Fulminant type 1 diabetes mellitus (FT1DM) is a clinical entity in which the process of beta-cell destruction and subsequent progression of hyperglycemia and ketoacidosis are extremely rapid. A 34-year-old woman without any known risk factor for diabetes mellitus experienced a sudden stillbirth at 30 weeks of gestation. She had normal oral glucose tolerance test during pregnancy. Her blood glucose level was 974 mg/dL. Her urine test for ketone bodies was positive. Her hemoglobin A1c level (6.8%) was near normal range at the first emergency room visit. These findings suggested a very recent onset of diabetes mellitus. Her serum C-peptide level was very low. Islet-related autoantibodies were undetectable. Her clinical course, biochemical, and immunological profiles were consistent with FT1DM. After fluid and insulin based management, beta-cell was rescued with insulin therapy during the evolution of FT1D. At 10 days after admission, maintenance dose of insulin was just 8 unit of insulin once daily. This is the first case of FT1DM with robust recovery in insulin secretion in a pregnant woman who had an initial manifestation of 3rd-trimester intrauterine fetal death in Korea.
Adult ; Autoantibodies ; Blood Glucose ; C-Peptide ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Emergency Service, Hospital ; Female ; Fetal Death* ; Glucose Tolerance Test ; Humans ; Hyperglycemia ; Insulin* ; Ketone Bodies ; Ketosis ; Korea ; Pregnancy ; Pregnant Women* ; Reference Values ; Risk Factors ; Stillbirth

Anti-erythropoietin antibodies usually cross-react with all kinds of recombinant erythropoietins; therefore, erythropoiesis-stimulating agent (ESA)-induced pure red-cell aplasia (PRCA) is not rescued by different ESAs. Here, we present a case of ESA-induced PRCA in a 36-yr-old woman with chronic kidney disease, whose anemic condition improved following reintroduction of darbepoetin-alpha. The patient developed progressive, severe anemia after the use of erythropoietin-alpha. As the anemia did not improve after the administration of either other erythropoietin-alpha products or erythropoietin-beta, all ESAs were discontinued. Oxymetholone therapy failed to improve the transfusion-dependent anemia and a rechallenge with ESAs continuously failed to obtain a sustained response. However, her anemia improved following reintroduction of darbepoetin-alpha at 3 yr after the initial diagnosis. Interestingly, anti-erythropoietin antibodies were still detectable, although their concentration was too low for titration. In conclusion, darbepoetin-alpha can improve ESA-induced PRCA when the anti-erythropoietin antibody titer declines and its neutralizing capacity is lost.
Adult ; Anemia/drug therapy/etiology ; Antibodies/*blood/immunology ; Bone Marrow Cells/pathology ; Drug Hypersensitivity/immunology ; Erythropoietin/*analogs & derivatives/therapeutic use ; Erythropoietin, Recombinant/adverse effects/*immunology/therapeutic use ; Female ; Glomerulonephritis, IGA/complications ; Hematinics/adverse effects/immunology/*therapeutic use ; Humans ; Kidney Failure, Chronic/complications ; Oxymetholone/therapeutic use ; Red-Cell Aplasia, Pure/chemically induced/*drug therapy/immunology

BACKGROUND/AIMS: Kidney transplantation (KT) reportedly provides a significant survival advantage over dialysis in diabetic patients. However, KT outcome in diabetic patients compared with that in non-diabetic patients remains controversial. In addition, owing to recent improvements in the outcomes of KT and management of cardiovascular diseases, it is necessary to analyze outcomes of recently performed KT in diabetic patients. METHODS: We reviewed all diabetic patients who received living donor KT between January 2008 and December 2011. Each patient was age- and sex-matched with two non-diabetic patients who received living donor KT during the same period. The outcomes of living donor KT were compared between diabetic and non-diabetic patients. RESULTS: Among 887 patients, 89 diabetic patients were compared with 178 non-diabetic patients. The incidence of acute rejection was not different between the diabetic and non-diabetic patients. Urinary tract infection and other infections as well as cardiovascular events occurred more frequently in diabetic patients. However, diabetes, cardiovascular disease, and infection were not significant risk factors of graft failure. Late rejection (acute rejection after 1 year of transplantation) was the most important risk factor for graft failure after adjusting for diabetes mellitus (DM), human leukocyte antigen mismatch, rejection and infection (hazard ratio, 56.082; 95% confidence interval, 7.169 to 438.702; p < 0.001). Mortality was not significantly different between diabetic and non-diabetic patients (0 vs. 2, p = 0.344 by log-rank test). CONCLUSIONS: End-stage renal disease patients with DM had favorable outcomes with living donor kidney transplantation.
Cardiovascular Diseases ; Diabetes Mellitus ; Dialysis ; Humans ; Incidence ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Leukocytes ; Living Donors* ; Mortality ; Risk Factors ; Transplants ; Urinary Tract Infections

Background: Demographic change and advances in technology affect transurethral surgery and outpatient procedures in the urologic field. There are few population-based studies that accurately assess the trend of transurethral surgery and outpatient procedures including diagnostic tests. We investigated the recent epidemiologic trends in transurethral surgeries and urological outpatient procedures from 2009 to 2016 in Korea using the entire populationbased cohort. Methods: We analyzed medical service claim data of transurethral surgery, urological outpatient procedures submitted by medical service providers from the Health Insurance Review and Assessment Service from 2009 to 2016. Results: Transurethral ureter surgery increased by 134.9% from 14,635 in 2009 to 34,382 in 2016 (B = 2,698; R ² = 0.98; P < 0.001). The transurethral bladder surgery increased by 65.5% from 12,482 in 2009 to 20,658 in 2016 (B = 1,149; R ² = 0.97; P < 0.001). Over the 8-years period, there were not significant changes in transurethral prostate (B = 43; R ² = 0.04; P = 0.617) and urethral surgery (B = −12; R ² = 0.18; P = 0.289). The significantly increasing trends in cystoscopy (B = 5,260; R ² = 0.95; P < 0.001) and uroflowmetry (B = 53,942; R² = 0.99; P < 0.001) were observed during the 8-year period. There was no difference in bladder catheterization during the 8-year period. Urodynamic study (UDS: B = −2,156; R ² = 0.77; P = 0.003) and electrical stimulation treatment (EST: B = −1,034; R ²= 0.87; P < 0.001) significantly decreased. Conclusion In Korea, transurethral ureter surgery and transurethral bladder surgery have been continuously increasing. Transurethral prostate surgery and transurethral urethral surgery remained constant with no increase or decrease. Cystoscopy and uroflowmetry continue to increase, while UDS and EST continue to decrease.

PURPOSE: Liver disease is one of the most common causes of hyponatremia and improper management of severe hyponatremia may result in serious complications. We evaluated the prevalence and clinical characteristics of severe hyponatremic patients according to the presence of liver disease in hospitalized patients. METHODS: We studied 12,729 hyponatremic patients during hospitalization in single tertiary referral hospital for 1 year. Hyponatremia was defined as serum sodium level <135 mmol/L and severe hyponatremia as < or =125 mmol/L at least twice. RESULTS: Of 12,729 hyponatremic patients, 711 (0.13%) patients had severe hyponatremia and 290 (40.8%) patients with severe hyponatremia had liver disease. The main cause of severe hyponatremia was liver failure (69.7%) in patients with liver disease and excessive administration of hypotonic fluid (37.3%) in non-liver disease patients. The administration of hypertonic saline was the most common treatment both in liver and non-liver disease group. In severe hyponatremic liver disease patients, the serum sodium level was lower (128.8+/-7.1 at admission, 127.1+/-8.4 at discharge vs 132.1+/-7.5, 131.5+/-8.3 mmol/L) and the duration of severe hyponatremia (5 days vs 3 days) was longer than those in non-liver disease group. Of 589 patients with severe hyponatremic patients who had been treated for the sodium correction, 261 patients were recovered from severe hyponatremia to normal range of serum sodium, and lower correction rate was observed in liver disease group. CONCLUSION: Liver failure was the most common cause of severe hyponatremia in hospitalized patients. Severe hyponatremia in patients with liver disease had poor clinical outcomes.
Hospitalization ; Humans ; Hyponatremia ; Inpatients ; Liver ; Liver Diseases ; Liver Failure ; Prevalence ; Reference Values ; Sodium ; Tertiary Care Centers