No abstract available.
Acute Kidney Injury* ; Heat Stroke* ; Hot Temperature*

No abstract available.

BACKGROUND: Renal infarction (RI) is an uncommon disease that is difficult to diagnose. As little is known about clinical characteristics of this disease, we investigated its underlying risk factors and outcomes. METHODS: We performed a retrospective single-center study of 89 patients newly diagnosed with acute RI between January 2002 and March 2015 using imaging modalities. Clinical features, possible etiologies, and long-term renal outcome data were reviewed. RESULTS: The patients' mean age was 63.5 ± 15.42 years; 23.6% had diabetes and 56.2% had hypertension. Unilateral and bilateral involvements were shown in 80.9% and 19.1% of patients, respectively; proteinuria and hematuria were reported in 40.4% and 41.6%, respectively. Cardiovascular disease was the most common underlying disease, followed by renal vascular injury and hypercoagulability disorder. Fourteen patients had no specific underlying disease. At the time of diagnosis, acute kidney injury (AKI) was found in 34.8% of patients. Univariate analysis revealed diabetes mellitus (DM), leukocytosis, and high C-reactive protein (CRP) as significant risk factors for the development of AKI. On multivariate analysis, DM and high CRP levels were independent predictors for AKI. During follow-up, chronic kidney disease developed in 27.4% of patients. Univariate and multivariate Cox regression analyses showed old age to be an independent risk factor for this disease, whereas AKI history was a negative risk factor. CONCLUSION: DM patients or those with high CRP levels should be observed for renal function deterioration. Clinicians should also monitor for RI in elderly patients.
Acute Kidney Injury ; Aged ; C-Reactive Protein ; Cardiovascular Diseases ; Diabetes Mellitus ; Diagnosis ; Follow-Up Studies ; Hematuria ; Humans ; Hypertension ; Infarction* ; Leukocytosis ; Multivariate Analysis ; Proteinuria ; Renal Artery ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors* ; Thrombophilia ; Vascular System Injuries

The nonstructural protein 4 (NSP4) of rotavirus encoded by gene 10, plays an important role in rotavirus pathogenicity. In this study, NSP4 gene sequences of human rotaviruses circulating in Seoul, Korea between March 2004 and April 2005 were determined. The nucleotide sequence data indicated that the NSP4 genes of human rotavirus Korean isolates were 750 or 751 bases in length and encoded one open reading frame of 175 amino acids with two glycosylation sites. The NSP4 of Korean isolates exhibited amino acid sequence homologies between 59.4% and 98.9%. The NSP4 of CAU4 and CAU15 showed a high degree of amino acid sequence homologies with NSP4 genotype A viruses, but the NSP4 of CAU5, CAU6, CAU11, CAU14, CAU16 and CAU22 exhibited a high degree of amino acid sequence homologies with NSP4 genotype B viruses. Interestingly, CAU3 and CAU7 showed low degree of amino acid sequence homology with those of currently described NSP4 genotypes A to D and belonged a distinct lineage on the phylogenetic tree. These findings suggests that distinct NSP4 type was circulating among human rotavirus strains in the local community of Seoul and raising intriguing questions regarding possible explanations for new genotype.
Amino Acid Sequence ; Amino Acids ; Base Sequence ; Genetic Variation* ; Genotype ; Glycosylation ; Herpesvirus 1, Cercopithecine ; Humans* ; Korea ; Open Reading Frames ; Rotavirus* ; Seoul* ; Sequence Homology, Amino Acid ; Virulence

BACKGROUND/AIMS: It has been suggested that chronic kidney disease (CKD) is a risk factor for Clostridium difficile infection (CDI) and is associated with increased mortality among patients infected with C. difficile. However, recent studies of the clinical impact of CKD on CDI in Asians are still insufficient. We sought to determine the relationship between CKD and CDI in a Korean population. METHODS: This was a single-center, retrospective case-control study. In total, 171 patients with CDI were included as cases and 342 age- and gender-matched patients without CDI were used as controls. We compared the prevalence of CKD in the study sample and identified independent risk factors that could predict the development or prognosis of CDI. RESULTS: Independent risk factors for CDI included stage IV to V CKD not requiring dialysis (odds ratio [OR], 2.90) and end-stage renal disease requiring dialysis (OR, 3.34). Patients with more advanced CKD (estimated glomerular filtration rate < 30) and CDI showed higher in-hospital mortality and poorer responses to the initial metronidazole therapy. CONCLUSIONS: More advanced CKD is an independent risk factor for CDI and is associated with higher in-hospital mortality and poor treatment responses in CDI patients. Thus, in CKD patients, careful attention should be paid to the occurrence of CDI and its management to improve the outcome of CDI.
Aged ; Anti-Infective Agents/therapeutic use ; Chi-Square Distribution ; Clostridium difficile/*pathogenicity ; Enterocolitis, Pseudomembranous/diagnosis/drug therapy/*microbiology/mortality ; Female ; Hospital Mortality ; Humans ; Kidney Failure, Chronic/*complications/diagnosis/therapy ; Logistic Models ; Male ; Metronidazole/therapeutic use ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Prevalence ; Renal Dialysis ; Renal Insufficiency, Chronic/*complications/diagnosis/mortality/therapy ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Treatment Outcome

PURPOSE: In this study, the etiology and the change of clinical characteristics of hyponatremia, in relation to the increased used of thiazide diuretics, have been assessed. METHODS: To perform a retrospective cohort study, a total sum of 322 patients who have been admitted in a single tertiary referral hospital between 2004 and 2009, were included. RESULTS: The most common cause of hyponatremia was due to thiazide diuretics (37.6%). Among the 121 patients who suffered from thiazide induced hyponatremia, 60 (48.0%) patients took combination thiazide. The incidence of hyponatremia has shown a tendency to increase from 2004 to 2009 (trend test, p<0.001). The incidence of hyponatremia due to the use of combination types has also increased (trend test, p<0.001). Thiazide induced hyponatremia showed no difference when compared to hyponatremia due the other causes, except the fact that the portion of female patients was higher (73.6% vs 64.6%, p<0.001), mean age was older (74.7 vs 69.9 years-old, p<0.001), and incidence of cerebrovascular accident was also higher (19.8% vs 6.5%, p<0.001). CONCLUSION: The use of thiazide is increasing and hence thiazide-induced hyponatremia is also increasing. This is thought to be particularly related to the increase of thiazide-combined drugs. Thiazideinduced hyponatremia shows a higher incidence in old age, female sex and those who have a history of a cerebrovascular event. Hence more caution is needed when using thiazide diuretics as antihypertensives, and plasma sodium levels should be monitored carefully.
Antihypertensive Agents ; Cohort Studies ; Diuretics ; Female ; Humans ; Hyponatremia ; Incidence ; Plasma ; Retrospective Studies ; Sodium ; Sodium Chloride Symporter Inhibitors ; Stroke ; Tertiary Care Centers

Autoimmune pancreatitis is a recently established clinicopathologic entity often associated with various types of other autoimmune diseases. We report a case of postrenal acute kidney injury (AKI) due to retroperitoneal fibrosis associated with autoimmune pancreatitis. The seventy one year old male patient was admitted because of oliguria and lower extremity edema. He had been diagnosed to have autoimmune pancreatitis and retroperitoneal fibrosis by increased serum IgG and IgG4 level with the presence of rim like attenuation around pancreas and the retroperitoneal fibrosing mass in abdominal CT scan 1 year ago but was lost to follow up. Magnetic resonance cholangiopancretogram and follow up abdominal CT scan showed progressed retroperitoneal fibrosis with newly developed bilateral hydronephrosis and atrophied left kidney despite partial improvement in pancreatitis. Because of progressively rising serum creatinine and oliguria, percutaneous nephrostomy in right kidney was performed. Steroid treatment was initiated with insertion of double J catheter at right ureter and renal function gradually returned. We report here a rare case of postrenal AKI developed in unilateral functioning kidney complicated by combined retroperitoneal fibrosis and autoimmune pancreatitis.
Acute Kidney Injury ; Autoimmune Diseases ; Catheters ; Creatinine ; Edema ; Follow-Up Studies ; Humans ; Hydronephrosis ; Immunoglobulin G ; Kidney ; Lost to Follow-Up ; Lower Extremity ; Magnetic Resonance Spectroscopy ; Male ; Nephrostomy, Percutaneous ; Oliguria ; Pancreas ; Pancreatitis ; Retroperitoneal Fibrosis ; Ureter

Secondary hyperparathyroidism is a common complication of chronic kidney disease and known to be associated with soft tissue calcification affecting patients' morbidity and mortality. However few cases of intestinal calcification related to secondary hyperparathyroidism have been reported. Herein we report a case of peritonitis complicating small intestinal perforation in a patient who had undergone peritoneal dialysis and had sustained hyperparathyroidism. Diffuse calcifications and perforations in small intestine were identified in abdomino-pelvic CT scan as well as in resected small intestine. Because of relapsing microperforation and resultant intra-abdominal abscess, the patient has been in fasting status depending on total parenteral nutrition for over 8 months after surgery.
Abdominal Abscess ; Fasting ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary ; Intestinal Perforation ; Intestine, Small ; Parenteral Nutrition, Total ; Peritoneal Dialysis ; Peritonitis ; Renal Insufficiency, Chronic

Scleroderma renal crisis is defined as rapidly progressive renal failure and/or new onset of malignant hypertension during the course of systemic sclerosis. Most patients show clinical features of malignant hypertension, but there have been several reports of normotensive renal crisis. We have experienced a 63 year old female patients with acute renal failure due to scleroderma renal crisis who did not show the clinical features of malignant hypertension. She had taken steroid for the treatment of degenerative osteoarthritis and gradually developed shortness of breath and edema. Her blood pressure on admission was 150/90 mmHg and easily controlled by diuretics. Renal biopsy showed onion-skin appearance in the interlobular arteries with varying degree of tubulointerstitial changes. Her renal function rapidly deteriorated despite ACE inhibitor therapy and cytotoxic therapy had to be initiated because of progressive interstitial pneumonitis and myocarditis. We describe a patient with scleroderma renal crisis who did not show the clinical features of malignant hypertension following steroid treatment.
Acute Kidney Injury ; Arteries ; Biopsy ; Blood Pressure ; Diuretics ; Dyspnea ; Edema ; Female ; Humans ; Hypertension, Malignant* ; Lung Diseases, Interstitial ; Middle Aged ; Myocarditis ; Osteoarthritis ; Renal Insufficiency ; Scleroderma, Systemic

PURPOSE: inflammation is a common feature in chronic kidney disease patients, and it could contribute to long-term morbidity and mortality related with malnutrition and atherosclerosis. In this study, we aimed to investigate the effect of initiating dialysis on inflammatory state, nutritional parameter, and immune response in end-stage renal disease (ESRD) patients. METHODS: 57 ESRD patients who initiated hemodialysis (HD, n=31) or continuous ambulatory peritoneal dialysis (CAPD, n=26) were enrolled. Pro-inflammatory cytokine, tumor necrosis factor (TNF)-alpha, and anti-inflammatory cytokines, interleukin (IL)-10 and adiponectin were measured before and 3 months after initiation of dialysis. Inflammatory marker, highly sensitive C-reactive protein (hs-CRP), and nutritional parameter, albumin, were also checked. Lipopolysaccharide (LPS)-stimulated production of TNF-alpha and IL-10 were measured for the evaluation of immune response by external stimuli. RESULTS: As uremia was reduced by initiating dialysis, serum level of TNF-alpha was decreased and adiponectin was increased. These changes were accompanied by the decrease of hs-CRP and the increase of serum albumin. LPS-stimulated cytokines production was increased after initiating dialysis. There differences in these parameters comparing HD and CAPD patients except more increase of serum adiponectin level in CAPD patients. CONCLUSION: Our study demonstrated that initiation of dialysis results in decrease of inflammation, improvement of nutritional status, and restoration of proper immune responsiveness in ESRD patients. These results suggest that correction of uremic milieu through dialysis has beneficial effects. Therefore, initiation of dialysis might have the advantage of improving inflammatory and nutritional status, and correcting immune dysfunction in ESRD patients.
Adiponectin ; Atherosclerosis ; C-Reactive Protein ; Cytokines ; Dialysis* ; Humans ; Inflammation ; Interleukin-10 ; Interleukins ; Kidney Failure, Chronic* ; Malnutrition ; Mortality ; Nutritional Status ; Peritoneal Dialysis, Continuous Ambulatory ; Renal Dialysis ; Renal Insufficiency, Chronic ; Serum Albumin ; Tumor Necrosis Factor-alpha ; Uremia