Sang Youb Han

Plasma and urinary vascular endothelial growth factor and diabetic nephropathy in Type 2 diabetes mellitus

Aimsu2003 Vascular endothelial growth factor (VEGF) has been implicated in the pathogenesis of diabetes mellitus. We determined whether alterations of plasma and urinary VEGF levels are related to diabetic nephropathy in Type 2 diabetic patients.

Cyclosporin A aggravates the Calcification of Vascular Smooth Muscle Cells under High Glucose conditions with a Calcifying Medium

Background Vascular calcification (VC) progresses substantially even in the case of stable kidney transplantation, and is a predictor of morbidity and mortality. However, the effect of cyclosporin A (CsA) on VC has not been reported in diabetic kidney transplant patients. In this study, we evaluated the effect of CsA on the VC of mouse vascular smooth muscle cells (VSMCs), in the diabetic milieu. Methods CsA of a concentration of 1.0 &mgr;mol/L was selected by the MTT assay for this study. To demonstrate the effect of CsA and high glucose (HG, 30mM) in the induction of the VC of the VSMCs, we determined alkaline phosphatase (ALP) activity, microscopic morphology of calcification, the expressions of the calcification and inflammation-related genes, and the intracellular calcium concentrations in VSMCs. Results Calcification was observed 14 days after exposure to a calcifying medium (sodium phosphate monobasic and dibasic mixture). On microscopic morphology, CsA alone did not induce calcification under HG conditions, but clearly increased calcification under HG with a calcifying medium. ALP activity increased under HG with CsA or a calcifying medium compared to HG conditions alone. CsA increased ALP activity under low glucose (LG, 5.5mM) with a calcifying medium, but markedly increased under HG with a calcifying medium. CsA significantly increased the mRNA expressions of the calcification markers (core binding factor-alpha 1, bone morphologic proteins 2) as well as those of the inflammatory marker (interleukin 6), under HG with a calcifying medium. Intracellular calcium concentrations was unchanged in CsA alone but significantly increased with the presence of a calcifying medium under both LG and HG conditions, Conclusion Considering the effect of CsA on VC, the vascular side effects of CsA need to be verified in diabetic transplant patients, in the future.

Inflammatory Response Variance Based on Quality of Ultrapure Water in Hemodialysis Patients

Both the quality of water and biocompatibility of dialyzers are responsible for systemic inflammation in hemodialysis patients. As the biocompatibility of dialyzers has improved, focus for procedural improvements has shifted to water quality. Although ultrapure water reduces the inflammatory response, it is not clear whether different qualities of ultrapure water can further decrease the inflammatory response. This study aims to evaluate the relationship between water quality and the inflammatory response in hemodialysis patients.

Acute Pancreatitis and Rhabdomyolysis with Acute Kidney Injury following Multiple Wasp Stings

Multiple wasp stings can induce multiple organ dysfunction by toxic reactions. However, acute pancreatitis is a rare manifestation in wasp sting injury. A 74-year-old woman visited the emergency department by anaphylactic shock because of multiple wasp stings. Acute kidney injury, rhabdomyolysis, hepatotoxicity, and coagulopathy were developed next day. Serum amylase and lipase were elevated and an abdominal computed tomography revealed an acute pancreatitis. Urine output was recovered after 16 days of oliguria (below 500u2009ml/day). Her kidney, liver, and pancreas injury gradually improved after sessions of renal replacement therapy.

Acute Tubular Necrosis after Ingestion of a Fertilizer Containing Sodium Silicate

Silica nephropathy occurs after chronic heavy exposure to silica, resulting in the development of chronic kidney disease and progression to end-stage renal disease. However, acute kidney injury due to silica exposure is rare and its renal pathology remains unclear. Here, we report a case of acute sodium silica poisoning presenting as acute kidney injury. A 42-year-old man ingested a fertilizer containing sodium silicate. His serum creatinine increased by 5.06u2009mg/dL from 1.1u2009mg/dL 2 days after silicate ingestion. Owing to the decline in kidney function despite fluid therapy, a kidney biopsy was performed. The kidney showed acute tubular necrosis without infiltration of inflammatory cells. On day 5 of admission, hemodialysis was initiated to treat the hyperkalemia and oliguria, and treatment with methylprednisolone was initiated for the acute lung injury. The patient was administered 1u2009mg/kg of methylprednisolone intravenously daily for 2 weeks, followed by a 2-week taper. Hemodialysis was discontinued on day 10 and the patients renal function recovered completely. However, he died on day 40 of hospitalization owing to complicated lung fibrosis and persistent pneumothorax/pneumomediastinum.