Ho Jung Kim

V2 Receptor Antagonist; Tolvaptan

Hyponatremia is the most common electrolyte disorder in hospitalized patients. Many studies documented that it was related to increased morbidity and mortality in patients with congestive heart failure, liver cirrhosis, and neurologic diseases. Although knowledge of hyponatremia has been cumulated, the optimal management of hyponatremia remains incompletely established in clinical practice because of the diversity of underlying disease states, and its multiple causes with differing pathophysiologic mechanisms. Since vasopressin receptor antagonists have unique aquaretic effect to selectively increase electrolytes-free water excretion, clinicians could apply a more effective method to treat hyponatremia. Tolvaptan has significant evidence that it improves serum sodium levels in patients with euvolemic or hypervolemic hyponatremia related with heart failure, cirrhosis or syndrome of inappropriate anti-diuretic hormone. Tolvaptan has acceptable safety and tolerability for long-term usage in chronic hyponatremia, and the beneficial effects on serum Na+ occurred in patients with both mild and marked hyponatremia.

Electrolyte imbalances and nephrocalcinosis in acute phosphate poisoning on chronic type 1 renal tubular acidosis due to Sjogren's syndrome.

Although renal calcium crystal deposits (nephrocalcinosis) may occur in acute phosphate poisoning as well as type 1 renal tubular acidosis (RTA), hyperphosphatemic hypocalcemia is common in the former while normocalcemic hypokalemia is typical in the latter. Here, as a unique coexistence of these two seperated clinical entities, we report a 30-yr-old woman presenting with carpal spasm related to hypocalcemia (ionized calcium of 1.90 mM/L) due to acute phosphate poisoning after oral sodium phosphate bowel preparation, which resolved rapidly after calcium gluconate intravenously. Subsequently, type 1 RTA due to Sjögrens syndrome was unveiled by sustained hypokalemia (3.3 to 3.4 mEq/L), persistent alkaline urine pH (> 6.0) despite metabolic acidosis, and medullary nephrocalcinosis. Through this case report, the differential points of nephrocalcinosis and electrolyte imbalances between them are discussed, and focused more on diagnostic tests and managements of type 1 RTA.

Giant ureteral stone in a patient with a single functioning kidney: a case report.

A 43-year-old man presented with long-standing left flank pain. A plain abdominal radiograph and intravenous urography (IVU) revealed a giant ureteral stone measuring 6.2 × 2.2 cm causing ureteral obstruction. A non-enhanced computerized tomography (CT) scan showed a significantly atrophied right kidney and left hydronephroureterosis with a giant stone. A left transperitoneal laparoscopic ureterolithotomy was performed with excellent results.

Identification of perirenal or renal splenosis from undetermined masses: case report and review of the literature.

The incidental finding of tumor-llke perirenal or renal splenosis (PRS) creates a challenge to the renal physicians, because its benign nature has to be distinguished from a malignancy. This paper describes the case of a 40-year-old man referred from a local clinic for further evaluation of an incidental finding of left abdominal masses by ultrasonogram suspecting neoplasm, but was eventually confirmed as PRS by obtaining a history of splenectomy that pointed to splenosis and subsequently by a fusion image from single photon emission computed tomography using 99mTc-labelled heat-denatured erythrocytes and computed tomography (hybrid SPECT/CT). In addition, a review of 27 cases of PRS in a MEDLINE search including the present case revealed the following: all the masses were found incidentally and were associated with a history of previous splenectomy or splenic injury; the initial impressions were neoplastic tumor/PRS (n = 9), PRS (n = 10), and neoplastic tumor without consideration of splenosis (n = 8); surgical exploration was undertaken in all the 8 cases of suspected neoplastic tumor only, whereas non-invasive radiological or radionuclide imaging confirmed splenosis in the rest of the cases (n = 19). To avoid unnecessary tests and invasive surgery for undetermined perirenal or renal masses accompanying previous splenic injury, we stress the paramount importance of careful history-taking, physical examination, and a high index of suspicion for splenosis. Also, fusion imaging of hybrid SPECT/CT was reconfirmed as a useful diagnostic technique for accurately detecting and localizing splenic tissues by PRS.