In response to the increase in the prevalence of chronic kidney disease (CKD) in Korea, the growth of patients requiring renal replacement therapy and the subsequent increase in medical costs, the rapid expansion of patients with end-stage kidney disease (ESKD), and the decrease in patients receiving home therapy, including peritoneal dialysis, the Korean Society of Nephrology has proclaimed the new policy, Kidney Health Plan 2033 (KHP 2033). KHP 2033 would serve as a milestone to bridge the current issues to a future solution by directing the prevention and progression of CKD and ESKD, particularly diabetic kidney disease, and increasing the proportion of home therapy, thereby reducing the socioeconomic burden of kidney disease and improving the quality of life. Here, we provide the background for the necessity of KHP 2033, as well as the contents of KHP 2033, and enlighten the Korean Society of Nephrology’s future goals. Together with patients, healthcare providers, academic societies, and national policymakers, we need to move forward with goal-oriented drive and leadership to achieve these goals.

A 69-year-old man was admitted to the hospital because of flu-like symptoms and fatigue for 2 weeks. Computed tomography revealed ground glass opacity and consolidation in both the lungs as well as pleural effusion. The patient was diagnosed with pneumonia and was hospitalized. At the time of hospitalization, he complained of shortness of breath and coughed-up blood-tinged sputum. Two days after admission, he died suddenly. An autopsy was performed; cardiomegaly was noted, and further examination revealed that the aortic valve had been destroyed by multiple, irregular vegetations. Herein, we report an autopsy case of infective endocarditis with a review of the relevant literatures.
Aged ; Aortic Valve ; Autopsy* ; Cardiomegaly ; Dyspnea ; Endocarditis* ; Fatigue ; Glass ; Hospitalization ; Humans ; Lung ; Pleural Effusion ; Pneumonia ; Sputum

Spontaneous dissection of peripheral arteries unrelated to the aorta is rare. Cases reported in the literature have involved the renal arteries, the coronary arteries, the cerebral arteries, and visceral arteries, in order of incidence. There is no consensus yet on indications for medical or surgical therapeutic modality. As a consequence of the rarity of spontaneous dissection of peripheral arteries, its natural history has been poorly described. A healthy 37-year-old male with normotension was admitted with an acute onset of left flank pain. Physical examination turned out an unremarkable result. Right renal infarction and splenic infarction was diagnosed by abdominal computed tomography. A spiral CT angiogram and angiography showed dissection of main right renal artery and celiac artery with involvement of branches. One year later, he has remained well and normotensive without treatment. To our knowledge, this is the first case of spontaneous renal and celiac artery dissection in normotensive patient in Korea.
Adult ; Angiography ; Aorta ; Arteries ; Celiac Artery ; Cerebral Arteries ; Consensus ; Coronary Vessels ; Flank Pain ; Humans ; Incidence ; Infarction ; Male ; Natural History ; Physical Examination ; Renal Artery ; Splenic Infarction ; Tomography, Spiral Computed

The reversible posterior leukoencephalopathy syndrome (RPLS) was first described by Hinchey et al. It is characterized by reversible posterior predominant white and gray matter lesions on brain magnetic resonance imaging (MRI) in patients with renal insufficiency or hypertension, or immunosuppression. The findings on neuroimaging are characteristic of subcortical edema without infarction. Patients with RPLS show various kinds of neurologic abnormalities characterized by headache, nausea, vomiting, visual disturbances, altered mental status, decreased alertness, seizures, and focal neurologic signs. The clinical and radiological findings usually resolve within two to three weeks when the underlying cause is removed. In this report we describe the case of RPLS with eclampsia in a 24-year-old woman, which appears to be involved in areas of the occipital, frontal, and parietal lobes. A brief review of the literature is also presented.
Brain ; Eclampsia* ; Edema ; Female ; Headache ; Humans ; Hypertension ; Immunosuppression ; Infarction ; Magnetic Resonance Imaging ; Nausea ; Neuroimaging ; Neurologic Manifestations ; Parietal Lobe ; Posterior Leukoencephalopathy Syndrome* ; Pregnancy ; Renal Insufficiency ; Seizures ; Vomiting ; Young Adult

BACKGROUND AND OBJECTIVES: We investigated whether prehypertensives (PHs) exhibit more prevalent electrocardiographic and echocardiographic left ventricular hypertrophy (ECG LVH) and if they are are more associated with impaired left ventricular (LV) diastolic function than are normotensives (NTs). SUBJECTS AND METHODS: A total of 608 subjects> or = 40 years of age with normal BP (SBP<120 mmHg and DBP<80 mmHg, n=335) and PH (n=273) and who were without a history of hypertension, diabetes and any other known cardiovascular diseases underwent blood sampling for obtaining the lipid profile, and they also underwent 12-lead electrocardiography and echocardiography. RESULTS: Compared with the NTs, the PHs had significantly higher Sokolow-Lyon and Cornell voltage for ECG LVH, and they ahd a higher prevalence of ECG LVH (men: 16.9% vs 5.9%, women: 2.0% vs 1.0%, respectively). The PHs had a more increased left ventricular mass index (LVMI, Men: 118.1+/-24.4 g/m2 vs 102.0+/-19.1 g/m2, p=0.02; Women: 117.5+/-26.4 g/m2 vs 101.9+/-30.7 g/m2, p=0.02) and a more decreased LV diastolic function (E/A, Men: 1.14+/-0.6 vs 1.30+/-0.4, p=0.03; Wemen: 1.11+/-0.6 vs 1.25+/-0.5, p=0.03) on echocardiography than the NTs. CONCLUSION: The PHs were associated with a higher prevalence of ECG LVH and a more increased LVMI on echocardiography than that of the NTs. Therefore, we should pay earlier attention to diagnose and screen the pre-hypertensive group.
Cardiovascular Diseases ; Echocardiography ; Electrocardiography ; Female ; Humans ; Hydrogen-Ion Concentration ; Hypertension ; Hypertrophy, Left Ventricular* ; Male ; Prevalence

BACKGROUND AND OBJECTIVES: A non-dipping pattern in hypertensive patients has been shown to be associated with a greater left ventricular (LV) hypertrophy, LV diastolic impairments and prolonged ventricular repolarization. The dynamic parameters of the QT dispersion (QTd) have been highlighted as markers of ventricular repolarization heterogeneity. The aim of this study was to demonstrate if the extent of nocturnal blood pressure (BP) fall was related to the LV mass, LV diastolic function and dynamic parameters of the QTd. SUBJECTS AND METHODS: 122 subjects, receiving electrocardiography, 24-hour ambulatory BP monitoring, 12 lead-24hr Holter monitoring and 2-dimensional Doppler echocardiography examinations, were enrolled. The subjects were classified as normotensive, dipper and non-dipper. The LV mass (LVM) and LV diastolic indices were measured. Using the QT Guard software, with 12 lead-24hr Holter monitoring, the QTd, mean QTd, QTd variation (the difference between the maximum minus the minimum QTd value observed over the recording time), QTd maximum (the maximum difference of QTd between consecutive beats) and QTd variability (QTd standard deviation) were analyzed. RESULTS: Of the 122 patients, 39 and 40 were placed in the dipper and non-dipper groups, respectively. The non-dipper group had a greater LVM index (LVMI) than the dipper group (p<0.01). The non-dipper group had greater increases in their A velocity (p<0.01), and more prolonged deceleration (p<0.01) and isovolumic relaxation (p<0.01) times than the dipper group. There were no significant differences in the QT and QTc interval between the 3 groups, but the QTd was much more increased in the non-dipper than the dipper and normotensive groups (p<0.01). For the dynamic parameters of the QTd, the QTd variation, QTd maximum and QTd variability were significantly increased in the non-dipper compared to the dipper and normotensive groups (p<0.05). Comparing the dipper and normotensive groups, there were no significant differences in the LVMI, LV diastolic indices, QTd and dynamic parameters of the QTd. CONCLUSION: The non-dipper group of hypertensive patients had a greater LVMI, more impaired LV diastolic function and greater increases in their QTd and dynamic parameters of the QTd compared to the dipper and normotensive groups, suggesting the possibility of a much greater chance of cardiovascular events, and their complications, in the non-dipper compared to the dipper group.
Blood Pressure* ; Deceleration ; Echocardiography, Doppler ; Electrocardiography ; Electrocardiography, Ambulatory ; Humans ; Hypertension ; Hypertrophy ; Hypertrophy, Left Ventricular ; Population Characteristics ; Relaxation

BACKGROUND AND OBJECTIVES: A new Doppler time index of myocardial performance (the Tei index) has been studied as a useful predictor of global cardiac function. It is defined as (a-b)/b, where a is the interval between the end and onset of the mitral inflow, and b is the ejection time of the left ventricular outflow. However, the Doppler time intervals are not measured on the same cardiac cycle. SUBJECTS AND METHODS: We compared the tissue Doppler imaging (TDI)-derived Tei index, which can be measured on the same cardiac cycle, with the conventional Tei index as measured by pulsed wave Doppler method, in healthy persons (n=44), in patients having diastolic dysfunction with an E/E' ratio >10 (DD, n=56), and in patients having systolic dysfunction with an ejection fraction<50% (SD, n=10). At the septal and lateral mitral annulus from the apical 4-chamber view, the time interval between the end and onset of the mitral annular velocities during diastole (a') minus the duration of the systolic wave (b') divided by b', which is (a'-b')/b', is defined as the TDI-tei index. RESULTS: The TDI-Tei index and the conventional Tei index were significantly higher in the SD group than in the DD group, and they were also higher in the DD group than in the healthy controls. The TDI-Tei index at the septal and lateral annulus correlated well with the Tei index (r=0.71, r=0.65, respectively, p<0.001) and this showed a good correlation with other echocardiographic parameters of diastolic function. CONCLUSION: We demonstrated that the TDI-Tei index correlates well with the conventional Tei index along with having the advantage of simultaneous recording of the systolic and diastolic velocities in adults.
Adult* ; Diastole ; Echocardiography ; Echocardiography, Doppler ; Humans ; Ventricular Function

The nonbacterial valvular and mural verrucous endocarditis known as Libman-Sacks endocarditis is found in 40~60% of patients with systemic lupus erythematosus. the Libman-Sacks endocarditis mostly affects the mitral and aortic valves and frequently displays valvular dysfunction. In rare cases, the Libman-Sacks endocarditis can embolize and cause stroke syndrome. We report a case of Libman-Sacks endocarditis confused with infective endocarditis because its clinical manifestations were very similar to those of infective endocarditis. We confirmed systemic lupus erythematosus with Libman-Sacks endocarditis by means of serology and successfully treated patient with steroid.
Aortic Valve ; Endocarditis* ; Humans ; Lupus Erythematosus, Systemic ; Stroke

Isolated tricuspid regurgitation (TR) is rare. Generally, TR is caused by pulmonary hypertension secondary to mitral or aortic valve disease, commonly referred to as "functional" regurgitation. The causes of isolated TR in adults include trauma, endocarditis, carcinoid heart disease, and congenital malformation of the tricuspid valve apparatus. In addition, isolated TR should be distinguished from Ebstein anomaly. In the present case, the patient had no definite causes of TR, and neither mitral nor aortic valve disease. The tricuspid valve of this patient showed no abnormalities other than a severely dilated tricuspid annulus. Isolated TR caused by annular dilatation was diagnosed and then ring annuloplasty was perfomed. The subsequent clinical course was satisfactory.
Adult ; Aortic Valve ; Carcinoid Heart Disease ; Dilatation* ; Ebstein Anomaly ; Endocarditis ; Humans ; Hypertension, Pulmonary ; Tricuspid Valve ; Tricuspid Valve Insufficiency*