The widespread use of colonoscopy for early detection of colorectal pathology has increased the use of osmotic laxatives for colonic cleansing. Among these, oral sodium phosphate preparations can cause renal insufficiency through the development of acute phosphate nephropathy. Acute phosphate nephropathy can be distinguished as early symptomatic and late insidious patterns. Patients whose presentation is insidious are easily overlooked and can progress to chronic kidney disease. We report a case of complete recovery from the late insidious type of acute phosphate nephropathy.
Colon ; Colonoscopy ; Humans ; Laxatives ; Pathology ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Sodium

BACKGROUND/AIMS: Immunoglobulin A nephropathy (IgAN) is the most common type of primary glomerulonephritis worldwide. Although several studies have identified IgAN prognostic factors in Korea, the follow-up period was insufficient to evaluate the natural history of IgAN. METHODS: A total of 471 patients were diagnosed with IgAN after percutaneous renal biopsy between April 1985 and March 2003. Patients with secondary IgAN and patients with a follow-up < 10 years since their diagnosis were excluded. Thus, 184 patients were enrolled. RESULTS: Among the 184 patients, 97 were males (52.7%) and 87 were females (47.3%). The mean age was 33.7 +/- 11.5 years, and the mean follow-up period was 181.3 +/- 46.3 months. During the follow up, 73 patients (36.9%) had progressed to end-stage renal disease (ESRD). The mean duration to ESRD was 98.1 +/- 55.9 months. The overall renal survival rate was 60.3%, the 10-years renal survival rate was 74.3%, and the 20-years renal survival rate was 49.3%. Univariate analyses indicated that hypertension, serum creatinine > 1.3 mg/dL, estimated glomerular filtration rate < 60 mL/min/1.73 m2, serum albumin < 3.5 g/dL, proteinuria > or = 1 g/day, and severe renal pathology by the Haas sub-classification were significantly associated with ESRD. When these factors were included in multivariate Cox regression analyses, only severe renal pathology by the Haas sub-classification was an independent prognostic factor for IgAN. CONCLUSIONS: Careful follow-up and treatment is recommended, particularly in patients with IgAN and severe renal pathology by the Haas sub-classification.
Biopsy ; Creatinine ; Diagnosis ; Female ; Follow-Up Studies* ; Glomerular Filtration Rate ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Humans ; Hypertension ; Kidney Failure, Chronic ; Korea ; Male ; Natural History ; Pathology ; Prognosis ; Proteinuria ; Serum Albumin ; Survival Rate

Posttransplant lymphoproliferative disorder (PTLD) is a life-threatening complication from organ transplantation. PTLD usually manifests as a mass in the lymph node or an extranodal mass in solid organs, such as the liver, transplanted kidney, tonsil, bone marrow, or spleen. PTLD rarely involves the central nervous system (CNS); however, here we report a case of PTLD that manifested as a brain tumor after kidney transplantation. A 52-year-old man who started peritoneal dialysis due to autosomal dominant polycystic kidney disease, underwent kidney transplantation 4 years ago. After kidney transplantation, he took tacrolimus, mycophenolate mofetil, and steroids. He was admitted to our hospital, complaining of a severe headache. Brain magnetic resonance imaging showed a multifocal, irregular, and round enhancing mass in the left basal ganglia. He underwent a needle biopsy for the enhancing mass and the pathological diagnosis was diffuse large B cell lymphoma. After this mass was confirmed as PTLD by histologic diagnosis, the patient had a reduction in his immunosuppression regimen (including a change from tacrolimus to sirolimus) and was treated with chemotherapy for PTLD. After 20 days, the patient expired from sepsis. PTLD involving the CNS is a rare and serious complication associated with solid organ transplantation. PTLD should be included in the differential diagnosis of brain tumors in recipients of solid organ transplants.
Basal Ganglia ; Biopsy, Needle ; Bone Marrow ; Brain ; Brain Neoplasms ; Central Nervous System ; Diagnosis, Differential ; Headache ; Humans ; Immunosuppression ; Kidney ; Kidney Transplantation ; Liver ; Lymph Nodes ; Lymphoma, B-Cell ; Lymphoproliferative Disorders ; Magnetic Resonance Imaging ; Mycophenolic Acid ; Organ Transplantation ; Palatine Tonsil ; Peritoneal Dialysis ; Polycystic Kidney, Autosomal Dominant ; Sepsis ; Spleen ; Steroids ; Tacrolimus ; Transplants

Although the incidence of uremic pericarditis was high in the past, it has decreased in recent decades with early and appropriate dialysis. However, cardiac tamponade caused by uremic pericarditis is still a life-threatening emergency and it requires urgent management. Herein we report a case of 38-year-old man with chronic renal disease who represented critical uremic pericarditis followed by cardiac tamponade despite of appropriate hemodialysis. Careful consideration of risk factors and aggressive treatment are very important for effective and safe treatment of uremic pericarditis and cardiac tamponade.
Adult ; Cardiac Tamponade* ; Dialysis ; Emergencies* ; Humans ; Incidence ; Pericardial Effusion ; Pericardiocentesis ; Pericarditis* ; Renal Dialysis* ; Renal Insufficiency, Chronic ; Renal Replacement Therapy ; Risk Factors

PURPOSE: Tuberculosis (TB) is one of the most important diseases that cause significant mortality and morbidity in young children. Data on TB transmission from an infected child are limited. Herein, we report a case of disseminated TB in a child and conducted a contact investigation among exposed individuals. METHODS: A 4-year-old child without Bacille Calmette-Guérin vaccination was diagnosed as having culture-proven disseminated TB. The child initially presented with symptoms of inflammatory bowel disease, and nosocomial and kindergarten exposures were reported. The exposed individuals to the index case were divided into 3 groups, namely household, nosocomial, or kindergarten contacts. Evaluation was performed following the Korean guidelines for TB. Kindergarten contacts were further divided into close or casual contacts. Chest radiography and tuberculin skin test or interferon-gamma-releasing assay were performed for the contacts. RESULTS: We examined 327 individuals (3 household, 10 nosocomial, and 314 kindergarten contacts), of whom 18 (5.5%), the brother of the index patient, and 17 kindergarten children were diagnosed as having latent TB infection (LTBI). LTBI diagnosis was more frequent in the children who had close kindergarten contact with the index case (17.1% vs. 4.4%, P=0.007). None of the cases had active TB. CONCLUSION: This is the first reported case of TB transmission among young children from a pediatric patient with disseminated TB in Korea. TB should be emphasized as a possible cause of chronic diarrhea and failure to thrive in children. A national TB control policy has been actively applied to identify Korean children with LTBI.
Child* ; Child, Preschool ; Diagnosis ; Diarrhea ; Failure to Thrive ; Family Characteristics ; Humans ; Inflammatory Bowel Diseases* ; Korea ; Mortality ; Radiography ; Siblings ; Skin Tests ; Thorax ; Tuberculin ; Tuberculosis* ; Vaccination