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Endostatin is released during extracellular matrix remodeling and is involved in the development of vascular pathology and cardiovascular (CV) disease. However, the role of circulating endostatin as a biomarker of vascular calcification and CV events in patients undergoing hemodialysis (HD) remains unclear. Methods: A total of 372 patients undergoing HD were prospectively recruited. Plasma endostatin levels were measured at baseline, and their associations with circulating mineral bone disease (MBD) biomarkers and abdominal aortic vascular calcification scores were analyzed. The primary endpoint was defined as a composite of CV and cardiac events. Results: Plasma levels of patients in endostatin tertile 3 were significantly associated with low-density lipoprotein cholesterol levels and predialysis systolic blood pressure in multivariate analysis. However, endostatin levels did not correlate with circulating MBD biomarkers or vascular calcification scores. Patients in endostatin tertile 3 had a significantly higher cumulative event rate for the composite of CV events (p = 0.006). Endostatin tertile 3 was also associated with an increased cumulative rate of cardiac events (p = 0.04). In multivariate Cox regression analyses, endostatin tertile 3 was associated with a 4.37-fold risk for composite CV events and a 3.88-fold risk for cardiac events after adjusting for multiple variables. Conclusion: Higher circulating endostatin levels were independently associated with atherosclerotic risk factors but did not correlate with MBD markers or vascular calcification. Higher circulating endostatin levels were associated with a greater risk of composite CV events in patients undergoing HD, and endostatin is a biomarker that helps to determine the high risk of CV events.
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Evidence of the ethical appropriateness and clinical benefits of shared decision-making (SDM) are accumulating. This study aimed to not only identify physicians’ perspectives on SDM, and practices related to end-of-life care in particular, but also to gauge the effect of SDM education on physicians in Korea. Methods: A 14-item questionnaire survey using a modified Delphi process was delivered to nephrologists and internal medicine trainees at 17 university hospitals. Results: A total of 309 physicians completed the survey. Although respondents reported that 69.9% of their practical decisions were made using SDM, 59.9% reported that it is not being applied appropriately. Only 12.3% of respondents had received education on SDM as part of their training. The main obstacles to appropriate SDM were identified as lack of time (46.0%), educational materials and tools (29.4%), and education on SDM (24.3%). Although only a few respondents had received training on SDM, the proportion of those who thought they were using SDM appropriately in actual practice was high; the proportion of those who chose lack of time and education as factors that hindered the proper application of SDM was low. Conclusion: The majority of respondents believed that SDM was not being implemented properly in Korea, despite its use in actual practice. To improve the effectiveness of SDM in the Korean medical system, appropriate training programs and supplemental policies that guarantee sufficient application time are required.
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High dietary protein intake may lead to increased intraglomerular pressure and glomerular hyperfiltration, which in the long-term can lead to de novo or aggravating preexisting chronic kidney disease (CKD). Hence, a low protein diet (LPD, 0.6 to 0.8 g/kg/day) is recommended for the management of CKD. There are evidences that dietary protein restriction mitigate progression of CKD and retard the initiation of dialysis or facilitate incremental dialysis. LPD is also helpful to control metabolic derangements in CKD such as metabolic acidosis and hyperphosphatemia. Recently, a growing body of evidence has emerged on the benefits of plant-dominant low-protein diet (PLADO), which composed of > 50% plant-based sources. PLADO is considered to be helpful for relieving uremic burden and metabolic complications in CKD compared to animal protein dominant consumption. It may also lead to favorable alterations in the gut microbiome, which can modulate uremic toxin generation along with reducing cardiovascular risk. Alleviation of constipation in PLADO may minimize the risk of hyperkalemia. A balanced and individualized dietary approach for good adherence to LPD utilizing various plant-based sources as patients’ preference should be elaborated for the optimal care in CKD. Periodic nutritional assessment under supervision of trained dietitians should be warranted to avoid protein-energy wasting.
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High dietary protein intake may lead to increased intraglomerular pressure and glomerular hyperfiltration, which in the long-term can lead to de novo or aggravating preexisting chronic kidney disease (CKD). Hence, a low protein diet (LPD, 0.6 to 0.8 g/kg/day) is recommended for the management of CKD. There are evidences that dietary protein restriction mitigate progression of CKD and retard the initiation of dialysis or facilitate incremental dialysis. LPD is also helpful to control metabolic derangements in CKD such as metabolic acidosis and hyperphosphatemia. Recently, a growing body of evidence has emerged on the benefits of plant-dominant low-protein diet (PLADO), which composed of > 50% plant-based sources. PLADO is considered to be helpful for relieving uremic burden and metabolic complications in CKD compared to animal protein dominant consumption. It may also lead to favorable alterations in the gut microbiome, which can modulate uremic toxin generation along with reducing cardiovascular risk. Alleviation of constipation in PLADO may minimize the risk of hyperkalemia. A balanced and individualized dietary approach for good adherence to LPD utilizing various plant-based sources as patients’ preference should be elaborated for the optimal care in CKD. Periodic nutritional assessment under supervision of trained dietitians should be warranted to avoid protein-energy wasting.
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BACKGROUND: Retroperitoneal fibrosis (RPF) is a rare disease characterized by fibroinflammatory tissue in the periaortic or periiliac retroperitoneum, where it frequently encases ureters. There is emerging evidence that a subset of this disease is part of a spectrum of multisystemic autoimmune diseases collectively referred to as “immunoglobulin G4 (IgG4)-related disease”. METHODS: We retrospectively analyzed 27 idiopathic RPF patients and identified a subset as IgG4-related RPF, which we categorized according to recently published comprehensive diagnostic criteria. We compared clinical and laboratory characteristics and response to treatment between the two groups. RESULTS: Of 27 total patients, 16 (59.3%) were diagnosed as having IgG4-related RPF, and these were predominantly male. They were also significantly older and more likely to have other organ involvement, hydronephrosis, and postrenal acute kidney injury (AKI) compared to those with idiopathic RPF. However, there was no difference in response rate to systemic steroid treatment. CONCLUSION: IgG4-related RPF accounts for a substantial portion of RPF cases previously identified as “idiopathic RPF” in Korea. Clinical and laboratory characteristics of IgG4-related RPF are similar to those of idiopathic RPF except for a striking male predominance, older age, and higher incidence of postrenal AKI in IgG4-related RPF. More comprehensive, prospective studies are needed to clearly distinguish IgG4-related RPF from idiopathic RPF based on clinical manifestation and to further assess treatment response and long-term prognosis.
Sujets)
Humains , Mâle , Atteinte rénale aigüe , Maladies auto-immunes , Hydronéphrose , Immunoglobulines , Incidence , Corée , Pronostic , Études prospectives , Maladies rares , Fibrose rétropéritonéale , Études rétrospectives , Grèves , UretèreRésumé
BACKGROUND: Anemia is a major risk factor that contributes to mortality in patients with chronic kidney disease. There is controversy over the optimal hemoglobin (Hb) target in these patients. This study investigated the association between Hb level and mortality in a cohort of hemodialysis (HD) patients in Korea. METHODS: This study was a multicenter prospective observational study of maintenance HD patients that was performed for 5 years in western Seoul, Korea. Three hundred and sixty-two participants were enrolled. Laboratory values and mortality were accessed every 6 months. Repeated measures of laboratory values in each interval were averaged to obtain one semiannual mean value. The Hb values were divided into six groups: (1) Hb or =13 g/dL. We analyzed the odds ratio for all-cause mortality, based on the Hb group, and adjusted for demographics and various laboratory values. Statistics were performed with SAS, version 9.1 software (SAS Institute Inc., Cary, NC, USA). RESULTS: Mortality odds ratios relative to the reference group (10-11 g/dL) in the fully adjusted model were 3.61 for or =13 g/dL (* indicates P<0.05). CONCLUSION: In this study, a Hb level of 10-11 g/dL was associated with the lowest mortality among the groups with Hb level<13 g/dL. Larger interventional trials are warranted to determine the optimal Hb target for Korean HD patients.
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Humains , Anémie , Études de cohortes , Démographie , Corée , Mortalité , Étude d'observation , Odds ratio , Études prospectives , Dialyse rénale , Insuffisance rénale chronique , Facteurs de risque , SéoulRésumé
BACKGROUND/AIMS: To prevent hypocalcemia after parathyroidectomy (PTX), parenteral calcium is required in addition to oral calcitriol and calcium. After switching to oral calcium, patients can be discharged from the hospital. The aim of this study was to analyze the clinical characteristics and outcomes of PTX performed at a single Korean center and to investigate the associated laboratory factors used to analyze the total amount of postoperative calcium required. METHODS: We enrolled 91 hemodialysis patients undergoing PTX from November 2003 to December 2011. We collected clinical and laboratory data preoperatively, 12 and 48 hours postoperatively, at discharge, and 3 and 6 months postoperatively. RESULTS: In total, 59 patients underwent PTX with autotransplantation (AT), 6 underwent total PTX without AT, 11 underwent subtotal PTX, and 15 underwent limited PTX. Total PTX without AT showed the lowest recurrence rate. At all postoperative time points, the mean levels of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) decreased significantly, compared with preoperative levels; however, alkaline phosphatase (ALP) increased significantly from 48 hours postoperatively to discharge (p < 0.001). On multiple linear regression analysis, the total amount of injected calcium during hospitalization showed a significant correlation with preoperative ALP (p < 0.001), preoperative iPTH (p = 0.037), and Deltaphosphorus at 48 hours (p < 0.001). We developed an equation for estimating the total calcium requirement after PTX. CONCLUSIONS: Preoperative ALP, preoperative iPTH, and Deltaphosphorus at 48 hours may be significant factors in estimating the postoperative calcium requirement. The formula for postoperative calcium requirement after PTX may help to predict the duration of postoperative hospitalization.
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Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Administration par voie intraveineuse , Administration par voie orale , Marqueurs biologiques/sang , Calcium/sang , Carbonate de calcium/administration et posologie , Composés du calcium/administration et posologie , Gluconate de calcium/administration et posologie , Techniques d'aide à la décision , Compléments alimentaires , Hyperparathyroïdie secondaire/sang , Hypocalcémie/diagnostic , Lactates/administration et posologie , Modèles linéaires , Modèles biologiques , Analyse multifactorielle , Hormone parathyroïdienne/sang , Parathyroïdectomie/effets indésirables , Phosphore/sang , Récidive , République de Corée , Études rétrospectives , Facteurs de risque , Facteurs temps , Résultat thérapeutiqueRésumé
Cryptococcus neoformans is a fungus that causes opportunistic infections in immunocompromised hosts. Skin lesions are found in 10-20% of systemic cryptococcal infections, usually secondary to cryptococcemia, while primary cutaneous cryptococcosis with cryptococcemia is very rare. We report a case of rapidly spreading cryptococcal cellulitis in a 64-year-old male on maintenance hemodialysis taking steroids for encapsulated peritoneal sclerosis. Bluish bullous cellulitis developed on the left forearm and spread rapidly to the other forearm. We identified C. neoformans in the blood and skin lesions. We treated him successfully with liposomal amphotericin B and fluconazole for 15 months. We also review the literature.
Sujets)
Humains , Mâle , Adulte d'âge moyen , Amphotéricine B , Cellulite sous-cutanée , Cryptococcose , Cryptococcus neoformans , Fluconazole , Avant-bras , Champignons , Sujet immunodéprimé , Infections opportunistes , Fibrose péritonéale , Dialyse rénale , Peau , StéroïdesRésumé
Radiocontrast-induced nephropathy (CIN) is the third most common cause of acute renal failure among inpatients. The number of patients undergoing examinations using radiocontrast is increasing, and the population at risk for CIN is growing; this population includes older individuals and those with underlying diabetes mellitus, chronic kidney disease, hypertensive nephropathy, and concomitant use of nephrotoxic drugs. However, little progress in CIN treatment has been made. CIN remains a substantial medical problem because of its association with prolonged hospitalization, the potential need for renal replacement therapy, and increased mortality. The exact pathogenesis of CIN has not been fully elucidated-and multiple factors including tubular renal vasoconstriction, direct renal tubular toxicity, increased oxidative stress, and cellular apoptosis-may contribute to the proximal tubular damage that occurs in patients with CIN. Despite the exploration of numerous prophylactic regimens and treatments, definite therapeutic and preventive strategies for CIN have not been established. This article reviews recent studies involving the risk factors for CIN as well as its pathophysiology and prevention.
Sujets)
Humains , Atteinte rénale aigüe , Diabète , Hospitalisation , Patients hospitalisés , Mortalité , Stress oxydatif , Caractéristiques de la population , Insuffisance rénale chronique , Traitement substitutif de l'insuffisance rénale , Facteurs de risque , VasoconstrictionRésumé
IgG4-related disease (IgG4-RD) is a group of fibro-inflammatory diseases affecting multiple organ systems, pathologically characterized by tissue infiltration with abundant IgG4-positive cells. We here report a case of IgG4-RD that was successfully controlled by mycophenolic acid (MPA). A 62-year-old male visited complaining of dizziness and loss of appetite. He had a clinical history of autoimmune pancreatitis treated with steroids and cyclophosphamide 5 years prior, and had also been diagnosed with Hashimoto's thyroiditis at the age of 55 years. We initially prescribed prednisolone (1 mg/kg), tapered to 5 mg/day over 8 months. However, his eosinophilia gradually deteriorated, and we added cyclophosphamide (1 mg/kg daily) for the next 7 months. His laboratory data fluctuated when he was on low-dose predinisolone and cyclophosphamide, and we thus changed his medication to prednisolone combined with MPA for the following 63 months. Currently, his laboratory findings are stable.
Sujets)
Humains , Mâle , Adulte d'âge moyen , Appétit , Cyclophosphamide , Sensation vertigineuse , Éosinophilie , Immunoglobuline G , Acide mycophénolique , Pancréatite , Prednisolone , Stéroïdes , Glande thyroide , ThyroïditeRésumé
Infliximab is a chimeric anti-tumor necrosis factor-alpha monoclonal antibody. Infusion related reactions and infection are well known side effects of infliximab; however, renal complications have not been well recognized. We report on a patient with late onset-acute tubulointerstitial nephritis (ATIN) after treatment with infliximab and mesalazine for Crohn's disease. A 25-year-old woman was admitted with a purpuric rash on both lower extremities and arthralgia. She had been diagnosed with Crohn's disease 5.6 years previously and had been treated with mesalazine and infliximab. Serum creatinine level, last measured one year ago, was elevated from 0.6 mg/dL to 1.9 mg/dL. Results of urinalysis, ultrasound, and serologic examinations were normal. With a tentative diagnosis of Henoch-Schonlein purpura, oral prednisolone was given, and serum creatinine decreased to 1.46 mg/dL, but was elevated to 2.6 mg/dL again at two months after discontinuation of prednisolone. Renal biopsy indicated that ATIN was probably induced by drug, considering significant infiltration of eosinophils. Concomitant use of infliximab with mesalazine was supposed to trigger ATIN. Oral prednisolone was administered, and serum creatinine level showed partial recovery. Thus, ATIN should be suspected as a cause of renal impairment in Crohn's disease even after a long period of maintenance treatment with infliximab and mesalazine.
Sujets)
Femelle , Humains , Adalimumab/usage thérapeutique , Anti-inflammatoires/usage thérapeutique , Créatine/sang , Maladie de Crohn/traitement médicamenteux , Association de médicaments , Granulocytes éosinophiles/immunologie , Infliximab/effets indésirables , Rein/anatomopathologie , Mésalazine/effets indésirables , Néphrite interstitielle/diagnostic , Prednisolone/usage thérapeutiqueRésumé
Paraneoplastic leukocytosis was defined as elevated white blood cell (WBC) levels caused by cytokines, likely produced by the tumor itself, without evidence of infection or myeloproliferative disease. We report a case of anaplastic thyroid carcinoma with leukocytosis caused by elevated production of granulocyte colony-stimulating factor (G-CSF) by the carcinoma. Initially, acute pyelonephritis (APN) was diagnosed and treatment for APN was ongoing, but the WBC count steadily increased to 68.8x10(9)/L. She was diagnosed with anaplastic thyroid carcinoma on her neck mass, and the serum concentration of G-CSF was found to be markedly increased at 1,010 pg/mL. In spite of supportive care, the patient's condition rapidly deteriorated and the patient died on day 23 of hospital stay. Leukocytosis without definite evidence of infection could be a paraneoplastic manifestation in patients with malignant tumors, and paraneoplastic leukocytosis may be related to poor prognosis.
Sujets)
Humains , Cytokines , Facteur de stimulation des colonies de granulocytes , Granulocytes , Durée du séjour , Leucocytes , Hyperleucocytose , Cou , Pronostic , Pyélonéphrite , Glande thyroide , Tumeurs de la thyroïdeRésumé
Paraneoplastic leukocytosis was defined as elevated white blood cell (WBC) levels caused by cytokines, likely produced by the tumor itself, without evidence of infection or myeloproliferative disease. We report a case of anaplastic thyroid carcinoma with leukocytosis caused by elevated production of granulocyte colony-stimulating factor (G-CSF) by the carcinoma. Initially, acute pyelonephritis (APN) was diagnosed and treatment for APN was ongoing, but the WBC count steadily increased to 68.8x10(9)/L. She was diagnosed with anaplastic thyroid carcinoma on her neck mass, and the serum concentration of G-CSF was found to be markedly increased at 1,010 pg/mL. In spite of supportive care, the patient's condition rapidly deteriorated and the patient died on day 23 of hospital stay. Leukocytosis without definite evidence of infection could be a paraneoplastic manifestation in patients with malignant tumors, and paraneoplastic leukocytosis may be related to poor prognosis.
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Humains , Cytokines , Facteur de stimulation des colonies de granulocytes , Granulocytes , Durée du séjour , Leucocytes , Hyperleucocytose , Cou , Pronostic , Pyélonéphrite , Glande thyroide , Tumeurs de la thyroïdeRésumé
No abstract available.
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Femelle , Humains , Mâle , Maladies cardiovasculaires/étiologie , Ostéoprotégérine/sang , Dialyse rénale , Insuffisance rénale chronique/thérapie , Rigidité vasculaireRésumé
Neointimal hyperplasia causes vascular stenosis and subsequent thrombosis, which result in vascular access failure in patients undergoing hemodialysis. Interleukin-10 (IL-10) and tumour necrosis factor-alpha (TNF-alpha) are involved in this inflammatory process. The aim of this study was to investigate the relationship between vascular access failure and various inflammatory markers including the genetic polymorphisms of IL-10 and TNF-alpha. Seventy-five patients on hemodialysis with an arteriovenous fistula in place or an artificial graft (18 with vascular access failure and 82 without failure) and 98 healthy individuals were genotyped for IL-10 and TNF-alpha single nucleotide polymorphisms. Clinical and laboratory data including serum IL-10 and TNF-alpha levels were compared. Stimulated IL-10 levels, from in vitro incubation of blood with lipopolysaccharide, were also obtained and compared. Female gender, hypoproteinemia, and hypertriglyceridemia were associated with vascular access failure. The basal TNF-alpha level was significantly higher in patients with access failure. The distribution of IL-10 and TNF-alpha genotype did not differ among patients with or without access failure. This study could not demonstrate a relationship between genetic polymorphisms and vascular access failure. However, an altered immune response and inflammation might contribute to vascular access failure.
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Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Anastomose chirurgicale artérioveineuse/effets indésirables , Cathéters à demeure/effets indésirables , Études transversales , Interleukine-10/sang , Polymorphisme de nucléotide simple , Dialyse rénale , Facteur de nécrose tumorale alpha/sangRésumé
PURPOSE: CHF is a life threatening acute complication in ESRD populations. An intensive hemodialysis (HD) has been effective in reducing intravascular volume and in removing uremic toxin with improved systolic function. Although recent progress has identified an inflammation as an important contributor to the pathogenesis of CVD, the effect of intensive HD on inflammatory parameters and left ventricle (LV) systolic dysfunction is not clear. The purpose of this study is to examine the effect of intensive HD on LV systolic function and serum cytokines levels. METHODS: Among ESRD patients who underwent dialysis and developed acute pulmonary edema due to LV systolic dysfunction were enrolled. Intensive HD consisted of daily 4 hours HD for 7 consecutive days. Data were prospectively collected and 2-D echocardiography was done before and after intensive HD. Serum levels of TNF-alpha and IL-10 were compared and lipopolysaccharide (LSP)-stimulated of these cytokines were measured. RESULTS: After intensive HD, weight and mean arterial blood pressure decreased significantly and ejection fraction (EF) increased significantly. Serum IL-10 and TNF-alpha levels decreased significantly after intensive HD. In contrast, LPS stimulated production of these cytokines increased significantly after intensive HD. The difference of CRP between after HD and before HD was negatively correlated with the difference of EF. CONCLUSION: In ESRD patients with acute LV dysfunction, intensive HD significantly improved EF and restored the immune responsiveness. These results suggest that intensive HD has the advantage of improving EF through modulating inflammation and correcting immune dysfunction in ESRD patients with acute LV dysfunction.
Sujets)
Humains , Pression artérielle , Cytokines , Dialyse , Échocardiographie , Défaillance cardiaque , Ventricules cardiaques , Imidazoles , Inflammation , Interleukine-10 , Défaillance rénale chronique , Composés nitrés , Études prospectives , Oedème pulmonaire , Dialyse rénale , Débit systolique , Facteur de nécrose tumorale alphaRésumé
PURPOSE: Depression is associated with increased inflammation and cardiovascular disease. And in patients with end stage renal disease (ESRD), depression is a common problem and cardiovascular disease is the main cause of death. The aim of this study is to investigate the association of depression with various inflammatory markers and with some cardiovascular risk factors in ESRD patients on hemodialysis METHODS: 53 patients with ESRD on maintenance hemodialysis were divided into depressive symptom (BDI> or =11) group and control (BDI < 11) group by the 21-items Becks depression inventory (BDI). We collected patients characteristics and laboratory measurements by medical records. And then, we measured the levels of IL-10 and TNF-alpha a and analyzed the genotype of IL-10 and TNF-alpha a promoter area. RESULTS: The levels of TNF-alpha, CRP and ferritin were significantly higher in depressive symptom group (p=0.001, 0.04, 0.02) and IL-10 concentration tended to be lower in depressive symptom group (p= 0.05). The prevalence of left ventricular hypertrophy was higher in depressive symptom group than in the control group (44% vs 9%, p=0.01). GG genotype known as high IL-10 producer was less common in depressive symptom group than in control group (8% vs 36%, p=0.039). CONCLUSION: Increased inflammation, high left ventricular hypertrophy prevalence and low ejection fraction were observed in depressive hemodialysis patients. Further prospective study is needed to clarify the role of depression in the development of inflammation and cardiovascular disease in ESRD patients.
Sujets)
Humains , Maladies cardiovasculaires , Cause de décès , Dépression , Ferritines , Génotype , Hypertrophie ventriculaire gauche , Inflammation , Interleukine-10 , Défaillance rénale chronique , Dossiers médicaux , Prévalence , Dialyse rénale , Facteurs de risque , Facteur de nécrose tumorale alphaRésumé
PURPOSE: inflammation is a common feature in chronic kidney disease patients, and it could contribute to long-term morbidity and mortality related with malnutrition and atherosclerosis. In this study, we aimed to investigate the effect of initiating dialysis on inflammatory state, nutritional parameter, and immune response in end-stage renal disease (ESRD) patients. METHODS: 57 ESRD patients who initiated hemodialysis (HD, n=31) or continuous ambulatory peritoneal dialysis (CAPD, n=26) were enrolled. Pro-inflammatory cytokine, tumor necrosis factor (TNF)-alpha, and anti-inflammatory cytokines, interleukin (IL)-10 and adiponectin were measured before and 3 months after initiation of dialysis. Inflammatory marker, highly sensitive C-reactive protein (hs-CRP), and nutritional parameter, albumin, were also checked. Lipopolysaccharide (LPS)-stimulated production of TNF-alpha and IL-10 were measured for the evaluation of immune response by external stimuli. RESULTS: As uremia was reduced by initiating dialysis, serum level of TNF-alpha was decreased and adiponectin was increased. These changes were accompanied by the decrease of hs-CRP and the increase of serum albumin. LPS-stimulated cytokines production was increased after initiating dialysis. There differences in these parameters comparing HD and CAPD patients except more increase of serum adiponectin level in CAPD patients. CONCLUSION: Our study demonstrated that initiation of dialysis results in decrease of inflammation, improvement of nutritional status, and restoration of proper immune responsiveness in ESRD patients. These results suggest that correction of uremic milieu through dialysis has beneficial effects. Therefore, initiation of dialysis might have the advantage of improving inflammatory and nutritional status, and correcting immune dysfunction in ESRD patients.
Sujets)
Humains , Adiponectine , Athérosclérose , Protéine C-réactive , Cytokines , Dialyse , Inflammation , Interleukine-10 , Interleukines , Défaillance rénale chronique , Malnutrition , Mortalité , État nutritionnel , Dialyse péritonéale continue ambulatoire , Dialyse rénale , Insuffisance rénale chronique , Sérumalbumine , Facteur de nécrose tumorale alpha , UrémieRésumé
BACKGOUND: Although the incidence has decreased markedly, mortality from uremic pericarditis still remained high at 8-10% due to hemodynamic compromise. Moreover, it is difficult to diagnose and discriminate from other causes of pericarditis such as tuberculous pericarditis in its early stage. The aim of this study was to analyze the factors that were related to the development of uremic pericarditis and factors that could distinguish it from other causes of pericarditis. METHODS: Eighteen patients who received pericardiocentesis due to uremic pericarditis from 1996 to 2005 in Korea university hospital were enrolled. All patients were diagnosed as severe uremic pericarditis by echocardiography. And as a comparison group, 37 patients with tuberculous pericarditis and 20 patients with malignant pericarditis were also enrolled. Analysis of the factors that were related to the development of uremic pericarditis or comparison of clinical, biochemical factors in uremic, tuberculous or malignant pericarditis were also done. RESULTS: In uremic pericarditis, the proportion of patients with peritoneal dialysis was higher (55.6%). The amount of pericardial effusion showed a positive correlation with the duration of dialysis, whereas showed negative correlation with hemoglobin and cholesterol levels. Pericardial fluid ADA was significantly higher in tuberculous pericarditis and pericardial fluid glucose was higher in uremic pericarditis. No specific factors that were related to the development of pericardial tamponade were identified. CONCLUSION: The development of severe uremic pericarditis might be related to poor nutritional status. In the early stage, ADA and glucose levels in pericardial fluid could be useful in distinguishing uremic pericarditis from tuberculous pericarditis. Prospective studies that enroll large patient population can be helpful in identifying factors that are related to the development of uremic pericarditis or tamponade.
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Humains , Tamponnade cardiaque , Cholestérol , Dialyse , Échocardiographie , Glucose , Hémodynamique , Incidence , Corée , Mortalité , État nutritionnel , Épanchement péricardique , Péricardiocentèse , Péricardite , Péricardite tuberculeuse , Dialyse péritonéaleRésumé
Heat stroke is a potentially fatal disorder that's caused by an extreme elevation in body temperature. We report here an unusual case of multiple organ failure that was caused by classical, nonexertional heat stroke due to taking a warm bath at home. A 68 year old diabetic man was hospitalized for loss of consciousness. He was presumed to have been in a warm bath for 3 hrs and his body temperature was 41 degrees C. Despite cooling and supportive care, he developed acute renal failure, disseminated intravascular coagulation (DIC) and fulminant liver failure. Continuous venovenous hemofiltration was started on day 3 because of the progressive oligouria and severe metabolic acidosis. On day 15, septic ascites was developed and Acinetobacter baumanii and Enterococcus faecium were isolated on the blood cultures. In spite of the best supportive care, the hepatic failure and DIC combined with septic peritonitis progressed; the patient succumbed on day 25.