Purpose: To determine the short (1 year of transplant) and long-term (1-5 years of transplantation) risk factors affecting the graft and patient survival in kidney transplantation recipients. Methods: Records of 149 patients who received kidney transplantation in 1996 from Asan Medical Center were followed for 5 years retrospectively. Results: All patients initiated triple immunosuppressive therapy with cyclosporine, prednisone and azathioprine. One, two, three, four, five year patient and graft survival rates were 98.7%, 98.0%, 98.0%, 97.3%, 97.3%, and 96.6%, 95.2%, 94.6%, 92.5%, 91.8%, respectively. There were 30 cases of acute rejection (AR) and 6 cases of chronic rejection (CR) within $2.1{\pm}3.2$ months and $42.1{\pm}13.2$ months of transplantation, respectively. The risk factors for AR were donor's age older than 30 years (p=0.02) and cardiovascular disease (p=0.05). The risk factors for CR were AR (p=0.0169) and episode of complications (p=0.0330). Increasing period of dialysis (p=0.0473), episodes of AR (p<0.0001) and complication (p=0.0317) were significant factors for graft loss. Seven grafts were lost from noncompliance during 1-5 year period. The most com- mon cause of the graft loss for both periods was the graft rejection. The graft survival rate was significantly lower in patients with than without rejection episodes (77.4% vs. 90.0%, p=0.002). Conclusions: Survival rate of the graft with rejection was significantly lower. The risk factors affecting AR were donor's age older than 30years and CVD. AR and episode of complications within 1year were the risk factors for CR and graft loss.
Leptospirosis is a spirochetal infectious disease caused by $Leptospira$$interrogans$, and may vary in degree from an asymptomatic infection to a severe and fatal illness. The kidney is one of the principal target organs of $Leptospira$. Renal disorders caused by $Leptospira$ infection vary from an abnonnality in urinalysis to acute kidney injury (AKI). Incidence of AKI in severe leptospirosis varies from 40% to 60%. AKI reflects the severity of leptospirosis and is generally accompanied by cholestatic jaundice. The pathophysiology of AKI in leptospirosis consists of hypovolemia, direct tubular toxicity, and rhabdomyolysis. Most patients with acute leptospirosis experience severe myalgias, and show laboratory evidence of mild rhabdomyolysis. However, occurrence of severe rhabdomyolysis is rare. We report here on a patient with leoptospirosis, who had severe rhabdomyolysis and acute kidney injury without jaundice.
The purpose of this study is to develop and evaluate the Self Efficacy Promotion and Exercise Training Program to decrease anxiety and depression and to increase the quality of life for kidney transplant recipients. The subjects were selected randomly among the patients who underwent renal transplant at three major transplantation hospitals in Seoul, Korea. The observed subjects in this study consisted of 56 patients who had renal transplantations between one to twelve months prior to this study. The patients did not take any regular physical exercise. This study was carried out between November, 1999 and March, 2000. The study groups were divided into 3 groups; exercise training group (n=16), self efficacy group (n=18) and control group (n=22). The exercise training group received self efficacy promotion and exercise training program for 12 weeks. The self efficacy group received self efficacy promotion education, but no exercise training was given. The control group was not offered any education. The anxiety, depression and quality of life were evaluated 3 times, before the experiment, after 8 weeks and after 12 weeks. The data were analyzed with mean, standard deviation, Chi-square test, ANOVA and $Scheff\acute{e}$ test. The results were as follows: 1. After the experiment, anxiety and depression scores of the exercise training group and self efficacy group were more significantly decreased than those of the control group (p=.05). 2. After the experiment, the quality of life score of the exercise training group and self efficacy group were more significantly increased than those of the control group (p=.05). This study showed that the Self Efficacy and Exercise Training Programs were effective. Therefore, it is expected that the Self Efficacy Promotion and Exercise Training Program could be widely applied as an effective independent nursing intervention to decrease anxiety and depression and to increase quality of life for kidney transplant recipients.
In order to evaluate the dietary regulation of cysteine sulfinic acid decarboxylase (EC 4.1.1.29) in cats, acitivity and protein content of CSAD were assessed in the liver and kidney of cats fed different levels of dietary protein, with and without taurine. Four groups of cats were fed one of the follow diets for 5 weeks ; 20% protein and taurine- free diet(LP0T) ; 20% protein and 0.15% taurine diet(LPNT) ; 60% protein and taurine-free diet(HP0T); and 60% protein and 0.15% taurine diet (HPNT). CSAD activity was determined in the liver and kidney of cats by measuring 14C2 released form [1-14C]-L cysteine sulfinic acid. CSAD protein was quantified using an immunochemical method. CSAD activity was extremely low in cat tissues, among which kidney showed the highest activity which was 0.118$\pm$0.050, and 0.377$\pm$0.056 nmol.min-1.mg soluble portein-1 iin animals fed LP0T and HP0T, respectively. Even though renal CSAD protein content was 18~55% of the hepatic CSAD protein content, renal CSAD acitivity was 1.3~6.5 times of the hepatic CSAD activity . Renal CSAD acitivities of cats fed 60% protein were about 1.6~3.2 times those of animals fed 2.% protein , and hepatic CSAD activity was not significantly affected by the dietary level of protein. Taurine depletion significantly elevated both hepatic and renal CSAD activities above the values for cats having normal taurine status most probably as an adaptive response.
The oriental-western Literatural study of Amnesia, the results were as follows. 1. esia is caused by qi-depression resulted from excessive thought and deficiency of the kidney resulted from congenital deficiency and deficiency of the heart, the disharmony between the heart and the kidney, phlegm, stagnant blood, loss of the blood etc. resulted from deficiency of the heart blood. 2. The treatment method of Amnesia is as follows, the highest frequence was growing blood-tranquilization-regulating spleen, in descending order removing phlegm-stagnant blood-relaxing the mind and invigorate the heart-spleen-kidney and much tonification qi-blood and growing nutrient qi-manifesting source qi and regulating the harmony between the heart and the kidney and maintaining patency for the flow of gi were the most treatment method. 3. The treatment medicine of Amnesia is as follows, the highest frequence was Kuei Bi Tang(歸脾湯) in decending order Jeng Ji Whan(定志丸), Su Seng Whan(壽星丸), Chun Whang Boo Sim Dan(天王補心丹), Ju Jak Whan(朱雀丸), Doo Dam Tang(導痰湯), Yin Sin Kuei Sa Dan(引神歸舍丹), Ga Gam Go Bon Dan(加減固本丸), Ryung Ji Go(寧志膏), Jang Won Dan(壯元丹), Tong Ol Tang(通鬱湯). 4. In oriental medicine functional physiology and pathology was significant in differential diagnosis and treatment and in western medicine it was explained organically and psychologically. 5. In western medicine As one of memory disorder Amnesia is divided into psychogenic amnesia and organic amnesia, and organic amnesia is divided into anterograde amnesia and retrograde amnesia and psychogenic amnesia is divided into localized amnesia, generalized amnesia selective amnesia.
Objectives: We aimed to investigate the incidence, manifestations, and outcomes of malignancy after pediatric kidney transplantation (KT) at our center over 30 years. Methods: We retrospectively reviewed the medical records of 155 patients under 18 years of age who underwent KT between January 1990 and February 2020 at Asan Medical Center. Results: Twelve patients (7.7%) were diagnosed with a malignancy after KT. Malignancy was diagnosed after a mean period of 6.4±5.9 years (median 4.6, range 0.5-20.6 years) after KT. Nine (75.0%) of the 12 cancer patients were diagnosed with post-transplant lymphoproliferative disease (PTLD), and the other three had papillary thyroid cancer, mucoepidermoid cancer of the hard palate, and T-cell acute lymphoblastic leukemia, respectively. PTLD was diagnosed within a mean of 3.7±3.4 years (median 3.7, range 0.5-9.8 years) after KT. Five patients diagnosed with PTLD were cured without recurrence. Three patients with PTLD died from the disease, and one patient with mucoepidermoid cancer from a non-PTLD malignancy died after progression, despite surgical resection and chemotherapy. Three (33.3%) of the nine survivors progressed to end-stage renal disease (ESRD) after completing cancer treatment. No patient with post-transplant malignancy (PTM) experienced critical renal deterioration during cancer treatment. Conclusion: PTLD was the most common PTM, occurring at 5.8% of the pediatric KT patients after KT in our center. Careful follow up is needed particularly considering the risk of PTLD after KT in children.
Kim, Donghee;Li, Hui Ying;Lee, Jong Han;Oh, Yoon Sin;Jun, Hee-Sook
Experimental and Molecular Medicine
/
제51권2호
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pp.9.1-9.10
/
2019
Mesangial cell proliferation has been identified as a major factor contributing to glomerulosclerosis, which is a typical symptom of diabetic nephropathy (DN). Lysophosphatidic acid (LPA) levels are increased in the glomerulus of the kidney in diabetic mice. LPA is a critical regulator that induces mesangial cell proliferation; however, its effect and molecular mechanisms remain unknown. The proportion of ${\alpha}-SMA^+/PCNA^+$ cells was increased in the kidney cortex of db/db mice compared with control mice. Treatment with LPA concomitantly increased the proliferation of mouse mesangial cells (SV40 MES13) and the expression of cyclin D1 and CDK4. On the other hand, the expression of $p27^{Kip1}$ was decreased. The expression of $Kr{\ddot{u}}ppel$-like factor 5 (KLF5) was upregulated in the kidney cortex of db/db mice and LPA-treated SV40 MES13 cells. RNAi-mediated silencing of KLF5 reversed these effects and inhibited the proliferation of LPA-treated cells. Mitogen-activated protein kinases (MAPKs) were activated, and the expression of early growth response 1 (Egr1) was subsequently increased in LPA-treated SV40 MES13 cells and the kidney cortex of db/db mice. Moreover, LPA significantly increased the activity of the Ras-related C3 botulinum toxin substrate (Rac1) GTPase in SV40 MES13 cells, and the dominant-negative form of Rac1 partially inhibited the phosphorylation of p38 and upregulation of Egr1 and KLF5 induced by LPA. LPA-induced hyperproliferation was attenuated by the inhibition of Rac1 activity. Based on these results, the Rac1/MAPK/KLF5 signaling pathway was one of the mechanisms by which LPA induced mesangial cell proliferation in DN models.
Objectives : Saam acupuncture is one of the indigenous therapeutic modalities in traditional Korean medicine. In this study, the neuroprotective effect of Saam acupuncture of kidney tonification was investigated using 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated mice. Methods : Twelve-week-old male C57BL/6 mice were intraperitoneally administered with 30 mg/kg of MPTP at 24-h intervals for 5 days and acupuncture stimulation at LU8, KI7, SP3 and KI3 was performed once a day for 12 days from the first MPTP injection. The pole test and the rotarod test were performed to evaluate motor function, and dopaminergic neuronal survival in the substantia nigra (SN) and striatum was evaluated using tyrosine-hydroxylase immunohistochemistry. Results : MPTP administration caused behavioral impairment and dopaminergic neuronal death in the nigrostriatal pathway. Whereas the Saam acupuncture treatment alleviated the MPTP-induced motor dysfunction and dopaminergic neuronal death in the SN and striatum. Conclusions : Saam acupuncture of kidney tonification can alleviate the MPTP-induced motor dysfunction and dopaminergic neuronal death in the nigrostriatal pathway, suggesting a possible role for acupuncture in the treatment of Parkinson's disease.
Kidney renal clear cell carcinoma (KIRC) is one of the most aggressive cancer type of the urinary system. Metastatic KIRC patients have poor prognosis and limited therapeutic options. Ankyrin 3 (ANK3) is a scaffold protein that plays important roles in maintaining physiological function of the kidney and its alteration is implicated in many cancers. In this study, we investigated differential expression of ANK3 in KIRC using GEPIA2, UALCAN, and HPA databases. Survival analysis was performed by GEPIA2, Kaplan-Meier plotter, and OS-kirc databases. Genetic alterations of ANK3 in KIRC were assessed using cBioPortal database. Interaction network and functional enrichment analyses of ANK3-correlated genes in KIRC were performed using GeneMANIA and Shiny GO, respectively. Finally, the TIMER2.0 database was used to assess correlation between ANK3 expression and immune infiltration in KIRC. We found that ANK3 expression was significantly decreased in KIRC compared to normal tissues. The KIRC patients with low ANK3 expression had poorer survival outcomes than those with high ANK3 expression. ANK3 mutations were found in 2.4% of KIRC patients and were frequently co-mutated with several genes with a prognostic significance. ANK3-correlated genes were significantly enriched in various biological processes, mainly involved in peroxisome proliferator-activated receptor (PPAR) signaling pathway, in which positive correlations of ANK3 with PPARA and PPARG expressions were confirmed. Expression of ANK3 in KIRC was significantly correlated with infiltration level of B cell, CD8+ T cell, macrophage, and neutrophil. These findings suggested that ANK3 could serve as a prognostic biomarker and promising therapeutic target for KIRC.
Sung-Il Hwang;Seung Hyup Kim;Young Jun Kim;Ah Young Kim;Jung Yun Cho;Joon Woo Lee;Hyung-Seok Kim;Kyung Mo Yeon
Korean Journal of Radiology
/
제1권3호
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pp.152-158
/
2000
Objective: The purpose of this study was to compare the effectiveness of MR urography (MRU) with that of ultrasonography (US) in the evaluation of urinary tract when this failed to opacify during excretory urography (EXU). Materials and Methods: Twelve urinary tracts in 11 patients were studied. In each case, during EXU, the urinary system failed to opacify within one hour of the injection of contrast media, and US revealed dilatation of the pelvocalyceal system. Patients underwent MRU, using a HASTE sequence with the breath-hold technique; multi-slice acquisition was then performed, and the images were reconstructed using maximal intensity projection. Each set of images was evaluated by three radiologists to determine the presence, level, and cause of urinary tract obstruction. Results: Obstruction was present in all twelve cases, and in all of these, MRU accurately demonstrated its level. In this respect, however, US was successful in only ten. The cause of obstruction was determined by MRU in eight cases, but by US in only six. In all of these six, MRU also successfully demonstrated the cause. Conclusion: MRU is an effective modality for evaluation of the urinary tract when this fails to opacify during EXU, and appears to be superior to US in demonstrating the level and cause of obstruction.
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