• The Korean Journal of Physiology and Pharmacology
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• 제22권5호
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• pp.567-575
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• 2018

Acute kidney injury (AKI), which is defined as a rapid decline of renal function, becomes common and recently recognized to be closely intertwined with chronic kidney diseases. Current treatment for AKI is largely supportive, and endoplasmic reticulum (ER) stress has emerged as a novel mediator of AKI. Since carbon monoxide attenuates ER stress, the objective of the present study aimed to determine the protective effect of carbon monoxide releasing molecule-2 (CORM2) on AKI associated with ER stress. Kidney injury was induced after LPS (15 mg/kg) treatment at 12 to 24 h in C57BL/6J mice. Pretreatment of CORM2 (30 mg/kg) effectively prevented LPS-induced oxidative stress and inflammation during AKI in mice. CORM2 treatment also effectively inhibited LPS-induced ER stress in AKI mice. In order to confirm effect of CO on the pathophysiological role of tubular epithelial cells in AKI, we used mProx24 cells. Pretreatment of CORM2 attenuated LPS-induced ER stress, oxidative stress, and inflammation in mProx24 cells. These data suggest that CO therapy may prevent ER stress-mediated AKI.

• Childhood Kidney Diseases
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• 제9권2호
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• pp.251-254
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• 2005

저자들은 핍뇨를 주소로 내원한 12세 남아에서 임상 소견 및 검사 소견 상 전신적 강직성 경련으로 유발뇐 횡문근융해증에 의해 초래된 급성신부전으로 진단하고 충분한 수액공급 소변의 알칼리화, 이뇨제 투여와 함께 항경련제의 사용으로 경련을 조절함으로써 급성신부전이 호전된 1례를 경험하였기에 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제62권12호
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• pp.433-437
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• 2019

Acute pyelonephritis (APN) should be detected and treated as soon as possible to reduce the risk of the development of acquired renal scarring. However, in the medical field, urine culture results are not available or considered when the prompt discrimination of APN is necessary and empirical treatment is started. Furthermore, urine culture cannot discriminate APN among children with febrile urinary tract infection (UTI) (pyelitis, lower UTI with other fever focus). Therefore, the usefulness of urine culture for diagnostic purposes is small and the sampling procedure is invasive. Congenital hypoplastic kidney is the most common cause of chronic kidney injury in children. Thus, it is desirable that a main target be detected as early as possible when imaging studies are performed in children with APN. However, if APN does not recur, no medical or surgical treatment or imaging studies would be needed because the acquired renal scar would not progress further. Therefore, the long-term prognosis of APN in young children, particularly infants, depends on the number of recurrent APN, not other febrile UTI. New methods that enable prompt, practical, and comfortable APN diagnosis in children are needed as alternatives to urinary catheterization for urine culture sampling.

• Clinical and Experimental Pediatrics
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• 제61권3호
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• pp.95-100
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• 2018

Purpose: This study aimed to evaluate the clinical findings in pediatric rhabdomyolysis and the predictive factors for acute kidney injury (AKI) in Korean children. Methods: Medical records of 39 Korean children, who were newly diagnosed with rhabdomyolysis from January 2008 to December 2015, were retrospectively analyzed. The diagnosis was made from the medical history, elevated serum creatinine kinase level >1,000 IU/L, and plasma myoglobin level >150 ng/mL. Patients with muscular dystrophy and myocardial infarction were excluded. Results: The median patient age at diagnosis was 14.0 years (range, 3-18 years), and the male to female ratio was 2.5. The most common presenting symptom was myalgia (n=25, 64.1%), and 14 patients (35.9%) had rhabdomyolysis-induced AKI. Eighteen patients (46.2%) had underlying diseases, such as epilepsy and psychotic disorders. Ten of these patients showed rhabdomyolysis-induced AKI. The common causes of rhabdomyolysis were infection (n=12, 30.7%), exercise (n=9, 23.1%), and trauma (n=8, 20.5%). There was no difference in the distribution of etiology between AKI and non-AKI groups. Five patients in the AKI group showed complete recovery of renal function after stopping renal replacement therapy. The median length of hospitalization was 7.0 days, and no mortality was reported. Compared with the non-AKI group, the AKI group showed higher levels of peak creatinine kinase and myoglobin, without statistical significance. Conclusion: The clinical characteristics of pediatric rhabdomyolysis differ from those observed in adult patients. Children with underlying diseases are more vulnerable to rhabdomyolysis-induced AKI. AKI more likely develops in the presence of a high degree of albuminuria.

• 한국임상약학회지
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• 제23권4호
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• pp.307-315
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• 2013

Objective: Colistimethate was first became available in 1950s and used until the early 1980s to treat infections caused by gram-negative bacteria and was abandoned due to its nephrotoxicity and neurotoxicity. However, it was recently reintroduced into the clinical practices due to emergence of multidrug-resistance gram-negative bacteria, particularly Pseudomonas aeruginosa and Acinetobacter baumanii. Therefore, it is increasingly used in the intensive care unit settings as a salvage therapy. This study was designed to investigate the incidence rates and risk factors of acute kidney injury associated with colistimethate by using the standardized definition in critically ill patients. Methods: This study retrospectively reviewed the electronic medical records of 71 adult patients above 18 years old receiving intravenous colistimethate at least 48 hours at intensive care unit, university-affiliated hospital from Nov 2012 to Aug 2013 and excluded patients with end-stage renal disease (ESRD) and required renal replacement therapy before initiation of the colistimethate therapy. Acute kidney injury (AKI) was determined by using the standardized RIFLE criteria, classified with risk, injury, failure, loss and ESRD according to serum creatinine (Scr) levels. Results: Among the 71 patients included in the analysis, AKI developed in 40 patients (56.3%) and 6 patients (8.4%) had irreversible kidney injury. AKI occurred within 5 days in 20 patients (50.0%). Maximum Scr level showed a significant increase in the patients with AKI ($1.92{\pm}0.86mg/dL$ vs. $1.12{\pm}0.46mg/dL$ p=0.001), maximum BUN also increased ($64.2{\pm}28.7mg/dL$ vs. $48.4{\pm}24.9mg/dL$ p=0.017) and minimum creatinine clearance (CLcr) was significantly decreased in the patients with AKI than non-AKI ($34.5{\pm}18.6ml/min$ vs. $64.4{\pm}33.7ml/min$ p=0.185). The patients with AKI had significantly longer duration of colistimethate therapy ($21.1{\pm}17.0$ days vs. $13.0{\pm}11.5$ days, p=0.020) and larger cumulative doses of colistimethate ($6465.9{\pm}4717.0mg$ vs. $4438.1{\pm}3426.7mg$, p=0.040). Conclusion: The incidence and severity of AKI associated with colistimethate in critically ill patients was high and serious. Drug monitoring program should be performed to shorten duration of therapy and reduce cumulative dose from initiation of colistimethate therapy for minimizing AKI of colistimethate.

• 한국임상수의학회지
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• 제28권1호
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• pp.63-70
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• 2011

To consider the iliac fossa as the vascular anastomosis site of kidney transplantation for the short-term study of acute rejection in pigs. Twelve domestic pigs weighing 39~48 kg underwent heterotopic renal allgraft transplantation. The experimental animals were divided into 2 groups in terms of renal vascular anastomosis site; the external iliac artery and vein were used in iliac fossa model (n = 6), the abdominal aorta and the caudal vena cava inferior to the kidney were used in abdominal cavity model (n = 6). Renal function was evaluated by daily measurement of plasma creatinine and BUN concentrations. The experiments' health including postoperative complications was also assessed daily for 8 days after transplantation. After euthanazation gross and histopathologic analysis was performed. All six pigs in iliac fossa model developed neuropraxia and lameness of the ipsilateral pelvic limb. However, no necrosis was observed in any pigs. In the abdominal cavity model, durations of both the surgical operation and the vascular anastomosis were significantly longer than those in the iliac fossa model. Furthermore, ischemia injury of the transplanted kidney was increased in abdominal cavity model, which induced accelerated-acute immune response from day 4 after transplantation. Despite of pelvic limb complication, the iliac fossa model showed more advantages including not only less ischemia time related to easy vascular anastomosis, but also less immune response during the acute rejection period. The results indicate that the iliac fossa model may be appropriate to the study of acute rejection in porcine kidney transplantation.

• Archives of Plastic Surgery
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• 제33권5호
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• pp.652-654
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• 2006

Beau first described transverse depressions of the fingernails after an acute febrile illness in 1846. It was the result of the temporary arrest of nail matrix formation. The transient interference of nail growth rate is usually induced by disability caused by severe systemic disease. Such as Raynaud disease, myocardial infarction, pulmonary embolism, acute renal failure, psoriasis and dysmenorrhea were reported to be the cause of Beau's line. The trauma caused either in a hand or in a forearm was also reported to be the cause of Beau's line. We experienced patients with Beau's line, two cases secondary to fingertip injury and one case due to fracture in radius. They had Beau's lines in all fingers of traumatized hand and nails of opposite hand were normal. During the follow-up, the growth rate of traumatized fingernails were normal and there was no complication.

• Journal of Yeungnam Medical Science
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• 제32권1호
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• pp.17-21
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• 2015

Amlodipine, a calcium channel blocker of the dihydropyridine group, is commonly used in management of hypertension, angina, and myocardial infarction. Amlodipine overdose, characterized by severe hypotension, arrythmias, and pulmonary edema, has seldom been reported in Korean literature. We report on a fatal case of amlodipine intoxication with complications including rhabdomyolysis and oliguric acute kidney injury. A 70-year-old woman with a medical history of hypertension was presented at the author's hospital 6 hours after ingestion of 50 amlodipine (norvasc) tablets (total dosage 250 mg) in an attempted suicide. Her laboratory tests showed a serum creatinine level of 2.5 mg/dL, with elevated serum creatine phosphokinase and myoglobin. The patient was initially treated with fluids, alkali, calcium gluconate, glucagon, and vasopressors without a hemodynamic effect. High-dose insulin therapy was also started with a bolus injection of regular insulin (RI), followed by continuous infusion of RI and 50% dextrose with water. Despite intensive treatment including insulin therapy, inotropics, mechanical ventilation, and continuous venovenous hemodiafiltration, the patient died of refractory shock and cardiac arrest with no signs of renal recovery 116 hours after her hospital admission.

• Childhood Kidney Diseases
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• 제23권2호
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• pp.77-85
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• 2019

Contrast-associated acute kidney injury (CA-AKI) is a major concern when iodinated contrast material is administered, especially in patients at risk. Efforts have been undertaken to understand the detrimental effects of contrast media (CM). With the use of low-osmolar or iso-osmolar CM the incidence of CA-AKI has steadily decreased within the past decade; however, especially in the pediatric population information is scarce. Incidence rates have been reported to range between 0% to 18.75%, particularly depending on indication, selection of population (i.e. preexisting co-morbidities), and definition of AKI. Different biomarkers have been proposed, but confirmatory studies are either lacking or have contributed to their lack of diagnostic power. Proteomic approaches have been employed and may pave the way to such discovery. Prevention strategies have been tested and proposed, but the recently published AMACING and PRESERVE trials have shown that commonly used strategies (such as systematic hydration or administration of N-acetylcysteine) have no role in the prevention of CA-AKI. We propose that thoughtful assessment of one's fluid state is the most appropriate approach and depending on the hydration status diuretics or fluid administration should be provided to achieve an euvolemic state ahead of contrast exposure.

• Annals of Clinical Neurophysiology
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• 제24권2호
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• pp.93-97
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• 2022

Posterior reversible encephalopathy syndrome (PRES) is a rare condition manifested by inflammation in certain areas of the brain. Rhabdomyolysis with acute kidney injury (AKI) complicated by PRES is rarely reported. A 26-year-old female presented with neurological symptoms, high blood pressure, and AKI. Her symptoms improved with blood pressure control, anticonvulsant drug medications, and renal replacement therapy. This case demonstrates that PRES should be considered in the differential diagnosis of patients who have rhabdomyolysis with AKI accompanied by neurological symptoms, including headaches and convulsions.