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The pathophysiological mechanism of cardiovascular disease in patients with chronic kidney disease (CKD) is complicated. Mediation analysis is an important statistical tool for gaining insight into the complex mechanisms of exposure-outcome effects. We investigated the potential mediating role of the left ventricular mass index (LVMI) on the association between fluid balance (overhydration/extracellular water, OH/ECW) and left ventricular diastolic function (E/e´ ratio) in patients with CKD not yet on dialysis. Methods: Bioimpedance spectroscopy, echocardiography, and laboratory evaluations were performed on 425 consecutive patients on the same day. The patients were classified into two groups according to the estimated glomerular filtration rate corresponding to CKD stages 3 and 5. Mediation analysis was performed using the PROCESS macro and bootstrapping methods. Results: OH/ECW and LVMI were positively correlated with the E/e´ ratio in both the CKD stages 3 and five groups. In CKD stage 5, there was a statistically significant association between OH/ECW and LVMI, whereas no correlation was observed in CKD stage 3. In the mediation analysis, LVMI positively mediated the relationship between OH/ECW and E/e´ ratio when controlling for confounders in patients with CKD stage 5 (B = 2.602; Boot 95% confidence interval, 1.313–4.076). Conclusion: In our analysis, the indirect effect of mediators was significant in patients with advanced CKD. Therefore, our study suggests that further research on several other risk factors may be needed to determine the underlying mechanisms of association between the associated factors in all CKD stages.
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The authors would like to publish this corrigendum to change the corresponding author in the above article.
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The metabolic burden caused by hyperglycemia can result in direct and immediate metabolic injuries, such as oxidative stress and tissue inflammation, in the kidney. Furthermore, chronic hyperglycemia can lead to substantial structural changes such as formation of advanced glycation end-products, glomerular and tubular hypertrophy, and tissue fibrosis. Glomerular hypertrophy renders podocytes vulnerable to increased glomerular filtration, leading to podocyte instability and loss. Thus, prevention of glomerular hypertrophy and attenuation of glomerular hyperfiltration may have therapeutic potential for diabetic nephropathy (DN). Adiponectin is an adipokine that improves insulin sensitivity in obesity-related metabolic disorders, including diabetes, but its efficacy is unknown. Moreover, the recently developed adiponectin receptor agonist, AdipoRon, shows therapeutic potential for DN. In this review, we focus on the role of glomerular hypertrophy in the pathogenesis of DN and discuss the role of adiponectin in its prevention.
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BACKGROUND@#Alcoholic ketoacidosis (AKA) is known as a benign disease, but the related mortality reported in Korea is high. Acidosis and alcohol change the immunity profile, and these changes can be identified early using the delta neutrophil index (DNI). We aimed to evaluate the use of DNI and other standard laboratory parameters as predictors of prognosis in AKA patients.@*METHODS@#One hundred eighteen males with AKA were evaluated at the Wonju Severance Christian hospital between 2009 and 2014. We performed a retrospective analysis of demographic, clinical, and laboratory parameters data. Receiver operating characteristic curves (ROC) and multivariate Cox regression was used to identify renal survival and mortality.@*RESULTS@#Survival patients had lower initial DNI levels than non-survival patients (4.8±6.4 vs 11.4±12.5, p<0.001). In multivariate-adjusted Cox regression analysis, higher initial increased DNI (HR 1.044, 95% CI 1.003–1.086, p=0.035), and lower initial pH (HR 0.044, 95% CI 0.004–0.452, p=0.008) were risk factors for dialysis during hospitalization. Further, higher initial DNI level (HR 1.037; 95% CI 1.006-1.069; p=0.018), lower initial pH (HR 0.049; 95% CI 0.008–0.312; p=0.001) and lower initial glomerular filtration rate (GFR) (HR 0.981; 95% CI 0.964–0.999; p=0.033) were predictors of mortality. A DNI value of 4.5% was selected as the cut-off value for poor prognosis and Kaplan-Meier plots showed that AKA patients with an initial level DNI ≥4.5% had lower cumulative survival rates than AKA patients with an initial DNI <4.5%.@*CONCLUSION@#Increased initial serum DNI levels may help to predict renal survival and prognosis in male AKA patients.
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Arteriovenous graft for hemodialysis vascular access is a widely used technique with many advantages. However, it has crucial complications with graft thrombosis and infection. We recently experienced an unusual case of arteriovenous graft complication involving graft thrombosis related to fistula formation between the graft and the natural vein with infection. We diagnosed this condition using Doppler ultrasound and computed tomography angiography. Successful surgical treatment including partial graft excision and creation of a secondary arteriovenous fistula using an inadvertently dilated cephalic vein was performed. The dialysis unit staff should keep this condition in mind and try to prevent this complication.
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Angiografía , Fístula Arteriovenosa , Diálisis , Fístula , Diálisis Renal , Trombosis , Trasplantes , Ultrasonografía , VenasRESUMEN
Post-transplant lymphoproliferative disorder (PTLD) is a serious complication resulting in mortality and renal graft failure. PTLD is a heterogeneous disorder, which causes different clinical forms of disease from non-specific viral syndrome to malignant lymphoma and has various etiologies, clinical features, and treatment strategies. Here, we report on a patient who had a PTLD in the hilum of a transplanted kidney at 5 months after renal transplantation. The PTLD resulted in hydronephrosis of the transplanted kidney and graft dysfunction by local urinary tract obstruction. Despite treatment including immunosuppression reduction and rituximab administration, we removed the transplanted kidney from the recipient because the PTLD did not respond to the therapy.
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Humanos , Hidronefrosis , Terapia de Inmunosupresión , Trasplante de Riñón , Riñón , Linfoma , Trastornos Linfoproliferativos , Mortalidad , Rituximab , Trasplantes , Sistema UrinarioRESUMEN
BACKGROUND/AIMS: The Oxford classification of immunoglobulin A nephropathy (IgAN) is a pathology-based prognostic classification system. However, further study is needed to determine its validity. We studied the relationships between the Oxford classification and established prognostic factors and renal survival. We also examined associations between electron microscopy findings and these parameters. METHODS: We reviewed and reclassified 213 patients who were diagnosed with IgAN from 1997 to 2007 using the Oxford and World Health Organization (WHO) classification systems. The patients were also categorized by a pathologist using electron microscopy findings, including foot process fusion, glomerular basement membrane thickness, and electron-dense deposits. We examined the correlations between light and electron microscopy data and known prognostic factors (e.g., age, sex, proteinuria, serum creatinine, estimated glomerular filtration rate [eGFR], and blood pressure). The same procedure was applied to renal survival. RESULTS: Patient age increased with the grades of segmental sclerosis (S) and tubular atrophy/interstitial fibrosis (T) (P < 0.05). eGFR decreased significantly with increasing mesangial hypercellularity (M) (p = 0.0034), S (p = 0.0003), endocapillary hypercellularity (E) (p = 0.0411), and T (P < 0.0001). MSET differed significantly by sex (P < 0.0001). The 24-h urine protein/creatinine ratio increased significantly with the degrees of S (p = 0.036), E (p = 0.0155), and T (p = 0.015). The serum creatinine level was significantly higher in patients with T2 than T1 or T0 (P < 0.0001). At the time of biopsy, the degree of tubular atrophy/interstitial fibrosis affected the doubling of serum creatinine or end-stage renal disease. However, the electron microscopy findings did not predict the renal outcome. CONCLUSIONS: Our study suggests that tubular atrophy/interstitial fibrosis is significantly associated with proteinuria and renal progression in IgAN.
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Humanos , Biopsia , Clasificación , Creatinina , Fibrosis , Pie , Membrana Basal Glomerular , Tasa de Filtración Glomerular , Glomerulonefritis por IGA , Fallo Renal Crónico , Microscopía Electrónica , Patología , Pronóstico , Proteinuria , Esclerosis , Organización Mundial de la SaludRESUMEN
PURPOSE: Copeptin has been considered as a useful marker for diagnosis and prediction of prognosis in heart diseases. However, copeptin has not been investigated sufficiently in hemodialysis patients. This study aimed to investigate the general features of copeptin in hemodialysis and to examine the usefulness of copeptin in hemodialysis patients with left ventricular dysfunction (LV dysfunction). MATERIALS AND METHODS: This study included 41 patients on regular hemodialysis. Routine laboratory data and peptides such as the N-terminal of the prohormone brain natriuretic peptide and copeptin were measured on the day of hemodialysis. Body fluid volume was estimated by bioimpedance spectroscopy, and the E/Ea ratio was estimated by echocardiography. RESULTS: Copeptin increased to 171.4 pg/mL before hemodialysis. The copeptin had a positive correlation with pre-dialysis body fluid volume (r=0.314; p=0.04). The copeptin level decreased along with body fluid volume and plasma osmolality during hemodialysis. The copeptin increased in the patients with LV dysfunction more than in those with normal LV function (218.7 pg/mL vs. 77.6 pg/mL; p=0.01). Receiver operating characteristic curve analysis showed that copeptin had a diagnostic value in the hemodialysis patients with LV dysfunction (area under curve 0.737; p=0.02) and that the cut-off value was 125.48 pg/mL (sensitivity 0.7, specificity 0.8, positive predictive value 0.9, negative predictive value 0.6). CONCLUSION: Copeptin increases in hemodialysis patients and is higher in patients with LV dysfunction. We believe that copeptin can be a useful marker for the diagnosis of LV dysfunction in hemodialysis patients.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Biomarcadores/sangre , Ecocardiografía , Glicopéptidos/sangre , Fallo Renal Crónico/sangre , Péptido Natriurético Encefálico/sangre , Valor Predictivo de las Pruebas , Pronóstico , Curva ROC , Diálisis Renal/efectos adversos , Sensibilidad y Especificidad , Disfunción Ventricular Izquierda/sangreRESUMEN
We conducted a study to determine whether the hemocontrol biofeedback system (HBS) can improve intradialytic hypotension (IDH) in hypotension-prone hemodialysis (HD) patients compared with conventional HD. In this multicenter prospective crossover study, 60 hypotension-prone patients were serially treated by conventional HD for 8 weeks (period A), by HD with hemoscan blood volume monitoring for 2 weeks (period B0), and by HBS HD for 8 weeks (period B1). The number of sessions complicated by symptomatic IDH during 24 HD sessions (14.9+/-5.8 sessions, 62.1% in period A vs 9.2+/-7.2 sessions, 38.4% in period B1, P<0.001) and the number of IDH-related nursing interventions in a session (0.96+/-0.66 in period A vs 0.56+/-0.54 in period B1, P<0.001) significantly decreased in period B1 than in period A. Recovery time from fatigue after dialysis was significantly shorter in period B1 than in period A. The patients with higher post-dialysis blood pressure, lower difference between pre- and post-dialysis blood pressure, less frequent IDH, and higher pre- and post-dialysis body weight in period A responded better to HBS in period B1 in regard to the reduction of IDH. In conclusion, HBS may improve the patient tolerability to HD by reducing the IDH frequency and promoting faster recovery from fatigue after dialysis.
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Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Biorretroalimentación Psicológica , Presión Sanguínea , Volumen Sanguíneo , Peso Corporal , Estudios Cruzados , Fatiga , Hipotensión/etiología , Fallo Renal Crónico/terapia , Posición Prona , Estudios Prospectivos , Diálisis Renal/efectos adversosRESUMEN
Oxalate nephropathy is commonly caused by ethylene glycol, vitamin C, and foods like star fruit that contain a lot of oxalate. Peanuts also have high oxalate contents. However, case reports of peanut-induced oxalate nephropathy are not common. Here, we describe a case of peanut-induced acute oxalate nephropathy with acute kidney injury and intend to demonstrate the conditions under which peanut-induced oxalate nephropathy is likely to occur.
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Lesión Renal Aguda , Arachis , Ácido Ascórbico , Glicol de Etileno , Frutas , OxalatosRESUMEN
PURPOSE: Estimation of body fluid volume in hyponatremia is useful for diagnosis and therapeutic decision-making. Physical examination has been generally used to estimate body fluid volume, but it depends on the physician's abilities. Bioimpedance spectroscopy has been suggested to be a reliable method for the estimation of body fluid volume. Therefore, this study investigated whether bioimpedance spectroscopy could replace physical examination in hyponatremia. MATERIALS AND METHODS: The study included 30 patients with hyponatremia. At the time of the initial visit, body fluid volume was estimated simultaneously by both physical examination and bioimpedance spectroscopy. Estimation of body fluid status by clinical diagnosis was performed as well, which determined body fluid status corresponds with the most likely cause of hyponatremia (clinical body fluid estimation). RESULTS: The results of body fluid volume estimated by physical examination, bioimpedance spectroscopy, and clinical body fluid estimation showed that 9, 10, and 9 patients, respectively, were hypervolemic; 13, 15 and 16 patients, respectively, were euvolemic; and 8, 5, and 5 patients, respectively, were hypovolemic. Cohen's kappa analysis showed a significant agreement between physical examination and bioimpedance spectroscopy (kappa coefficient, 0.632, p<0.001). In addition, bioimpedance spectroscopy showed a higher level of agreement with clinical body fluid estimation than physical examination (kappa coefficient, 0.602 vs. 0.524). CONCLUSION: This study suggests that bioimpedance spectroscopy could replace physical examination for estimating body fluid status in hyponatremia. In addition, bioimpedance spectroscopy might correspond better with clinical diagnosis than physical examination in the estimation of body fluid status in hyponatremia.
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Humanos , Líquidos Corporales , Diagnóstico , Hiponatremia , Hipovolemia , Métodos , Examen Físico , Análisis EspectralRESUMEN
Kidney transplantation is the preferred treatment in end stage renal disease for autosomal dominant polycystic kidney disease (ADPKD) patients. Removal of the native kidney is not usually recommended for ADPKD patients during a transplantation procedure because the operation time may be prolonged or the risk of bleeding may be higher. Therefore, native kidney removal is indicated for patients with chronic pain by enlarged kidney, frequent complications from cysts, such as infection or bleeding, and renal tumor development. Here, we report a case of a patient whose native kidneys were removed during a kidney transplantation procedure, and multifocal adenomas were identified in the removed kidneys after the procedure.
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Humanos , Adenoma , Dolor Crónico , Hemorragia , Riñón , Fallo Renal Crónico , Trasplante de Riñón , Enfermedades Renales Poliquísticas , Riñón Poliquístico Autosómico DominanteRESUMEN
BACKGROUND/AIMS: Diastolic dysfunction occurs frequently in patients with chronic kidney disease (CKD) and is associated with heart failure (HF) or mortality. We investigated whether the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e' ratio), estimated using tissue Doppler imaging, has prognostic value for cardiovascular morbidity and all-cause mortality in patients with CKD. METHODS: For 186 patients with CKD of stages III to V, we obtained echocardiograms with tissue Doppler imaging. A 5-year follow-up of 136 patients was performed based on hospital records and telephone interviews. The enrolled patients (79 males and 57 females) were categorized into the following CKD subgroups: stage III (n = 25); stage IV (n = 22); and stage V (n = 89). RESULTS: The average follow-up period was 30.45 months and the mean age of the patients was 61.13 years. The mortality rate after 5 years was 60.0%. The causes of death were: sepsis, 21.9%; HF, 16.2%; and sudden death, 15.2%. Age (p = 0.000), increased C-reactive protein level (p = 0.018), and increased E/e' ratio (p = 0.048) were found to correlate with mortality. Age (p = 0.000), decreased ejection fraction (p = 0.003), and increased E/e' ratio (p = 0.045) correlated with cardiovascular event. CONCLUSIONS: The E/e' ratio can predict mortality and cardiovascular events in patients with CKD who have diastolic dysfunction.
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Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Distribución de Chi-Cuadrado , Ecocardiografía Doppler , Tasa de Filtración Glomerular , Insuficiencia Cardíaca Diastólica/mortalidad , Incidencia , Estimación de Kaplan-Meier , Riñón/fisiopatología , Modelos Lineales , Válvula Mitral/fisiopatología , Valor Predictivo de las Pruebas , Pronóstico , Modelos de Riesgos Proporcionales , Curva ROC , Insuficiencia Renal Crónica/diagnóstico , República de Corea/epidemiología , Medición de Riesgo , Factores de Riesgo , Volumen Sistólico , Factores de Tiempo , Función Ventricular IzquierdaRESUMEN
The superior vena cava (SVC) syndrome refers to all clinical phenomena appeared as bronchial pneumonia, lymphoma, mediastinitis, and aortic aneurysm compress the superior vena cava and the veins in the vicinity in the superior mediastinum. Iatrogenic superior vena cava syndrome due to vascular stenosis or aneurysmal change has occurred by the repeated placement of cardiac pacemaker. Cardiac tamponade and hematoma have been reported in patients with end-stage renal disease due to impairment of blood coagulation caused by uremia. But acutely developed SVC syndrome was not reported after catheterization. In this report, we describe a case of acute SVC syndrome and mediastinal hematoma after insertion of internal jugular catheter for hemodialysis.
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Humanos , Aneurisma , Aneurisma de la Aorta , Coagulación Sanguínea , Bronconeumonía , Taponamiento Cardíaco , Cateterismo , Catéteres , Constricción Patológica , Diálisis , Hematoma , Fallo Renal Crónico , Linfoma , Mediastinitis , Mediastino , Diálisis Renal , Síndrome de la Vena Cava Superior , Uremia , Venas , Vena Cava SuperiorRESUMEN
Malignant tumors have been shown to be a major secondary cause of nephrotic syndrome. They have been associated with different glomerulopathy depending on their type. Membranoproliferative glomerulonephritis (MPGN) rarely develops in solid tumors, although cases have been reported in renal cell cancer, melanoma, lung cancer, and tumors in the urogenital system. However, to our knowledge, there have been no case reported of MPGN associated with thyroid cancer. In the present case, we observed MPGN associated with thyroid cancer in a 44-year-old woman with nephrotic syndrome and renal insufficiency. Her thyroid ultrasound revealed a tumor measuring 1.01x1.14x1.48 cm with an indistinct border that was partially calcified. The tumor was confirmed to be papillary carcinoma by percutaneous needle aspiration biopsy. Renal biopsy showed chronic tubulointerstitial nephritis and MPGN. On day 45 of admission, total thyroidectomy and neck lymphadenectomy were performed. After total thyroidectomy, serum total protein, albumin, C3, and C4 normalized. In conclusion, this case represents the first report of simultaneous development of MPGN and thyroid cancer.
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Adulto , Femenino , Humanos , Biopsia , Biopsia con Aguja , Carcinoma , Carcinoma Papilar , Carcinoma de Células Renales , Glomerulonefritis Membranoproliferativa , Neoplasias Pulmonares , Escisión del Ganglio Linfático , Melanoma , Cuello , Agujas , Nefritis Intersticial , Síndrome Nefrótico , Insuficiencia Renal , Glándula Tiroides , Neoplasias de la Tiroides , Tiroidectomía , Sistema UrogenitalRESUMEN
Rhabdomyolysis is caused by injury to skeletal muscle and it involves leakage of intracellular contents into the plasma. Rhabdomyolysis is an extremely rare manifestation of dermatomyositis. Dermatomyositis is a rare idiopathic inflammatory myopathy that is characterized by chronic inflammation of skeletal muscles and skin, resulting in muscle weakness. A 20 year old Korean male soldier presented with acute muscle pain, weakness and skin rashes over the face, neck and anterior chest. He received military training with carrying a radio set one week previouslyago. The patient was treated for rhabdomyolysis. However, the patient's symptoms did not improve. Muscle biopsy results suggested the diagnosis of rhabdomyolysis. Nevertheless, the features of skin and muscle inflammation raised the possibility of dermatomyositis. High dose steroid treatment was started, and then the symptoms and signs of muscle inflammation were improved. Rhabdomyolysis as the presenting sign of dermatomyositis has not been reported in Korea. Thus, we report on this case with a literature review.
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Humanos , Masculino , Biopsia , Dermatomiositis , Exantema , Inflamación , Corea (Geográfico) , Elevación , Personal Militar , Debilidad Muscular , Músculo Esquelético , Músculos , Miositis , Cuello , Plasma , Rabdomiólisis , Piel , TóraxRESUMEN
Nocardia is an opportunistic pathogen that can cause disseminated disease in serious immunosuppressive patients with organ transplantation, advanced HIV infection, malignancy or long-term corticosteroid use. Cerebral nocardiosis constitutes the most severe form of Nocardial infection. Early detection and treatment of cerebral abscess of Nocardia is important because the mortality is three times higher than that of other bacterial cerebral abscesses. We report a case of N. farcinica brain abscess in a focal segmental glomerulosclerosis (FSGS) patient after steroid treatment.
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Humanos , Encéfalo , Absceso Encefálico , Glomeruloesclerosis Focal y Segmentaria , Infecciones por VIH , Nocardia , Nocardiosis , Trasplante de Órganos , Esteroides , TrasplantesRESUMEN
Cisplatin is widely used for chemotherapy, but known to cause renal, auditory, hematologic, gastrointestinal, and neurologic toxicities. Hyponatremia after administration of cisplatin is related to renal tubular sodium excretion. A 71-year-old female was referred to our hospital for chemotherapy of laryngeal cancer. On admission, the patient's laboratory data were normal. The patient received for 3 days chemotherapy without complication, but presented mental confusion on the 4th hospital day. The laboratory findings were as follows; serum sodium was 118 mmol/L, urine sodium 163 mmol/L, serum osmolality 248 mmol/kg, and urine osmolality 594 mmol/kg. On physical exam, volume status was hypovolemic, so we supplied hypertonic and isotonic salines. On the 9th hospital day, she showed normal sodium concentration and clear consciousness. After chemotherapy, we should make differential diagnosis between SIADH (syndrome of inappropriate antidiuretic hormone) and renal salt wasting syndrome according to the physical examination. We report a case of renal salt wasting syndrome with severe mental change after chemotherapy using cisplatin.
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Anciano , Femenino , Humanos , Cisplatino , Estado de Conciencia , Diagnóstico Diferencial , Hiponatremia , Hipovolemia , Síndrome de Secreción Inadecuada de ADH , Neoplasias Laríngeas , Concentración Osmolar , Examen Físico , Sodio , Síndrome DebilitanteRESUMEN
Patients with autoimmune thyroid disease commonly have accompanying forms of systemic autoimmune disease. Some reports have indicated an association between autoimmune thyroiditis and the glomerulonephropathies. The most commonly reported glomerulonephropathy related to autoimmune thyroiditis is membranous glomerulonephritis, but it has not been reported in a case of membranoproliferative glomerulonephritis. We report the case of a 35-year-old woman who had Graves' disease combined with membranoproliferative glomerulonephritis confirmed by a renal biopsy.