176 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0500 Nephrology
Renal Infarction Caused by Thromboses in Both Renal Arteries, Associated with Thromboangiitis Obliterans
Hyo Jin YUN1, Kyung Ho LEE1, Min Ji PARK1, Won Min HWANG1, Sung Ro YUN1, Se Hee YOON1
Konyang University College of Medicine, Korea1
Thromboangiitis obliterans (Buerger’s disease) is nonatherosclerotic, segmental, infl am- matory vasculitis that is strongly associated with tobacco products, and commonly affects the small- and medium-sized arteries of the upper and lower extremities.
However, large central artery involvement in Buerger’s disease is rare. We report a case of end stage renal disease caused by renal artery thrombosis associated with Buerger’s disease. A 51-year-old man was admitted to the nephrology department because of acute left fl ank pain and anuria for three days. He was diagnosed as having Buerger’s disease 10 years ago. At that time, both fi rst toes had amputated. Since then, he had not visited the hospital and he had not quit smoking until now. He presented with severe tenderness in his left costovertebral angle area. Laboratory fi ndings disclosed the following: White blood cell (WBC) 9700/uL, hemoglobin 12.7g/dL, platelet 201 x103/uL, serum blood urea nitrogen (BUN) 82mg/dL, serum creatinine 14.02mg/dL and serum lactate dehydrogenase(LDH) 1687IU/L. Autoantibodies associated with hyperco- agulability were all either negative or non-signifi cant. Contrast-enhanced abdominal CT demonstrated left kidney multifocal infarction, combined with poor visualization of both renal arteries. Abdominal aortography revealed the total occlusion of the superior mesenteric artery, inferior mesenteric artery, both renal arteries, left common iliac artery, left superficial femoral artery, and bilateral tibial and peroneal arteries with collateral formation. Thus, he was diagnosed as having renal infarction caused by thromboses in both renal arteries, associated with Buerger’s disease. His renal function was not recovered. He began peritoneal dialysis and quit smoking.
PS 0501 Nephrology
Blocking Class I Histone Deacetylase Activity Inhibits Renal Fibrosis
Sun Woo KANG1, Yeong-Hoon KIM1, Su-Kil SEO2
Inje University Busan Paik Hospital, Korea1, Inje University, College of Medicine, Korea2
Background: Fibrosis is the final, common pathological outcome of many chronic kidney diseases. Although histone deacetylases (HDACs) have been reported to be involved in renal fibrosis, it is still unclear which class of HDAC is involved in the pathophysiology of renal fi brosis. To investigate which class of HDAC is involved in pathogenic renal fi brosis and evaluate anti-fi brotic effect of the defi ned HDAC inhibi- tors.
Methods: The enzyme activity of class I and class II was examined on TGF-beta 1-in- duced epithelial-to-mesenchymal transition (EMT) of the human renal proximal tubu- lar epithelial cell line HK-2. By using the pan-HDAC inhibitor (SB939), class I-specifi c HDAC inhibitor (MS275), and class II-specifi c HDAC inhibitor (MC1568), we defi ned the roles of class I and class II enzymes in EMT. To confi rm the role of HDACs in vivo, we used the unilateral ureteric obstruction (UUO) model of renal fi brosis.
Results: We found that class II enzyme activity was markedly induced on TGF-beta 1-induced EMT but class I enzyme was not induced. Treatment of pan-inhibitor SB939 strongly inhibited TGF-beta 1-induced upregulation of collagen type I and alpha-SMA.
Class II-specifi c inhibitor MC1568 had the similar effects of SB939, but class I-specifi c inhibitor MS275 did not have the effects. UUO model with SB939 treatment was markedly inhibited accumulation of alpha-SMA and deposition of collagen type I.
Conclusions: Our results demonstrate that class II HDACs contribute to renal fi brosis and suggest that class II-selective inhibitors have a therapeutic potential for the treat- ment of renal fi brosis.
PS 0502 Nephrology
Is the New GFR Equation Using Inulin Clearance a More Accurate Method for Asian Patients?
Beom Seok KIM2, Yong Kyu LEE1, Hoon Young CHOI3, Seung Ok CHOI4, Sug Kyun SHIN1, Sung Kyu HA3, Kang Wook LEE5, Yang Wook KIM6, Yong Lim KIM7, Yoshinari YASUDA8, Enyu IMAI9, Masaru HORIO10, Yasuhiko TOMINO11, Seiichi MATSUO8, Ho Yung LEE2 National Health Insurance Corp. Ilsan Hospital, Korea1, Yonsei University College of Medicine, Korea2, Kangnam Severance Hospital, Korea3, Yonsei University Wonju Christian Hospital, Korea4, Chungnam Na- tional University Hospital, Korea5, Inje University Busan Hospital, Korea6, Kyungpook National University Hos- pital, Korea7, Nagoya University Graduate School of Medicine, Japan8, Nakayamadera Imai Clinic, Japan9, Osaka University Graduate School of Medicinej, Japan10, Juntendo University School of Medicine, Japan11 Background: Recently, a new glomerular fi ltration rate (GFR) equation for the Japanese population was proposed using measured inulin clearance. To expand its applicability to other Asian populations, we performed a comparative study in the Korean population.
Methods: Inulin clearance was measured in 166 patients who were selected from seven participating medical centers in Korea. Patient’s sera and urine were collected, and baseline clinical characteristics were measured to provide an estimated GFR (eGFR) by the Japanese GFR equation using inulin clearance (Japanese-GFR equation), the Modifi cation of Diet in Renal Disease (MDRD) study equation, and the Chronic Kidney Disease - Epidemiology Collaboration (CKD-EPI) equation. We compared the equation results to determine which equation best estimated the measured GFR (mGFR).
Results: Accuracy (95% CI) within 30% of mGFR by the Japanese-GFR equation, the CKD-EPI equation and the MDRD study equation were 66 (58-72), 51(43-58), and 55 (47-62)%, respectively. Bias (mGFR minus eGFR) were 3.4 22.4, -12.0 22.1, and -9.7 23.8 ml/min/1.73 m2, respectively. The accuracy of the Japanese-GFR equation was signifi cantly better than MDRD study equation in subjects with mGFR <60 ml/min/1.73 m2 and in total subjects. The bias of the Japanese-GFR equation was significantly smaller compared with other two equations in total subjects. The coeffi cient (95%
CI) for the Japanese-GFR equation, the CKD-EPI equation, and the MDRD equation in Korean subjects were 1.067 (1.014-1.118), 0.847 (0.808-0.886), and 0.858 (0.816-0.901), respectively, indicating signifi cant overestimation of GFR by MDRD study equation and CKD-EPI equation. There were no adverse events associated with inulin administration during the study.
Conclusions: The Japanese-GFR equation has a higher accuracy with less bias than the other equations in estimating GFR in Korean populations.
PS 0503 Nephrology
Reasons of Emergency Department Admission of ESRD Patients : A Retrospective Analysis
Attila AYDIN1, Cemile AYDIN2, Selma KARAAHMETOGLUÖZKAN2, Zeynep GÜVEN2, Rukiye KARA2
Gülhane Military Academia of Medicine, Turkey1, Ankara Numune Research and Education Hospital, Turkey2
Background: End stage renal failure is an increasing clinical problem. That is why we should prevent it and capture patients in earlier stages in order to stop their progres- sion. We should determine the causes of hospitalization and acute complications.
Methods: The patients who were hospitalized for End Stage Renal Disease (ESRD) between March 2009-2011 patients were studied. We studied the causes of hospi- talization in concern with established parameters. The datas were analyzed in SPSS program.
Results: The total number of patients were 98 including 50 men and 48 women. The ages of patients were between 27-93. Chronic Kidney Disease (CKD) duration was 2-240 months, the dialysis duration was 0.5-240 months. The most common cause of emergency department admission was infection 39 (%39.8). The Patients admitted with an infection were taken dialysis treatment longer than other patients (p=0.034) and they had a higher initial hemoglobin level (p=0.002) and were hospitalized longer than the other patients (p=0.047). The most common type of infection was pneumonia (%43.6). The most common cause of mortality was sepsis with %40 and pneumonia with %20. There was no statistically difference in terms of albumin level between patients with infection and the others. Although in the exitus group albumin was statically lower than the survivors (p<0.05).
Conclusions: The most common cause of ESRD was infection. The most common cause of mortality was also infection; sepsis and pneumonia. We determined that a low albumin level was a bad prognostic factor.
