PURPOSE: The aim of this study is to identify postoperative renal function and preoperative factors that can predict renal impairment after living donor nephrectomy. MATERIALS AND METHODS: We studied 172 patients undergoing living donor nephrectomy for kidney transplantation (115 males, 57 females). We analyzed the renal function measured by serum creatinine and the 99mTc- diethylenetriamine penta-acetic acid (DTPA) renal scan. Using a univariate and multivariate analysis, we also analyzed multiple independent variables for the remaining renal function following living donor nephrectomy, such as serum creatinine, glomerular filtration rate (GFR), age, sex, duration of follow-up, blood pressure, body mass index (BMI), serum calcium, serum phosphate, serum uric acid. RESULTS: The mean age of the donors was 34 years, and the mean duration of the follow-ups was 11 months. The mean serum creatinine at 11 months after kidney donation was increased compared to preoperative creatinine (1.26mg/dl vs. 0.93mg/dl), and significantly greater in the males than in the females (1.36mg/dl vs. 1.09mg/dl). Mean GFR measured by the 99mTc- DTPA renal scan at 11 months after kidney donation was 69.2 ml/min/ 1.73m2 and similar for men and women (72.3ml/min/1.73m2 vs. 68.3ml/ min/1.73m2). The univariate analysis showed that preoperative creatinine was significantly associated with postoperative creatinine only (p<0.001), and age and sex were associated with the change in creatinine (p=0.046, p<0.001). The univariate analysis also showed that preoperative GFR and age were significantly associated with postoperative GFR (p<0.001, p<0.001), and age was associated with compensatory change in GFR (p= 0.008). The multivariate analysis showed that preoperative GFR was the primary predictive factor of postoperative GFR (r=0.73, p<0.001), and age was an independent secondary predictive factor (r= 0.67, p<0.001). CONCLUSIONS: These results suggest that postoperative renal function has been preserved in kidney donors, and preoperative creatinine, preoperative GFR, and age at donation were the important predictive factors of renal function after living donor nephrectomy.
Blood Pressure ; Body Mass Index ; Calcium ; Creatinine ; Female ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Kidney ; Kidney Transplantation ; Living Donors* ; Male ; Multivariate Analysis ; Nephrectomy* ; Pentetic Acid ; Tissue Donors ; Uric Acid

A xanthoma is an abnormal localized collection of histiocytic tissue containing lipid. It is not a true tumor, but is a reactive histiocytic proliferation often secondary to alternations in serum lipids. Xanthoma lesions are seen in the skin and tendons, and may occur at other sites, such as the stomach and arytenoepiglottic fold. However, a xanthoma is rare in the bladder, with only 9 reported cases. Here, a case of a xanthoma of the bladder detected incidentally during cystoscopic examination for a gross hematuria is reported.
Hematuria ; Skin ; Stomach ; Tendons ; Urinary Bladder* ; Xanthomatosis*

A spontaneous rupture of the kidney due to a metastatic choriocarcinoma, which is associated with a normal pregnancy, is very rare. A 33-year-old female patient presented with sudden colicky right flank pain on the 5th day after a Cesarian Section. An abdominal CT scan showed evidence of a right renal rupture with a perirenal hematoma. Under the impression of a spontaneous rupture of right kidney, an exploratory laparotomy with a radical nephrectomy was performed. The pathologic findings revealed a renal parenchymal rupture due to a metastatic choriocarcinoma.
Adult ; Choriocarcinoma* ; Female ; Flank Pain ; Hematoma ; Humans ; Kidney* ; Laparotomy ; Nephrectomy ; Pregnancy ; Pregnancy* ; Rupture ; Rupture, Spontaneous* ; Tomography, X-Ray Computed

OBJECTIVE: We wanted to investigate the incidence of serious infections among the rheumatoid arthritis (RA) patients who were treated with tumor necrosis factor alpha (TNF-alpha) antagonists. METHODS: We enrolled the 175 RA patients who were treated with TNF-alpha antagonists for at least 3 months during February 2003 to July 2008, and these patients were in the SMART-b cohort of Kangnam St. Mary's hospital. Patients were prescribed infliximab, etanercept or adalimumab. The data was retrospectively collected. RESULTS: The incidence of serious infections among the RA patients treated with TNF-alpha was significantly increased according to the survival analysis, as compared with that of those patient treated with conventional DMARDs (p<0.01). The most common serious infection was pneumonia. There was no significant difference in the incidence of serious infections among the three TNF-alpha antagonists used in this study (p=0.96). But the serious infections occurred more often in the patients who received more than 10 mg methotrexate (MTX) per week (p=0.02). CONCLUSION: RA patients treated with TNF-alpha antagonists had a higher incidence of serious infection. Therefore, close monitoring for serious infection is needed for RA patients who are receiving TNF-alpha antagonists.
Antibodies, Monoclonal ; Antibodies, Monoclonal, Humanized ; Antirheumatic Agents ; Arthritis, Rheumatoid ; Cohort Studies ; Humans ; Immunoglobulin G ; Incidence ; Methotrexate ; Pneumonia ; Receptors, Tumor Necrosis Factor ; Retrospective Studies ; Tumor Necrosis Factor-alpha

OBJECTIVE: We wanted to investigate the incidence of serious infections among the rheumatoid arthritis (RA) patients who were treated with tumor necrosis factor alpha (TNF-alpha) antagonists. METHODS: We enrolled the 175 RA patients who were treated with TNF-alpha antagonists for at least 3 months during February 2003 to July 2008, and these patients were in the SMART-b cohort of Kangnam St. Mary's hospital. Patients were prescribed infliximab, etanercept or adalimumab. The data was retrospectively collected. RESULTS: The incidence of serious infections among the RA patients treated with TNF-alpha was significantly increased according to the survival analysis, as compared with that of those patient treated with conventional DMARDs (p<0.01). The most common serious infection was pneumonia. There was no significant difference in the incidence of serious infections among the three TNF-alpha antagonists used in this study (p=0.96). But the serious infections occurred more often in the patients who received more than 10 mg methotrexate (MTX) per week (p=0.02). CONCLUSION: RA patients treated with TNF-alpha antagonists had a higher incidence of serious infection. Therefore, close monitoring for serious infection is needed for RA patients who are receiving TNF-alpha antagonists.
Antibodies, Monoclonal ; Antibodies, Monoclonal, Humanized ; Antirheumatic Agents ; Arthritis, Rheumatoid ; Cohort Studies ; Humans ; Immunoglobulin G ; Incidence ; Methotrexate ; Pneumonia ; Receptors, Tumor Necrosis Factor ; Retrospective Studies ; Tumor Necrosis Factor-alpha

Polyarteritis nodosa (PAN) is a necrotizing vasculitis of the medium-sized arteries. The symptoms and signs of PAN include purpuric skin lesions, mononeuritis multiplex, symptoms of mesenteric ischemia, and renal involvement. We report the first case of PAN manifesting as a neuropathy after influenza infection in Korea. A 68-year-old woman had fever, myalgia, hyperesthesia of both hand and foot, and lower extremity weakness. EMG findings showed severe sensorimotor polyneuropathy, such as multiple mononeuritis. A sural nerve biopsy showed vasculitis and Influenza A (H1N1) were positive. Our patient was treated by glucocorticoid and oral cyclophosphamide, thereafter, symptoms and signs improved. No recurrence has been observed for five months.
Aged ; Arteries ; Biopsy ; Cyclophosphamide ; Female ; Fever ; Foot ; Hand ; Humans ; Hyperesthesia ; Influenza, Human ; Ischemia ; Korea ; Lower Extremity ; Mononeuropathies ; Organic Chemicals ; Polyarteritis Nodosa ; Polyneuropathies ; Recurrence ; Skin ; Sural Nerve ; Vasculitis

The effects of several antihypertensive drugs on bone mineral density (BMD) and micro-architectural changes in ovariectomized (OVX) mice were investigated. Eight-week-old female C57/BL6 mice were used for this study. Three days after ovariectomy, mice were treated intraperitoneally with nifedipine (15 mg/kg), telmisartan (5 mg/kg), enalapril (20 mg/kg), propranolol (1 mg/kg) or hydrochlorothiazide (12.5 mg/kg) for 35 consecutive days. Uterine atrophy of all mice was confirmed to evaluate estrogen deficiency state. BMD and micro-architectural analyses were performed on tibial proximal ends by micro-computed tomography (micro-CT). When OVX mice with uterine atrophy were compared with mice without atrophy, BMD decreased (P < 0.001). There were significant differences in BMD loss between different antihypertensive drugs (P = 0.005). Enalapril and propranolol increased BMD loss in mice with atrophied uteri compared with control mice. By contrast, thiazide increased BMD in mice with uterine atrophy compared with vehicle-treated mice (P = 0.048). Thiazide (P = 0.032) and telmisartan (P = 0.051) reduced bone loss and bone fraction in mice with uterine atrophy compared with the control. Thiazide affects BMD in OVX mice positively. The reduction in bone loss by thiazide and telmisartan suggest that these drugs may benefit menopausal women with hypertension and osteoporosis.
Animals ; Antihypertensive Agents/*pharmacology ; Atrophy ; Benzimidazoles/pharmacology ; Benzoates/pharmacology ; Bone Density/*drug effects ; Enalapril/pharmacology ; Female ; Mice ; Mice, Inbred C57BL ; Ovariectomy ; Propranolol/pharmacology ; Thiazides/pharmacology ; Tibia/radiography ; Tomography, X-Ray Computed ; Uterus/anatomy & histology/pathology

The effects of several antihypertensive drugs on bone mineral density (BMD) and micro-architectural changes in ovariectomized (OVX) mice were investigated. Eight-week-old female C57/BL6 mice were used for this study. Three days after ovariectomy, mice were treated intraperitoneally with nifedipine (15 mg/kg), telmisartan (5 mg/kg), enalapril (20 mg/kg), propranolol (1 mg/kg) or hydrochlorothiazide (12.5 mg/kg) for 35 consecutive days. Uterine atrophy of all mice was confirmed to evaluate estrogen deficiency state. BMD and micro-architectural analyses were performed on tibial proximal ends by micro-computed tomography (micro-CT). When OVX mice with uterine atrophy were compared with mice without atrophy, BMD decreased (P < 0.001). There were significant differences in BMD loss between different antihypertensive drugs (P = 0.005). Enalapril and propranolol increased BMD loss in mice with atrophied uteri compared with control mice. By contrast, thiazide increased BMD in mice with uterine atrophy compared with vehicle-treated mice (P = 0.048). Thiazide (P = 0.032) and telmisartan (P = 0.051) reduced bone loss and bone fraction in mice with uterine atrophy compared with the control. Thiazide affects BMD in OVX mice positively. The reduction in bone loss by thiazide and telmisartan suggest that these drugs may benefit menopausal women with hypertension and osteoporosis.
Animals ; Antihypertensive Agents/*pharmacology ; Atrophy ; Benzimidazoles/pharmacology ; Benzoates/pharmacology ; Bone Density/*drug effects ; Enalapril/pharmacology ; Female ; Mice ; Mice, Inbred C57BL ; Ovariectomy ; Propranolol/pharmacology ; Thiazides/pharmacology ; Tibia/radiography ; Tomography, X-Ray Computed ; Uterus/anatomy & histology/pathology

POEMS syndrome is multisystemic disorder characterized polyneuropathy, organomegaly, endocrinopathies, monoclonal gammapathy. A 38 year-old man visited our hospital because of progressive general weakness, hyperpigmentation. We diagnosed him as idiopathic primary adrenal insufficiency. The symptoms of general weakness were improved after steroid replacement therapy. But after 6 months, he revisited ER with chief complaints of abdominal distension and edema in lower extremities. He had also polyneuropathy, hepatosplenomegaly, IgA light chain monoclonal gammopathy, hyperpigmentation and thickening of the skin. Bone marrow biopsy showed that the plasma cells, mainly mature forms, are about 40% of all nucleated elements and on tissue section. We think this is the first case of POEMS syndrome presenting as primary adrenocortical insufficiency in Korea, so we report the case with reviews of other literatures. And we recommend performing a rapid ACTH stimulation test in all POEMS syndrome in order to detect adrenal insufficiency.
Addison Disease* ; Adrenal Insufficiency ; Adrenocorticotropic Hormone ; Adult ; Biopsy ; Bone Marrow ; Edema ; Humans ; Hyperpigmentation ; Immunoglobulin A ; Korea ; Lower Extremity ; Multiple Myeloma* ; Paraproteinemias ; Plasma Cells* ; Plasma* ; POEMS Syndrome* ; Polyneuropathies ; Skin

We experienced a case of primary sclerosing cholangitis(PSC) in a 40-year-old female who complained of jaundice and pruritus. Marked elevation of serum alkaline phophatase level, typical beaded appearance and pruned-tree appearance on endoscopic retrograde cholangiography, together with a finding of chronic obliterative fibrosing cholangitis on sono-guided gun biopsy specimen of the liver led to a confirmative diagnosis of PSC. The patient responded to ursodeoxycholic acid (UDCA), but was reluctant to treatment and died of hepatic failure 7 months later. PSC is a very rare disease in Korea. So far, only 5 cases including our present case have been reported in the Korean literature. Male-to-female ratio was 2:3 and the median age was 40(27-80 years old). Ulcerative colitis was associated in one case. Four cases involved both intra, and extrahepatic bile ducts and one case was reported to be confined in the intrahepatic bile ducts. Fatality was in 3 cases, 20 days, 36 days, and 7 months after the initial presentaion, respectively. The causes of death were acute cholangitis and sepsis in two, and hepatic failure in one. We herein report a case of PSC and clinical charateristics of the reported cases in Korea, and review the literature with an emphasis on UDCA treatment in PSC.
Adult ; Bile Ducts, Extrahepatic ; Bile Ducts, Intrahepatic ; Biopsy ; Cause of Death ; Cholangiography ; Cholangitis ; Cholangitis, Sclerosing* ; Colitis, Ulcerative ; Diagnosis ; Female ; Humans ; Jaundice ; Korea ; Liver ; Liver Failure ; Pruritus ; Rare Diseases ; Sepsis ; Ursodeoxycholic Acid