A 63-year-old woman was admitted due to right upper quadrant abdominal pain. She was going through hemodialysis due to end stage renal disease and taking calcium polystyrene sulfonate orally and rectally due to hyperkalemia. Colonoscopy showed a circular ulcerative mass on the proximal ascending colon. Biopsy specimen from the mass showed inflammation and necrotic debris. It also revealed basophilic angulated crystals which were adherent to the ulcer bed and normal mucosa. These crystals were morphologically consistent with calcium polystyrene sulfonate. She was diagnosed with calcium polystyrene phosphate induced colonic necrosis and improved with conservative treatment.
Colonic Diseases/chemically induced/complications/*pathology ; Colonoscopy ; Female ; Humans ; Kidney Failure, Chronic/complications/*diagnosis ; Middle Aged ; Necrosis ; Polystyrenes/*adverse effects

Sodium bromate is a strong oxidant used as a neutralizing solution in hair permanents, as well as an auxiliary agent in printing and dyeing. Accidental or deliberate ingestion of bromate solution has rarely been reported in Korea. The clinical manifestations of bromate intoxication are vomiting, diarrhea, central nervous system symptoms, oliguric or non-oliguric acute kidney injury, hemolytic anemia, and deafness; most of these manifestations are reversible, with the exception of renal failure and deafness. Here, we report on two patients who demonstrated distinct clinical progressions. In the first case, a 16-year-old woman was successfully treated with hemodialysis and recovered renal function without hearing loss. However, in the second case, delayed hemodialysis resulted in persistent renal failure and hearing loss in a 77-year-old woman. This suggests that emergency therapeutic measures, including hemodialysis, should be taken as soon as possible, as the rapid removal of bromate may be essential to preventing severe intoxication and its sequelae.
Acute Kidney Injury/*chemically induced/therapy ; Adolescent ; Aged ; Bromates/*toxicity ; Fatal Outcome ; Female ; Hearing Loss ; Humans ; Kidney Failure, Chronic/*therapy ; Renal Dialysis ; Sodium Compounds/*toxicity

Bartter's syndrome is a renal tubular disorder characterized by hypokalemia, metabolic alkalosis, increased urinary excretion of potassium and prostaglandins, a relative vascular resistance to the pressor effects of exogenous angiotensin II, and hyperplasia of the juxtaglomerular apparatus. In most patients, the glomerular filtration rate is normal and chronic renal failure does not develop. We report here on a case of living-related kidney transplantation in Bartter's syndrome, in which a non-steroidal anti-inflammatory drug is suspected to be the cause of the end-stage renal disease.
Adult ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects* ; Bartter's Disease/drug therapy* ; Case Report ; Human ; Indomethacin/adverse effects* ; Kidney Failure, Chronic/surgery* ; Kidney Failure, Chronic/chemically induced* ; Kidney Transplantation* ; Living Donors* ; Male

Allopurinol-induced hypersensitivity syndrome is characterized by an idiosyncratic reaction involving multiple-organs, which usually begins 2 to 6 weeks after starting allopurinol. In rare cases, the adverse reactions to allopurinol are accompanied by a variety of liver injury, such as reactive hepatitis, granulomatous hepatitis, vanishing bile duct syndrome, or fulminant hepatic failure. Here we report a case with granulomatous hepatitis and ductopenia. A 69-year-old man with chronic renal failure, hyperuricemia, and previously normal liver function presented with jaundice, skin rash, and fever 2 weeks after taking allopurinol (200 mg/day). In histopathology, a liver biopsy specimen showed mild spotty necrosis of hepatocytes, marked cholestasis in parenchyma, and some granulomas in the portal area. There were vacuolar degeneration in the interlobular bile ducts and ductopenia in the portal tracts. Pathologic criteria strongly suggested the presence of allopurinol-induced granulomatous hepatitis with ductopenia and cholestasis. The patient fully recovered following the early administration of systemic corticosteroid therapy.
Aged ; Allopurinol/*adverse effects/therapeutic use ; Antimetabolites/*adverse effects/therapeutic use ; Bile Duct Diseases/*chemically induced/diagnosis/pathology ; Bile Ducts, Intrahepatic/*drug effects/pathology ; Cholestasis/*chemically induced/diagnosis/pathology ; Drug Eruptions/pathology ; Granuloma/*chemically induced/pathology ; Hepatitis, Toxic/*pathology ; Humans ; Kidney Failure, Chronic/complications/drug therapy ; Male

Drug-induced acute interstitial nephritis is a well-recognised and important reversible cause of acute renal failure. Peroxisome-proliferator activated receptor-gamma agonists, such as rosiglitazone, have been proven to be safe in chronic kidney disease patients. We describe a 65-year-old man with long-standing diabetes mellitus and hypertension, presenting with a five-day history of fluid overload and uraemic symptoms. There was no ingestion of analgesics, alternative medicine and other nephrotoxic drugs, the only new prescription being rosiglitazone, which was commenced during his last clinic follow-up two weeks prior to presentation. He required haemodialysis with minimal improvement in renal profile, despite cessation of the offending drug. Renal biopsy revealed findings consistent with acute interstitial nephritis. An episode of upper gastrointestinal bleeding with bleeding duodenal ulcer limited the use of steroids. He was treated with a course of mycophenolate mofetil which showed good gradual response and he remained stable with residual renal impairment.
Acute Kidney Injury ; chemically induced ; drug therapy ; Aged ; Humans ; Hypoglycemic Agents ; adverse effects ; Immunosuppressive Agents ; therapeutic use ; Kidney Failure, Chronic ; complications ; Male ; Mycophenolic Acid ; analogs & derivatives ; therapeutic use ; Renal Dialysis ; Thiazolidinediones ; adverse effects

OBJECTIVETo investigate the risk factors, clinical characteristics, and prognosis of contrast-induced nephropathy (CIN) in patients with renal dysfunction.

METHODSWe retrospectively analyzed 44 patients with renal dysfunction who received coronary angiography in our hospital. CIN was found in 23 patients, after angiography. We compared the clinical characteristics, medication during angiography day, volume of contrast-medium, as well as renal function changes before and after angiography in patients with (23 cases) and without (21 cases) CIN. The CIN patients were further divided into two groups according to their serum creatinine (Scr) levels: renal function recovery group (12 cases) and renal function non-recovery group (11 cases), and difference between these two groups was analyzed.

RESULTSCIN incidence was 52.3% (23/44) in all 44 patients with renal dysfunction. CIN incidence was 42% (8/19) in patients whose Scr was between 132.6 - 168 micromol/L, was 60% (15/25) in those whose Scr was more than 176.8 micromol/L. In all 23 CIN patients, the average volume of contrast-medium was (144.79 +/- 71.8) ml, while 43.5% of the CIN patients whose dosage was over the maximum threshold of contrast-medium; the average risk factors were 5.14 +/- 1.3. Compared with the group without CIN, the difference was statistically significant (P < 0.05). Multiple stepwise regression analysis showed the volume of radio-contrast-medium was correlated with CIN in patients with renal dysfunction (F=10.4, P=0.003). Patients in the CIN group showed a significant rise of Scr level 24, 48, and 72 hours after angiography. However, the urine volume had no change before and after angiography. Renal function was improved in 12 of 23 patients (52.2%), and deteriorated in 11 patients (47.8%). Four patients (17.4%) received dialysis. Compared with the non-reavery group, Scr levels [(194.5 +/- 70.7) micromol/L, (443.8 +/- 282.9) micromol/L, respectively] of pre-angiography in renal function recovery group and the patients whose dosage was over maximum threshold of contrast-medium (2/12, 8/11) had significant difference (P < 0.05).

CONCLUSIONSHigher volume of contrast-medium is a risk factor of CIN in patients with renal dysfunction. Pre-angiography Scr level and the contrast-medium volume are correlated with the prognosis of CIN in such patients.

Aged ; Contrast Media ; adverse effects ; Coronary Angiography ; Coronary Disease ; complications ; diagnostic imaging ; Female ; Humans ; Iohexol ; adverse effects ; Kidney Failure, Chronic ; complications ; Male ; Middle Aged ; Nephrosis ; chemically induced ; Prognosis ; Retrospective Studies ; Risk Factors

Urease was immobilized in a simple and effective way by physical aggregation using a precipitant-ammonium sulfate, followed by chemical cross-linking using a bifunctional reagent-glutaraldehyde to form insoluble Cross-linked urease aggregates (CLUAs). The optimum pH, optimum temperature and Km of CLUAs were 8.0, 70 degrees C and 0.021 mol/L respectively. Compared with that of free urease, the thermal stability, storage stability and resistance of cross-linked urease aggregates to the exogenous proteolysis were enhanced. The efficacy of CLUAs for the treatment of rats with chronic renal failure was also studies. The rats with chronic renal failure caused by adenine were divided into 3 groups randomly:the control group (fed with 10 mL water /kg per day), Coated Aldehyde Oxystarch (CAO) group (fed with 20 g CAO /kg and 10 mL water /kg per day) and CLUAs + CAO group (fed with 20 g CAO /kg and 10 mL CLUAs /kg per day) in which CAO was used to absorb the ammonia produced from urea. The contents of BUN and Scr in serum before and after 2 weeks treatment were determined. In three groups, the level of Scr decreased slightly (P = 0.922, 0.972 and 0.225 > 0.05 respectively) after treatment. The level of BUN was not changed (P = 0.211 > 0.05) in the control group, but decreased greatly BUN in both CAO group and CLUAs + CAO group (P = 0.004 < 0.05 and P < 0.001 respectively). Furthermore, the decrease of the BUN level after treatment in the CLUAs + CAO group was more remarkable than that in the CAO group (P = 0.016 < 0.05), which showed that the CLUAs + CAD system was more efficient than the CAO system for the removal of urea in serum.
Adenine ; toxicity ; Animals ; Enzyme Stability ; Female ; Glutaral ; chemistry ; Hydrogen-Ion Concentration ; Kidney Failure, Chronic ; chemically induced ; drug therapy ; Male ; Random Allocation ; Rats ; Rats, Wistar ; Temperature ; Urea ; blood ; Urease ; blood ; chemistry ; metabolism ; therapeutic use

Most reports on serious MTX toxicity have focused on hepatic abnormalities, while other effects, including hematologic reactions, have not been emphasized. We experienced a case of pancytopenia secondary to MTX therapy in a patient with RA and renal insufficiency. A 67-year-old woman with a 12-year history of active seropositive RA that was a response to non-steroidal anti-inflammatory drugs, hydroxychloroquinine and intra-articular steroid injections, had been followed up and was diagnosed as early chronic renal failure in October, 1993. Recently, because of significant morning stiffness and polyarthralgia, the decision was made to institute MTX treatment. This was begun as a single oral dose of 5mg/week. After 2 doses, the patient was admitted to the hospital with general weakness. Laboratory tests showed a hemoglobin level of 7.9 g/dl, WBC count 1800/mm3 and platelet count of 64000/mm3. The serum creatinine level was 6.1 mEq/dl and the BUN level was 82 mEq/dl. Liver function test results were normal, but the serum albumin level was 2.7 g/dl. The patient subsequently developed fever and blood transfusions, granulocyte colony stimulating factor (G-CSF) and intravenous prophylactic antibiotic therapy were required. Her condition was improved. In summary, Low-dose MTX-related adverse hematologic side effects, including fatal pancytopenia, are rare but are a cause of increasing concern in patients with RA and renal insufficiency. Close monitoring of associated risk factors, particularly impaired renal function, should be mandatory for all patients who are receiving MTX therapy.
Aged ; Antirheumatic Agents/adverse effects* ; Antirheumatic Agents/administration & dosage ; Arthritis, Rheumatoid/drug therapy ; Arthritis, Rheumatoid/complications ; Case Report ; Female ; Human ; Kidney Failure, Chronic/complications ; Methotrexate/adverse effects* ; Methotrexate/administration & dosage ; Pancytopenia/chemically induced* ; Risk Factors

It is reported that a conversion from mycophenolate mofetil (MMF) to enteric-coated mycophenolate sodium (EC-MPS) relieves gastrointestinal (GI) symptom burden and improves health-related quality of life (HRQoL). However, it is unclear whether renal transplant recipients using tacrolimus receive the same benefit from the conversion. In this prospective, multi-center, open-label trial, patients were categorized into two groups by their GI symptom screening. Equimolar EC-MPS (n=175) was prescribed for patients with GI burdens; those with no complaints remained on MMF (n=83). Gastrointestinal Symptom Rating Scale (GSRS) and Gastrointestinal Quality of Life Index (GIQLI) were evaluated at baseline and after one month. Patients and physicians completed Overall Treatment Effect (OTE) at one month. EC-MPS-converted patients had worse GSRS and GIQLI scores at baseline than MMF-continued patients (all P<0.001). Significant improvements in GSRS and GIQLI scores were observed for EC-MPS-converted patients at one month, but MMF-continued patients showed worsened GSRS scores (all P<0.05). OTE scale indicated that EC-MPS patients improved in overall GI symptoms and HRQoL more than MMF patients did (P<0.001). In tacrolimus-treated renal transplant recipients with GI burdens, a conversion from MMF to EC-MPS improves GI-related symptoms and HRQoL.
Adolescent ; Adult ; Aged ; Female ; Gastrointestinal Diseases/*chemically induced ; Graft Rejection/drug therapy ; Humans ; Immunosuppressive Agents/administration & dosage/*adverse effects/therapeutic use ; Kidney Failure, Chronic/therapy ; *Kidney Transplantation ; Male ; Middle Aged ; Mycophenolic Acid/administration & dosage/*adverse effects/*analogs & derivatives/therapeutic use ; Quality of Life ; Questionnaires ; Tablets, Enteric-Coated ; Tacrolimus/therapeutic use

After 4-months of alpha interferon (IFN-alpha), a 64-year old woman with chronic hepatitis C developed a cough and dyspnea and showed diffuse infiltrative opacities on her chest X-ray. Her symptoms persisted after stopping the IFN-alpha therapy. Pulmonary function testing revealed a reduced forced vital capacity. High-resolution computed tomography of the lung showed peripheral and peribronchovascular ground glass attenuation and consolidation associated with reticulation. Bronchoalveolar lavage was performed for further evaluation and showed a lymphocyte level of 8.2%, an uncommon finding in IFN-alpha-induced interstitial pneumonitis. We performed a lung biopsy to diagnose her disease and it suggested interstitial pneumonitis. This was considered to be due to the immunomodulatory effects of INF-alpha. Although rare, any sign of significant pulmonary involvement should be evaluated.
Antiviral Agents/*adverse effects/therapeutic use ; Bronchoalveolar Lavage ; Female ; Hepatitis C, Chronic/complications/*drug therapy ; Humans ; Interferon-alpha/*adverse effects/therapeutic use ; Kidney Failure, Chronic/complications ; Lung Diseases, Interstitial/*chemically induced/pathology/radiography ; Middle Aged ; Respiratory Function Tests ; Tomography, X-Ray Computed