Acute kidney injury (AKI) secondary to near-drowning is rarely described and poorly understood. Only few cases of severe isolated AKI resulting from near-drowning exist in the literature. We report a case of near-drowning who developed to isolated AKI due to acute tubular necrosis (ATN) requiring dialysis. A 21-yr-old man who recovered from near-drowning in freshwater 3 days earlier was admitted to our hospital with anuria and elevated level of serum creatinine. He needed five sessions of hemodialysis and then renal function recovered spontaneously. Renal biopsy confirmed ATN. We review the existing literature on near-drowning-induced AKI and discuss the possible pathogenesis.
Acute Kidney Injury/*diagnosis/*etiology ; Anuria/etiology ; Creatinine/blood ; Humans ; Kidney Tubular Necrosis, Acute/etiology/pathology ; Male ; Near Drowning/*complications ; Renal Dialysis ; Young Adult

No abstract available.
Adrenalectomy ; Arginine Vasopressin/diagnostic use ; Catecholamines/physiology ; Cushing Syndrome/diagnosis/*physiopathology/surgery ; Humans ; Hydrocortisone/*secretion ; Male ; Middle Aged ; Vasopressins/physiology

Immunoglobulin G4-related sclerosing disease is a novel clinicopathological disease entity known to involve various organs including the pancreas, bile ducts, gall bladder, retroperitoneum, kidney, salivary gland, lung and prostate. The most common organ involved is the pancreas and cases without pancreatic involvement are uncommon. Positive response to steroids is an important characteristic of this disease and this enables early diagnosis, which is required for good prognosis. We demonstrate a case of immunoglobulin G4-related tubulointerstitial nephritis in a 59-year-old male accompanied by sclerosing cholangitis and sialadenitis without any evidence of pancreatic infiltration. The patient was treated with prednisolone and was fully recovered in 6 months.
Bile Ducts ; Cholangitis ; Cholangitis, Sclerosing ; Early Diagnosis ; Humans ; Immunoglobulins ; Kidney ; Lung ; Male ; Middle Aged ; Nephritis, Interstitial ; Pancreas ; Prednisolone ; Prognosis ; Prostate ; Salivary Glands ; Sialadenitis ; Steroids ; Urinary Bladder

BACKGROUND: The aim of this study was to compare mineral metabolism between anuric and nonanuric chronic hemodialysis patients, and determine the differences in phosphate control between the two groups. METHODS: A total of 77 chronic hemodialysis patients were enrolled in this cross-sectional study from January 2012 to February 2012. Patient demographics, laboratory findings, medication histories, and vascular calcification scores were collected. We divided the patients into anuric and nonanuric groups according to the residual renal function and then compared their clinical features. Multivariate binary regression analysis was used in each group to determine the independent factors related to phosphate control. RESULTS: The mean patient age was 59.27+/-13.95 years, and 57.1% of patients were anuric. In anuric patients, dialysis vintage was significantly longer, but the mean Kt/V was not different between groups. Serum phosphate, fibroblast growth factor (FGF)-23, and Ca/P products were significantly higher, and 1,25(OH)2D3 levels were significantly lower in the anuric patients, although the intact parathyroid hormone and 25(OH)D levels were not different. In anuric patients, LnFGF-23 [hazard ratio (HR) 2.894, 95% confidence interval (CI) 1.294-6.474, P=0.010] was an independent factor predictive of phosphate control. However, in the nonanuric patients, glomerular filtration rate (HR 0.409, 95% CI 0.169-0.989, P=0.047) and blood urea nitrogen (HR 1.090, 95% CI 1.014-1.172, P=0.019) were independent factors predictive of phosphate control. CONCLUSION: In chronic hemodialysis patients, preservation of residual renal function is a significant determinant of phosphate control, and the factors associated with phosphate control is different depending on the residual renal function status. In the anuric patients, FGF-23 is most significantly associated with phosphate control; however, glomerular filtration rate and blood urea nitrogen are more important than FGF-23 in the nonanuric HD patients.
Blood Urea Nitrogen ; Cross-Sectional Studies ; Demography ; Dialysis ; Fibroblast Growth Factors ; Glomerular Filtration Rate ; Humans ; Metabolism ; Parathyroid Hormone ; Renal Dialysis* ; Vascular Calcification

A 74-yr-old woman presented with fever and abdominal discomfort. She was in a septic condition caused by urinary tract infection. Her computed tomogram of the abdomen revealed features of hydronephrosis with ureteral stones in both kidneys. During percutaneous nephrostomies, right pyeloduodenal fistula (PDF) was diagnosed. Elective surgery was originally planned but the patient was in a poor condition to undergo surgery. Instead, 2 times endoscopic clipping and ligation by endoloop were applied with parenteral antibiotics for the fistula lesion. On admission day 30, she was discharged from the hospital after confirmation of no more contrast leakage on fistulography. We reviewed the literature and discuss the etiologies, clinical presentations, diagnosis, and treatment of PDF.
Aged ; Duodenal Diseases/complications/radiography/*surgery ; Female ; Humans ; Hydronephrosis/complications/radiography ; Intestinal Fistula/complications/radiography/*surgery ; Kidney/radiography/surgery ; Kidney Calculi/complications/radiography ; Kidney Diseases/complications/radiography/*surgery ; Ligation ; Urethral Obstruction/complications/radiography ; Urinary Fistula/complications/radiography/*surgery ; Urinary Tract Infections/complications/radiography

A 56-year-old male with pulmonary tuberculosis was admitted to our hospital for evaluation of generalized edema. He began antituberculosis treatment with rifampin, isoniazid, ethambutol, and pyrazinamide. He experienced abnormal increments in weight and serum creatinine after 6 weeks. All serological findings, including anti-neutrophil cytoplasmic antibodies (ANCA), were negative. Rifampin was stopped because it might have caused the increase in creatinine. Renal biopsy was consistent with pauci-immune crescentic glomerulonephritis (CrGN). His renal function was improved by high-dose steroid treatment. Rifampin-induced, ANCA-negative pauci-immune CrGN is very rare; most cases of rifampin-induced acute renal failure are due to acute tubulointerstitial nephritis. We present here a case of rifampin-induced CrGN and pulmonary tuberculosis successfully treated with high-dose steroids and antituberculosis medications, excluding rifampin.
Acute Kidney Injury ; Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Creatinine ; Edema ; Ethambutol ; Glomerulonephritis ; Humans ; Isoniazid ; Male ; Middle Aged ; Nephritis, Interstitial ; Pyrazinamide ; Rifampin ; Steroids ; Tuberculosis, Pulmonary

BACKGROUND/AIMS: Accumulating data suggest that vitamin D deficiency is prevalent in patients with chronic kidney disease (CKD). However, comprehensive data are lacking for Koreans. The aim of this study was to survey vitamin D deficiency among patients with CKD in Korea and to identify the relationships among various factors. METHODS: We conducted a retrospective cohort study of 444 patients who were divided into four subgroups by estimated glomerular filtration rate (eGFR) for comparisons of mean 25-hydroxyvitamin D [25(OH)D] level and other parameters. In addition, non-dialyzed patients were categorized into four groups based on 25(OH)D levels (<10, 10-19, 20-29, and > or =30 ng/mL), and risk factors for severe vitamin D deficiency (<10 ng/mL) were investigated. RESULTS: Of patients with an eGFR > or = 60 mL/min/1.73 m2, 43% (34/79) showed severe 25(OH)D deficiency, and the mean 25(OH)D level was 11.7 +/- 5.3 ng/mL. In CKD3 group, 53.2% (41/77) showed severe 25(OH)D deficiency, with a mean level of 11.3 +/- 7.2 ng/mL. In CKD4 group, 53.3% (49/92) had severe 25(OH)D deficiency, with a mean level of 11.0 +/- 6.2 ng/mL. Approximately 71% (139/196) of patients in CKD5 group showed severe deficiency, and the mean level was 9.2 +/- 5.9 ng/mL. Severe 25(OH)D deficiency was affected by winter season, renal function, diabetes, and low-density lipoprotein cholesterol. The serum parathyroid hormone level was inversely correlated with the 25(OH)D level, such that 25(OH)D <20 ng/mL were associated with a steep increase in parathyroid hormone. CONCLUSIONS: Vitamin D deficiency is highly prevalent in the Korean population. Few patients met a sufficient 25(OH)D concentration, even in the early stages of CKD. Our data suggest that 25(OH)D level of 20 ng/mL is a threshold for a rapid increase in parathyroid hormone levels.
Cholesterol ; Cohort Studies ; Glomerular Filtration Rate ; Humans ; Korea ; Lipoproteins ; Parathyroid Hormone ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors ; Seasons ; Vitamin D ; Vitamin D Deficiency

BACKGROUND/AIMS: Cardiovascular complications are commonly seen in patients with chronic kidney disease (CKD). Recently, the prevalence of left ventricular diastolic dysfunction (LVDD) has increased, and the importance of LVDD has emerged in patients with CKD. The objectives of this study were to identify diagnostic criteria for LVDD related to ischemic heart disease (IHD) and evaluate the prognostic impact of diastolic dysfunction in patients with CKD. METHODS: A total of 71 patients with CKD who were evaluated between January 2005 and May 2010 were included in this study. These patients were evaluated by conventional echocardiography and tissue Doppler imaging (TDI) for diastolic dysfunction. RESULTS: Diagnostic cutoff values for LVDD related to IHD were E/E' = 15.55 (sensitivity: 100%, specificity: 64.7%, p = 0.005) and E/A = 0.79 (sensitivity: 84.6%, specificity: 55.9%, p = 0.006). Group I consisted of 19 patients with an E/E' > 15.55 and E/A > 0.79. Group II consisted of the remaining patients. Factors contributing to LVDD were age, history of ischemic heart disease, anemia, and high low-density lipoprotein (LDL) level. Factors contributing to IHD were LVDD, smoking, high LDL level, and high parathyroid hormone (PTH) level. The disease-free survival for IHD was significantly lower in group I compared to group II (p = 0.001). However, there was no significant difference in overall survival between groups I and II (p = 0.177). CONCLUSIONS: Our study showed that moderate LVDD (E/E' > 15.55 and E/A > 0.79) in patients with CKD is positively associated with IHD.
Anemia ; Disease-Free Survival ; Echocardiography ; Heart Failure, Diastolic ; Humans ; Lipoproteins ; Myocardial Ischemia ; Parathyroid Hormone ; Prevalence ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Smoke ; Smoking

A 56-year-old male with pulmonary tuberculosis was admitted to our hospital for evaluation of generalized edema. He began antituberculosis treatment with rifampin, isoniazid, ethambutol, and pyrazinamide. He experienced abnormal increments in weight and serum creatinine after 6 weeks. All serological findings, including anti-neutrophil cytoplasmic antibodies (ANCA), were negative. Rifampin was stopped because it might have caused the increase in creatinine. Renal biopsy was consistent with pauci-immune crescentic glomerulonephritis (CrGN). His renal function was improved by high-dose steroid treatment. Rifampin-induced, ANCA-negative pauci-immune CrGN is very rare; most cases of rifampin-induced acute renal failure are due to acute tubulointerstitial nephritis. We present here a case of rifampin-induced CrGN and pulmonary tuberculosis successfully treated with high-dose steroids and antituberculosis medications, excluding rifampin.
Acute Kidney Injury ; Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Creatinine ; Edema ; Ethambutol ; Glomerulonephritis ; Humans ; Isoniazid ; Male ; Middle Aged ; Nephritis, Interstitial ; Pyrazinamide ; Rifampin ; Steroids ; Tuberculosis, Pulmonary

Whether continuous renal replacement therapy (CRRT) should be applied to critically ill patients with both acute kidney injury (AKI) and cancer remains controversial because of poor expected outcomes. The present study determined prognostic factors for all-cause in-hospital mortality in patients with AKI and cancer undergoing CRRT. Methods: We included 471 patients with AKI and cancer who underwent CRRT at the intensive care unit of a Korean tertiary hospital from 2013 to 2020, and classified them by malignancy type. The primary outcomes were 28-day all-cause mortality rate and prognostic factors for in-hospital mortality. The secondary outcome was renal replacement therapy (RRT) dependency at hospital discharge. Results: The 28-day mortality rates were 58.8% and 82% in the solid and hematologic malignancy groups, respectively. Body mass index (BMI), presence of oliguria, Sequential Organ Failure Assessment (SOFA) score, and albumin level were common predictors of 28-day mortality in the solid and hematologic malignancy groups. A high heart rate and the presence of severe acidosis were prognostic factors only in the solid malignancy group. Among the survivors, the proportion with RRT dependency was 25.0% and 33.3% in the solid and hematologic malignancy groups, respectively. Conclusion: The 28-day mortality rate of cancer patients with AKI undergoing CRRT was high in both the solid and hematologic malignancy groups. BMI, presence of oliguria, SOFA score, and albumin level were common predictors of 28-day mortality in the solid and hematologic malignancy groups, but a high heart rate and severe acidosis were prognostic factors only in the solid malignancy group.