Effect of Renal Insufficiency on Stone Recurrence in Patients with Urolithiasis

Kang, Ho Won,Seo, Sung Phil,Kim, Won Tae,Kim, Yong-June,Yun, Seok-Joong,Lee, Sang-Cheol,Kim, Wun-Jae The Korean Academy of Medical Sciences 2014 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.29 No.8

<P>The study was designed to assess the relationship between glomerular filtration rate (GFR) and urinary stone-forming constituents, and to assess the effect of renal insufficiency on stone recurrence risk in first stone formers (SF). Baseline serum creatinine levels were obtained, and renal insufficiency was defined as creatinine clearance ≤60 mL/min (Cockroft-Gault). This retrospective case-control study consists of 342 first SF; 171 SF with normal renal function were selected with 1:1 propensity scores matched to 171 SF with renal insufficiency. Urinary metabolic evaluation was compared to renal function. GFR was positively correlated with urinary calcium, uric acid, and citrate excretion. Subjects with renal insufficiency had significantly lower urinary calcium, uric acid, and citrate excretion than those with normal renal function, but not urine volume. With regard to urinary metabolic abnormalities, similar results were obtained. SF with renal insufficiency had lower calcium oxalate supersaturation indexes and stone recurrence rates than SF with normal renal function. Kaplan-Meier curves showed similar results. In conclusion, GFR correlates positively with urinary excretion of stone-forming constituents in SF. This finding implies that renal insufficiency is not a risk factor for stone recurrence.</P><P><B>Graphical Abstract</B></P><P/>

고령인구에서 신기능 부전의 유병률과 위험인자

서정열 ( Seo Jeong Yeol ),정수석 ( Jeong Su Seog ),김향 ( Kim Hyang ),이규백 ( Lee Gyu Baeg ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.1

배 경 : 고령인구의 증가와 함께 말기 신부전 환자가 빠르게 증가하여 건강문제로 대두되고 있다. 만성 신기능 부전에는 당뇨병, 고혈압, 사구체 신염 같은 질환이 중요한 위험인자로 알려져 있으며, 최근 들어서 생활습관과 관련된 비만, 흡연, 고지혈증 등이 신기능 감소의 잠재적인 위험인자로 추정되고 있다. 저자들은 건강진단을 시행한 65세 이상의 고령의 수검자에서 신기능부전의 유병률과 영향을 미치는 위험인자를 알아보고자 연구를 시행하였다. 방 법 : 건강진단을 시행받은 65세 이상 수검자 1,014명 중에 당뇨병, 고혈압, 요검사의 이상 및 기타 중증의 질환이 없는 수검자 631명을 (평균연령 69±4세, 남:여=362:270) 대상으로 하였다. 사구체 여과율은 MDRD 연구에서 제안된 공식을 이용하여 측정하였으며, 사구체 여과율이 60 mL/min/1.73㎡ 미만인 경우를 신기능 부전으로 정의하였다. 대상 고령의 수검자의 체질량 지수, 혈압, 공복시 혈당, 혈중 지질농도, Lipoprotein(a) (Lp(a)), hs C-reactive protein (hs CRP), 흡연 등을 측정하여 신기능 부전에 대한 위험인자를 보기 위하여 회귀분석을 시행하고, odds ratio를 구하였다. 결 과 : 고령의 수검자에서 평균 사구체 여과율은 68.0±12.5 mL/min/1.73㎡ (남자 69.7±12.5, 여자 65.8±12.0)이었으며, 26% (남자 21%, 여자 33%)에서 신기능 부전이 있었다. 신기능 부전군 (n=165)과 정상군(n=467) 사이에 연령, 체질량지수, 수축기 혈압, 혈중 지질농도, Lp (a), hs CRP가 유의하게 차이가 있었다 (p<0.05). 여러 위험인자들을 회귀분석하고, odds ratio를 구한 결과 나이에 따른 odds ratio는 1.12 (95% CI 1.03-1.21, p=0.01), 체질량 지수에 따라서 1.17 (95% CI 1.04-1.31, P=0.01), 남자에서 흡연에 따라서 4.03 (95% CI 1.01-16.14, p=0.04)로 유의한 차이를 보였다. 결 론 : 당뇨병, 고혈압, 요검사의 이상 및 기타 중증의 질환이 없는 고령의 수검자에서 사구체 여과율은 평균 68.0±12.5 mL/min/1.73㎡ (남자 69.7±12.5, 여자 65.8±12.0)이었으며, 신기능 부전이 약 26%로 높은 유병률을 보여주고 있다. 고령인구에서 기존의 당뇨병, 고혈압 및 사구체 질환을 제외하고도 연령, 비만 및 남자에서 흡연이 신기능 감소와 연관이 있었다. Background : The effects of aging on kidney are anatomic and physiologic abnormality. The most important abnormality is the decreased GFR. Hypertension, diabetes and glomerular disease are the most important risk factors of renal damage. Previous evidence suggested that obesity, smoking and hyperlipidemia progress the renal disease in diabetic nephropathy and glomerular disease. However, it is unclear whether these factors are independently associated with renal insufficiency (GFR <60 mL/min/1.73m²). Methods : A total of 1,014 elderly (over 65 years) who participated in health screening examinations in Seoul, Korea was eligible for study. Those who had hypertension, diabetes, urinary abnormality and major disease (cardiovascular disease, cancer, etc) were excluded. Finally, a total of 632 elderly population (age 68.8±3.9 yr, M:F=362:270) was included in the analysis for the present study. Estimated GFR was calculated using the abbreviated MDRD equation. Bo요 mass index (BMI), blood pressure, fasting blood sugar, lipid study, Lp (a), hs CRP and smoking habit were measured. Logistic regression analysis was used to examine the risk factors of renal insufficiency. Results : The mean serum creatinine value was 1.04±0.16 mg/dL (male 1.12±0.13, female 0.94±0.13) and mean estimated GFR was 68.0±12.5 mL/min/ 1.73m² (male 69.7±12.5, female 65.8±12.0). The prevalence of renal insufficiency was 26%. In renal insufficiency group (n=165), age, BMI, systolic blood pressure, total cholesterol, LDL-cholesterol, Lp (a) and hs CRP were greater than normal renal function group (n=467). After adjusting for potential confounding factor, age (odds ratio=1.12, CI 1.04-1.21, p<0.01), BMI (odds ratio=1.17, CI 1.04-1.31, p=0.01) and smoking in man (odds ratio=4.03, CI 1.04-16.04,p=0.04) were significantly associated with renal insufficiency. Conclusion : Mean estimated GFR was 68.0±12.5 mL/min/1.73m² (male 69.7±12.5, female 65.8±12.0) in elderly population. The prevalence of renal insufficiency was 26%. This study suggests overweight and smoking may be associated with renal insufficiency in the elderly population. (Korean J Nephrol 2004;23(1):75-81)

Renal and abdominal visceral complications after open aortic surgery requiring supra-renal aortic cross clamping

Shin-Seok Yang,Keun-Myoung Park,Young-Nam Roh,Yang Jin Park,Dong-Ik Kim,Young-Wook Kim 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.83 No.3

Purpose: The aim of this study was to assess renal or abdominal visceral complications after open aortic surgery (OAS) requiring supra-renal aortic cross clamping (SRACC). Methods: We retrospectively reviewed the medical records of 66 patients who underwent SRACC. Among them, 17 followed supra-celiac aortic cross clamping (SCACC) procedure, 42 supra-renal, and 7 inter-renal aorta. Postoperative renal, hepatic or pancreatic complications were investigated by reviewing levels of serum creatinine and hepatic and pancreatic enzymes. Preoperative clinical and operative variables were analyzed to determine risk factors for postoperative renal insufficiency (PORI). Results: Indications for SRACC were 25 juxta-renal aortic occlusion and 41 aortic aneurysms (24 juxta-renal, 12 supra-renal and 5 type IV thoraco-abdominal). The mean duration of renal ischemic time (RIT) was 30.1 ± 22.2 minutes (range, 3 to 120 minutes). PORI developed in 21% of patients, including four patients requiring hemodialysis (HD). However, chronic HD was required for only one patient (1.5%) who had preoperative renal insufficiency. RIT ≥ 25 minutes and SCACC were significant risk factors for PORI development by univariate analysis, but not by multivariate analysis. Serum pancreatic and hepatic enzyme was elevated in 41% and 53% of the 17 patients who underwent SCACC, respectively. Conclusion: Though postoperative renal or abdominal visceral complications developed often after SRACC, we found that most of those complications resolved spontaneously unless there was preexisting renal disease or the aortic clamping time was exceptionally long.

Insufficient early renal recovery and progression to subsequent chronic kidney disease in living kidney donors

Yaerim Kim,Eunjeong Kang,Dong-Wan Chae,Jung Pyo Lee,Sik Lee,Soo Wan Kim,Jang-Hee Cho,Miyeun Han,Seungyeup Han,Yong Chul Kim,Dong Ki Kim,Kwon Wook Joo,Yon Su Kim,Hajeong Lee 대한내과학회 2022 The Korean Journal of Internal Medicine Vol.37 No.5

Background/Aims: Renal recovery of a kidney donor after undergoing nephrectomy though challenging is essential. We aimed to examine the effect of estimated glomerular filtration rate (eGFR) percent change at 1-month post-donation on insufficient kidney function after kidney donation. Methods: A total of 3,952 living kidney donors who underwent donor nephrectomy from 1982 to 2019 from eight different tertiary hospitals in Korea were initially screened. Percent changes in the eGFR from baseline to 1-month post-donation were calculated. The degree of percent changes was categorized by quartile, and the 1st quartile was regarded as the group with the lowest decreased eGFR at 1-month after donation. The remaining eGFR less than 60 mL/min/1.73 m2 was the endpoint. The Cox proportional hazard model was used for evaluating the impact of initial eGFR and eGFR percent change at 1-month post-donation on the condition with remaining eGFR < 60 mL/min/1.73 m2. In the multivariate analysis, we used variables with a p < 0.1 in the univariate analysis. Results: A total of 1,585 donors were included in the analysis. During 62.2 ± 49.3 months, 13.7% of donors showed renal insufficiency. The 4th (adjusted hazard ratio [aHR], 10.41; 95% confidence interval [CI], 5.15 to 21.04) and the 3rd (aHR, 4.29; 95% CI, 2.15 to 8.56) quartiles of percent change in eGFR and the pre-donation eGFR (aHR, 0.90; 95% CI, 0.88 to 0.92) were associated with the development of renal insufficiency. Conclusions: The impact of worse initial renal recovery on renal insufficiency was pronounced in donors with lower pre-donation eGFRs. Additionally, worse initial renal recovery of remaining kidney affected the long-term development of renal insufficiency in kidney donors.

Effect of Renal Insufficiency on Stone Recurrence in Patients with Urolithiasis

강호원,서성필,김원태,김용준,윤석중,이상철,김원재 대한의학회 2014 Journal of Korean medical science Vol.29 No.8

The study was designed to assess the relationship between glomerular filtration rate (GFR)and urinary stone-forming constituents, and to assess the effect of renal insufficiency onstone recurrence risk in first stone formers (SF). Baseline serum creatinine levels wereobtained, and renal insufficiency was defined as creatinine clearance ≤ 60 mL/min(Cockroft-Gault). This retrospective case-control study consists of 342 first SF; 171 SF withnormal renal function were selected with 1:1 propensity scores matched to 171 SF withrenal insufficiency. Urinary metabolic evaluation was compared to renal function. GFR waspositively correlated with urinary calcium, uric acid, and citrate excretion. Subjects withrenal insufficiency had significantly lower urinary calcium, uric acid, and citrate excretionthan those with normal renal function, but not urine volume. With regard to urinarymetabolic abnormalities, similar results were obtained. SF with renal insufficiency hadlower calcium oxalate supersaturation indexes and stone recurrence rates than SF withnormal renal function. Kaplan-Meier curves showed similar results. In conclusion, GFRcorrelates positively with urinary excretion of stone-forming constituents in SF. This findingimplies that renal insufficiency is not a risk factor for stone recurrence.

혈압 조절이 당뇨병성 만성 신부전증의 진행속도에 미치는 영향

박인석 ( Park In Seog ),박주현 ( Park Ju Hyeon ),이승헌 ( Lee Seung Heon ),안석주 ( An Seog Ju ),양철우 ( Yang Cheol U ),김석영 ( Kim Seog Yeong ),장윤식 ( Jang Yun Sig ),윤영석 ( Yun Yeong Seog ),손호영 ( Son Ho Yeong ),방병기 ( 대한내과학회 1993 대한내과학회지 Vol.44 No.6

연구 배경 : 당뇨병성 신증은 신 대치요법을 필요로 하는 주요 원인이며, 그 빈도가 증가추세에 있고, 말기 신부전으로의 진행이 필연적이므로 사구체의 손상에 대한 위험 요소들을 조절하여 신부전의 진행속도를 저하시키려는 노력이 필요하다. 그 중 고혈압의 조절이 그 진행속도를 늦출 수 있다는 여러 임상보고 및 동물실험의 증거가 있으나, 적정 혈압의 목표에 대해서는 알려져 있지 않다. 이에 저자들은 혈압 조절이 당뇨병성 만성 신부전증의 진행속도에 미치는 영향을 관찰하였다. 방법 : 가톨릭 의과대학에서 당뇨병성 만성 신부전증으로 진단받고 보존적인 치료를 받고 있는 6개월 이상 추적이 가능했던 환자 30명을 대상으로 내원시마다 측정된 혈압과 혈청 크레아티닌을 조사하였다. 또한 추적기간을 평균동맥압에 따라 3개의 period로 나누고 각 peirod에서의 신기능의 진행속도를 혈청 크레아티닌의 역수와 시간과의 상관계수로 계산하였다. 결과 : 혈청 크레아티닌의 증가치와 그 역수의 감소로 본 평균 동맥압에 따른 신부전증의 진행속도는 각각 A period(평균동맥압?105mmHg)에서 0.0797±0.0286mg/dl/month, -0.0079±0.0018dl/mg/month, B period(105<평균동맥압<115mmHg)에서0.2224±0.0976mg/dl/month, -0.0430±0.0093dl/mg/month, C period(평균동맥압?115mmHg)에서 0.2731±0.0452mg/dl/month, -0.0434±0.0073dl/mg/month였으며, 모두 평균동맥압이 105mmHg 이하일때 의미있게 신부전의 진행속도가 감소되었다(p<0.0). 결론 : 이상의 성적으로 보아 당뇨병성 만성 신부전증환자에서 평균 동맥압을 적어도 105mmHg 이하로 유지하는 것이 신부전의 진행속도를 감소시키는데 중요하다고 사료된다. Background : Dabetic nephropathy is considered as the main cause of end stage renal disease which needs the renal replacement therapy. The adequate control of blood pressure is known important to reduce the progression rate of renal function in patients with diabetic renal insufficiency. We investigate the effect of blood pressure control on the progression rate of renal function in 30 patients with diabetic renal insufficiency. Method : We divided the observation time to 3 periods arbitarily according to degree of blood pressure control. The progression rate of renal function was measured by the monthly changs of serum creatinine concentration and reciprocal serum creatinine concentration. Result : The monthly changes in serum creatinine concentration in A period (MBP?105mmHg), B period (105mmHg<MBP?115mmHg) and C period (MBP?115mmHg) were 0.0797±0.0286, 0.2224±0.0976 and 0.2731±0.0452mg/dl/month, respectively. The monthly changes in reciprocal serum creatinine concentrations in A, B, C period were -0.0079±0.0018, -0.0430±0.0093 and -0.0434±0.0073dl/mg/month respectively. The monthly changes in serum creatinine concentrations and reciprocal serum creatinine concentrations in A period were significantly low compared with B and C periods. Conclusion : The results may suggest that adequate control of mean blood pressure below 105mmHg is important to reduce the progression rate of renal function in patients with diabetic renal insufficiency.

Role of Soluble ST2 as a Prognostic Marker in Patients with Acute Heart Failure and Renal Insufficiency

김민석,정태동,한승봉,민원기,김재중 대한의학회 2015 Journal of Korean medical science Vol.30 No.5

This study sought to assess the relationship between serum concentrations of the soluble ST2 (sST2) and B-type natriuretic peptide (BNP) and investigate the role of sST2 as a prognosticator in patients hospitalized with acute heart failure (HF) and renal insufficiency. sST2 was measured at admission and discharge in 66 patients hospitalized with acute decompensated HF and renal insufficiency (estimated glomerular filtration rate [eGFR] < 90 mL/min/1.73 m2) using a high sensitivity immunoassay. BNP was sampled at the same time and compared to sST2. Demographical, biochemical, and echocardiographic data were also obtained during hospitalization.There were positive correlations between sST2 and BNP levels at admission (r = 0.330, P = 0.007) and at discharge (r = 0.320, P = 0.009) in overall patients. However, there was no correlation between them at each timepoint in patients with severe renal insufficiency (eGFR < 30 mL/min/1.73 m2, n = 17). sST2 level was not changed with the degree of renal function, even though BNP level was much higher in patients with severe renal insufficiency. During 3 month follow-up, 9 (13.6%) died and 16 (24.2%) were readmitted due to HF aggravation.On multivariate analysis, sST2 at discharge was independently associated with death or HF readmission during 3 months after discharge (hazard ratio, 1.038; 95% confidence interval, 1.011-1.066, P = 0.006). In conclusion, sST2 is not affected by renal function compared with BNP in acute HF patients. The measurement of predischarge sST2 can be helpful in predicting short-term outcomes in acute decompensated HF patients with renal insufficiency.

Comparison of drug-eluting versus bare-metal stent implantation in ST-elevation myocardial infarction patients with renal insufficiency: Results from the national registry in Korea

Kim, K.H.,Koo, B.K.,Min, H.S.,Park, S.K.,Kim, C.H.,Park, K.W.,Park, B.J.,Jeong, M.H.,Cho, M.C.,Lee, S.R.,Chae, S.C.,Seong, I.W.,Choi, D.J.,Kim, H.S. Elsevier/North-Holland Biomedical Press 2012 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.154 No.1

Introduction: It is unknown whether drug-eluting stents (DES), in comparison with bare-metal stents (BMS), improve clinical outcomes of ST-elevation myocardial infarction (STEMI) patients with renal insufficiency. We aimed to compare the clinical outcomes of BMS versus DES, as well as sirolimus-eluting stents (SES) versus paclitaxel-eluting stents (PES), in STEMI patients with renal insufficiency. Methods: From the Korea Acute Myocardial Infarction Registry, 874 STEMI patients with renal insufficiency (glomerular filtration rate <60ml/min) comprising 116 patients with BMS and 758 patients with DES (430 SES and 328 PES) implantation were selected. Major adverse cardiac events (MACE) within 1year, defined as composite of all-cause mortality, nonfatal myocardial infarction and target lesion revascularization were compared. In addition to multivariate adjusted analysis, propensity analysis for stent choice was performed. Results: With a median follow-up of 342days, 116 MACE occurred. MACE was more frequent in the BMS group than in the DES group before (HR [95% CI]=2.3 [1.3-3.8]) and after propensity score matching (HR [95% CI]=2.0 [1.0-3.8]). The difference of MACE was mainly driven by a higher rate of target lesion revascularization rate in the BMS group. In comparison between SES and PES, there was no significant difference between the 2 groups in propensity score-matched populations (HR [95% CI]=0.7 [0.4-1.1]). Conclusions: In STEMI patients with renal insufficiency, DES implantation exhibits a favorable 1year clinical outcomes than BMS implantation, however, no difference was found between SES and PES.

The Incidence and Risk Factors of Renal Insufficiency among Korean HIV infected Patients: The Korea HIV/AIDS Cohort Study

Kim Jun Hyoung,Jang Heeseon,Kim Jung Ho,Song Joon Young,Kim Shin-Woo,Kim Sang Il,Choi Bo Youl,Choi Jun Yong 대한감염학회 2022 Infection and Chemotherapy Vol.54 No.3

Renal insufficiency is one of the common issues in people living with human immunodeficiency virus (PLHIV). We studied the incidence and risk factors for renal insufficiency in male PLHIV using the Korea HIV/acquired immunodeficiency syndrome (AIDS) Cohort Study. Among the 830 enrolled patients, 32 (3.9%) cases of renal insufficiency occurred over 9576 patient-years of follow-up. The incidence of renal insufficiency in HIV-infected men in this study was 3.3 per 1000 patient-years. Diabetes mellitus, dyslipidemia, tenofovir or non-nucleoside reverse transcriptase inhibitor exposure for >1 year, and AIDS-defining illness were risk factors for renal insufficiency.

Changes in Renal Function After Laparoscopic Partial Nephrectomy: Comparison With Laparoscopic Radical Nephrectomy

강수환,류현열,김택상 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.1

Purpose: To evaluate alterations in renal function after laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN) for renal tumors. Materials and Methods: From March 2008 to August 2011, we performed 175 cases of laparoscopic kidney resection. Among these, we excluded patients who received perioperative immunotherapy or target therapy and also patients with a preoperative estimated glomerular filtration rate (eGFR) <60 mL/min. A total of 32 patients undergoing LPN and 92 patients undergoing LRN were enrolled. We retrospectively reviewed the changes in eGFR (by the modification of diet in renal disease method) at the following time points: preoperative, postoperative 1 week, and postoperative 1, 3, 6, and 12 months. Results: The mean warm ischemia time of the LPN group was 22 minutes range, 0 to 47 minutes). Mean eGFR values (mL/min/1.73 m2) during postoperative week 1 and 1, 3, 6, and 12 months were 70.8, 71.5, 76.7, 76.0, and 75.3 in the LPN group and 52.1, 50.6, 52.8, 53.4, and 52.4 in the LRN group, respectively. One year after the operation, 6.3% (2 patients) of LPN patients and 68.5% (63 patients) of LRN patients had progressed to chronic renal insufficiency (eGFR<60 mL/min/1.73 m2). Conclusions: Renal function recovered slightly after LPN and LRN and was maintained constantly after 3 months. However, renal function showed different patterns of decrease. Despite the concern for warm ischemia, LPN can preserve renal function better than can LRN. LPN should be considered for selected patients to prevent hronic renal insufficiency.