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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.
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.
Mi Jeoung Kim,Hyang Mo Koo,Woo Joo Lee,Jin Hwan Choi,Mi Nyong Choi,Sang Young Park,Woo Jung Kim,Seung Yeon Son 대한가정의학회 2016 Korean Journal of Family Medicine Vol.37 No.5
Diagnoses of pyelonephritis caused by Staphylococcus aureus should be accompanied by investigations of con-comitant bladder obstruction and metastatic infections, especially to the spine or heart. Complicated pyelonephri-tis due to S. aureus requires more than 2 weeks of antibiotics, which is the typically recommended treatment dura-tion for pyelonephritis. We describe a patient who was diagnosed with complicated epidural and paraspinal ab-scesses after insufficient evaluation and treatment of acute pyelonephritis due to S. aureus. A 62-year-old man with type 2 diabetes was admitted with fever, increased urinary frequency, and left flank pain. He was diagnosed with acute pyelonephritis caused by S. aureus. His fever and flank pain subsided after 3 days of intravenous antibiotics. Evaluation of bladder obstruction and metastatic infection were not performed, as he declined further evaluation. The patient was discharged with oral antibiotics and was requested to attend weekly appointments but was lost to follow-up. One month later, the patient presented at the outpatient clinic with similar symptoms. Computed to-mography showed recurrent pyelonephritis and a distended bladder. His flank pain persisted despite administra-tion of an opioid agent. Therefore, magnetic resonance imaging was performed, revealing epidural and paraspinal abscesses. Ultrasound-guided aspiration of the paraspinal muscle layer was performed, and blood and percutane-ous aspirated fluid cultures revealed S. aureus growth. The pattern of antimicrobial sensitivity was identical to that at his first admission. Following more than 4 weeks of antibiotics, magnetic resonance imaging showed the ab-scesses had decreased in size. The patient was discharged without neurologic sequelae and was provided with oral antibiotics.
Mild encephalopathy with a reversible splenial lesion in a girl with acute pyelonephritis
Yeom, Jung Sook,Koo, Chung Mo,Park, Ji Sook,Seo, Ji-Hyun,Park, Eun Sil,Lim, Jae-Young,Woo, Hyang-Ok,Youn, Hee-Shang The Korean Pediatric Society 2018 Clinical and Experimental Pediatrics (CEP) Vol.61 No.2
We report the case of a 12-year-old girl who had mild encephalopathy with a reversible splenial lesion (MERS) associated with acutepyelonephritis caused by Escherichia coli. The patient was admitted with a high fever, and she was diagnosed with acute pyelonephritis based on pyuria and the results of urine culture, which detected cefotaxime-sensitive E. coli. Although intravenous cefotaxime and tobramycin were administered, her fever persisted and her C-reactive protein level increased to 307 mg/L. On day 3 of admission, she demonstrated abnormal neuropsychiatric symptoms, such as delirium, ataxia, and word salad. Magnetic resonance imaging (MRI) of the brain performed on day 4 showed marked hyperintensities in the bilateral corpus callosum and deep white matter on diffusion-weighted images, with corresponding diffusion restriction on apparent diffusion coefficient mapping. No abnormalities or pathogens were detected in the cerebrospinal fluid; however, lipopolysaccharides (LPS, endotoxin) were detected in plasma (41.6 pg/mL), associated with acute neurological deterioration. Her clinical condition gradually improved, and no neurological abnormalities were observed on day 6. Follow-up brain MRI performed 2 weeks later showed near-disappearance of the previously noted hyperintense lesions. In this patient, we first proved endotoxemia in a setting of MERS. The release of LPS following antibiotic administration might be related to the development of MERS in this patient. The possibility of MERS should be considered in patients who present with acute pyelonephritis and demonstrate delirious behavior.
증례 : 혈액종양 ; 가돌리늄 기반 조영제 주입 후에 발생한 신성 전신 섬유화증 1예
홍민희 ( Min Hee Hong ),구향모 ( Hyang Mo Koo ),최준정 ( Jun Jeong Choi ),안정련 ( Jung Ryun Ahn ),전홍재 ( Hong Jae Chon ),김찬 ( Chan Kim ),이승태 ( Seung Tae Lee ) 대한내과학회 2010 대한내과학회지 Vol.78 No.1
신성 전신 섬유화증은 가돌리늄 제제에 노출된 신부전 환자에게서 나타날 수 있는 전신성 질환으로, 예후가 불량하며 특별한 치료방법이 없으므로 예방이 중요한 질환이다. 저자들은 국내에서 최초로 보고하는 바이다. Nephrogenic systemic fibrosis is a rare multisystemic disorder mainly affecting the skin and joints in patients with underlying renal insufficiency exposed to gadolinium-based contrast. We report a patient who had renal insufficiency caused by multiple myeloma and developed nephrogenic systemic fibrosis after exposure to gadolinium-based contrast for the first time in Korea. (Korean J Med 78:127-131, 2010)
대장내시경 전처치로 Picosulfate Sodium/Magnesium Citrate 사용 후 발생한 혼수를 동반한 급성 저나트륨혈증 1예
김우중 ( Woojung Kim ),박상영 ( Sang Young Park ),김미정 ( Mi Jeoung Kim ),구향모 ( Hyang Mo Koo ) 대한내과학회 2016 대한내과학회지 Vol.91 No.2
결론적으로, PS/MC는 효과적인 대장내시경 전처치제이나 장점막에 미세한 염증반응을 일으키거나, 삼투 효과에 의한 장점막에서의 수분과 전해질의 이동, 메스꺼움 등 비삼투성자극을 통한 ADH 과분비를 유발함으로써 저나트륨혈증 등의 전해질 불균형이 발생할 수 있다. 따라서 고령, 갑상선기능저하증, 기저 심장/신장/간질환이 있는 환자에게 처방시 특별한 주의가 요구되며, 갑작스러운 혈장량의 감소가 발생하지 않도록 전처치시 적절한 수분섭취를 교육하는 것이 중요하다. 그러나 비교적 맛과 용량 면에서 순응도가 높은 하제임에도 PS/MC가 위팽만이나 구역, 구토를 유발할 수 있고 항진된 장운동 자체도 비삼투성 자극체로서 ADH를 상당 수준과발현시켜 의식 소실이나 신경학적 이상을 유발할 정도의 심각한 저나트륨혈증이 발생할 수 있으며, 이것이 탈수나 기타 위험 인자가 없는 상황에서도 충분히 합병될 수 있음을 의료진이 인지하여, 3% 고장성 식염수나 항경련제 등의 치료가 시기적절하게 진행될 수 있도록 하는 것이 중요하겠다. Picosulfate sodium/Magnesium citrate (PS/MC) is a common bowel cleansing agent for colonoscopy. It is equally effective and better tolerated by patients with regard to taste and volume than polyethylene glycol. However, because of its osmotically active characteristics, PS/MC can cause plasma volume depletion and electrolyte disturbances, such as hyponatremia. Here, we report a case of severe hyponatremia combined with loss of consciousness in a 59-year-old woman following ingestion of PS/MC as bowel preparation for a screening colonoscopy. Upon arrival, serum sodium level was 109 mEq/L and urine osmolality and sodium levels were 393 mOms/Kg and 99 mmol/L, respectively. She was euvolemic and showed normal kidney, thyroid, and adrenal function. Based on these findings, inappropriate anti-diuretic hormone syndrome (SIADH) was diagnosed. She was treated with 3% hypertonic saline and completely recovered without any neurologic sequelae. This case shows that SIADH can be caused by PS/MC (not accompanied by dehydration), even in patients without any underlying renal, heart, or liver diseases. (Korean J Med 2016;91:206-210)
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>