Acute Kidney Injury ; diagnosis ; drug therapy ; etiology ; Adult ; Anti-Bacterial Agents ; therapeutic use ; Cyclophosphamide ; therapeutic use ; Female ; Humans ; Kidney Diseases ; diagnosis ; drug therapy ; Levofloxacin ; therapeutic use ; Malacoplakia ; complications ; diagnosis ; drug therapy ; Prednisone ; therapeutic use

Paroxysmal nocturnal hemoglobinuria (PNH) is a progressive, systemic, life-threatening disease, characterized by chronic uncontrolled complement activation. A retrospective analysis of 301 Korean PNH patients who had not received eculizumab was performed to systematically identify the clinical symptoms and signs predictive of mortality. PNH patients with hemolysis (lactate dehydrogenase [LDH] > or = 1.5 x the upper limit of normal [ULN]) have a 4.8-fold higher mortality rate compared with the age- and sex-matched general population (P < 0.001). In contrast, patients with LDH < 1.5 x ULN have a similar mortality rate as the general population (P = 0.824). Thromboembolism (TE) (odds ratio [OR] 7.11; 95% confidence interval [CI] (3.052-16.562), renal impairment (OR, 2.953; 95% CI, 1.116-7.818) and PNH-cytopenia (OR, 2.547; 95% CI, 1.159-5.597) are independent risk factors for mortality, with mortality rates 14-fold (P < 0.001), 8-fold (P < 0.001), and 6.2-fold (P < 0.001) greater than that of the age- and sex-matched general population, respectively. The combination of hemolysis and 1 or more of the clinical symptoms such as abdominal pain, chest pain, or dyspnea, resulted in a much greater increased mortality rate when compared with patients with just the individual symptom alone or just hemolysis. Early identification of risk factors related to mortality is crucial for the management of PNH. This trial was registered at www.clinicaltrials.gov as NCT01224483.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibodies, Monoclonal/therapeutic use ; Antibodies, Monoclonal, Humanized/therapeutic use ; Area Under Curve ; Child ; Dyspnea/etiology ; Female ; Hemoglobinuria, Paroxysmal/*diagnosis/drug therapy/mortality ; Hemolysis ; Humans ; Kaplan-Meier Estimate ; Kidney Diseases/complications/diagnosis ; L-Lactate Dehydrogenase/metabolism ; Male ; Middle Aged ; Odds Ratio ; ROC Curve ; Registries ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Thromboembolism/complications/diagnosis ; Young Adult

Few studies have reported on the long-term prognosis of anti-neutrophil cytoplasmic antibody (ANCA)-negative renal vasculitis. Between April 2003 and December 2013, 48 patients were diagnosed with renal vasculitis. Their ANCA status was tested using indirect immunofluorescence and enzyme-linked immunosorbent assays. During a median (interquartile range) follow-up duration of 933.5 (257.5-2,079.0) days, 41.7% of patients progressed to end stage renal disease (ESRD) and 43.8% died from any cause. Of 48 patients, 6 and 42 were ANCA-negative and positive, respectively. The rate of ESRD within 3 months was higher in ANCA-negative patients than in ANCA-positive patients (P = 0.038). In Kaplan-Meier survival analysis, ANCA-negative patients showed shorter renal survival than did ANCA-positive patients (log-rank P = 0.033). In univariate Cox-proportional hazard regression analysis, ANCA-negative patients showed increased risk of ESRD, with a hazard ratio 3.190 (95% confidence interval, 1.028-9.895, P = 0.045). However, the effect of ANCA status on renal survival was not statistically significant in multivariate analysis. Finally, ANCA status did not significantly affect patient survival. In conclusion, long-term patient and renal survival of ANCA-negative renal vasculitis patients did not differ from those of ANCA-positive renal vasculitis patients. Therefore, different treatment strategy depending on ANCA status might be unnecessary.
Age Factors ; Aged ; Antibodies, Antineutrophil Cytoplasmic/*analysis ; Cohort Studies ; Enzyme-Linked Immunosorbent Assay ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Kidney Diseases/*diagnosis/mortality ; Kidney Failure, Chronic/etiology ; Male ; Microscopy, Fluorescence ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Sex Factors ; Vasculitis/complications/*diagnosis/mortality

OBJECTIVETo evaluate the association between severity of obstructive sleep apnea hypopnea syndrome (OSAHS) without chronic kidney disease (CKD) and serum cystatin C.

METHODSA total of 238 patients with snoring during sleep admitted between January 2012 and June 2015 underwent full-night polysomnography for diagnosis of OSAHS. The patients were divided according to the apnea-hypopnea index (AHI) scores into simple snoring group (AHI<5) and mild (AHI, 5-15), moderate (AHI, 15-30), and severe OSAHS (AHI>30) groups. The medical history, baseline demographic characteristics, blood glucose, blood lipids, peripheral blood cell count and serum cystatin C were measured, and the correlation between polysomnographic parameters and serum cystatin C were analyzed in different groups.

RESULTSThe simple snoring, mild, moderate, and severe OSAHS groups consisted of 41, 49, 56, and 92 cases, respectively. Serum cystatin C, WBC and its subtype counts, RBC count, and superoxide dismutase (SOD) were all significantly higher in severe OSAHS group than in the other 3 groups (P<0.05), but serum creatinine and estimated glomerular filtration rate were comparable among the groups (P>0.05). Linear correlation analysis revealed that serum cystatin C was positively correlated with gender, BMI, neck circumference, abdominal circumference, SBP, AHI, and WBC (P<0.01) and inversely correlated with the average pulse oxygen saturation (ASpO2), minimum pulse oxygen saturation (MSpO(2)), and SOD (P<0.01). Multiple regression analysis identified AHI and SOD as independent factors that were positively and inversely correlated with serum cystatin C (β=0.218, P<0.010; β=-0.217, P<0.009), respectively.

CONCLUSIONSevere OSAHS is closely correlated with serum cystatin C, WBC, and SOD, suggesting that severe OSAHS may initiate the pathological process of early renal damage possibly in association with chronic intermittent hypoxia-induced oxidative stress and the initiation of the inflammatory cascade.

Blood Glucose ; Cystatin C ; blood ; Humans ; Hypoxia ; Kidney Diseases ; complications ; Leukocyte Count ; Polysomnography ; Sleep ; Sleep Apnea, Obstructive ; complications ; diagnosis ; Snoring ; Superoxide Dismutase ; blood

PURPOSE: We aimed to analyze the characteristics of urinary retention (UR) in female inpatients managed with medical treatments. MATERIALS AND METHODS: We retrospectively analyzed the medical records of female inpatients referred to the department of urology for UR at our institution from January 2009, to December 2014. UR was defined as a difficulty in self-voiding despite a sufficient urine volume or >300-mL postvoid residual. The data included patients' age, body mass index (BMI), ambulatory status, medical and surgical history, classes of taking drugs, and urinary tract infection. RESULTS: A total of 182 women were included as retention group, mean age of 72.64±12.94 years and BMI of 22.94±3.10 kg/m2. In the chi-square analysis, cardiovascular disorders (p=0.000), diabetes mellitus (p=0.008), metastatic malignancy (p=0.008), chronic renal disorders (p=0.028) were found significantly. In the multiple logistic regression analysis, cardiovascular disorders (p=0.002; odds ratio [OR], 0.491), metastatic malignancy (p=0.013; OR, 2.616) were found to increase the risk of UR. The most common surgical history was anti-incontinence surgery (7.2%). In term of medication use, the most prescribed agents were nonsteroidal anti-inflammatory drugs (NSAIDs) (53.8%). The patients taking multiple drugs with antimuscarinic effects except of NSAIDs, narcotics and diuretics were 48 (26.4%). Urinary tract infection was identified in 43 patients (23.6%). CONCLUSIONS: UR in females managed with medical treatments could be occurred occasionally. We think that thorough attentions are needed for UR to patients with cardiovascular disorders including diabetes mellitus, metastatic malignancy, chronic renal disorders urinary tract infection, and more careful interests when managing with drugs with antimuscarinic effects.
Age Factors ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Cardiovascular Diseases/complications ; Diabetes Complications ; Female ; Hospitalization ; Humans ; Kidney Diseases/complications ; Middle Aged ; Muscarinic Antagonists/adverse effects ; Neoplasm Metastasis ; Retrospective Studies ; Risk Factors ; Urinary Retention/diagnosis/*etiology/therapy ; Urinary Tract Infections/etiology

No abstract available.
Acute Disease ; Adult ; Anti-Bacterial Agents/therapeutic use ; Choristoma/*complications/radiography ; Escherichia coli Infections/diagnosis/drug therapy/*microbiology ; Female ; Hernias, Diaphragmatic, Congenital/*complications/radiography ; Humans ; *Kidney ; Predictive Value of Tests ; Pyelonephritis/diagnosis/drug therapy/*microbiology ; Thoracic Diseases/*complications/radiography ; Tomography, X-Ray Computed ; Treatment Outcome

Hematoma ; diagnosis ; diagnostic imaging ; etiology ; Humans ; Kidney Diseases ; complications ; diagnostic imaging ; physiopathology ; Male ; Middle Aged ; Ultrasonography

Lower gastrointestinal complications often develop in end stage renal disease patients, and among the more problematic is recurrent colon ulcer. The exact pathogenesis of this condition is not known and there were no specific therapeutic modalities concerning this type of disease entity. We report, with a literature review, a case of recurrent colon ulcer with intermittent hematochezia in an end stage renal disease patient on long term hemodialysis that improved after conversion to peritoneal dialysis.
Aspirin/therapeutic use ; Colon/pathology ; Colonic Diseases/complications/*diagnosis/drug therapy ; Colonoscopy ; Drug Therapy, Combination ; Gastrointestinal Hemorrhage ; Humans ; Kidney Failure, Chronic/*complications ; Male ; Middle Aged ; Peritoneal Dialysis ; Recurrence ; Ticlopidine/therapeutic use ; Ulcer/complications/*diagnosis/drug therapy

BACKGROUND/AIMS: The aim of this study is to measure the difference of ionized calcium between heparinized whole blood and serum. METHODS: We recruited 107 maintenance hemodialysis (HD) patients from our hospital HD unit. The clinical and laboratory data included ionized calcium in serum and in whole blood (reference, 4.07 to 5.17 mg/dL). RESULTS: The level of ionized calcium in serum was higher than that in whole blood (p < 0.001). Bland-Altman analysis showed that difference for ionized calcium was 0.5027. For the difference, the nonstandardized beta was -0.4389 (p < 0.001) and the intercept was 2.2418 (p < 0.001). There was a significant difference in the distribution of categories of ionized calcium level between two methods (kappa, 0.279; p < 0.001). CONCLUSIONS: This study demonstrates that whole blood ionized calcium is underestimated compared with serum ionized calcium. Positive difference increases as whole blood ionized calcium decreases. Therefore, significant hypocalcemia in whole blood ionized calcium should be verified by serum ionized calcium.
Aged ; Biological Markers/blood ; Calcium/*blood ; Female ; Humans ; Hypercalcemia/blood/*diagnosis/etiology ; Hypocalcemia/blood/*diagnosis/etiology ; Kidney Diseases/blood/complications/diagnosis/*therapy ; Male ; Middle Aged ; Predictive Value of Tests ; *Renal Dialysis/adverse effects ; Reproducibility of Results ; Specimen Handling/*methods

OBJECTIVETo study the clinical characteristics and diagnostic methods of rare autosomal recessive inherited Bardet-Biedl syndrome in patients presented with renal abnormalities.

METHODComprehensive analyses were performed on data of 4 confirmed Bardet-Biedl syndrome cases seen at nephrology department of Beijing Children Hospital affiliated to Capital Medical University, including clinical features, laboratory examination and diagnostic criteria.

RESULT(1) Four cases were confirmed to meet Bardet-Biedl syndrome diagnostic criteria (male: female = 1: 1): first diagnosis age was 10 y, 9 y 8 m, 10 y 10 m, 8 y 2 m. (2) Cases 1, 2, and 3 had a history of polyuria and polydipsia, cases 4 began with edema and oliguria. (3) All had slight change in urine routine test. Case 3 and Case 4 were presented with small to medium amount of proteinuria. None had microscopic hematuria. (4) All had different degree of renal injury, Case 1 and 3 were at the third phase of chronic kidney disease (CKD), Case 4 was at the fourth phase of CKD, Case 4 was at the fifth phase of CKD and needed dialysis. (5) All cases had obvious abnormalities of urinary tract ultrasound, 3 of them had chronic diffuse lesions with cyst formation of both kidneys. The rest one had dysplasia of right kidney and fused kidney. (6) All cases were presented with vision loss with 100% of electroretinogram abnormalities and 50% of fundus examination abnormalities. (7) Three cases were presented with obesity. (8) Multiple organs were involved in all cases, including electrocardiographic abnormality and/or thickening of the left ventricular wall (4/4) , polydactyly (2/4) , small penis and testicles (2/4) and short stature (2/4) .

CONCLUSIONClinical manifestations of Bardet-Biedl syndrome (BBS) conceals, routine urine test changes slightly, abnormalities of renal structure and (or) tubular interstitial function is a typical manifestation of children with BBS. Urinary tract ultrasound screening may show diffuse lesions with double kidney with cyst formation or structural abnormalities. Clinical manifestation accompany with retinal degeneration, obesity, myocardial involvement, polydactyly, and hypogonadism.

Abnormalities, Multiple ; Bardet-Biedl Syndrome ; complications ; diagnosis ; pathology ; Biomarkers ; blood ; urine ; Child ; Female ; Humans ; Intellectual Disability ; Kidney ; abnormalities ; diagnostic imaging ; Kidney Diseases ; diagnosis ; etiology ; pathology ; Male ; Renal Insufficiency ; etiology ; pathology ; Retinal Diseases ; etiology ; pathology ; Tomography, X-Ray Computed ; Ultrasonography, Doppler, Color