Adult ; Aged ; Cross-Sectional Studies ; Erectile Dysfunction ; epidemiology ; etiology ; Humans ; Kidney Failure, Chronic ; complications ; therapy ; Male ; Middle Aged ; Prevalence ; Renal Dialysis ; Risk Factors ; Young Adult

BACKGROUND/AIMS: A revised classification system for renal dysfunction in patients with cirrhosis was proposed by the Acute Dialysis Quality Initiative and the International Ascites Club Working Group in 2011. The aim of this study was to determine the prevalence of renal dysfunction according to the criteria in this proposal. METHODS: The medical records of cirrhotic patients who were admitted to Konkuk University Hospital between 2006 and 2010 were reviewed retrospectively. The data obtained at first admission were collected. Acute kidney injury (AKI) and chronic kidney disease (CKD) were defined using the proposed diagnostic criteria of kidney dysfunction in cirrhosis. RESULTS: Six hundred and forty-three patients were admitted, of whom 190 (29.5%), 273 (42.5%), and 180 (28.0%) were Child-Pugh class A, B, and C, respectively. Eighty-three patients (12.9%) were diagnosed with AKI, the most common cause for which was dehydration (30 patients). Three patients had hepatorenal syndrome type 1 and 26 patients had prerenal-type AKI caused by volume deficiency after variceal bleeding. In addition, 22 patients (3.4%) were diagnosed with CKD, 1 patient with hepatorenal syndrome type 2, and 3 patients (0.5%) with AKI on CKD. CONCLUSIONS: Both AKI and CKD are common among hospitalized cirrhotic patients, and often occur simultaneously (16.8%). The most common type of renal dysfunction was AKI (12.9%). Diagnosis of type 2 hepatorenal syndrome remains difficult. A prospective cohort study is warranted to evaluate the clinical course in cirrhotic patients with renal dysfunction.
Acute Kidney Injury/*epidemiology/etiology/mortality ; Adult ; Aged ; Cohort Studies ; Female ; Hospital Mortality ; Humans ; Kidney Failure, Chronic/*epidemiology/etiology/mortality ; Liver Cirrhosis/complications/*diagnosis ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Severity of Illness Index ; Survival Rate

The aim of this study was to investigate the clinical characteristics of acute hepatitis A during a recent outbreak in Korea. Data of patients diagnosed with acute hepatitis A from 2007 to 2009 were collected from 21 tertiary hospitals retrospectively. Their demographic, clinical, and serological characteristics and their clinical outcomes were analyzed. A total of 4,218 patients (mean age 33.3 yr) were included. The median duration of admission was 9 days. The mean of the highest ALT level was 2,963 IU/L, total bilirubin was 7.3 mg/dL, prothrombin time INR was 1.3. HBsAg was positive in 3.7%, and anti-HCV positive in 0.7%. Renal insufficiency occurred in 2.7%, hepatic failure in 0.9%, relapsing hepatitis in 0.7%, and cholestatic hepatitis in 1.9% of the patients. Nineteen patients (0.45%) died or were transplanted. Complications of renal failure or prolonged cholestasis were more frequent in patients older than 30 yr. In conclusion, most patients with acute hepatitis A recover uneventfully, however, complication rates are higher in patients older than 30 yr than younger patients. Preventive strategies including universal vaccination in infants and active immunization of hepatitis A to adult population should be considered for prevention of community-wide outbreaks of hepatitis A in Korea.
Acute Disease ; Adolescent ; Adult ; Age Factors ; Aged ; Child ; Child, Preschool ; Cholestasis/epidemiology/etiology ; Demography ; Hepatitis A/complications/*diagnosis/mortality ; Humans ; Kidney Failure, Chronic/epidemiology/etiology ; Liver Transplantation ; Middle Aged ; Morbidity ; Republic of Korea ; Retrospective Studies ; Tertiary Care Centers ; Young Adult

Either chronic inflammation or metabolic syndrome (MetS) is associated with renal impairment. This cross-sectional study was designed to investigate the relationship between elevated white blood cell (WBC) counts and chronic kidney disease (CKD) stage 3 or more according to the presence of MetS in adult Koreans. In total, 5,291 subjects (> or = 20 yr-old) participating in the 2005 Korean National Health and Nutrition Examination were included. CKD stage 3 or more was defined as having an estimated glomerular filtration rate below 60 mL/min/1.73 m2, as calculated using the formula from the Modification of Diet in Renal Disease study. The odds ratio (95% confidence interval) for CKD stage 3 or more in the highest WBC quartile (> or = 7,200 cells/microL) was 1.70 (1.17-2.39) after adjusting for MetS and other covariates, compared with the lowest WBC quartile (< 5,100 cells/microL). In subjects with MetS, the prevalence risk for CKD stage 3 or more in the highest WBC quartile was 2.25 (1.28-3.95) even after fully adjusting for confounding variables. In contrast, this positive association between WBC quartile and CKD stage 3 or more disappeared in subjects without MetS. Low-grade inflammation is significantly associated with CKD stage 3 or more in subjects with MetS but not in those without MetS.
Adult ; Cross-Sectional Studies ; Female ; Glomerular Filtration Rate ; Humans ; Inflammation/complications/*diagnosis ; Kidney Failure, Chronic/*epidemiology/etiology ; Leukocyte Count ; Male ; Metabolic Syndrome X/complications/*diagnosis ; Middle Aged ; Nutrition Surveys ; Odds Ratio ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors ; Severity of Illness Index

The number of patients with end-stage renal disease (ESRD) is rising very rapidly as the number of elderly and patients with diabetes increases in Korea. ESRD Registry Committee of the Korean Society of Nephrology (KSN) collected dialysis therapy data in Korea through an online registry program on the KSN website. The status of renal replacement therapy in Korea at the end of 2009 was as follows. First, total number of patients with ESRD was 56,396 (hemodialysis [HD], 37,391; peritoneal dialysis [PD], 7,618; functioning kidney transplant [KT], 11,387). The prevalence of ESRD was 1,113.6 patients per million population (PMP). Proportion of patients undergoing renal replacement therapy was 66.3% with HD, 13.5% with PD, and 20.2% with KT. Second, a total of 8,906 (HD, 6,540; PD, 1,125; KT, 1,241; incidence rate of 175.9 PMP) patients developed ESRD in 2009. Third, the most common primary causes of ESRD were diabetic nephropathy (45.4%), hypertensive nephrosclerosis (18.3%), and chronic glomerulonephritis (11.1%). Fourth, mean urea reduction rate was 67.5% and 73.8% in male and female patients, respectively, undergoing HD. Mean Kt/V was 1.38 in male patients and 1.65 in female patients. Fifth, the overall 5-year survival rate of male patients undergoing dialysis was 65.4% and that of female patients was 67.4%.
Adult ; Aged ; Anemia/drug therapy/etiology ; Comorbidity ; Erythropoietin, Recombinant/therapeutic use ; Female ; Hematinics/therapeutic use ; Humans ; Incidence ; Kidney Failure, Chronic/mortality/*therapy ; Male ; Middle Aged ; Prevalence ; Registries ; *Renal Dialysis/adverse effects/mortality ; Republic of Korea/epidemiology ; Risk Factors ; Survival Rate ; Time Factors ; Treatment Outcome

There have been many epidemiological researches of chronic kidney disease (CKD), accompanied by an increase in the incidence of coronary heart disease (CHD). However, as far as we know, little research has been done to examine the extent of the relationship between CKD and CHD as estimated by Framingham risk score (FRS) in Korean men. CKD was defined as either proteinuria or an eGFR of < 60 mL/min per 1.73 m2. The FRS has been used to predict the 10-yr risk of coronary events and usually divided into three levels of risk < 10% (low), 10%-19% (intermediate) and > or = 20% (high). We defined FRS > or = 10% as more-than-a-moderate CHD risk group and FRS > or = 20% as a high CHD risk group, respectively. After adjusting for covariates, multivariable-adjusted logistic regression analyses showed a strong statistical significant relationship between CKD and high risk of CHD (adjusted OR, 1.95 [95% CI, 1.32-2.87]). Dipstick urinalysis and eGFR can be readily measured in most clinical settings. The measurement of kidney function may represent a relatively inexpensive and efficient way to identify individuals at higher risk for CHD.
Adult ; Aged ; Coronary Disease/epidemiology/*etiology ; Glomerular Filtration Rate ; Humans ; Kidney Failure, Chronic/*complications ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Proteinuria/complications ; Renal Insufficiency, Chronic/*complications ; Republic of Korea ; Risk Factors

INTRODUCTIONHand infections in patients with end-stage renal failure (ESRF) are more diffi cult to treat and have had the worse outcomes. This paper examines the epidemiology, bacteriology and outcomes of surgically managed upper limb infections in these vulnerable patients.

MATERIALS AND METHODSAll patients from a single centre with surgically-managed upper limb infections between 2001 and 2007 were reviewed. We collected epidemiological data on demographics, type and site of infection, bacteriology, surgical treatment, complications and mortality.

RESULTSForty-seven out of 803 (6%) patients with surgically managed upper limb infections in the study period had ESRF. The average age was 59 years. ESRF was secondary to diabetes in 88% of cases. Patients presented on average 7 days after onset of symptoms. Abscesses (34%), wet gangrene (26%) and osteomyelitis (11%) were the commonest infections. Methicillin-resistant Staphylococcus aureus (MRSA) was the commonest pathogen (29%), occurring either in isolation or with other organisms. Eighteen percent of single organisms cultured were gram-negative. Multiple organisms occurred in 29%. A median of 2 operations were required. Thirty-six percent of all cases required amputation. Twenty-fi ve percent of patients had a life-threatening event (myocardial infarction or septic shock) during treatment.

CONCLUSIONSESRF patients present late with severe upper limb infections. Nosocomial infections are common. Initial empirical antibiotic treatment should cover MRSA and gram-negative bacteria. Immediate referral to a hand surgery unit is recommended. Multi-disciplinary management of the patient with input from physicians and anaesthetists or intensivists in the perioperative period is necessary to optimise the patient for surgery and to manage active medical comorbidities and complications after surgery.

Adult ; Aged ; Aged, 80 and over ; Amputation ; Diabetes Complications ; Epidemiologic Studies ; Female ; Hand ; surgery ; Hand Injuries ; epidemiology ; etiology ; surgery ; Humans ; Kidney Failure, Chronic ; complications ; epidemiology ; Male ; Methicillin-Resistant Staphylococcus aureus ; Middle Aged ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Surgical Wound Infection ; drug therapy ; epidemiology ; etiology

OBJECTIVEChronic renal failure (CRF) of childhood is not rare. The prognosis of CRF is very poor because of severe systemic complications. A nation-wide survey was conducted and data of hospitalized children (younger than 14 years old) with CRF during the period of 1990 to 2002 were analyzed. The aim was to investigate the epidemiology, natural history, clinical-pathological characteristics, treatment and outcome of the hospitalized children with CRF.

METHODSQuestionnaires concerning children with CRF were designed and distributed to the doctors of 91 hospitals in China. The criterion of CRF was creatinine clearance (CCr) < 50 ml/(min x 1.73 m(2)). The data were collected and analyzed.

RESULTSFrom January 1, 1990 to December 31, 2002, 1658 hospitalized children were diagnosed as CRF. The average annual cases of childhood CRF accounted for 1.31% (ranged from 0.72% to 1.75%) of the hospitalized cases with urologic-kidney diseases. In a comparison between 1990 - 1996 and 1997 - 2002, there were significant increases in the average annual number of cases of childhood CRF and the case ratio of CRF to urologic-kidney diseases (82 +/- 27 vs. 181 +/- 45 and 0.98 +/- 0.21 vs. 1.56 +/- 0.17, respectively, P < 0.001). Complete records were available for 1268 patients. The male to female ratio was 1.49:1. The mean age at the disease onset was 8.18 years. The mean duration of pre-diagnosis of CRF was 2.53 years. In this study, the main primary renal diseases causing CRF were chronic glomerulonephritis and nephrotic syndrome (52.7%). One-fourth of all cases had congenital and hereditary renal diseases, and the majority were renal hypoplasia and dysplasia. The main manifestations of CRF were anemia, gastrointestinal disorders, edema, hypertension and growth retardation. The mean serum creatinine and BUN were 594.7 micromol/L and 39.1 mmol/L, respectively. The cases with renal function >or= grade IV accounted for 80% of all cases. By renal ultrasound scanning, one-third of CRF children were found to have renal atrophy and a part of patients had cystic disorder. Most of the cases received conservative treatment. Dialysis therapy (including 66.5% of hemodialysis and 33.5% of peritoneal) was given to 15.8% of the patients. Twenty-nine cases received renal transplantation. The rate of graft survival was 93.1%. Follow-up was carried out for to 230 cases, the mean duration of follow-up was 2.36 years. One hundred and sixty-seven patients died during hospitalization over the 13-year review period. The main causes of death were cardiac failure and infections in addition to uremia.

CONCLUSIONThe incidence of CRF in children showed an increasing trend year after year. The main age of onset of the disease was school-age. The main primary renal diseases causing CRF were acquired renal diseases. Conservative treatment was the main therapy of CRF, but renal replacement therapy was initiated in some of the cases. The obvious difference between follow-up cases and lost cases warrants the need to establish a management system of childhood CRF.

Adolescent ; Child ; China ; Disease Progression ; Female ; Humans ; Kidney Failure, Chronic ; diagnosis ; epidemiology ; etiology ; therapy ; Male ; Treatment Outcome

Autosomal dominant polycystic kidney disease (ADPKD), a common genetic disease, is characterized by the development of hypertension and end stage renal disease. An increase in the activity of the renin-angiotensin system, due to a renal ischemia caused by cyst expansion, contributes to the development of hypertension and renal failure in ADPKD. Recently, the angiotensinogen (AGT) gene, M235T, and angiotensin II type 1 receptor (ATR) gene, A1166C, polymorphisms have been associated with the susceptibility to develop hypertension and renal disease. We hypothesized that the AGT M235T and ATR A1166C polymorphisms could account for some of the variability in the progression of ADPKD. Genotyping was performed in 108 adult patients with ADPKD, and 105 normotensive healthy controls, using PCR and restriction digestion. We analyzed the effects of the AGT M235T and ATR A1166C polymorphisms on hypertension and age at the end stage renal disease (ESRD). Of the 108 patients with ADPKD, 64 (59%) had hypertension and 24 (22%) reached the ESRD. The prevalence of hypertension were; [MM+MT], [TT] genotypes, 60%, 59% (p=1.00) ; [AA], [AC+CC] genotypes, 60%, 50% respectively (p=0.54). The ages at the onset of ESRD were; [MM+MT], [TT] genotypes, 50 +/- 9 years, 56 +/- 8 years (p=0.07) ; [AA], [AC+CC] genotypes, 54 +/- 8 years, 52 +/- 14 years, respectively (p=0.07). There were no differences in the prevalence of hypertension and the ages at the ESRD in relation to the AGT M235T and ATR A1166C polymorphisms. We suggest that the AGT and ATR gene polymorphisms would not have an effect on hypertension or the ESRD in ADPKD.
Adult ; Age of Onset ; Angiotensinogen/*genetics ; Disease Progression ; Female ; Human ; Hypertension/epidemiology/etiology ; Kidney Failure, Chronic/epidemiology/etiology ; Male ; Middle Aged ; Polycystic Kidney, Autosomal Dominant/complications/*genetics/physiopathology ; Polymorphism (Genetics) ; Prevalence ; Receptor, Angiotensin, Type 1 ; Receptors, Angiotensin/*genetics

BACKGROUND: The formation of urinary tract stones following renal transplantation is a rare complication. The clinical features of stones after transplantation differ from those of non-transplant patients. Renal colic or pain is usually absent and rarely resembles acute rejection. METHODS: We retrospectively studied 849 consecutive kidney transplant patients in The Rogosin Institute/The Weill-Cornell Medical Center, New York who were transplanted between 1980 and 1997 and had functioning grafts for more than 3 months, to determine the incidence of stone formation, composition, risk factors and patient outcome. RESULTS: At our center, urinary stones were diagnosed in 15 patients (1.8%) of 849 functioning renal grafts for 3 or more months. Of the 15 patients, 10 were males and 5 were females in their third and fourth decade. Eight patients received their transplant from living donors and 7 from cadaveric donors. The stones were first diagnosed between 3 and 109 months after transplantation (mean 17.8 months) and 5 patients had recurrent episodes. The stones were located in the bladder in 11 cases (73.3%), transplanted kidney in 3 cases and in multiple sites in one case. The size of stones varied from 3.4 mm to 40 mm (mean 12 mm). The composition of stones was a mixed form of calcium oxalate and calcium phosphate in 5 cases and 4 patients had infected stones consisting of struvite or mixed form of struvite and calcium phosphate. Factors predisposing to stone formation included tertiary hyperparathyroidism (n=8), hypercalciuria (n=5), recurrent urinary tract infection (n=5), hypocitraturia (n=4), and obstructive uropathy (n=2). Many cases had more than one risk factor. Clinically, painless hematuria was observed in 6 patients and dysuria without bacteriuria in 5 patients. None had renal colic or severe pain at any time. There were no changes in graft function at diagnosis and after removal of stones. Five patients passed stones spontaneously and 8 patients underwent cystoscopy for stone removal. CONCLUSION: Urinary stone formation following kidney transplantation is a rare complication (1.8%). Hyperparathyroidism, hypercalciuria, recurrent urinary tract infection and hypocitraturia are the most common risk factors, but often there are multiple factors which predispose to stone formation. To detect stones and determine their location and size, ultrasonography appears to be the most useful diagnostic tool. Prompt diagnosis, the removal of stones and stone-preventive measures can prevent adverse effects on renal graft outcome.
Adult ; Age Distribution ; Aged ; Calculi/chemistry ; Female ; Human ; Incidence ; Kidney Failure, Chronic/surgery ; Kidney Transplantation/*adverse effects/methods ; Korea/epidemiology ; Male ; Middle Age ; Prognosis ; Risk Assessment ; Sex Distribution ; Urinary Calculi/*epidemiology/etiology