There is a high incidence of tuberculosis in patients with chronic renal failure undergoing hemodialysis. Clinical features and laboratory findings are intermittent high fever of unknown origin, weight loss, high ESR and CRP. The diagnosis of tuberculosis in patients with hemodialysis can be difficult due to non specific symptoms, insidious onset, and unusually high frequency of extrapulmonary involvement. Sites of extrapulmonary involvement include mediastinum, meninges, pleura, kidney, peritoneum, and rarely pericardium. We experienced a unusual case of tuberculoma involving the right atrium in a hemodialysis patient. Our initial impression of this case was pericardial effusion. However, chest CT and echocardiography revealed a mass on the right atrium. Exploratory thoracotomy revealed tuberculous granuloma scattered throughout pericardium and tuberculoma involving right atrium. Following the administration of anti Tbc medication, clinical symptoms and signs resolved and follow up chest CT showed significant decrease in the size of the tuberculoma.
Diagnosis ; Echocardiography ; Fever of Unknown Origin ; Follow-Up Studies ; Granuloma ; Heart Atria* ; Humans ; Incidence ; Kidney ; Kidney Failure, Chronic ; Mediastinum ; Meninges ; Pericardial Effusion ; Pericardium ; Peritoneum ; Pleura ; Renal Dialysis* ; Thoracotomy ; Tomography, X-Ray Computed ; Tuberculoma ; Tuberculosis* ; Weight Loss

Rahnella aquatilis, an infrequently isolated gram-negative rod, is the only species of the genus Rahnella within the Enterobacteriaceae family. The organism's natural habitat is water, from which most isolates have been recoverd. Infecions in humans have only occasionally been reported, especially in immunocompromised patients. We reort a case of bacteremia caused by this organism in a hemodialysis patient.
Bacteremia* ; Ecosystem ; Enterobacteriaceae ; Humans ; Immunocompromised Host ; Rahnella* ; Renal Dialysis*

Spontaneous hemorrhage in the patients undergoing hemodialysis is the ralatively common problem, but spontaneous mediastinal hemorrhage in such patients reported only few cases. We experienced a case of spontaneous mediastinal hemorrhage in chronic hemodialysis patient who complained of continuous pleuritic chest pain and mild dyspnea. The diagnosis was made dy chest computed tomography,magnetic resonance imaging and percutaneous fine needle aspiration of liquified dark reddish old blood material guided by ultrasonography. Treatment is usually conservative, with blood volume replacement and intensive hemodialysis using regional heparinization. We report on a patient undergoing hemodialysis due to endstage renal disease who developed spontaneous mediastinal hemorrhage.
Biopsy, Fine-Needle ; Blood Volume ; Chest Pain ; Diagnosis ; Dyspnea ; Hemorrhage* ; Heparin ; Humans ; Renal Dialysis* ; Thorax ; Ultrasonography

The acute tumor lysis syndrome is an acute illness caused by massive cell lysis after chemotherapies. This syndrome is characterized by hyperuricemia, hyperphosphatemia with hypocalcemia and hyperkalemia. Among these electrolyte abnormalities, the most serious complication is the severe hyperphosphatemia (greater than 14mg/dL) that could result in sudden cardiac arrest or respiratory failure. In order to correct the severe hyperphosphatemia, hemodialysis has been used commonly as the renal replacement therapy . However the hemodialysis can make posthemodialysis serum phosphate rebounded unless the patient take this treatment for more than 6 hours. Therefore it is not sufficient to use hemodialysis treatment alone. To solve this problem, hemodialysis has been used with or replaced by the uninterrupted dialysis technique such as CRRT (continuous renal replacement therapy). We report a 33-year-old man with Burkitt lymphoma who showed severe hyperphosphatemia (peak phosphate value was 18.6mg/dL) during the course of chemotherapy. used with 5 day CAVH (continuous arteriovenous hemofiltration) his phosphate level could be maintained without any rebound. Therefore we concluded that CAVH in conjunction with hemodialysis would be a successful way to control severe hyperphosphatemia associated with tumor lysis syndrome.
Adult ; Burkitt Lymphoma ; Death, Sudden, Cardiac ; Dialysis ; Drug Therapy ; Hemofiltration* ; Humans ; Hyperkalemia ; Hyperphosphatemia* ; Hyperuricemia ; Hypocalcemia ; Renal Dialysis* ; Renal Replacement Therapy ; Respiratory Insufficiency ; Tumor Lysis Syndrome*

Primary aldosteronism is characterized by hypertension, hypokalemia, low plasma renin activity (PRA) and elevated plama aldosterone (PA) level. Primary aldosteronism is suspected in patients with hypertension and unexplained hypokalemia. In chronic renal failure(CRF), however, renin-angiotensin-aldosterone axis is altered by renal disease per se, antihyppertensive drugs used and volume status. Therefore, it is difficult to diagnose primary aldosteronism in CRF on the basis of serum potassium, PRA and PA level. Recently, we experienced a case of primary aldosteronism associated with nephrotic syndrome and CRF. The patient was a 49 years old woman who presented with 10 year old history of high blood pressure and general weakness of one year's duration. Her initial serum creatinine was 7.3mg/dL and serum potassium 2.6mEq/L. PRA was decreased and PA was markedly increased. Persistent hypokalemia urged to evaluate adrenal gland in this case. The round mass was found in left adrenal gland and it was surgically removed. CRF and nephrotic syndrome can alter serum potassium and PRA and there lies the diagnostic dilemma for primary aldosteronsim. It will be well to consider associated primary alodsteronism in a patient with CRF and persistent hypokalemia.
Adrenal Glands ; Aldosterone ; Axis, Cervical Vertebra ; Child ; Creatinine ; Female ; Humans ; Hyperaldosteronism* ; Hypertension ; Hypokalemia ; Kidney Failure, Chronic* ; Middle Aged ; Nephrotic Syndrome* ; Plasma ; Potassium ; Renin

Central diabetes insipidus (CDI) is a clinical syndrome that result from a failure of the neurohypophyseal axis to produce or release a sufficient quantity of arginine vasopressin (AVP) to permit normal function of the urinary concentrating mechanism. Polyuria and polydipsia are the symptoms associated with CDI. The most common cause of CDI is idiopathic variety and head trauma, neurohypophyseal surgery, primary or metastatic brain tumors acount for most of the remaining cases. CDI in Langerhans cell histiocytosis (LCH) is thought to be to infiltration of the hypothalamus-neurohypophyseal system. We report a patient with CDI and LCH underwent water depriviation test, MR imaging of the pituitary-hypothalamic region, and VATS associated open lung biopsy.
Arginine Vasopressin ; Axis, Cervical Vertebra ; Biopsy ; Brain Neoplasms ; Craniocerebral Trauma ; Diabetes Insipidus* ; Diabetes Insipidus, Neurogenic ; Histiocytosis* ; Histiocytosis, Langerhans-Cell ; Humans ; Lung ; Magnetic Resonance Imaging ; Polydipsia ; Polyuria ; Thoracic Surgery, Video-Assisted

Intrathoracic kidney is a very rare congenital anomaly in development of the kidney. It was firstly described by Mikulics in 1922. More than 130 cases were reported in the world. Most of the patients have no clinical problem and discovered incidentally in chest X-ray. We have experienced a case of intrathoracic kidney in a 48-year-old female who was admitted due to recurrent calculous cholecystitis. Intrathoracic mass lesion was noted in the plain chest film and confirmed as intrathoracic kidney by chest computed tomography and intravenous pyleography. We report a case of intrathorcic kidney with brief review of literature.
Adult* ; Cholecystitis ; Female ; Humans ; Kidney* ; Middle Aged ; Thorax

Oral contraceptives cause a number of serious side effects in young woman. Prominent among these is an increased incidence of thromboembolic events. Although these thromboemboli almost invariably occur on the venous side of the circulation, there have been reports describing the occurrence of arterial thromboses. Spontaneous thrombosis of the renal artery is a rare event. When reported, it has usually superimposed on an underlying anatomic abnormality of the renal artery after trauma, or very rarely in the setting of systemic disease such as polycythemia vera or thromboangiitis obliterans. Since isolated renal artery thrombosis in the absence of these underlying conditions has been rarely described, wewish to bring attention to the diagnosis of this disorder in a young woman taking oral contraceptives and without any other predisposing abnormality.
Contraceptives, Oral* ; Diagnosis ; Female ; Humans ; Incidence ; Polycythemia Vera ; Renal Artery* ; Thromboangiitis Obliterans ; Thrombosis*

Inguinal herniorrhaphy is the most frequent general surgical operation performed by pediatric surgeons, but some complications can usually be attributed to inappropriate approach and traumatic dissection. We experienced a case of acute renal failure due to bilateral ureter injuries after bilateral inguinal hernia repairs. The patient was a 3 month old male infant who presented as anuria and generalized edema after bilateral herniorrhaphy and was treated with peritoneal dialysis for 2 weeks. After 4 days of peritoneal dialysis, general conditions and symptoms were improved, but anuria persisted for 2 weeks. We performed IVP and abdominal CT. Both studies showed abnormal dye accumulation in peritoneal cavity. Ureteroneocystostomy on right and segmental resection of ureter and end to end anastomosis of left ureter were done without any complications. He has been doing well and has had normal kidney function. Therefore we report a case of acute renal failure due to bilateral ureter injuries after both inguinal herniorrhaphy with a brief review of literatures.
Acute Kidney Injury* ; Anuria ; Edema ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Infant ; Kidney ; Male ; Peritoneal Cavity ; Peritoneal Dialysis ; Tomography, X-Ray Computed ; Ureter*

Congenital nephrotic syndrome(CNS) is a rare disease defined by nephrotic syndrome at birth or within the 1st year of life. This study is performed to investigate a classification based on clinicopathology and to evaluate the clinical course and prognosis according to types of CNS. We performed retrospective clinical study with chart review in 8 patients who were diagnosed as CNS from 1980 to 1995. The results were as follows: Their ages at the onset of illness ranged from birth to 7 months (median 2.2 months) and there were 7 males and 1 female. There were proteinuria, hypoalbuminemia and edema in all cases, accompanied with ascites(7cases), hematuria(5cases), hepatosplenomegaly(2cases), umbilical hernia(1case) and inguinal hernia(1case). A classification of these based on clinicopathology showed CNS of Finnish type in 2 patients, congenital syphilitic nephrotic syndrome in 2, mesangial glomerulosclerosis, minimal change disease, Drash syndrome and undefined CNS in 1 each. Of the 8 patients with CNS, 3 died of sepsis and renal failure, 1 responded to steroid and cyclosporin therapy and is alive at 20 months, 1 responded to penicillin, 1 discharged voluntarily, and 2 were lost to follow-up. In conclusion, it had been considered that all forms of CNS except the secondary ones have a very poor prognosis. But if the appropriate management including early renal transplantation is established under the definite diagnosis which is based on clinicopathology, we can expect long term survival, normal growth and development for the child of CNS.
Child ; Classification ; Cyclosporine ; Denys-Drash Syndrome ; Diagnosis ; Edema ; Female ; Growth and Development ; Humans ; Hypoalbuminemia ; Kidney Transplantation ; Lost to Follow-Up ; Male ; Nephrosis, Lipoid ; Nephrotic Syndrome* ; Parturition ; Penicillins ; Prognosis ; Proteinuria ; Rare Diseases ; Renal Insufficiency ; Retrospective Studies ; Sepsis