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( Tae Ryom Oh ),( Seong Kwon Ma ),( Soo Wan Kim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
We present a rare case of continuous ambulatory peritoneal dialysis peritonitis by Citrobacter freundii complicating fungal infection with abscess formation. A 34-yearold woman was admitted our hospital with complaint of abdominal pain and turbid peritoneal dialysate. Culture studies were performed for identifi cation of pathogen, it isolate was confi rmed as Citrobacter freundii by using DNA sequencing of the 16s ribosomal RNA. Antibiotics therapy alone was not effective in her hospital course, she was recovered after removal of peritoneal catheter and drainage of abscess. Citrobacter species are unusual pathogens of peritonitis, it shows poor outcomes. Also fungal peritonitis is a serious complication of bacterial peritonitis, early diagnosis will reduce morbidity and mortality. Indwelling catheters should be removed, appropriate antibiotics therapy based on anti-biogram test is needed for management. Careful suspicion of complication of fungal infection in bacterial peritonitis will improve the prognosis of patients who undergoing peritoneal dialysis.
( Tae Ryom Oh ),( Hong Sang Choi ),( Se Won Oh ),( Jieun Oh ),( Dong Won Lee ),( Chang Seong Kim ),( Seong Kwon Ma ),( Soo Wan Kim ),( Eun Hui Bae ) 대한내과학회 2022 The Korean Journal of Internal Medicine Vol.37 No.1
Background/Aims: Hypertension is considered a risk factor in immunoglobulin A nephropathy (IgAN). However, after IgAN diagnosis, the relationship between early blood pressure control and renal prognosis remains unclear. This study aimed to analyze the association between the prognosis of IgAN patients and a controlled status of hypertension within the first year of IgAN diagnosis. Methods: We retrospectively analyzed 2,945 patients diagnosed with IgAN by renal biopsy. The patients were divided into ‘normal,’ ‘new-onset,’ ‘well-controlled,’ and ‘poorly-controlled’ groups using blood pressure data from two consecutive measurements performed within a year. The Kaplan-Meier survival analysis and Cox proportional-hazards regression model were used to survey the independent association between recovery from hypertension and the risk of IgAN progression. The primary endpoint was IgAN progression defined as the initiation of dialysis or kidney transplantation. Results: Before IgAN diagnosis, 1,239 patients (42.1%) had been diagnosed with hypertension. In the fully adjusted Cox proportional-hazards models, the risk of IgAN progression increased by approximately 1.7-fold for the prevalence of hypertension. In the subgroup analyses, the ‘well-controlled’ group showed a statistically significant risk of IgAN progression (hazard ratio [HR], 3.19; 95% confidence interval [CI], 1.103 to 9.245; p = 0.032). Moreover, the ‘new-onset’ and ‘poorly-controlled’ groups had an increased risk of IgAN progression compared to the ‘normal’ group (HR, 2.58; 95% CI, 1.016 to 6.545; p = 0.046 and HR, 3.85;95% CI, 1.541 to 9.603; p = 0.004, respectively). Conclusions: Although hypertension was well-controlled in the first year after IgAN diagnosis, it remained a risk factor for IgAN progression.
( Tae Ryom Oh ),( Sung Sun Kim ),( Soo Wan Kim ),( Seong Kwon Ma ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: lgM nephropathy is thought to be a variant of minimal change disease or focal segmental glomerulosclerosis. Although it has been proposed that immune dysfunction may play a crucial role in the pathogenesis of this disease, it remains elusive. Case presentation: A 40-year-old woman, who received thymectomy twenty years ago due to myasthenia gravis and then acetylcholinesterase inhibitor, presented with left submandibular palplabe mass lesion. Excisional biopy of the lesion confirmed Castleman`s disease. After one month, she developed nephrotic syndrome and hypothyroidism. The levels of anti-microsomal antibody titer and anti-thyroglobulin antibody titer were increased, and fine needle aspiration cytology of thyroid confirmed Hashimoto thyroiditis. Histopathologic findindgs of percutaneous kidney biopsy revealed mesangial proliferation with lgM deposition. After the treatment of steroid with levothyroxine, her nephrotic syndrome was resolved and thyroid function was maintained within normal ranges. Conclusions: We present a rare case of lgM nephropathy in a patient who developed myasthenia gravis, Castleman`s disease and Hashimoto thyroiditis. This case may provide important information for the immunologic pathogenesis of lgM nephropathy.
증례 : 신장 ; 16s ribosomal RNA의 염기서열 분석으로 진단된 진균 감염이 합병된 Citrobacter freundii 복막투석 복막염 1예
오태렴 ( Tae Ryom Oh ),마성권 ( Seong Kwon Ma ),김수완 ( Soo Wan Kim ) 대한내과학회 2015 대한내과학회지 Vol.88 No.5
저자들은 16s ribosomal RNA 염기서열 분석을 통해 진단된 Citrobacter에 진균 감염이 합병된 복막투석 복막염 환자를 경험하였기에 보고하는 바이다. 환자는 항생제 단독 치료에는 충분히 반응하지 않았으며 세균성 복막염의 합병증으로 진균 감염 및 복강 내 농양이 형성되어 복막투석 카테터 제거, 항진균제 사용 및 농양 배액술을 시행한 이후 호전되었다. 빠른 진단과 적절한 치료만이 환자의 예후를 호전시킬수 있기에 복막투석 복막염 환자에서 호전 속도가 일반적인 경우보다 느리다면 흔치 않은 원인균과 병발된 합병증에 대한 주의 깊은 검사가 임상의사에게 큰 도움을 줄 수 있을 것이다. We present a case of continuous ambulatory peritoneal dialysis peritonitis caused by Citrobacter freundii complicated by a fungal infection with abscess formation. A 34-year-old woman was admitted to our hospital with abdominal pain. Isolate cultures were confirmed as Citrobacter freundii by DNA sequencing of the 16s ribosomal ribonucleic acid (RNA). Antibiotic therapy was ineffective and Candida tropicalis was isolated in follow-up blood cultures. We administered an antifungal agent and removed the peritoneal catheter. A sudden fever developed, and abdominal computed tomography showed intra-abdominal abscesses. Percutaneous drainage was performed, but no bacteria were cultured. After draining the abscesses, the patient recovered. Citrobacter species are unusual pathogens in peritonitis, and fungal peritonitis is a serious complication of bacterial peritonitis. Indwelling catheters should be removed and appropriate antibiotic therapy provided. Suspicion of a fungal infection combined with bacterial peritonitis will improve the prognosis of patients on peritoneal dialysis. (Korean J Med 2015;88:593-597)
( Sang Heon Suh ),( Tae Ryom Oh ),( Hong Sang Choi ),( Chang Seong Kim ),( Eun Hui Bae ),( Seong Kwon Ma ),( Kook-hwan Oh ),( Tae-hyun Yoo ),( Dong-wan Chae ),( Soo Wan Kim ) 대한신장학회 2023 Kidney Research and Clinical Practice Vol.42 No.2
Background: Urine chloride has recently been suggested as a biomarker of renal tubule function in patients with nondialysis chronic kidney disease (CKD), as low urinary chloride concentration is associated with an increased risk of CKD progression. We investigate the association between urinary chloride excretion and the progression of coronary artery calcification (CAC). Methods: A total of 1,065 patients with nondialysis CKD were divided into tertiles by spot urine chloride-to-creatinine ratios. The 1st, 2nd, and 3rd tertiles were defined as low, moderate, and high urinary chloride excretion, respectively. The study outcome was CAC progression, which was defined as an increase in coronary artery calcium score of more than 200 Agatston units during the 4-year follow-up period. Results: Compared to moderate urinary chloride excretion, high urinary chloride excretion was associated with decreased risk of CAC progression (adjusted odds ratio, 0.379; 95% confidence interval, 0.190-0.757), whereas low urinary chloride excretion was not associated with risk of CAC progression. Restricted cubic spine depicted an inverted J-shaped curve, with a significant reduction in the risk of CAC progression in subjects with high spot urine chloride-to-creatinine ratios. Conclusion: High urinary chloride excretion is associated with decreased risk of CAC progression in patients with nondialysis CKD.
( Su Hyun Song ),( Tae Ryom Oh ),( Hong Sang Choi ),( Chang Seong Kim ),( Dong Ryeol Ryu ),( Sung Gyun Kim ),( Sun-hee Park ),( Seong Kwon Ma ),( Soo Wan Kim ),( Eun Hui Bae ) 대한신장학회 2021 Kidney Research and Clinical Practice Vol.40 No.3
Background: Minimal change disease (MCD) is one of the most common causes of nephrotic syndrome worldwide. Hyperuricemia increases the end-stage renal disease (ESRD) risk in glomerulonephritis. In this study, we aimed to determine the effect of high serum uric acid levels on the progression to ESRD in MCD. Methods: A total of 800 patients diagnosed with MCD by kidney biopsy were retrospectively analyzed. We determined the relation-ship of hyperuricemia with the progression to ESRD in MCD using the Cox proportional hazard model and Kaplan-Meier survival anal-ysis. The primary outcome was defined as the initiation of dialysis or kidney transplantation. Results: A total of 42 patients (5.3%) progressed to ESRD during the follow-up period. In the restricted cubic spline curve, serum uric acid levels exhibited a positive correlation with ESRD progression in patients with MCD. In the fully adjusted model, the risk of MCD progression increased by 29% for every 1 mg/dL increase in the baseline serum uric acid level (hazard ratio [HR], 1.29; 95% confi-dence interval [CI], 1.09-1.54; p = 0.004). Falling into the high uric acid group (serum uric acid level > 7 mg/dL in men and > 6 mg/ dL in women) was also a risk factor for progression of MCD to ESRD (HR, 3.40; 95% CI, 1.59-7.31; p < 0.001). Conclusion: Our study shows that hyperuricemia is an independent risk factor for the progression to ESRD in patients with MCD.
Prognostic role of the neutrophil-to-lymphocyte ratio in patients with chronic kidney disease
( Jin Kim ),( Su Hyun Song ),( Tae Ryom Oh ),( Sang Heon Suh ),( Hong Sang Choi ),( Chang Seong Kim ),( Seong Kwon Ma ),( Soo Wan Kim ),( Eun Hui Bae ) 대한내과학회 2023 The Korean Journal of Internal Medicine Vol.38 No.5
Background/Aims: The neutrophil-to-lymphocyte ratio (NLR) has a prognostic value in cardiovascular disease, infection, inflammatory disease, and several malignancies. Therefore, the NLR has a possible predictive value in patients with chronic kidney disease (CKD), but this predictive value has not been validated. Here, we aimed to investigate the possibility of NLR as a predictor of CKD progression. Methods: This retrospective observational study included 141 patients with non-dialysis CKD. The participants were divided into terciles (T1, T2, and T3) according to NLR. The primary outcome was defined as a composite kidney event, which included a decline in the estimated glomerular filtration rate (eGFR) of at least 50% or initiation of renal replacement therapy during the follow-up period. Results: The mean follow-up duration was 5.45 ± 2.11 years. The mean NLRs were 1.35 ± 0.05 in T1 (n = 47), 2.16 ± 0.04 in T2 (n = 47), and 4.29 ± 0.73 in T3 (n = 47). The group with the highest NLR (T3) had higher baseline CKD and serum creatinine and lower eGFR levels than the group with the lowest NLR (T1). The cumulative incidence rate of composite kidney events was significantly higher in T3 compared with T1 (p < 0.001, log-rank test). Cox regression analysis revealed that high NLR was associated with the risk of composite kidney events (adjusted hazard ratio, 3.33; 95% confidence interval, 1.43-7.76). Conclusions: A higher NLR reflects the more advanced stage of CKD and suggests a role for NLR as a biomarker for predicting CKD progression.
( Su Hyun Song ),( Young Jin Goo ),( Tae Ryom Oh ),( Sang Heon Suh ),( Hong Sang Choi ),( Chang Seong Kim ),( Seong Kwon Ma ),( Soo Wan Kim ),( Eun Hui Bae ) 대한전해질학회 2021 Electrolytes & Blood Pressure Vol.19 No.2
We report a case of severe hyperphosphatemia in advanced CKD with poor compliance. A 55-year-old male patient with underlying type 2 diabetes mellitus, hypertension, and chronic kidney disease presented emergently with general weakness and altered mental status. The creatinine level was 14mg/dL (normal range: 0.5-1.3mg/dL) 2 months prior to consultation, and he was advised initiation of hemodialysis, which he refused. Subsequently, the patient stopped taking all prescribed medications and self-medicated with honey and persimmon vinegar with the false belief it was detoxifying. At the time of admission, he was delirious, and his laboratory results showed blood urea nitrogen level of 183.4mg/dL (8-23 mg/dL), serum creatinine level of 26.61mg/dL (0.5-1.3mg/dL), serum phosphate level of 19.3mg/dL (2.5-5.5mg/dL), total calcium level of 4.3mg/dL (8.4-10.2 mg/dL), vitamin D (25(OH)D) level of 5.71 ng/mL (30-100 ng/mL) and parathyroid hormone level of 401 pg/ml (9-55 pg/mL). Brain computed tomography revealed non-traumatic spontaneous subdural hemorrhage, presumably due to uremic bleeding. Emergent hemodialysis was initiated, and hyperphosphatemia and hypocalcemia were rectified; calcium acetate and cholecalciferol were administered. The patient’s general condition and laboratory results improved following dialysis. Strict dietary restrictions with patient education were implemented. Multifaceted interventions, including dietary counseling, administration of phosphate-lowering drugs, and lifestyle modifications, should be implemented when encountering patients with CKD, considering the extent of the patient’s adherence.