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A Case of Acute Ethanol Intoxication Complicated with Sciatic Neuropathy Treated with Hemodialysis.

Kang Won HAN ; Kwan Hyun LEE ; Moo Yong PARK ; Wan Bok LEE ; Min Soo SONG ; Soo Jeong CHOI ; Na Ri KIM ; Hyun SUK ; Jin Kuk KIM ; Seung Duk HWANG

Korean Journal of Nephrology.2004;23(6):1015-1019.

A 20-year-old man presented with semicoma due to severe ethanol intoxication. Initially, his blood ethanol level was markedly elevated to 73 mmol/L. The patient's level of consciousness did not change for 6 hours with conservative treatment. In an attempt to expedite his recovery, hemodialysis was started using a femoral vein catheter. After an initial session of hemodialysis, his blood ethanol level was decreased to 19 mmol/L, and his mental status showed improvement. Subsequent hemodialysis further reduced his blood ethanol concentration to 3 mmol/L and improved his consciousness level. The patient was treated conservatively for additional complications caused by ethanol toxicity including liver failure, rhabdomyolysis and peripheral polyneuropathy. Most commonly, peripheral polyneuropathy is related with chronic ethanol intoxication and it is extremely rare in acute ethanol intoxication. We report a case of peripheral polyneuropathy related with acute ethanol intoxication and suggest that hemodialysis should be considered in patients with severe ethanol intoxication for life preservation and prevention of complications.
Catheters ; Consciousness ; Ethanol* ; Femoral Vein ; Humans ; Liver Failure ; Polyneuropathies ; Renal Dialysis* ; Rhabdomyolysis ; Sciatic Neuropathy* ; Young Adult

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A Case of Carcinoid Tumor in a Patient with Focal Segmental Glomerulosclerosis.

Han Kyu LEE ; Young Mo LEE ; Ki Ryang NA ; Kang Wook LEE ; Heon Young JEONG ; Kwang Sun SUH ; Young Tai SHIN

Korean Journal of Nephrology.2004;23(6):1009-1014.

A renal lesion of neoplasm-related nephrotic syndrome usually presents as membranous nephropathy. Neoplasm-related nephrotic syndrome exhibiting focal segmental glomerulosclerosis (FSGS) has been reported mainly in patients with hematological malignancies. But reports of an association between FSGS and neoplasm are extremely rare. We report a 66-year-old woman with FSGS who presented with nephrotic syndrome and was subsequently found to have carcinoid tumors in the duodenum, confirmed by tissue biopsy. After resection of carcinoid tumor, the patient received initial treatment with oral prednisolone for 2 months but her nephrotic syndrome persisted. The patient was then treated with oral cyclophosphamide. One month later, she was in complete remission of nephrotic syndrome as indicated by a normal serum albumin and no proteinuria. This case may be a coincidence or the lesions may be linked with each other but since little is known about the pathogenesis of FSGS and neoplasm, it is difficult to speculate on a pathogenetic link between these two lesions. We report a case of FSGS with nephrotic syndrome in a patient with carcinoid tumor.
Aged ; Biopsy ; Carcinoid Tumor* ; Cyclophosphamide ; Duodenum ; Female ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental* ; Hematologic Neoplasms ; Humans ; Nephrotic Syndrome ; Prednisolone ; Proteinuria ; Serum Albumin

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A Case of Rapidly Progressive Glomerulonephritis Associated with Hepatitis C Virus.

Chi Hun CHOI ; Kweon Woo HAN ; Kwang Hyuk PARK ; Chull Sung JUNG ; Seong Gyun KIM ; Ji Eun OH ; Jang Won SEO ; Young Ki LEE ; Ja Ryong KOO ; Hyung Jik KIM ; Jung Woo NOH ; Chong Woo YOO

Korean Journal of Nephrology.2004;23(6):1004-1008.

Chronic HCV infection has been reported to be associated with several extrahepatic conditions such as cryoglobulinemia, lymphoma, lichen planus, porphyria cutanea tarda, autoimmune thyroiditis, and renal disease. Glomerular disease may occur in patients with chronic HCV infection. The most common patterns are membranoproliferative glomerulonephritis, and less frequently, membranous nephropathy, fibrillary glomerulonephritis and immunotactoid glomerulopathy. Few crescentic glomerulonephritis has been reported in association with HCV infection, and no case was reported in Korea yet. We experienced one case of rapidly progressive glomeruloinephritis with the pathology of crescentic glomerulonephritis complicated in membranoproliferative glomerulonephritis in a patient with HCV infection.
Cryoglobulinemia ; Glomerulonephritis* ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans ; Korea ; Lichen Planus ; Lymphoma ; Pathology ; Porphyria Cutanea Tarda ; Thyroiditis, Autoimmune

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Propylthiouracil-associated p-ANCA Positive Vasculitis with Focal Segmental Glomerulosclerosis.

Yoon Kyung PARK ; Yeo Wook YUN ; Sang Suk SUNG ; Ui Soon PARK ; Sung Hyun PARK ; Jin Hyun WOO ; Jae Il PARK ; Sun Joo JANG ; Sang Woong HAN ; Young Ha OH ; Yong Wook PARK ; Moon Hyang PARK ; Ho Jung KIM

Korean Journal of Nephrology.2004;23(6):997-1003.

Antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis has been reported in Graves' disease patients treated with propylthiouracil (PTU). In most cases, it's renal involvements has been known as crescentic glomerulonephritis. A 41-year-old female patient with hyperthyroidism has been treated with PTU for 3 years. The patient had developed isolated hematuria and polyarthralgia with p-ANCA positivity, 6 months and 10 months after PTU treatment, respectively. She had been continuously treated with PTU until she was admitted at our hospital. Three months before admission, polyarthralgia was aggravated and purpura in both lower legs and hands was developed. Urinalysis revealed hematuria, proteinuria. Serologic evaluation showed p-ANCA positive. Skin biopy showed leukocytoclastic vasculitis and renal biopsy showed focal segmental glomerulosclerosis (FSGS). She was diagnosed as PTU-associated vasculitis with FSGS. Polyarthralgia and purpura were improved after discontinuing the PTU with prednisolone treatment but hematuria, proteinuria were not changed. We suggest that progression of PTU-associated focal segmental necrotizing glomerulonephritis to FSGS over two years might be due to continued PTU medication.
Adult ; Antibodies, Antineutrophil Cytoplasmic* ; Arthralgia ; Biopsy ; Cytoplasm ; Female ; Glomerulonephritis ; Glomerulosclerosis, Focal Segmental* ; Graves Disease ; Hand ; Hematuria ; Humans ; Hyperthyroidism ; Leg ; Prednisolone ; Propylthiouracil ; Proteinuria ; Purpura ; Skin ; Urinalysis ; Vasculitis*

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Spontaneous Rupture of Lumbar Artery & Inferior Epigastric Artery in a Hemodialysis Patient.

Sung Hee PYO ; Jang Won SEO ; Jong Ha PARK ; Kyu Pyo KIM ; Sang Hyun KIM ; Jai Won CHANG ; Kyu Bo SUNG ; Su Kil PARK

Korean Journal of Nephrology.2004;23(6):992-996.

We report a case of retroperitoneal hemorrhage and abdominal wall hemorrhage due to spontaneous lumbar artery and inferior epigastric artery rupture, in a patient with chronic renal failure treated with hemodialysis. There was no history of specific trauma. The bleeding was confirmed by CT and angiography, and controlled successfully by selective angiographic embolization. We suggest that a possibility of spontaneous retroperitoneal bleeding should be considered in a case of abdominal pain or mass in a hemodialysis patient.
Abdominal Pain ; Abdominal Wall ; Angiography ; Arteries* ; Epigastric Arteries* ; Hemorrhage ; Humans ; Kidney Failure, Chronic ; Renal Dialysis* ; Rupture ; Rupture, Spontaneous*

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A Case of Proliferative Glomerulonephritis with Monoclonal IgG Deposits.

Jin Gyu LEE ; Kyung Chul MOON ; Ji Eun LEE ; Paul KIM ; Jae Gyu LEE ; Jung Hwa KIM ; Kwang Young LEE

Korean Journal of Nephrology.2004;23(6):987-991.

Proliferative glomerulonephritis with monoclonal IgG deposits is a novel disease entity characterized by (1) glomerular monoclonal IgG deposits restricted to a single IgG subclass and a single light chain isotype, associated with proliferative GN; (2) granular deposits by EM; (3) no clinical and laboratory evidence of cryglobulinemia. A 47-year-old male presented with edema and muscle cramps. Urinalysis revealed protein 3+ and 5-9 RBC's/HPF. BUN/Cr were 25/1.7 mg/dL, 24 hour urine protein 5.4 g/day, and CCr 56.3 mL/min/1.73m2. Cryglobulin was negative. The histologic findings of the renal biopsy showed mesangial cell proliferation with double contour of GBM on LM, diffuse finely granular electron-dense deposit in subendothelial & mesangial area with no amyloid fibril on EM, and strong immune reactivity to IgG and kappa light chain along the glomerular basement membrane on IF. Serum and urine protein EP, IEP and immunofixation EP showed no evidence of monoclonal gammopathy. Bone marrow aspiration & biopsy were negative for plasma cell infiltration. The patient is on supportive management with an AII blocking agent.
Amyloid ; Biopsy ; Bone Marrow ; Edema ; Glomerular Basement Membrane ; Glomerulonephritis* ; Humans ; Immunoglobulin G* ; Male ; Mesangial Cells ; Middle Aged ; Muscle Cramp ; Paraproteinemias ; Plasma Cells ; Urinalysis

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Primary Sjogren's Syndrome Associated with Membranous Glomerulonephritis.

Seung Seok BAEK ; Ek Seong KIM ; Jae Seong LEE ; Seung Joon HWANG ; Tae Hee LEE ; Soon Won HONG ; Hyeong Cheon PARK ; Sung Kyu HA

Korean Journal of Nephrology.2004;23(6):982-986.

Sjogren's syndrome is a chronic autoimmune disorder causing dry eye or dry mouth from the lymphocytic infiltration in the lacrimal gland and the salivary gland. Renal involvement is seen in about 20-40% of patients with primary Sjogren's syndrome. Tubulointerstitial nephritis is the most common renal complication in primary Sjogren's syndrome. However, glomerulonephritis such as membranoproliferative glomerulonephritis, membranous glomerulonephritis rarely may complicate primary Sjogren's syndrome. Sjogren's syndrome associated with glomerulonephritis hasn't been reproted yet in Korea. We report nephrotic syndrome associated with membranous glomerulonephritis in a case with primary Sjogren's syndrome. Nephrotic syndrome resolved after treatment with corticosteroid.
Glomerulonephritis ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous* ; Humans ; Korea ; Lacrimal Apparatus ; Mouth ; Nephritis, Interstitial ; Nephrotic Syndrome ; Salivary Glands ; Sjogren's Syndrome*

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A Case of lambda-type Light Chain Deposition Disease Manifested as Acute Renal Failure and Multiple Organ Dysfunction by Embolic Events.

Gang Jee KO ; Jeong Yup KIM ; Myung Kyu KIM ; Hye Min CHOI ; Young Youl HYUN ; Chang Su BOO ; Su Ah SUNG ; Nam Hui WON ; Sang Kyung JO ; Won Yong CHO ; Hyeong Gyu KIM

Korean Journal of Nephrology.2004;23(6):975-981.

Light chain deposition disease is caused by systemic paraprotein deposition resulting from monoclonal plasma cell dyscrasia. It is usually characterized rapidly progressive renal failure and multiple organ dysfunctions. Besides deposition of light chain, it can lead to multiple organ dysfunctions due to hyperviscosity syndrome. We experienced a case of 54-year-old man who presented as an acute renal failure, and elevation of liver enzyme. Radiologically, there was no abnormal finding except enlargement of both kidney in abdominal sonogram. Globulinuria was noticed on 24 hrs-urine study. The histologic findings of kidney showed lambda chain deposits in basement membrane of tubules and glomeruli, interstitium, and vessel walls. On 10th day of hospitalization, he developed sudden hypoxia that was not corrected by oxygen supplementation, and focal neurologic signs accompanied with a change of consciousness. We report a case of light chain deposition disease manifested as an acute renal failure and liver enzyme elevation with suspicious multiple organ embolic events later.
Acute Kidney Injury* ; Anoxia ; Basement Membrane ; Consciousness ; Hospitalization ; Humans ; Kidney ; Liver ; Middle Aged ; Neurologic Manifestations ; Oxygen ; Paraproteinemias ; Renal Insufficiency

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A Case of Scleroderma Renal Crisis without Malignant Hypertension after Steroid Treatment.

Myung Gyu KIM ; Gang Jee KO ; Jeong Yup KIM ; Hye Won JEONG ; Su Ah SUNG ; Sang Kyung JO ; Won Yong CHO ; Hyeong Gyu KIM

Korean Journal of Nephrology.2004;23(6):970-974.

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

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A Case of Autosomal Dominant Nephrogenic Diabetes Insipidus with Renal Failure.

Hag Ei KIM ; Hye Suk HAN ; Byung Chul KIM ; Joungho HAN ; Sung Soon PARK ; Min Ok KIM ; Soon Kil KWON ; Hye Young KIM ; Sung Soo KOONG

Korean Journal of Nephrology.2004;23(6):965-969.

Congenital nephrogenic diabetes insipidus (NDI) is a rare inherited disorder. The X-linked recessive NDI, most of congenital DI (>90%), has been known to be caused by mutation of the AVPR2 gene. Less than 10% of congenital NDI has an autosomal recessive inheritance and mutations of the AQP2 gene. Although several adult cases of congenital NDI were reported in Korea, all of them had an X-linked recessive inheritance and no azotemia. We have experienced a case of autosomal dominant NDI with renal failure. A 38-year-old man was admitted due to polyuria and polydipsia. In his family, his grandfather, father, three sisters and nieces showed similar symptoms. On admission, serum creatinine level was 4.9 mg/dL and creatinine clearance decreased to 19.9 mL/min. On ultrasonography, both kidneys showed severe hydronephrosis. We performed water deprivation and vasopressin stimulation test, and the result was consistent with NDI. On gene mutational analysis of the two different genes, AVPR2 and AQP2, no specific mutations were found except polymorphism.
Adult ; Azotemia ; Creatinine ; Diabetes Insipidus, Nephrogenic* ; Fathers ; Humans ; Hydronephrosis ; Kidney ; Korea ; Polydipsia ; Polyuria ; Renal Insufficiency* ; Siblings ; Ultrasonography ; Vasopressins ; Water Deprivation ; Wills

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