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S-467 Circulating CD89-IgA complex does not predict progression of IgA nephropathy
( Jong Hyun Jhee ),( Su-young Jung ),( Seohyun Park ),( Chang Hyun Lee ),( Hyoungnae Kim ),( Hae Ryong Yun ),( Youn Kyung Kee ),( Chang-yun Yoon ),( Young Eun Kwon ),( Hye-young Kang ),( Jung Tak Park 대한내과학회 2016 대한내과학회 추계학술발표논문집 Vol.2016 No.1
Background: Pathogenesis of IgA nephropathy is a complicated multi-step process involving generation of galactose-deficient IgA1 and autoantibodies against the misglycated IgA1, deposition of immune complex within the mesangiaum, and complement activation. CD89 is a soluble receptor for circulating IgA and CD89-IgA facilitates the formation of immune-complex. However,there is lack of evidence supporting circulating levels of CD89-IgA complex is associated with disease progression. This study aimed to delineate whether circulating CD89-IgA levels can predict the future renal outcome in patients with IgAN. Methods: A total of 344 patients with biopsy-proven IgAN between 2005 and 2014 were included. Demographic and laboratory data were recruited from the Glomerulonephritis Registry of Yonsei University Health System. Sera of these patients were obtained at the time of biopsy and stored at -80℃. Circulating CD89-IgA complex levels were determined by sandwich ELISA method. The study outcome was a 30% decrease of estimated GFR during the follow up. Results: The median value of CD89-IgA complex was 7.20 ng/ml[Inter quartile range 4.25 to 12.98]. Patients were categorized into 3 groups by tertiles of circulating CD89-IgA levels. There were no significant differences in baseline eGFR and proteinuria among 3 groups. In addition, circulating CD89-IgA complex levels were not correlated with eGFR at the time of biopsy and did not differ among CKD stages. During follow-up, 23 (34.3%), 25 (37.3%), and 19 (28.4%) patients in the lowest, middle, and highest tertiles reached the study endpoint, respectively (p=0.59). In a multivariable Cox models adjusted for age, sex, mean arterial pressure, IgA levels, eGFR, and proteinuria, circulating CD89-IgA complex levels were not associated with developing a 30% decrease in eGFR [Lowest versus Middle, Hazard ratio 0.95, 95% Confidential interval 0.44-2.07, p=0.89 and Lowest versus Highest, HR 1.14, 95% CI 0.49-2.61, p=0.76]. A receiver operating curve analysis showed that area under the curve for CD89-IgA was 0.55. Conclusions: Although CD89-IgA complex mediates formation of immune complex, our findings suggest that its circulating level is not a predictor of adverse renal outcome in IgAN
Vitamin D Deficiency is Significantly Associated with Depression in Chronic Kidney Disease Patients
( Jong Hyun Jhee ),( Su-young Jung ),( Hyung Woo Kim ),( Geun Woo Ryu ),( Sul A Lee ),( Seohyun Park ),( Hyung Jung Oh ),( Jung Tak Park ),( Seung Hyeok Han ),( Shin-wook Kang ),( Tae-hyun Yoo ) 대한내과학회 2015 대한내과학회 추계학술발표논문집 Vol.2015 No.1
Background: Recent studies have reported significant associations between vitamin D deficiency and depression in the generalpopulation. Even though both vitamin D deficiency and depression are common in patients with chronic kidney disease (CKD), the association between these two prevalent factors remains poorly elucidated. Therefore, we investigated the association between vitamin D deficiency and depression in CKD patients. Methods: The data from Korean National Health and Nutritional Examination Survey between 2010 and 2012 were used. Patients with estimated glomerular filtration rate ≤60 mL/min/1.73 m2 were enrolled. VitaminD deficiency was defined as 25-hydroxyvitamin D3 [25(OH)D3] levels ≤10 ng/mL. The patients were divided into groups with or without vitamin D deficiency. Depression was determined by the EuroQOL-5D (EQ5D) questionnaire.Associations between vitamin D deficiency and depression were evaluated by multiple logistic regression analysis. Results: The mean age was 71.2±9.3 years, and 257 patients (51.9%) were female. The mean 25(OH)D3 levels were 17.9 ng/mL in total, 8.7 ng/mL in vitamin D deficient group, and 18.9 ng/mL in non-vitamin D deficient group. The prevalence of depression in CKD patients was higher compared to the general population (14.3% versus 11.1%, p=0.031). Moreover, the prevalence of depression was significantly higher in patients with vitamin D deficiency than those without vitamin D deficiency (27% versus 13.3%, p=0.022). Multiple logistic regression analysis showed that vitamin D deficiency was a significantly independent predictor of depression after adjusting for age, sex, alcohol, body mass index, hypertension, diabetes mellitus, anemia, suicidal idea, EQ5D index and serum parathyroid hormone levels (odds ratio=6.27, 95% confidence interval=1.57 to 25.05, p=0.009). Conclusions: Depression was highly prevalent in CKD patients. The prevalence ofdepression was higher in CKD patients with vitamin D deficiency. In addition, vitamin D deficiency was a significantly independent predictor of depression in CKD patients. Therefore, determining vitamin D levels might be helpful in predicting depression in these patients.
A Case of Collaenofibrotic Glomerlulopathy
( Jong Hyun Jhee ),( Jung Tak Park ) 대한내과학회 2015 대한내과학회 추계학술발표논문집 Vol.2015 No.1
A 61-year-old woman presented with proteinuria without specific symptoms or signs. Laboratory tests showed elevated levels of urine protein/creatinineratio (UPCr, 0.686 g/gCr). Levels of BUN and creatinine (Cr) were within normal range. Abdominal ultrasonogram revealed that both kidney sizes and echogenicity were unremarkable (Rt. kidney size: 11.5 cm, Lt. kidney size: 10.3 cm). During the out patient clinic (OPD) follow up, UPCr levels had been elevated up to 1.06 g/gCr, which prompted physicians to perform renal biopsy. The light microscopic (LM) findings demonstrated that the section contained 7 glomeruli and glomerular basement membrane was segmentally thickened with a double contour. On the Electron microscopy examination, irregular band-like deposition of fibrils with about 60 nm periodicity was noted in the widened subendothelial areas. Granular electron densities were present near the fibrils. These findings were compatible with collagenofibrotic glomerulopathy. The patient was prescribed with losartan and is currently being followed up at the out-patient clinic on regular bases. The patient’s proteinuria persists without further aggravation.
Severe vitamin D deficiency is a risk factor for renal hyperfiltration
Jhee, Jong Hyun,Nam, Ki Heon,An, Seong Yeong,Cha, Min-Uk,Lee, Misol,Park, Seohyun,Kim, Hyoungnae,Yun, Hae-Ryong,Kee, Youn Kyung,Park, Jung Tak,Han, Seung Hyeok,Kang, Shin-Wook,Yoo, Tae-Hyun Oxford University Press 2018 The American journal of clinical nutrition Vol.108 No.6
( Jong Hyun Jhee ),( Jae Yoon Park ),( Jung Nam An ),( Dong Ki Kim ),( Kwon Wook Joo ),( Yun Kyu Oh ),( Chun Soo Lim ),( Yon Su Kim ),( Seung Hyeok Han ),( Tae-hyun Yoo ),( Shin-wook Kang ),( Jung Pyo 대한신장학회 2020 Kidney Research and Clinical Practice Vol.39 No.4
Background: The effect of fluid balance on outcomes in elderly patients with acute kidney injury (AKI) requiring continuous renal-replacement therapy (CRRT) is not explained well. We investigated outcomes according to cumulative fluid balance (CFB) in elderly patients with AKI undergoing CRRT. Methods: A total of 607 patients aged 65 years or older who started CRRT due to AKI were enrolled and stratified into two groups (fluid overload [FO] vs. no fluid overload [NFO]) based on the median CFB value for 72 hours before CRRT initiation. Propensity score-matching analysis was performed. Results: The median age of included patients was 73.0 years and 60.0% of the population was male. The median 72- hour CFB value was 2,839.0 mL. The overall cumulative survival and 28-day survival rates were lower in the FO group than in the NFO group (P < 0.001 for both) and remained so after propensity score-matching. Furthermore, patients in the FO group demonstrated a higher overall mortality risk after adjustment for age, sex, systolic blood pressure, Charlson comorbidity index, Acute Physiology and Chronic Health Evaluation II score, serum albumin, creatinine, diuretic use, and mechanical ventilation status (hazard ratio, 1.38; 95% confidence interval, 1.13 to 1.89; P < 0.001). Among survivors, both the duration of CRRT and the total duration of hospitalization from CRRT initiation showed no difference between the FO and NFO groups. Conclusion: A higher CFB value is associated with an increased risk of mortality in elderly patients with AKI requiring CRRT.
( Jong Hyun Jhee ),( Young Su Joo ),( Jung Tak Park ),( Tae-hyun Yoo ),( Sue Kyung Park ),( Ji Yong Jung ),( Soo Wan Kim ),( Yun Kyu Oh ),( Kook-hwan Oh ),( Shin-wook Kang ),( Kyu Hun Choi ),( Curie A 대한신장학회 2020 Kidney Research and Clinical Practice Vol.39 No.1
Background: Higher statin intensity is associated with a lower risk of mortality in patients with cardiovascular disease. However, little is known about the relationship between statin intensity and chronic kidney disease (CKD) progression. Methods: We studied whether statin intensity affects kidney function decline in 1,073 patients from the Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease. The participants were classified based on statin intensity as low, moderate, and high. The study endpoint was CKD progression (composite of doubling of serum creatinine, ≥ 50% decrease in estimated glomerular filtration rate [eGFR] from baseline, or end-stage renal disease). Results: The mean age was 56.0 ± 11.4 years, and 665 (62.0%) participants were male. The mean eGFR was 51.7 ± 26.7 mL/min/1.73 ㎡; there were no differences in baseline eGFR among statin intensity groups. During the median follow-up of 39.9 (25.4-61.6) months, 255 (23.8%) patients reached the study endpoint. In multivariable Cox model after adjustment of confounders, the hazard ratios (95% confidence interval) for adverse kidney outcome were 0.97 (0.72-1.30) and 1.15 (0.60-2.20) in moderate and high statin intensity groups, respectively, compared with the low intensity group. In addition, no significant association was observed in subgroups stratified by age, sex, eGFR, and atherosclerotic cardiovascular disease risk scores. Conclusion: We did not observe any significant association between intensity of statin therapy and progression of CKD. Long-term kidney outcomes may not be affected by statin intensity.
S-495 Depression and Suicidal Ideation is Associated with Renal Function in Predialysis CKD Patients
( Jong Hyun Jhee ),( Su-young Jung ),( Seohyun Park ),( Chang Hyun Lee ),( Hyoungnae Kim ),( Hae Ryong Yun ),( Youn Kyung Kee ),( Chang-yun Yoon ),( Young Eun Kwon ),( Seung Hyeok Han ),( Tae-hyun Yoo 대한내과학회 2016 대한내과학회 추계학술발표논문집 Vol.2016 No.1
Background: Depression areprevalent mental health problemsin patients with ESRD. In addition to socioeconomic factors uremia related factors such as accumulation of indoxyl sulfate and increased oxidative stress have been suggested as causes of this increased prevalence in ESRD patients. Although uremic toxicity and oxidative stress are known to be increased even in early chronic kidney disease patients, the relationship between depression and renal function is not well elucidated. Therefore, the association between renal function and depressive symptoms including suicidal ideation was investigated in predialysis patients with CKD. Methods: Subjects who participated in the Korea National Health and Nutritional Examination Survey from 2010 to 2014 were evaluated. Estimated glomerular filtration rate was calculated using the CKD Modification of Diet in Renal Disease equation. Depression was screened using the Korean version of the World Health Organization Composite International Diagnostic Interview-Short Form. Results: A total of 21,250 subjects were evaluated.The mean age of the subjects was 49 years and 43.9% were male.The mean eGFR of the subjects was 93.2 ml/min/1.73m2. Suicidal ideation was found in 2518 (11.8%) patients, and 5235 (24.6%) patients had depressive symptoms. All of the patients that had suicidal ideation were depressive and 48.1% of the patients with depressive symptoms had suicidal ideations. Suicidal ideation was reported in 101 (11.5%), 86 (12.9%),63 (18.4%), and 6 (33.3%) of each CKD stage 1,2,3 and 4 respectively (P for trend <0.001).Depressive symptomswere reported in 193(21.9%),170(25.4%), 111(32.5%), and 8(44.4%)of each CKD stage 1,2,3 and 4 respectively (P for trend 0.002). When the relationship between renal function and mental health problems was evaluated, lower eGFR showed a significant relationship with having suicidal ideation (odds ratio 0.95,95% confidential interval 0.97-0.99, p=0.02) even after adjustments were made for confounding factors. Conclusions: Depressive symptoms and suicidal ideation weresignificantly more common in higher CKD stage patients. Evaluation and management strategies for mental health issues should be considered in predialysis CKD patients.
Skin Sodium and Blood Pressure Regulation
( Jong Hyun Jhee ),( Hyeong Cheon Park ),( Hoon Young Choi ) 대한전해질학회 2022 Electrolytes & Blood Pressure Vol.20 No.1
Hypertension is a major public health concern due to its high prevalence and increased risk of cardiovascular disease and mortality. Complex traits resulting from both genetic and environmental factors affect the development of hypertension. Among environmental factors, a high salt diet is an important cause for hypertension. Humans show a heterogeneous blood pressure (BP) response to sodium intake. Although the precise mechanisms for the association between salt sensitivity and hypertension have not been fully elucidated, renal sodium handling has been considered to play a pivotal role. However, this conventional view has recently been challenged in that a third compartment, namely, skin may have a role in the regulation of sodium homeostasis. Skin is comprised of a significant portion of interstitium, which is a major extracellular fluid compartment, and its complex capillary network regulates body temperature and skin perfusion. Growing evidence indicates that local regulatory action of cutaneous blood flow as well as salt and water metabolism is associated with systemic BP control. Previous experimental studies have shown that dietary salt loading resulted in nonosmotic sodium accumulation via glycosaminoglycans and lymphatics embedded in the skin that were mediated by several endogenous factors and attenuated an increase in BP. Studies in humans have also suggested that the skin serves as a buffer system for sodium storage and that skin sodium contributes to salt sensitivity and hypertension. Thus, skin sodium storage provides the possibility of being an additional buffering system in response to salt loading and concomitant BP changes in humans.