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( Ha Nee Jang ),( Kyungo Hwang ),( Min Jeong Kim ),( Dae Hong Jeon ),( Hyun Jung Kim ),( Hyun Seop Cho ),( Se Ho Chang ),( Dong Jun Park ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
It is known that commonly prescribed drugs are associated with hemolytic uremic syndrome (HUS) manifested with microanigopathic hemolytic anemia (MAHA), thrombocytopenia, and acute renal failure. Rifampicin may cause hemolysis, thrombocytopenia, and acute renal failure. However, rifampicin associated HUS has been rarely reported. We report a case of HUS in a patient taking rifampicin. A 74-year-old woman was admitted to our hospital due to azotemia aggravation. Her previous medical history included leprosy (30yr), HT (5yr), and angina pectoris (5yr). Her medication has not been changed during recent 5 years except for recent start of rifampicin 450 mg per day 5 days before. Laboratory findings revealed MAHA, thrombocytopenia, elevated reticulocyte count and lactate dehydrogenase (LDH), and lower haptoglobin level. Her serum creatinine level was increased to 6.68 mg/dL. In addition to immediate withdrawal of rifampicin medication, three times of hemodialysis and ten times of consecutive plasma exchange improved her renal function and restored above abnormal laboratory findings. She is currently following to the outpatient clinic without renal impairment. We should keep in mind that rifampicin is one of drug to induce HUS.
S-474 Clinical and pathologic findings of IgA nephropathy in a Single Center
( Yire Kim ),( Ha Nee Jang ),( Tae Won Lee ),( Hyun Seop Cho ),( Se-ho Chang ),( Hyun-jung Kim ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1
Immunoglobulin A nephropathy (IgAN) is reported for the most common primary glomerulonephritis in South Korea and the major cause of end-stage renal disease. So, we would like to evaluate the clinical characteristics and the contributing factor for the prognosis of IgAN. We reviewed all the patients who had kidney biopsies with the diagnosis of IgAN during the period from January, 2009 to June, 2016 in the context of the clinical features. In total, 737 patients were received kidney biopsy. The most common primary GN was IgAN (54%) in our center, too. A total of 307 patients with IgAN were finally analyzed; 185 (60%) of the patients were male, the mean age of the patients was 41.97±18.47 (range 15-84) year-old and the mean duration of disease from the first symptom to the kidney biopsy was 20.7±16.8 days. Hypertension was present in 38 (12.4%) patients. Diabetes was present in 11 (3.6%) patients. The mean proteinuria level was 2.16± 2.36 g/day (median: 1.4 g/day) and the mean initial serum creatinine level was 1.66±1.98 mg/dL (median: 1.01 mg/dL). The morphological sub-classification was evaluated by Haas system. Class 3 was the most common 117 (38.1%), followed by class 4 63 (20.5%). The decreased of estimated glomerular filtration rate was correlated with advanced histological damage. IgAN in our center had a less severe clinical presentation and renal function was correlated with histologic classification.
A Case Report of C-ANCA Positive Bartonella Endocarditis Associated Glomerulonephritis
( Minjeong Kim ),( Ha Nee Jang ),( Dae-hong Jeon ),( Hyun Seop Cho ),( Se-ho Chang ),( Dong Jun Park ),( Jeong Rang Park ),( Dae Hyun Song ),( Oh-hyun Cho ),( Hyun-jung Kim ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1
Background: Bartonella endocarditis is very rare in South Korea. Some bacterial endocarditis can involve the kidney. This is the first report of C-ANCA positive Bartonella endocarditis-associated glomerulonephritis in South Korea. Case presentation: A 67-year-old man complained 7kg weight loss with anorexia over the past 6 months. Serum creatinine was 4.35 mg/dL. Albumin/globulin ratio was reversed and the ratio of spot urine protein/creatinine was 1.1. Bone marrow exam showed normocellular marrow without monoclonality of plasma cells. There were two old vegetations on transesophageal echocardiography. Blood cultures of two couple were negative. The renal histology findings demonstrated global sclerosis, mesangial proliferation, crescent formation and diffuse glomerular capillary walls thickened with deposits of C3, IgM and C1q. The level of C3 was decreased to 43.9 mg/dL and C-ANCA was positive. In further history findings, he has drunken deer blood. So, We examed Q fever, Legionella and Bartonella antibody test and Bartonella IgG ab was elevated to 1: 2,048. Azotemia and proteinuria were not improved though doxycycline and rifampin treatment for 8 weeks. But these were improved after steroid therapy for 6 weeks with same antibiotics. Conclusions: It is necessary to evaluate rare organism like Bartonella infection in the BCNE. In addition, if there are azotemia and proteinuria, we should consider renal biopsy to rule out the renal complication of endocarditis-associated glomerulonephritis and for early aggressive treatment.
Kim, Min Jeong,Jang, Ha Nee,Lee, Tae Won,Cho, Hyun Seop,Chang, Se-Ho,Kim, Hyun-Jung Yeungnam University College of Medicine 2017 Yeungnam University Journal of Medicine Vol.34 No.1
Glomerulonephritis (GN) is sometimes associated with infective endocarditis (IE). Bartonella endocarditis is difficult to diagnose because it is rare and cannot be detected by blood culture. This is the first report of cytoplasmic anti-neutrophil cytoplasmic antibody-positive subacute endocarditis-associated GN caused by Bartonella infection in South Korea. A 67-year-old man was hospitalized due to azotemia. He complained of weight loss and anorexia for 6 months. A diagnosis of IE was made based upon echocardiographic detection of vegetations on the mitral and aortic valves and a Bartonella antibody titer of 1:2,048. Renal histology identified focal crescentic GN. Azotemia and proteinuria improved after doxycycline and rifampin treatment combining with steroid therapy.
( Min Jeong Kim ),( Ha Nee Jang ),( Tae Won Lee ),( Hyun Seop Cho ),( Se-ho Chang ),( Hyun-jung Kim ) 영남대학교 의과대학 2017 Yeungnam University Journal of Medicine Vol.34 No.1
Glomerulonephritis (GN) is sometimes associated with infective endocarditis (IE). Bartonella endocarditis is difficult to diagnose because it is rare and cannot be detected by blood culture. This is the first report of cytoplasmic anti-neutrophil cytoplasmic antibody-positive subacute endocarditis-associated GN caused by Bartonella infection in South Korea. A 67-year-old man was hospitalized due to azotemia. He complained of weight loss and anorexia for 6 months. A diagnosis of IE was made based upon echocardiographic detection of vegetations on the mitral and aortic valves and a Bartonella antibody titer of 1:2,048. Renal histology identified focal crescentic GN. Azotemia and proteinuria improved after doxycycline and rifampin treatment combining with steroid therapy.
A Report of Two Cases of Adventitial Cystic Disease of the Popliteal Artery
( Doo Jae Lee ),( Hyun Oh Park ),( Ha Nee Jang ),( Ki Nyun Kim ),( Jun Ho Yang ),( Seong Ho Moon ),( Joung Hun Byun ),( Sung Hwan Kim ),( Jun Young Choi ),( In Seok Jang ),( Jong Woo Kim ),( Chung Eun 대한슬관절학회 2018 대한슬관절학회지 Vol.30 No.2
Two patients were admitted to our department because of recent aggravation of claudication in the leg, which was exacerbated by walking. They were diagnosed as having a Baker cyst or acute thrombosis in the popliteal fossa at another hospital. There was no evidence of ischemia, and the ankle brachial index was normal. Computed tomography and magnetic resonance imaging were performed, revealing a cystic mass of the popliteal artery (PA). Intraoperatively, the cystic lesion was found within the adventitia of the PA; based on the biopsy findings, both patients were diagnosed as having adventitial cystic disease of the PA.
S-504 A case of purple urine bag syndrome on a patient with end-stage renal disease on hemodialysis
( Sung Bok Ji ),( Hyun -jung Kim ),( Tae-won Lee ),( Ha Nee Jang ),( Hyun-seop Cho ),( Dong-jun Park ),( Se-ho Chang ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1
Purple urine bag syndrome (PUBS) is a phenomenon where purple discoloration of urine occurs in patient with urinary catheters and urinary tract infection also. The bacteria producing sulfatase and phosphatate are involoved in the formation of pigment, indirubin and indigo. Tryptophan metabolism is involved in this pathogenesis. We present a case of this rare and interesting phenomenon. Our patient, an 80-year-old male, was admitted for general weakness. He was the patient with end stage renal disease (ESRD) on hemodialysis. Although the patient was on hemodialysis state, but the amount of urine was reserved. He recently did not receive hemodialysis for 2 weeks and came to the emergency room for uremic symptoms. A urinary catheter was placed due to decreased mentation. The urine color was changed to purple color after several days on admission. The patient did not have any signs of urinary tract infection like fever, chills and lower urinary tract symptoms. The urinalysis revealed a pH of 9.0, 20-29 white blood cells per high-power field, negative nitrite, 30-49 red blood cells per high-power field, and many bacteria. Urine culture grew more than 100,000 colony of Escherichia coli. He did not receive antibiotic therapy, because of no infection signs. We diagnosed purple urine bag syndrome associated with asymptomatic bacteriuria. After changing to the new urine bag, the urine color was returned to a dark yellow. Several cases were noted and this condition is often easily treated with antibiotics. We have to bear in mind that diagnosing PUBS in patients who have chronic kidney disease (CKD) probably reflect an increased serum and urinary concentration of indoxyl sulfate, and that this uremic toxin is involved not only in the progression of CKD, but also of cardiovascular disease in these patients. Though PUBS is a rare condition, but underlying disease like CKD has been recently recognized as a potential risk factor for its development.