The main cause of death in patients with end-stage renal disease (ESRD) is cardiovascular disease, and trimethylamine-N-oxide (TMAO) has been found to be one of the specific risk factors in the pathogenic process in recent years. TMAO is derived from intestinal bacterial metabolism of dietary choline, carnitine and other substances and subsequently catalyzed by flavin monooxygenase enzymes in the liver. The changes of intestinal bacteria in ESRD patients have contributed to the accumulation of gut-derived uremic toxins such as TMAO, indoxyl sulfate and indole-3-acetic acid. While elevated TMAO concentration accelerates atherosclerosis through mechanisms such as inflammation, increased scavenger receptor expression, and inhibition of reverse cholesterol transport. In this review, this research introduces the biological function, metabolic processes of TMAO and mechanisms by which TMAO promotes the progression of cardiovascular disease in ESRD patients and summarizes current interventions that may be used to reverse gut microbiota disturbances, such as activated carbon, fecal microbial transplantation, dietary improvement, probiotic and probiotic introduction. It also focuses on exploring intervention targets to reduce the gut-derived uremic toxin TMAO in order to explore the possibility of more cardiovascular disease treatments for ESRD patients.
Cardiovascular Diseases ; Humans ; Kidney Failure, Chronic ; Methylamines ; Oxides ; Uremic Toxins

Hemolytic uremic syndrome (HUS) is defined by the triad of renal failure, thrombocytopenia and hemolytic anemia. HUS is usually developed by infectious disease in children, but occasionally in adults. Infectious disease associated with HUS is characterized by fever and diarrhea-commonly related with Escherichia coli O157:H7. Verotoxin (Shiga-like toxin) produced by E. coli damage the endothelial cells, promote local thrombosis and finally step to HUS. Other causes of HUS include drugs, pregnancy, organ transplantation and malignant tumor. We report two adult patients cases of HUS associated with infectious diarrhea.
Adult* ; Anemia, Hemolytic ; Child ; Communicable Diseases ; Diarrhea* ; Endothelial Cells ; Escherichia coli ; Fever ; Hemolytic-Uremic Syndrome ; Humans ; Organ Transplantation ; Pregnancy ; Renal Insufficiency ; Shiga Toxins ; Thrombocytopenia ; Thrombosis ; Transplants

Enterohemorrhagic Escherichia coli infection can cause hemorrhagic colitis and hemolytic uremic syndrome. Since 1994 we have carried out surveillance for this infection in the south of Choongnam Province, in Korea. We investigated the patients with diarrhea who had admitted in Soonchunhyang University Chunan Hospital(Total : 130, age; from infant to elderly), from May 1994 through February 1996. E. coli O157 : H7, O26 : H11, O128 : H2, O111 : H- serotype were assessed by the slide agglutination test. E. coli culture was positive in the 53(male 33, female 20) out of 130 patients with diarrhea. One case of E. coli O157 : H7 infection was identified. He was 30 days old infant lived in Dangjin rural area. He suffered from bloody diarrhea and anemia with acute renal failure, suggesting hemolytic uremic syndrome which is a well recognized complication of E. coli O157 : H7 infection. We have to aware of the possibility of outbreaks of E. coli O157 : H7 infection in this area.
Acute Kidney Injury ; Agglutination Tests ; Anemia ; Chungcheongnam-do ; Colitis ; Diarrhea ; Disease Outbreaks ; Enterohemorrhagic Escherichia coli ; Escherichia coli O157* ; Escherichia coli* ; Escherichia* ; Female ; Hemolytic-Uremic Syndrome ; Humans ; Infant ; Korea* ; Shiga Toxins

PURPOSE: Hemolytic uremic syndrome(HUS) is the most common cause of renal failure in childhood in western countries, but it has been a relatively rare disease in Korea. To analyze the clinical and epidemiologic characteristics of HUS in Korea, we reporte our experience, METHODS: We reviewed retrospectively the medical records of 9 patients who were diagnosed the hemolytic uremic syndrorne at Pusan National University during the period from January 1984 to December 1998. RESULTS: The age at presentation ranged from 3 years to 12 years old(mean: 5.9 years). Six of the children were typical and three patients were atypical. Six cases had grossly bloody stools and seven had abdominal pain. Oliguria developed in four cases and gross hematuria in eight cases. One case had seizure and letargy. Verotoxin producing E. coli(VTEC) were found in the stool specimens of two pa- tients. One was the serotype 0157:H7 and the other was the serotype 026:H-, Olll:H21. Verotoxin 1 (VT1) genes were identified by PCR in both of the cases. All patients required conservative treatment. Two patients were treated with peritoneal dialysis, one patient with hemodialysis and one patient with plasmapheresis. Of 9 case, 6 recovered without residual sequelae, but two patients died, and one patient progressed to end stage renal failure. CONCLUSION: Two thirds of our cases were typical type of HUS, which is now the predominant type among Korean childhood HUS sufferers. From this study, we suggest that patients diagnosed with typical HUS should be studied for the verotoxin of E. coli isolated from stool.
Abdominal Pain ; Busan ; Child* ; Hematuria ; Hemolytic-Uremic Syndrome* ; Humans ; Korea ; Medical Records ; Oliguria ; Peritoneal Dialysis ; Plasmapheresis ; Polymerase Chain Reaction ; Rare Diseases ; Renal Dialysis ; Renal Insufficiency ; Retrospective Studies ; Seizures ; Shiga Toxins

Enterohemorrhagic Escherichia coli serotype O157:H7 is a pathotype of diarrheagenic E. coli that produces one or more Shiga toxins, forms a characteristic histopathology described as attaching and effacing lesions, and possesses the large virulence plasmid pO157. The bacterium is recognized worldwide, especially in developed countries, as an emerging food-borne bacterial pathogen, which causes disease in humans and in some animals. Healthy cattle are the principal and natural reservoir of E. coli O157:H7, and most disease outbreaks are, therefore, due to consumption of fecally contaminated bovine foods or dairy products. In this review, we provide a general overview of E. coli O157:H7 infection, especially focusing on the bacterial characteristics rather than on the host responses during infection.
Animals ; Cattle ; Cattle Diseases/blood/epidemiology ; Developing Countries ; *Enterohemorrhagic Escherichia coli ; Escherichia coli Infections/blood/*epidemiology/veterinary ; *Escherichia coli O157/genetics/pathogenicity ; Feces/microbiology ; Hemolytic-Uremic Syndrome/blood/epidemiology/veterinary ; Operon ; Shiga Toxins/analysis ; Shigella dysenteriae ; Virulence