Journal Detail Information

1

Cite

Share

A Case of Nodular Diabetic Glomerulosclersis and Proliferative Retinopathy without Diabetes Mellitus.

Seog Jae KIM ; Jun Chul KIM ; Sun Hee PARK ; Chan Duk KIM ; Mi Young BAEK ; Jun Hong KIM ; Sung Ho KIM ; Yong Lim KIM ; Dong Kyu CHO

Korean Journal of Nephrology.1998;17(6):994-998.

Nodular glomerulosclerosis was first described by Kimmelstiel and Wilson in 1936. Diabetic retinopathy and nephropath y are manifestation of the microangiopathy associated with diabetes. The severity of diabetic nephropathy and the occurrence of retinopathy correlate with the duration of clinical diabetes. However, there have been few reports of patients presents presenting with the classic lesions of diabetic microangiopathy in the absence of a known history of diabetes. These reports raise questions regarding the relationship and significance of carbohydrate intolerance to these pathologic abnormalities. A 34-year-old male patient clinically characterized by massive proteinuria and hypertension without evidence of systemic disease is reported. Renal biopsy showed the nodular glomerulosclerosis (Kimmelstiel-Wilson lesion) characteristic of diabetes. Direct opthalmoscopy and fluorescein angiography demonstrated a picture of advanced proliferative diabetic retinopathy. The patient had no history of diabetes mellitus and upon testing had normal glucose values in response to an oral glucose tolerance test. It is concluded that the nodular glomerulosclerosis lesions and proliferative retinopathy, thought to be specific for diabetes mellitus, may present in the absence of either overt clinical diabetes or impaired glucose tolerance.
Adult ; Biopsy ; Diabetes Mellitus* ; Diabetic Angiopathies ; Diabetic Nephropathies ; Diabetic Retinopathy ; Fluorescein Angiography ; Glucose ; Glucose Tolerance Test ; Humans ; Hypertension ; Male ; Proteinuria

2

Cite

Share

A Case of Acute Renal Failure due to Bilateral Acute Pyelonephritis.

Kyoung Soo KIM ; Kyu Beck LEE ; Hee Moo LEE ; Kwon CHOI ; Bum Soo KIM ; Hyang KIM ; Sang Jong LEE ; Chan Pil PARK ; Moon Hyang PARK

Korean Journal of Nephrology.1998;17(6):988-993.

Although urinary tract infections are common in adults, pyelonephritis is rarely considered in the differential diagnosis of acute renal failure. Acute pyelonephritis without urinary tract obstruction, previous renal diseases or septic shock is a rare cause of acute renal failure. Despite appropriate antibiotic therapy, recovery of renal function could be slow and incomplete. We experienced a 45 year-old woman with diabetes who developed bilateral acute pyelonephritis followed by acute renal failure. The renal biopsy revealed diffuse edematous and focal fibrotic inters- titium with infiltration of lymphocytes compatible with interstitial nephritis. Although her renal function improved gradually with antimicrobial treatment, the process was incomplete and renal dysfunction persisted at about 10-month follow-up, suggesting permanent renal damage. Therefore, we report this case with brief review of related literature.
Acute Kidney Injury* ; Adult ; Biopsy ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Lymphocytes ; Middle Aged ; Nephritis, Interstitial ; Pyelonephritis* ; Shock, Septic ; Urinary Tract ; Urinary Tract Infections

3

Cite

Share

Acute Renal Failure Associated with Kimura's Disease in a Patient with Chronic Renal Failure.

Therasa JANG ; Chang Whan KIM ; Cheol Whee PARK ; Seog Ju AHN ; Yoon Sik CHANG ; Byung Kee BANG

Korean Journal of Nephrology.1998;17(6):983-987.

Kimura's disease is a granulomatous disease which develops in the skin, subcutaneous tissues and lymph nodes and is characterized histologically by the presence of lymphoid follicles, vascular proli- feration and infiltration with eosinophils. The disease shows geographical predilection to Japan, China and South East Asia. The exact etiology and pathogenesis remain uncertain. Some patients had proteinuria or nephrotic syndrome. We have recently experienced the superimposed oliguric acute renal failure associated with Kimura's disease in a male patient with chronic renal failure who had been managed conservatively. Inguinal lymph node biopsy revealed Kimura's disease. He recovered from acute renal failure after being treated with hemodialysis and prednisolone. Lymphadeno- pathy and fever subsided with steroid treatment. We report a case of Kimura's disease which was complicated by acute renal failure in the patient with chronic renal failure.
Acute Kidney Injury* ; Biopsy ; China ; Eosinophils ; Far East ; Fever ; Humans ; Japan ; Kidney Failure, Chronic* ; Lymph Nodes ; Male ; Nephrotic Syndrome ; Prednisolone ; Proteinuria ; Renal Dialysis ; Skin ; Subcutaneous Tissue

4

Cite

Share

A Case of Membranous Nephropathy Improved by Removal of Early Gastric Cancer.

Chang Keun WOO ; Kyung Hee SUH ; Kyung Soon SHIN ; Duk Hyun LEE ; Dong Yeup LEE ; Suk Joon JE ; Joong Ha HWANG ; Choong Ki LEE ; Ik Soo KIM ; Yong Jin KIM

Korean Journal of Nephrology.1998;17(6):978-982.

The nephrotic syndrome in association with extrarenal malignancy is not an uncommon event. The membranous nephropathy is most frequently associated with various carcinomas of the lung, breast, stomach and colon. Though the exact causal relationship has not been determined completely, deposition of the immune complexes composed of antitumor antibody and tumor antigens in the subepithelium is most favorably accepted. We experienced a patient with previously diagnosed membranous nephropathy and subsequently demonstrated early gastric cancer during patient follow-up. After surgical resection proteinuria improved significantly. All physicians are strongly recommended to examine thoroughly and search carefully for possibility of concomitant occult malignancy when an aged patient, especially over 40 years old, is diagnosed as a nephrotic syndrome.
Adult ; Antigen-Antibody Complex ; Antigens, Neoplasm ; Breast ; Colon ; Follow-Up Studies ; Glomerulonephritis, Membranous* ; Humans ; Lung ; Nephrotic Syndrome ; Proteinuria ; Stomach ; Stomach Neoplasms*

5

Cite

Share

A Case of Furosemide Induced Acute Interstitial Nephritis.

Kuk Hee IM ; Young Ok KIM ; Soon Hwa HONG ; Jae Myoung PARK ; Sun Ae YOON ; Yong Soo KIM ; Eun Sun JUNG ; Kyung Ah CHUN ; Byung Kee BANG

Korean Journal of Nephrology.1998;17(6):973-977.

Drug-induced acute interstitial nephritis is characterized by renal interstitial inflammatory cell infiltration and commonly presents as acute renal failure. This is caused mainly by methicillin, non-steroidal antiinflammatory drugs, sulfonamide diuretics such as thiazide, but cases induced by furosemide are rare. We report a patient with acute interstitial nephritis causing reversible acute renal failure and dermatitis while she was taking furosemide. A 37-year old woman was referred to our hospital because of generalized skin rash and non-oliguric acute renal failure. She had peripheral eosinophilia (1,577/mm3) and serum creatinine level of 6.8mg/dL. Skin biopsy showed leukoclastic vasculitis and percutaneous renal biopsy showed severe interstitial infiltration of lymph ocyte and mild interstitial fibrosis with focal tubular atrophy. After withdrawal of furosemide, renal function and skin lesions were completely recovered.
Acute Kidney Injury ; Adult ; Atrophy ; Biopsy ; Creatinine ; Dermatitis ; Diuretics ; Eosinophilia ; Exanthema ; Female ; Fibrosis ; Furosemide* ; Humans ; Methicillin ; Nephritis, Interstitial* ; Skin ; Vasculitis

6

Cite

Share

Autosomal Dominant Polycystic Kidney Disease Complicated by Aldosterone-producing Adrenal Adenoma.

Dong Jun PARK ; Jung Il YANG ; Young Mi CHOI ; Mi Jeong KANG ; Hyun Jin KIM ; Sang Soo LEE ; Jong Duk LEE ; Se Ho CHANG ; Soon Il CHUNG ; Soo In KWON

Korean Journal of Nephrology.1998;17(6):968-972.

We report the case of a 34-year-old woman with autosomal dominant polycystic kidney disease associated with primary aldosteronism due to left adrenal adenoma. Although autosomal dominant polycystic kidney disease could mask hypokalemia and hypertension, refractory hypertension and hypokalemia were the clues that led to this diagnosis. The diagnosis of primary hyperaldosteronism was based on the presence of hypokalemia with excessive urinary potassium excretion and characteristic hormonal changes. Under laparoscopy, left adrenalectomy was performed. After surgery, plasma renin activity, plasma aldosterone titer, and serum potassium level normalized with only partial correction of the blood pressure. This could be explained by the persisting underlying polycystic kidney disease. We conclude that extrarenal causes in a hypertensive and hypokalemic patient with polycystic kidney disease may be ruled out.
Adenoma* ; Adrenalectomy ; Adult ; Aldosterone ; Blood Pressure ; Diagnosis ; Female ; Humans ; Hyperaldosteronism ; Hypertension ; Hypokalemia ; Laparoscopy ; Masks ; Plasma ; Polycystic Kidney Diseases ; Polycystic Kidney, Autosomal Dominant* ; Potassium ; Renin

7

Cite

Share

A Case of Renal Artery Stenosis Caused by Extraadrenal Pheochromocytoma.

Hyun Chul KIM ; Won KIM ; Chang Seop LEE ; Sung Kwang PARK ; Sung Kyew KANG ; Hyung Jin KIM ; Young Gon KIM

Korean Journal of Nephrology.1998;17(6):963-967.

The coexistence of extraadrenal pheochromocytoma and renal artery stenosis is extremely rare. The mechanisms of renal artery stenosis with pheochromocytoma include direct compression of the tumor mass on the renal artery and catecholamine-induced vasospasm, fibromuscular hyperplasia, and fibrous adhesion. We report a rare case of renal artery stenosis caused by extraadrenal pheochromocytoma in a 29- year-old female. She was admitted to the hospital because of palpitation and headache. She had been treated for hypertension for 2 years. On admission, her plasma epinephrine and norepinephrine levels were elevated as were her plasma renin activity, urinary vanillylmandelic acid (VMA) and metanephrine levels. Through the use of abdominal computed tomography, 131I-MIBG scan, and renal arteriography, a mass was found in the hilus of the left kidney which affected left renal artery stenosis. Surgical removal of the mass and left kidney restored the catecholamine excretion, plasma renin activity, and blood pressure to normal. Electronmicroscopic examination of the mass confirmed the pheochromocytoma.
Angiography ; Blood Pressure ; Epinephrine ; Female ; Headache ; Humans ; Hyperplasia ; Hypertension ; Kidney ; Metanephrine ; Norepinephrine ; Pheochromocytoma* ; Plasma ; Renal Artery Obstruction* ; Renal Artery* ; Renin ; Vanilmandelic Acid

8

Cite

Share

Risk Factors and Clinical Characteristics of Post-Renal Transplant Diabetes Mellitus.

Mi Hwa JANG ; Sun Dong JUNG ; Yong Hwan LEE ; Ji Hyun LEE ; Keun Tae KIM ; Jin Min KONG

Korean Journal of Nephrology.1998;17(6):957-963.

To investigate the risk factors and clinical characteristics of postrenal transplant diabetes mellitus (PTDM), we reviewed the records of 177 renal allograft recipients in Maryknoll Hospiatal whose allografts had functioned longer than 6 months. Nineteen patients (10.7%) developed PTDM at 5.0+/-7.8 (1-52) months; 9 (47%) of these within 1 month. PTDM patients were older than nondiabetic renal transplants (42+/-2 vs 37+/-1 years, P<0.05). Body mass index tended to be higher in PTDM (23.5+/-1.0 vs 21.8+/-0.3kg/m2, P=0.09). Number of acute rejections (0.6+/-0.2 vs 0.5+/-0.1) and serum creatinine at 1 year after transplantation (1.2+/-0.8 vs 1.3+/-0.3mg/dL) were not different. Fasting (103.6+/-10.4 vs 84.4+/-1.6mg/dL, P<0.05) and postprandial (189.2+/-24.8 vs 118.6+/-2.3 mg/dL, P<0.01) blood sugars, measured before transplantation, were higher in PTDM. CsA blood level at 1 month posttransplantation was higher in PTDM (350+/-34 vs 279+/-8ng/mL, P<0.05). Fasting serum insulin was significantly higher (28.2+/-12.2 vs 7.3+/-2.0 microunit/dL, P<0.05) and serum C-peptide tended to be higher in PTDM patients compared with euglycemic renal recipients (6.3+/-1.6 vs 3.8+/-0.9ng/dL, P=0.08). All the PTDM patients were treated by either insulin or oral agent; 15 of 19 required no treatment after 4.7+/-6.9 months. In conclusion, prevalence of PTDM was 10.7%. PTDM patients were older. Body mass index was tended to be higher. Fasting and postprandial blood sugars, measured before transplantation, were higher in PTDM. Faslting serum insulin was higher and C-peptide tended to be higher in diabetics. These results suggested that increased insulin resistance plays a major role in the pathogenesis of PTDM.
Allografts ; Blood Glucose ; Body Mass Index ; C-Peptide ; Creatinine ; Cyclosporine ; Diabetes Mellitus* ; Fasting ; Humans ; Insulin ; Insulin Resistance ; Prevalence ; Risk Factors*

9

Cite

Share

The Effect of Dialysate Dwelling on Gastric Emptying Time in Patients with Continuous Ambulatory Peritoneal Dialysis (CAPD).

Woo Heon KANG ; Bang Hoon LEE ; Beom KIM ; Sung Ku LEE ; Dong Jin OH ; Wooseong HUH ; Yoon Goo KIM ; Dae Joong KIM ; Ha Young OH

Korean Journal of Nephrology.1998;17(6):952-956.

We evaluated gastric emptying time (GET) by using Tc99m-sulfur colloid gastric emptying scintigraphy in 11 patients with CAPD (6 male, 5 female) and 14 healthy volunteers. We investigated the effect of dialysate dwelling on GET by studying twice, once without dialysate in the abdomen (drained) and once with 2 L of dialysate in the abdomen (full), and the relationship between body surface area (BSA) and delayed gastric emptying. 1) The mean of gastric emptying rate in 120 minute in patients with CAPD when drained (67.8+/-13.4%) was not different from that in healthy volunteers (65.4+/-8.6%) 2) The mean of gastric emptying rate in 120 minute when full (55.6+/-14.6%) was significantly lower than that when drained (67.8+/-13.4%) (P<0.05). In four of the 11 patients (36.4%), gastric emptying was extremely delayed from normal to abnormal range when full. 3) The BSA (1.5+/-0.11m2)of patients who had extremely delayed GET from normal to abnormal range was smaller than that (1.74+/-0.22m2) of patients who had minimal delayed or unchanged GET when full. This study showed the patient with CAPD had normal gastric emptying when drained, and that gastric emptying was delayed by dialysate dwelling, especially in the patients who has less than 1.5m2 of body surface area. Therefore, we suggest that intermittent nocturnal peritoneal dialysis or a small volume of dialysate may be considered for the patient with small body surface area based on the adequacy.
Abdomen ; Body Surface Area ; Colloids ; Gastric Emptying* ; Healthy Volunteers ; Humans ; Male ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Radionuclide Imaging

10

Cite

Share

Reference Range of Values of Peritoneal Equilibration Test and Changes in Peritoneal Kinetics in Korean Long-Term CAPD Patients.

Joo Hyun PARK ; Seung Hyun KOH ; Byung Soo KIM ; Chul Woo YANG ; Yong Soo KIM ; Suk Young KIM ; Euy Jin CHOI ; Yoon Sik CHANG ; Byung Kee BANG

Korean Journal of Nephrology.1998;17(6):945-951.

PURPOSE: The aim of this study was to define the reference range of the peritoneal solute transfer in Korean CAPD patients and to investigate the change in peritoneal kinetics in long-term patients. METHODS: Routine PET was done 14 days after catheter break-in in 102 new CAPD patients and using our reference range of PET, the patients were categorized into 4 groups as described by Twardow- ski. In 35 long-term (>3 yrs) CAPD patients, D/Pcr, D/D0 glucose and drain volume in last follow- up (mean duration, 60+/-23 months) PET were compared with those in initial PET. RESULTS: Dialysate to Plasma creatinine ratio (D/ Pcr) at 0 hour, 2 hours and 4 hours was 0.045+/-0.062, 0.408+/-0.151 and 0.612+/-0.154, respectively. D/D0 glucose at 2 hours and 4 hours was 0.594+/-0.129 and 0.398+/-0.121, respectively. Peritoneal solute transfer rate in Korean patients was slightly lower than previously reported results in North American patients (P=0.08). Mean drain volume was 2360+/-270ml and mean residual volume was 436+/-178ml. Drain volume was well correlated with D/D0 glucose (positively, r=0.375, P<0.01) and D/Pcr (negatively, r=-0.345, P<0.01). There were no difference in peritoneal solute transfer, drain volume and residual volume according to sex, age, body surface area and diabetes. In initially high and high average trans- porters, solute transfer rate decreased significantly in followup PET. Out of 7 initially high transporters, 3 remained in high and 4 became high average transporters. Out of 12 initially high average transporters, 3 became low average transporters. Out of 8 initially low average transporters, 2 became high average transporters. And out of 8 initially low transporters, 2 became high average and 1 became high transporters. The number of episodes of perito- nitis do not significantly correlated with the changes of peritoneal solute transport rate. CONCLUSION: These data suggest that peritoneal solute transfer rate in Korean patients is slighthly lower compared with that in North American patients and in long-term CAPD patients the peri- toneal solute transport rate changed to centropetal directions (towards to mean) according to initial PET result.
Body Surface Area ; Catheters ; Creatinine ; Follow-Up Studies ; Glucose ; Humans ; Kinetics* ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Plasma ; Reference Values* ; Residual Volume

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share