BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep disorder that causes daytime dysfunction and cardiovascular diseases. Nocturnal polysomnography (NPSG) is the standard method of evaluating OSA; however, it is time-consuming, inconvenient, and expensive. Selective performance of NPSG would be possible if we could better predict those who are more likely to have clinically significant OSA. The aim of this study is to define clinical and anthropometric predictors of OSA. METHODS: We included 100 consecutive patients in whom OSA was clinically suspected. Structured sleep interview, anthropometric measurement, and NPSG were performed in all subjects. Presence of OSA was defined when the apnea-hypopnea index was five or more. Parameters from sleep interview and anthropometric data were investigated with multiple logistic regression using the SAS program (ver 8.1, USA) to identify independent predictors of OSA. RESULTS: OSA was diagnosed in seventy-six patients after NPSG. Univariate analysis showed that the male sex, co-existing diabetes, overweight (BMI>or=25), habitual alcohol drinking, large neck circumference (>or=40 cm), high waist circumference/hip circumference (WC/HC) ratio (>or=0.94), and observed apnea were significantly more frequent in OSA patients (p<0.05). Using multivariate analysis, large neck circumference (>or=40 cm) (adjusted OR=4.43, 95% CI: 1.05~18.61) and high WC/HC ratio (adjusted OR=3.48, 95% CI: 1.12~10.80) were found to be the independent predictors of OSA on the NPSG. CONCLUSIONS: We report the predictors of OSA that could be easily identified by clinical and anthropometric evaluations before performing NPSG. This might aid the clinical decision whether or not to perform NPSG in subjects with clinically suspected OSA syndrome.
Alcohol Drinking ; Apnea ; Cardiovascular Diseases ; Humans ; Logistic Models ; Male ; Multivariate Analysis ; Neck ; Overweight ; Polysomnography ; Sleep Apnea, Obstructive* ; Waist-Hip Ratio

The nutcracker syndrome refers to compression of the left renal vein between the aorta and the superior mesenteric artery, which results in renal vein and left gonadal vein varices. This is an unusual, but well accepted cause of hematuria. We report a case of the nutcracker syndrome which is diagnosed by CT angiography before venography and pressure measurement of the left renal vein and managed by intravascular stent placement. A 47-year-old female patient was presented with gross hematuria. Urinalysis revealed hematuria with only 1% of dysmorphism. Abdominal spiral CT and 3D CT angiography revealed compression of the left renal vein between the aorta and superior mesenteric artery because of an acute branching angle of superior mesenteric artery from the aorta. Renal venography showed compression of the left renal vein and collateral circulations to the left ovarian vein and lumbar vein. The pressure gradient between the left renal vein and inferior vena cava was 4 mmHg. Intravascular stent was placed in this patient. We conclude that in patients with the nutcracker syndrome, CT angiography could be considered before venography and venous pressure measurements. When this syndrome leads to clinical symptoms, Intravascular stent placement should be considered. Well designed stent offers minimal invasiveness and physiologic relief as in the present case.
Angiography ; Aorta ; Collateral Circulation ; Female ; Gonads ; Hematuria ; Humans ; Mesenteric Artery, Superior ; Middle Aged ; Phlebography ; Renal Veins ; Stents* ; Tomography, Spiral Computed ; Urinalysis ; Varicose Veins ; Veins ; Vena Cava, Inferior ; Venous Pressure

BACKGROUND: Acute pyelonephritis (APN) is an unusual cause of acute renal failure (ARF) in patients without urinary obstruction and other predisposing conditions. Therefore, in the differential diagnosis of ARF, APN is rarely considered. METHODS: We retrospectively analyzed the data from the patients with ARF secondary to APN (ARF group, n=8) with normal renal anatomy and no known predisposing conditions which lead to ARF during the course of acute bacterial pyelonephritis, and investigated the differences of clinical parameters to the patients with uncomplicated APN (control group, n=20). RESULTS: Female were predominant in both groups. The mean age was 49.2+/-14.4 years in control group and 56.3+/-16.4 years in ARF group. On admission, the body temperature was 37.5+/-1.14degrees C in control group and 36.62+/-0.32degrees C in ARF group (p= 0.003). The days of pyuria, duration days of costovertebral angel (CVA) tenderness and hospitalization days were significantly prolonged in ARF group. CVA tenderness was unilateral in 65% of control group and bilateral in 65% of ARF group. Amounts of daily urine protein excretion were 0.15+/-0.48 gm/ day in control group and 2.99+/-2.89 gm/day in ARF group (p=0.001). Creatinine clearance and FeNa were 24.04+/-15.98 mL/min and 2.80+/-2.68 in patients group, respectively. Development of ARF had positive correlation with the duration of pyuria (r=0.579, p< 0.01), amounts of daily urine protein excretion (r=0.854, p< 0.01), duration of CVA tenderness (r=0.461, p< 0.05) and had a negative correlation with body temperature (r=-0.402, p< 0.05). CONCLUSION: APN is a rare but important cause of acute renal failure. Patients with ARF secondary to APN seems to have more prolonged period of pyuria and CVA tenderness, apyrexia and excrete more protein in urine than patients with uncomplicated APN. Adequate treatment of the bacterial infection by prompt antibiotic treatment may lead to full recovery of renal function.
Acute Kidney Injury* ; Bacterial Infections ; Body Temperature ; Creatinine ; Diagnosis, Differential ; Female ; Hospitalization ; Humans ; Pyelonephritis* ; Pyuria ; Retrospective Studies

BACKGROUND: Serum potassium level assessment is one of the commonly requested laboratory tests. Hypokalemia is defined as a serum potassium level of less than 3.5 mEq/L. It can be potentially life-threatening when severe, due to its association with cardiac arrhythmia and sudden deaths. The aim of our study is to determine the prevalence and to define clinical characteristics of severe hypokalemia in internal medicine hospitalized patients. METHODS: From December 1999 to June 2000, the group with at least one recorded plasma potassium concentration of less than 3.0 mEq/L was selected in department of internal medicine, Pusan national university hospital. Routine records of age, sex and prevalence was collected. Severe hypokalemia is defined as a serum potassium concentration less than 2.6 mEq/L. This patients were retrospectively studied for discharge diagnosis, medications prescribed before and during hospital stay, hospital course and laboratory findings. RESULTS: There were 7.52% (235/3124) with at least one recorded potassium level of less than 3.0 mEq/L. Severe hypokalemia were 75 patients (2.4%). It were more likely to be female, but statically insignificant. Of the 75 patients, 59 patients (77.3%) had hypokalemia during hospitalization. Gastrointestinal loss of potassium was only 13.8% of the patients. The main causes were combination of iatrogenic factors, including the adminstration of intravenous fluids with insufficient or no potassium, malnutrition, and several drugs. The discharge diagnosis included infection 20 patients (26.6%), malignancy 19 patients (25.3%), gastointestinal disorders 8 patients (10.6%). And each of cardiovascular, respiratory and renal disorders have 7 patients (9.3%). In-hospital mortality was 34.6% (26/75) in severe hypokalemia. Compared to the alive group, death group showed statically significant decrease in serum albumin concentration (p<0.05). CONCLUSION: Severe hypokalemia is fatal electrolyte disorder. The most frequent cause of this lethal condition is drug therapy and intravenous fluids with insufficient or no potassium replacement. It can be prevented by regular potassium monitoring and appropriate potassium supplementation in risky hospitalized patients.
Arrhythmias, Cardiac ; Busan ; Death, Sudden ; Diagnosis ; Drug Therapy ; Female ; Hospital Mortality ; Hospitalization ; Humans ; Hypokalemia* ; Internal Medicine* ; Length of Stay ; Malnutrition ; Plasma ; Potassium ; Prevalence ; Retrospective Studies ; Serum Albumin

BACKGROUND: Diabetic nephropathy is one of the major causes of end-stage renal disease. Microalbuminuria predicts not only progressive renal disease, but also increased cardiovascular morbidity and mortality. But, the relationship between urinary albumin excretion rate (UAER) and glomerular filtration rate (GFR) remains an unresolved issue. In order to investigate the early renal function abnormalities, UAER and GFR were assessed and their relationship was examined in normotensive patients with type 2 diabetes mellitus (DM). METHODS: Between January 1997 and June 2001, in a cross sectional study of 112 normotensive patients with type 2 DM not showing overt proteinuria and thirty healthy subjects served as control group. According to UAER, type 2 DM patients were divided into normoalbuminuria group and microalbuminuria group. The GFR was measured using 99mTc-DTPA renal scan. Clinical values in type 2 DM patients and control subjects were compared using one-way analysis of variance (ANOVA) with Scheffe's F test. In type 2 DM patients, Univariate Chi-square analysis was used to evaluate the prevalence of diabetic retinopathy and the differences in anti-diabetic treatment. Pearson correlation coefficients were used to demonstrate a strength of an association between UAER and other variables including GFR. RESULTS: Three groups were well matched with regard to gender, age and body mass index. There were no significant differences in disease duration and anti-diabetic treatment in type 2 DM patients. The GFR in microalbuminuric patients was significantly higher than in normoalbuminuric patients (124.0 17.6 vs 102.9+/-15.5 mL/min/1.73 m2, p<0.05). The prevalence of diabetic retinopathy in microalbuminuric patients was significantly higher than in normoalbuminuric patients (53.8% vs 24.7%, p<0.05). Only there was significant positive correlation between log UAER and GFR (r=0.303, p<0.05). CONCLUSION: As in type 1 DM patients, there was a significant relationship between UAER and GFR in normotensive type 2 DM patients without overt proteinuria.
Body Mass Index ; Diabetes Mellitus, Type 2* ; Diabetic Nephropathies ; Diabetic Retinopathy ; Glomerular Filtration Rate* ; Humans ; Kidney Failure, Chronic ; Mortality ; Prevalence ; Proteinuria

Neurofibromatosis type 1 is the most common neurocutaneous disorders and affects between 1/2,000 and 1/4,500 people. This occurs at any age and is hereditary disease with autosomal dominant fashion. Renovascular hypertension is major form of renal manifestation of the disease. There are few reported cases in Japan and Hungary of Recklinghausen's neurofibromatosis with several glomerular lesions but their relationship is not apparent. A 21-year-old man was admitted to the hospital because of general edema. On admission, the blood pressure was 130/ 80 mmHg and general edema was noted. He had a plexiform neuroma on right flank and multiple cafe- au-lait spots on chest and extremites. Laboratory findings were as follows : Hemoglobin 14.2 g/dL, AST 28 IU/L, ALT 12 IU/L, albumin 1.2 gm/dL, total cholesterol 533 mg/dL, urinary protein 4.0 gm/ day, C3 86.6 mg/dL, C4 19.9 mg/dL, HBs Ag/Ab (+/-), HBe Ag/Ab (+/-), HCV Ab (-), HBV DNA probe 6,000 pg/mL. Renal biopsy was performed and the histological findings were compatible with minimal change disease. The immunohistochemical method revealed that HBsAg was negative. We experienced a case of minimal change disease concurrent with Neurofibromatosis type 1, but their relationship is not clear. We report this case with a brief review.
Biopsy ; Blood Pressure ; Cholesterol ; DNA ; Edema ; Genetic Diseases, Inborn ; Hepatitis B Surface Antigens ; Hepatitis B, Chronic ; Humans ; Hungary ; Hypertension, Renovascular ; Japan ; Nephrosis, Lipoid* ; Neurocutaneous Syndromes ; Neurofibroma, Plexiform ; Neurofibromatoses* ; Neurofibromatosis 1* ; Thorax ; Young Adult

BACKGROUND: It is absolutely necessary to evaluate cardiac function on starting and during hemodialysis in patients with end stage renal disease. In this study, we tried to determinate the changes of cardiac function associated with hemodialysis. METHODS: Twenty patients with end stage renal disease, who had been in a hemodialysis program from February, 1997 to August, 1999 in Pusan National University Hospital, were enrolled. They were examined with echocardiography and gated blood pool scintigraphy on starting hemodialysis and after follow-up. The data were analyzed by paired t-test. RESULTS: The patients were 46.2 +/- 16.8 years old and male to female ratio was 8 : 12. The underlying diseases were diabetes mellitus (n=10), hypertension1), glomerulonephritis2) and others1). The duration of symptoms associated with end stage renal disease and underlying diseases was 3.4 2.6 years and the duration of hemodialysis was 13.8 7.0 months. The LVEDID, LVESID and RVC decreased significantly (-6.10, -7.80 and -20.00%, respectively, p < 0.05) with no significant changes for LAD, IVS, PWT and EF (p > 0.05). In ten cases associated with diabetes, LVEDID decreased (-7.90%, p < 0.05). In twelve cases associated with cardiac diseases, LVEDID and LVESID decreased (-8.60 and -10.50%, respectively, p < 0.05). In four cases associated with diabetes without cardiac diseases, LAD decreased (-5.10%, p 0.05) and in four cases associated with cardiac diseases without diabetes there were no significant changes in cardiac dimensions and EF. In seven cases associated with diabetes and cardiac diseases, LVEDID decreased (-10.50%, p < 0.05). The EF on gated blood pool scintigraphy decreased (-0.9%, p < 0.05) as a whole while it increased (5.90%, p < 0.05) in the cases associated with diabetes and cardiac diseases. CONCLUSION: During the early hemodialysis stage of end stage renal disease, we found a change of concentric left ventricular hypertrophy and relatively preserved left ventricular function. Furthermore, we can expect that adequate hemodialysis - with dry weight as low as possible - may prevent progression to eccentric left ventricular hypertrophy and dilated cardiomyopathy.
Adult ; Aged ; Cardiomyopathy, Congestive/prevention & control ; Diabetic Nephropathies/pathology/physiopathology/therapy ; Echocardiography ; Female ; Gated Blood-Pool Imaging ; Heart/*physiopathology ; Human ; Hypertrophy, Left Ventricular/prevention & control ; Kidney Failure, Chronic/pathology/*physiopathology/*therapy ; Male ; Middle Age ; Myocardium/pathology ; *Renal Dialysis ; Ventricular Function, Left

BACKGROUND: In patients with chronic renal failure, infection is caused by altered host defense mechanism, and contributes significantly to their morbidities and mortalities. Especially, urinary tract infection often occurs in patients with chronic renal failure and is due to azotemia, infrequent voiding, low urinary flow rate and urinary concentration defects. This study was designed to compare the incidence of asymptomatic bacteriuria with chronic renal failure with that of normal control group. We also investigated whether risk factors for urinary tract infections in patients with chronic renal failure are similar to those in normal control groups. METHODS: 34 patients (M : F=13 : 21) with chronic renal failure and 30 normal control groups (M : F= 11 : 19) were evaluated in the Pusan National University Hospital from January 2001 through December 2001. Etiology of chronic renal failure included diabetes mellitus (n=16, 47.1%), hypertension (n=14, 41.2%) and glomerular diseases (n=4, 11.7%). 25 patients were treated with hemodialysis and 5 patients were treated with peritoneal dialysis. Others (n=4) were not treated with dialysis. Clean-catch, first voided urine was collected in the morning and examined by routine urinalysis and urine culture. RESULTS: 7 of 34 (20.6%) patients with chronic renal failure were positive in urine cultures and only one of 30 (3.3%) from the normal control group were positive. E. coli (n=2), Acinetobacter baumanii (n=2), Enterococcus spp. (n=2), S. aureus (n=1), P. aeruginosa (n=1), S. epidermidis (n=1) and Str. viridans (n=1) are cultured from urine specimens. There was a significant difference between the incidence of asymptomatic bacteriuria in patients with chronic renal failure and that of normal control group. But there was no significant difference in the presence of bacteriuria according to sex, age, etiology of renal failure, dialysis modality and pyuria. CONCLUSION: Patients with chronic renal failure have higher frequency of asymptomatic bacteriuria and pyuria than healthy subjects and tend to lead to symptomatic urinary tract infections.
Acinetobacter ; Azotemia ; Bacteriuria* ; Busan ; Diabetes Mellitus ; Dialysis ; Enterococcus ; Humans ; Hypertension ; Incidence ; Kidney Failure, Chronic* ; Mortality ; Peritoneal Dialysis ; Pyuria ; Renal Dialysis ; Renal Insufficiency ; Risk Factors ; Urinalysis ; Urinary Tract Infections

BACKGROUND: Glomerular filtration rate(GFR) is an important parameter for the evaluation and monitoring of renal function. The aim of this study was to investigate the correlation between the relative 1 hour uptake of (99m)Tc-DMSA renal scan(DMSA- %uptake, TRUR) and GFR which was estimated by (99m)Tc-DTPA, serum creatinine and 24 hour-urinary creatinine excretion. METHODS: Between January 1998 and March 2001, 65 patients had undergone (99m)Tc-DMSA renal scan, (99m)Tc-DTPA renal scan, serum creatinine and 24 hour-urinary creatinine excretion. Of them, 42 patients had moderately or severely reduced renal function(DTPA-GFR 0.05). In group B, TRUR (mean+/-S.D. 16.3+/-7.4%) was significantly correlated with DTPA-GFR(r=0.731, p < 0.01). In both group, serum creatinine, Ccr and C and G Ccr were significantly correlated with TRUR. CONCLUSION: Although the relative 1 hour uptake of the (99m)Tc-DMSA renal scan, as a method of renal cortical image could not estimate the true GFR, it showed a good correlation with GFR in patients with moderately reduced renal function. (99m)Tc-DMSA renal scan seems to be helpful to evaluate the renal function in patients with moderately reduced renal function.
Creatinine ; Filtration ; Glomerular Filtration Rate* ; Humans ; Male

BACKGROUND: Vascular endothelial growth factor (VEGF) is a potent enhancer of microvascular permeability and a selective endothelial cell growth factor. In human kidney, VEGF is expressed mainly in glomerular visceral epithelial cells. We investigated the relationship between serum levels of VEGF and factors reflecting the severity of disease including histological patterns in order to elucidate the relevance of VEGF in the pathogenesis of IgA nephropathy. METHODS: Serum VEGF was studied using a sandwich ELISA from 21 patients with IgA nephropathy. Histological patterns are classified to 5 grades by WHO classification and frequencies of crescent and glomerular sclerosis, degree of interstitial fibrosis were recorded. Serum concentrations of creatinine, albumin, IgA, amounts of 24 hour urine protein excretion, and creatinine clearances are also evaluated. RESULTS: Serum VEGF levels were significantly correlated with histological grade(r=0.471, p < 0.05), frequency of cellular crescent(r=0.485, p < 0.05), degree of interstitial fibrosis(r=0.562, p < 0.01), and 24 hour urine protein excretion(r=0.439, p < 0.05), and inversely with serum albumin concentration(r=-0.594, p < 0.01). Studies in 17 patients without crescent formation revealed that only serum albumin concentration showed significant correlation with serum VEGF level. CONCLUSION: Serum VEGF concentration is mainly correlated with cellular crescent formation reflecting activity of the disease rather than chronic structural changes such as glomerular sclerosis or interstitial fibrosis. Elevated serum VEGF concentration seems to be due to the release of relatively large amounts of stored VEGF from damaged visceral epithelial cells. Serum VEGF concentration may be a useful marker to evaluate the degree of acute renal injury, especially cellular crescent formation.
Acute Kidney Injury ; Capillary Permeability ; Classification ; Creatinine ; Endothelial Cells ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells ; Fibrosis ; Glomerulonephritis, IGA* ; Humans ; Immunoglobulin A* ; Kidney ; Podocytes ; Sclerosis ; Serum Albumin ; Vascular Endothelial Growth Factor A*