Viral infections can be causative in many glomerular disease, and human immunodeficiency virus (HIV) infection is closely related to a collapsing focal segmental glomerulosclerosis (FSGS). This is known as HIV associated nephropathy (HIVAN) and is characterized clinically by proteinuria, often of sudden onset, with rapidly progressive renal dysfunction resulting in end stage renal disease (ESRD) over several months. Increasingly, other primary renal diseases are being described in HIV infected patients, including IgA nephropathy, an immune complex lupus-like neprhopathy, and tubulonephritis. We observed rare HIVAN case presenting membranous glomerulonephritis with nephrotic syndrome in a woman who was positive for HIV without hepatitis B viral infection. She was treated with Methylprednisolone 60 mg/day, zidovudine 600 mg/day, efavirenz 60 mg/day, and lamivudine 300 mg/day for 5 months. After treatment, proteinuria decreased from 4,092 mg/day to 419 mg/day and CD4 T cell count rose from 594/mL to 1,176/mL. The effectiveness and safety of corticosteroids in the treatment of HIVAN remained controversial but this case showed good response for steroid with triple antiviral therapy about HIVAN especially membranous glomerulonephritis.
Adrenal Cortex Hormones ; AIDS-Associated Nephropathy ; Antigen-Antibody Complex ; Cell Count ; Female ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranous* ; Glomerulosclerosis, Focal Segmental ; Hepatitis B ; HIV Infections* ; HIV* ; Humans ; Kidney Failure, Chronic ; Lamivudine ; Methylprednisolone ; Nephrotic Syndrome ; Proteinuria ; Zidovudine

Renal failure due to nephrocalcinosis after large-bowel cleansing with sodium phosphate preparations before endoscopic procedures is an easily overlooked diagnosis. While it has been reported that acute renal failure can result from the use of oral sodium phosphate preparations, chronic renal failure has not yet been reported. We report a case of chronic renal failure due to oral sodium phosphate, in which a kidney biopsy was performed.
Acute Kidney Injury ; Biopsy ; Cathartics ; Kidney ; Kidney Failure, Chronic ; Nephrocalcinosis ; Phosphates ; Renal Insufficiency ; Sodium

BACKGROUND/AIMS: Coagulopathy is a common complication of snakebite, but there is little information on the clinical importance of coagulopathy. We analyzed the characteristics of coagulopathy after envenomation. METHODS: Ninety-eight patients who experienced snakebite were enrolled in this study. We divided all the patients into three groups by the ISTH DIC scoring system: the normal, simple coagulopathy and DIC groups. The coagulopathy group included both the simple coagulopathy and DIC groups. We then conducted a case-control study. RESULTS: There was a significant decrease in the Hct, protein, albumin, ALP and cholesterol levels in the coagulopathy group, and only the cholesterol level was deceased in the DIC group (p<0.05). Leukocytosis and rhabdomyolysis were significantly associated with coagulopathy, and hemolysis and rhabdomyolysis were associated with DIC (p<0.05). The presence of rhabdomyolysis was considered a risk factor for coagulopathy (p<0.05). These conditions continued for up to six to seven days after the snakebite. CONCLUSIONS: Evaluation of coagulopathy with using these characteristics is helpful to properly manage the patients who experience snakebite.
Animals ; Blood Coagulation Disorders/*etiology ; Case-Control Studies ; Female ; Hemolysis/drug effects ; Humans ; Incidence ; Leukocytosis/etiology ; Male ; Retrospective Studies ; Rhabdomyolysis/etiology ; Risk Factors ; Snake Bites/*complications

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal disorder of the hematopoietic stem cells characterized by chronic intravascular hemolysis, venous thrombosis, deficient hematopoiesis. Kidney involvement is usually benign and secondary to chronic deposition of hemosiderin. However, acute kidney injury may rarely occur in association with a hemolytic crisis or thrombotic complication. Hemolytic crisis is precipitated by nonspecific factors, such as infection, surgery and transfusion. A 35-year-old woman, who developed hemolytic crisis and acute kidney injury was admitted to our hospital presenting with acute gastroenteritis. After being treated by hemodialysis and oral low dose steroid, she was discharged with recovered renal function. Renal biopsy demonstrated acute tubular necrosis with considerable hemosiderin deposition without evidence of vascular thrombosis. A review of Korean cases showed that most of the cases featured severe renal dysfunction to such an extent to require a hemodialysis although there were no definite etiologies other than the deposition of blood iron due to massive hemolysis unlike the foreign cases. It also showed that the disease duration was longer. It can therefore be inferred that the early diagnosis and active treatment will be mandatory for the treatment of Korean patients with PNH. We reported a case of PNH with acute kidney injury and hemolytic crisis and documented by renal biopsy with review of Korean literature.
Acute Kidney Injury ; Adult ; Biopsy ; Early Diagnosis ; Female ; Gastroenteritis ; Hematopoiesis ; Hematopoietic Stem Cells ; Hemoglobinuria, Paroxysmal ; Hemolysis ; Hemosiderin ; Humans ; Iron ; Kidney ; Korea ; Necrosis ; Renal Dialysis ; Thrombosis ; Venous Thrombosis

Hemorrhagic fever with renal syndrome is an acute disease characterized by fever, headache, bleeding tendency, and anuria. We recently treated a case of hemorrhagic fever in a renal allograft patient with renal syndrome. A 43-year-old woman presented with high fever, headache, and myalgia for 4 days. In February 1998, she had undergone allograft kidney transplantation following treatment with cyclosporine and steroids. Allograft function was stable. Hantaan virus infection was demonstrated by serology during the first hospital week. Her clinical course progressed through febrile, hypotensive, oliguria, polyuria, and recovery phases. The patient was successfully treated with continuous renal replacement therapy and supportive management with maintenance doses of immunosuppressive agents.
Acute Disease ; Adult ; Anuria ; Cyclosporine ; Female ; Fever ; Hantaan virus ; Headache ; Hemorrhage ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Kidney Transplantation ; Oliguria ; Polyuria ; Renal Replacement Therapy ; Steroids ; Transplantation, Homologous

PURPOSE: The increased prevalence and incidence of end-stage renal disease in the elderly is a worldwide phenomenon. We investigated the survival rate, technical success, cause of death and the predictors of death in patients starting peritoneal dialysis over 65 years of age. METHODS: We analyzed 67 patients; 37 were in the elderly group (>65 years of age) and 30 in the control group (45-64 years of age) that started peritoneal dialysis between January 1995 and June 2006. Clinical characteristics and laboratory findings at the beginning of dialysis and 6 months later were retrospectively analyzed. In addition, the survival rate and independent predictors of survival were analyzed. RESULTS: The prevalence of complication was not different in the two groups. However, leakage of dialysate was more common in the elderly group. The duration of patient survival, serum albumin levels and BMI were lower in the elderly group. The multivariate analysis showed that age, presence of diabetes, initial albumin level, and residual renal function was associated with patient survival, gender, age, initial albumin level, and the prevalence of peritonitis affected the technical success rate. CONCLUSION: Among elderly patients, leakage was more prevalent compared to the younger patients and the most common cause of death was cardiovascular disease. The presence of diabetes, a low serum albumin and BMI, and residual renal function were associated with the duration of survival
Aged ; Cardiovascular Diseases ; Cause of Death ; Dialysis ; Humans ; Incidence ; Kidney Failure, Chronic ; Multivariate Analysis ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Prevalence ; Retrospective Studies ; Serum Albumin ; Survival Analysis* ; Survival Rate

PURPOSE: During hemodialysis (HD) in patients with end-stage renal disease (ESRD) and preexisting liver cirrhosis (LC), there is a risk of inadequate ultrafiltration due to either intradialytic hypotension or a coagulopathy causing complications from alteration of clotting factors and platelets. Peritoneal dialysis has several benefits over HD for cirrhotic patients including proper hemodynamic stability, avoidance of anticoagulants and direct removal of ascitic fluid. We compared the factors associated with the survival rates in patients with ESRD and LC undergoing dialysis. METHODS: We analyzed 41 ESRD patients with LC (HD 23 patients, PD 18 patients). Their characteristics and laboratory findings at the beginning of dialysis, and survival rates were retrospectively analyzed. RESULTS: There was no significant difference in survival time with the treatment modality. The patients with severe ascites at the beginning of dialysis, low albumin (serum albumin <3.0 g/dL), high modified Child-Pugh score (MCP score > or =7) and low hemoglobin (Hb) level (Hb <10 g/dL) had poor survival. The multivariate analysis showed that age, the amount of ascites, the initial Hb level and the modified Child-Pugh score were risk factors for death. CONCLUSION: PD was an effective renal replacement therapy for patients with ESRD and LC. Patients with a modified Child-Pugh classification of A and B were not significantly different with regard to survival rates. Therefore, PD may be a safe and effective option for patients with ESRD and LC.
Anticoagulants ; Ascites ; Ascitic Fluid ; Classification ; Dialysis ; Hemodynamics ; Humans ; Hypotension ; Kidney Failure, Chronic* ; Liver Cirrhosis* ; Liver* ; Multivariate Analysis ; Peritoneal Dialysis* ; Renal Dialysis* ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Survival Rate ; Ultrafiltration

BACKGROUND/AIMS: Brain natriuretic peptide (BNP) levels are known to be elevated in patients with chronic kidney disease (CKD) and normal heart function. Therefore, the present study was performed to examine the effectiveness of BNP level in diagnosing heart failure in patients with CKD and to determine its effects on survival rate and prognosis. METHODS: A total of 182 patients with CKD who visited the hospital due to dyspnea of NYHA class II were included in the study. BNP levels were measured and echocardiography was performed to divide the subjects into groups with and without heart failure. Their BNP levels, clinical courses, and survival rates were analyzed retrospectively. RESULTS: When BNP level was > or =858.5 pg/mL in CKD patients, heart failure could be diagnosed with sensitivity and specificity of 77% and 72%, respectively. Survival rate of the group with BNP levels of > or =858.8 pg/mL was significantly lower than that of the group with BNP level below this threshold (p=0.012) and multivariate analysis showed that BNP level, age, and sex affected survival rate in the group with BNP level > or =858.8 pg/mL. CONCLUSIONS: BNP levels of patients with CKD showed a positive correlation with creatinine levels, and the critical point of BNP level for diagnosis of heart failure was 858.5 pg/mL. As the survival rate in patients with BNP level above the critical point was significantly low, this level was a useful indicator for predicting their prognosis. Care should be taken in interpreting BNP level because patients with stage 5 CKD may show a high concentration of BNP without heart failure.
Aged ; Cohort Studies ; Female ; Heart Failure/blood/complications/*diagnosis ; Humans ; Kidney Diseases/*blood/complications/mortality ; Male ; Middle Aged ; Natriuretic Peptide, Brain/*blood ; Predictive Value of Tests ; Retrospective Studies ; Survival Rate

BACKGROUND: Skin grafts are required in numerous clinical procedures, such as reconstruction after skin removal and correction of contracture or scarring after severe skin loss caused by burns, accidents, and trauma. The current standard for skin defect replacement procedures is the use of autologous skin grafts. However, donor-site tissue availability remains a major obstacle for the successful replacement of skin defects and often limits this option. The aim of this study is to effectively expand full thickness skin to clinically useful size using an automated skin reactor and evaluate auto grafting efficiency of the expanded skin using Yucatan female pigs. METHODS: We developed an automated bioreactor system with the functions of real-time monitoring and remote-control, optimization of grip, and induction of skin porosity for effective tissue expansion. We evaluated the morphological, ultra-structural, and mechanical properties of the expanded skin before and after expansion using histology, immunohistochemistry, and tensile testing. We further carried out in vivo grafting study using Yucatan pigs to investigate the feasibility of this method in clinical application. RESULTS: The results showed an average expansion rate of 180%. The histological findings indicated that external expansion stimulated cellular activity in the isolated skin and resulted in successful grafting to the transplanted site. Specifically, hyperplasia did not appear at the auto-grafted site, and grafted skin appeared similar to normal skin. Furthermore, mechanical stimuli resulted in an increase in COL1A2 expression in a suitable environment. CONCLUSION: These findings provided insight on the potential of this expansion system in promoting dermal extracellular matrix synthesis in vitro. Conclusively, this newly developed smart skin bioreactor enabled effective skin expansion ex vivo and successful grafting in vivo in a pig model.
Bioreactors ; Burns ; Cicatrix ; Contracture ; Extracellular Matrix ; Female ; Hand Strength ; Humans ; Hyperplasia ; Immunohistochemistry ; In Vitro Techniques ; Methods ; Models, Animal ; Porosity ; Skin Transplantation ; Skin* ; Swine ; Tissue Expansion ; Tissue Expansion Devices ; Transplants

Oral squamous cell carcinoma (OSCC) is the most common type of oral malignancy. Numerous therapies have been proposed for its cure. Research is continually being conducted to develop new forms of treatment as current therapies are associated with numerous side-effects. Luteolin, a common dietary flavonoid, has been demonstrated to possess strong anti-cancer activity against various human cancer cell lines. Nevertheless, research into luteolin-based anticancer activity against oral cancer remains scarce. Thus, the objective of this study was to assess the effect of luteolin as an anti-cancer agent. After treatment with luteolin, Ca9-22 and CAL-27 oral cancer cells showed condensed nuclei and enhanced apoptotic rate with evidence of mitochondria-mediated apoptosis. Epithelialmesenchymal transition (EMT) is closely related to tumor migration and invasion. Luteolin suppressed cancer cell invasion and migration in the current study. Elevated expression of E-cadherin, an adherens junction protein, was evident in both cell lines after luteolin treatment. Luteolin also significantly inhibited transcription factors (i.e., N-cadherin, Slug, Snail, Twist, and ZEB-1) that regulated expression of tumor suppressors such as E-cadherin based on Western blot analysis and quantitative PCR. Thus, luteolin could induce mitochondrial apoptosis and inhibit cancer cell invasion and migration by suppressing EMT-induced transcription factors.
Adherens Junctions ; Apoptosis ; Blotting, Western ; Cadherins ; Carcinoma, Squamous Cell ; Cell Line ; Epithelial Cells ; Epithelial-Mesenchymal Transition ; Gastropoda ; Humans ; Luteolin ; Mouth Neoplasms ; Polymerase Chain Reaction ; Snails ; Transcription Factors