Creatinine ; Humans ; Male ; Meals ; Methods ; Nitrogen ; Osmolar Concentration ; Potassium ; Sodium ; Sodium, Dietary ; Specific Gravity ; Urea ; Urine Specimen Collection

Background/Aims: The aim of this study was to investigate incidence, survival, and risk factors of cancer in end-stage renal disease (ESRD) patients with hemodialysis using information from the National Health Information Database (NHID). Methods: Using the NHID, we identified ESRD patients who started maintenance hemodialysis between 2003 and 2005 in Korea. Patients were followed from initiation of hemodialysis to renal transplantation, death, or December 31, 2016, whichever came first. We calculated the incidence, survival, and risk factors of cancer. Results: Of the total 14,382 ESRD patients, 1,124 (7.82%; men:women, 728:396) werediagnosed with cancer during follow-up. The mean duration from the start of hemodialysis to new cancer identification was 64.40 ± 41.81 months. Significant risk factors for the development of new cancer were old age, male sex, and liver disease. Conversely, patients with diabetes showed low risk for new cancer. The colorectum (17.31%) was the most common primary site of cancer in men, followed by the liver (15.8%), stomach (14.29%), lung (13.6%), and kidney (10.3%). In women, the colorectum (14.65%) was also the most common primary site of cancer, followed by the breast (12.88%), thyroid (12.63%), stomach (10.86%), and lung (8.08%). According to the primary site of cancer, breast cancer showed the longest median survival duration (130.93 months), followed by thyroid, kidney, colorectum, bladder,stomach, liver, and lung cancer. On multivariate analyses, overall survival was affected by age and diabetes. Conclusions The cancer incidence of chronic hemodialysis patients was relatively high. Thus, careful monitoring and a specific cancer screening program are needed for chronic hemodialysis patients.

Nephrogenic systemic fibrosis (NSF) is a progressive systemic fibrosing disease that may occur after gadolinium contrast exposure. It can lead to severe complications and even death.NSF is highly prevalent among patients with advanced chronic kidney disease (CKD). In this report, however, we describe the case of a patient with NSF that occurred during early CKD. A 65-year-old man with stage 3a CKD was transferred to our hospital because of lower extremity edema. The medical history revealed that he was exposed to gadolinium 185 days earlier, and the result of his tibial skin biopsy was consistent with NSF. The patient underwent a combined therapy with ultraviolet-A1 phototherapy and methotrexate and steroid therapy for 6 months. The combined therapy stopped the systemic progression of NSF.

BACKGROUND: The aim of this multicenter study was to evaluate the safety and efficacy of tolvaptan (TLV) in Korean patients with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). METHODS: Of 51 enrolled patients with SIADH, 39 patients (16 female patients, aged 70.8 ± 11.3 years) were included in an intention to treat analysis. All patients received 15 mg/day as the initial dose, and the dose was then increased up to 60 mg/day (as needed) until day 4. RESULTS: Serum sodium increased significantly from baseline during the first 24 hours (126.8 ± 4.3 vs. 133.7 ± 3.8 mmol/L, P < 0.001), rose gradually between days 1 and 4 (133.7 ± 3.8 vs. 135.6 ± 3.6 mmol/L, P < 0.05), and then plateaued until day 11 (136.7 ± 4.5 mmol/L). The correlation between the change in serum sodium for the first 24 hours and initial serum sodium concentration was significant (r = −0.602, P < 0.001). In severe hyponatremia (< 125 mmol/L), the change was significantly higher (11.1 ± 4.8 mmol/L) than in moderate (6.4 ± 2.5 mmol/L, P < 0.05) or mild hyponatremia (4.3 ± 3.3 mmol/L, P < 0.01). In addition, logistic regression analysis showed that body weight (odds ratio [OR], 0.858; 95% confidence interval [CI], 0.775–0.976; P = 0.020) and body mass index (BMI) (OR, 0.692; 95% CI, 0.500–0.956; P = 0.026) were associated with rapid correction. No serious adverse events were reported, but in 13% of patients hyponatremia was overcorrected. CONCLUSION: TLV is effective in correcting hyponatremia and well-tolerated in Korean patients with SIADH. However, those with low body weight, low BMI or severe hyponatremia, could be vulnerable to overcorrection with the initial dose of 15 mg TLV.

BACKGROUND/AIMS: This study was designed to investigate the roles of aristolochic acid I (AA-I) and hypokalemia in acute aristolochic acid nephropathy (AAN). METHODS: After an adaptation period (1 week), a total of 40 C57BL/6 mice (male, 8 weeks old) were divided into four groups: I (control group), II (low potassium [K] diet), III (normal K diet with administration of AA-I [10 mg/kg weight]), and IV (low K diet with AA-I). After collecting 24 hours of urine at 2 weeks, the mice were sacrificed, and their blood and kidneys were obtained to perform immunochemical staining and/or Western blot analysis. RESULTS: Proteinuria, glycosuria, and increased fractional excretion of sodium and K were prominent in groups III and IV (p < 0.05). Diffuse swelling and poor staining of collecting duct epithelial cells were evident in the medullas of group II. Typical lesions of toxic acute tubular injury were prominent in the cortices of groups III and IV. Α-Smooth muscle actin (α-SMA) was higher in the cortices of the mice in groups III and IV versus group II (p < 0.05), and higher in the medullas of group IV than groups I and III (p < 0.05). E-cadherin was higher in the cortices of groups III and IV compared to group I (p < 0.05). The F4/80 value was higher in the cortices and medullas of groups II, III, and IV compared to group I (p < 0.05), particularly in the case of group II. CONCLUSIONS: AA-I can induce acquired Fanconi syndrome in the acute stage of AAN. Macrophages appear to play a key role in the pathogenesis of AAN and hypokalemic nephropathy. It remains uncertain whether hypokalemia plays any role in AAN and hypokalemia.
Actins ; Animals ; Balkan Nephropathy ; Blotting, Western ; Cadherins ; Diet ; Epithelial Cells ; Fanconi Syndrome ; Glycosuria ; Hypokalemia* ; Kidney ; Macrophages ; Mice ; Potassium ; Proteinuria ; Rats* ; Sodium

No abstract available.
Alkalosis ; Humans ; Hypokalemia

Diabetic nephropathy is a chronic microvascular complication of type 2 diabetes and the leading cause of end-stage renal disease. We report the case of a 34-year-old male, newly diagnosed with type 2 diabetes mellitus, who had advanced-stage nephropathy with glomerular crescents. A moderately-to-severely decreased glomerular filtration rate with nephrotic syndrome was seen at the time of diagnosis of diabetes. Proliferative diabetic retinopathy was detected, but there was no positive finding in serology tests for glomerulonephritis. Non-necrotizing cellular crescents and nodular glomerulosclerosis were observed in a kidney biopsy, and renal function declined rapidly to the end stage. We review data on diabetic glomerulosclerosis with cellular crescents and the rapid progression of nephropathy.
Adult ; Biopsy ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies* ; Diabetic Retinopathy ; Diagnosis ; Disease Progression ; Glomerular Filtration Rate ; Glomerulonephritis ; Humans ; Kidney ; Kidney Failure, Chronic* ; Male ; Nephrotic Syndrome ; Pathology

No abstract available.
Proton Pump Inhibitors* ; Proton Pumps* ; Protons*

Prolonged hypokalemia from chronic laxative abuse is recognized as the cause of chronic tubulointerstitial disease, known as "hypokalemic nephropathy," but it is not clear whether it contributes to acute kidney injury (AKI). A 42-year-old woman with a history of chronic kidney disease as a result of chronic laxative abuse from a purging type of anorexia nervosa (AN-P), developed an anuric AKI requiring hemodialysis and a mild AKI 2 months later. Both episodes of AKI involved severe to moderate hypokalemia (1.2 and 2.7 mmol/L, respectively), volume depletion, and mild rhabdomyolysis. The histologic findings of the first AKI revealed the remnants of acute tubular necrosis with advanced chronic tubulointerstitial nephritis and ischemic glomerular injury. Along with these observations, the intertwined relationship among precipitants of recurrent AKI in AN-P is discussed, and then we postulate a contributory role of hypokalemia involved in the pathophysiology of the renal ischemia-induced AKI.
Acute Kidney Injury* ; Adult ; Anorexia Nervosa ; Female ; Humans ; Hypokalemia* ; Necrosis ; Nephritis, Interstitial ; Renal Dialysis ; Renal Insufficiency, Chronic ; Rhabdomyolysis