• Journal of Sasang Constitutional Medicine
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• v.36 no.2
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• pp.65-75
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• 2024

Objectives This case study was aimed to report improvement of taeum-in patient with chronic kidney disesase who had voiding dysfunction after intracerebral hemorrhage using Yeoldahanso-tanggamibang. Methods A patient who complained of voiding dysfunction after intracerebral hemorrhage was administered with Yeoldahanso-tanggamibang through sasang consitutional medicine approach. To evaluate the improvement of voiding dysfunction, the number of nelaton catheterizations after removal of foley catheter and the amount of post void residual volume were compared, and laboratory follow-up was performed to determine whether renal function deteriorated. Results After treatment with Yeoldahanso-tanggamibang for 8 weeks, the number of nelaton catheterizations after removal of foley catheter decreased, the amount of post void residual volume decreased, and the renal function did not change. Conclusions This case study suggests the significance of Yeoldahanso-tanggamibang treatment for taeum-in patient who had voiding dysfunction after intracerebral hemorrhage.

• Journal of Veterinary Clinics
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• v.34 no.3
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• pp.197-199
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• 2017

A 14-year-old castrated male ShihTzu diagnosed with chronic kidney disease (CKD) 6 months prior was referred to our clinic. The patient had been experiencing symptoms such as vomiting, poor appetite and hind limbs weakness. Hematology tests showed that he had a non-regenerative anemia. With aggressive treatment, the patient's state had gotten worse. He showed ragged breath, vomiting blood and loss of consciousness temporarily. Hematocrit maintained low level. Gastric hemorrhage was strongly suspected by hematemesis. Whole blood transfusion was performed and heparin was used as an anticoagulant. Prior to transfusion, the blood cross matching between donor and patient was performed and the result was compatible. After the transfusion was stabilized, 1 mg of protamine sulfate for each 100 units of heparin was prepared and given intravenously over 3 minutes to reverse the effects of heparin. Immediately after protamine injection, the patient conducted severe anaphylactic shock. Protamine sulfate is used to reverse the anticoagulant action of heparin in dogs and humans. The adverse reaction of protamine sulfate range from mild reaction to fetal cardiac arrest. When using protamine sulfate as heparin neutralization, it can lead to the death of a patient cause of anaphylactic shock. For this reason, the protamine sulfate should be injected slowly with antihistamine and the clinician should carefully monitor patients.

• Journal of Cardiovascular Imaging
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• v.26 no.4
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• pp.217-225
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• 2018

BACKGROUND: In patients with acute heart failure (AHF), diastolic dysfunction, especially pseudonormal (PN) or restrictive filling pattern (RFP) of left ventricle (LV), is considered to be implicated in a poor prognosis. However, prognostic significance of diastolic dysfunction in patients with ischemic heart disease (IHD) has been rarely investigated in Korea. METHODS: We enrolled 138 patients with IHD presenting as AHF and sinus rhythm during echocardiographic study. Diastolic dysfunction of LV was graded as ${\geq}2$ (group 1) or 1 (group 2) according to usual algorithm using E/A ratio and deceleration time of mitral inflow, E'/A' ratio of tissue Doppler echocardiography and left atrial size. RESULTS: Patients in group 1 showed higher 2-year mortality rate ($36.2%{\pm}6.7%$) than those in group 2 ($13.6%{\pm}4.5%$; p = 0.008). Two-year mortality rate of patient with LV ejection fraction (LVEF) < 40% ($26.8%{\pm}6.0%$) was not different from those with LVEF 40%-49% ($28.0%{\pm}8.0%$) or ${\geq}50%$ ($13.7%{\pm}7.4%$; p = 0.442). On univariate analysis, PN or RFP of LV, higher stage of chronic kidney disease (CKD) and higher New York Heart Association (NYHA) functional class were poor prognostic factors, but LVEF or older age ${\geq}75$ years did not predict 2-year mortality. On multivariate analysis, PN or RFP of LV (hazard ratio [HR], 2.52; 95% confidence interval [CI], 1.09-5.84; p = 0.031), higher stage of CKD (HR, 1.57; 95% CI, 1.14-2.17; p = 0.006) and higher NYHA functional class (HR, 1.81; 95% CI, 1.11-2.94; p = 0.017) were still significant prognostic factors for 2-year mortality. CONCLUSIONS: PN or RFP of LV was a more useful prognostic factor for long-term mortality than LVEF in patients with IHD presenting as AHF.

• Interdisciplinary Bio Central
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• v.4 no.2
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• pp.4.1-4.4
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• 2012

Background: Serum concentration of cystatin C, a marker of glomerular filtration has been associated with cardiovascular disease (CVD). The aim of this study was to evaluate cystatin C as a marker of obese patients without chronic kidney disease (CKD). Materials and Methods: The study population consisted of 36 subjects with metabolic syndrome and 32 subjects free of metabolic syndrome (the control group). HDL-C, LDL-C, blood urea, triglycerides, glucose, HbA1c, serum cystatin C and serum creatinine were measured in both groups. GFR was calculated in both groups using Cockroft-Gault equation. Results: Obese patients showed higher cystatin C levels than normal samples ($1.28{\pm}0.29$, P < 0.05). In the binary logistic regression, obese patients were significantly associated with elevated cystatin C levels. Conclusion: Our results suggest that cystatin C may be a marker for obese patients and may identify a certain degree of renal dysfunction even when serum creatinine does not exceed the normal level. In this study, we demonstrated that serum creatinineand GFR did not differ significantly between the diabetic and the control groups. Serum concentration of cystatin C was significantly higher in the diabetic group compared with the control group. The strengths of this study are the evaluation of reliability and sensivity in comparison with a 'routine test of GFR'. The methodology used allows an appropriate statistical comparison of reliability in contrast to most other previous evaluations of GFR.

• Journal of Nutrition and Health
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• v.46 no.6
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• pp.521-530
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• 2013

Protein-energy malnutrition, PEM, and increased hs-CRP level are considered to be associated with increased risk of cardiovascular disease (CVD) in hemodialysis (HD) patients. This is commonly referred to as the vicious circle of malnutrition-inflammation-atherosclerosis cardiovascular disease (MIA syndrome) in chronic kidney disease (CKD). Low protein intake can decrease the serum level of albumin and increase inflammational markers; further, both low serum albumin and high hs-CRP are independent risk factors for all-cause mortality in HD patients. The aim of this study is comparing the serum levels of albumin and hs-CRP in HD patients according to the protein intake levels. The total number of subjects was 60 hemodialysis patients; they were grouped by dietary protein intake: low protein intake group (LPI, protein intake < 1.0 g/kg IBW, 11 men and 19 women) and adequate protein intake group (API, protein intake ${\geq}$ 1.0g/kg IBW, 12 men and 18 women). Blood biochemical parameters, nutrient intake, and dietary behaviors were compared between the LPI and API groups. The LPI group showed a significantly lower serum level of albumin and higher serum level of hs-CRP than the API group (p < 0.05). The LPI group showed a significantly lower intake of most nutrients than the API group (p < 0.05). Index of Nutritional Quality of most nutrients of the LPI and API groups were lower than 1.0. Dietary protein intake was positively correlated with the serum level of albumin (r = 0.306, p < 0.05) and negatively correlated with the serum level of hs-CRP (r = -0.435, p < 0.01). The serum level of hs-CRP was negatively correlated with that of albumin (r = -0.393, p < 0.01). According to these result, serum albumin and hs-CRP in HD patients were influenced by the protein intake levels. To prevent MIA syndrome, it is necessary to improve nutritional status, especially in protein and energy.

• Korean Journal of Clinical Pharmacy
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• v.21 no.4
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• pp.364-375
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• 2011

Given that single blockade with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) can achieve only partial and undurable suppression of the Renin Angiotensin System (RAS), it has been hypothesized that dual blockage would be more beneficial in the management of blood pressure (BP) reduction and prevention of progressive chronic kidney disease (CKD) than either agent alone. Thus, it has been suggested that the combination of an ACEI and an ARB might provide renal benefits to hypertensive patients over and above BP reduction. However, this might also expose patients to additive or synergistic side effects. We attempted to conduct a systematic review to evaluate the benefits and harms of combination therapy in hypertensive patients with or without kidney diseases. MEDLINE and KoreaMed were searched for relevant randomized clinical trials in adult hypertensive patients with or without diabetes (restricted to 1997, limited to trials published in English). Results were summarized using the random-effects model, and between-studies heterogeneity was estimated with $I^2$. A final analysis of ten trials (23,928 patients) revealed that the combination of an ACEI and an ARB reduced blood pressure (SBP/DBP) by 3.95/2.02 mmHg (95% confidence interval [CI], -4.38 to -3.53/-2.33 to -1.71) compared with ACEI monotherapy, and 2.83/2.64 mmHg (95% CI, -3.25 to -2.41/-4.95 to -0.33) compared with ARB monotherapy. Eight trials (391 patients) demonstrated a significant reduction in 24h-proteinuria (weighted mean difference, 0.16 g/day, 95% CI, -0.26-0.05), but they did not translate into an improvement in GFR. Tests for heterogeneity showed no difference in effect among the studies. The combination therapy reduced proteinuria by 30% (95% CI, 23% to 37%) and 39% (95% CI, 31% to 48%) compared with ACEI monotherapy and ARB monotherapy, respectively. However, in patients who had proteinuria more than 0.5 g/day, the combination therapy failed to show significant reduction in urinary protein excretion. The current cumulative evidence suggests that diabetic patients with proteinuria on dual RAS blockade have an increase risk of adverse events such as hyperkalemia, hypotension, and so on, compared with ACEI or ARB alone. It is, therefore, proposed that the combination therapy should not be routinely used for the treatment of hypertension with or without compelling indications.

• Korean Journal of Clinical Laboratory Science
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• v.51 no.2
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• pp.145-154
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• 2019

This study examined the relationship between the estimated glomerular filtration rate (eGFR) and urine microalbumin/creatinine ratio (uACR) with ferritin in Korean adults. This study included 4,948 adults aged ${\geq}20years$ from the 2012 Korea National Health and Nutrition Examination Survey (KNHANES) data. A covariance test adjusted for covariates was performed for the ferritin levels in relation to the decreased eGFR (eGFR<$60ml/min/1.73m^2$) and elevated uACR ($uACR{\geq}30mg/g$). Several key findings were made in the present study. First, after adjusting for the related variables, the ferritin level was higher in the decreased eGFR group [$103.04{\pm}6.59mL/min/1.73m^2$; 95% confidence interval (CI), 90.12~115.96] than in the normal eGFR group ($84.87{\pm}1.16mL/min/1.73m^2$; 95% CI, 82.59~87.14; P=0.007). Second, after adjusting for the related variables, the ferritin level ($M{\pm}SE$) was similar in the normal uACR group ($85.70{\pm}1.20mg/g$; 95% CI, 83.35~88.05) and elevated uACR group ($82.72{\pm}4.09mg/g$; 95% CI, 74.71~90.73) (P=0.487). Chronic kidney disease was positively associated with the ferritin level in Korean adults but albuminuria was not.