BACKGROUND: The thickness of the renal cortex is useful in all aspects of nephrology but no normal range has been established. Therefore, we investigated the renal cortex thickness by ultrasonography in normal Korean adults and chronic renal failure (CRF) patients before renal replacement therapy. For the purpose of evaluating the normal range then, we are going to predict the threshold range of cortex thickness in irreVersible renal failure status. METHODS: In 243 healthy Korean adults and 57 CRF patients with the creatinine level, < or =4 mg/dL were measured the renal cortex thickness. Creatinine clearance was calculated on the basis of the Cockcroft-Gault formula. RESULTS: In normal adults, the difference between male and female was 0.74+/-0.15 cm, 0.69+/-0.13 cm respectively, male was greater than female (p<0.005) and the average value of the left and right renal cortex thickness was 0.76+/-0.14 cm, 0.67+/-0.13 cm, the left kidney was greater than right one (p<0.005). The combined average value of the left and right renal cortex was 0.72+/-0.14 cm. In CRF patients, There was no difference of cortex thickness between diabetes patients and non diabetes but in non diabetes patients, the difference between Ccr <30 mL/min and Ccr > or =30 mL/min was 0.63+/-0.10 cm, 0.79+/-0.11 cm (p<0.001). CONCLUSION: The overall mean of cortex thickness in korean normal adults was 0.72+/-0.14 cm (0.41-1.25) and approximately, a threshold of 0.72 cm was identified for the cortex thickness that allowed us to distinguish Ccr <30 mL/min from Ccr > or =30 mL/min in CRF patients. But the cortex thickness alone is not a sufficient marker to predict reversibility. We should consider other invasive procedure such as kidney biopsy.
Adult* ; Biopsy ; Creatinine ; Female ; Humans ; Kidney Failure, Chronic* ; Kidney* ; Male ; Nephrology ; Reference Values ; Renal Insufficiency ; Renal Replacement Therapy ; Ultrasonography*

BACKGROUND: If acute renal failure develops in patients with acute pyelonephritis, it is most commonly due to hypovolemia, sepsis, drug therapy or urinary obstruction. But there have been reported many cases about patients of acute renal failure derived from acute pyelonephritis itself without any predisposing factor. To find out the predisposing related factors, we analysed the clinical patterns of patients of acute pyelonephritis with acute renal failure compared to that of patients of acute pyelonephritis without acute renal failure. METHODS: From January 1996 to December 2000, the authors identified 172 patients older than 16 years of age who admitted to Korea University Hospital for acute pyelonephritis. Among them, patients whose serum creatinine level had been less than 1.5mg/dL before admission and who did not have any of chronic renal failure, diabetic nephropathy or hypertensive nephropathy were recruited. According to the level of serum creatinine at admission, the patients were divided into two groups. If ones serum creatinine level at admission was less than 1.5mg/dL, he or she included to control group, if more than 1.5 mg/dL to acute renal failure group. And we compared their clinical features and laboratory values. RESULTS: The patients with acute pyelonephritis complicated to renal failure showed the tendency of older age, more dehydration, more inflammation, more frequent abnormal findings in abdominal ultrasonography and more frequency of chronic systemic disease than those without renal failure. Acute renal failure due to acute pyelonephritis might be recovered rapidly by general supportive care like fluid replacement and adequate antimicrobial therapy. CONCLUSION: Acute pyelonephritis should be considered rare cause of acute renal failure. Especially in case of old age, severe dehydration, severe inflammation and comorbidity with chronic systemic disease involved in kidney, it would be helpful to observe the clinical course closely.
Acute Kidney Injury* ; Causality ; Comorbidity ; Creatinine ; Dehydration ; Diabetic Nephropathies ; Drug Therapy ; Humans ; Hypovolemia ; Inflammation ; Kidney ; Kidney Failure, Chronic ; Korea ; Pyelonephritis* ; Renal Insufficiency ; Sepsis ; Ultrasonography

A 34-yr-old female was diagnosed as being brain dead. Preoperative ultrasound revealed no abnormal focal lesions. However, the horseshoe kidney was identified during organ harvest. En bloc nephrectomy was performed. The kidney was divided at the midline of isthmus. The divided right kidney was discarded due to numerous arteries and veins. The divided left kidney was transplanted. After declamping, the kidney was well perfused and started clearing. Resistive index was 0.72. Glomerular filtration ratio was 84.69 mL/min on postoperative day 14. The horseshoe kidney can be successfully transplanted and could be a good solution for the shortage of organ donors.
Adult ; Cadaver ; Female ; Humans ; Kidney/*abnormalities/ultrasonography ; Kidney Failure, Chronic/diagnosis/*therapy ; Kidney Transplantation/*methods ; *Tissue Donors ; Tissue and Organ Harvesting/*methods ; Treatment Outcome

A 34-yr-old female was diagnosed as being brain dead. Preoperative ultrasound revealed no abnormal focal lesions. However, the horseshoe kidney was identified during organ harvest. En bloc nephrectomy was performed. The kidney was divided at the midline of isthmus. The divided right kidney was discarded due to numerous arteries and veins. The divided left kidney was transplanted. After declamping, the kidney was well perfused and started clearing. Resistive index was 0.72. Glomerular filtration ratio was 84.69 mL/min on postoperative day 14. The horseshoe kidney can be successfully transplanted and could be a good solution for the shortage of organ donors.
Adult ; Cadaver ; Female ; Humans ; Kidney/*abnormalities/ultrasonography ; Kidney Failure, Chronic/diagnosis/*therapy ; Kidney Transplantation/*methods ; *Tissue Donors ; Tissue and Organ Harvesting/*methods ; Treatment Outcome

PURPOSE: The renal manifestations of tuberous sclerosis complex (TSC) are remarkably diverse, including polycystic kidney disease, simple renal cysts, renal cell carcinomas, and angiomyolipomas. All of these occur in children as well as adults in TSC. Angiomyolipomas, which can cause spontaneous life-threatening hemorrhages, are by far the most prevalent and the greatest source of morbidity. Here, we will address our experience, adding to the literature on pediatric patients with TSC requiring evaluation and treatment for renal manifestations. METHODS: A retrospective analysis was made on 19 patients in whom TSC was diagnosed between May 2001 and Oct. 2005 at Severance Hospital. All patients had clinical diagnoses of TSC as defined by the 1998 tuberous sclerosis complex consensus conference. RESULTS: The patients consisted of 13 boys and 6 girls with a mean age of 7.3 years (range 1 to 22). The renal disease associated with TSC included angiomyolipoma in nine patients (47.4 percent), renal simple cyst in one (5.3 percent), hydronephrosis in one (5.3 percent) patient. Eight patients (42.1 percent) presented with normal kidney contours at abdominal ultrasonography. One patient underwent renal replacement therapy due to chronic renal insufficiency after nephrectomy. Hemorrhage from angiomyolipoma was not detected. CONCLUSION: In our review of 19 cases of TSC, renal manifestations are reported in 57.9 percent of patients. Asymptomatic angiomyolipoma associated with TSC grow gradually, although severe hemorrhages are rare. So patients with TSC should be followed up with serial computerized tomography or abdominal ultrasonography. And also, renal function should be monitored conservatively.
Adult ; Angiomyolipoma ; Carcinoma, Renal Cell ; Child ; Consensus ; Diagnosis ; Female ; Hemorrhage ; Humans ; Hydronephrosis ; Kidney ; Kidney Failure, Chronic ; Nephrectomy ; Polycystic Kidney Diseases ; Renal Insufficiency, Chronic ; Renal Replacement Therapy ; Retrospective Studies ; Tuberous Sclerosis* ; Ultrasonography

To evaluate the feasibility and accuracy of contrast-enhanced ultrasonography (CEUS) for the measurement of hemodialysis access recirculation (AR) and access flow rate (Qa), a two pump system was used to simulate access and dialyzer flow. AR and Qa under different conditions, such as reversal connection of dialysis lines and the needle orientation, were compared with each other. The value of access flow and recirculation flow were calculated based on the formulas introduced in this paper, and the correlation and consistency between true flow rate and calculated values were analyzed. The measured R correlated well with true value of flow rate (r = 0.57, P = 0.038, Qa > Qb; r = 0.95, P = 0.001, Qa < Qb). The Bland-altman test showed good agreement between the calculated value based on CEUS and true values. The CEUS can be used as a new advanced technology for AR and Qa measurement.
Arteriovenous Shunt, Surgical ; Blood Flow Velocity ; Computer Simulation ; Contrast Media ; Humans ; Kidney Failure, Chronic ; blood ; therapy ; Models, Biological ; Monitoring, Physiologic ; instrumentation ; Regional Blood Flow ; Renal Dialysis ; methods ; Ultrasonography

In general, a 2-yr disease-free duration is recommended before kidney transplantation (KT) in end-stage renal disease (ESRD) patients who also have acute leukemia. However, the optimal disease-free interval has not been specified for all subtypes of acute leukemia. Among these subtypes, acute promyelocytic leukemia (APL) shows a favorable prognosis and low relapse rate compared to other types of leukemia. We here report KT after complete remission (CR) of APL in an ESRD patient. Irreversible kidney injury developed in a 23-yr-old man with APL. First, we induced CR and subsequently performed KT 7 months after the achievement of CR. The patient's clinical course after KT was favorable, without allograft rejection or relapse of APL up to1 yr after KT. On the basis of our clinical experience, it is suggested that a long wait may not be necessary before KT in patients with ESRD and APL.
Adult ; Antineoplastic Agents/therapeutic use ; Arsenicals/therapeutic use ; Bone Marrow Cells/pathology ; Humans ; Kidney Failure, Chronic/*therapy/ultrasonography ; *Kidney Transplantation ; Leukemia, Promyelocytic, Acute/*diagnosis/drug therapy ; Male ; Oxides/therapeutic use ; Receptors, Retinoic Acid/genetics/metabolism ; Remission Induction

OBJECTIVE: The purpose of this study was to evaluate the fistulographic features of malfunctioning axillary loop-configured arteriovenous grafts and the efficacy of percutaneous interventions in failed axillary loop-configured arteriovenous grafts. MATERIALS AND METHODS: Ten patients with axillary loop-configured arteriovenous grafts were referred for evaluation of graft patency or upper arm swelling. Fistulography and percutaneous intervention, including thrombolysis, percutaneous transluminal angioplasty and stent placement, were performed. Statistical analysis of the procedure success rate and the primary and secondary patency rates was done. RESULTS: Four patients had graft related and subclavian venous stenosis, two patients had graft related stenosis and another four patients had subclavian venous stenosis only. Sixteen sessions of interventional procedures were performed in eight patients (average: 2 sessions / patient) until the end of follow-up. An interventional procedure was not done in two patients with central venous stenosis. The overall procedure success rate was 69% (11 of 16 sessions). The post-intervention primary and secondary patency rates were 50% and 63% at three months, 38% and 63% at six months and 25% and 63% at one year, respectively. CONCLUSION: Dysfunctional axillary loop-configured arteriovenous grafts almost always had subclavian venous and graft-related stenosis. Interventional treatments are helpful to overcome this and these treatments are expected to play a major role in restoring and maintaining the axillary loop-configured arteriovenous loop grafts.
Adult ; Aged ; Angioplasty, Balloon/*methods ; Arteriovenous Shunt, Surgical/*methods ; Blood Vessel Prosthesis Implantation/*methods ; Chronic Disease ; Constriction, Pathologic/therapy/ultrasonography ; Female ; Follow-Up Studies ; Graft Occlusion, Vascular/*therapy/ultrasonography ; Humans ; Kidney Failure, Chronic/*complications/therapy ; Male ; Middle Aged ; *Renal Dialysis ; Subclavian Vein/ultrasonography ; Survival Analysis ; Treatment Outcome ; Vascular Patency

PURPOSE: The aim of this study was to evaluate the clinical course of chronic viral hepatits in renal transplant recipients. METHODS: During the period from January 1980 to December 1998, a total of 1122 cases of kidney transplantation (KT) were performed at the Kangnam St. Mary's Hospital. Eighty- one transplant recipients received azathioprine (AZA) and 1041 transplant recipients received cyclosporin A (CsA). We tested hepatitis B surface antigen (HBS Ag) and hepatitis C virus antibody (HCV Ab). According to duration of hepatic dysfunction, radiologic examination and liver biopsy, clinical course of hepatitis was classified; (1) Health carrier: HBs Ag or HCV Ab positive with normal laboratory finding. (2) Chronic hepatitis: clinical and/or laboratory evidence of hepatic dysfunction that persisted more than 6 months. (3) Liver cirrhosis and hepatocellular carcinoma (HCC); liver ultrasonography, abdominal CT and liver biopsy. RESULTS: (1) The patients with HBs Ag positive were 117 cases (10.4%). Sixteen cases died within 1 year after KT because of hepatic failure or other complication. We followed up 101 cases. Sixty-seven cases (66.4%) were health carrier and two of them progressed to HCC. Thirty-four cases (33.5%) developed chronic hepatitis B and liver cirrhosis was developed in 10 cases (29.4%). (2) Because of availability of diagnostic method, 877 cases were tested for HCV Ab. The patients with HCV Ab positive were 94 cases (10.7%). Four cases died within 1 year after KT. Thirteen cases (13.8%) were both HBs Ag and HCV Ab positive. We followed up 75 cases only HCV Ab positive. Fifty-three cases (70.7%) were health carrier and 22 cases (29.3%) progressed to chronic hepatitis C. Any case did not progressed to liver cirrhosis or HCC. (3) Eight cases of HCC were developed from chronic hepatitis B, and one case was both HBs Ag and HCV Ab negative. Among these, male gender is predominant (male : female=7 : 2). The average age at KT were 37.9 years. HCC was diagnosed at 102.6 (range 44 to 173) months after KT. Eight cases received CsA and prednisolone and only 1 case received AZA and prednisolone. Two cases underwent surgical intervention and the other 7 cases treated with transarterial chemoembolization and chemotherapy. The average survival was 10.4 (1 to 40) months, 3 cases are still alive. CONCLUSION: Clinical course of HCV infection is less aggressive than that of HBV infection in renal transplant recipients.
Azathioprine ; Biopsy ; Carcinoma, Hepatocellular ; Cyclosporine ; Drug Therapy ; Hepacivirus ; Hepatitis B Surface Antigens ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis C ; Hepatitis C, Chronic ; Hepatitis* ; Hepatitis, Chronic ; Humans ; Kidney Transplantation ; Liver ; Liver Cirrhosis ; Liver Failure ; Male ; Prednisolone ; Tomography, X-Ray Computed ; Transplantation* ; Ultrasonography