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도화미 ( Fa Mee Doh ),장선정 ( Seon Jung Jang ),구향모 ( Hyang Mo Koo ),김은진 ( Eun Jin Kim ),신혜선 ( Hye Sun Shin ),한승혁 ( Seung Hyeok Han ),강신욱 ( Shin Wook Kang ),최규헌 ( Kyu Hun Choi ),유태현 ( Tae Hyun Yoo ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.4
We report a case of patient with malignant thymoma, who developed nephrotic syndrome several years after thymectomy. This 38-year-old man was diagnosed as myasthenia gravis and malignant thymoma and underwent thymectomy in 2004. Tumor resection and systemic chemotherapy were performed after recurrence in pleura in 2006. He also took pyridostigmine to control his symptoms of myasthenia gravis after thymectomy. Four years later, even though there was no evidence of recurrence of thymoma, he developed a nephrotic syndrome and was diagnosed as a minimal change disease on renal biopsy. After pulse therapy with methylprednisolone followed by oral administration of prednisolone therapy, nephrotic syndrome was improved.
Interdialytic Weight Gain and Cardiovascular Outcome in Incident Hemodialysis Patients
Lee, Mi Jung,Doh, Fa Mee,Kim, Chan Ho,Koo, Hyang Mo,Oh, Hyung Jung,Park, Jung Tak,Han, Seung Hyeok,Yoo, Tae-Hyun,Kim, Yong-Lim,Kim, Yon Su,Yang, Chul Woo,Kim, Nam-Ho,Kang, Shin-Wook S. Karger AG 2014 American journal of nephrology Vol.39 No.5
<P>Abstract</P><P><B><I>Background:</I></B> Interdialytic weight gain (IDWG) has been regarded as a surrogate of volume overload, but also as a marker of a better nutritional status in end-stage renal disease (ESRD) patients on hemodialysis (HD). This paradoxical meaning of IDWG requires further investigation, particularly in adverse cardiovascular outcomes. <B><I>Methods:</I></B> A prospective cohort of 1,013 incident HD patients from 36 HD centers of the Clinical Research Center for ESRD in Korea was included. Patients were categorized into five groups according to the IDWG%, a ratio of absolute IDWG to dry weight: <1.0, ≥4.0, and every 1.0 increment in between. Primary outcome was major adverse cardiac and cerebrovascular events (MACCE). <B><I>Results:</I></B> During a mean follow-up of 18.7 months, primary outcome was observed in 104 patients (10.3%). In multivariate analysis, compared to patients with IDWG% of 1.0-1.9 (reference group), the hazard ratios (HRs) for primary outcome in the IDWG% <1.0, 2.0-2.9, 3.0-3.9, and ≥4.0 groups were 1.10 [95% confidence interval (CI) 0.55-2.20, p = 0.80], 1.15 (95% CI 0.59-2.27, p = 0.68), 1.80 (95% CI 0.95-3.41, p = 0.07), and 1.93 (95% CI 1.02-3.64, p = 0.04), respectively. Furthermore, even when residual renal function and 24-hour urine volume were adjusted, IDWG% ≥4.0 remained as a significant predictor of primary outcome (HR 2.03, 95% CI 1.02-4.02, p = 0.04). <B><I>Conclusion:</I></B> Increased IDWG% is a significant independent predictor of MACCE in incident HD patients. It could be helpful to prevent excessive IDWG for improving clinical outcomes in incident HD patients.</P><P>© 2014 S. Karger AG, Basel</P>
복막투석 환자에서 발생한 Chryseobacterium meningosepticum 복막염 1예
구향모 ( Hyang Mo Koo ),도화미 ( Fa Mee Doh ),김은진 ( Eun Jin Kim ),강이화 ( Ea Wha Kang ),신석균 ( Suk Kyun Shin ),장태익 ( Tae Ik Chang ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.3
Chryseobacterium meningosepticum is rarely encountered as a pathogen causing peritonitis in peritoneal dialysis (PD) patients. We report a case of peritonitis due to Chryseobacterium meningosepticum, which was treated successfully with intraperitoneal (IP) vancomycin and ciprofloxacin, and without PD catheter removal. Peritonitis was developed in a 53-year-old PD patient on the third hospital day. Although empirical IP treatment with cefazolin and tobramycin was initiated and maintained for 3 days, the fever and signs of peritonitis persisted. Antibiotics were changed to cefoperazone/sulbactam, amikacin, and vancomycin due to clinical deterioration. After 3 days of vancomycin use, leukocyte count in PD fluid was less than 100/mm3 and the patient became asymptomatic. On seventh day after the onset of peritonitis, Chryseobacterium meningosepticum was isolated from initial dialysate sample, and this strain was susceptible to ciprofloxacin, piperacillin, and piperacillin/tazobactam. Accordingly, we changed the antibiotics to ciprofloxacin and vancomycin, which were given for the total of 14 days. Even though Chryseobacterium meningosepticum is an uncommon causative organism of peritonitis in PD patients, this report suggests that vancomycin and ciprofloxacin are effective as empiric therapy, and early suspicion and appropriate antimicrobial therapy are crucial to the successful treatment of peritonitis due to Chryseobacterium meningosepticum without catheter removal.
( Kwang Il Ko ),( Mi Jung Lee ),( Fa Mee Doh ),( Hyang Mo Koo ),( Chan Ho Kim ),( Dong Ho Shin ),( Hyung Jung Oh ),( Seung Hyeok Han ),( Shin Wook Kang ),( Kyu Hun Choi ),( Tae Hyun Yoo ) 대한신장학회 2013 Kidney Research and Clinical Practice Vol.32 No.3
A 74-year-old woman presented with edema in the lower extremities. Laboratory tests revealed anemia, thrombocytopenia, hypoalbuminemia, hypercholesterolemia, and nephrotic-range proteinuria. Myelodysplastic syndrome-refractory cytopenia with multilineage dysplasia (MDS-RCMD) was confirmed by bone marrow biopsy. Renal biopsy demonstrated membranous glomerulonephritis (MGN), stage I. Based on these clinicopathologic results, she was diagnosed as having MGN with MDS-RCMD. This is a rare case report of MGN in a parient with MDS-RCMD featuring nephrotic syndrome.
Ko, Kwang Il,Park, Kyoung Sook,Lee, Mi Jung,Doh, Fa Mee,Kim, Chan Ho,Koo, Hyang Mo,Oh, Hyung Jung,Park, Jung Tak,Han, Seung Hyeok,Kang, Shin-Wook,Yoo, Tae-Hyun S. Karger AG 2014 American journal of nephrology Vol.40 No.4
<P>Abstract</P><P><B><I>Background:</I></B> The aim of this study was to investigate the association between the dialysate MCP-1 (dMCP-1) and systemic inflammatory and nutritional markers in peritoneal dialysis (PD) patients. In addition, we examined the prognostic value of dMCP-1 on all-cause or cardiovascular mortality in these patients. <B><I>Methods:</I></B> We prospectively followed 169 prevalent PD patients from April 1st 2008 to December 31st 2012. At baseline, dMCP-1 and serum biochemical parameters including high sensitivity CRP (hs-CRP) and albumin were checked. All-cause mortality and cause of death were evaluated during the follow-up period. Based on the median level of dMCP-1, patients were classified as either low or high dMCP-1 groups. <B><I>Results:</I></B> Mean age, hs-CRP, and D/Pcr ratio at 4 h were significantly higher, while serum albumin levels and %lean body mass (LBM) were significantly lower in the high dMCP-1 group. During the mean follow-up period of 47.7 months, all-cause mortality and cardiovascular mortality rate were significantly higher in the high dMCP-1 group (9.6 and 6.3 per 100 person-years, respectively) compared to the low dMCP-1 group (5.1 and 3.1 per 100 person-years, respectively; p = 0.021, 0.038). In multivariate Cox analysis, high dMCP-1 was a significant independent predictor of all-cause mortality (hazard ratio: 1.83, 95% confidence interval: 1.03-3.24, p = 0.039). <B><I>Conclusions:</I></B> dMCP-1 levels are closely correlated with nutritional and systemic inflammatory markers in PD patients. In addition, increased dMCP-1 is significantly associated with higher all-cause and cardiovascular mortality. These findings suggest that local peritoneal inflammation could contribute to poor clinical outcomes in PD patients.</P><P>© 2014 S. Karger AG, Basel</P>
신혜선,홍지영,한정우,도화미,김기정,김도영,안상훈,최기홍 영남대학교 의과대학 2011 Yeungnam University Journal of Medicine Vol.28 No.2
Obstruction of the bile duct owing to the direct extension of a tumor is occasionally found in patients with a hepatic neoplasm, but bile duct tumor thrombus caused by the intrabiliary transplantation of a free-floating tumor is a rare complication of hepatocellular carcinoma. A 50-year-old woman was diagnosed with HCC with bile duct tumor thrombi. She received transarterial chemoembolization (TACE) because her liver function was not suitable for surgery at the time of diagnosis. After TACE, infected biloma occurred recurrently. Thus, resection of the HCC, including the bile duct tumor thrombi, was performed. Six months after the surgery, recurred HCC in the distal common bile duct as drop metastasis was noted. The patient was treated with tomotherapy and has been alive for three years as of this writing, without recurrence. The prognosis of HCC with bile duct tumor thrombi is considered dismal, but if appropriate procedures are selected and are actively carried out, long-term survival can occasionally be achieved.
구향모 ( Hyang Mo Koo ),김은진 ( Eun Jin Kim ),도화미 ( Fa Mee Doh ),강신욱 ( Shin Wook Kang ),최규헌 ( Kyu Hun Choi ),유태현 ( Tae Hyun Yoo ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.2
Renal anemia is a common complication of chronic kidney disease and known to be caused by erythropoietin or iron deficiency. However, erythrocytosis in patients on dialysis has rarely been reported and usually associated with renal cell carcinoma, polycythemia vera or acquired cystic kidney disease. Here we report a case of erythrocytosis in an ESRD patient with resolution after kidney transplantation. A 38-year-old man on peritoneal dialysis for 5 years was admitted for kidney transplantation. On admission, blood Hgb and Hct was 19.7 g/dL and 61.4%, respectively. Serum erythropoietin level was 347 mIU/mL. Multiple variable sized cystic lesions were identified on both kidneys without evidence of internal malignancy in abdomen and pelvis CT scan. After kidney transplantation, Hgb was 12.5 g/dL and serum erythropoietin level was 13.1 mIU/mL. Some of renal cysts on CT scan disappeared or decreased in size. This finding suggests that erythrocytosis in this patient can be associated with acquired cystic kidney disease.
Oh, Hyung Jung,Nam, Bo Young,Lee, Mi Jung,Kim, Chan Ho,Koo, Hyang Mo,Doh, Fa Mee,Han, Jae Hyun,Kim, Eun Jin,Han, Ji Suk,Park, Jung Tak,Yoo, Tae-Hyun,Kang, Shin-Wook,Han, Dae-Suk,Han, Seung Hyeok International Society for Peritoneal Dialysis 2015 Peritoneal dialysis international Vol.35 No.1
<P>♦ <I>Introduction:</I> It has been reported that klotho deficiency is associated with oxidative stress and inflammation in experimental kidney disease models. Patients with endstage renal disease (ESRD) are particularly characterized by increased oxidative stress and inflammation. However, little is known about the relationship between these features and klotho in patients with ESRD.</P><P>♦ <I>Methods:</I> We conducted a single-center, cross-sectional study of 78 patients receiving peritoneal dialysis (PD). Serum concentrations of klotho, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and 8-isoprostane were measured by enzyme-linked immunosorbent assay. To define factors independently associated with klotho, we determined Spearman’s correlation coefficients for between co-variates and conducted multiple linear regression analyses.</P><P>♦ <I>Results:</I> Patients were classified by median concentration of klotho. In patients with klotho levels > 329.6 pg/mL, serum 8-isoprostane and IL-6 levels were significantly higher than in those with klotho levels < 329.6 pg/mL. In correlation analyses, log 8-isoprostane (γ = –0.310, <I>p</I> = 0.006) and log IL-6 (γ = –0.343, <I>p</I> = 0.002) were inversely correlated with log klotho. After adjustment for age, gender, mean arterial pressure, log intact parathyroid hormone, and log IL-6, log 8-isoprostane was independently associated with log klotho (β = –0.158, <I>p</I> = 0.040). However, the significant relationship between klotho and IL-6 was not seen in an adjusted model.</P><P>♦ <I>Conclusions:</I> This study showed that circulating klotho levels were significantly associated with 8-isoprostane levels in patients undergoing PD, suggesting a potential link between klotho deficiency and enhanced oxidative stress in ESRD patients.</P>
Clinical implication of crescentic lesions in immunoglobulin A nephropathy
Lee, Mi Jung,Kim, Seung Jun,Oh, Hyung Jung,Ko, Kwang Il,Koo, Hyang Mo,Kim, Chan Ho,Doh, Fa Mee,Yoo, Tae-Hyun,Kang, Shin-Wook,Choi, Kyu Hun,Lim, Beom Jin,Jeong, Hyeon Joo,Han, Seung Hyeok Oxford University Press 2014 Nephrology, dialysis, transplantation Vol.29 No.2
<P><B>Background</B></P><P>To date, there has been much controversy about the role of crescentic lesion as a significant prognostic factor in immunoglobulin A nephropathy (IgAN). This study evaluated whether crescentic lesions predict adverse renal outcomes in IgAN patients.</P><P><B>Methods</B></P><P>A total of 430 patients with biopsy-proven IgAN between January 2000 and December 2009 were included. Histological variables of the Oxford classification (Oxford-MEST) and the presence of crescents were assessed. The primary endpoint was a 50% decline in estimated glomerular filtration rate.</P><P><B>Results</B></P><P>Of the 430 patients, 81 (18.8%) had a crescentic lesion. During a mean follow-up of 61 months, the primary outcome occurred in 19 (23.5%) patients with crescents compared with 40 (11.5%) patients without crescents (P = 0.01). A Kaplan–Meier plot showed that the 10-year renal survival rate was significantly lower in patients with crescents than patients without crescents (P = 0.01). However, in a multivariable Cox analysis which included clinical factors and the Oxford-MEST, crescents were not significantly associated with an increased risk of developing the primary outcome [hazard ratio: 0.71, 95% confidence interval (CI) 0.36–1.41, P = 0.33]. Furthermore, adding crescents to the Oxford-MEST did not improve the discriminative ability for the prediction of renal outcomes [<I>c</I>-statistic: 0.86 (0.81–0.91) vs. 0.86 (0.80–0.91), P = 0.21].</P><P><B>Conclusion</B></P><P>Crescentic lesion was not an independent prognostic factor, suggesting that crescents have limited value in predicting renal outcomes of IgAN.</P>