Journal Detail Information

1

Cite

Share

Lupus Cystitis and Azathioprine-iIduced Pure Red Cell Aplasia in a Patient with Systemic Lupus Erythematosus.

Tai Yeon KOO ; Hyun Jung KIM ; Kyung Min KIM ; Dong Kyu OH ; Geum Borae PARK ; Sang Koo LEE

Korean Journal of Nephrology.2011;30(1):102-106.

We report a case of lupus cystitis as the manifestation of lupus flare, and pure red cell aplasia resulting from the use of azathioprine in a patient with systemic lupus erythematosus (SLE). A 30-year-old female with a nine-year history of SLE was admitted to our hospital with complaint of anemia and azotemia. Eighteen and three months before, she had two episodes of lupus enteritis treated with high dose steroid. She had serologic evidence of an SLE flare at admission. Abdominal computed tomography revealed bilateral hydronephrosis and hydroureter with marked diffuse thickening of the urinary bladder wall, suggesting lupus cystitis. Treatment with corticosteroid led to prompt normalization of her renal function. Use of azathioprine may lead to severe anemia. The bone marrow examination revealed a decrease of erythropoiesis, suggesting pure red cell aplasia. Serologic tests for hepatitis B and parvovirus B19 were negative. There was immediate hemoglobin recovery after complete azathioprine discontinuation.
Adult ; Anemia ; Azathioprine ; Azotemia ; Bone Marrow Examination ; Cystitis ; Enteritis ; Erythropoiesis ; Female ; Hemoglobins ; Hepatitis B ; Humans ; Hydronephrosis ; Lupus Erythematosus, Systemic ; Parvovirus ; Red-Cell Aplasia, Pure ; Serologic Tests ; Urinary Bladder

2

Cite

Share

A Case of Nocardia farcinica Brain Abscess in a Focal Segmental Glomerulosclerosis Patient after Steroid Treatment.

Seung Tae HAN ; Young Sub KIM ; Shin Han SONG ; Young UH ; Byoung Geun HAN ; Seung Ok CHOI ; Jae Won YANG

Korean Journal of Nephrology.2011;30(1):98-101.

Nocardia is an opportunistic pathogen that can cause disseminated disease in serious immunosuppressive patients with organ transplantation, advanced HIV infection, malignancy or long-term corticosteroid use. Cerebral nocardiosis constitutes the most severe form of Nocardial infection. Early detection and treatment of cerebral abscess of Nocardia is important because the mortality is three times higher than that of other bacterial cerebral abscesses. We report a case of N. farcinica brain abscess in a focal segmental glomerulosclerosis (FSGS) patient after steroid treatment.
Brain ; Brain Abscess ; Glomerulosclerosis, Focal Segmental ; HIV Infections ; Humans ; Nocardia ; Nocardia Infections ; Organ Transplantation ; Steroids ; Transplants

3

Cite

Share

A Case of Adult Minimal Change Nephrotic Syndrome Associated with Thin Basement Membrane Nephropathy.

Ji Eun SONG ; Ki Hoi KIM ; Jeong Gwan KIM ; Wang Guk OH ; Sung Hyun PARK ; Kyung Chul MOON ; Jung Hwa KIM ; Kwang Young LEE

Korean Journal of Nephrology.2011;30(1):94-97.

Thin basement membrane nephropathy (TBMN) is characterized by persistent hematuria, mild proteinuria, normal renal function and family history of hematuria. Many studies report that TBMN commonly occurs together with other glomerular diseases such as minimal change nephrotic syndrome, membranous nephropathy, IgA nephropathy and focal segmental glomerulosclerosis. Especially, the case of TBMN with minimal change nephrotic syndrome has been rare. We report a case of adult minimal change nephrotic syndrome with TBMN in a 44-year-old female with general edema and microscopic hematuria. On renal biopsy, electron microscopic examination demonstrated diffuse thinning of glomerular basement membrane with the thickness less than 250nm and diffuse foot process effacement. Treatment with corticosteroid resulted in complete remission of proteinuria.
Adult ; Basement Membrane ; Biopsy ; Edema ; Electrons ; Female ; Foot ; Glomerular Basement Membrane ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Hematuria ; Humans ; Nephrosis, Lipoid ; Proteinuria

4

Cite

Share

A Case of Myoglobinuric Acute Kidney Injury due to Rhabdomyolysis Associated with Neuroleptic Malignant Syndrome.

Jung Nam CHO ; In Hee LEE

Korean Journal of Nephrology.2011;30(1):87-93.

Neuroleptic malignant syndrome (NMS) is a rare, adverse reaction associated with the use of neuroleptic medication, which is characterized by altered consciousness, muscle rigidity, autonomic instability, hyperthermia, and elevated serum creatine phosphokinase (CPK) levels. Myoglobinuric acute kidney injury (AKI) is considered as the most serious complication of NMS. We report here a 25-year-old female who developed NMS associated myoglobinuric AKI, and had previously received olanzapine, haloperidol, and quetiapine for the treatment of brief psychotic disorder. The peak level of blood urea nitrogen (BUN) was 53.5 mg/dL, serum creatinine (Cr) 2.2 mg/dL, serum myoglobin 36,745 ng/mL, and a serum CPK of >30,000 IU/L. She was treated supportively with combination therapy including withdrawal of neuroleptics, intravenous hydration, cooling, and oral dantrolene. She gradually improved with clearing of altered sensorium, decrease in rigidity and normalizing of the serum CPK level. Serum BUN and Cr also decreased to 8.0 mg/dL and 0.6 mg/dL, respectively. Early, aggressive volume repletion with alkalinized fluids, along with appropriate pharmacological therapy is needed to prevent myoglobinuric AKI in patients with NMS. Additionally, dipstick urinalysis including urine pH, specific gravity, and occult blood may be useful in monitoring changes in hydration status during periods of fluid therapy.
Acute Kidney Injury ; Adult ; Antipsychotic Agents ; Benzodiazepines ; Blood Urea Nitrogen ; Consciousness ; Creatine Kinase ; Creatinine ; Dantrolene ; Dibenzothiazepines ; Female ; Fever ; Fluid Therapy ; Haloperidol ; Humans ; Hydrogen-Ion Concentration ; Muscle Rigidity ; Myoglobin ; Neuroleptic Malignant Syndrome ; Occult Blood ; Psychotic Disorders ; Renal Insufficiency ; Rhabdomyolysis ; Specific Gravity ; Urinalysis ; Quetiapine Fumarate

5

Cite

Share

A Case of Severe Acute Renal Failure Due to Sodium Bromate Intoxication.

Sung Hyun PARK ; Ki Hoi KIM ; Jeong Gwan KIM ; Ji Eun SONG ; Wang Guk OH ; Jung Hwa KIM ; Kwang Young LEE

Korean Journal of Nephrology.2011;30(1):84-86.

Bromate is an oxidizing agent used as a permanent wave neutralizer. Accidental or deliberate ingestion of bromate has rarely been reported, but is potentially severe. We report a 36-year-old female hairdresser, who was admitted due to nausea and vomiting after ingestion of sodium bromate. The patient was successfully treated with hemodialysis therapy and renal function recovered without any complication. The clinicians must remember that early therapeutic measures, including hemodialysis, should be taken as soon as possible to prevent irreversible hearing loss and renal failure.
Acute Kidney Injury ; Adult ; Bromates ; Eating ; Female ; Hearing Loss ; Humans ; Nausea ; Renal Dialysis ; Renal Insufficiency ; Sodium ; Sodium Compounds ; Vomiting

6

Cite

Share

A Case of Renal Salt Wasting Syndrome Induced by Cisplatin for Chemotherapy.

Hye Won HWANG ; Shin Han SONG ; Seung Tae HAN ; Jae Seok KIM ; Byoung Geun HAN ; Seung Ok CHOI ; Jae Won YANG

Korean Journal of Nephrology.2011;30(1):80-83.

Cisplatin is widely used for chemotherapy, but known to cause renal, auditory, hematologic, gastrointestinal, and neurologic toxicities. Hyponatremia after administration of cisplatin is related to renal tubular sodium excretion. A 71-year-old female was referred to our hospital for chemotherapy of laryngeal cancer. On admission, the patient's laboratory data were normal. The patient received for 3 days chemotherapy without complication, but presented mental confusion on the 4th hospital day. The laboratory findings were as follows; serum sodium was 118 mmol/L, urine sodium 163 mmol/L, serum osmolality 248 mmol/kg, and urine osmolality 594 mmol/kg. On physical exam, volume status was hypovolemic, so we supplied hypertonic and isotonic salines. On the 9th hospital day, she showed normal sodium concentration and clear consciousness. After chemotherapy, we should make differential diagnosis between SIADH (syndrome of inappropriate antidiuretic hormone) and renal salt wasting syndrome according to the physical examination. We report a case of renal salt wasting syndrome with severe mental change after chemotherapy using cisplatin.
Aged ; Cisplatin ; Consciousness ; Diagnosis, Differential ; Female ; Humans ; Hyponatremia ; Hypovolemia ; Inappropriate ADH Syndrome ; Laryngeal Neoplasms ; Osmolar Concentration ; Physical Examination ; Sodium ; Wasting Syndrome

7

Cite

Share

Mortality Predictors in Patients Treated with Continuous Renal Replacement.

Eun Jung KIM ; Chul Ho CHUNG ; Moo Yong PARK ; Soo Jeong CHOI ; Jin Kuk KIM ; Seung Duk HWANG

Korean Journal of Nephrology.2011;30(1):73-79.

PURPOSE: Acute kidney injury (AKI) is a frequent condition with a high mortality rate that requires continuous renal replacement therapy (CRRT). We evaluated the Simplified Acute Physiology Score 3 (SAPS 3) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score, determined at the start of CRRT, for predicting mortality in AKI. METHODS: We retrospectively analyzed the demographic, clinical, and laboratory data of 89 patients with AKI or acute-on-chronic kidney disease who received CRRT between September 2006 and September 2009. We calculated the SAPS 3 and APACHE II score at the start of CRRT. RESULTS: The average age of the 89 patients was 64.4+/-13.9 (17-92) years. Fifty-nine (66.3%) were male. Eighteen (20.2%) patients had chronic kidney disease and 30 (33.7%) had diabetes. The overall mortality was 75.3%. The average SAPS 3 was 89.4+/-14.9 and the average APACHE II score was 28.4+/-5.2. The SAPS 3 was higher in non-survivors than survivors (p=0.038). Infection was more common in non-survivors (p=0.036). There were no significant differences between the two groups for other conditions. The variables influencing mortality on univariate analysis were SAPS 3 and presence of infection. The area under the receiver-operating characteristic curve for SAPS 3 was 0.69 (95% CI. 0.54-0.83). At a SAPS 3 of 84, the sensitivity for predicting mortality was 71.6% and the specificity was 69.2%. CONCLUSION: The SAPS 3 determined before starting CRRT could be a predictor of hospital mortality in patients with AKI.
Acute Kidney Injury ; APACHE ; Hospital Mortality ; Humans ; Kidney Diseases ; Male ; Renal Insufficiency, Chronic ; Renal Replacement Therapy ; Retrospective Studies ; Sensitivity and Specificity ; Survivors

8

Cite

Share

Sexual Functioning in Male Hemodialysis Patients.

Sung Rok KIM

Korean Journal of Nephrology.2011;30(1):67-72.

PURPOSE: The prevalence of sexual dysfunction among male hemodialysis patients is high. The causes of sexual dysfunction in chronic renal failure are composed of physiological and psychological factors. We assessed the prevalence, severity and factors of sexual dysfunction among male patients undergoing hemodialysis using of International index of erectile function (IIEF). METHODS: A single center cross-sectional study of 57 male hemodialysis patients was conducted to the determinants of sexual dysfunction. All patients were required to complete questionnaires by themselves (IIEF and Beck depression inventory (BDI)) and biochemical and hematological parameters were obtained. RESULTS: Sexual dysfunction prevalence was 86.0% in erectile function, 94.7% in sexual intercourse satisfaction, 86.0% in orgasmic function, 96.5% in sexual desire, 96.5% in overall satisfaction. Age, serum albumin, BDI, Karnofsky index, calcium channel blocker were statistically associated with sexual activity. But a multiple logistic regression analysis demonstrated that BDI is independently associated with sexual activity. A linear multivariable regression analysis demonstrated that age, BDI, serum albumin are independently associated with sexual desire of IIEF. CONCLUSION: Sexual dysfunction among male hemodialysis patients is high. Depression is an independent factor of sexual dysfunction in male hemodialysis patients. Evaluation of depression must be included to properly manage sexual dysfunction.
Calcium Channels ; Coitus ; Cross-Sectional Studies ; Depression ; Humans ; Karnofsky Performance Status ; Kidney Failure, Chronic ; Logistic Models ; Male ; Orgasm ; Prevalence ; Renal Dialysis ; Serum Albumin ; Sexual Behavior ; Sexuality ; Surveys and Questionnaires

9

Cite

Share

Low-Dose Nafamostat Mesilate in Hemodialysis Patients at High Bleeding Risk.

Eun Yi KIM ; Young Ki LEE ; Seung Min LEE ; Myung Jin CHOI ; Young Rim SONG ; Soo Jin KIM ; Tae Jin PARK ; Sung Gyun KIM ; Jieun OH ; Jang Won SEO ; Jong Woo YOON ; Ja Ryong KOO ; Hyung Jik KIM ; Jung Woo NOH

Korean Journal of Nephrology.2011;30(1):61-66.

PURPOSE: Systemic anticoagulation, usually with heparin, is required to prevent thrombosis in the blood circuit of hemodialysis. In patients at high bleeding risk, strategies to minimize the bleeding risk include heparin-free or regional anticoagulation methods. Nafamostat mesilate with conventional dose (35 mg/hr) has been used for this purpose. But it is an expensive anticoagulant to use conveniently for the dialysis therapy. Application of low-dose nafamostat mesilate has almost never been tried yet on hemodiaysis management. In this study, we examined the effect of low-dose nafamostat mesilate compared to heparin-free in hemodialysis patients with high risk of bleeding. METHODS: The current study was conducted on 35 hemodialysis patients with high bleeding risk (on-going bleeding, hemorrhage, surgery or severe thrombocytopenia). In the low-dose nafamostat group (n=17, mean age: 59+/-15 years), 238 sessions were performed with continuous infusion of nafamostat mesilate (12.5 mg/hr). In the control group with saline-flushing no heparin methods (n=18, mean age: 57+/-17 years), 247 sessions were analyzed. RESULTS: No significant differences were found in baseline characteristics between the low-dose nafamostat group and the saline group. In the progress of bleeding complications, there were no significant differences between the two groups (11.8% vs. 11.1%). In saline group, however, massive clotting occurred in 44.5 per 1000 sessions, while it occurred in 4.2 per 1000 sessions in the low-dose nafamostat group (p=0.006). CONCLUSION: In patients at high bleeding risk, low-dose nafamostat mesilat can be used as an inexpensive, effective, and safe anticoagulant for hemodialysis.
Dialysis ; Guanidines ; Hemorrhage ; Heparin ; Humans ; Mesylates ; Renal Dialysis ; Thrombosis

10

Cite

Share

The Effects of Low Sodium Dialysate in Hemodialysis Patients.

Sun Min KIM ; Jin Gun KIM ; Jung Ho SHIN ; Woo Jin NAM ; Jae Ug LEE ; Su Hyun KIM ; Dong Jin OH ; Suk Hee YU

Korean Journal of Nephrology.2011;30(1):53-60.

PURPOSE: Hypertension is a common problem in maintenance hemodialysis (HD) patients. We assessed the effects of low sodium dialysate on changes of blood pressure in maintenance HD patients. METHODS: Forty HD patients were enrolled in this cross-over study. All the patients underwent nine consecutive HD sessions with the dialysate contained 138 mEq/L sodium (conventional sodium HD), then concentrations of sodium were switched to match the patients average pre-HD plasma sodium measured during the conventional sodium phase (135 mEq/L for patients with sodium levels less than 137, 137 for patients with sodium levels over 137). Dry weight and dialysis prescription were not modified during the six weeks of the study. RESULTS: There was a significant decrease in the interdialytic weight gain (2.4+/-0.9 kg vs. 2.0+/-0.7 kg, p<0.001) and the interdialytic thirsty in low sodium HD sessions compare to conventional sodium HD sessions. Pre-HD systolic and diastolic blood pressure (BP), post-dialysis systolic BP was similar in both periods of the study. The use of low sodium dialysate is associated with significantly lower systolic BP in patients with uncontrolled hypertension (n=10,157.1+/-3.6 mmHg vs. 148.0+/-9.4 mmHg, p=0.011), but not in those with controlled hypertension. Cardio-thoracic ratio was significant decrease in low sodium dialysate HD (0.53+/-0.08 vs. 0.51+/-0.07, p=0.002). The episodes of intradialytic hypotension and related symptoms were not more frequent in low sodium dialysate HD. CONCLUSION: Low dialysate sodium concentration based on predialysis sodium levels of patients could reduce the pre-HD systolic BP, interdialytic thirsty and interdialytic weight gain in maintenance HD patients.
Blood Pressure ; Cross-Over Studies ; Dialysis ; Humans ; Hypertension ; Hypotension ; Plasma ; Prescriptions ; Renal Dialysis ; Sodium ; Thirst ; Weight Gain

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share