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￭ Sat-353 ￭
The effects of pretransplant pyuria of the deceased donor on posttransplant urinary tract infection
1인제대학교 해운대백병원 신장내과, 2인제대학교 부산백병원 신장내과
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윤은재
1, 김양욱
1, 이유진
1, 박시형
1, 박봉수
1, 박석주
2Background/Aims: Renal transplantation is one of the best treatment options in patients with end-stage renal diseas. However, due to the shortage of suit- able organs, expanded criteria candidates for organ donation have been progressively accepted. It is reported that kidney transplantation using organs from infected donors did not seem to be associated with a great risk of complication. The aim of this study is to investigate the effects of pre-transplant pyuria of the deceased donor on post-transplant urinary tract infections. Methods: We performed a retrospective cohort study reviewing the medical records of de- ceased donor patients and transplant recipients at Inje University Busan Paik Hospital from January 2006 to March 2017. We collected the data of deceased donors and the recipients including the presence of pyuria, microorganism identified from urine cultrure, the duration of ICU stay, BMI, serum creatinine, Blood type, Age, Gender, Rejection, HLA mismatch count and immuno- suppressants. Results: Of the 462 kideny transplants, 227 were deceased donor transplants. Of the deceased donors, 61 (26.9%) had pyuria, 46 (20.3%) were male and 15 (6.6%) were female. When a man with pyuria gave a kidney to a woman, there were 12 cases of pyuria within 3 months. When a woman with pyuria gave a kidney to a man, 4 cases of pyuria occurred within 3 months.
When a man with pyuria gave a kidney to a man, there were 7 cases of pyuria within 3 months. When a woman with pyuria gave a kidney to a woman, 4 women had pyuria within 3 months. Statistically, the incidence of pyuria was not related to the sex of the donor, but it was higher when recipients were female (P<0.005). In the donor urine, microorganisms were cultured in 12 patients (19.7%) in the fol- lowing order: Candia species >pseudomonas> E-coli In the recipient urine culture, microorganisms were grown in 21 patients (34.4%). E-coli was the most common microorganism followed by Enterococcus faecalis. Conclusions: The incidence of pyuria in the recipient is high in women who received kidney from deceased donors with pyuria. It is not related to the sex of the donor or the spe- cies of microorganism from the urine of the deceased donor.
￭ Sat-354 ￭
Clinical Characteristics of Metformin-Associated Lactic Acidosis: Case Series in Single Center
부산대학교 병원 내과
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전유현, 김동언, 안여진, 황철구, 한미연, 이하린, 송상헌
Metformin is the first choice oral anti-hyperglycemic drug for type 2 diabetes. Metformin-associated lactic acidosis (MALA) is associated high mortality rate, can occur in patients with impaired renal function, liver dysfunction and heart failure. We identified 134 patients with metabolic acidosis with lactic acidosis or ketoacidosis through the search of diagnosis code from January 2009 and January 2018. Among them, patients with type A lactic acidosis, alco- holic or diabetic ketoacidosis and low lactic acid level (<5 mmol/L) were excluded. A total of 13 patients was enrolled and reviewed about premorbid con- ditions, laboratory data, therapy and outcomes. The median age of 13 patients (7 males, 6 females) were 61.8 years old (range, 43- 78). The arterial pH was 6.9±0.1, median serum lactate 14.9±4.1 mmol/L, medain anion gap 44.2±5.1 and the median daily dose of metformin 1315.4±409.2mg. Twelve patients had impaired renal function on admission (eGFR, 22.4±24.5 ml/min/1.73m2). Among these patients, eight patients had chronic kidney disease (CKD) before admission. Six patients had history of alcohol abuse or liver cirrhosis. The most common symptom was decreased mentality and other symptoms were non-specific gastrointestinal symptoms such as anorexia, nausea, vomiting, diarrhea and abdominal pain. Nine patients received renal replacement therapy (continuous veno-venous hemodiafiltration, n=8; intermittent hemodialysis, n=1), and the remaining four patients were treated fluid resuscitation with so- dium bicarbonate. Two patients (15.4%) died despite renal replacement therapy. The symptom and sign of MALA is often not specific and undistinguish- able from other severe diseases, thus hindering early recognition. Physicians should suspect of MALA in all diabetic patients taking metformin with high anion-gap metabolic acidosis especially with predisposing factor.
