Hypernatremia developing in nonhospitalized adults is predominantly a disease of the elderly and mentally handicapped patients, possibly revealing inadequate nursing care of these patients. It has long been claimed that the duration of hypernatremia and its rate of correction are correlated with improvement in patients' neurologic status. Since there are only a handful of cases with serum sodium levels greater than 200 mEq/L until recently, it is not clear at what rate plasma sodium concentration can be safely normalized in severe hypernatremic patients. We report a case of severe hypernatremia with survival. This patient underwent rapid correction of serum sodium concentration during the management of this metabolic derangement using isotonic solution.
Journal Article ; Female ; Human ; Hypernatremia/therapy* ; Hypernatremia/physiopathology ; Hypernatremia/blood ; Middle Age ; Sodium/blood* ; Treatment Outcome

PURPOSE: Vesicoureteral reflux (VUR) in a transplanted kidney may affect the function of a grafted kidney with a recurrent urinary tract infection (UTI), and is a factor of graft failure. Our experience of surgical correction was investigated by performing transvesical ureteral reimplantation in VUR recipients. MATERIALS AND METHODS: Among 2,265 recipients, who had received a living kidney transplantation at Yonsei University Severance Hospital between April 1979 and October 2003, and 29 VUR recipients (7 Men, 22 Women), diagnosed with VCUG after recurrent UTI, were retrospectively analyzed. The mean age of the patients was 43.9, ranging from 24 to 61 years, with a mean follow up of 3.6, ranging from 0.7 to 8.0 years. The changes in the serum creatinine and complications after a transvesical ureteral reimplantation were analyzed. RESULTS: The incidence of VUR was 1.28% (29/2,265) and the mean diagnosis was made after 5.0, ranging from 0.8 to 13.4 years. The grades of VUR were 2 (I), 2 (II), 20 (III) and 5 (IV). Twenty-five recipients underwent a transvesical ureteral reimplantation. The mean serum creatinine decreased from 2.5+/-2.2 to 1.8+/-1.4mg/dl (p=0.14) 1 year after surgical correction, and was significantly decreased from 2.5+/-2.2 to 1.4+/-0.7mg/dl (p=0.017) 3 years after surgical correction. There were no UTI and acute pyelonephritis after a ureteral reimplantation. CONCLUSIONS: VUR, with recurrent UTI, in recipients administered an immunosuppressive agent may cause deterioration of the graft function. The suspicion of VUR should be borne in mind for renal recipients with recurrent UTI, which can be safely corrected by a transvesical ureteral reimplantation.
Creatinine ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Male ; Pyelonephritis ; Replantation ; Retrospective Studies ; Transplantation* ; Transplants ; Ureter ; Urinary Tract Infections ; Vesico-Ureteral Reflux*