Primary Glomerulonephritis with Unique C4d Deposition and Concurrent Non-infectious Intermediate Uveitis: a Case Report and Literature Review.

C4 glomerulopathy is a recently introduced entity that presents with bright C4d staining and minimal or absent immunoglobulin and C3 staining. We report a case of a 62-year-old man with C4 glomerulonephritis (GN) and uveitis. He presented to the nephrology department with proteinuria and hematuria. The patient also had intermediate uveitis along with proteinuria and hematuria. A kidney biopsy that was performed in light of continuing proteinuria and hematuria showed a focal proliferative, focal sclerotic glomerulopathy pattern on light microscopy, absent staining for immunoglobulin or C3 by immunofluorescence microscopy, with bright staining for C4d on immunohistochemistry, and electron-dense deposits on electron microscopy. Consequently, C4 GN was suggested as the pathologic diagnosis. Although laser microdissection and mass spectrometry for glomerular deposit and pathologic evaluation of the retinal tissue were not performed, this is the first report of C4 GN in Korea and the first case of coexisting C4 GN and uveitis in the English literature.

Unmasked chronic renal function deterioration after unilateral adrenalectomy in patients with primary aldosteronism.

We report 2 cases of chronic estimated glomerular filtration rate (eGFR) decline after unilateral adrenalectomy due to primary aldosteronism. The patients were diagnosed with unilateral adrenal cortical adenoma releasing aldosterone. Two patients were examined for hypertension and hypokalemia. Unilateral laparoscopic adrenalectomy was performed in both cases, and pathology confirmed adrenal cortical adenoma. After adrenalectomy, hypertension and hypokalemia improved to within normal range. However, the eGFR decreased postoperatively, and abdominal computed tomography scan showed decreased kidney size compared to previous images. Kidney biopsy was performed to delineate the exact cause of renal function deterioration and revealed hypertensive changes with chronic interstitial changes, indicating that glomerular hyperfiltration with aldosterone excess masked renal function damage. Physicians have to consider the probability of postadrenalectomy eGFR decline related to chronic hypertensive change.

Short- and Long-Term Mortality Rates of Elderly Acute Kidney Injury Patients Who Underwent Continuous Renal Replacement Therapy.

BACKGROUND: The world's population is aging faster and the incidence of acute kidney injury (AKI) needing continuous renal replacement therapy (CRRT) is increasing in elderly population. The outcome of AKI needing CRRT in elderly patients is known to be poor. However, the definitions of elderly used in the previous literatures were diverse and, there were few data that compared the long-term mortality rates of these patients with middle aged patients. This study was aimed to evaluate this issue. METHODS: This study was a single-center, retrospective cohort study of patients who underwent CRRT from January 2013 to December 2015. The patients were divided into the following four age cohorts: middle-aged (55-64), young-old (65-74), middle-old (75-84), and old-old (≥85). The short- and long-term mortality rates for each age cohort were compared. RESULTS: A total of 562 patients met the inclusion criteria. The short-term mortality rate was 57.3% in the entire cohort. Compared with the middle-aged cohort, the middle-old cohort (HR 1.48 (1.09-2.02), p = 0.012) and the old-old cohort (HR 2.33 (1.30-4.19), p = 0.005) showed an increased short-term mortality rate along with an increased SOFA score, acidemia and a prolonged prothrombin time. When we analyzed the long-term mortality rate of the 238 survived patients, the middle-old cohort (HR 3.76 (1.84-7.68), p<0.001), the old-old cohort (HR 4.40(1.20-16.10), p = 0.025), a lower BMI, the presence of liver cirrhosis, the presence of congestive heart failure and a history of sepsis were independent risk factors for the prediction of long-term mortality. CONCLUSION: Compared with the middle-aged cohort, the middle-old and the old-old cohort showed an increased short-term and long-term mortality rate. However, in the young-old cohort, neither the short-term nor the long-term mortality rate was increased.

Extracellular volume expansion and the preservation of residual renal function in Korean peritoneal dialysis patients: a long-term follow up study.

INTRODUCTION: In chronic peritoneal dialysis patients, preservation of residual renal function (RRF) is a major determinant of patient survival, and maintaining sufficient intravascular volume has been hypothesized to be beneficial for the preservation of RRF. The present study aimed to test this hypothesis using multifrequency bioimpedence analyzer (MFBIA), in Korean peritoneal dialysis patients. METHODS: A total of 129 patients were enrolled in this study. The baseline MFBIA was checked, and the patients were divided into the following two groups: group 1, extracellular water per total body water (ECW/TBW) < median, group 2, ECW/TBW > median. We followed up the patients, and then we analyzed the changes in the urine output (UO) and the solute clearance (weekly uKt/V) in each group. Data associated with patient and technical survivor were collected by medical chart review. The volume measurement was made using Inbody S20 equipment (Biospace, Seoul, Korea). We excluded the anuric patients at baseline. RESULT: The median value of ECW/TBW was 0.396. The mean patient age was 49.74 ± 10.01 years, and 62.1 % of the patients were male; most of the patients were on continuous ambulatory peritoneal dialysis (89.1 %). The mean dialysis vintage was 26.20 ± 28.71 months. All of the patients were prescribed hypertensive medication, and 48.5 % of the patients had diabetes. After 25.47 ± 6.86 months of follow up, ΔUO and Δweekly Kt/V were not significantly different in the two groups as follows: ΔUO (-236.07 ± 185.15 in group 1 vs -212.21 ± 381.14 in group 2, p = 0.756); Δ weekly Kt/v (-0.23 ± 0.43 in group 1 vs -0.29 ± 0.49 in group 2, p = 0.461). The patient and technical survivor rate was inferior in the group 2, and in the multivariable analysis, initial hypervolemia was an independent factor that predicts both of the patient mortality [HR 1.001 (1.001-1.086), p = 0.047] and the technical failure [HR 1.024 (1.001-1.048), p = 0.042]. CONCLUSIONS: Extracellular volume expansion, measured by MFBIA, does not help preserve residual renal function, and is harmful for the technical and patient survival in Korean peritoneal dialysis patients.

Severe Hypernatremia Caused by Acute Exogenous Salt Intake Combined with Primary Hypothyroidism.

This report describes a case of severe hypernatremia with a serum sodium concentration of 188.1mmol/L caused by exogenous salt intake. A 26-year-old man diagnosed with Crohn's disease 5 years previously visited our clinic due to generalized edema and personality changes, with aggressive behavior. He had compulsively consumed salts, ingesting approximately 154 g of salt over the last 4 days. Despite careful fluid management that included not only hypotonic fluid therapy for 8 hours but also hypertonic saline administration, his serum sodium level decreased sharply at 40.6 mmol/L; however, it returned to normal within 72-hour of treatment without any neurological deficits. Primary hypothyroidism was also diagnosed. He was discharged after 9 days from admission, with a stable serum sodium level. We have described the possibility of successful treatment in a patient with hypernatremia caused by acute salt intoxication without sustained hypotonic fluid therapy.

Synthesis and Characterization of New Poly(silole-fluorene) Copolymers.

New poly(silole-fluorene) copolymers were designed and synthesized. Copolymers were obtained by Suzuki coupling reaction with different ratio of fluorene and silole. The obtained copolymers were characterized by the spectroscopic methods such as FT-IR and 1H-NMR spectroscopies. The resulting copolymers were soluble in common organic solvents such as toluene, tetrahydrofurane, chloroform, chlorobenzene, etc. The obtained copolymers showed thermal stabilities, which were characterized by TGA and DSC. PLEDs with device configurations of ITO/PEDOT:PSS/Copolymer I~VI/LiF/AI. The best device performances, with maximum brightness of 231.5 cd/m2 at a current density (J) of 408.3 mA/cm2, and a maximum luminance efficiency of 0.115 cd/A, were achieved in the composition of fluorene and silole moiety (0.9:0.1).

Synthesis and Characterization of New Tercopolymer Containing Thienothiophene, Thiophene and Fluorene for Organic Thin-Film Transistors.

We have designed and synthesized the novel p-type polymer containing thienothiophene, thiophene and fluorene with OTFT characteristics. The polymer was synthesized by the palladium catalyzed Suzuki coupling reaction with thienothiophene derivatives, thiophene derivatives and fluorene derivatives. The obtained PTT2BTF can dissolve in common organic solvents such as toluene, THF, chloroform, chlorobenzene and dichlorobenzene. PTT2BTF has a number average molecular weight (Mn) of 25,000 with a poly dispersity index (PDI) of 1.66. PTT2BTF showed good thermal stability with high Td of 407 °C. The OTFT characteristics of the polymer (PTT2BTF) were fabricated. Organic semiconductor was found to exhibit typical p-channel FET characteristics with a hole mobility of 6.3 x 10(-5) cm2/Vs and a threshold voltage of - 4 V. Keywords: OTFT, Thiophene, Fluorene, Solution Process.

New-onset malignant pleural effusion after abscess formation of a subcarinal lymph node associated with endobronchial ultrasound-guided transbronchial needle aspiration.

We present a case of an unusual infectious complication of a ruptured mediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which led to malignant pleural effusion in a patient with stage IIIA non-small-cell lung cancer. EBUS-TBNA was performed in a 48-year-old previously healthy male, and a mediastinal abscess developed at 4 days post-procedure. Video-assisted thoracoscopic surgery was performed for debridement and drainage, and the intraoperative findings revealed a large volume pleural effusion that was not detected on the initial radiographic evaluation. Malignant cells were unexpectedly detected in the aspirated pleural fluid, which was possibly due to increased pleural permeability and transport of malignant cells originating in a ruptured subcarinal lymph node from the mediastinum to the pleural space. Hence, the patient was confirmed to have squamous cell lung carcinoma with malignant pleural effusion and his TNM staging was changed from stage IIIA to IV.

Synthesis and characterization of a new poly(octathiophene) based copolymer for organic thin-film transistor.

A new poly(octathiophene) based copolymer was designed and synthesized by the palladium catalyzed Suzuki coupling reaction. The structure of the newly obtained copolymer was confirmed by 1H-NMR and IR. The number-average molecular weight (M(n)) of the polymer was 36,000 with a poly-dispersity index of 1.15. The polymer has good solubility in common solvents such as chloroform, toluene, chlorobenzene, dichlorobenzene and tetrahydrofuran at room temperature. The optical, thermal and electrochemical properties of the polymer were characterized by UV-vis absorption, TGA and DSC and cyclovoltametry, respectively. A thin film transistor using the new polymer as an organic semiconductor was found to exhibit typical p-channel FET characteristics with a hole mobility of 5 x 10(-4) cm2/Vs.

Synthesis and characterization of pentathiophene based copolymer for organic thin film transistor.

The new dialkylated pentathiophene based copolymer was synthesized by Suzuki coupling reaction. The PD5TADF is synthesized and used as an active material for organic thin film transistor (OTFTs). The copolymer has good solubility in common organic solvent such as toluene, tetrahydrofuran (THF), chloroform, chlorobenzene and dichlorobenzene. The number average molecular weight (Mn) was measured to be 148,000. The TGA curve shows that the polymers exhibit good thermal stability with a weight loss of less than 5% upon heating to 419 °C with glass temperature at 184.9 °C. The ultraviolet (UV) maximum of the polymer was found at 494 nm in solution and 498 nm in the film. A thin-film transistor with PD5TADF was found to exhibit typical p-channel FET characteristics with a hole mobility of 2.6 x 10(-4) cm2/Vs and an on/off ratio of 3.04 x 10(4) with a threshold voltage of -4.5 V.