Progressive nephropathies are characterized by the enhanced accmulation of extracellular matrix in the kidney. Overproduction of transforming growth factor-beta(TGF-beta) was shown to result in pathological fibrosis of tissue via the accumulation of extracellular matrix proteins. It has been proposed that angiotensin II stimulates the production of TGF-beta. Despite accumulating volume of data supporting the effects of angiotensin converting enzyme(ACE) inhibitors in the attenuation of TGF-beta in vitro and in rats, studies in humans are absolutely lacking. There is evidence that TNF-alpha expression is increased in various glomerulonephritis. The present study sought to determine the effects of ACE inhibitors on TGF-beta1 and TNF-alpha in patients with IgA nephropathy. Using competitive polymerase chain reaction, TGF-beta1 and TNF-alpha mRNA abundance were measured. Patients taking ACE inhibitors showed significantly lower renal TGF-beta1 gene expression compared with patients not on these medications(ratios of TGF-beta1/beta-actin, 4.27+/-0.62 versus 14.81+/-3.87, p<0.05), whereas no difference was noted between patients on ACE inhibitors and normal controls(4.27+/-0.62 versus 2.78+/-0.71). ACE inhibitor therapy did not affect the TNF-alpha mRNA expres- sion in renal tissue. In conclusion, we observed a significant reduction of the TGF-beta1 expression in the kidney by ACE inhibitors, and this suggests that the effects of ACE inhibitors observed in animals can be extrapolated to patients with chronic renal disease.
Angiotensin II ; Angiotensin-Converting Enzyme Inhibitors* ; Angiotensins ; Animals ; Extracellular Matrix ; Extracellular Matrix Proteins ; Fibrosis ; Gene Expression* ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Humans ; Immunoglobulin A* ; Kidney ; Polymerase Chain Reaction ; Rats ; Renal Insufficiency, Chronic ; RNA, Messenger ; Transforming Growth Factor beta* ; Transforming Growth Factor beta1 ; Tumor Necrosis Factor-alpha*

Angiotensin II(ANG II) has been known to induce systemic and glomerular hypertension, which leads to renal tissue injury and progressive fibrosis of kidney. Some effects of ANG II may be mediated by its effect on the cytokine synthesis. In the present study, we investigated the effect of ANG II inhibition on the expression of various cytokines implicated in the pathogenesis and progression of the kidney disease. Blood samples of 11 patients with glomerulonephritis were obtained before the ACE inhibitor therapy and then while they were taking ACE inhibitors. Using peripheral blood mononuclear cells(PBMC) harvested from the samples, RT-PCR was performed to evaluate the changes in mRNA expression of TGF-beta1, IL-6, TNF-alpha and IL-10. The ratios of target cytokines and beta-actin were calculated. TGF-beta1 mRNA expression was decreased in five pat ients after ANG II inhibition with ACE inhibitors, while it was increased in the remaining six patients. ACE inhibitors consistently decreased IL-6 mRNA expression in all 11 patients. IL-10 expression was decreased in 4 patients, and increased in 3 patients after ANG II inhibition. It was not expressed in 4 patients. TNF-alpha expression was increased in 8 patients, and decreased in only 1 patient. In two patients, it was not changed while on ACE inhibitors. Conclusion: ACE inhibitors attenuate IL-6 expression consistently in all 11 patients. This is the first-time demonstration of the in vivo inhibitory effect of ACE inhibitors on IL-6 mRNA expression in humans. The lack of significant suppression of TGF-beta1 in PBMC suggests that the in vivo attenuating effect of ACE inhibitors on TGF-beta1 may be derived from renal hemodynamic changes. The tendency of heightened expression of TNF-alpha confirms the previous investigations in which IL-6 was shown to down regulate TNF-alpha expression
Actins ; Angiotensin II ; Angiotensin-Converting Enzyme Inhibitors* ; Angiotensins ; Cytokines* ; Fibrosis ; Gene Expression* ; Glomerulonephritis ; Hemodynamics ; Humans ; Hypertension ; Interleukin-10* ; Interleukin-6* ; Kidney ; Kidney Diseases ; RNA, Messenger ; Transforming Growth Factor beta* ; Transforming Growth Factor beta1 ; Tumor Necrosis Factor-alpha*

Systemic lupus erythematosus(SLE) is a multisystem disease. Gastrointestinal manifestations are common in SLE, occurring in 35% to 40% of patients at some stage of their illness. Acute pancreatitis is a rare complication of SLE. To date, seventy cases of acute pancreatitis related to SLE have been reported and fourteen cases were unrelated to drugs such as steroids, diuretics or other immunosuppressive agents. Furthermore, only seven out of fourteen cases manifested acute pancreatitis in their initial course of SLE as was seen in our case. Additionally, there have been no such cases reported in Korea. Corticosteroids have been considered as both a cause and as a therapy for acute pancreatitis. We report a case of acute pancreatitis in a 40 year old Korean man presenting with multi-organ manifestations and diagnosed to have SLE. Renal biopsy showed membranous glomerulonephritis(WHO Class V). His serum amylase and lipase returned to normal on high dose prednisolone treatment.
Adrenal Cortex Hormones ; Adult ; Amylases ; Biopsy ; Diuretics ; Humans ; Immunosuppressive Agents ; Korea ; Lipase ; Lupus Erythematosus, Systemic* ; Pancreatitis* ; Prednisolone ; Steroids

OBJECTIVES: Protein-calorie malnutrition is a common problem in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Serum albumin(SA) concentration has been used as a marker for assessing nutritional status. Hypoalbuminemia has been linked to an increased risk of morbidity and mortality and more numerous, prolonged hospitalization for peritoneal dialysis patients. The aim of this study was to determine factors affecting SA value in CAPD patients. METHODS: We performed a cross-sectional study which included patients' demographics, anthropometric data, biochemical parameters, urea kinetic data and comorbidity in 106 stable CAPD patients. RESULTS: 1) There were 50 men and 56 women with a mean CAPD duration of 43 months and mean age of 49 years. The mean concentration of SA was 3.9+/-0.5 (range 2.5-5.3) g/dl and weekly Kt/Vurea 2.0+/-0.4 (range 1.32-3.79) 2) Twenty-one patients(20%) were classified as group I(SA<3.5g/dl)and the remaining patients(80%) as group II(SA 3.5g/dl) 3) Group I patients were significantly older(55+/-11 vs 47+/-11 years, p<0.05) and had significantly higher comorbidity score(1.5+/-0.8 vs 0.7+/-0.9, p<0.05), C-reactive protein (4.5+/-0.9 vs 0.5+/-0.1 mg/dl, p<0.05), 24-hr dialysate-toplasma creatinine(D/PCr) ratio(0.84+/-0.1 vs 0.76+/-0.1, p<0.05), 24-hr dialysate protein (7167+/-2031 vs 5471+/-1515 mg, p<0.05) and had significantly lower residual renal function(RRF)(0.2+/-0.3 vs 0.7+/-1.2 ml/min, p<0.05), BUN(48+/-14.8 vs 55.6+/-14.9 mg/dl, p<0.05), serum creatinine(10.4+/-2.8 vs 12.6+/-3.5 mg/dl, p<0.05), IGF-1(186+/-99 vs 260+/-131 ng/ml, p<0.05), serum phosphorus(4.1+/-1.2 vs 5.0+/-1.3 mg /dl, p<0.05) than group II.4) SA showed positive correlation with anion gap (r=0.43, p value=0.001), transferrin(r=0.41, p value= 0.001) phosphorus(r=0.31, p value=0.001) and negative correlation with 24-hr dialysate protein loss(r=-0.51, p value=0.001), 24-hr D/PCr ratio(r=-0.49, p value=0.001), comorbidity score(r=-0.36, p vluue=0.001). NPCR(r=0.22, p value=0.023), IGF-1(r=0.30, p value=0.002), BUN(r=0.23, p value=0.016) weakly correlated with SA.5) By stepwise multiple logistic regression analysis, age, CRP, 24-hr D/PCr ratio and RRF independently influenced SA level. CONCLUSION: SA level seems to be affected by non-nutritional factors such as age, peritoneal membrane transport characteristics, residual renal function and presence of acute phase protein response manifested by CRP elevation, in addition to nutritional factors.
Acid-Base Equilibrium ; Acute-Phase Proteins ; C-Reactive Protein ; Comorbidity ; Cross-Sectional Studies ; Demography ; Female ; Hospitalization ; Humans ; Hypoalbuminemia ; Logistic Models ; Male ; Membranes ; Mortality ; Nutritional Status ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Protein-Energy Malnutrition ; Serum Albumin* ; Urea

Occurence of lactic acidosis with adequate tissue oxygenation(type B lactic acidosis) has been described in association with leukemia, lymphoma, small cell carcinoma and breast cancer. However, no such case has been reported in Korea. Therefore, we report a case of type B lactic acidosis in a man with rapidly progressing acute lymphoblastic leukemia which had been transformed from lymphoma.
Acidosis, Lactic* ; Breast Neoplasms ; Korea ; Leukemia ; Leukemia, Lymphocytic, Chronic, B-Cell ; Lymphoma ; Precursor Cell Lymphoblastic Leukemia-Lymphoma*

BACKGROUND: To evaluate the role of emergency debridement performed in conjunction with an empirical antibiotic therapy in clinically diagnosed, full-blown Vibrio vulnificus sepsis. METHODS: Immediate surgical debridement was performed on 13 out of 15 patients who were clinically diagnosed as having Vibrio vulnificus sepsis. RESULTS: Among 15 patients Vibrio vulnificus was isolated in 8 patients. Underlying diseases were liver cirrhosis (2), chronic alcohol ingestion or chronic liver disease (10), diabetes mellitus (3), gastrectomy (1) and in 4 cases no underlying condition was identified. All patients had skin lesions such as erythema, bulla, vesicle and gangrene. All but one initially showed variable degree of hypotension, thrombocytopenia, hepatic dysfunction, renal failure and mental confusion. Their mean APACHE III score was 84. Immediate survival (within 48hrs) in clinically diagnosed Vibrio sepsis was 80% (12/15) and long term survival rate among them was 66.6%. Forty-eight hour survival rate in bacteriologically confirmed cases of Vibrio vulnificus sepsis was 75%, where their long-term survival was 62.5%. CONCLUSION: In treating full-blown Vibrio vulnificus sepsis, immediate emergency surgical debridement performed in conjunction with the empirical antibiotics gives a possibility to improve both immediate and long term prognosis of the disease.
Anti-Bacterial Agents* ; APACHE ; Debridement* ; Diabetes Mellitus ; Eating ; Emergencies* ; Erythema ; Gangrene ; Gastrectomy ; Humans ; Hypotension ; Liver Cirrhosis ; Liver Diseases ; Prognosis ; Renal Insufficiency ; Sepsis* ; Skin ; Survival Rate ; Thrombocytopenia ; Vibrio vulnificus ; Vibrio*

BACKGROUND: Immunoglogulin A(IgA) nephropathy is the most common primary glomerular disease throughout the world. 30-50% of patients with IgA nephropathy(IgAN) have high serum IgA concentrations. However, we do not know if the degree of elevation in IgA level increases the likelihood of having IgAN. Neither do we know if the IgA level has any association with pathological findings of IgAN. METHODS: We analyzed the relationships between IgAN and the levels of serum IgA which has been a routine part of the study in all patients with glomerulonephritis in our institution for the last 4 years. We reviewed 270 patients in whom the pathological diagnosis and the results of their IgA levels were both available. RESULTS: Of 80 patients who were IgA nephropathy, 26 patients(32.5%) had higher than normal cut- off value of serum IgA(385 mg/dL). In contrast, 8.9 % of patients with other types of glomerulonephropathies showed the values above normal(p<0.0001). The risk ratio for an increase of one unit of the IgA level was 1.0025(logistic regression, p=0.0043), which was increased to 1.0079 when patients with low complement levels were excluded from the analysis. The data were also analyzed according to the immunofluorescence microscopic findings of IgAN, which were found to have no significant correlation with IgA concentrations. CONCLUSION: The IgA level is a risk factor for IgAN throughout the whole range. However, it does not correlate with the IgA deposition in the renal tissue. We believe that this study will help understanding the interpretation of IgA levels in patients with IgAN.
Complement System Proteins ; Diagnosis ; Fluorescent Antibody Technique ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Humans ; Immunoglobulin A* ; Odds Ratio ; Risk Factors

We describe a case of distal renal tubular acidosis in a 20-year-old woman with a history of glue sniffing. On admission she complained of nausea and somnolence. Severe hypokalemia and hyperchloremic metabolic acidosis with normal anion gap were noted. Her urinary osmolar gap and anion gap results were consistent with presence of renal tubular acidosis. Bicarbonate loading test along with urine PCO2 confirmed that she had type 1 renal tubular acidosis due to hydrogen ion secretion defect. Immunohistochemical staining of renal biopsy specimen with anti H+-ATPase antibody showed absence of proton pump in the collecting duct. Thus a case of distal renal tubular acidosis in association with glue sniffing is reported with a review of literatures.
Acid-Base Equilibrium ; Acidosis ; Acidosis, Renal Tubular* ; Adhesives* ; Biopsy ; Female ; Humans ; Hypokalemia ; Inhalant Abuse* ; Nausea ; Proton Pumps ; Protons ; Toluene ; Young Adult

Lung toxicity associated with cyclophosphamide use is a rare but serious side effect, that may result in a fatal course. However no such cases have been reported in Korea, so clinicians would not be alert to this adverse effect. We recently experienced a woman with Wegener's granulomatosis and idiopathic pulmonary fibrosis. This patient had been administered 12 grams of cyclophosphamide for 4 months. At that time of admission, She felt aggravating dyspnea on exertion for 2 weeks. Her chest x-ray and high resolution CT revealed aggravated reticular opacities and ground glass appearances. Dyspnea was improved and ground glass appearances on HRCT was disappeared after discontinuation of cyclophosphamide. We diagnosed this case as cyclophosphamide-induced pneumonitis and report it with a brief review of the literature.
Cyclophosphamide* ; Drug-Related Side Effects and Adverse Reactions ; Dyspnea ; Female ; Glass ; Humans ; Idiopathic Pulmonary Fibrosis ; Korea ; Lung* ; Pneumonia ; Thorax ; Wegener Granulomatosis*

The major clinical advantages of dialyzer reuse are improved biocompatibility and a decrease in the frequency of the first use syndrome. Dialyzer reuse has made it possible to use biocompatible high flux membranes of the high price. Although dialyzer reuse in chronic hemodialysis patients is commonly practiced in the United States, it is not widely accepted in Korea. At Ajou University Hospital, we have reprocessed dialyzers since March 2000, and here we report our clinical experience for the 1st 8 weeks. We used high flux dialyzers with reprocessing practice in 24 chronic hemodialysis patients. Dialyzer reprocessing was performed by an automated machine(Renatron) using Renalin. We limited reuse upto 20 times, and we were able to reuse dialyzers upto this number in 17 patients. During the study period, no significant complication was observed as a result of the reuse program. Kt/Vurea and urea reduction ratio(URR) were not different between high and low flux dialyzers(1.41+/-0.29 vs 1.61+/-0.41 for Kt/Vurea and 66.70+/- 6.40% vs 65.69+/-5.63% for URR). In contrast, beta2-microglobulin(beta2M) reduction ratio and clearance were greater in high flux dialyzers than low flux dialyzers(p<0.001, -9.52+/-20.28% vs 42.00+/-8.61% for beta2M reduction ratio and 9.54+/-11.71mL/min vs 48.54+/-14.33mL/min for beta2M clearance). Kt/Vurea, URR, beta2M reduction ratio and beta2M clearance did not deteriorate with the increasing number of reuse. The predialysis values of beta2M decreased by 51% after 19 uses(p<0.001, 37.04+/-13.39 to 18.98+/-3.41mg/L). In summary, during the short pilot study period of 8 weeks, no significant clinical complication was encountered as a result of dialyzer reuse, and our results confirmed the effects of high flux dialyzers on removal of beta2M.
Humans ; Kidneys, Artificial* ; Korea ; Membranes ; Pilot Projects ; Renal Dialysis ; United States ; Urea