Acute rejection in renal transplantation is a major risk factor threatening the longterm graft survival. Acute rejections refractory to conventional anti-rejection therapy using steroid pulse or antilymphocyte preparations occur in minority, preceding to progressive deterioration of renal function and graft loss. Recent reports showed that tacrolimus rescue therapy in this refractory rejections has converted rejection process. In order to evaluate the clinical outcome of tacrolimus rescue therapy in refractory rejections, we performed a retrospective study. Since April 1997, we performed tacrolimus rescue therapy intent-to-treat for steroid- or OKT3- resistant rejections in 5 patients. All rejections were histologically confirmed according to Banff criteria. As conventional antirejection therapy, steroid pulse therapy (solumedrol 500~1000 mg iv for 3 days) or OKT3 therapy (5 mg/day for 14 days) was performed. The outcome of the rescue therapy is classified into three categories by the change of serum creatinine level or the histologic findings; Improvement-return of serum creatinine level (sCr) to or below the prerejection baseline (nadir) level, Stabilization-arrested sCr increase, Failure-progressive deterioration of renal function, or graft loss. All were men and the mean age was 38 years. Living related- & unrelated-donor transplantation were 2 and 3 cases respectively. Immunosuppression were done with CsA Pd+ (3) or CsA+ Pd+ AZA (2). Acute rejection grades according to Banff criteria were mild (2) or moderate (3). The mean interval between transplantation and tacrolimus conversion was 54.4 days. The outcome was as follows; improvement 2 cases, stabilization 1 case and failure 2 cases. During 3~10 months followup PTLD occured in 1 case, treated with graft nephrectomy and no other complications in other 4 cases. In conclusion, we can convert ongoing refractory rejections to steroid and OKT3 therapy by tacrolimus rescue therapy in 60% (3/5) successfully. Although longterm followup result is necessary to confirm the efficacy and safety of the tacrolimus rescue therapy, the result of this early trial is so good that we may try tacrolimus in refractory rejections for rejection reversal.
Creatinine ; Follow-Up Studies ; Graft Survival ; Humans ; Immunosuppression ; Kidney Transplantation* ; Male ; Muromonab-CD3 ; Nephrectomy ; Retrospective Studies ; Risk Factors ; Tacrolimus* ; Transplants

Hemorrhagic fever with renal syndrome(HFRS) is an infectious disease showing diverse clinical manifestations according to different serotypes of hantavirus. Korean hemorrhagic fever(KHF), HFRS caused by Hantaan or Seoul virus in Korea, shows diverse clinical manifestations even in the same serotype of hantavirus. On the assumption that the antigenicity, nucleotide and amino acid sequence diversity of hantaviruses, as well as immune response diversity of individual KHF patient may be present, this study was performed to analyse the genetic diversity of hantaviruses isolated from patients with KHF. In the 13 samples(9 strains of hantavirus isolated from bloods, urines or autopsy tissue of KHF patients and 4 serums of KHF patients), hantaviral RNAs were extracted, cDNAs of partial M segment were amplified by RT-PCR using genus-reactive primer, amplified cDNAs were analysed by direct sequencing method, and then the nucleotide and deduced amino acid sequences were compared with previously known sequences of four serotypes of hantavirus isolated from rodent hosts and each other by the computer assistance. The results were as follows. The nucleotide and amino acid sequences of 11 samples among the 13 human isolates showed 90.3-95.5%, 86.7-97.9%, the other 1 sample 82.7%, 71.9% homology respectively to those of Hantaan virus 76-118 strain, and another 1 sample showed 83.7%, 75.3% homology respectively to those of Seoul virus B1 strain isolated from rodent host. The nucleotide and amino acid sequences of 7 among 12 Hantaan samples showed differences within 5%, 10% respectively each other and high genetic similarities, but those of the other 5 among 12 Hantaan samples showed low genetic similarities each other. In conclusion, hantaviruses isolated from KHF patients showed genetic diversity compared with previously known hantaviruses isolated from rodent hosts.
Amino Acid Sequence ; Autopsy ; Communicable Diseases ; DNA, Complementary ; Fever ; Genetic Variation ; Hantaan virus ; Hantavirus ; Hemorrhagic Fever with Renal Syndrome* ; Humans ; Korea ; RNA ; Rodentia ; Seoul virus

No abstract available.
Infarction* ; Retrospective Studies*

No abstract available.
Acid-Base Equilibrium* ; Acidosis*

Eleven hantavirus isolates were obtained by innoculation of viremic blood, urine, or autopsy tissue specimens from ten HFRS patients, and sera were obtained from five patients with HFRS. The disease was diagnosed by clinical manifestations and indirect immunofluorescent antibody technique. We obtained 6 hantaviruses from gene bank. So, we analyzed 22 hantavirus samples to elucidate the genetic diversity. The hantaviral RNAs were extracted and 365 base-pair complementary DNAs of M segment were obtained by reverse transcriptase polymerase chain reaction (RT-PCR) and 326 base-pair by nested PCR. The nucleotide sequences of amplified cDNA fragments were determined by the direct sequencing method using automatic DNA sequence analyzer. We got full M segment sequences of 28 reported hantaviruses with medline searching, and aligned them with our 22 samples, and the phylogenetic analysis for nucleotide and amino acid sequences were done by the Clustal method. The nucleotide and amino acid sequences of Hantaan virus 17 samples showed high (above 90%) homology with 76-118 strain, but 2 samples showed significant differences with 76-118 strain and with other 17 samples. The 3 Seoul virus samples showed high intraspecies differences in 1 sample, and showed singnificant differences with SR-11 strain. In phyogenetic tree analysis, Puumala virus and Hantavirus pulmonary syndrome viruses showed high homology, but Hantaan and Seoul viruses showed significant genetic diversity among strains. In conclusion, hantaviruses isolated from HFRS patients showed genetic diversity compared with those isolated from rodent hosts.
Amino Acid Sequence ; Autopsy ; Base Sequence* ; DNA, Complementary ; Genetic Variation ; Hantaan virus ; Hantavirus Pulmonary Syndrome ; Hantavirus* ; Hemorrhagic Fever with Renal Syndrome* ; Humans ; Korea* ; Polymerase Chain Reaction ; Puumala virus ; Reverse Transcriptase Polymerase Chain Reaction ; RNA ; Rodentia ; Seoul virus

Between January, 1990, and December, 1994, 105 elderly patients(over the age of sixty) were referred to the Division of Nephrology at the Seoul National University Hospital as acute renal failure(ARF) (serum creatinine >1.7mg/dL, patients who had been diagnosed to have acute on chronic renal failure were excluded). To find out the characteristics of ARF in the elderly, we made a retrospective study of our data. Sufficient data for analysis were available in 101 of these. Among these patients, prerenal failure occured in 5% of the cases, ischemic ATN 34%, toxic ATN 11%, renovascular obstruction 5%, glomerular disease 5%, postrenal failure 15%. Dialysis was required in 31 patients(31%). Twenty four patients were treated by hemodialysis, it was carried out in 1 patient by the peritoneal route, and the other 6 patients were treated by CAVH. The most common indication was hypervolemia(77%). Twenty seven patients died during the period of acute renal failure. The most common cause of death was infection(15 patients), and the others were underlying diseases, pulmonary complications and cardiovascular complications. Oliguria, and chronic underlying disease were poor prognostic factors. There were significant differences between living and died group in APACHE II score(P<0.05). We conclude that ischemic ATN is a more common cause of ARF in the elderly than in the younger, and presence of oliguria and chronic underlying disease are poor prognostic factors.
Acute Kidney Injury* ; Aged* ; APACHE ; Cause of Death ; Creatinine ; Dialysis ; Hemofiltration ; Humans ; Kidney Failure, Chronic ; Lung Diseases ; Mortality ; Nephrology ; Oliguria ; Renal Dialysis ; Retrospective Studies ; Seoul

Honeybee venom consists of melittin, apamin, phospholipase A2, hyaluronidase and other biologically active substances. It can cause potentially lethal reaction after mass envenomation. But, acute renal failure following multiple bee stings is rare and its pathogenesis is not well known. The possible causes of acute renal failure due to multiple bee stings are rhabdomyolysis, hemolysis and direct nephrotoxicity of bee venom. A 60-year-old man was the victim of a bee(Apis mellifera) attack. More than 780 bee stings were found over his face, neck and upper extremities. Gross hematuria, oliguria and generalized edema was developed within a few hours. He has fully recovered after general supportive care including hemodialysis. This case demonstrates that multiple bee stings may cause rhabdomyolysis with consequent acute renal failure.
Acute Kidney Injury* ; Apamin ; Bee Venoms ; Bees ; Bites and Stings* ; Edema ; Hematuria ; Hemolysis ; Humans ; Hyaluronoglucosaminidase ; Melitten ; Middle Aged ; Neck ; Oliguria ; Phospholipases A2 ; Renal Dialysis ; Rhabdomyolysis* ; Upper Extremity ; Venoms

Most cases of acute renal failure induced by rifampin are due to acute tubulointerstitial nephritis and usually resolve spontaneously after discontinuation of rifampin. But there were a few reports that rifampin could cause crescentic glomerulonephritis. We present a 67 year-old male patient who has suffered from pulmonary tuberculosis and taken antituberculosis drugs including rifampin. The medication was interrupted two times because of anorexia and nausea. Azotemia, lower extremity edema and palpable purpura on both legs developed after administering antituberculosis drugs for two months. We performed the skin and kidney biopsy. The skin biopsy showed necrotizing vasculitis and kidney biopsy showed crescentic IgA nephropathy. He was tentatively diagnosed as rifampin induced rapidly progressive glomerulonephritis and underlying Henoch-Sch nlein purpura. The antituberculosis regimen was switched excluding rifampin and prednisolone was administered orally. His renal function was improved slowly over 4 months.
Acute Kidney Injury ; Aged ; Anorexia ; Azotemia ; Biopsy ; Edema ; Glomerulonephritis* ; Glomerulonephritis, IGA ; Humans ; Kidney ; Leg ; Lower Extremity ; Male ; Nausea ; Nephritis, Interstitial ; Prednisolone ; Purpura ; Rifampin* ; Skin ; Tuberculosis, Pulmonary ; Vasculitis

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*

BACKGROUND: The proinflammatory cytokine, interleukin-6(IL-6), seems to be involved in the pathogenesis and progression of IgA nephropathy. The aim of this study is to elucidate the relationship between the intrarenal expression of IL-6 and the clinicopathological findings in IgA nephropathy, and to reveal whether allele-frequency differences of -174 G/C polymorphism of IL-6 gene promoter region exist between IgA nephropathy patients and the normal population. METHODS: The total RNA was extracted from renal tissue of 56 IgA nephropathy patients. Semiquantitative reverse-transcriptase polymerase chain reactions(RT-PCR) using the internal competitors were done for the quantification of IL-6 transcripts. Using PCR-RFLP, we examined the -174 G/C polymorphism in IgA nephropathy patients and in 53 of the normal Korean population. RESULTS: In RT-PCR, the degree of intrarenal IL-6 expression was not related with any clinicopathological characteristics of IgA nephropathy patients. The degree of IgA deposition in glomeruli was correlated with the expression of IL-6, but the correlation was not statistically significant. Among the 56 IgA nephropathy patients studied, 55 carried the GG wild type and only 1 carried the GC genotype. Among 53 normal controls studied, only 1 carried the GC genotype and the rest carried GG wild type(C allele frequency=0.009). CONCLUSION: These results suggest that IL-6 is not related with the pathophysiology of IgA nephropathy, and the -174 G to C polymorphism of IL-6 promoter region is very rare in Koreans. And, the IL-6 polymorphism at -174 is unlikely to contribute significantly to susceptibility to or the progression of IgA nephropathy in Koreans.
Alleles ; Genotype ; Glomerulonephritis, IGA* ; Humans ; Immunoglobulin A* ; Interleukin-6* ; Promoter Regions, Genetic ; RNA