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

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*

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

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

No abstract available.
Female ; Humans ; Hyperaldosteronism* ; Spondylitis, Ankylosing*

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

PURPOSE: The prevalence of Chronic Kidney Disease (CKD) is increasing worldwide and was recently reported to be up to 13.7% in general population in Korea. The purpose of this study was to investigate the prevalence of CKD in subjects undergoing coronary angiography (CAG). METHODS: Six hundred six subjects who underwent CAG in Korea University Anam Hospital during the time frame of 4 months were included and prevalence of CKD was estimated by using K/DOQI guideline with MDRD equation. Coronary artery disease was defined as one or more significant stenosis (50% or more) at CAG. RESULTS: The prevalence of CKD was 36.4%. The proportion of hypertension and diabetes, the well- known risk factors of CKD were not different with general population. The prevalence of coronary artery disease was not different between two groups with or without CKD. CONCLUSION: The prevalence of CKD in subjects who undergo CAG is higher than that in general population (36.4% vs. 13.7%). It seems to be related with or other factors than hypertension and diabetes. Subsequently, using contrast media to this population might carry a higher risk of developing contrast induced acute kidney injury. More attention to assessing kidney function before CAG in this population is needed.
Acute Kidney Injury ; Constriction, Pathologic ; Contrast Media ; Coronary Angiography ; Coronary Artery Disease ; Hypertension ; Kidney ; Korea ; Prevalence ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Risk Factors

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