Eun Young Seong

High serum and urine neutrophil gelatinase-associated lipocalin levels are independent predictors of renal progression in patients with immunoglobulin A nephropathy

Background/Aims Tubulointerstitial injury plays an important role in the progression of immunoglobulin A nephropathy (IgAN), and neutrophil gelatinase-associated lipocalin (NGAL) is among the most sensitive tubular biomarkers. We investigated whether serum or urine NGAL predicts prognosis in patients with IgAN. Methods The present study enrolled patients with biopsy-proven IgAN from January 2005 to December 2010, whose serum and urine samples at the time of kidney biopsy were preserved by freezing. We retrospectively reviewed patient clinical data and followed patients until October 2012. Serum and urine NGAL levels were measured using an enzyme-linked immunosorbent assay kit. Renal progression was defined as an estimated glomerular filtration rate decline by > 50% or progression to end-stage renal disease. Results There were 121 patients enrolled in this study. During the median follow-up period of 41.49 months, renal progression was found in nine patients (7.4%). Serum or urine NGAL alone could not predict renal progression; however, when serum and urine NGAL levels were combined, belonging to the high NGAL group independently predicted renal progression (hazard ratio [HR], 5.56; 95% confidence interval [CI], 1.42 to 21.73; p = 0.014), along with tubular damage graded according to the Oxford classification as T2 (HR, 8.79; 95% CI, 2.01 to 38.51; p = 0.004). In addition, a Kaplan-Meier curve of renal survival showed significantly higher renal progression in patients in the high NGAL group (log rank, p = 0.004). Conclusions In patients with IgAN, high serum and urine NGAL levels at the time of kidney biopsy predict renal progression.

Acute intradialytic exercise and oxidative stress in hemodialysis patients.

Patients with chronic kidney disease (CKD) receiving maintenance hemodialysis (HD) have diminished muscle mass, altered muscle quality, and severely impaired capacity for physical work and exercise tolerance, which has been reported to be as low as 50% of that measured in age-matched healthy individuals [1]. Uremic toxins, anemia, metabolic acidosis, vitamin D deficiency, hyperparathyroidism, and inflammation are among the possibilities; any or all of these could act to cause muscle wasting and/or altered neuromuscular function in dialysis patients [2]. Physical inactivity exacerbates these functional declines and also promotes cardiovascular disease (CVD). This cycle of disease and disability greatly reduces the quality of life (QOL) and increases mortality rates in these patients [3].

Initial experience with hand-assisted laparoscopic living donor nephrectomy: training and clinical practice as a general surgeon

BACKGROUND To analyze our initial results of hand-assisted laparoscopic living donor nephrectomy, executed by a skilled gastrointestinal surgeon. METHODS A total of 22 consecutive patients underwent the hand-assisted laparoscopic living donor nephrectomy between December 2014 and January 2017. We retrospectively analyze the patients perioperative clinical data, which were collected prospectively. RESULTS The right kidney was harvested in 12 patients. The mean operative time and intraoperative blood loss was 241.0 ± 43.4 minutes (range, 140-310 min) and 293.2 ± 203.1 mL (range, 50-700 mL), respectively. The mean warm ischemic time was 288.4 ± 103.4 seconds (range, 179-610 s). Postoperative complications included chyle leakage in 2 patients who were left kidney donors and oliguria in 1 patient who was a right kidney donor. All patients recovered with conservative care, and the mean hospital stay was 7.5 ± 1.7 days. The mean creatinine level was 0.7 ± 0.2 mg/dL before surgery, 1.1 ± 0.3 mg/dL at postoperative day (POD) 1, and 1.0 ± 0.2 mg/dL after discharge. The mean glomerular filtration rate was 97.9 ± 18.2 mL/min/1.73 m2 before surgery, 60.7 ± 10.4 at POD 1, and 67.3 ± 11.1 after discharge. Operation time was not associated with patient body mass index and case number. No significant differences, other than postoperative complications, were found in the perioperative data for the side of kidney donation. CONCLUSION A skilled surgeon with experience in laparoscopic abdominal surgery (such as gastrectomy or colectomy) might safely perform hand-assisted donor nephrectomy. However, we could not identify a clear case number to complete the learning curve.

Severe Hypernatremia Caused by Acute Exogenous Salt Intake Combined with Primary Hypothyroidism.

This report describes a case of severe hypernatremia with a serum sodium concentration of 188.1mmol/L caused by exogenous salt intake. A 26-year-old man diagnosed with Crohns disease 5 years previously visited our clinic due to generalized edema and personality changes, with aggressive behavior. He had compulsively consumed salts, ingesting approximately 154 g of salt over the last 4 days. Despite careful fluid management that included not only hypotonic fluid therapy for 8 hours but also hypertonic saline administration, his serum sodium level decreased sharply at 40.6 mmol/L; however, it returned to normal within 72-hour of treatment without any neurological deficits. Primary hypothyroidism was also diagnosed. He was discharged after 9 days from admission, with a stable serum sodium level. We have described the possibility of successful treatment in a patient with hypernatremia caused by acute salt intoxication without sustained hypotonic fluid therapy.

APOLIPOPROTEIN B/A1 IS INDEPENDENTLY ASSOCIATED WITH CAROTID INTIMAL-MEDIAL THICKNESS IN CHRONIC KIDNEY DISEASE PATIENTS.

Serum apolipoprotein B/A1 (apo B/A1) ratio has been known for strong predictor of cardiovascular disease (CVD). Measuring carotid artery intimal-medial thickness (CIMT) is non-invasive modality used to evaluate subclinical atherosclerosis and to predict future cardiovascular disease. The objective of this study is to evaluate the association between apo B/A1 and CIMT in chronic kidney disease (CKD).We retrospectively reviewed the 293 patients who had visited health promotion center in a single community. The patients were divided into 2 group which are CKD group (n=99, estimated glomerular filtration rate (eGFR): 15-59 mL/min) and non-CKD group (n=194, eGFR ≥ 60 mL/min). Age, sex, presence of diabetes mellitus (DM)/hypertension, smoking status, eGFR, body mass index, and various biochemical blood examinations (serum LDL/HDL cholesterol, serum homocystein, and serum apo B/A1 ratio) were evaluated in each patient. CIMT was measured by high-resolution B-mode ultrasonography. Multivariate linear regression analysis was performed to investigate which factors are associated with CIMT in each of 2 groups. In CKD group, age (β=0.163, p=0.024), presence of hypertension (β=0.208, p=0.006), and presence of DM (β=0.236, p=0.002) were independently associated with CIMT adjustment for other confounding factors. However, in CKD group, serum apo B/A1 (β=0.572, p In conclusion, this study showed serum apo B/A1 ratio was independently associated with CIMT only in CKD group, not in non-CKD group. Because CIMT is a strong predictor of CVD, the result of this study demonstrates serum apo B/A1 ratio could be included in cardiovascular risk stratification in CKD patients