BACKGROUND: Circardian variation in the onset of cardiovascular events includig sudden cardiac death, myocardial infarction and ventricular arrhythmias has been discribed. The frequency of ventricular premature complexes has also been reported to demonstrate a pattern consisting of a daytime peak and nightime nadir. We tried to see if the same circardian pattern is found in dilated cardiomyopathy patients. We have also studed how various modifying factors such as left ventricular ejection fration and ACE inhibitor use may affect the circardian pattern. METHOD: 24-hour ambulatory electrocaridiographic monitorings were performed in 50 dilated cardiomyopathy patients and 20 control subjects. Patients were prospectively divided in 2 groups based on LVEF and ACE inhibitor use. RESULTS: In dilated cardiomyopathy patients, the expected morning increase in VPC frequency is absent and show a peak in evening. This pattern is not correlated with heart rate. Evening peak is more prominent in low LVEF group and ACE inhibitor non-user group. CONCLUSION: In dilated cardiomyopathy patients, VPC frequency show a peak in the evening.
Arrhythmias, Cardiac ; Cardiomyopathy, Dilated* ; Death, Sudden, Cardiac ; Heart Rate ; Humans ; Myocardial Infarction ; Prospective Studies ; Ventricular Premature Complexes*

BACKGROUND: Angiotensin II plays a potential role in renal injury not only by its vasoconstrictive effects but also its biochemical effects. alpha-Actinin, an actin-linked glycoprotein, is expressed in podocytes and known to be rearranged and changed in various glomerular diseases. We investigated the effect of angiotensin II on the alpha-actinin in the glomerular epithelial cells to find out the fact that it could be prevented by losartan, a type 1 angiotensin receptor antagonist. METHODS: Glomerular epithelial cells were treated with various concentrations of angiotensin II in culture media, and then we compared the localization and amount of alpha-actinin by confocal microscopy and Western blot analysis, respectively. We also compared the differences in the localization and protein amount of alpha-actinin by various concentrations of losartan in the presence of angiotensin II. In addition, we tried to observe the mRNA expression of alpha-actinin via RT-PCR. RESULTS: The fluorescent and band intensities of alpha-actinin were decreased by angiotensin II in a dose-dependent manner by confocal microscopy and Western blot analysis, respectively. These changes of alpha-actinin by angiotensin II were reversed by losartan in dose dependent manner. Angiotensin II also changed the distribution of alpha-actinin from peripheral to inner cytoplasm in dose-dependent manner, which was also reversed by losartan. The different expression of alpha-actinin m-RNA by RT-PCR were unremarkable. CONCLUSIONS: Angiotensin II decreases the amount of alpha-actinin protein and and makes cytoskeletal changes in glomerular epithelial cells, which could be reversed by losartan. It suggests that it could be prevented by angiotensin II AT1 receptor blockers.

BACKGROUND: Angiotensin II plays a potential role in renal injury not only by its vasoconstrictive effects but also its biochemical effects. alpha-Actinin, an actin-linked glycoprotein, is expressed in podocytes and known to be rearranged and changed in various glomerular diseases. We investigated the effect of angiotensin II on the alpha-actinin in the glomerular epithelial cells to find out the fact that it could be prevented by losartan, a type 1 angiotensin receptor antagonist. METHODS: Glomerular epithelial cells were treated with various concentrations of angiotensin II in culture media, and then we compared the localization and amount of alpha-actinin by confocal microscopy and Western blot analysis, respectively. We also compared the differences in the localization and protein amount of alpha-actinin by various concentrations of losartan in the presence of angiotensin II. In addition, we tried to observe the mRNA expression of alpha-actinin via RT-PCR. RESULTS: The fluorescent and band intensities of alpha-actinin were decreased by angiotensin II in a dose-dependent manner by confocal microscopy and Western blot analysis, respectively. These changes of alpha-actinin by angiotensin II were reversed by losartan in dose dependent manner. Angiotensin II also changed the distribution of alpha-actinin from peripheral to inner cytoplasm in dose-dependent manner, which was also reversed by losartan. The different expression of alpha-actinin m-RNA by RT-PCR were unremarkable. CONCLUSIONS: Angiotensin II decreases the amount of alpha-actinin protein and and makes cytoskeletal changes in glomerular epithelial cells, which could be reversed by losartan. It suggests that it could be prevented by angiotensin II AT1 receptor blockers.

PURPOSE: Acute kidney injury is a critical complication in patients intensive care unit (ICU) and shows high mortality. After development of continuous renal replacement therapy (CRRT), there were many conflicting data for patient survival. We want to find out which parameter shows strong correlation in the survival of patients undergoing CRRT in intensive care unit. METHODS: Total 85 patients were enrolled who had been treated with CRRT in ICU. We compared the differences in clinical parameters between survivors with non-survivors. RESULTS: Mean age of the patients was 62.0+/-15.6 and 57 patients were male (67.1%). Out of 85 patients, 39 patients survived (45.9%). Mean duration of CRRT was 103.5+/-178.8 hours and mean Acute Physiology And Chronic Health Evaluation (APACHE) III score was 90.6+/-22.6. There were significant differences between survivors and non-survivors in APACHE III score (p=0.004), time to initiation of CRRT (p=0.05), systolic blood pressure at initiation of CRRT (p=0.001), arterial [H+] (50.18 vs. 84.19, p=0.001), respectively. But there was no difference in the age, sex, the level of pre CRRT blood urea nitrogen, duration of ICU admission, hypoxemia and hemoglobin level. CONCLUSION: Earlier initiation of CRRT and protection from metabolic acidosis were strongly associated with the survival of the patient with acute kidney injury in ICU.
Acidosis ; Acute Kidney Injury ; Anoxia ; APACHE ; Blood Pressure ; Blood Urea Nitrogen ; Hemodiafiltration ; Hemoglobins ; Humans ; Intensive Care Units ; Male ; Prognosis ; Renal Replacement Therapy ; Survivors

Cyclosporine can cause remission of 60% in steroid resistant FSGS, but its responses are variable. Now we report two cases of steroid resistant FSGS who are maintaining remission using cyclosporine continuous therapy. The first patient had been failed several times of steroid therapy, had edema, azotemia and severe proteinuria. We used steroid pulse therapy then maintenance dose of oral cyclosporine to reduce proteinuria for more than 6 years. He has been received cyclosporine therapy up to now and maintaining normal renal function. The second patient had severe azotemia who needed hemodialysis but after cyclosporine therapy, he recovered his renal funciton. The findings of renal biopsies in one patient after 6 years of cyclosporine therapy revealed that there was no improvement of sclerosing glomeruli, then we guess that maintenance therapy of cyclosporine might need for lifelong period.
Azotemia ; Biopsy ; Cyclosporine* ; Edema ; Humans ; Proteinuria ; Renal Dialysis

Left ventricular hypertrophy(LVH) is one of common cardiovascular complications in hypertensive patients and it is well known that hypertensive cardiac disease accompained by LVH is still common cause of congestive heart failure in spite of treatment of hypertension. The authors assessed the prevalence of anatomical and functional abnormalities of left ventricle by EKG, chest X-ray and echocardiography in 45 essential hypertensive patients and also in 20 normal controls. Average values of left ventricular posterior wall thickness(LVPWd), interventricular septal thickness(IVSd), left ventricular mass(LVM), and left ventricular mass index(LVM/BSA) by echocardiography in hypertensive groups with LVH by EKG or chest X-ray were significantly higher than those of hypertensive groups without LVH by EKG or chest X-ray(P<0.005). Among 27 hypertensive patients with LVH by EKG and chest X-ray increased LVPWd was found in 24 patients(18%) and increased LVH in 26 patients(19%). Increased LVPWd and LVM were found in 3 patients(23%) among 13 hypertensives without LVH by EKG and chest X-ray. Hypertensive patients with increased LVH showed LVH by EKG and chest X-ray more frequently than those with increased LVPWd. Also, hypertensive patients without increased LVM showed MVH by EKG and chest X-ray less frequently than those without increased LVPWd. Therefore, echocardiography appears to be superior to routine chest X-ray and EKG for defecting LVH in hypertensive patients, especially without LVH by these tests. In conclusion, even though estimation of LVM by echocardiography seems to be a better method than single measurement of LVPWd, it seems thant estimation of LVM together with LVPWd will be more valuable in diagnosis of LVH in hypertensive patients.
Diagnosis ; Echocardiography* ; Electrocardiography ; Heart Diseases ; Heart Failure ; Heart Ventricles ; Humans ; Hypertension* ; Hypertrophy, Left Ventricular* ; Prevalence ; Thorax

Type 1 diabetes mellitus (T1DM) commonly occurs in childhood and adolescence and diabetic nephropathy is a serious metabolic complication of T1DM that leads to serious morbidity. With poor glycemic control prepubertal diabetes duration contributes to the risk of long-term microvascular complications, however, the younger age at onset or longer prepubertal diabetes duration seems to prolong the time to development of microalbuminuria or later end-stage renal disease (ESRD). Therefore, there have been a few cases of diabetic nephropathy in prepubertal patients and therefore the ESRD cases developed during adolescence in T1DM children were very rare. Here we report an adolescent with T1DM who had poor glycemic control and was diagnosed as diabetic nephropathy in a prepubertal period and leading to end-stage renal disease during adolescence.
Adolescent ; Child ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diabetic Nephropathies ; Humans ; Kidney Failure, Chronic

Current practice guidelines recommend alkali therapy in patients with chronic kidney disease (CKD) and metabolic acidosis to prevent complications. This study aims to investigate the effect of oral sodium bicarbonate supplementation on the progression of renal function and nutritional indices in patients with predialysis advanced CKD. Forty patients with predialysis stage 5 CKD(estimated glomerular filtration rate, eGFR <15mL/min per 1.73m2) and 40 patients with stage 4 CKD (eGFR 15 to 30mL/min per 1.73m2) who had a total CO2 less than 22mEq/L were assigned into the bicarbonate treatment group or control group for 12 months. In stage 4 CKD, there were significant differences in the changes of eGFR during the study between the treatment group and the control group (-2.30+/-4.49 versus -6.58+/-6.32mL/min/1.73m2, p<0.05). However, in stage 5 CKD, there were no significant differences in the change of eGFR during the study between the two groups (-2.10+/-2.06 versus -3.23+/-1.95mL/min/1.73 m2).There were no significant differences in the changes of nutritional indices such as albumin, prealbumin, transferrin, total lymphocyte count (TLC), and Ondodera's prognostic nutritional index (OPNI) during the study between the two groups. In stage 5 CKD, there were significant differences in the changes of TLC and OPNI between the two groups. In conclusion, our results demonstrate that bicarbonate supplementation slows the rate of decline of renal function in stage 4 CKD and improves nutritional indices in stage 5 CKD. Alkali therapy in advanced CKD may have beneficial effect on renal function and malnutrition.
Acidosis ; Alkalies ; Glomerular Filtration Rate ; Humans ; Lymphocyte Count ; Malnutrition ; Nutrition Assessment* ; Prealbumin ; Renal Insufficiency, Chronic* ; Sodium Bicarbonate ; Transferrin

PURPOSE: To report a case of prepapillary loops (PPLs) associated with branch retinal artery occlusion (BRAO) and vitreous hemorrhage in a patient with IgA nephropathy. METHODS: A 26-year-old woman presented with sudden loss of vision in her right eye. One year prior, she had been diagnosed as having IgA nephropathy. Examination of the right fundus revealed vitreous hemorrhage that appeared to be extending from the optic disc and a pale and edematous superior retina that was compatible with BRAO. Subretinal and intraretinal hemorrhage extending from the optic disc were also present. Laboratory tests of the factors associated with coagulation were normal. RESULTS: After spontaneous resolution of the vitreous hemorrhage and retinal edema, arterial PPLs and a venous PPL were detected at the superior portion of the optic disc. Fluorescein angiogram demonstrated slow filling of the superior branch of the retinal veins and the venous PPL. The filling of the arterial PPLs was normal and there was no delayed perfusion in the superior retina. These PPLs did not show any fluorescein leakage in the late phase of the angiogram. At the last follow-up visit, 18 months after the onset of symptoms, the vitreous hemorrhage and subretinal hemorrhage had been completely absorbed and no other ocular complications hd developed. CONCLUSIONS: PPL is usually asymptomatic; however, complications such as BRAO and vitreous hemorrhage can develop in some cases with causative factors.
Adult ; Female ; Fluorescein ; Follow-Up Studies ; Glomerulonephritis, IGA ; Hemorrhage ; Humans ; Papilledema ; Perfusion ; Retina ; Retinal Artery Occlusion* ; Retinal Vein ; Vitreous Hemorrhage*

This study aimed to investigate the influence of different peritoneal dialysis regimens on blood pressure control, the diurnal pattern of blood pressure and left ventricular hypertrophy in patients on peritoneal dialysis. Forty-four patients undergoing peritoneal dialysis were enrolled into the study. Patients were treated with different regimens of peritoneal dialysis: 26 patients on continuous ambulatory peritoneal dialysis (CAPD) and 18 patients on automated peritoneal dialysis (APD). All patients performed 24-hour ambulatory blood pressure monitoring (ABPM) and echocardiography. Echocardiography was performed for measurement of cardiac parameters and calculation of left ventricular mass index (LVMI). There were no significant differences in average of systolic and diastolic blood pressure during 24-hour, daytime, and nighttime between CAPD and APD groups. There were no significant differences in diurnal variation of blood pressure, systolic and diastolic blood pressure load, and LVMI between CAPD and APD groups. LVMI was associated with 24 hour systolic blood pressure load (r = 0.311, P < 0.05) and daytime systolic blood pressure load (r = 0.360, P < 0.05). In conclusion, this study found that there is no difference in blood pressure control, diurnal variation of blood pressure and left ventricular hypertrophy between CAPD and APD patients. The different peritoneal dialysis regimens might not influence blood pressure control and diurnal variation of blood pressure in patients on peritoneal dialysis.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Diphosphonates ; Echocardiography ; Humans ; Hypertrophy, Left Ventricular ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory