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Spinning-induced Rhabdomyolysis: Eleven Case Reports and Review of the Literature.

Daejin KIM ; Eun Jung KO ; Hyejeong CHO ; Su Hyung PARK ; Sang Hwan LEE ; Nam Gil CHO ; So Young LEE ; Hye Yun JEONG ; Dong Ho YANG

Electrolytes & Blood Pressure.2015;13(2):58-61. doi:10.5049/EBP.2015.13.2.58

Non-traumatic exertional rhabdomyolysis (exRML) occurs in individuals with normal muscles when the energy supplied to the muscle is insufficient. Here, we report 11 cases of spinning-induced rhabdomyolysis and review related literature. Spinning is a kind of indoor bicycle sport. The 11 patients who were diagnosed with exRML and admitted to CHA Bundang Medical Center were female and their ages ranged from 15 to 46 years. Two to three days prior to the presentation, the patients had attended a spinning class for the first time. All the patients had been otherwise healthy without any known medical illnesses. They were successfully treated without any complications, except mild non-symptomatic hypocalcemia. However, in the literature, severe complications such as compartment syndrome or acute kidney injury had been reported in relation to exRML including spinning-induced rhabdomyolysis. This spinning exercise needs prior guidelines and specific warnings to prevent exertional rhabdomyolysis.
Acute Kidney Injury ; Compartment Syndromes ; Creatine Kinase ; Female ; Humans ; Hypocalcemia ; Muscles ; Rhabdomyolysis* ; Sports

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A Case Report of Familial Renal Hypouricemia Confirmed by Genotyping of SLC22A12, and a Literature Review.

Hyung Oh KIM ; Chun Gyoo IHM ; Kyung Hwan JEONG ; Hyun Joon KANG ; Jae Min KIM ; Hyung Suk LIM ; Jin Sug KIM ; Tae Won LEE

Electrolytes & Blood Pressure.2015;13(2):52-57. doi:10.5049/EBP.2015.13.2.52

A 24-year-old male visited our hospital because of pain in both flanks. His biochemistry profile showed an elevated serum creatinine level and low serum uric acid level. History taking revealed that he had undertaken exercise prior to the acute kidney injury (AKI) event, and he stated that family members had a history of urolithiasis. His renal profile improved after hydration and supportive care during hospitalization. Although the patient was subsequently admitted again due to AKI, his status recovered with similar treatment. Since the diagnosis of the patient was familial renal hypouricemia with exercise-induced AKI, we performed genotyping of SLC22A12, which encodes human urate transporter 1. The diagnosis was confirmed by the detection of a homozygous mutation of W258X. We herein, report a case of familial renal hypouricemia confirmed by genotyping of SLC22A12, and review the relevant literature.
Acute Kidney Injury ; Biochemistry ; Creatinine ; Diagnosis ; Hospitalization ; Humans ; Male ; Uric Acid ; Urolithiasis ; Young Adult

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High Water Intake and Progression of Chronic Kidney Diseases.

Hoon Young CHOI ; Hyeong Cheon PARK ; Sung Kyu HA

Electrolytes & Blood Pressure.2015;13(2):46-51. doi:10.5049/EBP.2015.13.2.46

Impact of water intake on the courses of chronic kidney and urinary tract diseases, such as urolithiasis, urinary tract infections, chronic kidney diseases (CKD), autosomal dominant polycystic kidney diseases and bladder cancer, has recently been studied. It still remains controversial whether increased water intake slows the progression of CKD or not. However, high water intake suppresses plasma levels of arginine vasopressin (AVP), which is expected to be beneficial for the preservation of the kidney function. Previous studies suggest that water intake suppresses plasma levels of AVP, and high levels of AVP have been suggested to play deleterious roles in animal models of kidney disease. Moreover, recent epidemic of CKD of unknown origin, which was supposed to be related to the insufficient water intake and chronic volume depletion, has been reported in Central America, further suggesting that the suppression of AVP by sustained water intake might be beneficial in this CKD population. Indeed, the data from recent studies were consistent with the view that high water intake is associated with slower progression of CKD. However, contradictory findings also exist. The intriguing effects of increased urine volume in preserving the glomerular filtration rate in human patients with CKD require more large and well-designed randomized prospective clinical trials.
Arginine Vasopressin ; Central America ; Dehydration ; Drinking* ; Glomerular Filtration Rate ; Humans ; Kidney ; Kidney Diseases ; Models, Animal ; Plasma ; Polycystic Kidney, Autosomal Dominant ; Prospective Studies ; Renal Insufficiency, Chronic* ; Urinary Bladder Neoplasms ; Urinary Tract Infections ; Urolithiasis ; Urologic Diseases ; Water*

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Hypertension in Chronic Glomerulonephritis.

Chun Gyoo IHM

Electrolytes & Blood Pressure.2015;13(2):41-45. doi:10.5049/EBP.2015.13.2.41

Chronic glomerulonephritis (GN), which includes focal segmental glomerulosclerosis and proliferative forms of GN such as IgA nephropathy, increases the risk of hypertension. Hypertension in chronic GN is primarily volume dependent, and this increase in blood volume is not related to the deterioration of renal function. Patients with chronic GN become salt sensitive as renal damage including arteriolosclerosis progresses and the consequent renal ischemia causes the stimulation of the intrarenal renin-angiotensin-aldosterone system(RAAS). Overactivity of the sympathetic nervous system also contributes to hypertension in chronic GN. According to the KDIGO guideline, the available evidence indicates that the target BP should be < or =140mmHg systolic and < or =90mmHg diastolic in chronic kidney disease patients without albuminuria. In most patients with an albumin excretion rate of > or =30mg/24 h (i.e., those with both micro-and macroalbuminuria), a lower target of < or =130mmHg systolic and < or =80mmHg diastolic is suggested. The use of agents that block the RAAS system is recommended or suggested in all patients with an albumin excretion rate of > or =30mg/ 24 h. The combination of a RAAS blockade with a calcium channel blocker and a diuretic may be effective in attaining the target BP, and in reducing the amount of urinary protein excretion in patients with chronic GN.
Albuminuria ; Arteriolosclerosis ; Blood Volume ; Calcium Channels ; Glomerulonephritis* ; Glomerulonephritis, IGA ; Glomerulosclerosis, Focal Segmental ; Humans ; Hypertension* ; Ischemia ; Renal Insufficiency, Chronic ; Sympathetic Nervous System

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Magnesium Metabolism.

Jang Won SEO ; Tae Jin PARK

Electrolytes & Blood Pressure.2008;6(2):86-95. doi:10.5049/EBP.2008.6.2.86

Magnesium is the second most common intracellular divalent cation. Magnesium balance in the body is controlled by a dynamic interplay among intestinal absorption, exchange with bone, and renal excretion. Intestinal magnesium absorption proceeds in both a passive paracellular and an active transcellular manner. Regulation of serum magnesium concentrations is achieved mainly by control of renal magnesium reabsorption. Only 20% of filtered magnesium is reabsorbed in the proximal tubule, whereas 60% is reclaimed in the cortical thick ascending limb (TAL) and another 5-10% in the distal convoluted tubule (DCT). The passive paracellular transport of magnesium in the TAL is closely related with the mutations in claudin-16/paracellin-1 and is responsible for familial hypomagnesemia with hypercalciuria and nephrocalcinosis. The active transcellular transport of magnesium in the DCT was similarly enhanced by the realization that defects in transient receptor potential melastatin 6 (TRPM6) cause hypomagnesemia with secondary hypocalcemia. This channel regulates the apical entry of magnesium into epithelia and alters whole-body magnesium homeostasis by controlling urinary excretion. TRPM6 is regulated at the transcriptional level by acid-base status, 17beta-estradiol, and both FK506 and cyclosporine. The molecular identity of the protein responsible for the basolateral exit of magnesium from the epithelial cell remains unidentified.
Absorption ; Cyclosporine ; Epithelial Cells ; Extremities ; Homeostasis ; Hypercalciuria ; Hypocalcemia ; Intestinal Absorption ; Magnesium ; Nephrocalcinosis ; Renal Tubular Transport, Inborn Errors ; Tacrolimus ; Transcytosis ; Transient Receptor Potential Channels

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Kidney and Phosphate Metabolism.

Nak Won CHOI

Electrolytes & Blood Pressure.2008;6(2):77-85. doi:10.5049/EBP.2008.6.2.77

The serum phosphorus level is maintained through a complex interplay between intestinal absorption, exchange intracellular and bone storage pools, and renal tubular reabsorption. The kidney plays a major role in regulation of phosphorus homeostasis by renal tubular reabsorption. Type IIa and type IIc Na+/Pi transporters are important renal Na+-dependent inorganic phosphate (Pi) transporters, which are expressed in the brush border membrane of proximal tubular cells. Both are regulated by dietary Pi intake, vitamin D, fibroblast growth factor 23 (FGF23) and parathyroid hormone. The expression of type IIa Na+/Pi transporter result from hypophosphatemia quickly. However, type IIc appears to act more slowly. Physiological and pathophysiological alteration in renal Pi reabsorption are related to altered brush-border membrane expression/content of the type II Na+/Pi cotransporter. Many studies of genetic and acquired renal phosphate wasting disorders have led to the identification of novel genes. Two novel Pi regulating genes, PHEX and FGF23, play a role in the pathophysiology of genetic and acquired renal phosphate wasting disorders and studies are underway to define their mechanism on renal Pi regulation. In recent studies, sodium-hydrogen exchanger regulatory factor 1 (NHERF1) is reported as another new regulator for Pi reabsorption mechanism.
Fibroblast Growth Factors ; Homeostasis ; Hypophosphatemia ; Intestinal Absorption ; Kidney ; Membranes ; Microvilli ; Parathyroid Hormone ; Phosphoproteins ; Phosphorus ; Sodium-Hydrogen Antiporter ; Sodium-Phosphate Cotransporter Proteins ; Vitamin D

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Kidney and Calcium Homeostasis.

Un Sil JEON

Electrolytes & Blood Pressure.2008;6(2):68-76. doi:10.5049/EBP.2008.6.2.68

Plasma calcium concentration is maintained within a narrow range (8.5-10.5 mg/dL) by the coordinated action of parathyroid hormone (PTH), 1,25(OH)2D3, calcitonin, and ionized calcium (iCa2+) itself. The kidney plays a key role in this process by the fine regulation of calcium excretion. More than 95% of filtered calcium is reabsorbed along the renal tubules. In the proximal tubules, 60% of filtered calcium is reabsorbed by passive mechanisms. In the thick ascending limb, 15% of calcium is reabsorbed by paracellular diffusion through paracellin-1 (claudin-16). The calcium sensing receptor (CaSR) in the basolateral membrane of the thick ascending limb senses the change in iCa2+ and inhibits calcium reabsorption independent to PTH and 1,25(OH)2D3. The fine regulation of calcium excretion occurs in the distal convoluted tubules and connecting tubules despite the fact that only 10-15% of filtered calcium is reabsorbed there. Transient receptor potential vanilloid 5 (TRPV5) and 6 (TRPV6) in the apical membrane act as the main portal of entry, calbindin-D28K delivers Ca2+ in the cytoplasm, and then Na2+/Ca2+ exchanger (NCX1) and plasma membrane Ca2+-ATPase in the basolateral membrane serve as an exit. In the cortical collecting duct, TRPV6 is expressed, but the role might be negligible. In addition to PTH and 1,25(OH)2D3, acid-base disturbance, diuretics, and estrogen affect on these calcium channels. Recently, klotho and fibroblast growth factor 23 (FGF23) are suggested as new players in the calcium metabolism. Klotho is exclusively expressed in the kidney and co-localized with TRPV5, NCX1, and calbindin-D28K. Klotho increases calcium reabsorption through trafficking of TRPV5 to the plasma membrane, and also converts FGF receptor to the specific FGF23 receptor. FGF23:klotho complex bound to FGF receptor inhibits 1alpha- hydroxylase of vitamin D, and contributes to calcium reabsorption and phosphate excretion in the kidney.
Calcitonin ; Calcium ; Calcium Channels ; Calcium-Binding Protein, Vitamin D-Dependent ; Cell Membrane ; Cytoplasm ; Diffusion ; Diuretics ; Estrogens ; Extremities ; Fibroblast Growth Factors ; Homeostasis ; Kidney ; Membranes ; Parathyroid Hormone ; Plasma ; Receptors, Calcium-Sensing ; Receptors, Fibroblast Growth Factor ; TRPV Cation Channels ; Vitamin D

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Clinical Factors Associated with Brachial-Ankle Pulse Wave Velocity in Patients on Maintenance Hemodialysis.

Eun Young KIM ; Joo Hark YI ; Sang Woong HAN ; Jinho SHIN ; Jae Ung LEE ; Soon Gil KIM ; Ho Jung KIM

Electrolytes & Blood Pressure.2008;6(2):61-67. doi:10.5049/EBP.2008.6.2.61

Pulse wave velocity (PWV) is a main parameter for arterial stiffness. In patients with end-stage renal disease (ESRD), PWV is known to be associated with increased mortality. But factors related to the increased PWV in ESRD patients are not well defined. In addition, the carotid-femoral PWV (cfPWV) measurement, which traditionally has been used to evaluate arterial stiffness, has low reproducibility. Recently, brachial-ankle PWV (baPWV) measurement, which can be performed more easily than cfPWV measurement, has become available as a means of measuring PWV. The aim of this study is to investigate the clinical factors associated with increased baPWV in ESRD patients. BaPWV was examined for 65 ESRD patients on maintenance hemodialysis during the period between the 7th to the 11th of February in 2005 using VP-1000. The clinical factors included age, sex, smoking history, blood pressure, diabetes, body mass index, interdialytic weight gain, duration of dialysis, lipid profile, uric acid, albumin, creatinine, C-reactive protein, calcium, phosphate, intact parathyroid hormone, and hematocrit were analyzed regarding associations (or to determine associations) with baPWV. The median age was 53.8+/-12.0, 31 males and 34 females. BaPWV was 18.9+/-5.2 m/s and there was no significant difference between gender (18.1+/-4.4 m/s vs 19.4+/-5.9 m/s, p=NS). In multiple regression models, age, predialysis systolic blood pressure, and diabetes were independent variables. In conclusion, age, systolic blood pressure, and diabetes were correlated with baPWV in ESRD patients. Thus baPWV measured by simple, noninvasive methods may become available for screening high risk groups in ESRD patients, although further longitudinal studies are necessary.
Atherosclerosis ; Blood Pressure ; Body Mass Index ; C-Reactive Protein ; Calcium ; Creatinine ; Dialysis ; Female ; Hematocrit ; Humans ; Kidney Failure, Chronic ; Male ; Mass Screening ; Parathyroid Hormone ; Pulse Wave Analysis ; Renal Dialysis ; Smoke ; Smoking ; Uric Acid ; Vascular Stiffness ; Weight Gain

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Effect of Bicarbonate Supplementation on Renal Function and Nutritional Indices in Predialysis Advanced Chronic Kidney Disease.

Jiwon JEONG ; Soon Kil KWON ; Hye Young KIM

Electrolytes & Blood Pressure.2014;12(2):80-87. doi:10.5049/EBP.2014.12.2.80

Current practice guidelines recommend alkali therapy in patients with chronic kidney disease (CKD) and metabolic acidosis to prevent complications. This study aims to investigate the effect of oral sodium bicarbonate supplementation on the progression of renal function and nutritional indices in patients with predialysis advanced CKD. Forty patients with predialysis stage 5 CKD(estimated glomerular filtration rate, eGFR <15mL/min per 1.73m2) and 40 patients with stage 4 CKD (eGFR 15 to 30mL/min per 1.73m2) who had a total CO2 less than 22mEq/L were assigned into the bicarbonate treatment group or control group for 12 months. In stage 4 CKD, there were significant differences in the changes of eGFR during the study between the treatment group and the control group (-2.30+/-4.49 versus -6.58+/-6.32mL/min/1.73m2, p<0.05). However, in stage 5 CKD, there were no significant differences in the change of eGFR during the study between the two groups (-2.10+/-2.06 versus -3.23+/-1.95mL/min/1.73 m2).There were no significant differences in the changes of nutritional indices such as albumin, prealbumin, transferrin, total lymphocyte count (TLC), and Ondodera's prognostic nutritional index (OPNI) during the study between the two groups. In stage 5 CKD, there were significant differences in the changes of TLC and OPNI between the two groups. In conclusion, our results demonstrate that bicarbonate supplementation slows the rate of decline of renal function in stage 4 CKD and improves nutritional indices in stage 5 CKD. Alkali therapy in advanced CKD may have beneficial effect on renal function and malnutrition.
Acidosis ; Alkalies ; Glomerular Filtration Rate ; Humans ; Lymphocyte Count ; Malnutrition ; Nutrition Assessment* ; Prealbumin ; Renal Insufficiency, Chronic* ; Sodium Bicarbonate ; Transferrin

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Epidermal Proteinase-Activated Receptor-2 Expression is Increased in End-Stage Renal Disease Patients with Pruritus: A Pilot Study.

Sung Jin MOON ; Hyun Jung KIM ; Sung Bin CHO ; Seung Hun LEE ; Hoon Young CHOI ; Hyeong Cheon PARK ; Sung Kyu HA

Electrolytes & Blood Pressure.2014;12(2):74-79. doi:10.5049/EBP.2014.12.2.74

Uremic pruritus is a common problem in patients with end-stage renal disease (ESRD), but the underlying mechanisms are not yet fully understood. We aimed to investigate the association between severity of uremic pruritus and cutaneous serine protease activity, as well as proteinase-activated receptor-2 (PAR-2) expression. Twelve ESRD patients with pruritus, 4 ESRD patients without pruritus, and 6 healthy controls were enrolled. Skin biopsies were obtained from the abdomen. Protease activity and PAR-2 expression in the epidermis were examined by in situ zymography and confocal laser microscopy, respectively. All ESRD patients presented more pronounced cutaneous protease activity compared with that in healthy controls. The skin samples from the patients with pruritus showed higher protease activity than either nonpruritic ESRD patients or healthy controls. The epidermis in all samples of ESRD patients presented higher immunoreactivity against PAR-2 versus those of healthy controls. In addition, correlation analysis between PAR-2 expression and VAS pruritus scores showed a significant positive correlation. Our data suggests that levels of serine protease and PAR-2 expression could play important roles in the pathogenesis of uremic pruritus.
Abdomen ; Biopsy ; Epidermis ; Humans ; Kidney Failure, Chronic* ; Microscopy, Confocal ; Pilot Projects* ; Pruritus* ; Serine Proteases ; Skin ; Uremia

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