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

Intramural duodenal hematoma is a rare finding in the adult, especially when related to iatrogenic complications of ulcer treatment, it can lead to biliary obstruction and pancreatitis, which can be fatal in severe case. We report one case of intramural duodenal hematoma complicated with pancreatitis after endoscopic hemostasis in a chronic renal failure patient with maintenance hemodialysis. He had a duodenal ulcer bleeding treated with endoscopic epinephrine injection and electro-coagulation therapy, but on the second day, he complained of persistent abdominal pain, nausea and vomiting. Abdominal ultrasound showed acute, edematous pancreatitis and a mass with low echodensity in the wall of the 2nd portion of the duodenum. Symptom and laboratory findings were persistent under conservative therapy, 7 days later, gastric resection, hematoma evacuation was carried out, subsequently the patient recovered from the pancreatitis but the patient died of septic shock and multiple organ dysfunction.
Abdominal Pain ; Adult ; Duodenal Ulcer ; Duodenum ; Epinephrine ; Hematoma* ; Hemorrhage ; Hemostasis, Endoscopic* ; Humans ; Kidney Failure, Chronic* ; Nausea ; Pancreatitis* ; Renal Dialysis* ; Shock, Septic ; Ulcer ; Ultrasonography ; Vomiting

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

PURPOSE: CHF is a life threatening acute complication in ESRD populations. An intensive hemodialysis (HD) has been effective in reducing intravascular volume and in removing uremic toxin with improved systolic function. Although recent progress has identified an inflammation as an important contributor to the pathogenesis of CVD, the effect of intensive HD on inflammatory parameters and left ventricle (LV) systolic dysfunction is not clear. The purpose of this study is to examine the effect of intensive HD on LV systolic function and serum cytokines levels. METHODS: Among ESRD patients who underwent dialysis and developed acute pulmonary edema due to LV systolic dysfunction were enrolled. Intensive HD consisted of daily 4 hours HD for 7 consecutive days. Data were prospectively collected and 2-D echocardiography was done before and after intensive HD. Serum levels of TNF-alpha and IL-10 were compared and lipopolysaccharide (LSP)-stimulated of these cytokines were measured. RESULTS: After intensive HD, weight and mean arterial blood pressure decreased significantly and ejection fraction (EF) increased significantly. Serum IL-10 and TNF-alpha levels decreased significantly after intensive HD. In contrast, LPS stimulated production of these cytokines increased significantly after intensive HD. The difference of CRP between after HD and before HD was negatively correlated with the difference of EF. CONCLUSION: In ESRD patients with acute LV dysfunction, intensive HD significantly improved EF and restored the immune responsiveness. These results suggest that intensive HD has the advantage of improving EF through modulating inflammation and correcting immune dysfunction in ESRD patients with acute LV dysfunction.
Arterial Pressure ; Cytokines ; Dialysis ; Echocardiography ; Heart Failure ; Heart Ventricles ; Humans ; Imidazoles ; Inflammation ; Interleukin-10 ; Kidney Failure, Chronic ; Nitro Compounds ; Prospective Studies ; Pulmonary Edema ; Renal Dialysis ; Stroke Volume ; Tumor Necrosis Factor-alpha

BACKGROUND: Because of its ready availability in over-the-counter sleep preparations, doxylamine succinate is used frequently for suicidal attempts. Non-traumatic rhabdomyolysis is known to be a rare complication of doxylamine succinate but its pathogenesis and dose dependent effect are not known. The purpose of this study is to examine the frequency of various complications, especially rhabdomyolysis in doxylamine overdose and also to examine the effect of dose on the occurrence of these complications. METHODS: Medical records of patients who ingested doxylamine succinate from July 1996 to June 2000 were reviewed. Their age, sex, amount of ingestion and laborotory data are collected and also the occurrence of complication and dose-complication relationship were examined. RESULTS: 1) Total number of patients was 33 and average dose of ingestion was 1,510.6+/-180.7mg(150-5,000). 2) Complication rates were as follows tachycardia 20 patients(66%), hypertension 17 patients(51%), rhabdomyolysis 16 patients(48.4%), generalized seizure 7 patients(21.2%) and hyperthermia 5 patients(15.1%). 3) Tachycardia, seizure and rhabdomyolysis were occured more frequently in high dose groups. CONCLUSION: Rhbdomyolysis is not an infrequent complication in doxylamine overdose. Recognition of potential hazard for rhabdomyolysis and the institution of vigorous treatment to prevent acute renal failure, especially in patients who have taken a large amount of drugs will be required.
Acute Kidney Injury ; Doxylamine* ; Eating ; Fever ; Humans ; Hypertension ; Medical Records ; Rhabdomyolysis* ; Seizures ; Succinic Acid ; Tachycardia

BACKGROUND/AIMS: The potential physiologic roles of Klotho in acute kidney injury (AKI) have recently been demonstrated in animal models. However, to date, there have been no human studies investigating the expression of renal Klotho in AKI. METHODS: We retrospectively collected biopsy specimens and clinical data of AKI patients between January 2001 and December 2012. Klotho expression was determined by immunohistochemical staining, and the clinical-pathological correlation was examined. RESULTS: Among the 34 patients diagnosed with acute tubular necrosis or acute tubulointerstitial nephritis, 21 patients without chronic histological lesions were included. The mean age was 37.3 +/- 18.5 years and the mean peak creatinine level was 8.2 +/- 5.5 mg/dL. In total, 10 patients (47.6%) received temporary renal replacement therapy (RRT); however, 17 patients (81%) showed functional recovery with creatinine levels of < 1.3 mg/dL after 1 month. The intensity of Klotho expression was scored as a percentage of Klotho-positive area. The renal Klotho score showed a significant negative correlation with the initial or peak creatinine level. When the patients were divided into three groups according to the Klotho score (low, middle, high), the low group had a significantly higher peak creatinine level and a more frequent requirement for RRT. However, the Klotho score was not a significant predictor of renal recovery. CONCLUSIONS: The results demonstrated that renal Klotho expression in humans decreased significantly according to the severity of AKI, regardless of the etiology, and that low expression was associated with a poor short-term outcome.
Acute Kidney Injury/diagnosis/etiology/*metabolism/physiopathology/therapy ; Adolescent ; Adult ; Biomarkers/analysis ; Biopsy ; Down-Regulation ; Female ; Glucuronidase/*analysis ; Humans ; Immunohistochemistry ; Kidney/*chemistry/pathology/physiopathology ; Kidney Tubular Necrosis, Acute/diagnosis/etiology/*metabolism/physiopathology/therapy ; Male ; Middle Aged ; Necrosis ; Predictive Value of Tests ; Recovery of Function ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Time Factors ; Treatment Outcome ; Young Adult

BACKGROUND: Although emerging evidence suggests that intra-abdominal hypertension (IAH) is a predictor of the development of acute kidney injury (AKI), it remains unclear whether the presence of IAH is a predictor of prognosis in patients with AKI. The purpose of this study was to assess whether the presence of IAH could predict prognosis in critically ill patients with AKI. The prognostic value of urinary biomarkers was also determined. METHODS: In this prospective observational study, we enrolled 57 patients with established AKI, who were admitted to the intensive care unit between February 2012 and June 2014. IAH was defined as a sustained elevation in intra-abdominal pressure of > or =12 mmHg, in three consecutive measurements performed daily on the first 3 days. Urinary neutrophil gelatinase-associated lipocalin (NGAL), liver-type fatty acid-binding protein, and simplified acute physiology score II score at the time of admission were also examined. RESULTS: IAH was observed in 78.9% of patients. The in-hospital mortality was 21.1%, and renal recovery during hospitalization was achieved in 40.4% of patients. Although high urinary NGAL [odds ratio (OR), 1.015] and liver-type fatty acid-binding protein (OR, 1.003) were found to be independent predictors of renal recovery, IAH was not. High urinary NGAL (OR, 1.003) and a high simplified acute physiology score II score (OR, 1.102) were independent predictors of in-hospital mortality, while IAH or urinary liver-type fatty acid-binding protein was not. CONCLUSION: Although IAH is prevalent in critically ill patients with AKI, it did not predict AKI prognosis. However, urinary NGAL was found to be a useful predictor of both renal recovery and in-hospital mortality.
Acute Kidney Injury* ; Biomarkers ; Critical Illness* ; Hospital Mortality* ; Hospitalization ; Humans ; Intensive Care Units ; Intra-Abdominal Hypertension* ; Lipocalins ; Neutrophils ; Observational Study ; Physiology ; Prognosis ; Prospective Studies

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

Posttransplant lymphoproliferative disorders (PTLDs) represent a potentially life-threatening complication following renal transplantation. Their incidence is usually low, in the range of 1-2%. The majority of PTLD is B cell origin and strongly associated with Epstein Barr virus (EBV). PTLD of T cell origin is uncommon and has a poor prognosis. We have experienced a case of NK/T cell lymphoma involving stomach, mesenteric lymph nodes, and heart after renal transplantation. The patient was 34 years old man who received renal transplant in 1999. He was admitted with a complaint of fever and pancytopenia for 2 weeks in 2003. Though antibiotic and antifungal treatment, fever and pancytopenia were continued. On the third hospital day, he present waterly diarrhea. We found multiple hemorrhagic erosions in the stomach by gastrofiberscopy and did biopsy there. Gastric mucosal biopsy showed infiltration by atypical cells between the mucosal glands and submucosal layer. The immunophenotype of these tumor cells were CD3+, UCHL+, and CD56+ and all negative for B cell markers. He was dead because of massive gastrointestinal bleeding after endoscopic biopsy of stomach. The autopsy revealed the widespreading of tumor cells involving heart and mesenteric lymph nodes.
Adult ; Autopsy ; Biopsy ; Diarrhea ; Fever ; Heart ; Hemorrhage ; Herpesvirus 4, Human ; Humans ; Incidence ; Kidney Transplantation ; Lymph Nodes ; Lymphoma* ; Lymphoproliferative Disorders ; Pancytopenia ; Prognosis ; Stomach ; Transplantation*

Posttransplant lymphoproliferative disorders (PTLDs) represent a potentially life-threatening complication following renal transplantation. Their incidence is usually low, in the range of 1-2%. The majority of PTLD is B cell origin and strongly associated with Epstein Barr virus (EBV). PTLD of T cell origin is uncommon and has a poor prognosis. We have experienced a case of NK/T cell lymphoma involving stomach, mesenteric lymph nodes, and heart after renal transplantation. The patient was 34 years old man who received renal transplant in 1999. He was admitted with a complaint of fever and pancytopenia for 2 weeks in 2003. Though antibiotic and antifungal treatment, fever and pancytopenia were continued. On the third hospital day, he present waterly diarrhea. We found multiple hemorrhagic erosions in the stomach by gastrofiberscopy and did biopsy there. Gastric mucosal biopsy showed infiltration by atypical cells between the mucosal glands and submucosal layer. The immunophenotype of these tumor cells were CD3+, UCHL+, and CD56+ and all negative for B cell markers. He was dead because of massive gastrointestinal bleeding after endoscopic biopsy of stomach. The autopsy revealed the widespreading of tumor cells involving heart and mesenteric lymph nodes.
Adult ; Autopsy ; Biopsy ; Diarrhea ; Fever ; Heart ; Hemorrhage ; Herpesvirus 4, Human ; Humans ; Incidence ; Kidney Transplantation ; Lymph Nodes ; Lymphoma* ; Lymphoproliferative Disorders ; Pancytopenia ; Prognosis ; Stomach ; Transplantation*