BACKGROUND: Human high density lipoprotein (HDL) is known to stimulate endothelin-1 (ET-1) production through the phospholipase C (PLC)/Ca2+/ protein kinase C (PKC) pathway. Calcium channel blockers may be involved in the decrease of HDL- induced ET-1 production. This study was designed to evaluate whether HDL-induced ET-1 production was affected by Ca2+ channel blockers in cultured human proximal tubular cells (PTC). METHODS: The human PTC were obtained from human nephrectomized tissues, and cultured in six different media, which were bovine serum free (SF) DMEM/F12 medium alone, and five other SF DMEM/F12 media with 200 microgram/ml of HDL, with 200 microgram/ml of HDL and each 10 micrometer of diltiazem, nifedipine, and verapamil solved in 100% ethanol 0.1 volume%, and with 200 microgram/ml of HDL and 0.1 volume% of 100% ethanol as a control. After 24 hours of exposure, ET-1 in the supernatant was measured by radioimmunoassay, and ET-1 level in each well were marked as pg ET-1/mg cell protein/ 24 hr in consideration of cell count. RESULTS: In SF medium, ET-1 production was 1.803+/-0.295pg/mg cell protein/24 hr. In SF medium with 200 microgram/ml of HDL, ET-1 production significantly increased from 1.803+/-0.295 to 10.860+/-0.476 pg/mg cell protein/24 hr (P<0.05). In SF medium with 200 microgram/ml of HDL and 100% ethanol 0.1 volume%, ET-1 production significantly decreased from 10.860+/-0.476 to 6.700+/-1.273pg/mg cell protein/ 24 hr (P<0.05). In SF media with 200 microgram/ml of HDL and each 10 micrometer of diltiazem, nifedipine, and verapamil solved in 100% ethanol 0.1 volume%, ET- 1 production was decreased from 6.700+/-1.273 to 4.043+/-1.550 by diltiazem (P<0.05), to 3.260+/-0.752pg/ mg cell protein/24 hr by verapamil (P<0.05), and to 4.414+/-1.567pg/mg cell protein/24 hr by nifedipine (P=0.067). CONCLUSION: These results suggest that the HDL- induced ET-1 production in cultured human PTC was significantly decreased by diltiazem and verapamil, and it seemed to be decreased by nifedipine.
Calcium Channel Blockers* ; Calcium Channels* ; Calcium* ; Cell Count ; Diltiazem ; Endothelin-1* ; Ethanol ; Humans* ; Lipoproteins ; Nifedipine ; Protein Kinase C ; Radioimmunoassay ; Type C Phospholipases ; Verapamil

Systemic sclerosis is a generalized connective tissue disorder. It is characterized by fibrosis, degenerative changes and vascular lesions affecting the skin, joints, skeletal muscles and multiple internal organs. Clinical renal disease in systemic sclerosis ranges from scleroderma renal crisis to more subtle abnormalities. Scleroderma renal crisis is characterized by malignant hypertension and rapidly progressive renal failure. It can be successfully treated with angiotensin converting enzyme inhibitors, but remains the most feared complication of systemic sclerosis. We have experienced a 57 year old female patient who visited emergency room with a sudden onset of mental deterioration, azotemia and oliguria. She was under symptomatic treatment for Raynaud's phenomenon for 2 years. Renal biopsy of the patient showed onion-skin configuration in the interlobular arteries which is characteristic of scleroderma renal crisis. She proceded to maintenance hemodialysis despite a angiotensin converting enzyme inhibitor treatment. We report a case of SRC with a brief review of literature.
Angiotensin-Converting Enzyme Inhibitors ; Arteries ; Azotemia ; Biopsy ; Connective Tissue ; Emergency Service, Hospital ; Female ; Fibrosis ; Humans ; Hypertension ; Hypertension, Malignant ; Joints ; Middle Aged ; Muscle, Skeletal ; Oliguria ; Peptidyl-Dipeptidase A ; Renal Dialysis ; Renal Insufficiency ; Scleroderma, Systemic ; Skin

No abstract available.
Fistula*

BACKGROUND: Malnutrition in maintenance hemodialysis(HD) patients has been referred to underdialysis with low protein intake and to metabolic acidosis. However, the respective effects of underdialysis, protein intake and metabolic acidosis have not been clearly demonstrated. To evaluate the role of the dialysis dose, protein intake and metabolic acidosis on nutrition, we measured the predialysis serum HCO3, pH, serum albumin, PCRn, Kt/V, and BMI in 41 uremic patients on maintenance bicarbonate HD for 66.93+/-51.86 months. Patients with chronic liver diseases, malignancies, diabetes and cachexia were excluded. RESULTS: Mean age was 46+/-13 years; Kt/V, 1.22+/-0.27; PCRn, 0.90+/-0.16g/kg/day; serum albumin, 4.2+/-0.21g/dL; BMI, 20.47+/-2.09kg/m2; HCO3, 18.4+/-2.9mEq/L; Serum albumin showed a significant direct correlation with PCRn(p=0.001), and a significant inverse correlation with serum HCO3(r=0.43, p<0.01) but no correlation with Kt/V and BMI. PCRn showed a significant inverse correlation with serum HCO3(p<0.01), and a direct correlation with Kt/V(p<0.05). Multiple regression analysis confirmed the significant role of protein intake but not of Kt/V and serum bicarbonate, on serum albumin concentrations. Dividing patients into two groups, serum albumin was 4.05+/-0.34g/dL in those with HCO3 <20mEq/L and 3.95+/-0.24g/dL in those with HCO3 >or=20mEq/L. PCRn in the former was 0.94+/-0.6g/kg/day and in the latter 0.80+/-0.14g/kg/day(p<0.05). The role of PCRn appeared to be more important than metabolic acidodsis in determining the serum albumin levels. CONCLUSIONS: In patients hemodialyzed with relatively adequate Kt/V and whose serum bicarbonate levels maintained within mild acidosis range, PCRn may exert a detrimental effect on serum albumin concentration.
Acidosis ; Cachexia ; Dialysis ; Humans ; Hydrogen-Ion Concentration ; Liver Diseases ; Malnutrition* ; Renal Dialysis* ; Serum Albumin

BACKGROUND: Recombinant human erythropoietin (rHuEPO) has become attractive option of anemia therapy in chronic hemodialysis patients, but the use of rHuEPO is primarily limited by its high cost. So, the current cost-containment policy renders valuable any strategies that enhances the erythropoietic response to rHuEPO, thus resulting in lower rHuEPO dosing. Before the widespread availability of rHuEPO, androgen was the mainstay of nontransfusional therapy for the anemia of end-stage renal failure. However, previous studies that used androgen to enhance the response to rHuEPO showed variable results. METHODS: We carried out a prospective study to examine the effect of adjuvant androgen on anemia and nutritional parameters in chronic hemodialysis patients using low-dose rHuEPO. Studies were performed in seventeen hemodialysis patients previously treated with low-dose rHuEPO (1,000 U rHuEPO subcutaneously three times a week), mean hemoglobin < 9.0 g/dL for 6 months (group A: before adjuvant androgen therapy). Same patients received the same dose of rHuEPO plus nandrolone decanoate 100 mg intramuscularly weekly for 6 months (group B: after adjuvant androgen therapy). RESULTS: Transferrin saturation, serum ferritin, intact serum parathyroid hormone, plasma aluminium, ALT, ESR, albumin, PCRn and Kt/V were not significantly changed before and after adjuvant androgen therapy. The increase in hemoglobin and hematocrit in the group B was statistically greater than in the group A, respectively (8.99+/-1.39 g/dL vs 7.75+/-0.90 g/dL; p=0.001, 26.66+/-3.91% vs 23.68+/-2.85%; p= 0.003, respectively). With the exception of mild discomfort at the injected site, there were no significant side effects from nandrolone decanoate. CONCLUSION: Adjuvant androgen in patients treated with low-dose rHuEPO is effective treatment for the anemia of poor responsive patients to low-dose rHuEPO and lower the economical cost compared with the higher dose rHuEPO treatment alone.
Anemia* ; Erythropoietin* ; Ferritins ; Hematocrit ; Humans ; Humans* ; Kidney Failure, Chronic ; Nandrolone ; Parathyroid Hormone ; Plasma ; Prospective Studies ; Renal Dialysis* ; Transferrin

BACKGROUND: Recombiant human erythropoietin (epoetin) has greatly contributed to improvement of the anemia of chronic renal failure patients on hemodialysis. However, the reduced erythropoietic effect to epoetin and its high cost have induced lots of supplementary treatments. Therefore, we performed a prospective study to evaluate the effects of adjuvant low-dose androgen therapy in patients using a lower-dose of epoetin than the commonly recommended dose on anemia and the nutritional parameters. METHODS: 17 patients of hemoglobin (Hgb) less than 9 g/dL even after being treated with 1,000 U epoetin subcutaneously (s.c.) 3 times per week on a stable status for more than 6 months, who were on hemodialysis at our institution were examined. They were injected with the same dose of epoetin s.c. and nandrolone decanoate 100 mg intramuscularly (i.m) weekly for another 6 months. Blood test was performed every month before therapy for 6 months and after therapy for 6 months and the mean values were reviewed for comparison. RESULTS: Hgb (7.75+/-0.9 vs 8.99+/-1.39 g/dL, p < 0.01) and hematocrit (Hct) (23.68+/-2.85 vs 26.66+/-3.91%, p < 0.01) were apparently changed before and after adjuvant therapy. Hgb and Hct, weekly dose of epoetin were not statistically different in 9 male patients before and after adjuvant therapy. The weekly dose of epoetin was not statistically different in 8 female patients, but Hgb and Hct (8.02+/-0.6 vs 9.72+/-1.31 g/dL, 24.54+/-1.7 vs 28.74+/-3.06%, p < 0.01) were statistically different before and after adjuvant therapy. In comparison between male and female groups, weekly doses of epoetin and nandrolone decanoate were significantly greater in the female group than the male group (epoetin; 50.66+/-6.23 vs 61.18+/-8.76 U/kg/week, nandrolone decanoate; 1.69+/-0.2 vs 2.04+/-0.29 mg/kg/week, p < 0.05). CONCLUSION: Our data show that the adjuvant androgen therapy is effective for the anemia of hemodialysis patients who did not recover from anemia even after being continuously treated with low-dose epoetin.
Adult ; Anabolic Steroids/*administration & dosage/blood ; Anemia, Aplastic/blood/*drug therapy ; Chemotherapy, Adjuvant ; Erythropoiesis/drug effects ; Erythropoietin, Recombinant/*administration & dosage/blood ; Female ; Human ; Kidney Failure, Chronic/blood/drug therapy ; Male ; Middle Age ; Nandrolone/*administration & dosage/blood ; Nutritional Status ; Prospective Studies ; *Renal Dialysis

Toxic epidermal necrolysis (T~EN) is a severe mucocutaneous disease characterized by epidermal necrosis possibly extended to the entire body surface and involving multiple internal organs. Digestive tract may be involved too, but there is few report about gastrointestinal lesion in patient with TEN. Recently we experienced a case of TEN with gastrointestinal bleeding in previously healthy 32-year-old woman. The condition developed three days after the initiation of treatment with NSAID and progressed caudally, involving 60 percent of the skin surfaces. During a period of admission gastrointestinal bleeding was noticed. The gastrofiberscopy showed diffuse superficial mucosal lesion with oozing from swollen friable and erythematous mucosa. The skin lesion was progressed inspite of withdrawal of causative agents. The patient was expired due to combined septic shock 10 days later. We report this case with gastrofiberscopic findings and a brief review of literature.
Adult ; Female ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Mucous Membrane ; Necrosis ; Shock, Septic ; Skin ; Stevens-Johnson Syndrome*

Candida albicans cystitis is an uncommon but well described complication of modern therapeutics. The significance of systemic factors in the defense of the urinary tract against candidal infection is unknown. However, secretions from the prostate grand in men and from periurethral glands in women have been reported to be fungistatic. Conditions that predispose to candiduria include diabetes mellitus, antibiotic and corticosteroid therapy and disturbance of urine flow. Cystoscopy with bladder biopsy are necessary to rule out bladder tumor. We report a case of BPH with candidal cystitis and review the relevant literatures.
Biopsy ; Candida albicans* ; Candida* ; Cystitis* ; Cystoscopy ; Diabetes Mellitus ; Female ; Humans ; Male ; Prostate ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Tract

Microscopic polyangiitis is a systemic small vessel vasculitis, which, although primarily associated with necrotizing and crescentic glomerulonephritis and pulmonary capillaritis, often has cutaneous and muscul-oskelectal features. Microscopic polyangiitis is strongly associated with antineutrophil cytoplamic autoantibody that are a useful diagnostic serologic marker for the most common form of necrotizing vasculitis, and that have two patterns(C-ANCA and P-ANCA). We have experienced a case of microscopic polyangiitis with purpurae on both lower extrimities, C-ANCA positive and cresent formation on renal biopsy, which had no history of asthma and no pathologic evidence of granuloma. In our case, deterioration of renal function was recovered after steroid pulse therapy.
Antibodies, Antineutrophil Cytoplasmic ; Asthma ; Biopsy ; Glomerulonephritis ; Granuloma ; Microscopic Polyangiitis* ; Purpura ; Vasculitis

We report here a case of pulmonary benign metastasizing leiomyoma from the uterus in a 45 year old woman. The patient presented for investigation of multiple pulmonary nodules on a routine chest roentgenogram. The patient had undergone uterine myomectomy due to uterine leiomyoma 10 years earlier. We performed thoracoscopic wedge resection for definitive diagnosis. Histologically, spindle shaped smooth muscle cells appeared between collagen stroma, histology similar to that seen in uterine myoma. The tumor tissue tested positive for estrogen and progesterone receptors. The pathological findings were consistent with benign metastasizing leiomyoma. The patient was in pre-menopause. She received no specific treatment for lung tumors, and we did not found any changes in the lesions after one year follow up without any medication.
Collagen ; Diagnosis ; Estrogens ; Female ; Follow-Up Studies ; Humans ; Leiomyoma* ; Lung ; Lung Neoplasms ; Middle Aged ; Multiple Pulmonary Nodules ; Myocytes, Smooth Muscle ; Neoplasm Metastasis ; Premenopause ; Receptors, Progesterone ; Thorax ; Uterine Myomectomy ; Uterus