BACKGROUND: Diagnosis of RTA (renal tubular acidosis) is not easy due to its nonspecific and various manifestations. To find out the clues to diagnosis, we investigated initial manifestations, laboratory features and clinical course of RTA patients. METHODS: Thirty-seven patients with RTA type I or II, whose follow-up period was over 6 months were included in the study. We reviewed their medical records retrospectively. RESULTS: Male to female ratio was 5:32 and the average age at the time of diagnosis was 38.7 (15~60). Twenty-five patients had RTA type I, nine had type II, and three had both. The average follow-up period was 6.4 years. Initial manifestations were asthenia (54%), nausea (46%), urinary stone (24%), paresthesia (24%), lower extremity weakness (22%), and paralysis (11%). Underlying diseases at the time of diagnosis include Sjogren's syndrome (14%), SLE (8%), drug-induced nephropathy (11%), diabetic nephropathy (5.4%), Sjogren's syndrome combined with SLE (2.7%), and medullary sponge kidney (2.7%). Laboratory tests revealed acidosis with hypokalemia (59%), acidosis without hypokalemia (14%), and hypokalemia without acidosis (24%). The level of total CO2 was 22 mmol/L or lower in 27 patients. The Na:Cl ratio on the average was 1:1.26 and for 33 patients below 1:1.35. Renal function deteriorated in 8 patients and 7 of them had underlying diseases. Urinary stone developed in 2 patients with RTA type I. CONCLUSION: When patients with nonspecific symptoms show decreased levels of serum total CO2, potassium, or Na:Cl ratio, RTA should always be considered.
Acidosis ; Acidosis, Renal Tubular* ; Asthenia ; Diabetic Nephropathies ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hypokalemia ; Lower Extremity ; Male ; Medical Records ; Medullary Sponge Kidney ; Nausea ; Paralysis ; Paresthesia ; Potassium ; Retrospective Studies ; Sjogren's Syndrome ; Urinary Calculi

BACKGROUND: One of the major complications of liver transplantation is acute renal failure(ARF). The outcome in patients who develop postoperative renal failure has been dismal. But there are few reports on ARF after liver transplantation in Korea. The aim of this study was to determine the incidence, clinical characteristics, and prognosis of ARF in patients undergoing liver transplantation. METHODS: The records of 35 adult patients who received liver transplantation at the Seoul National University Hospital between october 1992 and June 2001 were reviewed retrospectively. RESULTS: 22 patients were male and 13 were female, with an age range of 15 years to 65 years(median, 49 years). The 35 recipients included 18 with liver cirrhosis, 10 with liver cirrhosis and hepatoma, 3 with hepatoma, 3 with fulminant hepatitis, and 1 with biliary atresia. Death occurred in 10 patients (29%) overall. ARF was developed in 25 cases(71%), and 8 cases(32%) expired. Among the 9 patients with peak serum creatinine level > or = 2.0 mg/dL, 7 patients expired. 2 patients required hemodialysis following liver transplantation and all of them expired. ARF was developed within 1day(0-39 days). Of 25 ARF cases, 21 cases of hypotension, 6 acute rejection, 10 spontaneous bacterial peritonitis(SBP), and 8 massive packed RBC transfusion were associated. Renal function at latest follow-up was improved in patients who were suffered with ARF. CONCLUSION: ARF is a frequent complication of liver transplantation, and the strategy of management and prevention of ARF needs to be developed.
Acute Kidney Injury ; Adult ; Biliary Atresia ; Carcinoma, Hepatocellular ; Creatinine ; Female ; Follow-Up Studies ; Hepatitis ; Humans ; Hypotension ; Incidence ; Korea ; Liver Cirrhosis ; Liver Transplantation* ; Liver* ; Male ; Prognosis* ; Renal Dialysis ; Renal Insufficiency ; Retrospective Studies ; Seoul

BACKGROUND: Monocyte chemoattractant protein- 1(MCP-1) plays an important role in progression of lupus nephritis.(LN) The genetic polymorphism in the regulatory region would influence clinical manifestations by controlling serum levels of MCP-1. METHODS: We determined the genotypes of the MCP-1 gene, the secretion of MCP-1 by pheripheral blood monocytes(PBMCs) and transcription activity according to polymorphism on ELISA and luciferase assay. We also correlated serum MCP-1 level with proteinuria according to the genotypes to evaluate the clinical implication of genetic polymorphism in LN. RESULTS: 10 patients with SLE(20%) were AA homozygous, 21(42%) GA heterozygous, and 18(38%) GG homozygous, which was similar with normal controls[AA 9(20%), GA 27(58%), GG 46(22%)](n= 46). By in-vitro stimulation of PBMCs using Phytohemagglutinin, differential expression of MCP-1 appeared according to the genotypes at -2518 position; PBMCs from AA homozygotes 22.37+/-.07 ng/mL, GA 6.98+/-.72 ng/mL, GG 5.48+/-.22 ng/mL. In the luciferase assay, the gene construct with G at -2518 site showed decreased activity to 39% of that showed by A gene construct. In addition, After cells were treated with TNF-alpha 10 ng/mL), the transcription activity of A gene construct was approximately 3 fold greater than that of G gene construct. Levels of serum MCP-1 were significantly higher in patients with SLE(n=89) than normal controls(n=21)(418.17+/-35.30 pg/mL vs. 127.78+/-14.53 pg/mL, respectively; p<0.05). In contrast, there were no significant differences in serum MCP-1 levels between patients with LN, patients without LN and normal controls. Also, correlation between serum MCP-1 levels and proteinuria was not found(r=0.191, p>0.05). But, in patients with LN, levels of serum MCP-1 were significant higher in patients with AA genotype than those of GA genotyes and GG genotypes(p<0.01). CONCLUSION: MCP-1 gene polymorphism at regulatory region may be a considerable marker for LN and may modulate the level of protein expression. Our study could make it possible to screen high risk individuals, thus help us to develop a practical application of the molecular findings in clinical practice.
Enzyme-Linked Immunosorbent Assay ; Genes, vif ; Genotype ; Homozygote ; Humans ; Luciferases ; Lupus Nephritis* ; Monocytes ; Polymorphism, Genetic ; Proteinuria ; Regulatory Sequences, Nucleic Acid* ; Tumor Necrosis Factor-alpha

BACKGROUND: Tuberculosis is more prevalent in dialysis patients than in the general population, and more difficult to make a diagnosis, and often leads to death, Moreover, extra-caution is needed in prescribing anti-tuberculosis medications as dose modification is frequently needed in patients with renal insufficiency. Several pharmacokinetic studies have been performed for antimycobacterial regimens in patients with renal insufficiency, including under hemodialysis. However, the anti-mycobacterial regimens of patients on peritoneal dialysis have been made based on empirical methods because of few pharmacokinetic studies. METHODS: To elucidate the pharmacokinetic profiles of anti-mycobacterial regimens for peritoneal dialysis, we measured both plasma and peritosol concentrations of anti- tuberculous drugs including isoniazide, rifampin and pyrazinamide in 9 patients maintained on chronic ambulatory peritoneal dialysis(CAPD). RESULTS: After a conventional oral dose of anti-tuberculosis medication, their plasma concentrations were in the therapeutic range, but the peritosol concentration of rifampin was below the therapeutic range. CONCLUSION: No dose adjustments are required for isoniazid, rifampin and pyrazinamide for the treatment of systemic or peritoneal tuberculosis in CAPD patients. On the contrary, oral rifampin is not expected to be effective in the treatment of tuberculous peritonitis, because of its low peritosol concentration.
Diagnosis ; Dialysis ; Humans ; Isoniazid ; Peritoneal Dialysis* ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis, Tuberculous ; Pharmacokinetics* ; Plasma ; Pyrazinamide ; Renal Dialysis ; Renal Insufficiency ; Rifampin ; Tuberculosis

BACKGROUND: Two genetic loci, PKD1 and PKD2, have been identified as being responsible for ADPKD, and PKD1 is known to be associated with poor prognosis. However, the presence of intrafamilial clinical diversity suggests the presence of disease-modifying loci. Because the mechanism of renal failure in ADPKD includes cystic growth and tubulointerstitial atrophy and fibrosis, we studied the associations between two cytokine gene polymorphisms in the TGF-beta gene, which are known to be related with chronic tubulointerstitial inflammation, and ADPKD progression in Korean patients. METHODS: 47 normal controls and 114 individuals with ADPKD were genotyped by PCR-RFLP, and the TGF-beta gene leader sequence of T869C(Leu10Pro) variant was compared with MspA1I and G915C (Arg25Pro) with BglI. Statistic significances were determined using the Chi-square test. RESULTS: The distribution of alleles for the TGF-beta Leu10Pro polymorphism in ADPKD was : T 52%, C 48%, which was similar to the Korean(56 : 44, p= 0.670) and Western controls(65 : 35), and in addition, no differences were found between the CRF and the non-CRF groups(p=0.571) or the early hypertension and the normotension groups(p=0.252). The distribution of alleles for the TGF-beta Arg25Pro polymorphism was all GG type, which was different from Western controls(90 : 10, p=0.000). CONCLUSION: Our results suggest that the polymorphism at Arg25Pro of TGF-beta in Korean population has different allele distribution from Western, and the polymorphism at Leu10Pro of TGF-beta has no association with the renal progression of Korean ADPKD patients.
Alleles ; Atrophy ; Fibrosis ; Genetic Loci ; Humans ; Hypertension ; Inflammation ; Polycystic Kidney, Autosomal Dominant* ; Prognosis ; Renal Insufficiency ; Transforming Growth Factor beta*

PURPOSE: Fungal peritonitis is a fatal disease with a high mortality and morbidity to the peritoneal dialysis(PD) patients. This study was implemented to provide a guideline for the prevention and treatment of fungal peritonitis in PD patients by analyzing the clinical and microbiologic features of fungal peritonitis cases. METHODS: We analyzed retrospectively into the 15 cases(14 patients) of fungal peritonitis among 376 end stage renal disease(ESRD) patients who newly started PD in the Seoul National University Hospital from Jan. 1991 to Dec. 1999. RESULTS: The patients' age was 53.6+/-11.6 years (mean+/-standard deviation) and their male to female ratio was 12:3. They have been on PD for 29.2+/-27.7 months before the fungal peritonitis developed. Candida species was the most common etiologic agent, accounting for 10(62.5%) out of the 16 fungal organisms isolated from our patients. Among others were two Aspergillus, one Cryptococcus, one Penicillium, one Torulopsis, and one Trichosporon beigelii cases. Bacterial agents were isolated simultaneously in five fungal peritonitis cases. Peritoneal catheters were all removed no later than 72 hours after the diagnosis was made. Patients were given a single or combined therapy with amphotericin B, fluconazole, or flucytosine on the physician's choice. The outcomes of fungal peritonitis were as follows; 20% continued PD, 60% converted to HD and 20% died of fungal peritonitis. We made a comparative analysis between the fungal and bacterial peritonitis cases which developed in the same 5-year period, which showed significantly higher catheter removal and technique failure rates in the fungal cases. CONCLUSION: Fungal peritonitis is a rare but a fatal disease with a high mortality and a technique failure rate. Candida species was the most prevalent microorganism in our study.
Amphotericin B ; Aspergillus ; Candida ; Catheters ; Cryptococcus ; Diagnosis ; Female ; Fluconazole ; Flucytosine ; Fungi ; Humans ; Male ; Mortality ; Penicillium ; Peritoneal Dialysis* ; Peritonitis* ; Retrospective Studies ; Seoul ; Trichosporon

BACKGROUND: Ischemic heart disease has become more important in regard to mortality in hemodialysis patients. Although PTCA has been used for the treatment of ischemic heart disease, its result has little been reported in chronic renal failure(CRF) patients not in maintenance dialysis. We examined the therapeutic outcome of PTCA in CRF group in comparison with that in control group with normal renal function. METHODS: In a retrospective case-control study, 15 patients with CRF(Scr >or=1.4 mg/dL) were compared with 29 sex, age and diabetes mellitus matched controls without renal disease who had been randomly selected from the PTCA registry of our institution. Restenosis was evaluated by follow-up angiography or recurrent angina. Twenty-two PTCAs were performed over 26 stenotic lesions in CRF group, and thirty-nine PTCAs undergone over 56 lesions in control group. RESULTS: CRF group consisted of 11 men and 4 women with a mean age of 59.2+/-9.2(mean+/-SD) years and a mean serum creatinine of 3.8+/-2.4 mg/ dL. Cause of renal failure was diabetes mellitus in 11 cases(73%). Angiographic lesion success was confirmed in 17(65%) out of the 26 stenotic sites and stents were inserted successfully in the other nine lesions. Restenosis was confirmed by angiography in 10 lesions(38.5%) over a mean of seven months and suspected by recurrent angina in 6 lesions(23.1%), so overall restenosis rate was 61.6% in CRF group. Risk of restenosis was little different compared with control group in single- and double vessel disease, but increased up to 89% in triple vessel disease in CRF in contrast with control group. Among CRF group patients with serum creatinine >or=2.5 mg/dL showed much increased restenosis rate(77%) compared with those with serum creatinine <2.5 mg/dL (46%). CONCLUSION: Restenosis rate significantly increased in CRF patients who have multivessel disease or advanced renal failure, so other reperfusion therapy should be considered for them.
Angiography ; Angioplasty, Balloon, Coronary* ; Case-Control Studies ; Creatinine ; Diabetes Mellitus ; Dialysis ; Female ; Follow-Up Studies ; Humans ; Kidney Failure, Chronic* ; Male ; Mortality ; Myocardial Ischemia ; Renal Dialysis ; Renal Insufficiency ; Reperfusion ; Retrospective Studies ; Stents

BACKGROUND: The antidiuretic action of oxytocin in human has been controversial. To investigate whether oxytocin directly acts on water balance in human, we evaluated the parameters of urinary concentration in response to administration of oxytocin in ten healthy male volunteers. METHODS: Oxytocin was infused intravenously at a rate of 20 mU/hour for 2.5 hours and urine was collected during the last 2 hours of oxytocin infusion. Changes in urine volume, urine osmolality, excretions of urine electrolytes and free water clearance after the administrartion of oxytocin were compared with the baseline data. RESULTS: The changes in the levels of serum electrolytes and osmolality after the administration of oxytocin were not significant compared with the baseline data. The volume of 2 hours' urine were 446+/-75 mL and 289+/-53 mL in the basal state and after the administration of oxytocin, respectively. The urine osmolality was increased significantly by the infusion of oxytocin(427+/-63 mOsm/kg) compared with that in the basal state(223+/-25 mOsm/kg)(p < 0.05). The free water clearance was 110+/-51 mL/2 hours in the basal state and decreased significantly to -57+/-51 mL/2 hours(p < 0.05). CONCLUSION: We conclude that administration of oxytocin to normal men enhances urinary concentration, evidenced by increased urinary osmolality and decreased free water clearance. In human, oxytocin may play an important role in the regulation of renal water excretion as an antidiuretic hormone.
Electrolytes ; Humans ; Male ; Osmolar Concentration ; Oxytocin* ; Volunteers ; Water

BACKGROUND: Common complications after hematopoietic stem cell transplantation(HCT) include sepsis, graft versus host disease(GVHD), veno-occlusive disease(VOD), drug-induced nephrotoxicity, and acute renal failure(ARF). Prior studies report that the presence of ARF affects prognosis. However, we are unaware of such reports on the incidence of ARF after HCT in Koreans, and whether or not the development of ARF is related to prognosis. The purpose of our study was to investigate the cause of ARF after HCT and its relation to prognosis. METHODS: 163 patients received HCT at Seoul National University Hospital since 1985, of which, 107 were available for review. RESULTS: ARF after HCT developed in 52 patients (48.6%). In the three clinical causes, VOD, sepsis, and GVHD, risk factor related to the development of ARF was preexisting VOD. Logistic regression confirmed this association(odds ratio 4.4). The causes of ARF were different according to the periods it developed, and cyclosporin nephrotoxicity was the main cause through the whole period after HCT. The overall survival was worse in the ARF group(60 vs 73 %; p < 0.05). ARF group was split into two groups : patients whose peak serum creatinine levels were below 3.0 mg/dL(mild ARF group) and those who were above 3.0 mg/dL(severe ARF group). Severe ARF group had worse survival than mild ARF group and patients without ARF(p < 0.01). CONCLUSION: VOD, sepsis, GVHD after HCT increase the risk of the deveolopment of ARF, but cyclosprin nephrotoxicity is the main cause of ARF. Severe ARF is a factor influencing the prognosis of patients who received HCT.
Acute Kidney Injury* ; Cell Transplantation* ; Creatinine ; Cyclosporine ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Incidence ; Logistic Models ; Prognosis* ; Renal Insufficiency ; Risk Factors ; Seoul ; Sepsis ; Transplants*

PURPOSE: This study was implemented to investigate the prevalence of proteinuria and its combined morbidity in apparently normal adults. METHODS: We examined the mass screening data of Health Promotion Center in Seoul National University Hospital from May 1, 1995 to February 11, 2000. The random urine samples of all screenees were examined by dipstick test. Among them 22,595 adults(men 11,737 and women 10,858) who didn't take anti- hypertensive medication and whose fasting blood sugar <126 mg/dL were included in this analysis. RESULTS: The prevalence of proteinuria was 6.7% in men and 3.6% in women. Risk factors for proteinuria by simple correlation analysis were age, sex, body weight, systolic blood pressure, diastolic blood pressure, fasting blood sugar, blood urea nitrogen, serum creatinine, total cholesterol and smoking. As the degree of proteinuria increased, the systolic and diastolic blood pressures also increased significantly and creatinine clearance significantly decreased above the '++' level of proteinuria. Probability of proteinuria was calculated at each blood pressure level graded by JNC VI. With the increase of the level of blood pressure, the probability of proteinuria increased significantly between normal and high normal, high normal and hypertension1, and hypertension 2 and hypertension 3 level. Creatinine clearance and blood pressure level showed negative correlation. When total screenees were divided to proteinuria and no proteinuria groups, proteinuria group showed significant decrease of creatinine clearance in high normal and hypertension 1 level. CONCLUSION: Our results suggest that proteinuria in the apparently normal adults is not a benign condition, and it can be accompanied by significantly increased blood pressures and decreased renal function.
Adult* ; Blood Glucose ; Blood Pressure ; Blood Urea Nitrogen ; Body Weight ; Cholesterol ; Creatinine ; Fasting ; Female ; Health Promotion ; Humans ; Hypertension ; Male ; Mass Screening ; Prevalence* ; Proteinuria* ; Risk Factors ; Seoul ; Smoke ; Smoking