No abstract available.
Humans*

Posttransplant diabetes mellitus, a complication due to corticosteroids and the calcineurin inhibitors, cyclosporine and tacrolimus, is commonly regarded as a form of type 2 diabetes mellitus. Diabetes ketoacidosis, which requires relative insulin deficiency to impair fatty acid metabolism, is a complication of type 1 diabetes mellitus. We report two patients who presented with diabetic ketoacidosis after kidney transplantation. Two patients presented with severe hyperglycemia, significant ketosis and metabolic acidosis of variable severity. One patient was treated with a cyclosporine-based regimen, and the other with a tacrolimus-based regimen. Both were found to have moderate to high serum levels of calcineurin inhibitors on presentation. Our experience suggests that post-transplant diabetes mellitus, in association with calcineurin inhibitor, may result in ketoacidosis either secondary to relative beta cell dysfunction, peripheral insulin resistance, or a combination of the two effects. Post transplant diabetes mellitus can be an atypical form of adult-onset diabetes with features of both type 1 and type 2 diabetes mellitus.
Acidosis ; Adrenal Cortex Hormones ; Calcineurin ; Cyclosporine ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diabetes Mellitus, Type 2 ; Diabetic Ketoacidosis ; Humans ; Hyperglycemia ; Insulin ; Insulin Resistance ; Ketosis ; Kidney Transplantation ; Metabolism ; Tacrolimus

Posttransplant diabetes mellitus, a complication due to corticosteroids and the calcineurin inhibitors, cyclosporine and tacrolimus, is commonly regarded as a form of type 2 diabetes mellitus. Diabetes ketoacidosis, which requires relative insulin deficiency to impair fatty acid metabolism, is a complication of type 1 diabetes mellitus. We report two patients who presented with diabetic ketoacidosis after kidney transplantation. Two patients presented with severe hyperglycemia, significant ketosis and metabolic acidosis of variable severity. One patient was treated with a cyclosporine-based regimen, and the other with a tacrolimus-based regimen. Both were found to have moderate to high serum levels of calcineurin inhibitors on presentation. Our experience suggests that post-transplant diabetes mellitus, in association with calcineurin inhibitor, may result in ketoacidosis either secondary to relative beta cell dysfunction, peripheral insulin resistance, or a combination of the two effects. Post transplant diabetes mellitus can be an atypical form of adult-onset diabetes with features of both type 1 and type 2 diabetes mellitus.
Acidosis ; Adrenal Cortex Hormones ; Calcineurin ; Cyclosporine ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diabetes Mellitus, Type 2 ; Diabetic Ketoacidosis ; Humans ; Hyperglycemia ; Insulin ; Insulin Resistance ; Ketosis ; Kidney Transplantation ; Metabolism ; Tacrolimus

The term type II membranoproliferarive glomerulonephritis (MPGN) refers to the histopathologic entity characterized by dense intramembranous deposits. It have a variable clincal courses, frequently occurs in older children and young adult. In comparison with The western, the idiopathic membranoproliferative glomerulonephritis (MPGN) has a lower frequency than secondary MPGN. Especially, of the idiopathic MPGN, the frequency of type 2 MPGN, so called dense deposit disease, is very rare in Korea. We are reporting two cases of type II MPGN, which was proven by renal biopsy. The clinical manifestations were recurrent gross hematuria in one patient and persistent nephrotic-ranged proteinuria in the other patient. The biopsy findings are characterized by diffuse wall thickening of capillary walls and focal proliferation of mesangial cell in light microscopy, and by capillary wall and granular basement membrane staining of C3 in immunofluorescence microscopy, and an irregular fusiform swelling of the lamina densa which resulting in a further thickening of basement of basement membrane in electron microscopy. Our two patients were treated conservatively without using steroid or immunosuppressive agents. One patient who had followed-up for 7 years after diagnosis remain stable in renal function, and the other patient who had followed-up for 4 years after diagnosis showed persistent nephrotic-range proteinuria.
Basement Membrane ; Biopsy ; Capillaries ; Child ; Diagnosis ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative* ; Hematuria ; Humans ; Immunosuppressive Agents ; Korea ; Mesangial Cells ; Microscopy ; Microscopy, Electron ; Microscopy, Fluorescence ; Proteinuria ; Young Adult

The term type II membranoproliferarive glomerulonephritis (MPGN) refers to the histopathologic entity characterized by dense intramembranous deposits. It have a variable clincal courses, frequently occurs in older children and young adult. In comparison with The western, the idiopathic membranoproliferative glomerulonephritis (MPGN) has a lower frequency than secondary MPGN. Especially, of the idiopathic MPGN, the frequency of type 2 MPGN, so called dense deposit disease, is very rare in Korea. We are reporting two cases of type II MPGN, which was proven by renal biopsy. The clinical manifestations were recurrent gross hematuria in one patient and persistent nephrotic-ranged proteinuria in the other patient. The biopsy findings are characterized by diffuse wall thickening of capillary walls and focal proliferation of mesangial cell in light microscopy, and by capillary wall and granular basement membrane staining of C3 in immunofluorescence microscopy, and an irregular fusiform swelling of the lamina densa which resulting in a further thickening of basement of basement membrane in electron microscopy. Our two patients were treated conservatively without using steroid or immunosuppressive agents. One patient who had followed-up for 7 years after diagnosis remain stable in renal function, and the other patient who had followed-up for 4 years after diagnosis showed persistent nephrotic-range proteinuria.
Basement Membrane ; Biopsy ; Capillaries ; Child ; Diagnosis ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative* ; Hematuria ; Humans ; Immunosuppressive Agents ; Korea ; Mesangial Cells ; Microscopy ; Microscopy, Electron ; Microscopy, Fluorescence ; Proteinuria ; Young Adult

The most common causes of acute pancreatitis are microlithiasis and alcohol. In pediatrics, anomalies in pancreaticobiliary system should be considered as possible causes. Among many anomalies, pancreas divisum associated with anomalous pancreaticobiliary ductal union (APBDU) is very rare. APBDU is associated with acute pancreatitis, choledochal cyst, and gallbladder cancer. Pancreas divisum is also a well known cause of acute recurrent pancreatitis. In adult cases with such conditions, the role of endoscopic management including sphincterotomy or stenting through the Santorini duct is well documented. However, it is still controversial to perform endoscopic retrograde cholangiopancreatography in pediatrics. Herein, we experienced a case of 4 year 7 month old female patient suffered from recurrent attacks of acute pancreatitis, which were caused by APBDU and incomplete pancreas divisum. She was treated by endoscopic sphincteretomy of both openings to the Santorini's and Wirsung's ducts. Thus, we report this interesting case with literature review.
Abnormalities, Multiple ; Acute Disease ; Child, Preschool ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct/*abnormalities/surgery ; Female ; Humans ; Pancreas/*abnormalities ; Pancreatic Ducts/*abnormalities/surgery ; Pancreatitis/*diagnosis/etiology/surgery ; Sphincterotomy, Endoscopic ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: Local compression of the ulnar nerve occurs most commonly at the elbow and optimal surgical intervention should be directed at the specific site of involvement. This study is designed to localize the more discrete region by using the method of short segment stimulation in ulnar neuropathy at the elbow. METHODS: Thirty seven patients who were diagnosed as entrapment ulnar neuropathy at the elbow by routine nerve conduction studies were investigated. Latency changes and amplitude changes including conduction block were determined by stimulating the ulnar nerve at 2cm intervals across the elbow. Six of these patients had orthopedic surgery after undergoing short segment stimulation studies. RESULT: All patients had significant latency changes(> OR =0.7msec) in specific segments by short segment stimulation and 6 patients of them showed conduction block. The most frequently involved segments were between medial epicondyle and 2cm proximal(20 patients) and between medial epicondyle and 2cm distal(9 patients). Only two patients exhibited significant latency changes between 2 and 4cm distal to the medial epicondyle, suggesting cubital tunnel syndrome. Lesions, as identified by surgery, proved to be accurately predicted by preoperative short segment stimulation in 5 of 6 patients. CONCLUSION: Short segment stimulation studies are helpful in localizing more accurate involved segment in ulnar neuropathy at the elbow. And the most commonly involved site is within 2cm of the medial epicondyle suggesting tardy ulnar nerve palsy.
Cubital Tunnel Syndrome ; Elbow* ; Humans ; Neural Conduction ; Orthopedics ; Ulnar Nerve ; Ulnar Nerve Compression Syndromes ; Ulnar Neuropathies*

BACKGROUND: IgA nephropathy (IgAN) is the most frequent primary glomerulonephritis in the world. Despite 20 years of research into this condition, much remains unknown about its pathogenesis and therapy. One major problem is that the prognostic evaluation and renal survival of IgAN is unreliable. METHODS: A retrospective study was performed to clarify the prognostic factors and the long-term renal survival rates of this disease. RESULTS: One hundred fifty-two patients with IgAN who followed-up at least 3 years after renal biopsy were included in this study. During a mean followed-up of 9.3 years after their renal biopsy (range:36-215 months), 33 of them (21.7%) had progressed to end-stage renal disease (ESRD). The actuarial renal survival rate was 97% at 5 years, and 85% at 10 years. Using univariate analysis, 5 risk factors for developing ESRD were identified:male sex, hypertension, heavy proteinuria, renal insufficiency at the time of biopsy, severe histopathologic findings such as subclass IV/V lesions by Haas' subclassification were associated with significant risk factors for developing ESRD. In multivariate regression analysis, only Haas' subclass IV/V lesions and renal insufficiency at the time of biopsy were the independent prognostic factors of IgAN. CONCLUSION: In conclusion, further long-term prospective study with larger number of patients would be necessary to assess the prognostic factors in IgAN.
Biopsy ; Glomerulonephritis ; Glomerulonephritis, IGA ; Humans ; Hypertension ; Immunoglobulin A* ; Kidney Failure, Chronic ; Prognosis* ; Proteinuria ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Survival Rate

BACKGROUND: The natural history of idiopathic membranous nephropathy is often benign, but approximately 30% of the patients develop renal insufficiency and progress to end-stage renal failure over 5 to 15 years. Several retrospective analyses have been performed to identify favorable factors influencing the long-term prognosis of idiopathic membranous nephropathy. However, little attention has been paid to the significance of remission of proteinuria in this disease. METHODS: Forty-six patients with biopsy-proven idiopathic membranous nephropathy who achieved complete remission (CR) of proteinuria between 1982 and 2003 were enrolled. We retrospectively analyzed the clinical and laboratory data between persistent remission group and relapsing group after CR of proteinuria. RESULTS: Complete remission of proteinuria was seen in 46 patients (31%) and was obtained 7-170 months (mean 38 months) after discovery of the disease. During mean 89 months follow-up, 74% of the patients remained in remission and 26% relapsed. However, proteinuria disappeared again spontaneously in some patients so that at last follow-up 83% of the patients are in CR. The probability of remaining free of proteinuria at 5 and 10years after CR was 0.73 and 0.60, respectively. 5 and 10years renal survival in patient with CR were 100%, respectively, whereas those of patient without remission were 89 % and 75%, respectively, which was significantly different (p<0.05). We could not find any specific clinical factors favored maintenance of remission, except serum level of creatinine and serum cholesterol during remission, which are significantly less in patients with persistent remission. CONCLUSION: In conclusion, CR of proteinuria is a strong predictor of long-term favorable outcome in patients with idiopathic membranous nephropathy.
Cholesterol ; Creatinine ; Follow-Up Studies ; Glomerulonephritis, Membranous* ; Humans ; Kidney Failure, Chronic ; Natural History ; Prognosis* ; Proteinuria* ; Renal Insufficiency ; Retrospective Studies

PURPOSE: Renal tubular aicdosis (RTA) is a disorder of renal acidification out of porportion to the reduction in glomerular filtration rate. Type IV RTA refers to hyperkalemic metabolic acidosis resulting from aldosterone deficiency or resistance. The incidence of each type RTA has not been reported exactly, however reports on type IV RTA have been recently increasing. METHODS: A retrospective clinical analysis was performed in 50 patients with hyperkalemic distal renal tubular acidosis diagnosed between Jan. 1984 and Feb. 2003 at Department of Internal Medicine, Keimyung University, Dongsan Medical Center. RESULTS: From 1984 to 2003, 50 cases of hyperkalemic distal renal tubular acidosis were diagnosed. The mean age was 50.8+/-19.5 years. The two most common conditions were posttransplantation (28%), and diabetes mellitus (22%), which were followed by hypertension (12%), systemic lupus erythematosus (12%), chronic renal failure (12%), and others (26%). Asymptomatic hyperkalemia (34%), and muscle weakness (28%) were the two most common clinical presentations. All patients demonstrated normal anion gap acidosis with positive urine anion gap. The mean creatinine clearance was 25.6+/-16.4 mL/min. The mean baseline PRA and aldosterone levels were 3.82+/-7.16 ng/mL/hr and 110.02+/-108.2 ng/mL, respectively. Hyperkalemia was well responded to 9-alpha-fludrocortisone, furosemide, K-exchane resin, and combinations of these regimens. CONCIUSION: Type IV RTA is the most common type of RTA in children and adults, and can be an important cause of asymptomatic hyperkalemia. Therefore, type IV RTA should be included in the diffrential diagnosis of unexplained hyperkalemia in various clinical settings.
Acid-Base Equilibrium ; Acidosis ; Acidosis, Renal Tubular* ; Adult ; Aldosterone ; Child ; Creatinine ; Diabetes Mellitus ; Diagnosis ; Furosemide ; Glomerular Filtration Rate ; Humans ; Hyperkalemia ; Hypertension ; Hypoaldosteronism ; Incidence ; Internal Medicine ; Kidney Failure, Chronic ; Lupus Erythematosus, Systemic ; Muscle Weakness ; Retrospective Studies