Combined liver-kidney transplantation (LKT) has been increasingly performed procedure for end-stage liver and kidney disease. We experienced four cases of LKT. All patients were affected by viral hepatopathy. There were three patients of hepatocellular carcinoma, treated with trans-arterial chemoembolization or chemotherapy and one cirrhotic patient. The causes of chronic renal failure were polycystic kidney disease in one patient, glomerulonephropathies in two, and diabetes mellitus in one. Three of them were on dialysis treatment. All patients were selected based on blood group identity and negative cross-match before LKT. There was no post-operative surgical complication or acute rejection. At the mean follow-up of 37 months after LKT, all patients showed normal hepatic and renal function except for one case of biopsy-proven tacrolimus nephrotoxicity. Seroconversions of HBsAg, HBeAg, and HBV-DNA were achieved in hepatitis B positive patients. However, HCV-RNA was sustained in hepatitis C positive patient after LKT. Alpha-fetoprotein was normalized in every HCC patient. Combined liver-kidney transplantation can be a proper therapeutic procedure for the patient with liver failure and irreversible renal disease, and it can be done safely and effectively.
alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Diabetes Mellitus ; Dialysis ; Drug Therapy ; Follow-Up Studies ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis C ; Humans ; Kidney ; Kidney Diseases ; Kidney Failure, Chronic ; Liver ; Liver Failure ; Polycystic Kidney Diseases ; Tacrolimus ; Transplantation

Liposarcoma accounts for at least 20% of all soft tissue sarcoma in adults and occur anywhere in the body, although about 14% of cases arise from retroperitoneum. Liposarcoma usually presents as a painless, enlarging mass that can slowly grow over many years. We here report a case of retroperitoneal liposarcoma in a 52 years old female patient undergoing continuous ambulatory peritoneal dialysis. Retroperitoneal liposarcoma was incidentally found by computed tomography which was performed due to ventral hernia and confirmed by ultrasonography guided-biopsy. She was treated successfully by wide surgical resection and transferred to hemodialysis.
Adult ; Female ; Hernia, Ventral ; Humans ; Liposarcoma* ; Middle Aged ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Renal Dialysis ; Retroperitoneal Neoplasms ; Sarcoma ; Ultrasonography

A 52-year-old man presented as an intermittent right flank pain and microscopic hematuria on urinalysis. Abdominal ultrasonography showed that the left kidney was normally positioned but the right kidney was not observed in the normal position. The ectopic kidney was 7 cm sized and its pelvis was rotated anteriorly. To further evaluate the urinary system, angiography with urography by computed tomography (CT) was carried out. The ectopic kidney was received blood supply from two arteries which directly arose from the abdominal aorta. There was no detectable abnormality on distal urinary system. The authors report here a rare adult case of ectopic kidney associated with rotation anomaly and aberrant arterial supply presenting as an intermittent flank pain and microscopic hematuira.
Adult* ; Angiography ; Aorta, Abdominal ; Arteries ; Flank Pain ; Hematuria* ; Humans ; Kidney* ; Middle Aged ; Pelvis ; Renal Artery ; Ultrasonography ; Urinalysis ; Urography

Gitelman syndrome is a hereditary renal tubular disorder characterized by hypokalemia, metabolic alkalosis, hypomagnesemia, and hypocalciuria. This syndrome is caused by the genetic mutation of SLC12A3 gene encoding thiazide-sensitive sodium-chloride symporters in the apical membrane of distal convoluted tubular cells. Even though Gitelman syndrome is very similar to Bartter syndrome, it might be differentiated by hypomagnesemia, hypocalciuria, older onset age and higher prevalence rate. However, the precise diagnosis is made by gene variation through molecular genetic study. Herein, we report two cases of Gitelman syndrome in sisters diagnosed by familial genetic study.
Age of Onset ; Alkalosis ; Bartter Syndrome ; Diagnosis ; Genetic Testing ; Gitelman Syndrome* ; Humans ; Hypokalemia ; Ion Transport ; Membranes ; Molecular Biology ; Prevalence ; Siblings* ; Symporters

PURPOSE: Number of patients expecting for kidney transplantation and transplantations in foreign countries are rapidly increasing. However, there was a lack of information about clinical progresses and outcomes of kidney recipients, underwent cadaveric kidney transplantation in China. METHODS: We included 44 patients (China group), received cadaveric kidney transplantation in China and have been managed at our institute from Jan 2002 to Jan 2006 and 33 patients (domestic group), received cadaveric kidney transplantation at our institute from Feb 2000 to Jan 2006. We performed retrospective study based on medical records. RESULTS: Duration of pre-transplantation renal replacement therapy and of post-transplantation follow up was longer in domestic group (China group vs. domestic group; 89.9 months vs. 24.6 months, 31.9 months vs. 13.9 months) (p<0.05, p<0.05). Final GFR of China group was lower than domestic group (China group vs. domestic group; 54.97+/-18.92 mL/min vs. 64.26+/-18.23 mL/min) (p<0.05). Infection and rejection rates of China group were higher than domestic group (Incidences/ Pantients *Yr./1000; China group vs. domestic group; infection; 2.05 vs. 0.76, rejection; 1.34 vs. 0.51) (p<0.05). There was no difference of patient and graft survival between two groups. CONCLUSION: Korean recipients of Chinese cadaveric kidneys showed lower final GFR and higher rates of infection and rejection. We should be aware of the possible rejections and complications of kidney recipients undergoing cadaveric kidney transplantation in China. Mutual exchange of information about current status of patients, transplantation indications, donor status and treatment protocols is needed between foreign transplantation centers and our medical centers.
Asian Continental Ancestry Group ; Cadaver* ; China* ; Follow-Up Studies ; Graft Survival ; Humans ; Kidney Transplantation* ; Kidney* ; Medical Records ; Renal Replacement Therapy ; Retrospective Studies ; Tissue Donors

PURPOSE: The prevalence of blood eosinophilia in patients who are maintained on regular hemodialysis has been well established. Blood eosinophilia in patients initiating peritoneal dialysis has been mentioned, but its prevalence and etiologic factors have not been well delineated. Therefore, we performed this retrospective study to find out prevalence and possible etiologic factors of blood eosinophilia in patients undergoing continuous ambulatory peritoneal dialysis. METHODS: Between May 2001 to May 2004, the patients who began continuous ambulatory peritoneal dialysis at one renal center were included in this study. Patients with allergic history or allergic reaction during observed period were excluded. The routine peripheral WBC counts of 47 patients were reviewed and possible predisposing factors of eosinophilia were investigated. RESULTS: Blood eosinophilia was observed in 17 of 47 patients (35% of all patients). In most patients with blood eosinophilia, the time in which the eosinophil count began to be rise was within 40 days, and duration of eosinophilia was variable (mean+/-SD;74+/-67 days). The mean of the peak eosinophil count was 750+/-257/mm3 (mean+/-SD). Possible predisposing factors included recent parenteral iron therapy, but not statistically significant (p=0.09). CONCLUSION: Our retrospective study showed that the eosinophil counts in patients with end stage renal disease on continuous ambulatory peritoneal dialysis were frequently elevated. Predisposing factors for this eosinophilia were not clear, suggesting that immunologic disturbance by uremia or dialysis itself might have influence on eosinophil homeostasis.
Causality ; Dialysis ; Eosinophilia* ; Eosinophils ; Homeostasis ; Humans ; Hypersensitivity ; Iron ; Kidney Failure, Chronic ; Peritoneal Dialysis* ; Peritoneal Dialysis, Continuous Ambulatory ; Prevalence ; Renal Dialysis ; Retrospective Studies ; Uremia

PURPOSE: Icodextrin in peritoneal cavity is absorbed via the lymphatics to the blood and metabolized to maltose and maltriose which may interfere with correct measurement of glucose. In an attempt to evaluate the effects of icodextrin on the erroneous results of blood glucose, we measured blood glucose by different methods. METHODS: Peripheral capillary blood and venous blood were obtained from 12 patients using icodextrin and from 12 patients not using icodextrin. Venous blood glucose was measured by using the laboratory technique (glucose oxidase method), and capillary blood glucose was measured by using a Surestep (glucose oxidase method) and an Acucheck (GDH-PQQ method). To estimate icodextrin and its metabolites indirectly, we calculated osmolal gap. We measured blood icodextrin and its metabolites with amyloglucosidase in icodextrin group. RESULTS: In icodextrin group, glucose was overestimated in the results of the GDH-PQQ method (delta= GDH-GOD=56.2+/-30 mg/dL [vein] 58+/-32 mg/dL [capillary]), but in the control group, there were no significant differences in the results between the glucose oxidase method and the GDH-PQQ method. There was a correlation between the osmolal gap and the differences in the results (delta=GDH-GOD) (r=0.741, p=.006 [vein], r=0.671, p=.017 [capillary]). Blood icodextrin and its metabolites were related with the differences in the results (delta=GDH-GOD) (p=.026, r=0.635), but there was no significant correlation between the osmolal gap and the icodextrin and its metabolites (p=0.086, r=0.515). CONCLUSION: Icodextrin and its metabolites may lead to erroneously high blood glucose levels when measured by GDH-PQQ method. It is necessary to be aware of this factor in order to prevent overlooking dangerous hypoglycemia.
Blood Glucose* ; Capillaries ; Glucan 1,4-alpha-Glucosidase ; Glucose ; Glucose Oxidase ; Humans ; Hypoglycemia ; Maltose ; Oxidoreductases ; Peritoneal Cavity ; Peritoneal Dialysis, Continuous Ambulatory*

PURPOSE: To detect the dysfunction of arteriovenous fistula (AVF) early, we have developed a new method to calculate the intra-vascular conduit flow rate based on the Bernoulli's theory. However, this method has limitation on detection of inflow stenosis. For detection of both in- and out-flow stenosis, we tried to measure intra-access static (pS) and total pressure (pT), and compared with angiographic findings. METHODS: From a total of 46 cases of native AVFs, of at least 3 months of construction, intra-access pS and pT were measured, before starting hemodialysis. deltap (pT-pS) and pT/mean arterial pressure (MAP) ratio were calculated, and compared with angiographic findings. RESULTS: Among 37 patients without outflow stenosis (Vs) in fistulogram, 10 patients with inflow stenosis (As) had significantly lower pT/MAP ratio and deltap than those without As patients (p<0.005). Among 34 patients without As, deltap was significantly lower in 7 patients with Vs than those 27 patients without Vs (p=0.001). CONCLUSION: pT/MAP ratio was correlated with As, and deltap reflects Vs in angiography. The measurement of pS and pT might be useful to predict inflow and outflow stenosis of AVFs.
Angiography ; Arterial Pressure ; Arteriovenous Fistula* ; Constriction, Pathologic ; Humans ; Renal Dialysis*

PURPOSE: We examined the clinical characteristics and incidence of adults idiopathic nephrotic syndrome (NS) according to pathologic diagnosis, age, sex. METHODS: We retrospectively reviewed the clinical and pathological characteristics of primary glomerular lesions in adults idiopathic NS taken a renal biopsy from 1978 to 2005 at the Dongsan Medical Center. We compared the prevalence of adults idiopathic NS according to the pathologic diagnosis between two time intervals 1978 to 1990 and 1991 to 2005. RESULTS: The patients had mean age of 36.7+/-16.3 years and male to female ratio was 1.7:1 with male predominance. The frequency of histopathologic diagnoses were minimal change nephrotic syndrome (MCNS) 51.6%, membranous glomerulonephritis (MGN) 21.3%, focal segmental glomerulosclerosis (FSGS) 12.1%, IgA nephropathy 9.1%, membranoproliferative glomerulonephritis (MPGN) 4.2% in decreasing order of frequency. The mean age was youngest in MCNS (32.9+/-15.1) and oldest in MGN (46.2+/-16.6). Between 1978 to 1990 period and 1991 to 2005 period, the prevalence of MGN was significantly increased, whereas the prevalence of MPGN was decreased significantly. The prevalence of MCNS had a tendency to decrease and that of IgA nephropathy had a tendency to increase, however, both didn't reach statistical significance. The incidence of FSGS didn't show a significant change during the both study periods. CONCLUSION: MCNS was the most common disease among adults idiopathic NS. MGN was the most frequent etiology in patients older than 45 years. The incidence of MGN was increased over the 28-year period, and that of MPGN decreased significantly. There was no change in the frequency of FSGS.
Adult* ; Biopsy ; Diagnosis ; Female ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Humans ; Incidence ; Korea* ; Male ; Nephrosis, Lipoid ; Nephrotic Syndrome* ; Prevalence ; Retrospective Studies

PURPOSE: Compared to children, adult MCD patients tend to have a slower response to steroids, however, little is known about the relationships between pathologic findings or the expression of certain gene and the response to steroid treatment in adult-onset MCD. This study was undertaken to investigate the differences in pathologic findings and the mRNA expression of nephrin and glucocorticoid receptor (GCR) in renal tissue according to steroid responsiveness in adult-onset MCD. METHODS: Twenty-eight adult patients who presented with idiopathic nephrotic syndrome at our institution and fulfilled the criteria for MCD clinically and pathologically were chosen for this study. Based on the response to steroid treatment, patients were divided into two groups: early responders (ER) in whom CR was achieved within 4 weeks of steroid treatment; late responders (LR) in whom CR was achieved after 4 weeks of steroid treatment. RESULTS: Of the 28 patients, ER consisted of 20 patients. Time to CR was significantly shorter in ER compared to LR (16.5+/-0.9 vs. 52.0+/-4.9 days, p<0.01). The proportion of patients with minimal IgM deposition on immunofluorescence was significantly higher in LR compared to ER (75.0% vs. 30.0%, p<0.01). On the other hands, the mRNA expression of GCR, assessed by real time-PCR, was significantly lower in LR than that in ER (p<0.005), whereas nephrin mRNA expression was not different between the two groups. CONCLUSION: The presence of glomerular IgM deposition and the amount of GCR in renal tissue may be useful predictors of steroid responsiveness in adult MCD patients.
Adult ; Adult Children ; Fluorescent Antibody Technique ; Gene Expression* ; Hand ; Humans ; Immunoglobulin M ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Receptors, Glucocorticoid ; RNA, Messenger ; Steroids