There is an increasing incidence of gout and hyperuricemia worldwide. It is because the population is getting older, their life style is sedentary, and they take protein-enriched food. Gout is one of the most common but best controllable chronic diseases of adult. There have been recent advances in the understanding of underlying mechanisms and treatment of gout and hyperuricemia. This article is aimed to provide the practical review of the currently recommended practice of care and also to introduce some recently approved drugs. The management concept of hyperuricemia is changing because not only the gout but also the hyperuricemia appear to be independent risk factors for hypertension, renal disease and cardiovascular disease. Gout causes a significant individual and social burden and loss of working force. Still hyperuricemia in the gout patient is often under-treated by the patients themselves and by the physicians also. Once the acute gout attack is controlled, patients should be followed with goal-oriented treatment of hyperuricemia and other risk factors. Allopurinol has remained as a first-line treatment for chronic hyperuricemia, but uricosuric agents may also be considered in some patients. These drugs have provided good control of the disease in most gout patients until now but the elderly patients with gout often carry co-medications, contra-indication to these drugs, and risk of adverse drug reaction. Febuxostat is a nonpurine xanthine-oxidase inhibitor. It is a new agent approved by the US FDA and Korean FDA for the treatment of hyperuricemia in patients with gout which may be used when allopurinol is not tolerated or contraindicated. Pegloticase is the PEGylated urate oxidase which is very potent and so recently approved by the US FDA for the gout refractory to conventional treatment.
Adult ; Aged ; Allopurinol ; Arthritis, Gouty ; Cardiovascular Diseases ; Chronic Disease ; Drug Toxicity ; Gout ; Humans ; Hypertension, Renal ; Hyperuricemia ; Incidence ; Life Style ; Polyethylene Glycols ; Risk Factors ; Thiazoles ; Urate Oxidase ; Uricosuric Agents ; Febuxostat

Vibrio metschnikovii is worldwidely distributed in the aquatic environment and human infections are very rarely associated, such as septicemia, urinary tract infection, wound infection, and peritonitis. V. metschnikovii is negative in nitrate reduction and oxidase reaction, and these findings are different from other vibrio species. V. metschnikovii was isolated from the ascitic fluid and blood of a patient with peritonitis, sepsis and renal insufficiency. This patient was a 41-year old man who suffered from post-necrotic liver cirrhosis, chronic hepatitis B, gastric ulcer, esophageal varix bleeding, and alcoholism. He had neither history of ingestion of seafoods nor exposure to seawater before onset of illness. He was successfully treated with antimicrobial agents. This is the first case report of septicemia and peritonitis by V. metschnikovii in Korea.
Adult ; Alcoholism ; Anti-Infective Agents ; Ascitic Fluid ; Eating ; Esophageal and Gastric Varices ; Hemorrhage ; Hepatitis B, Chronic ; Humans ; Korea ; Liver Cirrhosis ; Oxidoreductases ; Peritonitis* ; Renal Insufficiency ; Seafood ; Seawater ; Sepsis* ; Stomach Ulcer ; Urinary Tract Infections ; Vibrio* ; Wound Infection

The object of this study was to evaluate the effect of uric acid lowering therapy in reducing the new development of comorbidities and the frequency of acute attacks in gout patients. We retrospectively reviewed patients who were diagnosed to have gout with at least 3 yr of follow up. They were divided into 2 groups; 53 patients with mean serum uric acid level (sUA)<6 mg/dL and 147 patients with mean sUA> or =6 mg/dL. Comorbidities of gout such as hypertension (HTN), type II diabetes mellitus (DM), chronic kidney disease, cardiovascular disease (CVD) and urolithiasis were compared in each group at baseline and at last follow-up visit. Frequency of acute gout attacks were also compared between the groups. During the mean follow up period of 7.6 yr, the yearly rate of acute attack and the new development of HTN, DM, CVD and urolithiasis was lower in the adequately treated group compared to the inadequately treated group. Tight control of uric acid decreases the incidence of acute gout attacks and comorbidities of gout such as HTN, DM, CVD and urolithiasis.
Adult ; Allopurinol/therapeutic use ; Antimetabolites/therapeutic use ; Benzbromarone/therapeutic use ; Cardiovascular Diseases/epidemiology/prevention & control ; Comorbidity ; Diabetes Mellitus, Type 2/epidemiology/prevention & control ; Enzyme Inhibitors/therapeutic use ; Female ; Gout/*drug therapy/*prevention & control ; Gout Suppressants/*therapeutic use ; Humans ; Hypertension/epidemiology/prevention & control ; Male ; Middle Aged ; Renal Insufficiency, Chronic/epidemiology/prevention & control ; Retrospective Studies ; Thiazoles/therapeutic use ; Uric Acid/*blood/metabolism ; Uricosuric Agents/therapeutic use ; Urolithiasis/epidemiology/prevention & control

Spontaneous renal artery dissection (SRAD) is a rare event, which may be a challenge to physicians due to its rarity and nonspecific clinical presentation. We report two cases of SARD who were previously healthy men and complicated with renal infarction. Both presented with acute flank pain and high blood pressure. One was diagnosed by abdominal computed tomography and treated conservatively. The other was confirmed to have right renal artery dissection by selective arteriography and underwent renal artery stenting. Conservative treatment with antihypertensives and anticoagulantion usually bring up satisfactory results in most cases, but revascularization may be indicated for patients who have uncontrolled hypertension, renal insufficiency as a consequence of the dissection, or bilateral renal artery dissection.
Angiography ; Antihypertensive Agents ; Flank Pain ; Humans ; Hypertension ; Hypertension, Renal ; Infarction ; Male ; Renal Artery ; Renal Artery Obstruction ; Stents

Acute nonmyoglobinuric renal failure with severe loin pain and patchy renal vasoconstriction is a clinical syndrome that occurs following exercise in previously healthy young persons. Also nonsteroidal anti-inflammatory drugs predispose to acute renal failure in conditions associated with decreased renal blood flow. Probably exercise-induced renal ischemia and prostaglandin inhibition by NSAIDs may predispose to develop this syndrome. Here, we report two cases of acute renal failure with severe loin pain after strenuous exercise while taking NSAIDs with review of literature.
Acute Kidney Injury* ; Anti-Inflammatory Agents, Non-Steroidal ; Humans ; Ischemia ; Renal Circulation ; Renal Insufficiency ; Vasoconstriction

Hepatitis C virus (HCV) infection is prevalent in patients with chronic kidney disease, especially those on hemodialysis. Chronic HCV infection in patients with end-stage renal disease is associated with increased morbidity and mortality in the pre- and post-kidney transplant periods. Increased mortality is associated with liver complications and an elevated cardiovascular risk in HCV-infected patients on hemodialysis. Antiviral treatment may improve the prognosis of patients with HCV, and standard interferon remains the cornerstone of treatment. Direct-acting antiviral agents (DAA) are a potential new treatment modality for chronic HCV infection. Whatever DAA combination is administered, the use of ribavirin is still problematic in this population and this might affect the virological outcomes of some anti-HCV therapies.
Antiviral Agents ; Hepacivirus* ; Hepatitis C ; Humans ; Interferons ; Kidney Failure, Chronic ; Liver ; Mortality ; Prognosis ; Renal Dialysis ; Renal Insufficiency, Chronic* ; Ribavirin

The advent of novel, direct-acting antiviral (DAA) regimens for hepatitis C virus (HCV) infection has revolutionized its treatment by producing a sustained virologic response of more than 95% with few side effects and no comorbidities in the general population. Until recently, ideal DAA regimens have not been available to patients with severe renal impairment and end-stage renal disease because there are limited data on the pharmacokinetics, safety, and efficacy of treatment in this unique population. In a hemodialysis context, identifying patients in need of treatment and preventing HCV transmission may also be a matter of concern. Recently published studies suggest that a combination of paritaprevir/ritonavir/ombitasvir and dasabuvir, elbasvir/grazoprevir, or glecaprevir/pibrentasvir successfully treats HCV infection in chronic kidney disease stage 4 or 5 patients with or without hemodialysis.
Antiviral Agents* ; Comorbidity ; Hepacivirus ; Hepatitis C* ; Hepatitis C, Chronic ; Hepatitis* ; Humans ; Kidney Failure, Chronic ; Pharmacokinetics ; Renal Dialysis* ; Renal Insufficiency, Chronic*

Takayasu's arteritis (TA) is a nonspecific, chronic and stenotic panarteritis which usually involves the aorta and its major branches. Corticosteroid and immunosuppressants are recommended to manage the acute inflammatory phase, but their long term benefits are uncertain. Blood pressure (BP) control during the chronic phase of TA is essential to preserve renal function, which is associated with the patient's long-term prognosis and survival. Revascularization in organ damaging arterial stenosis with percutaneous angioplasty (PTA)/stenting or bypass surgery have been accepted as established treatment options in chronic complicated phase of TA. We present a case of a 31-year-old female patient with a two-day history of sudden onset oliguria and generalized edema whose acute oliguric renal failure was successfully reversed following PTA and stenting in a solitary functioning kidney with critical renal artery stenosis (RAS) caused by TA.
Acute Kidney Injury ; Adult ; Angioplasty ; Aorta ; Blood Pressure ; Constriction, Pathologic ; Edema ; Female ; Humans ; Immunosuppressive Agents ; Kidney ; Oliguria ; Prognosis ; Renal Artery ; Renal Artery Obstruction ; Renal Insufficiency ; Stents ; Takayasu Arteritis

Ischemic nephropathy is defined as renal dysfunction due to renal hypoperfusion mainly through renal artery stenosis. It is a common cause of chronic renal failure in old patients with atherosclerosis and is also a potentially correctable cause of renal failure if diagnosed earlier. We experienced a case of sudden Rt. main renal artery occlusion and renal failure after femoral artery angioplasty in an aged male patient with underlying atherosclerotic bilateral renovascular stenosis associated with ischemic nephropathy. He received successful Lt. renal artery angioplasty with stenting and restored Lt. renal artery blood flow. His blood pressure was more easily controlled with fewer antihypertensive drugs after renal artery revascularization. His renal function was recovered to his baseline level and became stabilized thereafter. Early diagnosis of ischemic nephropathy with MRA and timely renal angioplasty with stenting are beneficial to avoiding progression to irreversible renal failure.
Angioplasty* ; Antihypertensive Agents ; Atherosclerosis ; Blood Pressure ; Constriction, Pathologic ; Early Diagnosis ; Femoral Artery ; Humans ; Kidney Failure, Chronic ; Male ; Renal Artery Obstruction* ; Renal Artery* ; Renal Insufficiency* ; Stents*

Primary renal sarcoma is a rare malignant mesenchymal tumor with a variety of histologic type. The clinical differential diagnosis with renal cell carcinoma may be impossible. The prognosis of primary renal sarcoma is extremely poor and majority of patients die within 2 years. We experienced two cases or primary renal sarcoma, which was diagnosed by immunohistochemical stains.
Carcinoma, Renal Cell ; Coloring Agents ; Diagnosis, Differential ; Humans ; Kidney ; Prognosis ; Sarcoma*