Autosomal dominant polycystic kidney disease (ADPKD) is a common genetic disorder characterized by innumerable bilateral renal cysts. It has an prevalence rate of one in 200~1,000 individuals and is a relatively common cause of renal failure. As renal function deteriorates, overall renal size usually diminish in patients with chronic renal failure. However, renal size of patients with ADPKD usually continues to increase, even after the initiation of dialysis therapy, because numerous cysts replace renal mass. Attempted methods to reduce the size of enlarged kidneys have included needle aspiration and sclerotherapy, cyst decompression surgery, laparoscopic and surgical nephrectomy. The outcome of these therapy frequently has been suboptimal, and there is a need to develop a more effective therapy. We report a case of renal arterial embolization using 99% ethanol and lipiodol mixture for ADPKD in a hemodialysis pathient, which has not been previously reported.
Decompression ; Dialysis ; Ethanol* ; Ethiodized Oil* ; Humans ; Kidney ; Kidney Failure, Chronic ; Laparoscopy ; Needles ; Nephrectomy ; Polycystic Kidney, Autosomal Dominant* ; Prevalence ; Renal Dialysis* ; Renal Insufficiency ; Sclerotherapy

Chryseobacterium meningosepticum is rarely encountered as a pathogen causing peritonitis in peritoneal dialysis (PD) patients. We report a case of peritonitis due to Chryseobacterium meningosepticum, which was treated successfully with intraperitoneal (IP) vancomycin and ciprofloxacin, and without PD catheter removal. Peritonitis was developed in a 53-year-old PD patient on the third hospital day. Although empirical IP treatment with cefazolin and tobramycin was initiated and maintained for 3 days, the fever and signs of peritonitis persisted. Antibiotics were changed to cefoperazone/sulbactam, amikacin, and vancomycin due to clinical deterioration. After 3 days of vancomycin use, leukocyte count in PD fluid was less than 100/mm3 and the patient became asymptomatic. On seventh day after the onset of peritonitis, Chryseobacterium meningosepticum was isolated from initial dialysate sample, and this strain was susceptible to ciprofloxacin, piperacillin, and piperacillin/tazobactam. Accordingly, we changed the antibiotics to ciprofloxacin and vancomycin, which were given for the total of 14 days. Even though Chryseobacterium meningosepticum is an uncommon causative organism of peritonitis in PD patients, this report suggests that vancomycin and ciprofloxacin are effective as empiric therapy, and early suspicion and appropriate antimicrobial therapy are crucial to the successful treatment of peritonitis due to Chryseobacterium meningosepticum without catheter removal.
Amikacin ; Anti-Bacterial Agents ; Catheters ; Cefazolin ; Chryseobacterium ; Ciprofloxacin ; Fever ; Humans ; Leukocyte Count ; Middle Aged ; Peritoneal Dialysis ; Peritonitis ; Piperacillin ; Sprains and Strains ; Tobramycin ; Vancomycin

Background: The purpose of this study was to analyze the clinical and microbiological characteristics of recurrent urinary tract infection (UTI) caused by Escherichia coli— the most common etiological agent. Methods: Cases of recurrent and single episodes of UTI caused by E. coli were evaluated retrospectively for a period of 6 months (January-June 2019) to analyze the clinical and molecular characteristics of this disease. Results: Healthcare-associated UTI, E. coli bacteremia, and poor microbial clearance 7 days post infection were associated more with the recurrent episodes of infection. E. coli isolates from subjects with recurrent UTIs showed higher rates of antimicrobial resistance and extended-spectrum β-lactamase (ESBL) production. The E. coli clone— sequence type 131 was detected in similar proportions in isolates, recovered from subjects in both groups— recurrent episodes and single episode of UTI. Conclusion The control of antimicrobial-resistant ESBL-producing E. coli strains may be difficult using antimicrobial therapy and subsequently delay the clearance of the etiologic agent. This could play a major role in the development of recurrent UTIs.

This report describes the case of a hypertensive 51-year-old male with a 3-year history of peritoneal dialysis. We followed the patient through his diagnosis of severe obstructive sleep apnea (OSA) and treatment with continuous positive airway pressure (CPAP). Therapeutic use of CPAP led to the improvement of not only sleep-related problems, but also cognitive function and quality of life. To our knowledge, this is the first paper describing the benefits of long-term CPAP treatment in an OSA patient undergoing dialysis. This case report emphasizes the need for the proactive diagnosis and treatment of OSA in end-stage renal disease patients to improve patient-centered healthcare.
Cognition* ; Continuous Positive Airway Pressure* ; Delivery of Health Care ; Diagnosis ; Dialysis ; Humans ; Kidney Failure, Chronic ; Male ; Middle Aged ; Peritoneal Dialysis* ; Quality of Life* ; Sleep Apnea, Obstructive*

BACKGROUND: 16S rRNA gene-targeted next-generation sequencing (NGS) can detect microorganisms in a comprehensive reference database. To date, NGS has been successfully applied to samples such as urine, blood, and synovial fluid. However, there is no data for continuous ambulatory peritoneal dialysis (CAPD) fluid. The purpose of this study was to evaluate the clinical usefulness of microbiome analysis of CAPD fluids for the diagnosis of CAPD peritonitis. METHODS: We included 21 patients with high suspicion of CAPD peritonitis. Routine CAPD fluid culture was performed using a pellet of 50 mL CAPD fluid onto the chocolate and blood agar for two days, and thioglycollate broth for one week. 16S rRNA gene-targeted NGS of pellets, stored at −70℃ was performed with MiSeq (Illumina, USA). RESULTS: Many colonized or pathogenic bacteria were detected from CAPD fluids using NGS and the microbiomes were composed of 1 to 29 genera with a cut-off 1.0. Compared to the culture results, NGS detected the same pathogens in 6 of 18 valid results (three samples failed with low read count). Additionally, using NGS, anaerobes such as Bacteroides spp. and Prevotella spp. were detected in six patients. In two of five samples in which no bacterial growth was detected, possible pathogens were detected by NGS. CONCLUSION To our knowledge, this is the first report about the application of 16S rRNA gene-targeted NGS for diagnosis of CAPD peritonitis. Etiology of culture-negative CAPD peritonitis can be better defined in NGS. Furthermore, it also helped the detection of anaerobic bacteria.

Background: The use of newly developed mixed-dilution hemodiafiltration (HDF) can supplement the weaknesses of pre- and postdilution HDF. However, it is unclear whether mixed-HDF performs well compared to predilution HDF. Methods: We conducted a prospective, open-labeled, randomized controlled trial from two hemodialysis centers in Korea. Between January 2017 and September 2019, 60 patients who underwent chronic hemodialysis were randomly assigned at a 1:1 ratio to receive either predilution HDF (n = 30) or mixed-HDF (n = 30) for 6 months. We compared convection volume, changes in small- and medium-sized molecule clearance, high-sensitive C-reactive protein (hs-CRP) level, and dialysis-related parameters between the two dialysis modalities. Results: A mean effective convection volume of 41.0 ± 10.3 L/session in the predilution HDF group and 51.5 ± 9.0 L/session in the mixed-HDF group was obtained by averaging values of three time-points. The difference in effective convection volume between the groups was 10.5 ± 1.3 L/session. This met the preset noninferiority criteria, suggesting that mixed-HDF was noninferior to predilution HDF. Moreover, the β2-microglobulin reduction rate was greater in the mixed-HDF group than in the predilution HDF group, while mixed-HDF provided greater transmembrane pressure. There were no significant between-group differences in Kt/V urea levels, changes in predialysis hs-CRP levels, proportions of overhydration, or blood pressure values. Symptomatic intradialytic hypotension episodes and other adverse events occurred similarly in the two groups. Conclusion Use of mixed-HDF was comparable to predilution HDF in terms of delivered convection volume and clinical parameters. Moreover, mixed-HDF provided better β2-microglobulin clearance than predilution HDF.

Antineutrophil cytoplasmic antibodies (ANCAs) are now regarded as a serologic marker for pauci-immune crescentic necrotizing glomerulonephritis either in renal-limited form or in association with systemic vasculitis, such as Wegener? granulomatosis, microscopic polyarteritis, and Churg-Strauss syndrome. Two major ANCA antigens have been indentified: proteinase3, which produces a cytoplasmic staining pattern termed C-ANCA, and myeloperoxidase, which produces a perinuclear pattern termed P-ANCA on ethanol-fixed neutrophils by indirect immunofluorescence. In ANCA- associated diseases, eosinphilia in excess of 1.5X109/L has been proposed to be characteristic of Churg-Strauss syndrome and is rare in other forms of ANCA-associated systemic vasculitis and crescentic necrotizing glomerulonephritis. Recently, there were two cases of P-ANCA positive crescentic necrotizing glomerulonephritis with peripheral blood eosinophilia and extrarenal microscopic vasculitis without asthma or granulomas. We experienced a patient with P-ANCA positive pauci-immune necrotizing glomerulonephritis with few eosinophilic infiltration and eosinophilia. He improved with oral prednisolone along with combination of intravenous cyclophosphamide. So we report this case with the review of literature.
Antibodies, Antineutrophil Cytoplasmic* ; Asthma ; Churg-Strauss Syndrome ; Cyclophosphamide ; Cytoplasm ; Eosinophilia* ; Eosinophils ; Fluorescent Antibody Technique, Indirect ; Glomerulonephritis* ; Granuloma ; Humans ; Neutrophils ; Peroxidase ; Prednisolone ; Systemic Vasculitis ; Vasculitis

Acquired C1 inhibitor deficiency is a rare syndrome which usually presents with episodes of angioedema. The association of lupus erythematosus and angioneurotic edema has been previously reported but is usually related to hereditary C1 inhibitor deficiency. Currently the relationship between acquired C1 inhibior deficiency and lupus erythematosus is being discussed. So we report the case of a previously healthy 28-year-old woman, who developed simultaneously and acquired angioneurotic edema and systemic lupus erythematosus.
Adult ; Angioedema ; Angioedemas, Hereditary* ; Female ; Humans ; Lupus Erythematosus, Systemic

Anterior ischemic optic neuropathy (AION) is rarely reported in end stage renal disease. In particular, AION combined with sudden sensorineural hearing loss (SNHL) has not been reported in domestic and international journals. Here we report the first case of this combined condition. A 58-year-old male patient in end-stage renal disease presented on painless bilateral visual and hearing deterioration. Clinical findings and imaging studies were compatible with a diagnosis of AION and SNHL. Despite of high-dose steroid therapy, vision and hearing were not significantly recovered. Uremic patients often have coexisting pathology such as hypotension during dialysis, atherosclerosis and anemia, predisposing to AION and SNHL. We describe a patient of dialysis for 10 years who presented with bilateral visual and hearing loss due to complications of long-term dialysis. Our case suggests that nephrologists have to know and treat more carefully this rare but emergent complications of dialysis.
Anemia ; Atherosclerosis ; Dialysis ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Hypotension ; Kidney Failure, Chronic ; Male ; Middle Aged ; Optic Neuropathy, Ischemic ; Renal Dialysis ; Vision, Ocular

PURPOSE: It has been proposed that a decreased nephron number may be associated with the increased risk of glomerulosclerosis. In order to test the hypothesis that a reduced number and an increased volume of glomeruli may contribute to the pathogenesis of focal segmental glomerulosclerosis (FSGS), we compared the number and volume of glomeruli between 9 patients with FSGS and 8 with minimal change nephrotic syndrome (MCNS). METHODS: Mean glomerular volume was measured using the method of Weibel and Gomez. An estimate of glomerular number (index) was obtained by multiplying the cortical volume of a kidney by the fraction of renal cortex made up of glomeruli and dividing this by the mean glomerular volume for that kidney x 10(6). We determined kidney volume from ultrasonographic measurement. RESULTS: Patients with FSGS had significantly greater glomerular volume than patients with MCNS [2.02+/-0.36 (x10(6) micrometer3) vs. 1.57+/-0.27 (x10(6) micrometer3)] (p<0.025). However, there was no significant difference in the index of glomerular number (estimated glomerular number) between FSGS & MCNS patients (2.8+/-1.4 vs. 3.0+/-0.8). CONCLUSION: The glomerular volume was greater in FSGS patients than MCNS patients. But there was no significant difference in the index of glomerular number between patients with FSGS and MCNS.
Glomerulosclerosis, Focal Segmental* ; Humans ; Kidney ; Kidney Glomerulus ; Nephrons* ; Nephrosis, Lipoid* ; Nephrotic Syndrome