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Central Diabetes Insipidus Linked to Rathke's Cleft Cyst, Polyuria in a 17-year-old Girl.

Ha Yeon KIM ; Seung Jin LEE ; Eun Hui BAE ; Seong Kwon MA ; Soo Wan KIM

Electrolytes & Blood Pressure.2017;15(1):23-25. doi:10.5049/EBP.2017.15.1.23

A 17-year-old girl presented with polyuria (7 L/day) and polydipsia for one year. Initial urine osmolality was 113mOsm/kg H₂O. Following 6 h of fluid restriction, serum plasma osmolality reached 300mOsm/kg H₂O, whereas urine osmolality was 108mOsm/kg H₂O. Urine osmolality was increased by 427% from 108 to 557mOsm/kg after vasopressin challenge. The patient was diagnosed with central diabetes insipidus, possibly derived from the atypical occupation of a Rathke's cleft cyst at the pituitary stalk following magnetic resonance imaging with enhancement. She was discharged with desmopressin nasal spray (10 µg); urine output was maintained at 2-3 L/day, and urine osmolality was >300 mOsm/kg. Additional pituitary image studies and evaluation of hypopituitarism should be included in the differential diagnosis of patients with central diabetes insipidus.
Adolescent* ; Deamino Arginine Vasopressin ; Diabetes Insipidus, Neurogenic* ; Diagnosis, Differential ; Female* ; Humans ; Hypopituitarism ; Magnetic Resonance Imaging ; Occupations ; Osmolar Concentration ; Pituitary Gland ; Plasma ; Polydipsia ; Polyuria* ; Vasopressins

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Renal Tubular Acidosis in Patients with Primary Sjögren's Syndrome.

Su Woong JUNG ; Eun Ji PARK ; Jin Sug KIM ; Tae Won LEE ; Chun Gyoo IHM ; Sang Ho LEE ; Ju Young MOON ; Yang Gyun KIM ; Kyung Hwan JEONG

Electrolytes & Blood Pressure.2017;15(1):17-22. doi:10.5049/EBP.2017.15.1.17

Primary Sjögren's syndrome (pSS) is characterized by lymphocytic infiltration of the exocrine glands resulting in decreased saliva and tear production. It uncommonly involves the kidneys in various forms, including tubulointerstitial nephritis, renal tubular acidosis, Fanconi syndrome, and rarely glomerulonephritis. Its clinical symptoms include muscle weakness, periodic paralysis, and bone pain due to metabolic acidosis and electrolyte imbalance. Herein, we describe the cases of two women with pSS whose presenting symptoms involve the kidneys. They had hypokalemia and normal anion gap metabolic acidosis due to distal renal tubular acidosis and positive anti-SS-A and anti-SS-B autoantibodies. Since one of them experienced femoral fracture due to osteomalacia secondary to renal tubular acidosis, an earlier diagnosis of pSS is important in preventing serious complications.
Acid-Base Equilibrium ; Acidosis ; Acidosis, Renal Tubular* ; Autoantibodies ; Diagnosis ; Exocrine Glands ; Fanconi Syndrome ; Female ; Femoral Fractures ; Glomerulonephritis ; Humans ; Hypokalemia ; Kidney ; Muscle Weakness ; Nephritis, Interstitial ; Osteomalacia ; Paralysis ; Saliva ; Tears

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Unusual Case of Posterior Reversible Encephalopathy Syndrome in a Patient with Anti-glomerular Basement Membrane Antibody Glomerulonephritis: A Case Report and Review of the Literature.

Boram CHA ; Dae Young KIM ; Hyunil JANG ; Seun Deuk HWANG ; Huck Jei CHOI ; Moon Jae KIM

Electrolytes & Blood Pressure.2017;15(1):12-16. doi:10.5049/EBP.2017.15.1.12

Posterior reversible encephalopathy syndrome (PRES) is characterized by a clinical and radiological entity with the sudden onset of seizures, headache, altered consciousness, and visual disturbances in patients with the findings of reversible vasogenic subcortical edema without infarction. Hypertension, renal disease, and autoimmune disease are co-morbid conditions of PRES. Nevertheless, there have only been a few case reports of PRES in a patient with anti-glomerular basement membrane antibody glomerulonephritis (anti-GBM GN). This paper presents the possible first Korean case of a 36-year-old woman with the striking features of PRES. She presented with a sudden onset of visual blindness, headache, and seizure. The brain MRI images revealed hyperintense lesions in both the occipital and parietal lobes, which suggested vasogenic edema. Three months before this presentation, she was diagnosed with anti-GBM GN. Since then, she underwent immunosuppression with cyclophosphamide and steroid, and hemodialysis for renal failure with a treatment of anti-GBM GN.
Adult ; Autoimmune Diseases ; Basement Membrane* ; Blindness ; Brain ; Consciousness ; Cyclophosphamide ; Edema ; Female ; Glomerulonephritis* ; Headache ; Humans ; Hypertension ; Hypertension, Renal ; Immunosuppression ; Infarction ; Magnetic Resonance Imaging ; Parietal Lobe ; Posterior Leukoencephalopathy Syndrome* ; Renal Dialysis ; Renal Insufficiency ; Seizures ; Strikes, Employee

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Vitamin D and Hypertension.

Hye Yun JEONG ; Kyung Mi PARK ; Mi Jung LEE ; Dong Ho YANG ; Sang Hoon KIM ; So Young LEE

Electrolytes & Blood Pressure.2017;15(1):1-11. doi:10.5049/EBP.2017.15.1.1

Vitamin D has the pleiotropic effects in multiple organ systems, and vitamin D deficiency was suggested to be associated with high blood pressure according to previous reports. Several interventional studies have examined the effect of vitamin D supplementation on high blood pressure patients, but the results have been inconsistent. In this article, we examined the literature that have proposed a mechanism involving vitamin D in the regulation of blood pressure and review previous observational and interventional studies that have shown the relationship between vitamin D and hypertension among various populations.
Blood Pressure ; Humans ; Hypertension* ; Physiology ; Vitamin D Deficiency ; Vitamin D* ; Vitamins*

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A Case of Post-radiotherapy Urethral Stricture with Spontaneous Bladder Rupture, Mimicking Obstructive Uropathy due to Cancer Metastasis.

Jun Young SHIN ; Sang Min YOON ; Hyuck Jae CHOI ; Si Nae LEE ; Hai Bong KIM ; Woo Chul JOO ; Joon Ho SONG ; Moon Jae KIM ; Seoung Woo LEE

Electrolytes & Blood Pressure.2014;12(1):26-29. doi:10.5049/EBP.2014.12.1.26

Non-traumatic, spontaneous urinary bladder rupture is a rare complication of urethral stricture. Furthermore, its symptoms are often nonspecific, and misdiagnosis is common. The authors experienced a case of urethral stricture with spontaneous bladder rupture and bilateral hydronephrosis, mimicking obstructive uropathy attributed to cancer metastasis. A 55-year-old woman was admitted with abdominal pain and distension, oliguria, and an elevated serum creatinine level. She had undergone radical hysterectomy for uterine cervical cancer and received post-operative concurrent chemoradiation therapy 13 years previously. Non-contrast enhanced computed tomography showed massive ascites and bilateral hydronephrosis. The initial diagnosis was acute kidney injury due to obstructive uropathy caused by malignant disease. After improvement of her renal function by bilateral percutaneous nephrostomy catheterization, contrast-enhanced computed tomography and a cytologic examination of ascites showed no evidence of malignancy. However, during retrograde pyelography, a severe urethral stricture was found, and subsequent cystography showed leakage of contrast into the peritoneal cavity and cystoscopy revealed a defect of the posterior bladder wall. After urethral dilatation and primary closure of the bladder wall, acute kidney injury and ascites were resolved.
Abdominal Pain ; Acute Kidney Injury ; Ascites ; Catheterization ; Catheters ; Creatinine ; Cystoscopy ; Diagnosis ; Diagnostic Errors ; Dilatation ; Female ; Humans ; Hydronephrosis ; Hysterectomy ; Middle Aged ; Neoplasm Metastasis* ; Nephrostomy, Percutaneous ; Oliguria ; Peritoneal Cavity ; Radiotherapy ; Rupture* ; Rupture, Spontaneous ; Urethral Stricture* ; Urinary Bladder* ; Urography ; Uterine Cervical Neoplasms

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Association between Hypophosphatemia and Cardiac Arrhythmias in the Early Stage of Sepsis: Could Phosphorus Replacement Treatment Reduce the Incidence of Arrhythmias?.

Andrei SCHWARTZ ; Evgeni BROTFAIN ; Leonid KOYFMAN ; Ruslan KUTZ ; Shaun E GRUENBAUM ; Moti KLEIN ; Alexander ZLOTNIK

Electrolytes & Blood Pressure.2014;12(1):19-25. doi:10.5049/EBP.2014.12.1.19

It is well known that new-onset arrhythmias are common in septic patients. It is thought that hypophosphatemia in the early stages of sepsis may contribute to the development of new arrhythmias. In this study, we hypothesized that intravenous (IV) phosphorus replacement may reduce the incidence of arrhythmias in critically ill patients. 34 adult septic patients with hypophosphatemia admitted to the general intensive care unit were treated with IV phosphorus replacement per ICU protocol, and the incidence of new arrhythmias were compared with 16 patients from previously published data. IV phosphorus replacement was associated with a significantly reduced incidence of arrhythmias (38% vs. 63%, p=0.04). There were no differences in observed mortality between subgroups, which may be due to the small sample size. This study demonstrated that IV phosphorus replacement might be effective in reducing the incidence of new arrhythmias in septic patients.
Adult ; Arrhythmias, Cardiac* ; Critical Care ; Critical Illness ; Humans ; Hypophosphatemia* ; Incidence* ; Intensive Care Units ; Mortality ; Phosphorus* ; Sample Size ; Sepsis*

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Dietary Salt Intake and Hypertension.

Sung Kyu HA

Electrolytes & Blood Pressure.2014;12(1):7-18. doi:10.5049/EBP.2014.12.1.7

Over the past century, salt has been the subject of intense scientific research related to blood pressure elevation and cardiovascular mortalities. Moderate reduction of dietary salt intake is generally an effective measure to reduce blood pressure. However, recently some in the academic society and lay media dispute the benefits of salt restriction, pointing to inconsistent outcomes noted in some observational studies. A reduction in dietary salt from the current intake of 9-12 g/day to the recommended level of less than 5-6 g/day will have major beneficial effects on cardiovascular health along with major healthcare cost savings around the world. The World Health Organization (WHO) strongly recommended to reduce dietary salt intake as one of the top priority actions to tackle the global non-communicable disease crisis and has urged member nations to take action to reduce population wide dietary salt intake to decrease the number of deaths from hypertension, cardiovascular disease and stroke. However, some scientists still advocate the possibility of increased risk of CVD morbidity and mortality at extremes of low salt intake. Future research may inform the optimal sodium reduction strategies and intake targets for general populations. Until then, we have to continue to build consensus around the greatest benefits of salt reduction for CVD prevention, and dietary salt intake reduction strategies must remain at the top of the public health agenda.
Blood Pressure ; Cardiovascular Diseases ; Consensus ; Dissent and Disputes ; Health Care Costs ; Hypertension* ; Income ; Mortality ; Public Health ; Sodium ; Stroke ; World Health Organization

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Uric Acid Puzzle: Dual Role as Anti-oxidantand Pro-oxidant.

Duk Hee KANG ; Sung Kyu HA

Electrolytes & Blood Pressure.2014;12(1):1-6. doi:10.5049/EBP.2014.12.1.1

Hyperuricemia is known to be associated with the presence of cardiovascular and metabolic syndrome and with the development of incipient kidney disease and an accelerated renal progression. However, an elevated uric acid level was not generally regarded as a true etiology or mediator, but an indicator of these diseases. Uric acid has recently regained the clinical interest and popularity based on emerging data suggesting the causative role of hyperuricemia in cardiovascular and renal disease. Experimental data demonstrates oxidative stress is one of the earliest phenomena observed in vascular, renal, liver cells and adipocytes exposed to uric acid. Since uric acid is one of the major antioxidants of plasma acting as a free radical scavenger and a chelator of transitional metal ion, uric acid-induced oxidative stress seems paradoxical. Data regarding the clinical implication of hyperuricemia is even more confusing, which defines hyperuricemia as a useless parameter to be eliminated from routine follow-up or a major risk factor to be therapeutic target. With a review of experimental and epidemiologic data, the presence of molecular switch to regulate the role of uric acid as anti- or pro-oxidant in different compartment of our body is suggested, which may shed light on understanding the paradoxical role of uric acid and solving the "uric acid debate".
Adipocytes ; Antioxidants ; Follow-Up Studies ; Hyperuricemia ; Kidney Diseases ; Liver ; Oxidative Stress ; Plasma ; Risk Factors ; Uric Acid*

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Difference of Clinical Characteristics between Hospital-acquired Hypernatremia and Hypernatremia on Admission.

Hyung Do CHO ; Ji Hoon KIM ; Sang Woong HAN ; Ho Jung KIM

Electrolytes & Blood Pressure.2005;3(2):97-101.

Hypernatremia in adults is a common problem that has been associated with mortality rates ranging from 40% to 60%. Clinical characteristics of hospital-acquired hypernatremia have not been well defined. To evaluate the difference between hypernatremia on admission and hospital-acquired hypernatremia, we reviewed 50 patients with hypernatremia at Hanyang University Guri Hospital for 51-month period from 1 March 2001 to 31 May 2005. We defined hypernatremia as serum sodium concentration more than or equal to 150 mEq/L. Hospital-acquired hypernatremia was more frequently (62%) observed than hypernatremia on admission (38%). Patients with hypernatremia on admission (73.1+/-11.7 years) were older than those with hospital-acquired hypernatremia (59.3+/-13.7 years). Only 30% of patients was alert in mental status. Fifty six percent of all patients (n=50) had neurologic problem such as head injury, cerebral infarction or hemorrhage. Admission hypernatremia was caused by severe dehydration due to no access to water. Seventy seven percent of hospital-acquired hypernatremic patients were associated with diuretics and solute diuresis. Treatments of hospital-acquired hypernatremia were also delayed and inadequate. Rate of correction in 6, 12, 24 hours after peak sodium level was not different between hypernatremia on admission and hospital-acquired hypernatremia. More rapid correction during 6 hours in hypernatremia on admission was associated with higher mortality (survival 2.1+/-0.7 mEq/L, death 7.1+/-4.9 mEq/L, p<0.05). Higher mortality was observed in patients with more severe renal insufficiency. In conclusion, hospital-acquired hypernatremia is largely avoidable by clinical attention and appropriate therapy. Patients with cerebrovascular events or renal insufficiency, patients treated with diuretics or hypertonic solute need careful fluid management and the close monitoring of blood sodium level. Particularly, the rate of correction during the first 6 hours should be also managed very cautiously in hypernatermia on admission.
Adult ; Cerebral Infarction ; Craniocerebral Trauma ; Dehydration ; Diuresis ; Diuretics ; Hemorrhage ; Humans ; Hypernatremia* ; Mortality ; Renal Insufficiency ; Sodium

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Altered Regulation of Renal Aquaporins and Sodium Transporters in Experimental Chronic Renal Failure.

Tae Hwan KWON

Electrolytes & Blood Pressure.2005;3(2):91-96.

Chronic renal failure, which has an increased single nephron glomerular filtration rate in remnant kidney, is known to cause characteristic structural alterations in renal tubule epithelia in association with impaired urinary concentration and deranged urinary sodium excretion. This mini-review will deal with the changes in the renal expression of aquaporins (AQPs) and sodium transporters for elucidating the underlying cellular and molecular mechanisms for the urinary abnormalities of decreased urinary concentration and increased urinary sodium excretion.
Aquaporins* ; Glomerular Filtration Rate ; Kidney ; Kidney Failure, Chronic* ; Membrane Transport Proteins ; Nephrons ; Renal Insufficiency ; Sodium*

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