Background: Contrast-induced nephropathy (CIN) is a complication that occurs in patients undergoing an imaging procedure with intravenous injection of contrast media, most notably iodinated dyes. Fluorescein angiography is a diagnostic procedure performed by ophthalmologists to determine abnormalities in retinal blood vessels. It uses sodium fluorescein, an organic dye, to capture and visualize these blood vessels. There have been conflicting data and practices on how to approach the procedure especially in patients with renal insufficiency. Objective: To determine the risk of CIN among patients undergoing fluorescein angiography. Methods: We searched PubMed, HerdIn, Cochrane Library, and Google Scholar, for published articles on the topic. Other sources were searched for unpublished data or ongoing clinical trials. All research articles pertaining to fluorescein angiography and its effect on renal function with serum creatinine monitoring were included. Two independent authors separately screened records, assessed full texts, and extracted data. We used RevMan computer software to analyze data from the included studies. The primary outcome was the risk of CIN among patients undergoing fluorescein angiography based on the differences on serum creatinine levels and estimated glomerular filtration rates pre- and post-angiography, while the secondary outcome included risk factors for CIN. Results: A total of 6 studies were included in the meta-analysis. Four studies had poor quality as assessed using the Newcastle-Ottawa Scale. One study was deemed to have good quality. Data analysis showed that hemoglobin (p = 0.002) and albumin (p < 0.001) levels may be associated with CIN using sodium fluorescein but were not independent risk factors for CIN (multivariable logistic regression, p = 0.648 and p = 0.069, respectively); while sex, diabetes mellitus and chronic kidney disease were not significantly associated. As a primary outcome, only 6.8% of included patients had CIN with serum creatinine levels post-exposure showed significant differences from baseline values (mean difference 0.05; 95% CI 0.02, 0.07; I2 = 49%), but translating it to eGFR yielded non-significant differences (mean difference -0.37; 95% CI -2.33, 1.59; I2 = 0%). Conclusion Among patients undergoing fluorescein angiography, sodium fluorescein does not pose an increased risk for CIN.
fluorescein angiography ; renal function

To investigate long term effects of CAPD on the left ventricular function in end-stage renal disease patients, M-mode echocardiographic studies and measurement o fsystolic time intervals were performed in 20 CAPD cases, 28 hemodialysis cases and 29 uremic controls. Compared to the uremic control grup, the patients on CAPD treatment revealed significant improvement of ventricular contractility and reduction of volume. On the other hand in hemodialysis group, even though there was improvement of ventricular contractility, volume control was not adequate. In the systolic time interval measurement, it is postulated that increase of PEP/LVET ratio in CAPD group probably results from reduction of volume(preload) rather than from deranged ventricular function.
Echocardiography ; Hand ; Humans ; Kidney Failure, Chronic* ; Peritoneal Dialysis, Continuous Ambulatory* ; Renal Dialysis* ; Systole ; Ventricular Function ; Ventricular Function, Left

Renal function may be adversely effected by the renal vein ligation. However, because of a rich collateral circulation, the left kidney may continue to function after renal vein ligation. This study was made to investigate the renal function recovery after the renal vein ligation in dogs. Excretory urogram and selective left renal venogram were performed before ligation, and on 1st, 2nd, 3rd and 6th week after renal vein ligation. Gross and microscopic studies were also done. The experimental results were as follows ; 1. In excretory urogram, there was non-visualization of the left kidney on 1st and 3rd week, and decreased opacity on 2nd and 6th week in complete ligation group and decreased opacity was seen on 1st week and normal appearance was found from 2nd week in the partial ligation than in the complete group. 2. In selective left renal venogram, three collateral veins were observed. The capsular and unknown vein were appeared by the 2nd week in the complete group, the capsular vein only by the 2nd week in partial group, and the ureteric vein by the 3rd week in partial ligation group only. By the 6th week capsular and ureteric vein were observed in the complete and partial group. 3. In morphologic studies, maximum increase in size of the kidney was observed by the 1st week in the complete and partial group. By the 6th week the kidney underwent an atrophic change in the complete group, but returned to normal in the partial group. 4. In conclusion, the recovery of renal function is depended on the formation of the collateral circulation which is influenced by the site and degree of renal vein ligation.
Animals ; Collateral Circulation ; Dogs* ; Kidney ; Ligation* ; Recovery of Function ; Renal Veins* ; Ureter ; Veins

BACKGROUND: The aim of this study was to characterize the nature and elucidate the pathogenesis of hemodialysis ascites(HA), especially with regard to the levels of Serum Ascites Albumin radient(SAAG) and the degrees of hemodialysis adequacy(Kt/Vurea). METHODS: In the study group, seven cases of HA which had developed in 6 patients from Feb. 1997 through July 1998 were included. In the control group, 24 cases which had not developed HA were included. The study design was a retrospective. Analysis of ascites on WBC, total protein and albumin, cytology, ADA(Adenosine deaminase), osmolality, SAAG and routine work-up were performed in HA group. Serum total protein and albumin, C-reactive protein(CRP), osmolality, and routine liver function test were also checked. Kt/Vurea and weekly Kt/Vurea were calculated in both group. In statistical analyses, t-test and chi-square test were used. RESULTS: Mean SAAG of HA was >1.1(1.49+/-0.40) gm/dL, and mean concentration of total protein of HA was >2.5(4.26+/-0.58) gm/dL. The mean of weekly Kt/Vurea of patients with HA(2.61+/-0.85) was significantly lower than that of patients without HA(3.48+/-0.90)(p<0.05). Positive ratio of CRP in patients with HA was higher than that of patients without HA(p<0.05). Mean concentration of serum total protein was significantly higher in patients with HA than that of patients without HA but with comparable weekly Kt/Vurea levels(p<0.05). CONCLUSION: It is regarded that the nature of HA is an exudate having high SAAG over 1.1 gm/dL. Low weekly Kt/Vurea is suggested as a cause of HA. Chronic inflammation was also regarded as an important factor causing HA.
Ascites* ; Exudates and Transudates ; Humans ; Inflammation ; Liver Function Tests ; Osmolar Concentration ; Renal Dialysis ; Retrospective Studies ; Urea*

INTRODUCTION: Contrast-induced nephropathy (CIN) is a serious but preventable complication of coronary procedures. Trimetazidine (TMZ) has recently been explored for use in preventing post-procedural CIN due to its cellular anti-ischemic and antioxidant properties. The objective is to assess the efficacy of oral TMZ in the prevention of contrast induced nephropathy during elective coronary angiography and PCI among patients with renal impairment.

METHODS: We conducted a systematic search of the Cochrane Central Register of Controlled Trials, Pubmed/ MEDLINE, EMBASE, clinicaltrials.gov for articles published until June 2016 for randomized controlled trials examining the effects of adding oral TMZ to standard therapy in preventing CIN. Outcome measures were incidence of CIN, defined as a 0.5 mg/dl or ?25% increase in serum creatinine 48-72 hours after contrast exposure, and incidence of dialysisrequiring CIN. Validity of studies was assessed through a risk assessment tool available from Cochrane. Treatment effect was estimated by calculating the Mantel-Haenszelweighted risk ratio (RR) using a fixed-effects model available from RevMan 5.3.

RESULTS: A total of four studies comprising 714 patients (TMZ group=352, Control group=362) were included in the final analysis. Pooled results revealed the TMZ group was associated with significantly fewer incidences of CIN compared to control (RR 0.33, 95% confidence interval [CI], 0.20, 0.53; P<.00001), with a relative risk reduction of 67% and an absolute risk reduction of 11.04% (NNT=nine). No dialysis-requiring CIN was observed in the included studies.

CONCLUSION: The addition of oral TMZ to standard hydration confers a significant benefit in preventing CIN after coronary procedures among patients with mild to moderate renal impairment. We recommend the addition of TMZ to standard prevention strategies. However, a large well-designed trial should be conducted to determine its effect on other outcomes such as prevention of dialysis-requiring CIN and mortality. 

Human ; Trimetazidine ; Coronary Angiography ; Medline ; Creatinine ; Pubmed ; Risk Assessment ; Renal Insufficiency ; Kidney Function Tests

OBJECTIVETo investigate the etiology and therapy of delayed graft function (DGF) recovery in renal transplant recipients.

METHODSThe clinical data were retrospectively analyzed in 15 renal recipients with DGF. All the 15 patients received hemodialysis along with pulse treatment against acute rejection (AR), or immunosuppressant adjustment, or in situ retransplantation after the resection of the original transplanted kidney according to different etiological factors.

RESULTSAmong the 15 patients, 8 developed AR, 5 showed acute renal tubular necrosis (ATN), 1 had grafting-associated renal vein embolism and 1 had acute cyclosporine nephrotoxication. The renal function recovered within 10 to 35 days after transplantation without complication during the follow-up period (0.5-3.0 years).

CONCLUSIONDGF is a common complication after kidney transplantation mainly due to the occurrence of AR and ATN. Good prognosis is expected if etiology-oriented therapy is performed properly and promptly.

Adult ; Delayed Graft Function ; physiopathology ; therapy ; Female ; Graft Rejection ; physiopathology ; therapy ; Graft Survival ; Humans ; Immunosuppressive Agents ; therapeutic use ; Kidney Transplantation ; Male ; Recovery of Function ; Renal Dialysis ; Retrospective Studies

BACKGROUND: The worldwide standard of renal replacement therapy for acute renal failure patients is intermittent hemodialysis (IHD). Continuous renal replacement therapy (CRRT) has recently emerged as an alternative modality. We performed the study to find the effects of renal replacement therapy on outcome of the acute renal failure patients in the ICU. METHODS: 373 adult patients under the diagnosis of acute renal failure (ARF) in the ICUs (medical-surgical and coronary care unit) at Severance Hospital Yonsei University College of Medicine between January 1, 1998 and July 31, 2002 were included. Patients with ARF were divided into two groups depending on their need for renal replacement therapy. Renal replacement therapy group was subdivided into IHD and CRRT group. RESULTS: There was significant difference in the mortality between renal replacement group and non-renal replacement group, 74.4% vs. 45.2% (P < 0.001). Renal function recovery rate of renal replacement group was lower compared to that of non-renal replacement group, 36 % vs. 59% (P < 0.001). APACHE II score, ventilator support, vasopressors, number of organ failure, and oliguria during RRT were higher in CRRT group than in IHD group (P < 0.001). CRRT group was associated with higher mortality rate, CRRT 86.2% vs. IHD 42.2% and lower renal function recovery rate, CRRT 9.8% vs. IHD 63.0% (P < 0.001). CONCLUSIONS: Although the result of this study implies that IHD is associated with better survival and better renal recovery, the preferred use of CRRT in severely ill patients with an unstable circulatory system must be reminded.
Acute Kidney Injury* ; Adult ; APACHE ; Diagnosis ; Humans ; Intensive Care Units ; Mortality ; Oliguria ; Recovery of Function ; Renal Dialysis ; Renal Replacement Therapy* ; Ventilators, Mechanical

Classic distal renal tubular acidosis(type 1 RTA) is a hypokalemic, hyperchloremic metabolic acidosis due to selective defect in distal acidification. Type 1 RTA may be associated with genetic(usually autosomal dominant) or autoimmune disease, drugs and toxin and various tubulointerstitial diseases. This case report describes a 27 year-old female patient with distal RTA, Sjogren' s syndrome and Graves' disease the first case. She had been suffered from muscle weakness and peripheral numbness and was found to have low serum potassium(1.6mEq/L). She was revealed to have 1) distal RTA by NaHCO3 loading test 2) Sjogren' s syndrome by Schirmer' s test and palate biopsy and 3) Graves' disease by exophthalmometry and autoantibody test, thyroid function test. This is the first case as far as I search that report the association of distal RTA, Sjogren' s syndrome, and Graves' disease caused by autoimmune mechanism.
Acidosis ; Acidosis, Renal Tubular* ; Adult ; Autoimmune Diseases ; Biopsy ; Female ; Graves Disease* ; Humans ; Hypesthesia ; Muscle Weakness ; Palate ; Thyroid Function Tests

The risk of development of hypoglycemia increases during glycemic control in end-stage renal disease (ESRD) patients. We report the case that an ESRD patient on maintenance hemodialysis has experienced sustained hypoglycemia with a nateglinide. A 73-year old male ESRD patient on hemodialysis was admitted with exertional dyspnea and increased liver function test. On the 4th day after admission, he had mental change with his blood glucose level of 41 mg/dL. His mental state improved promptly after intravenous injection of 25 g of glucose. To prevent rebound hypoglycemia 10% glucose solution was continuously infused and nateglinide was discarded. However, he has had recurrent hypoglycemic attacks until the 6th day after admission, and thereafter there was no further hypoglycemic attack. On the 5th day of admission, when there was second hypoglycemic attack, the fasting insulin level was 31.62 U/mL, indicating that hypoglycemia was accompanied by insulin hypersecretion. In conclusion, we suggest that nateglinide may provoke a severe and sustained hypoglycemia in an ESRD patient on maintenance hemodialysis and its use might be avoided.
Aged ; Blood Glucose ; Dyspnea ; Fasting ; Glucose ; Humans ; Hypoglycemia* ; Injections, Intravenous ; Insulin ; Kidney Failure, Chronic ; Liver Function Tests ; Male ; Renal Dialysis*

BACKGROUND AND OBJECTIVES: The speckle tracking method using 2-dimensional (2D) echocardiography is not affected by the tethering of neighboring segments and angulation. Global circumferential strain (GCS) of the left ventricle (LV) has been suggested as a systolic index and correlated with LV contractility. The purpose of this study was to investigate whether acute changes in preload affect global circumferential strain and to evaluate the usefulness of GCS by the speckle tracking method. SUBJECTS AND METHODS: 2D echocardiography was performed in 69 patients with end-stage renal disease before and after hemodialysis to measure the LV end-diastolic volume and LV ejection fraction. 2D images were acquired from the short-axis view of the mid-LV for the evaluation of GCS. RESULTS: Mean LV end-diastolic volume significantly decreased from 91.2+/-33.3 mL to 72.3+/-32.0 mL (p+/-0.05), and LV ejection fraction decreased from 63.6+/-13.1% to 60.0+/-11.2% (p=0.006) after hemodialysis. However, mean GCS showed no significant change after hemodialysis (17.2+/-5.3% vs. 16.6+/-4.7%, p=0.13). GCS was found to be well correlated with LV ejection fraction (r=0.54, p<0.05) and peak systolic mitral annular velocity (r=0.46, p=0.000), but not with LV preload (r=0.06, p=0.622). CONCLUSION: GCS using the speckle tracking method is a useful index for the evaluation of LV systolic function because it is not affected by acute preload change and is correlated with LV ejection fraction and peak systolic mitral annular velocity.
Echocardiography ; Heart Ventricles ; Humans ; Kidney Failure, Chronic ; Renal Dialysis ; Sprains and Strains ; Stroke Volume ; Track and Field ; Ventricular Function, Left