BACKGROUND: The diabetic milieu augments the expression of transforming growth factor-beta1 (TGF-beta1) in mesangial cells, which, in turn, stimulates the accumulation of extracellular matrix in glomeruli. Accordingly, mesangial cells have been shown to produce increased amount of TGF-beta1 when exposed to high glucose concentrations in vitro. METHODS: In the present study, we examined the effects of antisense TGF-beta1 gene transfer on the expressions of several cytokines implicated in kidney fibrosis. The DNA fragment containing bases -162 to +168 of rat TGF-beta1 sequence was isolated by reverse transcription-polymerase chain reaction (RT- PCR) from rat kidney tissue. This PCR product was ligated in the xbaI-KpnI restriction sites of a shuttle vector in forward and reverse orientations and replication defective recombinant adenoviral vectors containing either the sense or antisense TGF-beta1 genes under the control of a cytomegalovirus promoter - rAdTGFbeta1S and rAdTGFbeta1AS, respectively - were generated. Rat mesangial cells infected with recombinant adenoviruses were grown in normal (NG, 100 mg/dL) or high glucose (HG, 450 mg/dL) media for six days, and mRNA expressions of the monolayers were evaluated by RT-PCR. RESULTS: An adenoviral vector containing the antisense TGF-beta1 gene significantly downregulated the gene expressions of TGF-beta1, collagen, fibronectin and PDGF-B in cultured rat mesangial cells. CONCLUSION: The expression of fibrogenic molecules were significantly attenuated by adenoviral vectors with antisense TGF-beta1, and such results should be confirmed in the future study of animal models of diabetic nephropathy or chronic kidney diseases.
Adenoviridae ; Animals ; Collagen ; Cytokines ; Cytomegalovirus ; Diabetic Nephropathies ; DNA ; Extracellular Matrix ; Fibronectins ; Fibrosis ; Gene Expression ; Genetic Vectors ; Glucose ; Kidney ; Mesangial Cells* ; Models, Animal ; Polymerase Chain Reaction ; Rats* ; Renal Insufficiency, Chronic ; RNA, Messenger ; Transforming Growth Factor beta1

No abstract available.
Hemodiafiltration ; Hyperpigmentation ; Skin

PURPOSE: Automated peritoneal dialysis (APD) is increasingly used due to freedom from daytime exchanges and flexibility of prescription. In this study, we compared APD with continuous ambulatory peritoneal dialysis (CAPD) to assess the influence of mode of PD on various measures of clinical performance. METHODS: We followed 26 APD patients prospectively over a 12-month period and compared them with 16 CAPD patients in whom examinations of dialysis dose and residual renal function (RRF) at least twice during the 1st one year after dialysis were done. Weekly Kt/V urea (Kt/V) and standard creatinine clearance (SCCr) of PD, and RRF (24hr urine creatinine clearance) were measured at 1st month, 6th month and 12th month after start of dialysis. In addition, serial biochemical tests were analyzed every three months during this period. RESULTS: No statistically significant differences in baseline characteristics, RRF, SCCr and Kt/V were observed between APD and CAPD patients. Serum concentrations of bicarbonate, hemoglobin, and calcium tended to be higher in the APD group and actually serum bicarbonate levels at 9 months, calcium levels at 12 months and hemoglobin levels at 6 and 9 months were significantly higher in APD patients (p<0.05). There was no significant difference in serum sodium concentrations and peritonitis rate between the two groups. CONCLUSION: No significant differences were observed between APD and CAPD in Kt/V, SCCr and RRF for one year after start of PD. APD, however, may be advantageous in improving several biochemical markers such as blood levels of hemoglobin, bicarbonate, and calcium compared to CAPD.
Biochemistry ; Biomarkers ; Calcium ; Creatinine ; Dialysis ; Diphosphonates ; Freedom ; Hemoglobins ; Humans ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Pliability ; Prescriptions ; Prospective Studies ; Sodium ; Urea

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

PURPOSE: Renal graft mass has been known as a determinant of the outcome after kidney transplantation. We evaluated the correlation between the donated kidney weight and the recipient's creatinine clearance (Ccr), the donated kidney weight and serum creatinine (Scr) as well as the correlation between the donor traits and graft function after living-donor transplantation in adults. METHODS: The weight of a donated kidney was measured just after flushing during the operative procedures, and the recipient's Scr was measured on a daily basis postoperatively. When the Scr of the recipient reached the baseline level, we collected the recipient's 24-hour urine for the Ccr calculation. Based on the measured body weight and height, body surface area (BSA) and lean body weight (LBW) were calculated. Pearson correlation analysis was carried out using the SPSS. RESULTS: The weight of donated kidney was significantly correlated with the post-transplant recipient's Ccr (P=0.022). Scr was significantly correlated with the variable of graft weight/ recipient body weight ratio (P=0.047, Pearson correlation=-0.539), graft weight/recipient BSA ratio (P=0.028, Pearson correlation=-0.438), graft weight./recipient LBW ratio (P=0.001, Pearson correlation=-0.603), donor body weight/recipient body weight ratio (P<0.001, Pearson correlation= 0.667), donorBSA/recipient BSA ratio (P<0.001, Pearson correlation=0.743), donor LBW/recipient LBW ratio (p<0.001 Pearson correlation=0.759). CONCLUSIONS: It may be appropriate to select potential living donors based on the predicted size of the kidney, especially for the recipient who will likely to have higher metabolic demands.
Adult ; Body Height ; Body Weight ; Creatinine ; Flushing ; Humans ; Kidney Transplantation* ; Kidney* ; Living Donors* ; Surgical Procedures, Operative ; Tissue Donors ; Transplants*

BACKGROUND: TGF-beta1 is the main fibrogenic cytokine associated with human glomerulonephritis. TGF-beta1 levels were found to be significantly increased in the urine of patients with IgA nephropathy. However, urinary TGF-beta1 excretion has so far not been evaluated with respect to the risk of kidney disease progression. METHODS: In the current study, urine samples were taken for TGF-beta1 protein analysis from 37 patients diagnosed with IgA nephropathy on the day of renal biopsy, and patients were followed until either the date of serum creatinine doubling or until the end of the follow-up period. RESULTS: The median follow-up was 3.6 years (range, 0.4-6.2 years). Urinary TGF-beta1/creatinine ratios (TGF-beta1/Cr, pg/mg) were significantly higher in IgA nephropathy patients than in normal controls (10.7+/-1.92 versus 2.38+/-0.52). The area under the receiver-operating-characteristics curve was 0.78 (P<0.05, 95% confidence interval 0.61-0.90), indicating that urinary TGF-beta1/Cr is an excellent predictor of kidney disease progression. Univariate Cox regression analysis showed that urinary TGF-beta1/Cr was the most powerful predictor of serum creatinine doubling (p=0.0026, relative risk 1.09, 95% confidence interval 1.03-1.15). Furthermore, multivariate Cox regression analysis adjusted for other confounders revealed that urinary TGF-beta1/Cr was the only significant predictor of serum creatinine doubling. In contrast, serum TGF-beta1 levels were not found to be a risk factor of kidney disease progression. CONCLUSION: Our findings provide new evidence of a robust association between urinary TGF-beta1 and kidney disease progression in patients with IgA nephropathy.
Biopsy ; Creatinine ; Follow-Up Studies ; Glomerulonephritis ; Glomerulonephritis, IGA ; Humans ; Kidney Diseases* ; Kidney* ; Risk Factors ; Transforming Growth Factor beta1

BACKGROUND/AIMS: It has been shown that circulating tumor necrosis factor α (TNF-α) is elevated in end stage renal disease patients; however, the relationship between TNF-α and the development of infection in these patients is unknown. In this study, we investigated the association of plasma TNF-α and interleukin 6 (IL-6) with infection in peritoneal dialysis (PD) patients. We also evaluated the association of their plasma levels with the production by peripheral blood mononuclear cells (PBMC), and with various clinical parameters. METHODS: We enrolled 32 patients on maintenance PD and 10 healthy controls. Plasma and PBMC were isolated from blood. PBMC were stimulated with lipopolysaccharide in vitro. RESULTS: Mean follow-up duration was 775 days. Six patients developed organ infections (five pneumonia and one liver abscess), and six patients developed PD peritonitis and eight developed exit site infection. Plasma TNF-α and IL-6 levels were significantly elevated in organ infections but not in peritonitis or in exit site infection. Plasma TNF-α was the only significant risk factor for organ infections and pneumonia in multivariate regression analysis. Patients with high plasma TNF-α levels showed a significantly greater cumulative hazard rate for organ infections compared to those with low TNF-α levels. Plasma TNF-α levels correlated with TNF-α production by PBMC and showed an inverse association with Kt/V. CONCLUSIONS: This is the first study showing that plasma TNF-α is a significant risk factor for infection in PD patients.
Follow-Up Studies ; Humans ; In Vitro Techniques ; Interleukin-6 ; Kidney Failure, Chronic ; Liver ; Peritoneal Dialysis* ; Peritonitis ; Plasma ; Pneumonia ; Risk Factors* ; Tumor Necrosis Factor-alpha*

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: Basiliximab has become widely used in clinical practice for initial immunosuppression in renal transplantation cases, to reduce the incidence of acute rejection without adverse events. Herein, we report the early outcomes of renal transplantation using basiliximab at a single center. METHODS: This retrospective study included 148 renal allograft recipients at a single center. All patients were followed for longer than 1 year after transplantation, and treated with a calcineurin inhibitor and steroids for maintenance immunosuppression. The use of basiliximab and mycophenolate mofetil (MMF) was optional. We compared the incidence of episodes of acute graft rejection in kidney recipients who were treated with basiliximab as an initial immunosuppressive therapy with those who were treated without basiliximab. RESULTS: Basiliximab was used for initial immunosuppression in 58 patients. Patients maintained immunosuppression with triple (n=69) or double (n=79) regimens including a calcineurin inhibitor (cyclosporine A (n=111) or tacrolimus (n=37)) and methylprednisolone with or without MMF. Thirty-six (24.3%) patients had a rejection episode within 1 year after transplantation and twenty-six (17.6%) patients had an episode of infection. The patients who were treated with basiliximab had fewer rejection episodes (n=11, 18.9%) within the first year after transplantation than the patients who did not take basiliximab (n=25, 27.7%); this difference was not statistically significant. (P=0.245). However, basiliximab significantly affected the number of rejection episodes in the double regimen group (P=0.006), but not the number of rejections in the triple regimen group (P=0.432) and did not affect the number of infection episodes in both groups (P value of double, triple=0.291, 0.772) within one year after transplantation. CONCLUSION: The results of this study suggest that basiliximab might be more useful for graft recipients who are treated with double immunosuppression with a calcineurin inhibitor and steroid than for the recipients with triple immunosuppression including MMF.
Allografts* ; Calcineurin ; Graft Rejection ; Humans ; Immunosuppression ; Incidence* ; Kidney ; Kidney Transplantation ; Methylprednisolone ; Retrospective Studies ; Steroids ; Tacrolimus ; Transplants

Mushroom-related poisoning can cause acute kidney injury. Here we report a case of acute kidney injury after ingestion of Amanita punctata, which is considered an edible mushroom. Gastrointestinal symptoms occurred within 24 hours from the mushroom intake and were followed by an asymptomatic period, acute kidney injury, and elevation of liver and pancreatic enzymes. Kidney function recovered with supportive care. Nephrotoxic mushroom poisoning should be considered as a cause of acute kidney injury.
Acute Kidney Injury* ; Agaricales ; Amanita* ; Eating ; Kidney ; Liver ; Mushroom Poisoning ; Poisoning*