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

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

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

No abstract available.
Infarction* ; Retrospective Studies*

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

Minimal change nephrotic syndrome is the most common cause of adult nephrotic syndrome in Korea as well as in Asia. Even though hepatitis B virus (HBV) infection has been infrequently noted in patients with minimal change nephrotic syndrome, and even though there is a controversy in using steroid in patients with hepatitis B virus infections, impacts of HBV infection on the clinical course and the therapeutic modalities has not been evaluated. To elucidate this, we analysed clinicopathologic manifestations of 21 minimal change nephrotic syndrome patients with HBs antigenemia(HB-MCNS), in comparision with 25 minimal change nephrotic syndrome patients without any evidence of HBV infection(MCNS). The prevalence rate of HBs antigenimia among minimal change nephrotic syndrome was 8.7%. Age at diagnosis(median; HB-MCNS, 28 vs. MCNS, 22years : P<0.05), serum albumin level(median; HB- MCNS, 2.1 vs. MCNS, 1.8g/dL : P<0.05) and serum IgG level(median; HB-MCNS, 541 vs. MCNS, 271mg/dL : P<0.05) of HB-MCNS were higher than MCNS. C4(median; HB-MCNS, 36 vs. MCNS, 55mg/ dL : P<0.05) was lower. Other clinical findings including sex ratio, amount of 24HU protein, degree of hypercholesterolemia, seropositive rates for serologic markers such as rheumatoid factor, cryoglobulin, and ANA were not different between HB-MCNS and MCNS. The cumulative remission rates of 17 HB-MCNS patients who received steroid or cytotoxic therapy were 85% at 8th weeks and 100% at 11th weeks. Nephrotic syndrome was relapsed in 8% at 8th weeks and 38% at 70th weeks. These remission and relapse rate were not different from that of MCNS. During the course of steroid treatments, serum aspartate/alanine aminotransferase levels were elevated in 6 patients. Among those, 2 patients showed abnormal liver function persistent more than 4 weeks. One of them had positive seroconversion of HBeAg, and the other was proved to have liver cirrohsis. The negative seroconversion of HBeAg was not associated with clinical remission. Clinical finding suggested that HBV infection is unlikely a cause for most HB-MCNS. Even though steroids and cytotoxic agents was effective in HB-MCNS as much as in MCNS, careful monitoring of liver function and HBV marker is needed.
Adult ; Asia ; Cytotoxins ; Hepatitis B e Antigens ; Hepatitis B virus ; Humans ; Hypercholesterolemia ; Immunoglobulin G ; Korea ; Liver ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Prevalence ; Recurrence ; Rheumatoid Factor ; Serum Albumin ; Sex Ratio ; Steroids

Hepatitis B virus(HBV) infection has been suggested as the etiologic agent in membranoproliferative glomerulonephritis(MPGN), but the mechanism by which HBV infection leads to MPGN in human has not been established. To localize the HBV antigen and HBV-DNA in the kidney tissue, we examined paraffin sections of kidney biopsies which were positive for HBsAg by immunohistochemical study from 13 HBV carriers with MPGN (HBV-MPGN). Polymerase chain reaction(PCR) and in situ PCR(ISP) were used for the HBV DNA amplification and localization in kidney tissues. Primers used in PCR and ISP were from the S, C, and X HBV-DNA regions. Immunohistochemical study showed HBsAg deposits on the mesangium and glomerular capillaries. Arteriolar deposits were also occasionally observed. PCR for the S, C, and X regions were positive in 11 patients(85%), 11 patients(85%), and 9 patients (69%), respectively. The PCR findings were further confirmed by direct sequencing of PCR products and the amplification of HSP70 gene as a control. ISP showed the amplified HBV-DNA at the glomeruli and renal tubules. For S region, ISP was positive in 7 patients. For C and X regions, ISP was positive in 8 patients, respectively. 5 patients showed the positive signals for both the glomeruli and tubules, while 4 patients were positive at the tubules only. These 4 patients seemed to have the longer disease durations when compared to the other 5 patients (52.8 months vs. 11.8 months), but it was not statistically significant. In conclusion, the detection and the localization of HBV antigen and DNA in renal tissues indicate the presence of the complete virion in the kidney. These results suggest that HBV may infect the kidneys of HBV carriers with MPGN.
Biopsy ; Capillaries ; DNA ; Glomerulonephritis, Membranoproliferative* ; Hepatitis B Surface Antigens* ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Immunohistochemistry ; Kidney ; Paraffin ; Polymerase Chain Reaction ; Virion

Immune complex formation has been recently emphasized as an important pathogenetic mechanism of hepatitis B virus associated glomerulonephritis (HBGN), but little are known on the role of cell- mediated immunity in that disease. In this study, we measured lymphocyte subsets of the blood samples from three groups(HBGN group, healthy control group, hepatitis B group without renal disease) by flow cytometry in order to clarify abnormalities in immune regulatory system of HBGN. The results were as follows: 1) To compare between HBGN and healthy control group, the proportion of CD4+ cells were higher for HBGN than for healthy control but that of B lymphocytes were lower for HBGN than for healthy control. Between HBGN and hepatitis B group without renal disease, the proportion of B lymphocytes were higher for HBGN but that of NK cells were lower for HBGN(P<0.05). 2) To compare the male data of the three groups, the percentage of CD4+ cells in HBGN group were higher and the percentage of B lymphocytes were lower than healthy control. Between HBGN group and hepatitis B group without renal disease, no significant difference were noted in CD4+ cells, CD8+ cells, B lymphocytes, NK cells and CD4/CD8 ratio (P<0.05). 3) HBGN patients with membraneous nephropathy (MN) showed higher proportion of CD4+ cells than those with membranoproliferative glomerulonephritis (MPGN)(P<0.05). But, no difference was observed between HBGN patients with and without nephrotic syndrome. Nor between HBGN patients with and without HBe antigenemia. In conclusion, above result implies the pathogenetic role of cell-mediated immunity in HBGN. Analysis of lymphocyte subsets for each stage of HBGN, together with the assay of lymphocyte activation markers is required in the future.
Antigen-Antibody Complex ; B-Lymphocytes ; Flow Cytometry ; Glomerulonephritis* ; Glomerulonephritis, Membranoproliferative ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Immunity, Cellular ; Killer Cells, Natural ; Lymphocyte Activation ; Lymphocyte Subsets* ; Lymphocytes* ; Male ; Nephrotic Syndrome

PURPOSE: This study was implemented to investigate the prevalence of proteinuria and its combined morbidity in apparently normal adults. METHODS: We examined the mass screening data of Health Promotion Center in Seoul National University Hospital from May 1, 1995 to February 11, 2000. The random urine samples of all screenees were examined by dipstick test. Among them 22,595 adults(men 11,737 and women 10,858) who didn't take anti- hypertensive medication and whose fasting blood sugar <126 mg/dL were included in this analysis. RESULTS: The prevalence of proteinuria was 6.7% in men and 3.6% in women. Risk factors for proteinuria by simple correlation analysis were age, sex, body weight, systolic blood pressure, diastolic blood pressure, fasting blood sugar, blood urea nitrogen, serum creatinine, total cholesterol and smoking. As the degree of proteinuria increased, the systolic and diastolic blood pressures also increased significantly and creatinine clearance significantly decreased above the '++' level of proteinuria. Probability of proteinuria was calculated at each blood pressure level graded by JNC VI. With the increase of the level of blood pressure, the probability of proteinuria increased significantly between normal and high normal, high normal and hypertension1, and hypertension 2 and hypertension 3 level. Creatinine clearance and blood pressure level showed negative correlation. When total screenees were divided to proteinuria and no proteinuria groups, proteinuria group showed significant decrease of creatinine clearance in high normal and hypertension 1 level. CONCLUSION: Our results suggest that proteinuria in the apparently normal adults is not a benign condition, and it can be accompanied by significantly increased blood pressures and decreased renal function.
Adult* ; Blood Glucose ; Blood Pressure ; Blood Urea Nitrogen ; Body Weight ; Cholesterol ; Creatinine ; Fasting ; Female ; Health Promotion ; Humans ; Hypertension ; Male ; Mass Screening ; Prevalence* ; Proteinuria* ; Risk Factors ; Seoul ; Smoke ; Smoking