Spontaneous remission of nephrotic syndrome in patients with IgA nephropathy.

BACKGROUND: IgA nephropathy (IgAN) can be complicated by nephrotic syndrome. Because the spontaneous resolution of heavy proteinuria is rare, corticosteroid therapy should be considered in such cases, particularly when IgAN is combined with minimal-change disease. Here, we report our experience of spontaneous remission of nephrotic syndrome in patients with IgAN and the long-term outcomes of these patients. METHODS: Two hundred and thirty-three patients with biopsy-proven IgAN were enrolled between January 2001 and March 2009. Demographic, clinical and laboratory data were collected retrospectively based on medical records. In addition, pathologic findings were reviewed for glomerular and tubulointerstitial lesions. Outcome data for complete or partial remission, spontaneous remission, relapse, deterioration of renal function, and end-stage renal disease were recorded. RESULTS: Twenty-four patients (10.3%) presented nephrotic syndrome. Among them, five patients underwent spontaneous remission within 6 months after the presentation of nephrotic syndrome. Interestingly, spontaneous remission occurred even in two patients who had elevated serum creatinine levels and advanced renal damage. During follow-up, neither recurrence nor relapse occurred, and no patients showed progressive deterioration of kidney function. Conclusions. This study suggests that spontaneous remission of nephrotic syndrome may occur in any stage of IgAN and carries a favourable long-term outcome without relapse. Given the possibility of under-reported cases, large-scale studies are required, and careful attention should be paid to such complicated cases.ope

Reduced residual renal function is associated with endothelial dysfunction in patients receiving peritoneal dialysis

BACKGROUND: Endothelial dysfunction, which contributes to atherosclerosis and arteriosclerosis, commonly accompanies end-stage renal disease (ESRD). However, little is known about the role of residual renal function (RRF) in endothelial protection in ESRD patients. This study aimed to investigate the relationship between endothelial function and RRF in patients undergoing peritoneal dialysis (PD). METHODS: This was a cross-sectional study involving 72 prevalent PD patients. Demographic and clinical data were recorded and residual glomerular filtration rate (GFR), Kt/V urea, and serum concentrations of inflammatory markers were measured. Endothelial function was assessed by brachial artery endothelium-dependent vasodilation [flow-mediated dilation (FMD)] to reactive hyperemia following 5 minutes of forearm ischemia. RESULTS: In patients with FMD% above the median value (FMD > 2.41%), residual GFR was significantly higher compared to that in patients with FMD% below the median [1.50 (0 - 9.64) vs 0.48 (0 - 3.89) mL/min/1.73 m(2), P = 0.026]. Correlation analyses revealed that residual GFR (ρ = 0.381, P = 0.001) and total Kt/V urea (γ = 0.408, P < 0.001) were positively correlated with FMD%, whereas PD duration (γ = -0.351, P = 0.003), high-sensitivity C-reactive protein (ρ = -0.345, P = 0.003), pulse pressure (γ = -0.341, P = 0.003), and age (γ = -0.403, P < 0.001) were inversely correlated with FMD%. In contrast, there was no correlation between peritoneal Kt/V urea and FMD%. In multivariate linear regression analysis adjusted for these factors, residual GFR was found to be an independent determinant of FMD% (β = 0.317, P = 0.017). CONCLUSION: This study shows that RRF is independently associated with endothelial dysfunction in ESRD patients on PD, suggesting that RRF may contribute to endothelial protection in these patients.ope

50세 이상 성인 성장호르몬결핍증에서 서방형 유전자재조합 인성장호르몬 투약 후 신체조성과 삶의 질 향상

의과대학/석사Context: The elderly experiencing somatopause and the resultant metabolic impairment can obtain partial recovery from administration of recombinant human GH (rhGH). However, aged adults suffer inconvenience from daily injection of existing rhGH. Objectives: To evaluate the effects, safety, and compliance of weekly administered low dose of sustained-release recombinant human GH (SR-rhGH) in aged adults with somatopause. Design: This is a 26-week prospective, single-arm, multicenter phase IV trial in adults. Intervention/Participants: A total of 38 subjects, aged ≥ 50 years with somatopause (serum IGF-1 < 150 ng/ml) were enrolled and each received 2 mg of SR-rhGH for 26 weeks. Results: Mean baseline IGF-1 level of 123.4 ± 41.6 ng/ml increased to 174.8 ± 59.6 ng/ml after administration of SR-rhGH at 4 weeks and it was maintained for the remainder of the study period. At 26 weeks, average lean body mass increased by 0.45 kg, waist circumference reduced by 1.06 cm, and Quality of Life was improved significantly (P<0.01 in each index). There was a simultaneous increase in serum levels of biochemical markers of bone resorption and formation. Estrogen substitute in women attenuated the beneficial effects of SR-rhGH on body composition and metabolic indices. There was no significant change in the body fat distribution or fat mass. Adverse events included pruritus (10.5%), arthralgias (5.3%), and edema (5.3%), but their symptoms were well tolerable. Conclusions: Body composition and Quality of Life can be restored in part by the replacement of low dose SR-rhGH for 26 weeks in patients with somatopause without significant adverse effects.ope

Optimal surgical approaches for Rathke cleft cyst with consideration of endocrine function

BACKGROUND: Surgical indications for Rathke cleft cyst are not clear. OBJECTIVE: To evaluate postoperative outcomes in terms of endocrine function. METHODS: The study analyzed a total 73 patients who underwent transsphenoidal surgery. All patients underwent a visual field test, combined pituitary function test, and magnetic resonance imaging before and after surgery. A follow-up combined pituitary function test was performed at 1.5-year intervals. RESULTS: The mean age at the time of surgery was 35 ± 14 years, and the male/female ratio was 1:1.25 (33/40). The mean follow-up duration after surgery was 59 ± 39 months. The most common symptoms were headache (84%), visual disturbance (48%), and polyuria (38%). After transsphenoidal surgery, 75% of polyuria and 96% of visual field defects were resolved, and pituitary function improved in 42% of patients. The mean age of patients who exhibited worsened hypopituitarism was significantly higher than that of patients who exhibited unchanged or improved hypopituitarism (44 ± 15.7 vs 33 ± 13.5 years; P = .02). Twelve patients (16%) experienced recollection of cyst, but none required reoperation. Five of the recollected cysts presented with characteristics that were different from those of the initial lesions, and 2 recollected cysts underwent spontaneous regression. CONCLUSION: Minimal incision with radical removal of cyst content is reasonable to prevent the development of endocrine disturbances and other complications. Individualized risks and benefits must be assessed before a decision is reached regarding surgery and surgical method. Patients with recurrent Rathke cleft cyst require careful follow-up with special attention rather than a hasty operation.ope

Sustained-release recombinant human growth hormone improves body composition and quality of life in adults with somatopause

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