• The Korean Journal of Pain
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• v.24 no.3
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• pp.154-157
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• 2011

Background: Postherpetic neuralgia (PHN) is usually managed pharmacologically. It is not uncommon for patients with chronic kidney disease (CKD) to suffer from PHN. It is difficult to prescribe a sufficient dose of anticonvulsants for intractable pain because of the decreased glomerular filtration rate. If the neural blockade and pulsed radiofrequency ablation provide only short-term amelioration of pain, spinal cord stimulation (SCS) with a low level of evidence may be used only as a last resort. This study was done to evaluate the efficacy of spinal cord stimulation in the treatment of PHN in patients with CKD. Methods: PHN patients with CKD who needed hemo-dialysis who received insufficient relief of pain over a VAS of 8 regardless of the neuropathic medications were eligible for SCS trial. The follow-up period was at least 2 years after permanent implantation. Results: Eleven patients received percutaneous SCS test trial from Jan 2003 to Dec 2007. Four patients had successfully received a permanent SCS implant with their pain being tolerable at a VAS score of less than 3 along with small doses of neuropathic medications. Conclusions: SCS was helpful in managing tolerable pain levels in some PHN patients with CKD along with tolerable neuropathic medications for over 2 years.

• Korean Journal of Clinical Pharmacy
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• v.30 no.4
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• pp.259-263
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• 2020

Background: Dual-type calcium channel blockers (CCBs), such as efonidipine and cilnidipine, are renoprotective drugs that reportedly reduce proteinuria by dilating afferent and efferent arterioles of the glomerulus. However, studies comparing the effect of dual-type CCB on proteinuria have not been conducted. Therefore, we aimed to compare the effect of dual-type CCB (efonidipine and cilnidipine) usage patterns in hypertensive patients with chronic kidney disease (CKD). Methods: This single-center, retrospective study included 53 patients with CKD who 1) initiated efonidipine or cilnidipine treatment while on a renin-angiotensin system inhibitor and 2) had received efonidipine or cilnidipine for at least one year. We compared usage patterns between the efonidipine and cilnidipine groups during the one-year period and analyzed the following outcomes: urinary protein-to-creatinine ratio, blood pressure, and serum creatinine. Results: The study included 25 patients in the efonidipine group and 28 patients in the cilnidipine group. In both groups, blood pressure and urinary protein-to-creatinine ratios tended to decrease; however, the change during each interval was not significant. Conclusions: In patients with CKD who were on renin-angiotensin system inhibitor therapy, the addition of a dual-type CCB (i.e., efonidipine or cilnidipine) tended to reduce proteinuria; however, the change during each interval was not significant.

• Childhood Kidney Diseases
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• v.27 no.2
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• pp.121-126
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• 2023

The administration of angiotensin type 2 receptor blockers (ARBs) during pregnancy is known to cause ARB fetopathy, including renal insufficiency. We aimed to analyze the outcomes of two patients who survived ARB fetopathy and perform an accompanying literature review. Case 1 was exposed antenatally from a gestational age of 30 weeks to valsartan because of maternal pregnancy-induced hypertension. The patient presented with oliguria immediately after birth, and renal replacement therapy was administered for 24 days. Seven years after birth, renal function was indicative of stage 2 chronic kidney disease (CKD) with impaired urinary concentration. Case 2 had a maternal history of hypertension and transient ischemic attack and was treated with olmesartan until 30 weeks of pregnancy. Renal replacement therapy was performed for 4 days since birth. After 8 years, the patient is with CKD stage 2, with intact tubular function. Recent reports suggest that ARB fetopathy might manifest as renal tubular dysgenesis and nephrogenic diabetes insipidus, in contrast to mild alterations of glomerular filtration. Tubular dysfunction may induce CKD progression and growth retardation. Patients with ARB fetopathy should be monitored until adulthood. The ARB exposure period might be a critical factor in determining the severity and manifestations of fetopathy.

• The Korean Journal of Nuclear Medicine Technology
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• v.25 no.2
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• pp.35-40
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• 2021

Purpose Glomerular filtration rate(GFR) is an important indicator for the diagnosis, treatment, and follow-up of kidney disease and is also used by healthy individuals for drug use and evaluating kidney function in donors. The gold standard method of the GFR test is to measure by continuously injecting the inulin which is extrinsic marker, but it takes a long time and the test method is complicated. so, the method of measuring the serum concentration of creatinine is used. Estimated glomerular filtration rate (eGFR) is used instead. However, creatinine is known to be affected by age, gender, muscle mass, etc. eGFR formulas that are currently used include the Cockroft-Gault formula, the modification of diet in renal disease (MDRD) formula, and the chronic kidney disease epidemilogy collaboration (CKD-EPI) formula for adults. For children, the Schwartz formula is used. Measurement of GFR using ⁵¹Cr-EDTA (diethylenetriamine tetraacetic acid), ^99mTc-DTPA (diethylenetriamine pentaacetic acid) can replace inulin and is currently in use. Therefore, We compared the GFR measured using ^99mTc-DTPA with the eGFR using CKD-EPI formula. Materials and Methods For 200 kidney transplant donors who visited Asan medical center.(96 males, 104 females, 47.3 years ± 12.7 years old) GFR was measured using plasma(Two-plasma-sample-method, TPSM) obtained by intravenous administration of ^99mTc-DTPA(0.5mCi, 18.5 MBq). eGFR was derived using CKD-EPI formula based on serum creatinine concentration. Results GFR average measured using ^99mTc-DTPA for 200 kidney transplant donors is 97.27±19.46(ml/min/1.73m²), and the eGFR average value using the CKD-EPI formula is 96.84±17.74(ml/min/1.73m²), The concentration of serum creatinine is 0.84±0.39(mg/dL). Regression formula of ^99mTc-DTPA GFR for serum creatinine-based eGFR was Y = 0.5073X + 48.186, and the correlation coefficient was 0.698 (P<0.01). Difference (%) was 1.52±18.28. Conclusion The correlation coefficient between the ^99mTc-DTPA and the eGFR derived on serum creatinine concentration was confirmed to be moderate. This is estimated that eGFR is affected by external factors such as age, gender, and muscle mass and use of formulas made for kidney disease patients. By using ^99mTc-DTPA, we can provide reliable GFR results, which is used for diagnosis, treatment and observation of kidney disease, and kidney evaluation of kidney transplant patients.

• Nutrition Research and Practice
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• v.16 no.2
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• pp.147-160
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• 2022

BACKGROUND/OBJECTIVES: Patients with chronic kidney disease (CKD) have a high concentration of uremic toxins in their blood and often experience muscle atrophy. Indoxyl sulfate (IS) is a uremic toxin produced by tryptophan metabolism. Although an elevated IS level may induce muscle dysfunction, the effect of IS on physiological concentration has not been elucidated. Additionally, the effects of ursolic acid (UA) on muscle hypertrophy have been reported in healthy models; however, it is unclear whether UA ameliorates muscle dysfunction associated with chronic diseases, such as CKD. Thus, this study aimed to investigate whether UA can improve the IS-induced impairment of mitochondrial biogenesis. MATERIALS/METHODS: C2C12 cells were incubated with or without IS (0.1 mM) and UA (1 or 2 μM) to elucidate the physiological effect of UA on CKD-related mitochondrial dysfunction and its related mechanisms using real-time reverse transcription-polymerase chain reaction, western blotting and enzyme-linked immunosorbent assay. RESULTS: IS suppressed the expression of differentiation marker genes without decreasing cell viability. IS decreased the mitochondrial DNA copy number and ATP levels by downregulating the genes pertaining to mitochondrial biogenesis (Ppargc1a, Nrf1, Tfam, Sirt1, and Mef2c), fusion (Mfn1 and Mfn2), oxidative phosphorylation (Cycs and Atp5b), and fatty acid oxidation (Pdk4, Acadm, Cpt1b, and Cd36). Furthermore, IS increased the intracellular mRNA and secretory protein levels of interleukin (IL)-6. Finally, UA ameliorated the IS-induced impairment in C2C12 cells. CONCLUSIONS: Our results indicated that UA improves the IS-induced impairment of mitochondrial biogenesis by affecting differentiation, ATP levels, and IL-6 secretion in C2C12 cells. Therefore, UA could be a novel therapeutic agent for CKD-induced muscle dysfunction.

• Phonetics and Speech Sciences
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• v.14 no.4
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• pp.45-56
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• 2022

This paper proposes an optimal methodology for automatically diagnosing and predicting the severity of the chronic kidney disease (CKD) using patients' utterances. In patients with CKD, the voice changes due to the weakening of respiratory and laryngeal muscles and vocal fold edema. Previous studies have phonetically analyzed the voices of patients with CKD, but no studies have been conducted to classify the voices of patients. In this paper, the utterances of patients with CKD were classified using the variety of utterance types (sustained vowel, sentence, general sentence), the feature sets [handcrafted features, extended Geneva Minimalistic Acoustic Parameter Set (eGeMAPS), CNN extracted features], and the classifiers (SVM, XGBoost). Total of 1,523 utterances which are 3 hours, 26 minutes, and 25 seconds long, are used. F1-score of 0.93 for automatically diagnosing a disease, 0.89 for a 3-classes problem, and 0.84 for a 5-classes problem were achieved. The highest performance was obtained when the combination of general sentence utterances, handcrafted feature set, and XGBoost was used. The result suggests that a general sentence utterance that can reflect all speakers' speech characteristics and an appropriate feature set extracted from there are adequate for the automatic classification of CKD patients' utterances.

• Journal of Veterinary Clinics
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• v.40 no.6
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• pp.399-407
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• 2023

Chronic kidney disease (CKD) occurs in more than 15% of the dogs over 10 years of age and causes irreversible renal function deterioration. Therefore, it is important to diagnose CKD early and treat the disease properly. The purpose of this study aimed to to evaluate the clinical utility of urine albumin/creatinine ratio (ACR) using POC (point-of-care) device as an early detection urinary biomarker in CKD dogs and to confirm the correlation between ACR and other known CKD biomarkers. Urine and serum samples were obtained from 50 healthy dogs and 50 dogs with CKD. Serum blood urea nitrogen (BUN), creatinine, and symmetric dimethylarginine (SDMA) concentrations, and urine protein creatinine ratio (UPC) were measured. Urine specific gravity (USG) was evaluated using refractometer, and ACR was measured using an i-SENS A1Care analyzer. The ACR values of dogs with CKD were significantly different from those of healthy dogs (p < 0.001), as with other renal biomarkers. ACR showed significant differences between healthy dogs and dogs with CKD at every IRIS stage (p < 0.005), whereas no significant differences were observed between dogs with CKD IRIS stage I and healthy dogs with UPC. There are significant positive correlation between ACR and BUN (r = 0.611, p < 0.001), creatinine (r = 0.788, p < 0.001), SDMA (r = 0.747, p < 0.001), and UPC (r = 0.784, p < 0.001), and significant negative correlation between ACR and USG (r = -0.700, p < 0.001). In receiver operator characteristic curve analysis, the area under the curve (AUC) was 0.982 (95% CI 0.963-1.000, p < 0.001), with an optimal cut-off value of 64.20 mg/g (94% sensitivity and 94% specificity). Thus, ACR is a useful urinary biomarker for the early diagnosis of proteinuria in CKD and combined use of ACR and other renal biomarkers may be helpful for early diagnosis and prevention of CKD in dogs.

• Childhood Kidney Diseases
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• v.27 no.2
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• pp.70-75
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• 2023

Dent disease is a rare inherited kidney tubulopathy caused by mutations in either the CLCN5 (Dent disease 1) or OCRL1 (Dent disease 2) genes, and which is often underdiagnosed in practice. A diagnosis is clinically suspected in patients with low-molecular-weight proteinuria, hypercalciuria, and one of the following: hematuria, nephrolithiasis, nephrocalcinosis, hypophosphatemia, or chronic kidney disease. Inheritance is X-linked recessive, meaning, these symptoms are generally only found in males; female carriers may have mild phenotypes. Genetic testing is only a method to confirm the diagnosis, approximately 25% to 35% of patients have neither the CLCN5 nor OCRL1 pathogenic variants (Dent disease 3), making diagnosis more challenging. The genotype-phenotype correlations are not evident with the limited clinical data available. As with many other genetic diseases, the management of patients with Dent disease concentrates on symptom relief rather than any causative process. The current treatments are mainly supportive to reduce hypercalciuria and prevent nephrolithiasis. Chronic kidney disease progresses to end-stage between the ages of the third to fifth decades in 30% to 80% of affected males. In this review, we aimed to summarize the literature on Dent disease and reveal the clinical characteristics and molecular basis of Korean patients with Dent disease.

• The Journal of Internal Korean Medicine
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• v.42 no.5
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• pp.727-737
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• 2021

Objectives: This study investigated the effect of Korean medicine on an elderly patient with posterior circulation cerebral infarction, chronic kidney disease (CKD), and early neurological deterioration (END). Methods: The patient, who already had CKD, was treated with Korean medicine, comprising herbal medicine, acupuncture, moxa, and cupping combined with Western medicine (antiplatelet, diabetes) and physical therapy. A manual muscle test (MMT) and a modified Barthel index (MBI) were used to observe the treatment effects, and blood tests were performed to check estimated glomerular filtration rate (eGFR), creatinine and blood urea nitrogen (BUN), which represent renal function. Results: After the treatment, MMT, MBI, and renal function scores had increased. Conclusions: This study suggests that Korean medicine can effectively treat posterior circulation cerebral infarction with END in CKD, but further studies should be conducted.

• Journal of Veterinary Clinics
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• v.27 no.6
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• pp.723-725
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• 2010

A 14-year-old spayed, mixed breed, female cat was admitted for evaluation of a polyphagia, hyperactivity and chronic weight loss. Physical examination revealed a tachycardia and mild elevated systemic blood pressure. This cat had azotemia and mild increased total thyroxin (TT4) and free thyroxin concentration. However triiodothyronine (T3) level was normal, the T3 suppression test for definite diagnosis were made. No changes of TT4 serum concentration before and after the exogenous T3 administration in this cat showed hyperthyroidism. This cat was diagnosed as mild hyperthyroidism concurrent with chronic kidney disease (CKD) and antithyroid drug, methimazole, was used for medical management. This is first case report describing clinical and laboratory characteristic features of feline hyperthyroidism complicated with CKD and its clinical outcome using medical management in our country.