In five years, there were 52 acute renal failure under 15 years old patients (6.19% of total nephrotic syndrome patients, male - 71.15% and female- 28.85%, under five year children- 38.46%). All had oedema and in the majority it was of medium and severe grade of oligouria and anuria occurred in 3/4 of patients. Normal blood pressure or lightly high blood pressure was recorded in all. In 95% of acute renal failure patients, blood albumin low or very low level was noted and in haft a total number of patients, blood sodium level was very low (130 mmol/l)
Nephrotic Syndrome ; Kidney Failure, Acute ; diagnosis

During the five-year period of 1991-1995, there were 840 children suffered from primary nephrotic syndrome including 52 of acute renal failure with a frequency of 6.19%. In treating, 35.72% of patients got a most rapid decrease of oedema, 66.67% remained lasting oedema, 19.23% got a urine volume restored after 3 days. Before the treatment, hypertension occupied 44.68% and after treatment 27.68% of patients. In 52 studied patients, good response to the treatment occurred in 44 (84.62)%, 8 (15.38%) got the chronic form of renal or died. In regard to laboratory data, in patients with light decrease of blood albumin level, renal function were well restored, while with large decrease, it was worse even could be transformed to chronic or deadly form. In 90% of patients, the BUN/blood creatinine ratio was 20
Nephrotic Syndrome ; Kidney Failure, Acute ; diagnosis ; child

Hepatitis A is generally regarded as a mild, self-limiting disease of the liver. Acute renal failure has rarely been reported in association with non-fulminant acute hepatitis A. Acute tubular necrosis is the most common form of renal injury in such patients. We recently experienced two cases of hepatitis A in which acute renal failure occurred early in the course of the illness and had a clinical course suggestive of acute tubular necrosis. In both patients, the clinical course of renal dysfunction was almost parallel to that of hepatic dysfunction. Hemodialysis was performed in patient 1 because of severe uremia despite maintaining urine output more than 2,000 mL per day. On the other hand, hemodialysis was not performed in patient 2 who showed a rapid recovery of renal dysfunction. The renal biopsy of patient 1 demonstrated typical findings of acute tubular necrosis on microscopy.
Acute Disease ; Adult ; Hepatitis A/complications/*diagnosis/pathology ; Humans ; Kidney Failure, Acute/complications/*diagnosis/pathology ; Male ; Renal Dialysis/methods

Poisoning due to potassium bromate, cold wave neutralizer for permanent waving solution in hair styling, is rarely encountered and only few cases are as a cause of acute renal failure reported in medical literature. Recently, we saw a 18 year-old-female patient, hair stylist, who was admitted to Severance Hospital due to acute renal failure after accidental ingestion of potassium bromate. This is the first known case of acute renal failure due to potassium bromate poisoning in Korea.
Adolescent ; Bromates/poisoning* ; Bromine/poisoning* ; Female ; Hair Preparations/poisoning* ; Human ; Kidney Failure, Acute/chemically induced* ; Kidney Failure, Acute/diagnosis ; Korea ; Potassium/poisoning

Acute viral hepatitis A has recently become a major public health problem in Korea, and the incidence of symptomatic hepatitis A is growing rapidly. With improvements in socioeconomic conditions and environmental hygiene, the chances of exposure to hepatitis A virus (HAV) during childhood have decreased and, in turn, the proportion of young adults with positive anti-HAV has significantly decreased. This has led to the incidence of symptomatic acute hepatitis A increasing since the late 1990s. The incidence of serious complications including fulminant hepatic failure and acute kidney injury has also showed an increasing trend. Variation of the genotype of virus isolated from recent hepatitis A patients suggests an inflow of the hepatitis virus from other countries. In this review article, we present the situation and epidemiology of hepatitis A in Korea, and recommend further investigation and policies for vaccination on a national level.
Acute Disease ; Genotype ; Hepatitis A/complications/diagnosis/*epidemiology ; Hepatitis A Antibodies/analysis ; Humans ; Incidence ; Kidney Failure, Acute/etiology ; Liver Failure, Acute/etiology ; Vaccines, Inactivated/pharmacology

BACKGROUND: The prognosis following surgery for gastric cancer has been markedly improved as a result of early diagnosis and advancements both in operative techniques and perioperative management. However, gastrointestinal surgery in the presence of hepatic cirrhosis has shown high operative morbidity and mortality due to severe perioperative complications, such as bleeding, lymphorrhea, anastomosis leakage, hepatic failure, fluid retention, acute renal failure and multiple organ failure. Recently, the frequency of gastric cancer involving liver cirrhosis has been increasing, especially early gastric cancer cases. METHODS: From June 1995 to December 1997, a total of 410 patients with gastric cancer were treated surgically. Among them, 9 cases with liver cirrhosis underwent gastric resection. RESULTS: Three major postoperative complications occurred in 2 patient, anastomosis leakage in one, and bleeding in both. CONCLUSIONS: The purposes of this study were to assess the causes of complications and to decide the appropriate operation type for improving the prognosis for these patients with liver cirrhosis.
Acute Kidney Injury ; Early Diagnosis ; Hemorrhage ; Humans ; Liver Cirrhosis* ; Liver Failure ; Mortality ; Multiple Organ Failure ; Postoperative Complications ; Prognosis ; Stomach Neoplasms*

PURPOSE: A number of studies have examined the B-type natriuretic peptide level in dialysis patients and in patients with lesser degrees of renal insufficiency. However, relationships between BNP and renal function are unknown. We sought to assess the diagnostic utility of BNP in differentiating congestive heart failure (CHF) from non-congestive heart failure (non-CHF) in patients with renal insufficiency. METHODS: BNP levels were obtained in 395 patients presenting to our emergency department with dyspnea. Of those 395 patients, 48 patients showed renal insufficiency. Patients transferred to other hospitals and those in a donot- resuscitate state were excluded. RESULTS: In patients with acute renal failure, patients with CHF (n=8) had BNP levels of 360+/-254 pg/ml whereas patients with non-CHF (n=3) had BNP levels of 114+/-103 pg/ml; however, this difference was not statistically significant. In patients with chronic renal failure, patients with CHF (n=22) had BNP levels of 1147+/-635 pg/ml, which was significantly higher than the BNP levels of 459+/-508 pg/ml for patients with non-CHF (n=7) (p=0.01). The area under the receiver operating curve, which plots sensitivity versus specificity for BNP levels in separating congestive heart failure from non-congestive heart failure in patients with chronic renal failure, was 0.805 (p=0.01). The diagnostic accuracy of BNP at a cutoff of 600 pg/ml was 76 %. CONCLUSION: The BNP cut-off value for diagnosis of CHF in patients with chronic renal failure is 600 pg/ml.
Acute Kidney Injury ; Diagnosis* ; Dialysis ; Dyspnea ; Emergency Service, Hospital ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Humans ; Kidney Failure, Chronic ; Natriuretic Peptide, Brain* ; Renal Insufficiency ; Sensitivity and Specificity

We report two cases of acute renal failure in patients with nonfulminant acute hepatitis A. First case is a healthy 25 year-old man complained of myalgia and jaundice. Initial laboratory results showed BUN 40 mg/dL, creatinine 5.23 mg/dL, AST 2,220 IU/L, ALT 3,530 IU/L, total bilirubin 6.26 mg/dL, and positive anti-HAV IgM antibody. Supportive treatments including fluid therapy were started. Serum creatinine and total bilirubin levels were 7.98 mg/dL and 7.66 mg/dL respectively on the 5th hospital day, and decreased gradually. He was discharged on the 12th hospital day, and was being followed up in outpatient department. Second case is a 33 year-old woman who admitted for bilateral flank pain, high fever, nausea, and vomiting. She was diagnosed as acute pyelonephritis and acute hepatitis A. On admission, BUN 13 mg/dL, creatinine 0.74 mg/dL, AST 3,720 IU/L, ALT 2,280 IU/L, total bilirubin 0.9 mg/dL were noted, and acute renal failure developed next day. Fluid therapy with antibiotics administration were started, and maximal BUN and creatinine was 41.7 and 8.09 mg/dL respectively on the 8th day. She recovered without dialysis and was discharged on the 19th hospital day. Proper and prompt comprehensive supportive measures would decrease the need for dialysis in patient of acute renal failue associated with acute hepatitis A.
Acute Disease ; Adult ; Female ; Hepatitis A/complications/*diagnosis ; Humans ; Kidney Failure, Acute/*diagnosis/etiology/ultrasonography ; Male ; Pyelonephritis/diagnosis ; Tomography, X-Ray Computed

A 55 yr-old man presented with progressive muscle weakness and oliguria for 5days. Laboratory findings suggested rhabdomyolysis complicated with acute renal failure. A diagnosis of polymyositis was based upon the proximal muscle weakness on both upper and lower limbs, elevated muscle enzyme levels, muscle biopsy findings and the needle electromyography findings. The muscle biopsy showed extensive muscle necrosis and calcification. Investigations for underlying malignancy demonstrated hepatocellular carcinoma. The patient was managed with hemodialysis and high dose prednisolone. His renal function was fully recovered and his muscle power did improve slightly, but he died of a rupture of the hepatic tumor. In our view, this is an interesting case in that the hepatocellular carcinoma was associated with polymyositis and fulminant rhabdomyolysis-induced acute renal failure requiring hemodialysis.
Carcinoma, Hepatocellular/complications/*diagnosis ; Diagnosis, Differential ; Humans ; Kidney Failure, Acute/*diagnosis/etiology ; Liver Neoplasms/complications/*diagnosis ; Male ; Middle Aged ; Polymyositis/complications/*diagnosis ; Rhabdomyolysis/*diagnosis/etiology

OBJECTIVETo compare the acute kidney injury classification systems of RIFLE,AKIN,KDIGO and conventional criteria for determining prognosis of acute-on-chronic liver failure (ACLF) patients.

METHODSPatients with ACLF admitted to our hospital between July 2008 and March 2014 were enrolled in the study. The incidence, stages, and outcomes of acute kidney injury were determined according to the RIFLE, AKIN,KDIGO and conventional criteria.ROC curves were generated to compare the predictive ability for 30-day mortality of the four systems.Chi-square test and Fisher's exact test were used for statistical analyses, as well.

RESULTSAll four classification systems detected acute kidney injury among the patients in the study population (n =358), but the detection rates were not consistent (expressed as % of total): KDIGO criteria: 45.0%, AKIN: 38.8%, rIFLE: 35.5%, conventional criterion: 20.4%. The KDIGO and AKIN criteria showed higher sensitivity (72%), especially to early kidney injury, but the conventional criterion showed higher specificity (92%). The AUC for 30-day mortality was highest for the conventional criteria (0.75), followed by AKIN (0.72), rIFLE (0.70) and KDIGO (0.69) (all, P less than 0.05). In-hospital mortality increased with severity of AKI in a stepwise manner.

CONCLUSIONAmong the four common evaluation systems for acute kidney injury, the conventional criteria has the highest specificity for predicting short-term prognosis of patients with ACLF, while the AKIN and KDIGO criteria have the highest sensitivity for the presence of acute kidney injury, especially at the early stage.

Acute Kidney Injury ; classification ; diagnosis ; Acute-On-Chronic Liver Failure ; diagnosis ; Hospital Mortality ; Humans ; Incidence ; Prognosis ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity