The influence of chronic renal failure on the spectrum and antimicrobial susceptibility of uropathogens in community-acquired acute pyelonephritis presenting as a positive urine culture

<p>Abstract</p> <p>Background</p> <p>The role of chronic renal failure (CRF) in the antimicrobial resistance of uropathogens in patients with community-acquired acute pyelonephritis (APN) remains poorly understood.</p> <p>Method</p> <p>We performed a retrospective analysis of 502 adults (54 men, 448 women; mean age 61.7 ± 16.0 years, range 18-98 years) who were treated for community-acquired APN at Kosin University Gospel Hospital (Busan, Republic of Korea) during a ten-year period (January 2000 to December 2009). We evaluated the spectra and antimicrobial susceptibility profiles of uropathogens in CRF and non-CRF patients with community-acquired APN that presented as a positive urine culture.</p> <p>Results</p> <p>The 502 adult subjects were classified as either non-CRF APN patients (336 patients, 66.9%) or CRF APN patients (166 patients, 33.1%) according to their estimated glomerular filtration rate. No significant differences in the sensitivity of <it>E. coli </it>to a third cephalosporin, aminoglycoside (except gentamycin), or ciprofloxacin were observed between non-CRF and CRF patients.</p> <p>Conclusions</p> <p>In our series of patients with community-acquired APN that initially presented as a positive urine culture, CRF did not influence the isolation rates of different uropathogens or their patterns of susceptibility to antimicrobials.</p

Transcatheter Arterial Embolization Using Ethanol in a Dialysis Patient for Contracting Enlarged Polycystic Kidneys

The mass effect of nephromegaly in patients with autosomal dominant polycystic kidney disease may cause pain and symptoms by compressing the alimentary tract, lungs, and heart. Conventional therapies exist to contract enlarged polycystic kidneys including surgical and interventional procedures. A surgical nephrectomy is often difficult to perform in dialysis patients due to the associated risks related to surgery. In contrast, renal transcatheter arterial embolization (TAE) with metallic coils, which is a less invasive interventional procedure, can also be utilized to contract enlarged kidneys in dialysis patients as an effective treatment. However, metallic coils present the possibility of recanalization and cost issues. Thus, we used ethanol instead of coils in renal TAE to resolve these issues. We report a dialysis patient with enlarged polycystic kidneys and poor oral intake due to abdominal distention that was successfully treated by TAE with absolute ethanol

Comparison of circuit patency and exchange rates between the original and generic versions of nafamostat mesylate in critically ill adults receiving continuous renal replacement therapy

Background Nafamostat mesylate is widely used as an anticoagulant in continuous renal replacement therapy (CRRT). The generic versions of nafamostat mesylate have identical main components to the original product. However, it is questionable whether the generic versions have the same efficacy as the original. Therefore, we compared the circuit patency and exchange rates of the original nafamostat mesylate and a generic version to determine which is more efficient as an anticoagulant in CRRT. Methods This retrospective study enrolled 1,255 patients hospitalized to receive CRRT who received the original version of nafamostat mesylate or a generic version between January 2010 and July 2018. We evaluated the filter lifespan, number of filters used per day, mean blood flow, and transmembrane pressure (TMP). Results The mean filter lifespan was 36.3±15.1 hours in the original product group and 22.2±16.2 hours in the generic product group, which was not a statistically significant difference (p=0.060). The mean TMP was 62.2±47.3 mmHg in the original product group and 74.5±45.6 mmHg in the generic product group (p=0.045). Conclusions This retrospective study suggests no meaningful difference in filter lifespan between the original and generic versions of nafamostat mesylate. However, TMP was lower in the original product group than in the generic product group

Relationship of serum bilirubin concentration to kidney function and 24-hour urine protein in Korean adults

<p>Abstract</p> <p>Background</p> <p>The relationships among serum bilirubin concentration, kidney function and proteinuria have yet to be fully elucidated, nor have these relationships been investigated in Korean adults.</p> <p>Method</p> <p>We retrospectively reviewed the medical records of Korean adults who were evaluated at Kosin University Gospel Hospital (Busan, Republic of Korea) during a five-year period from January 2005 to December 2009. We evaluated the relationships among serum bilirubin concentration, estimated glomerular filtration rate (eGFR) and 24-hour urinary protein excretion in a sample of 1363 Korean adults aged 18 years or older.</p> <p>Results</p> <p>The values of eGFR <60 mL/min/1.73 m²and 24-hour urine albumin ≥150 mg/day were observed in 26.1% (n = 356) and 40.5% (n = 553) of subjects, respectively. Fasting glucose levels ≥126 mg/dL were observed in 44.9% (n = 612) of the total sample. After adjustment for potential confounding factors including demographic characteristics, comorbidities and other laboratory measures, total serum bilirubin was positively associated with eGFR and negatively associated with proteinuria both in the whole cohort and in a subgroup of diabetic individuals.</p> <p>Conclusions</p> <p>To our knowledge, this is the first hospital-based study specifically aimed at examining the relationships among serum total bilirubin concentration, 24-hour urine protein and kidney function in Korean adults. We demonstrated that serum total bilirubin concentration was negatively correlated with 24-hour urine protein and positively correlated with eGFR in Korean non-diabetic and diabetic adults.</p

Toll-like Receptors

Mammals sense pathogen invasion through pattern-recognition receptors (PRRs). A group of transmembrane proteins, Toll-like receptors (TLRs) are mainly expressed on antigen-presenting cells, such as macrophages or dendritic cells, and play critical roles as PRRs (1). TLR signaling activates antigen-presenting cells that provoke innate immunity and establish adaptive immunity. TLRs can be activated not only by invading pathogens but also by certain danger or stress-associated endogenous molecules leading to the induction of sterile inflammation. Activation of TLRs is a first line defense of the immune system, leading not only to the activation and recruitment of neutrophils and macrophages to sites of infection, but also to the enhancement of antimicrobial activity (2). Each TLR has common effects, such as inflammatory cytokine induction or upregulation of costimulatory molecule expression. However, TLRs also have specific functions, exemplified by type I IFN-inducing ability. These immunoadjuvant effects are critical in antimicrobial immunity and also involved in manifestations of autoimmunity (1). Therefore, understanding the molecular mechanisms of TLRs should facilitate the development of therapeutic solutions for allergy and autoimmune diseases

Uremic Encephalopathy with Basal Ganglia Lesions in a Diabetic Predialysis Patient

Syndromes associated with acute bilateral lesions of the basal ganglia in diabetic uremic patients are uncommon, and usually have reversible clinical and imaging findings. Such syndromes are seen almost exclusively in patients with diabetes mellitus and renal failure. Previously reported cases have described diabetic men with uremia on dialysis. Here, we report a case of uremic encephalopathy with lesions of the basal ganglia in a diabetic predialysis patient. A 44-year-old man with uremic encephalopathy presented with dysarthria, chorea, and right upper extremity paresthesia. Magnetic resonance imaging of the brain showed classic findings of hyper intensity in the bilateral basal ganglia. The patient had no family history of psychiatric or neurological disease. Laboratory findings revealed elevated levels of blood urea nitrogen, creatinine, and glucose. Haloperidol and ropinirole therapy was continued, resulting in significant improvement without dialysis. The patient recovered from his episode without apparent sequelae

A case of tacrolimus-induced supraventricular arrhythmia after kidney transplantation

CONTEXT Tacrolimus is a potent immunosuppressive drug often administered to transplant recipient patients and exhibits a variety of adverse cardiovascular effects. CASE REPORT We report a case of a 53-year-old Asian female who developed various arrhythmic phenomena including atrial premature complexes and supraventricular tachycardia after administration of tacrolimus. CONCLUSION Tacrolimus-associated arrhythmia after kidney transplantation may be life-threatening, and so patients undergoing this procedure should be carefully monitored

The Association of Geriatric Nutritional Risk Index and Total Lymphocytes Count with Mortality in Korean Hemodialysis Patients

Background: Our objective was to examine the association between the Geriatric Nutritional Risk Index (GNRI) and Total lymphocytes count (TLC) with mortality in Korean Hemodialysis Patients. Methods: We examined the GNRI and TLC of 120 maintenance hemodialysis patients and followed these patients for 120 months. Predictors for all-cause death were examined using life table analysis and the Cox proportional hazards model. Results: Life table analysis revealed that subjects with a GNRI < 90 (n = 19) had a lower survival rate than did those with a GNRI ≥ 90 (n = 101) (Wilcoxon test, P = 0.048), but subjects with a TLC < 1500/mm3 (n = 76)had a similar survival rate compared those with a TLC ≥ 1500/mm3 (n = 44) (Wilcoxon test, P = 0.500). Multivariate Cox proportional hazards analyses demonstrated that the GNRI was a significant predictor of mortality [hazard ratio (HR) 9.315, 95% confidence interval (CI) 1.161–74.753, P = 0.036], after adjusting for age, sex, presence of type 2 diabetes mellitus, Kt/V, nPCR and TLC. The association of a GNRI ≥ 90 with a TLC ≥ 1500/mm3 seemed to exclude the occurring of complications with moderate reliability. Conclusion: These results demonstrate that the GNRI may be a significant predictor of mortality in Korean hemodialysis patients. However, the use of TLC might improve the evaluation of nutritional risk and the identification of patients at risk of malnutrition.Figure 1. Total lymphocytes count and 120-month survival of hemodialysis patients. In both groups, survival rate during the follow-up period was similar. (life table analysis, P = 0.500).fx

Thunderclap-like headache triggered by micturition and angina as an initial manifestation of bladder pheochromocytoma. A case report

CONTEXT: Pheochromocytoma is a catecholamine-producing tumor characterized by hypertension, headache, tachycardia, excessive diaphoresis and angina. The thunderclap headache is so named because the pain strikes suddenly and severely. Although the symptoms of bladder pheochromocytoma are rather evident, the diagnosis of this rare neuroendocrine tumor can be missed. CASE REPORT: This study reports the case of a woman diagnosed with bladder pheochromocytoma who experienced thunderclap headache triggered by micturition and angina as an initial manifestation. CONCLUSION: This case study suggests that thunderclap headache and angina occurring concurrently with sudden blood pressure elevation during or immediately after micturition are important diagnostic clues for bladder pheochromocytoma