BACKGROUND: Quinolone antibiotics are now frequently used for the empirical therapy of acute pyelonephritis (APN). However, failure of this empirical therapy is often encountered in clinical practice, and the emergence of quinolone resistance should be concerned. This study was undertaken to investigate the prevalence of quinolone resistance in community-acquired APN and to analyze the clinical characteristics of quinolone-resistant APN. METHODS: Clinical data were retrospectively analyzed from 367 patients who were admitted to Hanyang University Hospital for APN from January 2002 through December 2004. According to the result of urine culture, the patients were divided into quinolone-susceptible and quinolone-resistant groups, and clinical characteristics were compared. RESULTS: Urine culture was positive in 241 out of 367 patients, and E. coli was the most common (90%) isolate. The prevalence of quinolone resistance based on the in vitro ciprofloxacin susceptibility test was found to be 19.5%, and among the E. coli isolates the prevalence of quinolone resistance was 19.8 %. 91 patients had underlying diseases and they were more frequently complicated by urosepsis. The ages and the prevalence of azotemia were not significantly different between two groups. Quinolone-resistant group had a lesser frequency of urosepsis compared with quinolone-susceptible group. Diabetic patients were more frequently quinolone-susceptible than quinolone-resistant. CONCLUSION: Although the prevalence of quinolone resistance is rather high in community-acquired APN based on the in vitro susceptibility test, the choice of quinolone antibiotics seems to be valid for the empirical therapy.
Anti-Bacterial Agents ; Azotemia ; Ciprofloxacin ; Humans ; Prevalence ; Pyelonephritis* ; Retrospective Studies

Renal involvement is one of the extra-articular manifestations found in patients with rheumatoid arthritis (RA). Membranous glomerulonephopathy, membranoproliferative glomeruonophritis, secondary amyloidosis, and focal segmental glomerulosclerosis are reported as pathologic diagnoses of renal involvement. However, reports of renal involvement in patients with RA and antineutrophil cytoplasmic autoantibody (ANCA)-associated pauci-immune glomerulonephritis are rare. Recently, we experienced two patients with RA who developed azotemia and were finally diagnosed with ANCA-associated pauci-immune glomerulonephritis. Because of the rarity of these cases, we report two cases in patients with RA with a literature review.
Amyloidosis ; Arthritis, Rheumatoid ; Azotemia ; Cytoplasm ; Glomerulonephritis ; Glomerulosclerosis, Focal Segmental ; Humans

PURPOSE: Previously positive but currently negative HLA crossmatching is considered to be a risk factor not in the first renal transplantation but in the second renal transplantation. The aim of this study is to analyse the outcome of living-related renal transplantation with previously positive but currently negative HLA crossmatching. METHODS: The results of first HLA crossmatching, demographic characteristics, the outcome of renal trasplantation were examined in four patients undergoing renal transplantation with previously positive but currently negative HLA crossmatching. RESULTS: The acute rejection was occurred in 3 patients. Azotemia was improved with the immunosuppressive therapy containing tacrolimus. There were no graft failures in four patients for 1 year. In the first HLA crossmatching, anti-human globulin T cell HLA crossmatching was positive in all patients with acute rejection. The period that positive HLA crossmatchings were converted to negative was longer in patients with acute rejections than without acute rejections (177 days vs 22 days). CONCLUSION: There were 3 acute rejections in 6 patients undergoing living related renal transplantations with previously positive and current negative HLA crossmatching. There were no graft failure for 1 year.
Azotemia ; Humans ; Kidney Transplantation* ; Risk Factors ; Tacrolimus ; Transplants

Augmentation cystoplasty using bowel is effective method for the functional enlargement of bladder capacity in contracted bladder due to various causes. Prevention of vesicoureteral reflux after augmentation cystoplasty is still controversial but generally accepted that prevention of reflux is essential for good long term result. Therefore, antireflux augmentation cystoplasty including the use of ileocecal valve and hemi-Kock intussuscepted ileal nipple valve has been used recently for this purpose. Herein, we report the result of 3 cases of ileocecal cystoplasty and 6 cases of hemi-Kock ileocystoplasty. Hemi-Kock ileocystoplasty is better than ileocecal cystoplasty in a viewpoint of reflux prevention and continence, but complication is more common and serious in hemi-Kock ileocystoplasty than ileocecal cystoplasty. It is considered that azotemia is not contraindication for these procedures, and renal function deterioration has not been observed postoperatively.
Azotemia ; Ileocecal Valve ; Nipples ; Urinary Bladder ; Vesico-Ureteral Reflux

Cyclosporine can cause remission of 60% in steroid resistant FSGS, but its responses are variable. Now we report two cases of steroid resistant FSGS who are maintaining remission using cyclosporine continuous therapy. The first patient had been failed several times of steroid therapy, had edema, azotemia and severe proteinuria. We used steroid pulse therapy then maintenance dose of oral cyclosporine to reduce proteinuria for more than 6 years. He has been received cyclosporine therapy up to now and maintaining normal renal function. The second patient had severe azotemia who needed hemodialysis but after cyclosporine therapy, he recovered his renal funciton. The findings of renal biopsies in one patient after 6 years of cyclosporine therapy revealed that there was no improvement of sclerosing glomeruli, then we guess that maintenance therapy of cyclosporine might need for lifelong period.
Azotemia ; Biopsy ; Cyclosporine* ; Edema ; Humans ; Proteinuria ; Renal Dialysis

BACKGROUND: Urine/serum protein electrophoresis (PEP) and immunofixation electrophoresis (IEP) for monoclonal protein (M-protein) are used for initial evaluation in patients with multiple myeloma. We evaluated the prognostic significance of M-proteinuria status and its association with other prognostic factors. METHODS: Between December 2002 and December 2004, 64 de novo symptomatic multiple myeloma patients with intact immunoglobulin (Ig) type were divided into two groups according to their initial urine PEP/IEP findings. RESULTS: Twenty-seven patients with undetectable or free light-chains only were classified into F group, and 37 with whole Ig with or without light-chains were classified into W group. The two groups were similar in sex, age, performance, azotemia, beta2-microglobulin, stage and treatment, but M-protein concentration was significantly higher in the W than in F group (5.1 vs 1.3g/dL, P<0.01). The overall response rate was significantly higher in F group than in W group (80.8% vs 63.6%, P=0.02), whereas the 2-year OS rate did not differ significantly between the groups (81.0% vs 57.7%, P=0.15). CONCLUSION: Monoclonal proteinuria is helpful in identifying patients with advanced disease and poorer prognosis in multiple myeloma.
Azotemia ; Electrophoresis ; Humans ; Immunoglobulins* ; Multiple Myeloma* ; Prognosis ; Proteinuria*

BACKGROUND/AIMS: Acute pyelonephritis (APN) can involve a single kidney or both kidneys. The aim of this study was to define the clinical characteristics of unilateral and bilateral APN and compare their differences in acute kidney injury (AKI). METHODS: This was a retrospective study of patients admitted to Konyang University Hospital from January, 2006 to December, 2010 with APN diagnosed by the presence of definitive APN lesions on abdominal CT. Patients with a history of renal disease or anatomical predisposing factors were excluded. The patients were divided into two groups: unilateral and bilateral APN. BUN, creatinine, MDRD eGFR, and FENa were evaluated. RESULTS: Of the 177 patients, 130 had unilateral APN and 47 had bilateral APN. Significant differences were noticed in BUN, creatinine, and MDRD eGFR between the two groups. According to RIFLE criteria, 51 patients were at "risk" and six were in "failure." Compared with unilateral APN, bilateral APN patients had lower eGFR (65.2 vs. 61.7, p = 0.042) and higher FENa (0.81 vs. 1.43, p = 0.04), and "failure" was more frequent (4 vs. 2, p = 0.044). CONCLUSIONS: Our study showed a significant correlation between bilateral APN and decreased renal function. AKI in bilateral APN was more likely than AKI in unilateral APN to result in severe renal dysfunction. The pathophysiology of AKI may differ between unilateral and bilateral APN.
Acute Kidney Injury ; Azotemia ; Creatinine ; Glomerular Filtration Rate ; Humans ; Kidney ; Pyelonephritis ; Retrospective Studies

Mortality and morbidity of malignant hyperthermia has decreased markedly by the avoidance of succinylcholine, and the earlier detection and introduction of dantrolene. We report a fourteen-year-old boy who developed malignant hyperthermia during general anesthesia. He showed the earlier clinical signs, such as elevation of end-tidal CO2, tachycardia, and hypertension. After prompt administration of dantrolene, operation was continued with profopol and midazolam. Rhabdomyolysis and myoglobinuria followed, and were managed by hydration and alkalinization of urine. Azotemia did not occur, and he was discharged without any sequelae on the 10th postoperative day.
Anesthesia, General ; Azotemia ; Dantrolene ; Humans ; Hypertension ; Male ; Malignant Hyperthermia* ; Midazolam ; Mortality ; Myoglobinuria ; Rhabdomyolysis* ; Succinylcholine ; Tachycardia

Glomerular diseases occurring in the absence of a known systemic process are called primary. This review focuses on the approach and diagnosis of primary glomerular disease. Inflammatory and/or noninflammatory insults to glomeruli results in a multiplicity of signs and symptoms of diseases, including hematuria, proteinuria, azotemia, edema, and hypertension. Patients with glomerular diseases generally present with one of the following clinical syndromes: asymptomatic urinary abnormalities, nephrotic syndrome, acute nephritic syndrome, rapidly progressive glomerulonephritis, or chronic glomerulonephritis. The urinalysis, the degree of proteinuria, the estimated glomerular filtration rate, and patient characteristics often allow the differential diagnosis of glomerular disease prior to renal biopsy. However, a renal biopsy is usually required to establish diagnosis and treatment of most glomerular disease.
Azotemia ; Biopsy ; Diagnosis, Differential ; Edema ; Glomerular Filtration Rate ; Glomerulonephritis ; Hematuria ; Humans ; Hypertension ; Nephrotic Syndrome ; Proteinuria ; Urinalysis

PURPOSE: Clinical treatment for lupus nephritis largely depends upon histological renal biopsy classification. But it has been reported that serologic biochemical markers are not strongly associated with pathologic classification. The aim of this study is to see whether serologic markers could predict pathologic class of lupus nephritis for appropriate treatment. METHODS: We investigated 67 patients, who underwent renal biopsy with lupus nephritis at Hanyang University Hospital between January, 2005 and August, 2007. Biological markers for this study are hematuria, proteinuria, serologic data of lupus activity and azotemia. They were retrospectively analyzed from patients grouped by ISN/RPS 2003 lupus nephritis classification. RESULTS: Total 67 patients (men 5, women 62) were enrolled and the mean age of the patients was 30.6+/-9 years. The number of patient group by pathologic classification was 4 cases for class II, 15 cases for class III, 30 cases for class IV and 15 cases for class V. Spot urine protein to creatinine ratio more than 3 increased in class IV group statistically (p=.007). C3 level decreased more in class IV group than class III, V groups. Ten patients showed azotemia, and 9 of them were class IV group (p=.048). CONCLUSION: The patients with more increased proteinuria, decreased C3 level and azotemia showed more frequently in class IV group. Hence those three biological markers may be a clinical clue to pathologic diagnosis.
Azotemia ; Biomarkers ; Biopsy ; Creatinine ; Female ; Hematuria ; Humans ; Lupus Nephritis ; Proteinuria ; Retrospective Studies