No abstract available.
Kidney Diseases* ; Kidney* ; Obesity*

There are a variety of causes of intestinal obstruction, with the most common cause being malignant diseases; however, volvulus, inflammatory bowel disease or diverticulitis, radiation injury, ischemia, and pseudo-obstruction can also cause colonic obstruction. These are benign conditions; however, delayed diagnosis of acute intestinal obstruction owing to these causes can cause critical complications, such as perforation. Therefore, high levels of clinical suspicion and appropriate treatment are crucial. There are variable treatment options for colonic obstruction, and endoscopic treatment is known to be a less invasive and an effective option for such. In this article, the authors review the causes of benign colonic obstruction and pseudo-obstruction and the role of endoscopy in treating them.

Syndrome of inappropriate antidiuretic hormone secretion (SIADH), the most common cause of euvolemic hyponatremia, results from the inappropriate release of antidiuretic hormone. SIADH may be caused by a variety of malignant tumors, central nervous system (CNS) disorders, intrathoracic disorders, and pharmacological agents. We experienced a case of SIADH associated with sarcoidosis that involved the lungs and mediastinal lymph nodes. A 72-year-old male was admitted to hospital with epigastric and back pain. Laboratory tests showed hyponatremia and low serum osmolality, while the urine sodium concentration and urine osmolality were inappropriately high. A chest x-ray and computed tomography showed mediastinal lymph node enlargement, and a mediastinoscopic lymph node biopsy revealed a noncaseating granuloma. Brain magnetic resonance imaging showed no evidence of CNS sarcoidosis. Systemic corticosteroid therapy improved the observed mediastinal lymph node involvement, and tolvaptan as an SIADH treatment corrected the patient's abnormal sodium level and restored the laboratory findings to normal.
Aged ; Back Pain ; Biopsy ; Brain ; Central Nervous System Neoplasms ; Granuloma ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Lung ; Lymph Nodes ; Magnetic Resonance Imaging ; Male ; Osmolar Concentration ; Sarcoidosis ; Sodium ; Thorax

Because of increases in the elderly population and diabetic patients, the proportion of elderly among dialysis patients has rapidly increased during the last decades. The mortality and morbidity of these elderly dialysis patients are obviously much higher than those of young patients, but large analytic studies about elderly dialysis patients' characteristics have rarely been published. The registry committee of the Korean Society of Nephrology has collected data about dialysis therapy in Korea through an Internet online registry program and analyzed the characteristics. A survey on elderly dialysis patients showed that more than 50% of elderly (65 years and older) patients had diabetic nephropathy as the cause of end-stage renal disease, and approximately 21% of elderly dialysis patients had hypertensive nephrosclerosis. The proportion of elderly hemodialysis (HD) patients with native vessel arteriovenous fistula as vascular access for HD was lower than that of young (under 65 years) HD patients (69% vs. 80%). Although the vascular access was poor and small surface area dialyzers were used for the elderly HD patients, the dialysis adequacy data of elderly patients were better than those of young patients. The laboratory data of elderly dialysis patients were not very different from those of young patients, but poor nutrition factors were observed in the elderly dialysis patients. Although small surface area dialyzers were used for elderly HD patients, the urea reduction ratio and Kt/V were higher in elderly HD patients than in young patients.
Aged* ; Arteriovenous Fistula ; Diabetic Nephropathies ; Dialysis* ; Humans ; Internet ; Kidney Failure, Chronic ; Korea* ; Mortality ; Nephrology ; Nephrosclerosis ; Renal Dialysis ; Renal Replacement Therapy ; Urea

As the clinical outcomes improve in kidney transplantation, largely because of the prevention of loss due to acute rejection, the incidence of allograft loss due to recurrent glomerulonephritis have become more important. Actually recurrent glomerulonephritis is the third most common cause of graft failure, ranking only behind immunologic rejection and death with a functioning graft. Preventive and therapeutic treatment strategies are necessary for those patients at risk. Current newer immunosuppressive protocols over the past 10 years have not affected the rate of disease recurrence or graft loss. In a certain recurrent glomerulitis, for example membranous nephropathy, there is emerging evidence that rituximab may be efficacious; however, larger clinical trials are warranted.
Antibodies, Monoclonal, Murine-Derived ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Humans ; Immunoglobulin A ; Incidence ; Kidney Transplantation ; Recurrence ; Rejection (Psychology) ; Rituximab ; Transplantation, Homologous ; Transplants

Background: Due to the COVID-19 pandemic, from 2020, many pharmaceutical companies have developed vaccines. To determine the efficacy of AstraZeneca's and Pfizer's vaccines, which were the first and second vaccines to be approved in Korea, respectively, we developed a method to measure their antibody-generating efficacies using immunology analyzers and a rapid antibody test available in Korea. Methods: The antibody-stimulating efficacies of the Pfizer and AstraZeneca vaccines were evaluated using Centaur® XPT SARS-CoV-2 (Siemens Healthineers, Germany), Elecsys® AntiSARS-CoV-2 S (Roche Diagnostics, Germany), and STANDARD F SARS-CoV-2 nAb FIA (SD Biosensor, Korea). Healthcare workers were enrolled in two groups: the Pfizer (121) and AstraZeneca (117) groups. Antibody levels were measured pre-vaccination, three weeks after vaccination, and 16 weeks after vaccination. Results: The Pfizer group comprised 41 males and 80 females, while the AstraZeneca group comprised 38 males and 79 females. Antibody results were analyzed after excluding four individuals who had recovered from COVID-19. Between weeks 3 and 16, there was no significant difference (P= 0.5, 1.0) between the results of the Roche and Siemens antibody tests in the Pfizer vaccine group. However, the SD biosensor results comparing with the Roche and Siemens antibody tests at three weeks after the initial vaccination showed a significant difference (P < 0.0001). Analysis of the Roche antibody test results before, at three weeks, and at 16 weeks after the administration of the Pfizer and AstraZeneca vaccines revealed a statistically significant difference between before and at three weeks after the first injection (P < 0.0001). Conclusion After two doses of the Pfizer and AstraZeneca vaccines, antibody formation was above the 90 th percentile of the measurement range in all subjects.

BACKGROUND: In recent years, introduction of novel immunosuppressive agents and its proper implementation for clinical practice have contributed to improving clinical outcomes of kidney transplantation (KT). Here, we report clinical outcomes of KTs and related risk factors. METHODS: From July 1998 to June 2016, 354 KTs (182 from living and 172 from deceased donors) have been performed at Ulsan University Hospital. We retrospectively reviewed the clinical characteristics and outcomes of KT recipients, then estimated graft and patient survival rate were estimated and analyzed risk factors using Cox-regression. RESULTS: The median follow-up period was 53 months (range; 3 to 220 months). The mean ages of recipients and donors were 45.0 years (SD, 12.5) and 44.7 years (SD, 13.6) years, respectively. During follow-up, 18 grafts were lost and 5- and 10-year death-censored graft survival was 96.7% and 91.5%, respectively. Biopsy-proven acute rejection (BPAR) occurred in 71 patients (55 cases of acute cellular rejection and 16 of antibody-mediated rejection). Cox-regression analysis showed that BPAR was a risk factor related to graft loss (hazard ratio [HR], 14.38; 95% confidence interval [CI], 3.79 to 54.53; P < 0.001). In addition, 15 patients died, and the 5- and 10-year patient survival was 97.2% and 91.9%, respectively. Age ≥60 years (HR, 6.03; 95% CI, 1.12 to 32.61; P=0.037) and diabetes (HR, 6.18; 95% CI, 1.35 to 28.22; P=0.019) were significantly related to patient survival. CONCLUSIONS: We experienced excellent clinical outcomes of KT in terms of graft failure and patient survival despite the relatively high proportion of deceased donors. Long-term and short-term clinical outcomes have improved in the last two decades.
Follow-Up Studies ; Graft Survival ; Humans ; Immunosuppressive Agents ; Kidney Transplantation* ; Kidney* ; Retrospective Studies ; Risk Factors ; Survival Rate ; Tissue Donors ; Transplants ; Ulsan

BACKGOUND: In addition to recombinant human erythropoietin (rHuEPO) adequate iron replacement is essential to treatment of anemia in hemodialysis (HD) patients, and intravenous iron therapy has been recommended recently. But, low dose (100-200 mg/ month) intravenous iron sucrose regimen as a "maintenance therapy" in HD patients with adequate iron storage has not been established well. METHODS: We included the 40 of HD patients with serum ferritin of 200-500 ng/mL receiving rHuEPO therapy. During 4 months of study period, 100-200 mg/month of iron sucrose was administrated. rHuEPO doses were titrated to maintain target hematocrit (Hct) of 30%. To evaluate efficacy of iron sucrose, we compared serum ferritin, TSAT and rHuEPO requirements before and after iron sucrose therapy. RESULTS: Thirty-nine patients [mean age 61+/-13 yrs, M:F=20:19] completed this study. After low dose intravenous iron sucrose maintenance therapy, serum ferritin and TSAT significantly increased (370+/-84 vs. 518+/-155 ng/mL, p<0.001 and 26.0+/-9.7 vs. 31.1+/-11.8%, p=0.046). Mean weekly rHuEPO dose didn't significantly decrease (5,756+/-2,295 vs. 5,474+/-2,237 IU/week, p=0.441) but ERI significantly decreased (3.86+/-2.19 vs. 3.20+/-1.70 IU/week/kg/%, p=0.021). No iron overload defined as serum ferritin >800 ng/mL was observed during the study. CONCLUSION: Low dose intravenous iron sucrose maintenance therapy is effective and safe in the HD patient receiving rHuEPO therapy with adequate iron storage.
Anemia ; Erythropoietin ; Ferritins ; Hematocrit ; Humans ; Iron Overload ; Iron* ; Kidney Failure, Chronic ; Renal Dialysis* ; Sucrose*

A pyogenic liver abscess (PLA) mostly occurs in association with biliary tract disease, but some PLAs have no apparent underlying cause, i.e., they are cryptogenic. The authors experienced three cases of PLA or liver cyst infection after colon polypectomy without other distinct etiologies. These cases suggest that colonoscopic polypectomy can cause a mucosal defect that provides a route for bacteria to invade the portal system or spread intraperitoneally to the liver. Colonoscopic polypectomy should be considered as a procedure that might cause PLA. Moreover, clinicians should be aware of this possibility if a patient complains of fever or abdominal pain after a colonoscopic polypectomy.

Background/Aims: Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is a chronic inflammatory disorder of the gastrointestinal tract that requires lifetime management. Many studies have attempted to establish questionnaires and/or parameters to assess the quality of care for IBD patients. However, no study to date has investigated patients using the Q-methodology, which is subjective and has been studied systematically, to identify and categorize their opinions and subjective thinking about their disease and treatment. We have therefore aimed here to conduct a preliminary study of the Q-methodology to investigate the subjective thinking of IBD patients in Korea. Methods: Q-methodology, a method of analyzing the subjectivity of questionnaire items, was examined in this study. Inputs from 50 IBD patients were classified into 34 normalized statements using a 9-point scale with a normal distribution. The collected data were analyzed using the QUANL PC program. Results: Using the Q-methodology, IBD patients were classified into type I, II, III, and IV treatment needs: medical staff-dependent, relationship-oriented, information-driven, and social awareness, respectively. Conclusions The subjective needs of IBD patients and their thoughts about the treatment can be classified into four types. Our findings suggest that we can establish a systematic strategy for personalized care according to patient type.