The epidemiological synergy between human immunodeficiency virus (HIV) and tuberculosis (TB) is a major threat to public health. However, the association between HIV and multi-drug resistant tuberculosis (MDR-TB) is not clear. To explore the association between HIV and MDR-TB infection, a case-control study was performed in Korea. A total of 1606 culture-proven TB patients (45 HIV vs. 1561 non-HIV) from January 2006 to October 2014 were included in this analysis. MDR-TB rates were 11.1% and 8.2% in the HIV and non-HIV groups, respectively (p=0.42), thus indicating that MDR-TB was not significantly associated with HIV infection in Korea.
Case-Control Studies ; HIV ; HIV Infections ; Humans ; Korea* ; Public Health ; Tuberculosis ; Tuberculosis, Multidrug-Resistant*

The epidemiological synergy between human immunodeficiency virus (HIV) and tuberculosis (TB) is a major threat to public health. However, the association between HIV and multi-drug resistant tuberculosis (MDR-TB) is not clear. To explore the association between HIV and MDR-TB infection, a case-control study was performed in Korea. A total of 1606 culture-proven TB patients (45 HIV vs. 1561 non-HIV) from January 2006 to October 2014 were included in this analysis. MDR-TB rates were 11.1% and 8.2% in the HIV and non-HIV groups, respectively (p=0.42), thus indicating that MDR-TB was not significantly associated with HIV infection in Korea.
Case-Control Studies ; HIV ; HIV Infections ; Humans ; Korea* ; Public Health ; Tuberculosis ; Tuberculosis, Multidrug-Resistant*

BACKGROUND: We aimed to evaluate the performance of serum cystatin C-based equations in calculating the glomerular filtration rate (GFR) in patients with varying stages of chronic kidney disease (CKD). METHODS: Serum cystatin C and creatinine levels were measured in 615 CKD patients. The CKD stage was determined by the creatinine-based estimated GFR (eGFR) equation using the four-variable abbreviated Modification of Diet in Renal Disease equation suggested by the Kidney Disease Outcome Quality Initiative with the addition of a coefficient applicable to Korean populations (K-aMDRD). In each CKD stage, the ratio of serum cystatin C to creatinine was calculated and six different cystatin C-based equations were used to estimate GFR. Cystatin C-based eGFR and aMDRD eGFR values were compared using the paired t test, Pearson correlation test, and the Bland-Altman plot. RESULTS: The mean age of patients was 53.21+/-14.45 years; of the 615 patients, 346 were male. The serum cystatin C-to-creatinine ratio was inversely correlated with the CKD stage. Compared with the K-aMDRD values, the results of the Hoek, Filler, and Le Bricon's cystatin C-based eGFR equations were lower in CKD Stages 1-3 and higher in Stages 4 and 5. However, the results of the Orebro-cystatin (Gentian) equation [GFR=100/ScytC (mL/minute/1.73m2) - 14] were similar to those of the K-aMDRD equation in CKD Stages 4 and 5 (15.44+/-9.45 vs. 15.17+/-9.05mL/minute/1.73m2, respectively; P=0.722; bias=0.27+/-8.87). CONCLUSION: The eGFRs obtained from the six cystatin C-based equations differed widely. Therefore, further studies are required to determine the most accurate equation to estimate GFR in Koreans with CKD.
Creatinine ; Cystatin C ; Diet ; Glomerular Filtration Rate* ; Humans ; Kidney Diseases ; Male ; Renal Insufficiency, Chronic*

BACKGROUNDCentral blood pressure (BP) is pathophysiologically more important than peripheral BP for the pathogenesis of cardiovascular disease. Arterial stiffness is also a good predictor of cardiovascular morbidity and mortality. The effects of benidipine, a unique dual L-/T-type calcium channel blocker, on central BP have not been reported. This study aimed to compare the effect of benidipine and losartan on the central BP and arterial stiffness in mild to moderate essential hypertensives.

METHODSThis 24 weeks, multi-center, open label, randomized, active drug comparative, parallel group study was designed as a non-inferiority study. The eligible patients (n = 200) were randomly assigned to receive benidipine (n = 101) or losartan (n = 99). Radial artery applanation tonometry and pulse wave analysis were used to measure the central BP, pulse wave velocity (PWV) and augmentation index (AIx). We also measured the metabolic and inflammatory markers.

RESULTSAfter 24 weeks, the central BP decreased significantly from baseline by (16.8 ± 14.0/10.5 ± 9.2) mmHg (1 mmHg = 0.133 kPa) (systolic/diastolic BP; P < 0.001) in benidipine group and (18.9 ± 14.7/12.1 ± 10.2) mmHg (P < 0.001) in losartan group respectively. Both benidipine and losartan groups significantly lowered peripheral BP (P < 0.001) and AIx (P < 0.05), but there were no significant differences between the two groups. The mean aortic, brachial and femoral PWV did not change in both groups after 24-week treatment. There were no significant changes of the blood metabolic and inflammatory biomarkers in each group.

CONCLUSIONBenidipine is as effective as losartan in lowering the central and peripheral BP, and improving arterial stiffness.

Adolescent ; Adult ; Aged ; Angiotensin II Type 1 Receptor Blockers ; therapeutic use ; Blood Pressure ; drug effects ; Calcium Channel Blockers ; therapeutic use ; Dihydropyridines ; adverse effects ; therapeutic use ; Essential Hypertension ; Female ; Humans ; Hypertension ; drug therapy ; physiopathology ; Losartan ; adverse effects ; therapeutic use ; Male ; Middle Aged ; Vascular Stiffness ; drug effects

PURPOSE: Efonidipine, which inhibits both T- and L-type calcium channels, has been shown to be effective in reducing proteinuria and preserve renal function. This study was conducted to compare the effects of efonidipine versus amlodipine on the management of hypertension and proteinuria in patients with chronic kidney disease (CKD) receiving ACE inhibitors or ARB. METHODS: This study included 41 CKD patients who were at stages 2-4 and had a urine spot protein/ creatinine ratio of >0.5. Patients were administered amlodipine (5 mg/day) and efonidipine (40 mg/ day) for 3 months in a cross-over design. Blood pressure and spot urine protein/creatinine ratio were compared before and after the cross-over treatment. RESULTS: There were 24 male patients and 17 female patients. The mean age of the patients was 55.9+/-12.9 years. When the patients' medication was changed to eponidifine, we obtained the following results. First, there were no significant changes in blood pressure and serum creatinine. Second, the urine spot protein/creatinine ratio was significantly decreased (before the cross-over, 2.9+/-2.6; after the cross-over, 2.3+/-1.9 g/g; p=0.02). Finally, the reduction rate of proteinuria was significantly higher in patients with CKD at stages 2-3 than in those with CKD at stage 4 after the cross-over (stage 2, - 26.1%; stage 3, -17%; stage 4, +12.8%; p=0.03). CONCLUSION: It is concluded that efonidipine may significantly decrease proteinuria compared with amlodipine in CKD patients receiving ACE inhibitors or ARB. Further double-blind clinical trials with a larger sample size are needed to confirm our results.
Amlodipine ; Angiotensin-Converting Enzyme Inhibitors ; Blood Pressure ; Calcium Channels, L-Type ; Creatinine ; Cross-Over Studies ; Dihydropyridines ; Female ; Humans ; Hypertension ; Male ; Nitrophenols ; Organophosphorus Compounds ; Proteinuria ; Renal Insufficiency, Chronic ; Sample Size

Wegener's granulomatosis is a rare disease that pathologically causes necrotizing granulomatous vasculitis in the arterioles and venules and it can invade the whole body. In addition, it is difficult to distinguish between a nontuberculous mycobacteria infection that shows manifestations of granuloma and Wegener's granulomatosis. There has been no reported on a patient who had the 2 abovementioned two diseases at the same time. A 69 year old male patient had Wegener's granulomatosis that had invaded the prostate. He also had a scrotal swelling and back pain. He had manifestations of granulomatous infection on the scrotum and spine biopsies. However, there was no clinical evidence of Wegener's granulomatosis. As a result, we examined him for other diseases that can cause a granuloma. Consequently, he was also diagnosed as suffering with a nontuberculous mycobacteria infection. We report here on this case and we review the relevant medical literature.
Arterioles ; Back Pain ; Biopsy ; Granuloma ; Humans ; Male ; Nontuberculous Mycobacteria ; Prostate ; Rare Diseases ; Scrotum ; Spine ; Stress, Psychological ; Vasculitis ; Venules ; Wegener Granulomatosis

In end stage renal disease, the precise mechanism of metastatic calcification remains unclear, except that it occurs with hyperphosphatemia, increased Ca x P product, and secondary hyperparathyroidism. It involves various organs such as lung, eye, stomach, kidney, and so on. A 62-year-old male patient, who had acute renal failure (ARF), developed gastric calcification in our institution. The ARF had been result of membranoproliferative glomerulonephritis (MPGN), and the metastatic calcification seemed to be caused by increased Ca x P product and hyperphosphatemia. This case shows that metastatic calcification could arise even in ARF.
Acute Kidney Injury ; Eye ; Glomerulonephritis, Membranoproliferative ; Humans ; Hyperparathyroidism, Secondary ; Hyperphosphatemia ; Kidney ; Kidney Failure, Chronic ; Lung ; Male ; Middle Aged ; Stomach

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