BACKGROUND/AIMS: Accumulating data suggest that vitamin D deficiency is prevalent in patients with chronic kidney disease (CKD). However, comprehensive data are lacking for Koreans. The aim of this study was to survey vitamin D deficiency among patients with CKD in Korea and to identify the relationships among various factors. METHODS: We conducted a retrospective cohort study of 444 patients who were divided into four subgroups by estimated glomerular filtration rate (eGFR) for comparisons of mean 25-hydroxyvitamin D [25(OH)D] level and other parameters. In addition, non-dialyzed patients were categorized into four groups based on 25(OH)D levels (<10, 10-19, 20-29, and > or =30 ng/mL), and risk factors for severe vitamin D deficiency (<10 ng/mL) were investigated. RESULTS: Of patients with an eGFR > or = 60 mL/min/1.73 m2, 43% (34/79) showed severe 25(OH)D deficiency, and the mean 25(OH)D level was 11.7 +/- 5.3 ng/mL. In CKD3 group, 53.2% (41/77) showed severe 25(OH)D deficiency, with a mean level of 11.3 +/- 7.2 ng/mL. In CKD4 group, 53.3% (49/92) had severe 25(OH)D deficiency, with a mean level of 11.0 +/- 6.2 ng/mL. Approximately 71% (139/196) of patients in CKD5 group showed severe deficiency, and the mean level was 9.2 +/- 5.9 ng/mL. Severe 25(OH)D deficiency was affected by winter season, renal function, diabetes, and low-density lipoprotein cholesterol. The serum parathyroid hormone level was inversely correlated with the 25(OH)D level, such that 25(OH)D <20 ng/mL were associated with a steep increase in parathyroid hormone. CONCLUSIONS: Vitamin D deficiency is highly prevalent in the Korean population. Few patients met a sufficient 25(OH)D concentration, even in the early stages of CKD. Our data suggest that 25(OH)D level of 20 ng/mL is a threshold for a rapid increase in parathyroid hormone levels.
Cholesterol ; Cohort Studies ; Glomerular Filtration Rate ; Humans ; Korea ; Lipoproteins ; Parathyroid Hormone ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors ; Seasons ; Vitamin D ; Vitamin D Deficiency

A multicenter prospective study was done in four-university hospital to evaluate the efficacy and safety of cyclosporin A(CyA, Cipol-N(R)) in 64 patients with adult nephrotic syndrome mean age 34.8 years, male:female 2.4:1, duration of disease 38.0+/-40.9months, 31 patients with MCD, 33 patients with Non-MCD (8 FSGS, 14 MGN, 7 MPGN, 2 lupus nephritis, 1 HBsAg associated GN)]. The prior steroid responses of these patients were 17 steroid dependent, 9 frequent relapser, 4 steroid resistant and 1 other in MCD patients, and 5 steroid dependent, 5 frequent relapser, 22 steroid resistant and 1 other in Non-MCD patients. After a 2-week steroid (predni-solon 10mg/day or deflazacort 12mg/day) run-in period, CyA 5mg/kg/day and prednisolone 10mg/day (or deflazacort 12mg/day) were administered for up to 16 weeks. Of the 64 patients enrolled, ll patients were dropped out prematurely due to adverse events or protocol violation. Of the 53 patients who completed the study, 27 had MCD and 26 had Non- MCD. High response (CR and PR) rate of 68% (36/53) were obtained with CyA treatment in all patients. Although the response rate in MCD was significantly higher than that in Non-MCD (89 vs. 46%, p<0.05) and response rates were significantly different according to the previous steroid responses by univariate analysis, only previous steroid responses affected the response to CyA significantly by Logistic multiple regression analysis (p=0.03, RR 7.08); responses were 84% (27/32) in steroid dependent and frequent relapser patients, and 37% (7/19) in steroid resistant patients. 24-hr proteinuria significantly decreased after 2 weeks and serum albumin and cholesteroi increased significantly after 4 weeks of treatment compared to baseline level. The serum creatinine level was not changed during the study. No serious and unexpected side event was observed. In conclusion, cyclosporine therapy is a safe and effective mode of treatment in patients with ne-phrotic syndrome, especially in those who need prolonged administration of steroids with resulting in unavoidable steroid complications such as frequent relapser and steroid dependent type. The patients with steroid resistant type and contraidications of steroid administration such as DM, aseptic bone neerosis etc. can also be candidates for this treatment.
Adult* ; Creatinine ; Cyclosporine* ; Glomerulonephritis, Membranoproliferative ; Hepatitis B Surface Antigens ; Humans ; Lupus Nephritis ; Nephrotic Syndrome ; Prednisolone ; Prospective Studies ; Proteinuria ; Serum Albumin ; Steroids

This survey was done on 79 out-patients in order to investigate the present status of cutaneous candidiasis in clinical and mycological aspects in dermatologic clinic of Korea University Hospital from January, 1982 to July1983. Among the 79 specimens, 56 strains of candida species were identified by KOli mount, Sabourauds dextrose agar culture, sugar assimilation test, sugar fermentation test a.nd corn meal agar with Tween 80 culture. Following results were obtained. 1. The incidence of cutaneous candiasis was l. 6A (79 cases among 4, 963 outpatients). 2. The cutaneous candidiasis was more frequent in fcmale than in male(1: 1. 7) 3. The cutaneous candidiasis had its highest in.cidence during first decade (45 .6%). 4 Candidal intertrigo was the commonest type of the infection (51. 9%,) 5. Thrush, diaper candidiasis and candidal intertrigo were common during first. decade, and candidal paronychia and candidal onychia were common during third decade. 6, Positive rate on KOH mount was 60. 8% Nail (38. 5%) and periungal area (42.9%) should low positive rate. 7. Positive culture rate on Sabourauds dextrose agar of Candida species was 70. 9% (56 cases). 8 Candida species isolated from cutaneous lesions were Candida albicans (52 case) and Candida trapicalis(2 cases). Two species could not be identified.
Agar ; Candida ; Candida albicans ; Candidiasis ; Candidiasis, Cutaneous* ; Candidiasis, Oral ; Fermentation ; Glucose ; Humans ; Incidence ; Intertrigo ; Korea ; Meals ; Outpatients ; Paronychia ; Polysorbates ; Zea mays

Cutaneous metastases from internal carcinomas are relatively rare, especially from pancreatic carcinoma. Pancreatic carcinomas are usually adenocarcinomas which arise in the head of the gland, and are known to rapidly metastasize to the lymphatic system by permeation and embolization. We report a case of cutaneous metastasis from pancreatic adenocarcinoma. in 74-year-old male patient who have two pea sized, slight erythematous nodules on the lower abdomen and posterior side of the neck.
Abdomen ; Adenocarcinoma* ; Aged ; Head ; Humans ; Lymphatic System ; Male ; Neck ; Neoplasm Metastasis* ; Peas