PURPOSE: We designed this study to identify the risk factors affecting the quality of graft after live donor kidney transplantation. METHODS: The study cohort included 259 adult patients who had been followed up for an average of 37 months after transplantation. Cyclosporine (CsA) and steroids were used as main immunosuppressive agents. Seven variables [HLA match, numbers of acute rejection (AR) within post-transplant 1 year, blood type compatibility, use of anti-lymphocyte antibody, age of donor (DA), age of recipient, and the donor kidney weight to recipient body weight ratio (KW/BW)] were examined by multiple regression analysis during the first 3 years. Serum creatinine (Scr), creatinine clearance rate (Ccr) and the 24 hours urinary excretion of protein (24 UP) were used as parameters. RESULTS: AR, DA, or KW/BW independently affected the quality of graft function. Scr, Ccr, or 24 UP at post-transplant 1 year was strongly correlated with AR (p<0.0001, p=0.002, or p=0.002, respectively). However, Scr, Ccr, or 24 UP at post-transplant 3 years was strongly affected by KW/BW (p<0.0001, p<0.0001, or p=0.008, respectively) or DA (p<0.0001, p=0.001, or p=0.039, respectively). CONCLUSION: Non-immunologic factors independently affected the graft function through the study periods. The impact of non-immunologic factors on the function of the graft increased year by year. During renal allocation, KW/BW and DA should be included as reference indices to improve the long-term graft function.
Adult ; Body Weight ; Cohort Studies ; Creatinine ; Cyclosporine ; Humans ; Immunosuppressive Agents ; Kidney Transplantation* ; Kidney* ; Risk Factors ; Steroids ; Tissue Donors* ; Transplants*

Bone scan is one of the most frequently performed studies in nuclear medicine with few adverse reactions for the examination of pathologic conditions of bone. Diffuse liver uptake of Technetium-99m methylene diphosphonate (Tc-99m MDP) is a rare occurrence with only a few reports in the literature. Furthermore, there is no report of Tc-99m MDP-induced liver injury. Here we report a case of acute hepatitis with diffusely increased uptake of Tc-99m MDP in a hemodialysis patient.
Diphosphonates ; Hepatitis ; Humans ; Liver ; Nuclear Medicine ; Renal Dialysis ; Technetium Tc 99m Medronate

Necrolytic migratory erythema (NME) is a typical cutaneous manifestation of glucagonoma syndrome. The entire syndrome consists of NME, glucose intolerance, weight loss, anemia, glossitis, diarrhea, and increased glucagon levels. We herein report a patient with glucagonoma syndrome who was diagnosed as having NME. A 48-year-old male presented with a 2-month history of painful erythematous, desquamative, erosive papules and plaques on both lower extremities. Histological examination revealed an intraepidermal cleft, the presence of vacuolated, pale epidermal cells, and necrosis in the upper epidermis. His glucagon level was 2650 pg/ml, with the upper limit of a normal range being 250 pg/ml. The patient was treated with octreotide, and showed an improvement of the skin eruption with normalization of the glucagon level within 4 weeks.
Anemia ; Diarrhea ; Epidermis ; Glossitis ; Glucagon ; Glucagonoma* ; Glucose Intolerance ; Humans ; Lower Extremity ; Male ; Middle Aged ; Necrolytic Migratory Erythema* ; Necrosis ; Octreotide ; Reference Values ; Skin ; Weight Loss

The evaluation of a patient referred for kidney transplantation is divided into 3 phases. First, a through evaluation is carried out, both to identify risk factors for undergoing transplantation. Second, a surgical evaluation is carried out to look for signs of vascular disease and urological abnormalities, and finally an immunologic evaluation is initiated to assess the patient's blood and HLA types. In patients with chest pain, chronic heart failure, or abnormal EEG, non-invasive cardiac test, when necessary followed by coronary angiography, is indicated. Patients with significant narrowing of the major coronary vessels should undergo percutaneous angioplasty or bypass grafting before transplantation. In diabetic patients over the age of 45, coronary artery disease is a common occurrence even in the absence of symptoms or clinical signs. Non-invasive cardiac evaluation during exercise should be performed routinely. The decision to perform a renal transplantation in a patient who has previously been treated for a malignancy is not an easy one. A waiting period of 2 years seems justified for most neoplasm. A waiting time of more than 2 years is required in malignant melanoma, breast carcinoma, or colorectal carcinomas. The advantages of immediate function after kidney transplantation include a higher long-term success rate, the ability to use potentially nephrotoxic immunosuppressive agents at an earlier time, shortened hospitalization and cost of the procedure as well as the avoidance of post-operative dialysis. Deliberate hydration of the patients during surgery is carried out in order to reduce the risk of acute tubular necrosis. This can be done with either crystalloid or colloid solution. The amount of intravenous solution depends on the patient's hydration status at the start of the procedure and CVP reading during the operation. Close monitoring of urine output is maintained in the early post-operative period. Intravenous hydration is maintained to keep up with the post-operative diuresis. Hypertension is very common in the post-operative period and must be controlled to reduce the risk of post-operative bleeding. If the patient is oliguric in the immediate post-operative period, an attempt at deliberate hydration is employed, however, if the oliguria persists, such hydration must be abandoned in order to avoid pulmonary edema. Dialysis will be required if the kidney does not function adequately. The price a transplant recipient pays for effective immunosuppression is an increased risk of developing infectious complications. Empirical administration of antibiotics, anti-viral agents, or anti-fungal agents in clinically declining patients is justified.
Angioplasty ; Anti-Bacterial Agents ; Breast Neoplasms ; Chest Pain ; Colloids ; Colorectal Neoplasms ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Dialysis ; Diuresis ; Electroencephalography ; Heart Failure ; Hemorrhage ; Hospitalization ; Humans ; Hypertension ; Immunosuppression ; Immunosuppressive Agents ; Kidney Transplantation* ; Kidney* ; Melanoma ; Necrosis ; Oliguria ; Perioperative Care* ; Pulmonary Edema ; Risk Factors ; Transplantation ; Transplants ; Vascular Diseases

Background: and Purpose To determine the imaging characteristics and cutoff value of18F-florapronol (FC119S) quantitative analysis for detecting β-amyloid positivity and Al- zheimer’s disease (AD), we compared the findings of FC119S and 18F-florbetaben (FBB) positron-emission tomography (PET) in patients with cognitive impairment. Methods: We prospectively enrolled 35 patients with cognitive impairment who underwent FBB-PET, FC119S-PET, and brain magnetic resonance imaging. We measured global and vertex-wise standardized uptake value ratios (SUVRs) using a surface-based method with the cerebellar gray matter as reference. Optimal global FC119S SUVR cutoffs were determined using receiver operating characteristic curves for β-amyloid positivity based on the global FBB SUVR of 1.478 and presence of AD, respectively. We evaluated the global and vertex-wise SUVR correlations between the two tracers. In addition, we performed correlation analysis for global or vertex-wise SUVR of each tracer with the vertex-wise cortical thicknesses. Results: The optimal global FC119S SUVR cutoff value was 1.385 both for detecting β-amyloid positivity and for detecting AD. Based on the global SUVR cutoff value of each tracer, 32 (91.4%) patients had concordant β-amyloid positivity. The SUVRs of FC119S and FBB had strong global (r=0.72) and vertex-wise (r>0.7) correlations in the overall cortices, except for the parietal and temporal cortices (0.4Conclusions Quantitative FC119S-PET analysis provided reliable information for detecting β-amyloid deposition and the presence of AD.

Reduced renal mass, increased recipient body size, and their mismatching are the potential risk factor to explain the non-immunologic graft dysfunction. Present study was designed to assess the effect of mismatch between donor kidney weight (KW) and recipient body weight (BW) on the 3-year graft function in live donor renal transplantation (TX) patients (pts) who were operated before Nov. 1995 under cyclosporine. To remove immunologic injuries and effect of glomerulonephritis (GN), the pts experiencing episode of acute rejection or showing post-TX biopsy-proven GNs were excluded. A total of 82 pts cohort was identified and followed up till Nov. 1998. The donor KW after cold flushing, BW of recipient at TX, and renal parameters at 3-year post-TX such as serum creatinine (Scr), creatinine clearance ratio (CCR) and 24-hour urinary excretion of protein (24UP) were recorded. First, any correlation between the index value of the KW/BW ratio and each parameters was studied by the regression analysis, and secondly, the pts were stratified into 3 groups by the KW/BW ratio (< or =3.5,>3.5 < or = 4.0 >4.0) and compared with each parameters by ANOVA test. Scr, CCR, and 24 UP was well correlated with the ratio KW/BW (p<0.01, respectively). The pts with high ratio (>4.0) have significantly lower Scr, higher CCR and lower 24 UP compared with pts showing medium or low ratio. In conclusion, the mismatch between the donor KW and recipient BW has a substantial effect on the medium term graft function. Since estimating the kidney volume by CT scan or ex vivo after bench surgery is simple and easily applicable in clinical practice, KW/BW ratio is to be considered for the selection or allocation of potential donor in both cadaveric and living donor TX programs.
Body Size ; Body Weight ; Cadaver ; Cohort Studies ; Creatinine ; Cyclosporine ; Flushing ; Glomerulonephritis ; Humans ; Kidney Transplantation ; Kidney* ; Living Donors ; Risk Factors ; Tissue Donors ; Tomography, X-Ray Computed ; Transplants*

PURPOSE: The decrease in bone mineral density (BMD) is a major complication after kidney transplantation. This was reported to occur preferentially during the first 6 months. However, the treatment and prevention strategies against a decline of BMD are not yet clear. METHODS: The data on the pre-transplant baseline and post-transplant 1 year BMD were archived and retrieved in 125 renal transplant recipients. The post-transplant changes of the BMD were compared by the baseline status of the BMD and the types of anti-osteoporosis treatment either with a vitamin D agent (alfacalcidiol) (n=18) or alendronate (n=21). Anti-osteoporosis treatment began within 30 days after transplantation, with an oral administration of 0.5 mcg/day vitamin D or 70 mg/week alendronate, and maintained until 1 year after transplantation. RESULTS: Regardless the degree of baseline BMD status, each group (the control, vitamin D, or alendronate group) showed a significant and uniform decrease of BMD during the post-transplant 1 year. The mean change in the spine BMD in the control, vitamin D, and alendronate group was -7.1+/-7.5%, -3.3+/-7.4% and -2.6+/-6.5%, respectively. The femur BMD also changed -5.1+/-7.7%, 1.1+/-5.3% and -1.5+/-8.2%, respectively. The degree of BMD decrease in the treatment groups was significantly lower than that in the control (P=0.014 in spine, P=0.003 in femur). When the severely reduced baseline BMD (T-score of spine or femur < or =-1) subgroups were analysed separately, the treatment groups (-3.7+/-6.5% in vitamin D and -1.1+/-6.4% in alendronate group) showed a significantly less decrease in the spine BMD than the control (-8.2+/-6.2%)(P=0.036). The femur BMD also showed a less decrease in the BMD in the treatment group, but this was not statistically significant (P=0.234). There was no significant difference between the vitamin D and alendronate treatment groups. CONCLUSION: After renal transplantation, early administration of vitamin D or alendronate showed some benefit to reduce the post-transplant decrease of BMD in both spine and femur area.
Administration, Oral ; Alendronate* ; Bone Density* ; Femur ; Kidney Transplantation* ; Spine ; Transplantation ; Vitamin D* ; Vitamins*

PURPOSE: Acute pyelonephritis (APN) is among the most common infectious diseases. Most APN occurs in young women and easily treated. Bacteremia has been associated in approximately 20-30% of those with APN. But recent documents demonstrated that blood cultures provide no useful information toward the clinical management of acute pyelonephritis. Thus we compared demographic and clinical characteristics as related to the bacteremic status, and investigated the risk factors for bacteremia. METHODS: One hundred sixty five patients, who visited myongji hospital for APN from January, 2004 to December, 2006 were included. Retrospective data were analyzed by medical record review. RESULTS: Bacteremic patients (N=51, 30.9%) were significantly older than those in nonbacteremic group (p<0.0001), had elevated serum creatinine (p=0.008), decreased platelet counts (p=0.029), lower serum protein (p=0.010), and lower serum albumin (p=0.011) than those without bacteremia. Hematuria was more severe in bacteremic patients (p<0.0001). The bacteremic cases were observed more frequently in patients with complicated APN patients than uncomplicated patients (46.7% vs. 21.4%, p=0.001). No significant difference existed between the bacteremic and non-bacteremic patients in the prevalence of resistance to quinolone of E. coli. In multivariate logistic regression analysis, serum albumin (p= 0.023), hematuria (p=0.003), and age (p=0.003) at presentation were found to be independent risk factors for bacteremia in acute pyelonephritis. CONCLUSION: Our study reveals that patients with bacteremia have different clinical characteristics compared to those without bacteremia. It is recommended to concern about the presence of bacteremia in the treatment of APN.
Bacteremia ; Communicable Diseases ; Creatinine ; Female ; Hematuria ; Humans ; Logistic Models ; Medical Records ; Platelet Count ; Prevalence ; Pyelonephritis ; Retrospective Studies ; Risk Factors ; Serum Albumin ; Urinary Tract Infections

PURPOSE: Although renal transplantation is the most effective treatment for end stage renal disease (ESRD), the incidence of malignant tumors due to long-term immunosuppression has been increasing. We experienced 9 cases of Kaposi's sarcoma (KS) after renal transplantation in our institution out of 2250 renal transplant recipients. KS is a rare mesenchymal tumor involving blood and lymphatic vessels. The oncogenesis by human herpesvirus 8 (HHV8) represent important condition for this tumor to develop. METHODS: Clinicopathologic features, treatment results, and prognosis of the 9 patients diagnosed with KS after renal transplantation were analyzed retrospectively. RESULTS: There were 6 male and 3 female patients. The mean age was 41.1 years. The average period until diagnosis of KS after renal transplantation was 60 months (range: 6 months~8 years). Clinical features were variable, but mostly presenting several red- purple papular and nodular tumors. Lesions were found in the lower extremities in 6 patients. Three patients presented with palpable lymph nodes in the neck and inguinal area without any skin lesions. Computed tomography showed diffusely enlarged showed an aggressive course. lymphnodes. Systemic involvement was found in 2 patients. Diagnosis was confirmed by histopathologic studies. Immunohistochemical stains for HHV8 were positive in all patients. Five patients showed regression of lesions after drastic reduction of immunosuppression, local resection and/or radiotherapy. But other 4 patients resistant to therapy. CONCLUSION: KS is a rare tumor and appears to be caused primarily by HHV8 in Korea as well. Reduction or cessation of immunosuppression potentially improves symptoms, but it also increases the risk of chronic graft rejection or graft failure. A large-scale study, accumulating data from transplantation cases in Korea, to understand the relationship between the various types of immunosuppression and KS, and to set guidelines for treatment appears to be necessary in the future.
Carcinogenesis ; Coloring Agents ; Diagnosis ; Female ; Graft Rejection ; Herpesvirus 8, Human ; Humans ; Immunosuppression ; Incidence ; Kidney Failure, Chronic ; Kidney Transplantation* ; Korea ; Lower Extremity ; Lymph Nodes ; Lymphatic Vessels ; Male ; Neck ; Prognosis ; Radiotherapy ; Retrospective Studies ; Sarcoma, Kaposi* ; Skin ; Transplantation ; Transplants

Anti-glomerular basement membrane (Anti-GBM) nephritis is an autoimmune disorder characterized by rapidly progressive crescentic glomerulonephritis (RPGN). The treatment of anti-GBM nephritis with plasmapheresis, steroids and immunosuppressant has improved outcomes. An early diagnosis is essential for the survival of patients and a recovery of renal function. The diagnosis of anti-GBM disease has been traditionally based on the demonstration of linear deposits of immunoglobulins along the glomerular basement membrane by immunofluorescence (IF) microscopy. However, a kidney biopsy cannot always be easily performed in such ill patients. Recent development of specific enzyme immunoassays for anti-GBM antibody in the serum has made possible a provisional diagnosis without a kidney biopsy. A 46-year-old male patient with hypertension and hepatitis B presented with generalized edema and general weakness. Laboratory findings were compatible with acute renal failure and nephrotic syndrome with positive serum anti-GBM antibodies. After plasmapheresis with steroid pulse therapy, renal biopsy was performed and diagnosed as membranoproliferative glomerulonephritis (MPGN) with granular deposit of Ig G and C3. Follow-up antibody titers were negative. This case demonstrates the possibility of false-positive anti-GBM antibody in the serum. Therefore, enzyme immunoassay for anti-GBM antibody should be used only as a screening or follow-up test in patients that have been confirmed positive by IF microscopy.
Acute Kidney Injury ; Anti-Glomerular Basement Membrane Disease ; Antibodies ; Autoantibodies ; Basement Membrane ; Biopsy ; Early Diagnosis ; Edema ; False Positive Reactions ; Fluorescent Antibody Technique ; Follow-Up Studies ; Glomerular Basement Membrane ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative ; Hepatitis B ; Humans ; Hypertension ; Immunoenzyme Techniques ; Immunoglobulins ; Kidney ; Male ; Mass Screening ; Microscopy ; Middle Aged ; Nephritis ; Nephrotic Syndrome ; Plasmapheresis ; Steroids