Cyclosporine can cause remission of 60% in steroid resistant FSGS, but its responses are variable. Now we report two cases of steroid resistant FSGS who are maintaining remission using cyclosporine continuous therapy. The first patient had been failed several times of steroid therapy, had edema, azotemia and severe proteinuria. We used steroid pulse therapy then maintenance dose of oral cyclosporine to reduce proteinuria for more than 6 years. He has been received cyclosporine therapy up to now and maintaining normal renal function. The second patient had severe azotemia who needed hemodialysis but after cyclosporine therapy, he recovered his renal funciton. The findings of renal biopsies in one patient after 6 years of cyclosporine therapy revealed that there was no improvement of sclerosing glomeruli, then we guess that maintenance therapy of cyclosporine might need for lifelong period.
Azotemia ; Biopsy ; Cyclosporine* ; Edema ; Humans ; Proteinuria ; Renal Dialysis

BACKGROUND: Quinolone antibiotics are now frequently used for the empirical therapy of acute pyelonephritis (APN). However, failure of this empirical therapy is often encountered in clinical practice, and the emergence of quinolone resistance should be concerned. This study was undertaken to investigate the prevalence of quinolone resistance in community-acquired APN and to analyze the clinical characteristics of quinolone-resistant APN. METHODS: Clinical data were retrospectively analyzed from 367 patients who were admitted to Hanyang University Hospital for APN from January 2002 through December 2004. According to the result of urine culture, the patients were divided into quinolone-susceptible and quinolone-resistant groups, and clinical characteristics were compared. RESULTS: Urine culture was positive in 241 out of 367 patients, and E. coli was the most common (90%) isolate. The prevalence of quinolone resistance based on the in vitro ciprofloxacin susceptibility test was found to be 19.5%, and among the E. coli isolates the prevalence of quinolone resistance was 19.8 %. 91 patients had underlying diseases and they were more frequently complicated by urosepsis. The ages and the prevalence of azotemia were not significantly different between two groups. Quinolone-resistant group had a lesser frequency of urosepsis compared with quinolone-susceptible group. Diabetic patients were more frequently quinolone-susceptible than quinolone-resistant. CONCLUSION: Although the prevalence of quinolone resistance is rather high in community-acquired APN based on the in vitro susceptibility test, the choice of quinolone antibiotics seems to be valid for the empirical therapy.
Anti-Bacterial Agents ; Azotemia ; Ciprofloxacin ; Humans ; Prevalence ; Pyelonephritis* ; Retrospective Studies

Augmentation cystoplasty using bowel is effective method for the functional enlargement of bladder capacity in contracted bladder due to various causes. Prevention of vesicoureteral reflux after augmentation cystoplasty is still controversial but generally accepted that prevention of reflux is essential for good long term result. Therefore, antireflux augmentation cystoplasty including the use of ileocecal valve and hemi-Kock intussuscepted ileal nipple valve has been used recently for this purpose. Herein, we report the result of 3 cases of ileocecal cystoplasty and 6 cases of hemi-Kock ileocystoplasty. Hemi-Kock ileocystoplasty is better than ileocecal cystoplasty in a viewpoint of reflux prevention and continence, but complication is more common and serious in hemi-Kock ileocystoplasty than ileocecal cystoplasty. It is considered that azotemia is not contraindication for these procedures, and renal function deterioration has not been observed postoperatively.
Azotemia ; Ileocecal Valve ; Nipples ; Urinary Bladder ; Vesico-Ureteral Reflux

Renal involvement is one of the extra-articular manifestations found in patients with rheumatoid arthritis (RA). Membranous glomerulonephopathy, membranoproliferative glomeruonophritis, secondary amyloidosis, and focal segmental glomerulosclerosis are reported as pathologic diagnoses of renal involvement. However, reports of renal involvement in patients with RA and antineutrophil cytoplasmic autoantibody (ANCA)-associated pauci-immune glomerulonephritis are rare. Recently, we experienced two patients with RA who developed azotemia and were finally diagnosed with ANCA-associated pauci-immune glomerulonephritis. Because of the rarity of these cases, we report two cases in patients with RA with a literature review.
Amyloidosis ; Arthritis, Rheumatoid ; Azotemia ; Cytoplasm ; Glomerulonephritis ; Glomerulosclerosis, Focal Segmental ; Humans

PURPOSE: Previously positive but currently negative HLA crossmatching is considered to be a risk factor not in the first renal transplantation but in the second renal transplantation. The aim of this study is to analyse the outcome of living-related renal transplantation with previously positive but currently negative HLA crossmatching. METHODS: The results of first HLA crossmatching, demographic characteristics, the outcome of renal trasplantation were examined in four patients undergoing renal transplantation with previously positive but currently negative HLA crossmatching. RESULTS: The acute rejection was occurred in 3 patients. Azotemia was improved with the immunosuppressive therapy containing tacrolimus. There were no graft failures in four patients for 1 year. In the first HLA crossmatching, anti-human globulin T cell HLA crossmatching was positive in all patients with acute rejection. The period that positive HLA crossmatchings were converted to negative was longer in patients with acute rejections than without acute rejections (177 days vs 22 days). CONCLUSION: There were 3 acute rejections in 6 patients undergoing living related renal transplantations with previously positive and current negative HLA crossmatching. There were no graft failure for 1 year.
Azotemia ; Humans ; Kidney Transplantation* ; Risk Factors ; Tacrolimus ; Transplants

BACKGROUND: Urine/serum protein electrophoresis (PEP) and immunofixation electrophoresis (IEP) for monoclonal protein (M-protein) are used for initial evaluation in patients with multiple myeloma. We evaluated the prognostic significance of M-proteinuria status and its association with other prognostic factors. METHODS: Between December 2002 and December 2004, 64 de novo symptomatic multiple myeloma patients with intact immunoglobulin (Ig) type were divided into two groups according to their initial urine PEP/IEP findings. RESULTS: Twenty-seven patients with undetectable or free light-chains only were classified into F group, and 37 with whole Ig with or without light-chains were classified into W group. The two groups were similar in sex, age, performance, azotemia, beta2-microglobulin, stage and treatment, but M-protein concentration was significantly higher in the W than in F group (5.1 vs 1.3g/dL, P<0.01). The overall response rate was significantly higher in F group than in W group (80.8% vs 63.6%, P=0.02), whereas the 2-year OS rate did not differ significantly between the groups (81.0% vs 57.7%, P=0.15). CONCLUSION: Monoclonal proteinuria is helpful in identifying patients with advanced disease and poorer prognosis in multiple myeloma.
Azotemia ; Electrophoresis ; Humans ; Immunoglobulins* ; Multiple Myeloma* ; Prognosis ; Proteinuria*

PURPOSE: Percutaneous renal biopsy in children with primary nephrotic syndrome(NS) contributed to establish the renal pathology and clinicopathological correlation. The most common minimal change lesion(MCL) was steroid sensitive and could be predicted by clinical and laboratory findings. It was uniformly agreed that most nephrotic children who were predicted as MCL, should receive an 8 week course of prednisolone before considering renal biopsy. Early indications of renal biopsy has been those nephrotic children with the age below 1 year and above 8 years, hypertension, hematuria, low serum C3, renal insufficiency which are not compatible with MCL. Late indications has been frequent relapser(FR), steroid dependent(SDNS) and steroid resistant nephrotic syndrome(SRNS). The indications have been challenging recently and we tried to evaluate the commonly recommended indications. METHODS: Clinical, laboratory, pathologic findings and therapeutic responses were compared in 81 children with primary nephrotic syndrome who had renal biopses beteen 1984 and 1996. RESULTS: 1) Among 11 children with the age indication, MCLs were diagosed in 9(81.8%), mesangial proliferative glomerulonephritis(MsPGN) in 1(9.1%) and membranous nephropathy(MGN) in 1(9.1%). 2) Among 4 children with microscopic hematuria, MCLs were diagosed in 3(75.0%), MsPGN in 1(25.01%). In 13 children with hypertension, macrohematuria, azotemia and low serum C3, focal segmental glomerulosclerosis(FSGS), membrano-proliferative glomerulonephritis(MPGN) and IgA nephropathy(IgA) were frequently diagnosed instead of MCL. 3) All 5(100%) frequent relapsers were diagnosed as MCLS Among 30 children with the indication of SDNS, MCLs were diagosed in 28(93.3%), MsPGN in 2(6.7%) 4) Among 18 children with the indication of SRNS, MCLs were diagosed in 6(33.3%), MsPGN in 6(33.3%), FSGS in 6(33.3%) 5) The probability to diagnose MCL was 81.8%(9/11) in age indication, 75.0%(3/4) in microscopic hematuria, 100%(5/5) in FR and 93.3%(28/30) in SDNS. 6) The response rate to standard steroid treatment were 81.8%(9/11) in age indication 75.0%(3/4) in microscopic hematuria, 100%(5/5) in FR and 96.7%(29/30) in SDNS. CONCLUSIONS: Among the commmon indications of renal biopsy in children with primary nephrotic syndrome, age, microscopic hematuria, frequent relapser and steroid dependant should be reevauated to reduce the unnecessary renal biopsy.
Azotemia ; Biopsy* ; Child* ; Hematuria ; Humans ; Hypertension ; Immunoglobulin A ; Nephrotic Syndrome* ; Pathology ; Prednisolone ; Renal Insufficiency

To know the prevalence of the diabetes mellitus and associated diseases, we analyzed the date of the 3,088 subjects who were examined with the Computed Automated Medi-Screening Test System which consisted of 65 parameters including blood glucose determination fasting and one hour after 100 g of oral glucose load. We grouped the subjects by the modified criteria of National Diabetic Data Group. Followings are the results of the various analysis: 1. The prevalence of diabetes mellitus and impaired glucose tolerance in 2.27% and 18.26% respectively. 2. The prevalence of diabetes mellitus is 2.63% in male and 1.66% in female. There is no statistically significant difference between male and female. 3. There in tendency of increasing prevalence of diabetes mellitus as the age increases. From second to eighth decade, the prevalence of diabetes mellitus increases as 0.0, 0.45, 0.67, 2.28, 3.47, 5.36, 10.00% respectively. 4. There is no statistically significant difference of prevalence of obesity between normal and diabetes: that is, 18.03%, 22.86% respectively (P≥0.1). 5. There is no statistically significant difference of prevalence of impaired glucose tolerance and diabetes between non-obese and obses group (P≥0.1). 6. There is statistically significant increases of frequency of proteinuria, azotemia, hypertension as the glucose tolerance decreases (P≤0.05).
Azotemia ; Blood Glucose ; Diabetes Mellitus* ; Fasting ; Female ; Glucose ; Humans ; Hypertension ; Male ; Obesity ; Prevalence* ; Proteinuria

Renal angiomyolipoma is a rare benign tumor and often associated with tuberous sclerosis. During the last 11 years 6 patients with renal angiomyolipoma were managed at Seoul National University Hospital. One patient with known tuberous sclerosis had bilateral tumors which were multiple and massive as well as extrarenal lesions. Five other patients had unilateral tumor. Two most common presentations were flank or abdominal pain and palpable renal mass but hematuria appeared in only two patients. In four patients preoperative diagnosis were possible and two of them were managed successfully with selective renal arterial embolization. Three patients are free of disease for 3 to 6 years after nephrectomy and one patient is free of symptoms for 7 months following selective renal arterial embolization. One patient is alive with mild azotemia after nephrectomy followed by embolization. One patient died of acute fulminate hepatitis on postoperative 19th day after nephrectomy.
Abdominal Pain ; Angiomyolipoma* ; Azotemia ; Diagnosis ; Hematuria ; Hepatitis ; Humans ; Nephrectomy ; Seoul ; Tuberous Sclerosis

BACKGROUND/AIMS: Acute pyelonephritis (APN) can involve a single kidney or both kidneys. The aim of this study was to define the clinical characteristics of unilateral and bilateral APN and compare their differences in acute kidney injury (AKI). METHODS: This was a retrospective study of patients admitted to Konyang University Hospital from January, 2006 to December, 2010 with APN diagnosed by the presence of definitive APN lesions on abdominal CT. Patients with a history of renal disease or anatomical predisposing factors were excluded. The patients were divided into two groups: unilateral and bilateral APN. BUN, creatinine, MDRD eGFR, and FENa were evaluated. RESULTS: Of the 177 patients, 130 had unilateral APN and 47 had bilateral APN. Significant differences were noticed in BUN, creatinine, and MDRD eGFR between the two groups. According to RIFLE criteria, 51 patients were at "risk" and six were in "failure." Compared with unilateral APN, bilateral APN patients had lower eGFR (65.2 vs. 61.7, p = 0.042) and higher FENa (0.81 vs. 1.43, p = 0.04), and "failure" was more frequent (4 vs. 2, p = 0.044). CONCLUSIONS: Our study showed a significant correlation between bilateral APN and decreased renal function. AKI in bilateral APN was more likely than AKI in unilateral APN to result in severe renal dysfunction. The pathophysiology of AKI may differ between unilateral and bilateral APN.
Acute Kidney Injury ; Azotemia ; Creatinine ; Glomerular Filtration Rate ; Humans ; Kidney ; Pyelonephritis ; Retrospective Studies