A 46-year-old woman was admitted to emergency room for muscle weakness and repiratory difficulty. She was taking furosemide (4 tablets per day : 160 mg/day) without physician's prescription. Her blood pressure was 90/50 mmHg and her heart rate 74/ min. Her laboratory finding showed a low serum potassium concentration (0.9 mmol/L), CK 368 IU/L, creatine 1.6 mg/dL. The result was rechecked and confirmed. Electrocardiography showed a dip in the ST segment, prolonged QTc, 1st degree AV block and 2 : 1 AV block. Echocardiography was normal. Abdominal CT scan show right lower pole calyceal stones without nephrocalcinosis. Treatment was initiated consisting of intravenous potassium chloride. Hypokalemia was overcome in 3 days. Kidney biopsy showed hypokalemic nephropathy - interstitial nephrosis, vacuolar change of tubule, proliferation of juxtaglomerular apparatus. Paralytic ileus, rebound pleural effusion, glucose intolerance, elevation of CK were associated findings. After correction of hypokalemia, her symptoms and electrocardiographic findings returned to normal.
Atrioventricular Block ; Biopsy ; Blood Pressure ; Creatine ; Echocardiography ; Electrocardiography ; Emergency Service, Hospital ; Female ; Furosemide* ; Glucose Intolerance ; Heart Rate ; Humans ; Hypokalemia* ; Intestinal Pseudo-Obstruction ; Juxtaglomerular Apparatus ; Kidney ; Middle Aged ; Muscle Weakness ; Nephrocalcinosis ; Nephrosis ; Pleural Effusion ; Potassium ; Potassium Chloride ; Prescriptions ; Tablets ; Tomography, X-Ray Computed

Renal lymphangiectasia is a rare cystic kidney disorder. This disorder has been termed renal lymphangioma, renal lymphangiomatosis, pararenal lymphatic cyst. We report on a 32-year-old man admitted with complaints of abdominal discomfort, in whom unilateral renal lymphangiectasia with renal vein thrombosis was diagnosed. Abdominal computed tomography revealed left perirenal fluid collection with multiloculation. Left renal vein was completely obliterated due to thrombosis and inferior vena cava (IVC) was partially obliterated. Perirenal fluid collection and renal vein thrombosis were treated initially with percutaneous drainage and anticoagulation therapy. The biochemical features of the drained fluid were compatible with lymphatic fluid. Since there was no decrease in the amount of daily drainage, left nephrectomy and IVC thrombectomy was performed on the 34th day of hospitalization. Left kidney was enlarged (15x10x18 cm, 750 g) and composed of numerous smooth, thin-walled cysts. Pathologic diagnosis was renal lymphangiectasia.
Adult ; Diagnosis ; Drainage ; Hospitalization ; Humans ; Kidney ; Kidney Diseases, Cystic ; Lymphangioma ; Lymphocele ; Nephrectomy ; Renal Veins* ; Thrombectomy ; Thrombosis* ; Vena Cava, Inferior

Nail-patella syndrome is a relatively rare autosomal dominant disorder characterized by dysplastic nail, hypoplastic or absent patella, and dislocation of radial head and iliac horns. In addition, renal abnormalities have been reported. The usual clinical signs of the renal involvement are asymptomatic proteinuria, microscopic hematuria, and in some cases progression to end stage renal disease. We present the case of adult with nail-patella syndrome, who developed proteinuria. Electron microscopy revealed irregular thickening of the glomerular basement membrane with areas of rarefaction, giving rise to a pathognomonic "moth-eaten" appearance.
Adult ; Animals ; Dislocations ; Glomerular Basement Membrane ; Head ; Hematuria ; Horns ; Humans ; Kidney Failure, Chronic ; Microscopy, Electron ; Nail-Patella Syndrome* ; Patella ; Proteinuria

Spontaneous renal artery dissection is an uncommon cause of renal infarction. Previous reports of spontaneous renal artery dissection has been associated with hypertension or fibromuscular dysplasia. We report herein the case of a previously healthy, normotensive patient with renal infarction due to spontaneous renal artery dissection who remained normotensive throughout his course without therapy. A previously healthy 31-year-old man with well- documented normotension had a sudden onset of right flank pain and delayed onset of elevation of lactic dehydrogenase, hematuria, and proteinuria. Thin section spiral computerized tomogram shows linear intraluminal filling defect suggesting intimal flap. Angiography shows dissection of main right renal artery. Six months later, he has remained well and normotensive without therapy. To our knowledge, this is the first case of spontaneous renal artery dissection in normotensive patients in Korea.
Adult ; Angiography ; Fibromuscular Dysplasia ; Flank Pain ; Hematuria ; Humans ; Hypertension ; Infarction* ; Korea ; Oxidoreductases ; Proteinuria ; Renal Artery*

Medullary cystic disease (MCD) and familial juvenile nephronophthisis are inherited diseases characterized by development of small cysts at the cortico- medullary borders of the kidneys. Both diseases consist of microscopic or gross cysts of the renal medullae associated with atrophy of nephrons, anemia, renal insufficiency, polyuria, and salt-wasting. We report a 27-year-old pregnant female patient with MCD which caused acute renal failure progressing to end stage renal disease during the second trimester. Hypertension, oliguria, preeclampsia, placenta abruptio, and disseminated intravascular coagulation were also accompanied. Radiologically, abdominal ultrasonography and computed tomogram showed many cysts confined only to the renal medullae, which are typical findings consistent with MCD. In spite of conservative therapy, her renal function deteriorated rapidly and uremic symptoms including pulmonary edema were aggravated. She was started on hemodialysis and she has received regular hemodialysis without recovery of renal function.
Acute Kidney Injury ; Adult ; Anemia ; Atrophy ; Disseminated Intravascular Coagulation ; Female ; Humans ; Hypertension ; Kidney ; Kidney Failure, Chronic* ; Nephrons ; Oliguria ; Placenta ; Polyuria ; Pre-Eclampsia ; Pregnancy Trimester, Second ; Pregnancy* ; Pulmonary Edema ; Renal Dialysis ; Renal Insufficiency ; Ultrasonography

Membranous nephropathy (MGN) is a common cause for nephrotic syndrome in adults. Renal failure usually develops gradually in patients with MGN and rapid deterioration of renal function is a rare complication. Moreover, the development of crescentric glomerulonephritis (CGN) as a cause of acute renal failure (ARF) in patients with preexisting MGN is very rare. We report 20-year-old male patient with MGN who presented with ARF due to superimposed CGN. He had been diagnosed as idiopathic MGN and his renal function was maintained within normal range. After 13 months of conservative treatment, ARF was developed and renal biopsy was performed to differentiate the possible causes of ARF. Renal biopsy revealed diffuse crescents formation on preexisting MGN. Anti-GBM antibody and ANCA were not detected. This patient was treated with combination therapy including methylprednisolone pulse therapy followed by high dose steroid and cyclophosphamide. His renal function was improved significantly 2 weeks after treatment. In conclusion, when unexplained ARF in patient with MGN develops, prompt investigation for superimposed conditions including CGN is necessary and repeat renal biopsy should be considered.
Acute Kidney Injury ; Adult ; Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Cyclophosphamide ; Glomerulonephritis* ; Glomerulonephritis, Membranous* ; Humans ; Male ; Methylprednisolone ; Nephrotic Syndrome ; Reference Values ; Renal Insufficiency ; Young Adult

Peritonitis remains the leading cause of morbidity and technique failure for patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Chryseobacterium meningosepticum is the most common pathogen for humans among Chryseobacterium species and a few cases of CAPD peritonitis caused by C. meningosepticum were reported in the world. We experienced a case of CAPD peritonitis by C. meningosepticum in Ewha Womans University Hospital, Seoul, Korea. A 52-year-old diabetic woman on CAPD was admitted with turbid peritoneal fluid. She was suffered from three episodes of peritonitis. Effluent was cloudy with a cell count of 1,620 WBC/ mm3 (94% neutrophils, 4% lymphocytes). Effluent cultures obtained on 6th hospital day revealed a mixed growth of C. meningosepticum and P. aeruginosa. Tenckhoff catheter was removed due to persistent cloudy effluent till 9th hospital day. We herein report a case of peritonitis caused by C. meningosepticum and review the literature of similar cases of peritonitis.
Ascitic Fluid ; Catheters ; Cell Count ; Chryseobacterium* ; Female ; Humans ; Korea ; Middle Aged ; Neutrophils ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Seoul

BACKGROUND: The efficacy of dialysis on the autonomic and peripheral nerve function has been a subject of considerable debate. In addition, no longitudinal study on the course of uremic neuropathy in end-stage renal disease (ESRD) during dialysis has been reported. We carried out a prospective study to investigate the effect of dialysis on the autonomic and peripheral nerve function during the first 12 months of dialysis. METHODS: Twenty-five patients with ESRD (14 on HD and 11 on CAPD; 11 diabetic and 14 non- diabetic) were enrolled. Autonomic nerve function test and median nerve conduction velocity study were done at the initiation of dialysis and then repeated after 12 months of dialysis. RESULTS: At the initiation of dialysis, sympathetic nerve function and parasympathetic nerve function were abnormal in all HD and CAPD patients. After 12 months of dialysis, no significant changes occurred in autonomic function test. There was no significant difference in autonomic function test between HD and CAPD patients. There was no significant difference in median nerve conduction velocity between HD and CAPD patients after 12 months of dialysis. At the initiation of dialysis, 6 of 11 diabetic and 4 of 14 non-diabetic patients had abnormal median nerve conduction velocity. After 12 months of dialysis, normalization of median nerve conduction velocity occurred only in 3 non-diabetic patients. There was a singinficant difference in median nerve conduction velocity between diabetic and non-diabetic patients after 12 months of dialysis. CONCLUSION: We conclude that dialysis does not significantly alter the autonomic nerve function during the first 12 months of dialysis, but may improve the peripheral nerve function in non-diabetic uremic patients.
Autonomic Pathways ; Dialysis* ; Humans ; Kidney Failure, Chronic* ; Longitudinal Studies ; Median Nerve ; Peripheral Nerves* ; Peritoneal Dialysis, Continuous Ambulatory ; Prospective Studies

PURPOSE: The object of the present study were to clarify the effect of dialysis treatment and residual renal function on olfactory function of patients with chronic renal failure and to assess the correlations between the Cross Cultural Smell Identification Test (CC-SIT) scores and various clinical variables. METHODS: Ninety subjects were studied and divided four groups; age- and sex-matched healthy controls (Control, n=20), patients with varying degree of renal insufficiency but not on dialysis (Pre- dialysis, n=20), patients on CAPD (PD, n=22), and patients on hemodialysis (HD, n=28). We performed olfactory function test using the CC-SIT kit and compared the CC-SIT scores of each of the groups. RESULTS: The CC-SIT scores of each of the groups were; Control : 8.6+/-1.5, Pre-dialysis : 7.2+/-2.0, PD : 8.1+/-1.2, HD : 8.5+/-1.4. In Pre-dialysis group, the CC-SIT scores were significantly lower than Control group (p=0.01). But, no significant difference was observed in the CC-SIT scores between HD and PD group and control group (p>0.05). Creatinine clearance was positively correlated with the CC-SIT scores in control and Pre-dialysis group (r=0.58, p= 0.0001). Total Kt/V was positively correlated with the CC-SIT scores only in HD group (r=0.39, p= 0.03). But, no correlation was found between Kt/ Vurea, URR or residual renal function and the CC- SIT scores in HD and PD group (p>0.05). Age was negatively correlated with the CC-SIT scores only in Control group (r=-0.76, p=0.0001). CONCLUSION: Our results indicate that smell disturbance in patients with chronic renal faliure can be recovered by adequate dialysis treatment.
Creatinine ; Dialysis* ; Humans ; Kidney Failure, Chronic* ; Peritoneal Dialysis, Continuous Ambulatory ; Renal Dialysis ; Renal Insufficiency ; Smell

BACKGROUND: The objective of the present study was to assess the efficacy and safety of iron sucrose by determining the subsequent change in hemoglobin (Hgb), hematocrit (Hct), transferrin saturation (TAST), serum ferritin values and blood pressures in hemodialysis patients receiving Epoetin. METHODS: A total of 19 adult patients who had been receiving hemodialysis three times a week at Chonnam Natinal University Hospital were assigned. Their Hgb level was less than 10 g/dL and their serum ferritin level was less than 100 ng/mL, and/or TSAT was less than 20%. Iron sucrose was administered as 1,000 mg in 10 divided doses diluted in 100 mL normal saline over the last 60 minutes during hemodialysis with a one-time prior test dose of 20 mg on 10 consecutive dialysis sessions. Iron sucrose dosage was adjusted to 25-100 mg/week depending on serum ferritin level, and TSAT in the following 3 months. Epoetin administration was stopped due to insurance regulation when Hgb level was more than 10 g/dL and Hct level was more than 30 %. To evaluate efficacy of iron sucrose, assessment of serum iron parameters and anemia indices was determined just before the first dose (baseline), at 1 month after the first dose (loading) and then, monthly for 3 months (maintenance). To evaluate safety of iron sucrose, we recorded blood pressure 1 hour before and at the time of completion of iron sucrose injection, and also recorded blood pressure during observation sessions before dialysis and at intervals of 2 hours and 4 hours after starting dialysis. We determined routine serum chemistry and hematologic results at 1 month after the first dose and compared results with those obtained at baseline. RESULTS: 1,000 mg iron surcose injection in 10 divided dose (loading) produced a significant rise in Hgb, Hct, serum iron, serum ferritin, TSAT, MCV and MCH at 1 month after first dose (respectively p<0.001, p<0.001, p<0.01, p<0.001, p<0.01, p<0.01, p< 0.01). During the following maintenance period of 3 months, Hgb, Hct, serrum ferritin, and TSAT level remained more elevated than at baseline respectively. In 19 enrolled patients, we experienced no serious adverse drug reactions and no significant changes in intradialytic blood pressure associated with iron sucrose administration. Serum albumin concentrations was higher at 1 month than at base line and however, changes in other serum chemistry and hematologic results were not statistically significant. CONCLUSION: Intravenous iron sucrose administration is an efficient and safe method to supply iron in end-stage renal disease patients receiving Epoetin with iron deficiency, who are undergoing hemodialysis.
Adult ; Anemia ; Blood Pressure ; Chemistry ; Dialysis ; Drug-Related Side Effects and Adverse Reactions ; Ferritins ; Hematocrit ; Humans ; Insurance ; Iron* ; Jeollanam-do ; Kidney Failure, Chronic ; Renal Dialysis* ; Serum Albumin ; Sucrose* ; Transferrin