In Langerhans cell histiocytosis, diabetes insipidus is the most common endocrinologic complication. We experienced a case of Langerhans cell histiocytosis, involving pituitary stalk and lung. The patient was a 43 year old male with complaint of polyuria and polydipsia. The water deprivation test was carried out to confirm the diagnosis of diabetes insipidus. We found multiple small cysts and nodules in HRCT of lung, and diagnosed Langerhans cell histiocytosis by transbronchial lung biopsy, The patient was managed conservatively with DDAVP nasal spray. The polyuria,polydipsia was relieved completely. After that, we follow up and observe closely the patients lung and pituitary lesion.
Adult ; Biopsy ; Deamino Arginine Vasopressin ; Diabetes Insipidus ; Diagnosis ; Follow-Up Studies ; Histiocytosis, Langerhans-Cell ; Humans ; Lung ; Male ; Pituitary Gland ; Polydipsia ; Polyuria ; Water Deprivation

OBJECTIVE: Graft survival rate has been improved due to newly developed immunosuppressive agents, care of recipient and operative method. However, since many risk factors are still threatening the graft survival, many studies have been underway to identify such factors, one of which has been on delayed graft function(DGF). Extending the definition of DGF to oliguria within 2 months postoperative period(POP), we began this study in order to evaluate what effects oliguria within 2 months POP have on graft survival and what are the risk factors involved. METHODS: 103 patients who have had renal transplantation performed were divided into two groups (oliguric group and non-oliguric group), based on the presence or absence of oliguria within 2 months POP. Risk factors such as the recipient factors(age, gender), donor factors(age, gender), operative factors(warm ischemia time, intraoperative urine volume), HLA typing, postoperative hypotension, postoperative hypovolemia were compared between the two groups and the impact of oliguria on graft outcome was also analysed. RESULTS: 1) 14 were Oliguric patients and 89 were nonoliguric patients. 2) One-year graft survival rate was 40% in the oliguric group and 98% in the non-oliguric group(P<0.05). 3) As the result of analyzing the risk factors, non living related donor(living non-related donor and cadaver donor) were 7(50%) in the oliguric group and 16(18%) in the non-oliguric group(P<0.05). The mean intraoperative urine volume was 442m1 in the oliguric group and 774m1 in the non-oliguric group(P<0.05). The occurrence of postoperative hypotension were 5(36%) in the oliguric group and 1(1%) in the non-oliguric group(P<0.05). Other risk factors such as the recipient fractors, donor factors, warm ischemia time, HLA typing and postoperative hypovolemia were not significantly different between the two groups. CONCLUSION: Graft survival rate in the oliguric group was lower than in the non-oliguric group. The risk factors for oliguria were non living related donor, intraoperative urine volume lower than 500m1 and postoperative hypotension. In conclusion, renal transplantation from non living related donor needs to be proceeded with caution; the maintenance of intraoperative urine volume and the prevention of postoperative hypotension are essential for better graft outcome.
Cadaver ; Graft Survival ; Histocompatibility Testing ; Humans ; Hypotension ; Hypovolemia ; Immunosuppressive Agents ; Ischemia ; Kidney Transplantation* ; Oliguria* ; Postoperative Period* ; Risk Factors ; Tissue Donors ; Transplants* ; Warm Ischemia