Oral or rectal sodium phosphate(NaP) preparation is commonly used for the colonic cleansing. Since the sole route of excretion of absorbed phosphate is renal, diminished renal function will limit the ability to excrete a sudden phosphate load. To date, about 20 adult cases of hyerphosphatemia associated with oral or rectal sodium phosphate solution have been reported, but not a single case in Korea to our knowledge. We report two cases of hyperphosphatemia and hypocalcemia after the administration of NaP(Colclean(R)) to reemphasizes the potential hazard of sodium phosphate bowel preparation in patients with compromised renal function.
Adult ; Colon ; Humans ; Hyperphosphatemia* ; Hypocalcemia* ; Kidney Failure, Chronic* ; Korea ; Laxatives* ; Sodium

A 64-year-old woman with ischemic heart disease was admitted to our hospital because of both leg pain and difficulty to walk for 5 days. She had taken cerivastatin and gemfibrozil for atherosclerosis and ischemic heart disease. One year ago, she had been admitted to our hospital because of acute renal failure due to rhabdomyolysis of unknown origin and was improved after conservative therapy. Laboratory studies revealed serum creatinine 1.2 mg/dL, creatine kinase 23,700 IU/L, serum myoglobin >500 ng/mL, urine myoglobin >3,000 ng/mL. (99m)Tc-HDP whole body Bone scan showed multiple increased uptakes of the soft tissue, especially both calf. With supportive care, she was recovered and discharged with normal creatinine(0.8 mg/dL) and creatine kinase(260 IU/L).
Acute Kidney Injury ; Atherosclerosis ; Creatine ; Creatine Kinase ; Creatinine ; Female ; Gemfibrozil ; Humans ; Leg ; Middle Aged ; Myocardial Ischemia ; Myoglobin ; Rhabdomyolysis*

An 51-year-old woman presented with microscopic hematuria without protenuria for long time. Laboratory studies demonstrated the presence of red blood cells in urine, a normal serum IgM level, the absence of antinuclear antibodies, and a normal complement level. Renal biopsy revealed that some glomeruli are enlarged with endocapillary cell proliferation and a few glomeruli exhibit prominent vascular pole of the tufts and segmental increase in mesangial cell and matrix. Immunofluorescence studies demonstrated segmental granular deposits for IgM. Electron microscopy showed well-preserved foot process associated with focal effacement. Biopsy findings were consistent with IgM nephropathy. We present this case to promote understanding of the pathogenesis of IgM nephropathy.
Antibodies, Antinuclear ; Biopsy ; Cell Proliferation ; Complement System Proteins ; Erythrocytes ; Female ; Fluorescent Antibody Technique ; Foot ; Hematuria ; Humans ; Immunoglobulin M* ; Mesangial Cells ; Microscopy, Electron ; Middle Aged ; Proteinuria*

We have described a male patient with a episode of acute renal failure after strenuous exercise. He was found to have low serum uric acid(0.6 mg/dL, after recovery) and normal 24 hour urinary excretion in the steady state. The possibility of other diseases that cause hypouricemia could be excluded, acute renal failure associated with idiopathic renal hypouricemia was diagnosed in this case. A renal computed tomography showed the delayed wedge shaped contrast enhancement, these findings suggested that the cause of acute renal failure could be renal vasoconstriction rather than obstruction by uric acid crystals. Hypouricemia appear to play a crucial role in this reperfusion oxygen free radical induced acute renal failure. We have suggested that the renal hypouricemia should be suspected in the case of acute renal failure associated with exercise when the patient's uric acid level was within or slight alone normal range at the time of acute renal failure.
Acute Kidney Injury* ; Humans ; Male ; Oxygen ; Reference Values ; Reperfusion ; Uric Acid ; Vasoconstriction

PURPOSE: Fungal peritonitis is a fatal disease with a high mortality and morbidity to the peritoneal dialysis(PD) patients. This study was implemented to provide a guideline for the prevention and treatment of fungal peritonitis in PD patients by analyzing the clinical and microbiologic features of fungal peritonitis cases. METHODS: We analyzed retrospectively into the 15 cases(14 patients) of fungal peritonitis among 376 end stage renal disease(ESRD) patients who newly started PD in the Seoul National University Hospital from Jan. 1991 to Dec. 1999. RESULTS: The patients' age was 53.6+/-11.6 years (mean+/-standard deviation) and their male to female ratio was 12:3. They have been on PD for 29.2+/-27.7 months before the fungal peritonitis developed. Candida species was the most common etiologic agent, accounting for 10(62.5%) out of the 16 fungal organisms isolated from our patients. Among others were two Aspergillus, one Cryptococcus, one Penicillium, one Torulopsis, and one Trichosporon beigelii cases. Bacterial agents were isolated simultaneously in five fungal peritonitis cases. Peritoneal catheters were all removed no later than 72 hours after the diagnosis was made. Patients were given a single or combined therapy with amphotericin B, fluconazole, or flucytosine on the physician's choice. The outcomes of fungal peritonitis were as follows; 20% continued PD, 60% converted to HD and 20% died of fungal peritonitis. We made a comparative analysis between the fungal and bacterial peritonitis cases which developed in the same 5-year period, which showed significantly higher catheter removal and technique failure rates in the fungal cases. CONCLUSION: Fungal peritonitis is a rare but a fatal disease with a high mortality and a technique failure rate. Candida species was the most prevalent microorganism in our study.
Amphotericin B ; Aspergillus ; Candida ; Catheters ; Cryptococcus ; Diagnosis ; Female ; Fluconazole ; Flucytosine ; Fungi ; Humans ; Male ; Mortality ; Penicillium ; Peritoneal Dialysis* ; Peritonitis* ; Retrospective Studies ; Seoul ; Trichosporon

BACKGROUND: Ischemic heart disease has become more important in regard to mortality in hemodialysis patients. Although PTCA has been used for the treatment of ischemic heart disease, its result has little been reported in chronic renal failure(CRF) patients not in maintenance dialysis. We examined the therapeutic outcome of PTCA in CRF group in comparison with that in control group with normal renal function. METHODS: In a retrospective case-control study, 15 patients with CRF(Scr >or=1.4 mg/dL) were compared with 29 sex, age and diabetes mellitus matched controls without renal disease who had been randomly selected from the PTCA registry of our institution. Restenosis was evaluated by follow-up angiography or recurrent angina. Twenty-two PTCAs were performed over 26 stenotic lesions in CRF group, and thirty-nine PTCAs undergone over 56 lesions in control group. RESULTS: CRF group consisted of 11 men and 4 women with a mean age of 59.2+/-9.2(mean+/-SD) years and a mean serum creatinine of 3.8+/-2.4 mg/ dL. Cause of renal failure was diabetes mellitus in 11 cases(73%). Angiographic lesion success was confirmed in 17(65%) out of the 26 stenotic sites and stents were inserted successfully in the other nine lesions. Restenosis was confirmed by angiography in 10 lesions(38.5%) over a mean of seven months and suspected by recurrent angina in 6 lesions(23.1%), so overall restenosis rate was 61.6% in CRF group. Risk of restenosis was little different compared with control group in single- and double vessel disease, but increased up to 89% in triple vessel disease in CRF in contrast with control group. Among CRF group patients with serum creatinine >or=2.5 mg/dL showed much increased restenosis rate(77%) compared with those with serum creatinine <2.5 mg/dL (46%). CONCLUSION: Restenosis rate significantly increased in CRF patients who have multivessel disease or advanced renal failure, so other reperfusion therapy should be considered for them.
Angiography ; Angioplasty, Balloon, Coronary* ; Case-Control Studies ; Creatinine ; Diabetes Mellitus ; Dialysis ; Female ; Follow-Up Studies ; Humans ; Kidney Failure, Chronic* ; Male ; Mortality ; Myocardial Ischemia ; Renal Dialysis ; Renal Insufficiency ; Reperfusion ; Retrospective Studies ; Stents

BACKGROUND: Continuous ambulatory peritoneal dialysis(CAPD) patients with low albumin(LA) and signs of inflammation reflected by increased C-reactive protein(CRP) level have an increased mortality, but the mechanism of this phenomenon is not clear yet. METHODS: To answer whether LA and inflammation also enhance cardiovascular risk in CAPD patients, we performed cross sectional study measuring carotid artery intima-media thickness(IMT), calculated intima-media area(cIM area) and the presence of plaque by high-resolution B-mode ultrasonography in 93 non-diabetic CAPD patients. RESULTS: Patients with coronary artery disease (CAD, n=8) had significantly increased IMT(0.79+/-0.21 mm vs. 0.60+/-0.11 mm, p < 0.05) and higher prevalence of carotid plaques(75.0% vs. 63.5%) compared to the non-CAD patients. Significant inverse correlation was observed between serum albumin (SA) level and cIM area(r=-0.27, p < 0.05). Those patients with LA(SA <3.5 g/dL) had significantly increased IMT compared to non-LA patients(0.67+/-0.15 mm vs 0.61+/-0.12 mm, p < 0.05). Prevalence of carotid plaques was also significantly higher in LA patients (68.0% vs. 55.8%, p < 0.05). CRP level revealed a significant positive correlation with cIM area(r=0.21, p < 0.05). Patients with high CRP(>or=0.8 mg/dL, n=18) had higher prevalence of carotid plaques (65.8% vs. 50.0%, p < 0.05) compared to those patients with CRP <0.8 mg/dL, but IMT and cIMT area were not different. By multivariate logistic regression analysis, old age, high CRP, history of CAD and low SA were the independent risk factors affecting IMT. CONCLUSION: Our study strongly suggests that low albumin and chronic inflammatory state of CAPD patients could be associated with increasing atherosclerotic cardiovascular disease.
Atherosclerosis ; C-Reactive Protein ; Cardiovascular Diseases ; Carotid Arteries* ; Coronary Artery Disease ; Humans ; Inflammation ; Logistic Models ; Mortality ; Peritoneal Dialysis, Continuous Ambulatory ; Prevalence ; Risk Factors ; Serum Albumin ; Ultrasonography*

PURPOSE: The purpose of this study was to evaluate the effect of percutaneous transluminal angioplasty(PTA) and to determine patency rates and the factors affecting the long-term patency rates in the management of insufficient arteriovenous fistulae. METHODS: Sixty-one cases of insufficient dialysis shunts in 53 patients underwent venography of the fistula. These patients' indications of venographys were reviewed. Forty-six cases of insufficient dialysis shunts in 38 patients were treated by PTA. These patients' clinical characteristics and patency rates were evaluated. According to the patient's age, history of diabetes mellitus, duration of renal failure, type and age of the arteriovenous fistula, the site of AVF and length of the stenosis, and to the degree of residual stenosis, patency rates were compared within each subgroup using the Kaplan-Meier log- rank test. To estimate reasons for the incidence of vascular access failure, Cox regression model was used. Venographic findings of failed PTAs and PTA related complications were evaluated RESULTS: The success rate was 80.7%. In cases in which initial success was obtained, postintervention primary patency rate at 6, 12 and 24 months were 68%, 38% and 5% respectively. With repeatitive PTAs, postintervention assisted primary patency rate at 6, 12 and 24 months were 69%, 40% and 10% respectively. The effect of the above mentioned factors(age, DM, duration of CRF etc.) on long-term patency was not statistically significant(p > 0.05). Among 11 cases of failed PTA, there were 6 cases of total obstruction due to massive thrombosis and 5 cases of extensive vascular stenosis(>5 cm of length, >4 sites of stenosis and >75% of stenosis in all cases). There were no PTA related complications. CONCLUSION: PTA is considered to be an effective and safe treatment modality for shunt stenosis. No factors affected long-term patency rates in our study.
Angioplasty* ; Arteriovenous Fistula ; Constriction, Pathologic ; Diabetes Mellitus ; Dialysis ; Fistula ; Humans ; Incidence ; Phlebography ; Renal Dialysis* ; Renal Insufficiency ; Thrombosis

BACKGROUND: Modified lipoproteins may be involved in nephro- and glomerulosclerosis. Diabetic nephropathy-like lesions have also been induced in a rat model by glycated and glycoxidized albumin. In cultured rat or human mesangial cells, enhanced cell proliferation and production of mesangial matrix in response to lipoproteins and their modified forms have been demonstrated by [3H]-thymidine incorporation and cell counting assays. But these methods are relatively complex and most of them have used only one or two of the lipoprotein, albumin and their modified forms. METHODS: We investigated the effects of native and modifed lipoproteins, and albumin on cultured human mesangial cell proliferation using non-radioactive colorimetric method by MTS/PMS assay. Lipoproteins added were low density lipoprotein(LDL), high density lipoprotein(HDL), very low density lipoprotein(VLDL), oxidized LDL(oxidation with copper sulfate in vitro) and glycated LDL and we also used albumin, glycated albumin, and interleukin-1beta as a positive control. RESULTS: Interleukin-1beta promoted the proliferation of cultured human mesangial cells up to concentration 20 ng/mL. LDL induced the proliferation of mesangial cells in a concentration-dependent manner up to concentration 100 microgram/mL. HDL and VLDL had no significant proliferative effect. Oxidized LDL caused the proliferation of mesangial cells at low concentration up to concentration 25 microgram/mL. Addition of glycated LDL resulted in a concentration- dependent inhibition of mesangial cells. Albumin and glycated albumin inhibited the proliferation of mesangial cells at low concentration of 100 microgram/mL, but cell growth was increased at higher concentrations. CONCLUSION: We demonstrated the effects of the single and modified proteins on the proliferation of cultured human mesangial cell by relatively simple colorimetric method. Results were almostly identical to those of previous studies obtained by radioactive method or cell counting assay.
Animals ; Cell Count ; Cell Proliferation ; Copper Sulfate ; Humans* ; Interleukin-1beta ; Lipoproteins* ; Mesangial Cells* ; Models, Animal ; Rats

BACKGROUND: High glucose upregulates MCP-1 expression in rat glomerular mesangial cells and in human peritoneal mesothelial cells. However, the role of high glucose-induced MCP-1 on the development and progression of diabetic renal injury and peritoneal injury during peritoneal dialysis(PD) using high glucose PD solutions are not clear. Since MCP-1 was shown to upregulate transforming growth factor-beta1(TGF-beta1) and collagen expression in lung fibroblasts, the present study investigated the effects of MCP-1 on fibronectin secretion by mouse mesangial cells(MMC), human peritoneal mesothelial cells (HPMC), and human peritoneal fibroblasts(HPFB). METHODS: Synchronized cells were stimulated by different concentrations of MCP-1(0.1-100 ng/mL) or TGF-beta1(0.1-10 ng/mL) for 48 hours. Fibronectin protein secreted into the media was analyzed by Western blot analysis. RESULTS: MCP-1 up to 100 ng/mL did not affect fibronectin secretion by MMC. TGF-beta1 10 ng/mL, however, increased fibronectin secretion by MMC 2.8 fold that of control. MCP-1 up to 100 ng/mL did not affect fibronectin secretion by HPMC. But, TGF-beta1 0.1 ng/mL increased fibronectin secretion by HPMC 1.8 fold compared to control. On the other hand, MCP-1 increased fibronectin secretion by HPFB in a dose-dependent manner. MCP-1 at 1-10 ng/mL significantly increased fibronectin when compared to M199 control. 100 ng/mL MCP-1 further increased fibronectin secretion by HPFB compared to 0.1-10 ng/mL MCP-1. CONCLUSION: These results suggest a possible role for MCP-1 in the development and progression of peritoneal fibrosis and support the view that in addition to recruiting inflammatory cells MCP-1 may play a role in tissue fibrosis in other organs.
Animals ; Blotting, Western ; Chemokine CCL2* ; Collagen ; Fibroblasts* ; Fibronectins* ; Fibrosis ; Glucose ; Hand ; Humans* ; Lung ; Mesangial Cells ; Mice ; Monocytes* ; Peritoneal Fibrosis ; Rats ; Transforming Growth Factor beta1