Sung Kyew Kang

Angiotensin-Converting Enzyme Gene Polymorphism in Patients with Minimal-Change Nephrotic Syndrome and Focal Segmental Glomerulosclerosis

To evaluate angiotensin-converting enzyme (ACE) gene insertion/deletion polymorphism in nephrotic syndrome, 85 patients (minimal-change nephrotic syndrome, MCNS: 55 cases; focal segmental glomerulosclerosis, FSGS: 30 cases) and 61 control subjects were examined. The distribution of ACE genotype in the control group was II 44%, ID 41% and DD 15%. The distribution of ACE genotypes in MCNS was similar to that in controls. However, the distribution of ACE genotypes in FSGS was markedly different from those of MCNS. The DD genotype was more frequent (p < 0.05) in FSGS than in MCNS. Patients with the DD genotype tended to present clinical symptoms at an earlier age. They also showed a lower responsiveness to corticosteroid therapy and a higher incidence of chronic renal failure than those with other genotypes. Our results indicate that the ACE DD genotype in FSGS may be a risk factor for the poor responsiveness to steroid therapy and the development of chronic renal failure.

Acute Renal Failure Associated with Dermatomyositis and Colon Cancer

Sung Kyew Kang, MD, Department of Internal Medicine, Chonbuk National University Medical School, Chonju, Chonbuk 560-182 (Korea) Dear Sir, Dermatomyositis is a collagen disease characterized by a nonpurulent polymyositis, often accompanied by dermatitis and localized edema. When skin lesions are absent, the condition is referred to as polymyositis. The kidneys are generally spared in dermatomyositis. A few cases of acute renal failure in dermatomyositis have been reported [1–4]. This report describes a case of acute renal failure associated with dermatomyositis and colon cancer in which the renal necropsy showed a typical acute tubular necrosis associated with nontraumatic rhabdomyolysis. Case Report A 49-year-old male patient was admitted with anuria, and proximal muscle weakness. He had had surgery for colon cancer 3 years earlier. The specimen obtained showed poorly differentiated aden-ocarcinoma. On admission he appeared acutely ill. ‘Heliotrope rash’ and eyelid edema were noted on his face. There was no rash on any other part of the body. Neurologic examination showed marked weakness and hypotonia of proximal muscles, especially in the shoulders. Biceps, triceps and knee jerk were hypoactive. Sensation and superficial reflexes were normal. He was anuric. The laboratory findings revealed Hb 10.5 g/dl; WBC 6,900/mm3 with differential count showing neutrophils 75%, lymphocytes 15%. ESR was 116 mm/h. Serum Na was 140 mEq/1, K 7.0 mEq/1, P 4.0 mg/dl, uric acid 11.8 mg/dl, albumin 2.9 g/dl and globulin 3.0 g/dl. Serum creatine kinase was 144 U/l, lactic dehydrogenase 203 U/l, SGOT 265 U/l, SGPT113 U/l. BUN was 84 mg/dl and creatinine was 13.9 mg/dl. A skin biopsy of the rash on the face revealed flattening of the rete ridge and liquefactive degeneration of basal cell layer. A biopsy of the deltoid muscle showed edema between muscle fibers, variable diameter of muscle fibers, massive fiber necrosis, and perivascular infiltration of acute and chronic inflammatory cells. Electromyogram revealed myopathic findings compatible with dermatomyositis. Computed tomographic scanning of abdomen showed extensive obstructive uropathy in both midureters due to retroperitoneal lymphadenopathy but no evidence of liver metastasis. He had hemodialysis 3 times via subclavian catheter but refused further treatment. Two weeks later the patient died of uremia and sepsis with pneumonia. A renal necropsy performed just after death revealed focal, severe necrosis of the tubular epithelium with pigmented casts in the lumens. Interstitial tissue

Renal subcapsular hematoma : a consequence of reperfusion injury of long standing renal artery stenosis.

Renal artery stenosis is a cause of secondary hypertension which can be cured by surgical or radiological intervention such as percutaneous transluminal renal artery stent placement. In this case we present a subcapsular hematoma of the kidney, a complication following percutaneous transluminal stent placement in the renal artery. Reperfusion injury to the kidney may be a possible mechanism of subcapsular hematoma of the kidney. Long standing severe renal artery stenosis and high pre- and post-procedure pressure gradient might contribute to the complication.

Acute Water Intoxication during Whole Gut Irrigation

Sung Kyew Kang, MD, Department of Internal Medicine, Chonbuk National University Medical School, Chonju, Chonbuk 560-756 (Korea) Time after irrigation, h 6 12 16 24 Dear Sir, It is generally believed that water intoxication does not normally occur in a healthy adult after voluntary ingestion of water. If the mechanisms for excreting water are compromised by some event, the continued ingestion of abnormally large amounts of water could exceed the reduced excretory capacity, and water retention and intoxication would result [1]. Since its introduction by Hewitt in 1973, whole gut irrigation has been recognized as a rapid, safe and acceptable alternative that is highly effective in clearing the bowel for colon surgery, endoscopy and barium enema [2–4]. To our knowledge no case has yet been reported of a water intoxication after whole gut irrigation in a healthy young man. We encountered just such a case recently, and herewith is our report. Table I. Serum electrolytes and condition of the patient Serum K mEq/l Patient’s condition Serum Na mEq/1