Because of increases in the elderly population and diabetic patients, the proportion of elderly among dialysis patients has rapidly increased during the last decades. The mortality and morbidity of these elderly dialysis patients are obviously much higher than those of young patients, but large analytic studies about elderly dialysis patients' characteristics have rarely been published. The registry committee of the Korean Society of Nephrology has collected data about dialysis therapy in Korea through an Internet online registry program and analyzed the characteristics. A survey on elderly dialysis patients showed that more than 50% of elderly (65 years and older) patients had diabetic nephropathy as the cause of end-stage renal disease, and approximately 21% of elderly dialysis patients had hypertensive nephrosclerosis. The proportion of elderly hemodialysis (HD) patients with native vessel arteriovenous fistula as vascular access for HD was lower than that of young (under 65 years) HD patients (69% vs. 80%). Although the vascular access was poor and small surface area dialyzers were used for the elderly HD patients, the dialysis adequacy data of elderly patients were better than those of young patients. The laboratory data of elderly dialysis patients were not very different from those of young patients, but poor nutrition factors were observed in the elderly dialysis patients. Although small surface area dialyzers were used for elderly HD patients, the urea reduction ratio and Kt/V were higher in elderly HD patients than in young patients.
Aged* ; Arteriovenous Fistula ; Diabetic Nephropathies ; Dialysis* ; Humans ; Internet ; Kidney Failure, Chronic ; Korea* ; Mortality ; Nephrology ; Nephrosclerosis ; Renal Dialysis ; Renal Replacement Therapy ; Urea

Chronic kidney disease (CKD) is a worldwide public health problem that affects millions of people from all racial and ethnic groups. Although CKD is not one specific disease, it is a comprehensive syndrome that includes IgA nephropathy. As reported by the Japanese Society of Nephrology, 13.0 million people have CKD. In Japan, major causes of end-stage kidney disease are type 2 diabetic nephropathy, chronic glomerulonephritis, especially IgA nephropathy, hypertensive nephrosclerosis, and polycystic kidney disease. IgA nephropathy is characterized by polymeric IgA1 with aberrant galactosylation (galactose-deficient IgA1) increased in the blood and deposited in the glomerular mesangial areas, as well as partially in the capillary walls. The tonsils are important as one of the responsible regions in this disease. The clarification of the mechanism of galactose-deficient IgA1 production will pave the way for the development of novel therapies. The results of future research are eagerly awaited. At present, the most important therapeutic goals in patients with IgA nephropathy are the control of hypertension, the decrease of urinary protein excretion, and the inhibition of progression to end-stage kidney disease. Several investigators have reported that renin–angiotensin–aldosterone system inhibitors reduce levels of urinary protein excretion and preserve renal function in patients with IgA nephropathy. In Japan, tonsillectomy and steroid pulse therapy are more effective for patients with IgA nephropathy.
Asian Continental Ancestry Group ; Capillaries ; Diabetic Nephropathies ; Diagnosis* ; Ethnic Groups ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Humans ; Hypertension ; Immunoglobulin A* ; Japan* ; Kidney Failure, Chronic ; Nephrology ; Nephrosclerosis ; Palatine Tonsil ; Polycystic Kidney Diseases ; Polymers ; Public Health ; Renal Insufficiency, Chronic ; Research Personnel ; Tonsillectomy

The Korean Society of Nephrology (KSN) launched the official end-stage renal disease (ESRD) patient registry in 1985, and an Internet online registry program was opened in 2001 and revised in 2013. The ESRD Registry Committee of KSN has collected data on dialysis therapy in Korea through the online registry program in the KSN Internet website. The status of renal replacement therapy in Korea at the end of 2012 is described in the following. The total number of ESRD patients was 70,211 at the end of 2012, which included 48,531 hemodialysis (HD) patients, 7,552 peritoneal dialysis (PD) patients, and 14,128 functioning kidney transplant (KT) patients. The prevalence of ESRD was 1,353.3 patients per million population (PMP), and the distribution of renal replacement therapy among ESRD patients was as follows: HD, 69.1%; PD, 10.8%; and KT, 20.2%. The number of new ESRD patients in 2012 was 11,742 (HD, 8,811; PD, 923; and KT, 1,738; the incidence rate was 221.1 PMP). The primary causes of ESRD were diabetic nephropathy (50.6%), hypertensive nephrosclerosis (18.5%), and chronic glomerulonephritis (18.1%). The mean urea reduction ratio was 67.9% in male and 74.1% in female HD patients. The mean Kt/V was 1.382 in male and 1.652 in female HD patients. The 5-year survival rates of male and female dialysis patients were 70.6% and 73.5%, respectively.
Diabetic Nephropathies ; Dialysis ; Female ; Glomerulonephritis ; Humans ; Incidence ; Internet ; Kidney ; Kidney Failure, Chronic ; Korea ; Male ; Nephrology ; Nephrosclerosis ; Peritoneal Dialysis ; Prevalence ; Renal Dialysis ; Renal Replacement Therapy* ; Survival Rate ; Urea

Hypertensive nephrosclerosis is usually associated with chronic hypertension, which increases the risk of progressive renal disease. Among the causes of malignant hypertension, thrombotic microangiopathy is complicated and is associated with renal dysfunction at the time of diagnosis. In this case, a young man with hypertension presented with renal failure and thrombocytopenia in the emergency department. This case emphasizes the importance of early recognition of renal failure and thrombocytopenia among patients with uncontrolled hypertension.
Blood Pressure* ; Diagnosis ; Emergency Service, Hospital ; Humans ; Hypertension ; Hypertension, Malignant ; Nephrosclerosis ; Renal Insufficiency ; Thrombocytopenia ; Thrombotic Microangiopathies*

The Korean Society of Nephrology (KSN) launched the End-Stage Renal Disease (ESRD) Patient Registry in 1985, and the online internet registry program was begun in 2001. The increasing number of elderly people and diabetic patients in Korea has resulted in a very rapid increase in the number of ESRD patients. The total number of dialysis patients was 50,289: 42,596 receiving hemodialysis (HD) and 7,694 receiving peritoneal dialysis (PD) at the end of 2011. The prevalence of dialysis therapy was 972.4 patients per million population (PMP), and the proportion of dialysis therapy was HD: 84.7% and PD: 15.3%. The primary causes of ESRD were diabetic nephropathy (47.1%), hypertensive nephrosclerosis (19.6%), and chronic glomerulonephritis (10.4%). The mean urea reduction ratio of hemodialysis was 68.11% in male HD patients and 74.09% in female HD patients. The mean Kt/V was 1.395 in male patients and 1.660 in female patients. The most common cause of death was cardiac arrest (26%), followed by sepsis (9.7%), cerebro-vascular accident (8.7%), respiratory infection (8.4%), and myocardial infarction (6.6%), respectively. The five-year survival rates of male and female dialysis patients were 65.3% and 68.0% in Korea.
Aged ; Cause of Death ; Diabetic Nephropathies ; Dialysis ; Female ; Glomerulonephritis ; Heart Arrest ; Humans ; Internet ; Kidney Failure, Chronic ; Korea ; Male ; Myocardial Infarction ; Nephrology ; Nephrosclerosis ; Peritoneal Dialysis ; Prevalence ; Renal Dialysis ; Sepsis ; Survival Rate ; Urea

The renal glomeruli of 12 male Osborne-Mendel (OM) rats 3 to 24 weeks old were examined by electron microscopy. Effacement of podocyte foot processes (FPs) developed at 3 weeks of age and became progressively worse over time. Loss or dislocation of the slit membrane was also found. Vacuoles and osmiophilic lysosomes appeared in the podocytes starting at 6 weeks of age. Podocyte detachment from the glomerular basement membrane (GBM) was apparent at 18 weeks of age. Laminated GBM was occasionally observed in all animals. These features might lead to the development of spontaneous proteinuria and glomerulosclerosis in OM rats.
Animals ; Animals, Outbred Strains ; Glomerular Basement Membrane/*pathology/ultrastructure ; Kidney Diseases/complications/etiology/*pathology ; Male ; Microscopy, Electron, Transmission ; Nephrosclerosis/etiology/pathology ; Nephrosis/complications/pathology ; Podocytes/*pathology/ultrastructure ; Proteinuria/etiology/pathology ; Rats

The Korean Society of Nephrology (KSN) launched the official End-Stage Renal Disease (ESRD) Patient Registry in 1985 and the Internet online registry program was opened in 2001. The ESRD Registry Committee of KSN has collected data on dialysis therapy in Korea through the online registry program in the KSN Internet website. The increasing number of elderly people and diabetic patients in Korea has resulted in a very rapid increase in the number of ESRD patients. The total number of ESRD patients was 58,860 (hemodialysis [HD], 39,509; peritoneal dialysis [PD], 7309; and functioning kidney transplant [KT], 12,042). The prevalence of ESRD was 1144.4 patients per million population (PMP), and the proportion of renal replacement therapy was HD, 67.1%; PD, 12.4%; and KT, 20.5%. The number of new ESRD patients in 2010 was 9335 (HD, 7204; PD, 867; and KT, 1264; the incidence rate was 181.5 PMP). The primary causes of ESRD were diabetic nephropathy (45.2%), hypertensive nephrosclerosis (19.2%), and chronic glomerulonephritis (11.3%). The mean urea reduction ratio was 67.9% in male HD patients and 73.9% in female HD patients. The mean Kt/V was 1.394 in male patients and 1.659 in female patients. Five-year survival rates of male and female dialysis patients were 64.9% and 67.3%, respectively.
Aged ; Diabetic Nephropathies ; Dialysis ; Female ; Glomerulonephritis ; Humans ; Incidence ; Internet ; Kidney ; Kidney Failure, Chronic ; Korea ; Male ; Nephrology ; Nephrosclerosis ; Peritoneal Dialysis ; Prevalence ; Renal Dialysis ; Renal Replacement Therapy ; Survival Rate ; Transplants ; Urea

In South Korea at the end of 2006, the total number of patients that had undergone renal replacement therapy was 46,730 (hemodialysis: 62.1%, peritoneal dialysis: 17.1%, functioning kidney transplantation: 20.8%). There were 9,197 new renal replacement therapy patients in 2006 and the incidence rate per million 185.3. In South Korea, the most common primary cause of end stage renal disease was diabetic nephropathy (42.3%), hypertensive nephrosclerosis (16.9%), and chronic glomerulonephritis (13.0%). The National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) has recommended placement of autogenous arteriovenous fistulas over alternatives including the use of arteriovenous grafts and central venous catheters to improve the overall outcome of patients undergoing hemodialysis. However, autogenous arteriovenous fistulas, like polytetrafluoroethylene grafts, are also subject to dysfunction and eventual failure. Since first described in 1982, percutaneous transluminal balloon angioplasty has become the mainstay of treatment for accesses failing because of underlying central or peripheral venous stenoses. When angioplasty alone fails, alternative treatment modalities, including stent placement and atherectomy, allow immediate salvage in most cases. Consequently, interventional treatment should be attempted first for dysfunctional and thrombosed autogenous vascular access and should be initiated in all dialysis centers so long as the local radiologists are trained and enthusiastic.
Angioplasty ; Angioplasty, Balloon ; Arteriovenous Fistula ; Atherectomy ; Central Venous Catheters ; Constriction, Pathologic ; Diabetic Nephropathies ; Dialysis ; Glomerulonephritis ; Humans ; Incidence ; Kidney ; Kidney Failure, Chronic ; Nephrosclerosis ; Polytetrafluoroethylene ; Renal Dialysis ; Renal Replacement Therapy ; Republic of Korea ; Stents ; Thrombosis ; Transplants

BACKGROUND/AIMS: Although renal manifestations are often involved in patients with rheumatoid arthritis (RA), the causal relationship between RA and renal manifestations has not been clearly defined. The prevalence and causes of renal manifestations in patients with RA were investigated in this study. METHODS: The clinical data from 457 patients with RA and who were admitted to Hanyang University Hospital between 2001 and 2005 were retrospectively analyzed. Renal manifestations were defined as proteinuria (> or =300 mg/day) or azotemia (serum creatinine > or =1.7 mg/dL), with or without hematuria. RESULTS: Renal manifestation was present in 82 (17.9%) out of 457 RA patients. Among them, proteinuria was observed in 81 (17.7%), azotemia in 37 (8.1%) and hematuria with either proteinuria or azotemia in 35 (7.7%). For the cases with proteinuria, the amount of preteinuria was 1353+/-207 (mean+/-SD) mg/day. There was no significant correlation between the degree of proteinuria and the duration of RA. For the cases with azotemia, the serum creatinine was 3.98+/-0.35 mg/dL. The presence of azotemia had no significant association with the duration of RA (14.4+/-1.5 vs. 11.6+/-1.2 years, respectively). When the etiology of the renal manifestation was classified into primary and secondary renal disease, the latter included diabetic nephropathy in 13 (15.9%), hypertensive nephrosclerosis in 8 (9.8%), drug induced chronic tubulointerstitial disease in 11 (13.4%) and AA amyloidosis in 2. Renal biopsy revealed 10 cases of primary glomerulopathy, including IgA nephropathy in 3, membranous nephropathy in 2, mesangial proliferative glomerulonephritis in 1, focal segmental glomerulosclerosis in 1 and chronic sclerosing glomerulonephritis in 3. CONCLUSIONS: The prevalence of chronic kidney disease in patients with RA is high, although direct renal invasion by RA is very rarely encountered. Renal biopsy would be of great help to identify the various causes of renal manifestations in patients with RA.
Amyloidosis ; Arthritis, Rheumatoid ; Azotemia ; Biopsy ; Creatinine ; Diabetic Nephropathies ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Hematuria ; Humans ; Nephrosclerosis ; Prevalence ; Proteinuria ; Renal Insufficiency, Chronic ; Retrospective Studies

OBJECTIVE: To investigate the effect of enalapril on renal interstitial fibrosis in rats with unilateral ureteral obstruction(UUO). METHODS: UUO model was induced by ligating the left ureter in rats. Male Sprague-Dawley(SD) rats were randomly divided into a sham-operated group(n=16), a UUO model group(n=24), and an enalapril treated group(n=24). The rats were treated with 10 mg/kg.d by gastric gavage in the enalapril treated group from 24 h before the operation, and the rats were treated with the identical dose of normal saline in the other 2 groups. The rats were sacrificed at 3,7,14, and 21 days after UUO. Pathological changes of the renal tissue were observed by HE and Masson staining, the mRNA expression of collagen I (Col I) was detected by real-time PCR, and the protein expression of connective tissue growth factor (CTGF) was detected by Western blot. RESULTS: The renal interstitial damage index, relative collagen area and the expression of Col I mRNA and CTGF in the renal tissues in the model group increased with the prolongation of obstruction. Enalapril significantly reduced the renal interstitial damage index and relative collagen area, and inhibted the expression of Col I mRNA and CTGF. There was significant difference on day 3,7,and 14 (P<0.05), but not on day 21 (P>0.05). CONCLUSION Enalapril significantly attenuates renal interstitial fibrosis by supressing the expression of Col I mRNA and CTGF.
Animals ; Collagen Type I ; biosynthesis ; genetics ; Connective Tissue Growth Factor ; biosynthesis ; genetics ; Enalapril ; therapeutic use ; Male ; Nephritis, Interstitial ; etiology ; prevention & control ; Nephrosclerosis ; etiology ; prevention & control ; RNA, Messenger ; biosynthesis ; genetics ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Ureteral Obstruction ; complications