divided into two groups : a therapeutic response group(n=24), and a therapeutic non-response group

A Case of Focal Segmental Glomerulosclerosis in Takayasu's Arteritis / 대한신장학회잡지

Takayasu's arteritis(TA) is a chronic inflammatory and obliterative disease of medium- and large-sized arteries characterized by a strong predilection for the aortic arch and its branches. Renal involvement is usually manifested by renovascular hypertension. Glomerular involvement is rare and largely exists as a mild mesangial proliferative glomerulonephritis, commonly manifesting microscopic hematuria and proteinuria. The association of glomerular disease with TA is of interest since common immunologic mechanisms are proposed for the pathogenesis of both entities. We report a case of TA associated with focal segmental glomerulosclerosis. The patient presented with hypertension(Upper limb; Rt. 200/80mmHg, Lt. 95/60mmHg, Lower limb; Rt. 140/90mmHg, Lt. 110/70mmHg) and nephrotic syndrome(Serum albumin : 2.3g/dL, cholesterol : 454mg/dL, BUN : 18.0mg/dL, creatinine 1.3mg/dL, 24-hour urine protein : 5.17g). Digital substraction angiography showed multiple narrowing and occlusive changes of aortic arch and its branches. Renal biopsy was interpreted as focal segmental glomerulosclerosis. Therapy was instituted with prednisolone.