• Kidney Research and Clinical Practice
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• v.37 no.4
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• pp.384-392
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• 2018

Background: A very low protein diet (VLPD) with ketoacid analogs of essential amino acids (KA/EAA) administration can remarkably influence protein synthesis and metabolic disturbances of patients with advanced chronic kidney disease (CKD), and may also slow the decline in renal function. Methods: A retrospective cohort study was carried out to monitor renal progression and metabolic and nutritional status among 140 patients with CKD stage III or IV. One group (n = 70) was on a low protein diet (LPD) with 0.6 g of protein intake, and another group (n = 70) was on a VLPD with 0.3 g of protein and KA/EAA supplementation of 100 mg/kg/day for 12 months. Results: At 12-month follow-up, estimated glomerular filtration rate (GFR) significantly decreased from $41.6{\pm}10.2$ to $36.4{\pm}8.8mL/min/1.73m^2$ (P < 0.001) and urine protein increased from $0.6{\pm}0.5$ to $0.9{\pm}1.1g/day$ (P = 0.017) in the LPD group, but no significant changes in estimated GFR and urine protein were found in the VLPD plus KA/EAA group. A significant mean difference in rate of change in estimated GFR ($-5.2{\pm}3.6mL/min/1.73m^2$ per year; P < 0.001) was observed between the two groups. After Cox regression analysis, treatment with VLPD plus KA/EAA significantly protected against the incidence of declining GFR > 10% annually (adjusted hazard ratio, 0.42; 95% confidence interval, 0.23-0.79; P = 0.006) and significant correlations were found between using VLPD plus KA/EEA and increased GFR. Conclusion: VLPD supplementation with KA/EAA is associated with delayed renal progression while preserving the nutritional status in the patients with CKD. Co-administration of VLPD and KA/EAA may prove an effective alternative to conservative management of CKD.

• Electrolytes & blood pressure
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• v.16 no.2
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• pp.19-22
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• 2018

Renal Fanconi syndrome (RFS) is caused by generalized proximal tubular dysfunction and can be divided into hereditary and acquired form. Adult-onset RFS is usually associated with drug toxicity or systemic disorders, and modern molecular genetics may explain the etiology of previous idiopathic cases of RFS. Here, we report the case of a 52-year-old woman with RFS whose etiology could not be identified. She presented with features of phosphaturia, renal glucosuria, aminoaciduria, tubular proteinuria, and proximal renal tubular acidosis. Her family history was unremarkable, and previous medications were nonspecific. Her bone mineral density was compatible with osteoporosis, serum intact parathyroid hormone level was mildly elevated, and 25(OH) vitamin D level was insufficient. Her blood urea nitrogen and serum creatinine levels were 8.4 and 1.19 mg/dL, respectively (estimated glomerular filtration rate, $53mL/min/1.73m^2$). Percutaneous renal biopsy was performed but revealed no specific renal pathology, including mitochondrial morphology. No mutation was detected in EHHADH gene. We propose the possibility of involvement of other genes or molecules in this case of adult RFS.

• Journal of Medicine and Life Science
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• v.19 no.1
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• pp.14-19
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• 2022

We investigated the safety and efficacy of pemetrexed monotherapy in patients with lung adenocarcinoma and various renal conditions, including chronic kidney disease. We also analyzed whether baseline renal function affected progression-free survival (PFS). We retrospectively analyzed 71 patients who received maintenance-and second-line pemetrexed monotherapy. Patients were divided into two groups according to estimated glomerular filtration rate (eGFR): fair eGFR (>60 mL/min/1.73 m²) and lower eGFR (59 mL/min/1.73 m² or less). The safety and efficacy were evaluated for each group. Median ages were 73.2 years in the lower eGFR group (n=28) and 64.5 years in the fair eGFR group (n=43). Patients with a lower eGFR achieved a median PFS of 4.7 months, while the median PFS for patients with a fair eGFR was 2.7 months. The difference between the two groups was not statistically significant (P=0.075). Both groups showed treatment-related low-grade hematological and non-hematological adverse events. Pemetrexed monotherapy is safe and effective in patients with lung adenocarcinoma with a lower eGFR.

• Childhood Kidney Diseases
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• v.27 no.1
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• pp.40-45
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• 2023

Tubulointerstitial nephritis and uveitis (TINU) syndrome is defined as the occurrence of tubulointerstitial nephritis and uveitis in the absence of other systemic diseases. Three pediatric cases have been reported in the Republic of Korea, and we now report a fourth case. A 15-year-old girl presented to the ophthalmology department with a 1-week history of bilateral ocular discomfort that worsened on the day of presentation with redness and pain in both eyes. She was diagnosed with bilateral uveitis, and her baseline examination revealed moderate renal dysfunction and mild proteinuria. A renal biopsy was performed and confirmed the diagnosis of TINU syndrome. She was started on steroid eye drops and a 12-week course of oral steroids at a dose of 40 mg/m²/day, which completely resolved the proteinuria and mild renal function to an estimated glomerular filtration rate of 60 mL/min/1.73 m². However, the uveitis did not improve, and despite the addition of oral methotrexate as a second-line treatment, the uveitis remains unresponsive to treatment over 21 months. Further evaluation and treatment are ongoing, and active therapeutic intervention is suggested even at a pediatric age, considering the lack of improvement in renal function and uveitis to date.

• Clinical and Experimental Pediatrics
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• v.48 no.11
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• pp.1219-1224
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• 2005

Purpose : The prevalence of obesity in children and adolescents has been rising rapidly in Korea because of changes of diet and lifestyle. As with adults, obesity in children and adolescents can cause diabetes mellitus, hyperlipidemia, cardiovascular diseases and renal diseases. The aim of the present study is to examine the relation of obesity, glomerular filtration rate(GFR) and serum cystatin C concentration in children and adolescents. Methods : Data of 115 children and adolescents aged between 6 years and 20 years without clinical evidence of renal diseases were included in the study. From May 2004 to December 2004, blood samples were collected from children and adolescents who were seen at the Department of Pediatrics at Chungang University Yongsan Hospital. Obesity degrees and body mass indices(BMI) were measured, and GFRs were estimated from Schwartz's formula. Serum cystatin C was measured by particle enhanced nephelometric immunoassay using Behring Nephelometer II. Results : GFRs were significantly different between the obese group(BMI >95 percentile, $145.79{\pm}23.10mL/min$) and the non-obese group(BMI <95 percentile, $134.61{\pm}26.19mL/min$) divided by BMI (P=0.031). GFRs were not significantly different between the obese group(obesity degree >120 percent, $144.29{\pm}23.08mL/min$) and the non-obese group(obesity degree <120 percent, $134.54{\pm}26.57mL/min$) divided by obesity degree(P=0.051), but were significantly different between severe obese group (obesity degree >150 percent, $155.55{\pm}20.40mL/min$) and the non-obese group(P=0.004). GFRs were correlated positively with BMI($r^2=0.037$, P=0.039), but were not correlated significantly with obesity degree($r^2=0.030$, P=0.066). Serum cystatin C concentrations were not significantly different between the obese group and the non-obese group, divided by BMI as well as by obesity degree(P>0.05). Conclusion : Obesity may lead to an alteration of renal hemodynamics such as hyperfiltration, appropriate control and management for obesity is necessary.

• Investigative and Clinical Urology
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• v.59 no.6
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• pp.376-382
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• 2018

Purpose: The authors performed this study to investigate the risk factors for predicting stent failure and to evaluate its impact on prognosis. Materials and Methods: Between January 2002 and March 2017, we retrospectively reviewed 117 consecutive patients who underwent retrograde ureteral stenting and exchanging at least once every 3 months for malignant ureteral obstruction. The patients were classified according to their pre-stenting chronic kidney disease (CKD) stage. The factors affecting stent failure were analyzed using a logistic regression model. Overall survival (OS) was estimated, and the prognostic significance of each variable was estimated using Cox proportional-hazards regression modeling. Results: Before stenting, 91 patients were CKD stages 1-3 and 26 patients were CKD stages 4-5. These two groups differed significantly only in pre-stenting estimated glomerular filtration rate (eGFR), bilateral obstruction, and pre-stenting pyuria. Among the 117 patients, stent failure occurred in 30 patients (25.6%), and there were no differences between the groups. Pre-stenting pyuria and post-stenting complications were significant predictors of stent failure. There were 79 deaths in total, including 56 in the CKD stages 1-3 group and 23 in the CKD stages 4-5 group. In the multivariate analysis predicting patient OS, pre-stenting eGFR and post-stenting disease progression were significant factors. Conclusions: Internal ureteral stenting was effective for maintaining renal function in malignant ureteral obstruction. However, it did not restore renal function, which is related to the prognosis of the patients. Therefore, to improve patients' renal function and prognosis, patients who require stenting must be quickly recognized and treated.

• The Korean Journal of Nuclear Medicine
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• v.34 no.5
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• pp.418-425
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• 2000

Purpose: There is no established formula for estimating renal depths in Korean. As a result, we undertook this study to develop a new formula, and to apply this formula in the calculation of glomerular filtration rate (GFR). Materials and Methods: We measured the renal depth (RD) on the abdominal CT obtained in 300 adults (M:F: 167:133, mean age 50.9 years) without known renal diseases. The RDs measured by CT were compared with the estimated RDs based on the Tonnesen and Taylor equations. New formulas were derived from the measured RDs in 200 out of 300 patients based on several variables such as sex, age, weight, and height by multiple regression analysis. The RDs estimated from the new formulas were compared with the measured RDs in the remaining 100 patients as a control. In 48 patients who underwent Tc-99m DTPA renal scintigraphy, GFR was measured with three equations (new formula, Tonnesen and Taylor equations), respectively, and compared with each other. Results: The mean values of the RDs measured from CT were 6.9 cm for right kidney of the men (MRK), 6.7 cm for left kidney of the men (MLK), 6.7 cm for right kidney of the women (WRK), and 6.6 cm for left kidney of the women (WLK). The RDs estimated from Tonnesen equation were shorter than the ones measured from CT significantly. The newly derived formulas were 12.813 (weight/height)+0.002 (age)+ 2.264 for MRK, 15.344 (weight/height)+0.011 (age)+0.557 for MLK, 12.936 (weight/height)+ 0.014 (age)+1.462 for WRK and 13.488 (weight/height)+0.019 (age)+0.762 for WLK. The correlation coefficients of the RD measured from CT and estimated from the new formula were 0.529 in MRK, 0.729 in MLK, 0.601 in WRK, and 0.724 in WLK, respectively. The GFRs from the new formula were significantly higher than those from the Tonnesen equation significantly, which was the most similar to normal GFR values. Conclusion: We generated new formulas for estimating RD in Korean from the data by CT. By adopting these formulas, we expect that GFR can be measured by the Gates method accurately in Korean.

• Kosin Medical Journal
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• v.33 no.2
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• pp.191-199
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• 2018

Objectives: We designed the study to compare the oncologic and renal function outcomes of off-clamp, laparoscopic partial nephrectomy (OCLPN) and conventional laparoscopic partial nephrectomy (HCLPN) for renal tumors. Methods: Between March 2008 and July 2015, 114 patients who underwent laparoscopic partial nephrectomy (LPN) of a renal neoplasm were studied. We performed LPN without hilar clamp on 40 patients (OCLPN, Group 1), and conventional LPN with hilar control and renorrhaphy on another 40 patients (HCLPN, Group 2). We retrospectively reviewed the medical records of each patient's age, sex, R.E.N.A.L. nephrometry score (RNS), operation time, complications, hospitalization period, tumor size, positive resection margin, histologic classification of tumor, pathologic stage, Fuhrman grade, estimated blood loss (EBL), warm ischemic time (WIT), and estimated glomerular filtration rate (eGFR) before and one year after surgery. Results: There were no significant differences in age, sex, preoperative eGFR, EBL, surgical (anesthesia) time, and tumor size between the two groups. The mean eGFR was not significantly different between the OCLPN and HCLPN groups 1 month (95 and $86.2mL/min/1.73m^2$, respectively; P = 0.106), 6 months (92.9 and $83.6mL/min/1.73m^2$, respectively; P = 0.151) and 12 months (93.8 and $84.7mL/min/1.73m^2$, respectively; P = 0.077) postoperatively. The change in eGFR after one year was 3.9% in the OCLPN group and -7.9% in the HCLPN group. Conclusions: OCLPN was superior to HCLPN in preserving renal function one year after surgery, and there was no statistically significant difference in tumor treatment results.

• Journal of Chest Surgery
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• v.53 no.6
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• pp.392-399
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• 2020

Background: Surgical treatment of empyema thoracis in patients with chronic kidney disease is challenging, and few studies in the literature have evaluated this issue. In this study, we aim to report the surgical outcomes of empyema and to analyze factors predicting perioperative mortality in patients with chronic kidney disease. Methods: This retrospective study included data from 34 patients with chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 ㎡ for 3 or more months) who underwent surgery for empyema between 2012 and 2020. An analysis of demographic characteristics and perioperative variables, including complications, was carried out. Postoperative mortality was the primary outcome measure. Results: Patients' age ranged from 20 to 74 years with a 29-to-5 male-female ratio. The majority (n=19, 55.9%) of patients were in end-stage renal disease (ESRD) requiring maintenance hemodialysis. The mean operative time was 304 minutes and the mean intraoperative blood loss was 562 mL. Postoperative morbidity was observed in 70.5% of patients (n=24). In the subgroup analysis, higher values for operative time, blood loss, intensive care unit stay, and complications were found in ESRD patients. The mortality rate was 38.2% (n=13). In the univariate and multivariate analyses, poor performance status (Eastern Cooperative Oncology Group >2) (p=0.03), ESRD (p=0.02), and late referral (>8 weeks) (p<0.001) significantly affected mortality. Conclusion: ESRD, late referral, and poor functional status were poor prognostic factors predicting postoperative mortality. The decision of surgery should be cautiously assessed given the very high risk of perioperative morbidity and mortality in these patients.

• Journal of Chest Surgery
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• v.49 no.1
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• pp.15-21
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• 2016

Background: We aimed to evaluate the incidence, predictive factors, and impact of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR). Methods: A total of 53 patients who underwent 57 TEVAR operations between 2008 and 2015 were reviewed for the incidence of AKI as defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease risk) consensus criteria. The estimated glomerular filtration rate was determined in the perioperative period. Comorbidities and postoperative outcomes were retrospectively reviewed. Results: Underlying aortic pathologies included 21 degenerative aortic aneurysms, 20 blunt traumatic aortic injuries, six type B aortic dissections, five type B intramural hematomas, three endoleaks and two miscellaneous diseases. The mean age of the patients was $61.2{\pm}17.5years$ (range, 15 to 85 years). AKI was identified in 13 (22.8%) of 57 patients. There was an association of preoperative stroke and postoperative paraparesis and paraplegia with AKI. The average intensive care unit (ICU) stay in patients with AKI was significantly longer than in patients without AKI (5.3 vs. 12.7 days, p=0.017). The 30-day mortality rate in patients with AKI was significantly higher than patients without AKI (23.1% vs. 4.5%, p=0.038); however, AKI did not impact long-term survival. Conclusion: Preoperative stroke and postoperative paraparesis and paraplegia were identified as predictors for AKI. Patients with AKI experienced longer average ICU stays and greater 30-day mortality than those without AKI. Perioperative identification of high-risk patients, as well as nephroprotective strategies to reduce the incidence of AKI, should be considered as important aspects of a successful TEVAR procedure.