BACKGROUND: Early identification and appropriate management of mild chronic renal failure has been increasingly recognized as an important opportunity to delay the progression of renal disease. Many physicians rely on serum creatinine (Scr) as a screening test for renal impairment; however, Scr levels can remain within the normal range even when renal function is significantly impaired in certain group of patients. METHODS: The subjects were 20, 245 persons who were enrolled a regular health check up program, Jan. 1997 to Jun. 2001, at Ajou University Hospital, Korea. We identified GFR below 60 mL/min/1.73 m2 as abnormal and found the percentage of patients with Scr value from 1.1 mg/dL to 1.4 mg/dL and their sex and age distribution, using GFRs calculated by Cockroft-Gault Equation, MDRD Equation, and Kang's Equation. RESULTS: Average Scr was 1.07+-0.13 mg/dL in male and 0.82+-0.11 mg/dL in female. Among 34 University hospital in metro Seoul area, 11 hospital used 1.4 mg/dL as normal upper limit of Scr and 7 hospital used 1.3 mg/dL. Taking normal Scr upper limit as 1.3 or 1.4 mg/dL, the frequency of GFR below 60 mL/min/1.73 m2 was 3.9-50% in males and 75-100% in females, although some differences existed according to the equation used. CONCLUSION: Currently used normal Scr upper limit 1.3, 1.4 mL/dL was found to be much too high and we concluded a downward adjustment is needed and one-time test is not adequate to conclude renal impairment but several regular tests are required.
Age Distribution ; Creatinine* ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Failure, Chronic ; Korea ; Male ; Mass Screening ; Reference Values* ; Seoul

A high intake of licorice can cause hypermineralocorticoidism with sodium retention and potassium loss, edema, increased blood pressure and depression of renin-angiotensin-aldosterone system. Glycyrrhizic acid, a component of licorice, produces hypermineralocorticoidism through the inhibition of 11beta-hydroxysteroid dehydrogenase. We report a 55-year-old woman with severe muscle weakness with hypokalemia(Serum K+ : 1.7 mEq/ L) due to raw licorice tea. She boiled the licorice 50 g in water and drunk intermittently for 4 months due to her foreign body sensation on her throat. In Korea there is a traditional recipe that licorice works out for the above symptom. Her serum renin activity and aldosterone level were far beyond normal range which was typical to licorice ingestion. She also had metabolic alkalosis with pH 7.55 and hypertension. After quitting the licorice, hypokalemia and muscle weakness gradually improved and her blood pressure returned to normal.
11-beta-Hydroxysteroid Dehydrogenases ; Aldosterone ; Alkalosis ; Blood Pressure ; Depression ; Eating ; Edema ; Female ; Foreign Bodies ; Glycyrrhiza* ; Glycyrrhizic Acid ; Humans ; Hydrogen-Ion Concentration ; Hypertension ; Hypokalemia* ; Korea ; Middle Aged ; Muscle Weakness ; Pharynx ; Potassium ; Reference Values ; Renin ; Renin-Angiotensin System ; Sensation ; Sodium ; Tea ; Water

PURPOSE: Disturbances of mineral metabolism are common during the course of chronic kidney disease (CKD) and may lead to serious and debilitating complications unless properly treated. The purpose of this study is to quantify the prevalence of secondary hyperparathyroidism and vitamin D deficiency in non-dialysed chronic kidney disease 3, 4, and 5 in Korea. METHODS: This study included patients who had documented eGFR<60 mL/min/1.73m2 and non-dialysed and had not received any vitamin D compounds. eGFR was calculated by simplified MDRD (Modification of Diet in Renal Disease study) equation. Blood samples were collected for serum creatinine, calcium, phosphate, intact PTH and vitamin D metabolites between May 2006 and April 2007. RESULTS: According to K/DOQI guideline, the prevalence of hyperparathyroidism was 46.9% (15/32) in stage 3 (iPTH>70 pg/mL),45.9% (17/37) in stage 4 (iPTH>110 pg/mL) and 20.5% (9/44) in stage 5 patients (iPTH>300 pg/mL). The prevalence of 25-hydroxyvitamin D deficiency (25(OH)D3<15 ng/mL) was 86.2% (25/29) in stage 3, 75.7% (28/37) in stage 4 and 88.4% (38/43) in stage 5. There was a negative correlation between eGFR and intact PTH (r=-0.531, p=0.000) and a positive correlation between eGFR and 1,25-dihydroxyvitamin D (r=0.587, p=0.000). Conclusions: So far as non-dialysed CKD patients in Korea are concerned, quantification of the prevalence of abnormality of intact PTH and vitamin D deficiency has been described in this study. More research should be conducted in the future in a prospective, multi-center community cohort study, of which subjects include the early stages like CKD 1 and 2.
Calcium ; Cohort Studies ; Creatinine ; Diet ; Glomerular Filtration Rate ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary ; Kidney Failure, Chronic ; Korea ; Parathyroid Hormone ; Prevalence ; Renal Insufficiency, Chronic ; Vitamin D ; Vitamin D Deficiency ; Vitamins

Objective: Insomnia is associated with elevated high-frequency electroencephalogram power in the waking state. Although affective symptoms (e.g., depression and anxiety) are commonly comorbid with insomnia, few reports distinguished objective sleep disturbance from affective symptoms. In this study, we investigated whether daytime electroencephalographic activity explains insomnia, even after controlling for the effects of affective symptoms. Methods: A total of 107 participants were divided into the insomnia disorder (n = 58) and healthy control (n = 49) groups using the Mini-International Neuropsychiatric Interview and diagnostic criteria for insomnia disorder. The participants underwent daytime resting-state electroencephalography sessions (64 channels, eye-closed). Results: The insomnia group showed higher levels of anxiety, depression, and insomnia than the healthy group, as well as increased beta [t(105) = −2.56, p = 0.012] and gamma [t(105) = −2.44, p = 0.016] spectra. Among all participants, insomnia symptoms positively correlated with the intensity of beta (r = 0.28, p ＜ 0.01) and gamma (r = 0.25, p ＜ 0.05) spectra. Through hierarchical multiple regression, the beta power showed the additional ability to predict insomnia symptoms beyond the effect of anxiety (ΔR2 = 0.041, p = 0.018). Conclusion Our results showed a significant relationship between beta electroencephalographic activity and insomnia symptoms, after adjusting for other clinical correlates, and serve as further evidence for the hyperarousal theory of insomnia. Moreover, resting-state quantitative electroencephalography may be a supplementary tool to assess insomnia.