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Rhee H, Jang GS, An YJ, Han M, Park I, Kim IY, Seong EY, Lee DW, Lee SB, Kwak IS, Song SH. Long-term outcomes in acute kidney injury patients who underwent continuous renal replacement therapy: a single-center experience. Clin Exp Nephrol 2018; 22:1411-1419. [PMID: 29948445 DOI: 10.1007/s10157-018-1595-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/29/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) is the most severe form of AKI associated with poor short- and long-term patient outcomes. The aim of this study was to evaluate the variables associated with long-term patient survival in our clinic. METHODS This was a single-center retrospective study with AKI survivors who received CRRT from March 2011 to February 2015. During the study period, all consecutive AKI survivors who underwent CRRT were included. Patients on maintenance dialysis prior to CRRT were excluded. Data were collected by reviewing the patients' medical charts. Long-term follow-up data were gathered through February 2018. RESULTS A total of 430 patients were included, and 62.8% of the patients were male. The mean age of the patients was 63.4 ± 14.6 years. The mean serum creatinine level at the time of CRRT initiation was 3.5 ± 2.5 mg/dL. At the time of discharge, the mean eGFR and serum creatinine levels were 58.4 ± 46.7 and 1.7 ± 1.6 mg/dL, respectively. After 3 years, 44.9% of the patients had survived. When we investigated the factors associated with long-term patient mortality, a longer stay in the ICU [OR 1.034 (1.016-1.053), p < 0.001], a history of cancer [OR 3.830 (1.037-3.308), p = 0.037], a prolonged prothrombin time [OR 1.852 (1.037-3.308), p = 0.037] and a lower eGFR at the time of discharge [OR 0.988 (0.982-0.995), p = 0.001] were independently associated with long-term patient mortality. CONCLUSION Our study demonstrates that long-term mortality after CRRT is associated with longer ICU stays and lower eGFRs at the time of hospital discharge. Our data imply the importance of renal recovery for long-term survival of AKI patients treated with CRRT.
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Kim IY, Park IS, Kim MJ, Han M, Rhee H, Seong EY, Lee DW, Lee SB, Kwak IS, Song SH, Chung HC. Change in kidney function after unilateral adrenalectomy in patients with primary aldosteronism: identification of risk factors for decreased kidney function. Int Urol Nephrol 2018; 50:1887-1895. [PMID: 29779118 DOI: 10.1007/s11255-018-1887-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/06/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE Glomerular filtration rate (GFR) has been reported to decrease after unilateral adrenalectomy in patients with primary aldosteronism (PA). The aim of this study was to identify clinical predictors for decreased GFR after adrenalectomy in patients with PA. METHODS The records of 187 patients (98 patients with PA and 89 with non-PA adrenal disease) who were followed up for at least 6 months after unilateral adrenalectomy were retrospectively analyzed. Estimated GFR (eGFR) was investigated at 1, 3, and 6 months postoperatively. Preoperative risk factors for eGFR% decline at 1 month ([preoperative eGFR-eGFR at 1 month]/preoperative eGFR × 100) and postoperative CKD development were investigated. RESULTS The eGFR decreased significantly at 1 month and remained stable in the PA group. However, there were no significant changes in eGFR in the non-PA group over the 6-month period. In the PA group, a high preoperative eGFR and high aldosterone to renin ratio (ARR) were independently associated with eGFR% decline at 1 month. In patients with PA but without preoperative CKD (n = 68), a low preoperative eGFR and high ARR were independent risk factors for developing postoperative CKD. The best preoperative cut-off values of eGFR and ARR for predicting the development of postoperative CKD were ≤ 102 ml/min/1.73 m2 and ≥ 448 ng/dl:ng/ml/h, respectively. CONCLUSIONS Renal function deteriorated significantly after unilateral adrenalectomy in patients with PA. Clinicians must pay attention to postoperative renal function in PA patients at elevated risk of developing decreased kidney function.
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Hwang JY, Shin JH, Seong EY, Kang EJ. FeCl 2
-mediated Nucleophilic Chlorination of Iodoalkanes Accelerated by Phenanthroline Ligand. B KOREAN CHEM SOC 2018. [DOI: 10.1002/bkcs.11453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Park JM, Lee H, Song S, Seong EY, Kwak IS, Park SW, Kim YK, Shin N, Sol MY. Primary Glomerulonephritis with Unique C4d Deposition and Concurrent Non-infectious Intermediate Uveitis: a Case Report and Literature Review. J Korean Med Sci 2018; 33:e136. [PMID: 29713256 PMCID: PMC5920125 DOI: 10.3346/jkms.2018.33.e136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/10/2017] [Indexed: 12/14/2022] Open
Abstract
C4 glomerulopathy is a recently introduced entity that presents with bright C4d staining and minimal or absent immunoglobulin and C3 staining. We report a case of a 62-year-old man with C4 glomerulonephritis (GN) and uveitis. He presented to the nephrology department with proteinuria and hematuria. The patient also had intermediate uveitis along with proteinuria and hematuria. A kidney biopsy that was performed in light of continuing proteinuria and hematuria showed a focal proliferative, focal sclerotic glomerulopathy pattern on light microscopy, absent staining for immunoglobulin or C3 by immunofluorescence microscopy, with bright staining for C4d on immunohistochemistry, and electron-dense deposits on electron microscopy. Consequently, C4 GN was suggested as the pathologic diagnosis. Although laser microdissection and mass spectrometry for glomerular deposit and pathologic evaluation of the retinal tissue were not performed, this is the first report of C4 GN in Korea and the first case of coexisting C4 GN and uveitis in the English literature.
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Kim MJ, Kim JH, Kim IY, Lee SB, Park IS, Han MY, Rhee H, Song SH, Seong EY, Kwak IS, Lee DW. Light Chain Deposition Disease Associated With Multiple Myeloma Developing in Late Pregnancy. IRANIAN JOURNAL OF KIDNEY DISEASES 2018; 12:132-134. [PMID: 29507277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 10/22/2017] [Indexed: 06/08/2023]
Abstract
Preeclampsia is the most common cause of proteinuria with hypertension during pregnancy. Primary kidney disease and kidney disease secondary to systemic disorders may rarely occur during pregnancy, resulting in proteinuria. A 34-year-old woman was admitted to our hospital with abdominal distention and lower extremity edema. The pregnancy was terminated at the 24th week of gestation due to preterm labor. Even after the delivery, proteinuria and renal deterioration continued to progress. The M-peak was not found on serum and urine protein electrophoresis. The serum free light chains assay showed absolute elevation of lambda chains at 1013.9 mg/L with a decreased kappa to lambda ratio of 0.05. Kidney biopsy revealed light chain deposition disease with lambda light chain deposits on immunofluorescence. Bone marrow examination was compatible with multiple myeloma. To our knowledge, this is the first reported case of light chain deposition disease associated with multiple myeloma during pregnancy.
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Mun HJ, Seong EY, Ahn KH, Kang EJ. Fe(II)/Fe(III)-Catalyzed Intramolecular Didehydro-Diels–Alder Reaction of Styrene-ynes. J Org Chem 2018; 83:1196-1203. [DOI: 10.1021/acs.joc.7b02672] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Rhee H, Jang GS, Han M, Park IS, Kim IY, Song SH, Seong EY, Lee DW, Lee SB, Kwak IS. The role of the specialized team in the operation of continuous renal replacement therapy: a single-center experience. BMC Nephrol 2017; 18:332. [PMID: 29132321 PMCID: PMC5683314 DOI: 10.1186/s12882-017-0746-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 10/20/2017] [Indexed: 11/13/2022] Open
Abstract
Background The requirement of continuous renal replacement therapy (CRRT) is increasing with the growing incidence of acute kidney injury (AKI). The decision to initiate CRRT is not difficult if an adequate medical history is obtained. However, the handling and maintenance of CRRT constitute a labor-intensive intervention that requires specialized skills. For these reasons, our center organized a specialized CRRT team in March 2013. The aim of this study is to report on the role of a specialized CRRT team and to evaluate the team’s outcome. Methods This retrospective single-center study evaluated AKI patients who underwent CRRT in the intensive care unit (ICU) from March 2011 to February 2015. Patients were divided into two groups based on whether they received specialized CRRT team intervention. We collected information on demographic characteristics, laboratory parameters, SOFA score, CRRT initiation time, actual delivered dose and CRRT down-time. In-hospital mortality was defined by medical chart review. Binary logistic regression analysis was used to define factors associated with in-hospital mortality. Results A total of 1104 patients were included in this study. The mean patient age was 63.85 ± 14.39 years old, and 62.8% of the patients were male. After the specialized CRRT team intervention, there was a significant reduction in CRRT initiation time (5.30 ± 13.86 vs. 3.60 ± 11.59 days, p = 0.027) and CRRT down-time (1.78 ± 2.23 vs. 1.38 ± 2.08 h/day, p = 0.002). The rate of in-hospital mortality decreased after the specialized CRRT team intervention (57.5 vs. 49.2%, p = 0.007). When the multivariable analysis was adjusted, delayed CRRT initiation (HR 1.054(1.036–1.072), p < 0.001) was a significant factor in predicting in-hospital mortality, along with an increased SOFA score, lower serum albumin and prolonged prothrombin time. Conclusions Our study shows that specialized CRRT team intervention reduced CRRT initiation time, down-time and in-hospital mortality. This study could serve as a logical basis for implementing specialized CRRT teams hospital-wide. Electronic supplementary material The online version of this article (10.1186/s12882-017-0746-8) contains supplementary material, which is available to authorized users.
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Lee DW, Lee SB, Kim JH, Kim IY, Rhee H, Song SH, Seong EY, Kwak IS. SP073NEUTROPHIL TO LYMPHOCYTE RATIO IS AN INDEPENDENT PREDICTOR OF SEVERITY OF CORONARY ARTERY DISEASE IN PATIENTS WITH CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx140.sp073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lee DW, Lee SB, Kim IY, Kim JH, Rhee H, Song SH, Seong EY, Kwak IS. SP056INCREASED PLASMA NGAL LEVELS ARE INDEPENDENTLY ASSOCIATED WITH LEFT VENTRICULAR HYPERTROPHY AND DIASTOLIC DYSFUNCTION IN PATIENTS WITH CHRONIC KIDNEY DIEASE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx140.sp056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Seong EY, Rhee H, Jang KS, Park JM, Kim IY, Song SH, Lee DW, Lee SB, Kwak IS. SP218CLINICAL OUTCOMES OF ELDERLY PATIENTS WITH ACUTE KIDNEY INJURY ON CONTINUOUS RENAL REPLACEMENT THERAPY. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx143.sp218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Song SH, Rhee H, Park J, Kim IY, Seong EY, Lee DW, Lee SB, Kwak IS. MP365THE EFFECT OF FEBUXOSTAT ON THE PRESERVATION OF GLOMERULAR FILTRATION RATE IN NON-DIABETIC PATIENTS WITH CKD. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx169.mp365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Song SH, Rhee H, Kim IY, Seong EY, Lee DW, Lee SB, Kwak IS. SP213THE PREDICTION OF CLINICAL OUTCOME IN DIABETIC PATIENTS WITH CONTINUOUS RENAL REPLACEMENT THERAPY: FOCUSING HBA1C. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx143.sp213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Song SH, Rhee H, Kim IY, Seong EY, Lee DW, Lee SB, Kwak IS, Lee MY, Bang SY, Lovett DH. MP501A SPATIAL DISTRIBUTION OF TWO ISOFORMS OF MATRIX METALLOPROTEINASE-2 IN DIABETIC KIDNEY ACCORDING TO THE TIME OF DIABETIC MILIEU. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx174.mp501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kim IY, Kim JH, Lee DW, Lee SB, Rhee H, Seong EY, Kwak IS, Song SH. Fluid overload and survival in critically ill patients with acute kidney injury receiving continuous renal replacement therapy. PLoS One 2017; 12:e0172137. [PMID: 28196107 PMCID: PMC5308862 DOI: 10.1371/journal.pone.0172137] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/31/2017] [Indexed: 01/20/2023] Open
Abstract
Background Fluid overload is known to be associated with increased mortality in patients with acute kidney injury (AKI) who are critically ill. In this study, we intended to uncover whether the adverse effect of fluid overload on survival could be applied to all of the patients with AKI who received continuous renal replacement therapy (CRRT). Methods We analyzed 341 patients with AKI who received CRRT in our intensive care units. The presence of fluid overload was defined as a minimum 10% increase in body weight from the baseline. Demographics, comorbid diseases, clinical data, severity of illness [the sequential organ failure assessment (SOFA) score, number of vasopressors, diagnosis of sepsis, use of ventilator] upon ICU admission, fluid overload status, and time elapsed from AKI diagnosis until CRRT initiation were reviewed from the medical charts. Results Patients with total fluid overload from 3 days before CRRT initiation to ICU discharge had a significantly lower survival rate after ICU admission, as compared to patients with no fluid overload (P < 0.001). Among patients with sepsis (P < 0.001) or with high SOFA scores (P < 0.001), there was a significant difference in survival of the patients with and without fluid overload. In patients without sepsis or with low SOFA score, there was no significant difference in survival of patients irrespective of fluid overload. Conclusion Our study demonstrates that the adverse effect of fluid overload on survival is more evident in patients with sepsis or with more severe illness, and that it might not apply to patients without sepsis or with less severe illness.
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Kim SS, Shin N, Bae SS, Lee MY, Rhee H, Kim IY, Seong EY, Lee DW, Lee SB, Kwak IS, Lovett DH, Song SH. Enhanced expression of two discrete isoforms of matrix metalloproteinase-2 in experimental and human diabetic nephropathy. PLoS One 2017; 12:e0171625. [PMID: 28178341 PMCID: PMC5298282 DOI: 10.1371/journal.pone.0171625] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 01/23/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We recently reported on the enhanced expression of two isoforms of matrix metalloproteinase-2 (MMP-2) in human renal transplantation delayed graft function. These consist of the conventional secreted, full length MMP-2 isoform (FL-MMP-2) and a novel intracellular N-Terminal Truncated isoform (NTT-MMP-2) generated by oxidative stress-mediated activation of an alternate promoter in the MMP-2 first intron. Here we evaluated the effect of hyperglycemia and diabetes mellitus on the in vitro and in vivo expression of the two MMP-2 isoforms. METHODS We quantified the abundance of the FL-MMP-2 and NTT-MMP-2 transcripts by qPCR in HK2 cells cultured in high glucose or 4-hydroxy-2-hexenal (HHE) and tested the effects of the NF-κB inhibitor pyrrolidine dithiocarbamate (PDTC). The streptozotocin (STZ) murine model of Type I diabetes mellitus and renal biopsies of human diabetic nephropathy were used in this study. RESULTS Both isoforms of MMP-2 in HK2 cells were upregulated by culture in high glucose or with HHE. PDTC treatment did not suppress high glucose-mediated FL-MMP-2 expression but potently inhibited NTT-MMP-2 expression. With STZ-treated mice, renal cortical expression of both isoforms was increased (FL-MMP-2, 1.8-fold; NTT-MMP-2, greater than 7-fold). Isoform-specific immunohistochemical staining revealed low, but detectable levels of the FL-MMP-2 isoform in controls, while NTT-MMP-2 was not detected. While there was a modest increase in tubular epithelial cell staining for FL-MMP-2 in STZ-treated mice, NTT-MMP-2 was intensely expressed in a basolateral pattern. FL-MMP-2 and NTT-MMP-2 isoform expression as quantified by qPCR were both significantly elevated in renal biopsies of human diabetic nephropathy (12-fold and 3-fold, respectively). CONCLUSIONS The expression of both isoforms of MMP-2 was enhanced in an experimental model of diabetic nephropathy and in human diabetic nephropathy. Selective MMP-2 isoform inhibition could offer a novel approach for the treatment of diabetic renal disease.
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Jung WJ, Park SM, Park JM, Rhee H, Kim IY, Lee DW, Lee SB, Seong EY, Kwak IS, Song SH. Severe Hypernatremia Caused by Acute Exogenous Salt Intake Combined with Primary Hypothyroidism. Electrolyte Blood Press 2016; 14:27-30. [PMID: 28275385 PMCID: PMC5337430 DOI: 10.5049/ebp.2016.14.2.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/30/2016] [Indexed: 11/05/2022] Open
Abstract
This report describes a case of severe hypernatremia with a serum sodium concentration of 188.1mmol/L caused by exogenous salt intake. A 26-year-old man diagnosed with Crohn's disease 5 years previously visited our clinic due to generalized edema and personality changes, with aggressive behavior. He had compulsively consumed salts, ingesting approximately 154 g of salt over the last 4 days. Despite careful fluid management that included not only hypotonic fluid therapy for 8 hours but also hypertonic saline administration, his serum sodium level decreased sharply at 40.6 mmol/L; however, it returned to normal within 72-hour of treatment without any neurological deficits. Primary hypothyroidism was also diagnosed. He was discharged after 9 days from admission, with a stable serum sodium level. We have described the possibility of successful treatment in a patient with hypernatremia caused by acute salt intoxication without sustained hypotonic fluid therapy.
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Park SM, Jung WJ, Park JM, Rhee H, Kim IY, Seong EY, Lee DW, Lee SB, Kwak IS, Shin N, Song SH. Unmasked chronic renal function deterioration after unilateral adrenalectomy in patients with primary aldosteronism. Kidney Res Clin Pract 2016; 35:255-258. [PMID: 27957422 PMCID: PMC5142303 DOI: 10.1016/j.krcp.2016.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 05/02/2016] [Accepted: 05/10/2016] [Indexed: 12/05/2022] Open
Abstract
We report 2 cases of chronic estimated glomerular filtration rate (eGFR) decline after unilateral adrenalectomy due to primary aldosteronism. The patients were diagnosed with unilateral adrenal cortical adenoma releasing aldosterone. Two patients were examined for hypertension and hypokalemia. Unilateral laparoscopic adrenalectomy was performed in both cases, and pathology confirmed adrenal cortical adenoma. After adrenalectomy, hypertension and hypokalemia improved to within normal range. However, the eGFR decreased postoperatively, and abdominal computed tomography scan showed decreased kidney size compared to previous images. Kidney biopsy was performed to delineate the exact cause of renal function deterioration and revealed hypertensive changes with chronic interstitial changes, indicating that glomerular hyperfiltration with aldosterone excess masked renal function damage. Physicians have to consider the probability of postadrenalectomy eGFR decline related to chronic hypertensive change.
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Hwang NK, Rhee H, Kim IY, Seong EY, Lee DW, Lee SB, Kwak IS, Kim CW, Song SH. Three cases of spontaneous lumbar artery rupture in hemodialysis patients. Hemodial Int 2016; 21:E18-E21. [PMID: 27670146 DOI: 10.1111/hdi.12491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Indexed: 11/28/2022]
Abstract
We encountered three cases of retroperitoneal hematoma caused by spontaneous lumbar artery rupture, a rare vascular complication. At the time of retroperitoneal hematoma, two patients were on anticoagulant/antiplatelet therapy. One patient was not taking any anticoagulant/antiplatelet agents but was receiving hemodialysis treatment with heparin. Lumbar artery rupture was successfully controlled by transcatheter arterial embolization in all patients, but one patient developed multiple organ failure and died. We suggest that spontaneous lumbar artery rupture may occur in patients being treated with maintenance hemodialysis or anticoagulant/antiplatelet therapy. Therefore, clinicians should suspect lumbar artery rupture in patients with unstable vital signs and rapid onset of anemia because early diagnosis and appropriate intervention are necessary to decrease the risks of morbidity and mortality.
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Lee SB, kim IY, Kim JH, Lee DW, Park JM, Rhee H, Song SH, Seong EY, Kwak IS. SP354SERUM 1,25 DIHYDROXYVITAMIN D IS IASSOCIATED WITH LEFT VENTRICULAR HYPERHTROPHY AND DIASTOLIC DYSFUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw167.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lee DW, Kim JS, Kim IY, Kim MJ, Kim J, Rhee H, Seong EY, Song SH, Lee SB, Kwak IS. MP191CATHETER-BASED RENAL SYMPATHETIC DENERVATION INDUCES REVERSIBLE ACUTE KIDNEY INJURY AND MYOCARDIAL DAMAGE THROUGH THE ACTIVATION OF CASPASE-1 AND NLRP3 INFLAMMASOME. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw186.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kim IY, Kim MJ, Lee DW, Lee SB, Rhee H, Song SH, Seong EY, Kwak IS. Glycated albumin is a more accurate glycaemic indicator than haemoglobin A 1c in diabetic patients with pre-dialysis chronic kidney disease. Nephrology (Carlton) 2015; 20:715-720. [PMID: 25974106 DOI: 10.1111/nep.12508] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2015] [Indexed: 12/11/2022]
Abstract
AIM Glycated albumin (GA) has been reported to be a more reliable glycaemic indicator than haemoglobin A1c (HbA1c ) in patients with diabetes on dialysis. However, the significance of these assays has been less evaluated in patients with diabetes and pre-dialysis chronic kidney disease (CKD). METHODS GA, HbA1c and fasting serum glucose were measured simultaneously in 146 patients with diabetes. Based on estimated glomerular filtration rate (eGFR), the subjects were categorized into a pre-dialysis CKD group (eGFR < 60 mL/min per 1.73 m2 , n = 97) and a non-CKD group (eGFR ≥ 60 mL/min per 1.73 m2 , n = 49). RESULTS The glucose/HbA1c and GA/HbA1c ratios were significantly higher in the CKD group than those in the non-CKD group. The glucose/GA ratio did not differ significantly between the two groups. In the pre-dialysis CKD group, eGFR was negatively correlated with the glucose/HbA1c ratio (r = -0.343, P = 0.001) and the GA/HbA1c ratio (r = -0.499, P < 0.001). However, no significant correlation was detected between eGFR and the glucose/GA ratio. In the non-CKD group, eGFR was not correlated with the glucose/HbA1c ratio, the glucose/GA ratio, or the GA/HbA1c ratio. A multivariate regression analysis showed that eGFR had a significant impact on HbA1c but no effect on GA in the pre-dialysis CKD group (β = 0.210, P = 0.005). In the non-CKD group, eGFR did not affect HbA1c or GA. CONCLUSION Our results show that HbA1c significantly underestimated glycaemic control, whereas GA more accurately reflected glycaemic control in diabetic patients with pre-dialysis CKD.
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Shin MJ, Rhee H, Kim IY, Song SH, Lee DW, Lee SB, Kwak IS, Seong EY. RIFLE classification in geriatric patients with acute kidney injury in the intensive care unit. Clin Exp Nephrol 2015; 20:402-10. [PMID: 26354675 DOI: 10.1007/s10157-015-1165-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 09/01/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND The RIFLE classification is widely used to assess the severity of acute kidney injury (AKI), but its application to geriatric AKI patients complicated by medical problems has not been reported. METHODS We investigated 256 geriatric patients (≥65 years old; mean age, 74.4 ± 6.3 years) who developed AKI in the intensive care unit (ICU) according to the RIFLE classification. Etiologic, clinical, and prognostic variables were analyzed. RESULTS They were categorized into RIFLE-R (n = 53), RIFLE-I (n = 102), and RIFLE-F (n = 101) groups. The overall in-hospital mortality was 39.8 %. There were no significant differences in RIFLE category between survivors and non-survivors. Survivors had significantly less needs for a ventilator and vasopressor, and lower number of failing organs. Survivors had higher systolic blood pressure, hemoglobin level, and serum albumin levels. We performed a logistic regression analysis to identify the independent predictors of in-hospital mortality. In a univariate analysis, hypertension, chronic kidney disease, RIFLE classification, number of failing organs, need for a ventilator and vasopressor, systolic blood pressure, hemoglobin level, and serum albumin levels were identified as prognostic factors of in-hospital mortality. However, in a multivariate analysis, hypertension, chronic kidney disease, number of failing organs, and serum albumin levels were independent risk factors, with no significant difference for in-hospital mortality with the RIFLE classification. CONCLUSION The RIFLE classification might not be associated with mortality in geriatric AKI patients in the ICU. In geriatric patients with AKI, various factors besides severity of AKI should be considered to predict mortality.
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Kang JS, Jang HR, Lee JE, Park YJ, Rhee H, Seong EY, Kwak IS, Kim IY, Lee DW, Lee SB, Song SH. The bacterial colonization in tunneled cuffed dialysis catheter and its effects on residual renal function in incident hemodialysis patients. Clin Exp Nephrol 2015. [PMID: 26223871 DOI: 10.1007/s10157-015-1148-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The bacterial colonization of hemodialysis catheter occurs frequently and reaches to the catheter-related bloodstream infections (CRBSIs). We hypothesized bacterial colonization promotes inflammation and that might be associated with renal outcome. The aim of this study was to investigate the colonization status for tunneled cuffed dialysis catheter (TCC) and the factors for contributing to the catheter colonization and explore whether bacterial colonization would be related with declining of residual renal function (RRF). METHODS 115 patients who received TCC removal operation and underwent catheter tip culture from January 2005 to June 2014 were enrolled. The follow-up data such as urine output (UO), time to anuria and patients' survival were collected from the patients or their family members by telephone in June, 2014. RESULTS There were nineteen patients (16.5 %, 19/115) with positive tip culture (colonization group). In the analysis of demographic and biochemical parameters, there were no significant differences between both groups. Fifty of all the subjects responded to the telephone survey and ten patients (20.0 %, 10/50) belonged to colonization group. The monthly decreasing rate of UO was significantly more rapid in colonization group (p = 0.001). The survival analysis showed that colonization group had worse estimated anuria-free survival than non-colonization group (p < 0.001). In multivariate cox regression, bacterial colonization of TCC was an independent factor influencing the loss of RRF (HR 4.29, 95 % CI: 1.905-9.683, p ≤ 0.001). CONCLUSIONS Bacterial colonization of TCC was associated with rapid loss of RRF.
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Rhee H, Jang KS, Shin MJ, Lee JW, Kim IY, Song SH, Lee DW, Lee SB, Kwak IS, Seong EY. Use of Multifrequency Bioimpedance Analysis in Male Patients with Acute Kidney Injury Who Are Undergoing Continuous Veno-Venous Hemodiafiltration. PLoS One 2015; 10:e0133199. [PMID: 26186370 PMCID: PMC4505923 DOI: 10.1371/journal.pone.0133199] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/24/2015] [Indexed: 02/06/2023] Open
Abstract
Introduction Fluid overload is a well-known predictor of mortality in patients with acute kidney injury (AKI). Multifrequency bioimpedance analysis (MF-BIA) is a promising tool for quantifying volume status. However, few studies have analyzed the effect of MF-BIA-defined volume status on the mortality of critically ill patients with AKI. This retrospective medical research study aimed to investigate this issue. Methods We retrospectively reviewed the medical records of patients with AKI who underwent continuous veno-venous hemodiafiltration (CVVHDF) from Jan. 2013 to Feb. 2014. Female patients were excluded to control for sex-based differences. Volume status was measured using MF-BIA (Inbody S20, Seoul, Korea) at the time of CVVHDF initiation, and volume parameters were adjusted with height squared (H2). Binary logistic regression analyses were performed to test independent factors for prediction of in-hospital mortality. Results A total of 208 male patients were included in this study. The mean age was 65.19±12.90 years. During the mean ICU stay of 18.29±27.48 days, 40.4% of the patients died. The in-hospital mortality rate increased with increasing total body water (TBW)/H2 quartile. In the multivariable analyses, increased TBW/H2 (OR 1.312(1.009-1.705), p=0.043) and having lower serum albumin (OR 0.564(0.346-0.919, p=0.022) were independently associated with higher in-hospital mortality. When the intracellular water (ICW)/H2 or extracellular water (ECW)/H2 was adjusted instead of the TBW/H2, only excess ICW/H2 was independently associated with increased mortality (OR 1.561(1.012-2.408, p=0.044). Conclusions MF-BIA-defined excess TBW/H2 and ICW/H2 are independently associated with higher in-hospital mortality in male patients with AKI undergoing CVVHDF.
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Rhee H, Shin N, Shin MJ, Yang BY, Kim IY, Song SH, Lee DW, Lee SB, Kwak IS, Seong EY. High serum and urine neutrophil gelatinase-associated lipocalin levels are independent predictors of renal progression in patients with immunoglobulin A nephropathy. Korean J Intern Med 2015; 30:354-61. [PMID: 25995666 PMCID: PMC4438290 DOI: 10.3904/kjim.2015.30.3.354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 08/26/2014] [Accepted: 09/05/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/AIMS Tubulointerstitial injury plays an important role in the progression of immunoglobulin A nephropathy (IgAN), and neutrophil gelatinase-associated lipocalin (NGAL) is among the most sensitive tubular biomarkers. We investigated whether serum or urine NGAL predicts prognosis in patients with IgAN. METHODS The present study enrolled patients with biopsy-proven IgAN from January 2005 to December 2010, whose serum and urine samples at the time of kidney biopsy were preserved by freezing. We retrospectively reviewed patient clinical data and followed patients until October 2012. Serum and urine NGAL levels were measured using an enzyme-linked immunosorbent assay kit. Renal progression was defined as an estimated glomerular filtration rate decline by > 50% or progression to end-stage renal disease. RESULTS There were 121 patients enrolled in this study. During the median follow-up period of 41.49 months, renal progression was found in nine patients (7.4%). Serum or urine NGAL alone could not predict renal progression; however, when serum and urine NGAL levels were combined, belonging to the high NGAL group independently predicted renal progression (hazard ratio [HR], 5.56; 95% confidence interval [CI], 1.42 to 21.73; p = 0.014), along with tubular damage graded according to the Oxford classification as T2 (HR, 8.79; 95% CI, 2.01 to 38.51; p = 0.004). In addition, a Kaplan-Meier curve of renal survival showed significantly higher renal progression in patients in the high NGAL group (log rank, p = 0.004). CONCLUSIONS In patients with IgAN, high serum and urine NGAL levels at the time of kidney biopsy predict renal progression.
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