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

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

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

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

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*

Membranous glomerulopathy (MGN) is a common cause of nephrotic syndrome in adults. Renal failure gradually develops in patients with MGN and crescentic glomerulonephritis (CGN) superimposed on MGN is a rare cause of acute renal failure. In most cases patients showed nephrotic syndrome with acute renal failure. We report a 33-year-old woman with azotemia but with no other symptoms such as nephrotic syndrome she had been diagnosed to have MGN 15 months before. There seemed to be no other cause of azotemia. Renal biopsy was performed and revealed CGN on existing MGN. She was treated with immunosuppression treatment and azotemia was improved. When unexplained azotemia develops in patients with MGN, we should promptly investigate superimposed conditions including CGN. In CGN superimposed on MN, a potentially reversible condition with appropriate immunosuppression therapy should be considered.
Acute Kidney Injury ; Adult ; Azotemia ; Biopsy ; Female ; Glomerulonephritis ; Glomerulonephritis, Membranous ; Humans ; Immunosuppression ; Nephrotic Syndrome ; Renal Insufficiency

Cockcroft and Gault's formula is frequently used to estimate creatinine (Ccr) in clinical practice. To determine the accuracy of such estimation in Korean patients, we measured simultaneously, serum creatinine and 24-hour urinary creatinine excretion in 696 Korean patients (male:350, female:346). Measured Ccr was significantly different from estimated Ccr in several age groups and the decrease of creatinine excretion with age is less than Cockcroft and Gault's estimation. We assumed that this difference can be due to difference of the body habitus and difference of urinary creatinine excretion per body weight between different races. So we divided the sample population into two groups and derived the new formula in one group with regression analysis between age and 24 hour urinary creatinine excretion per body weight for estimation of Ccr as Cockcroft and Gault derived their formula and applied it to another group to compare the new formula with Cockcroft and Gault's formula in Korean patients. The new formula was Ccr (mL/min)=[ (260-age)x weight (kg)]/[160 x serumCr (mg/dL)] for male and Ccr (mL/min)-[ (236-age) x weight (kg)]/[180 x serum Cr (mg/dL)] for female. Predictive accuracy of the new formula was significantly better than the Cockcroft and Gault's formula in the other sample population and also in subgroup of the patients with azotemia.
Azotemia ; Body Weight ; Continental Population Groups ; Creatinine* ; Female ; Glomerular Filtration Rate ; Humans ; Male

50 cases of B.P.H. admitted during the period from Jan. 1970 to Jul. 1977 were studied clinically in the Department of Urology National Medical Center and following results were obtained. 1. During the period, 1,235 patients hospitalized, there were 50 cases of B.P.H.. giving a rate of 4%. Among 251 male cases of 50 years or men, there were 50 cases of B.P.H. with a rate of 19.9 %. 2. The youngest age was 51 and the oldest 83. The average age of 50 cases was 70.9 years. 3. The average duration of symptom was 30.9 months. The presenting symptom in 22 case (44%) was acute retention, 2 case(4%) was chronic retention and 28 cases(52%) was dysuria. 4. Pyuria revealed in 18 cases (36%). Hemsturis in 24 cases(48%). Azotemia in 15 cases(30%). 5. Comparative analysis was made among suprapubic prostatectomy and retropubic prostatectomy and T.U.R. on operation time, transfusion rate, days of urethral catheter drainage, days of postoperative hospital dischange and complications. Slight superior results were obtained in retropubic prostatectomy group compared to suprapubic prostatectomy group. 6. Average weight of the removed prostate was 37 gm. Occult Carcinoma was found in 4 cases (10 %) 7. The analysis of correlation between age and postoperative dischange yielded no significance in this study.
Azotemia ; Drainage ; Dysuria ; Humans ; Male ; Prostate ; Prostatectomy ; Prostatic Hyperplasia* ; Pyuria ; Urinary Catheters ; Urology

Although the opacification of the excretory nephrogram is visible on the routine intravenous urogram as well as the image of renal collecting system, the attention of the urologists and radiologists was not paid to its diagnostic value until last several years. The author has been studied on the diagnosis of so-called non-visualizing kidney utilizing the antegrade pyelography and 203Hg renal scanning with successful results. As an another diagnostic armamentarium on this field, the author came to notice the practicability of excretion nephrogram, as it outlines functioning renal parenchymal mass radiologically, even in the absence of a later pyelogram. In this paper, the author observed the opacification ratio of excretion nephrogram on the normal subjects and patients with renal disease and studied the relationship between the opacification of excretion nephrogram and degree of azotemia and blood pressure in renal failure together with the technical problems influencing the opacification. One hundred of normal subjects and 459 patients with renal disease are included in this study The results are as follows. 1. In normal subjects, the opacification ratio of excretion nephrogram is 71.78 and 77% in 5.15 and 30 minute film, respectively. 2. In the group with renal diseases, the opacification ratio of excretion nephrogram is similar to that of normal ones in most instances, while there is some fluctuations particularly in serious renal diseases. 3. Marked reduction of opacification ratio of excretion nephrogram is noticed in groups with renal failure showing more than 120 mg % of NPN, 100 mg% of BUN and 10 mg% of creatinine, as well as showing hypertension and less than 7.5gram of Hb than in groups with less azotemic, less anemic and normotensive state. 4. Excellent opacification of excretion nephrogram is found on 15 min. film while less clearly on 30 min. film and poorly on 5 min. film. 5. It is suggested that the careful intestinal lavage and large dose of x-ray medium are essential to obtain a highly opacified excretion nephrogram.
Azotemia ; Blood Pressure ; Creatinine ; Diagnosis ; Humans ; Hypertension ; Kidney ; Renal Insufficiency ; Therapeutic Irrigation ; Urography