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￭ Sun-317 ￭
Bioelectrical Impedance Analysis to Predict Outcomes in Hemodialysis Patients
1순천향대학교 부천 병원 신장내과, 2영남대학교 병원 신장내과, 3중앙대학교 병원 신장내과, 4 순천향대학교 부천 병원 호흡기알레르기내과
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이민성
1, 강석희
2, 김수현
3, 백애린
4, 박수정
1, 유병철
1, 박무용
1, 김진국
1, 황승덕
1, 최수정
1Background/Aims: Overhydration and sarcopenia in patients with end stage renal disease (ESRD) are associated with all-cause mortality and car- diovascular events, while obesity is associated with better survival. Although ESRD patients on hemodialysis check body weight every session, it is not easy to check the change of body composition. Our aim was to evaluate the effect of body composition on survival and hospitalization during maintained HD period. Methods: We enrolled trice weekly HD patients and assigned them to get body composition test using bio-impedance analysis. We followed up their body composition and outcomes for 2 years. Results: Total 114 HD patients (56.2±13.3 years old, 58 males) were enrolled. Forty eight (42%).
Patients were diabetic. At baseline, BMI and appendicular skeletal muscle index (ASMI) was 22.2 (15.5-34.1) and 8.5kg/m² (4.1-13.7), respectively. So obesity (> 25 kg/m²) and sarcopenia (ASMI <7.0 kg/m²; male or <5.7 kg/m²; female) was 19.4% and 41.6%, respectively. Thirty two patients had over- hydration (the ratio of extracellular water to total body water >0.40). During 23.5 (0-27) months, 12 and 2 patients died. Total 37 patients (34.3%) admitted 2.5 (1-15) times and 23 (1-209) days, respectively. Sarcopenia had no difference of survival and hospitalization. Obesity was not associated with survival, but with hospitalization. Overhydation was associated with survival (hazard ratio [HR] 5.8; 95% confidence interval [CI], 1.54-21.9, p<0.01) and hospital- ization (HR 1.69; 95% CI, 1.08-2.66, p=0.022), respectively. However, this difference disappeared after adjusting age, sex, diabetes, weight and albumin.
Conclusions: Hydration status may predict survival and outcomes of HD patients rather than fat or muscle mass. Further controlled studies are need to confirm the effect of body composition in HD patients.
￭ Sun-318 ￭
Steroid treatment in Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposit
고려대학교 안산병원 내과학교실
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김종경, 강영선, 이호준, 차대룡, 차진주
Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a recently described form of glomerular injury with monoclonal im- munoglobulin IgG deposition. Here, we present a case of PGNMID with renal insufficiency resulting in a partial remission with steroid treatment. A 74 year old male visited the clinic with persistent lower extremity edema. He was diagnosed as monoclonal gammopathy of Undertermined Significance (MGUS) 10 years ago and on repeated bone marrow biopsy, he was confirmed as MGUS again. At the time of admission, the patient’s creatinine level was 1.17mg/dl and 24 hour urine protein level was 932mg. Urine protein electrophoresis(PEP) did not show any abnormal M-protein, however, urine im- munofixation(IFE) showed IgG/kappa &IgA/kappa type의 biclonal gammopathy. As the patient refused to perform renal biopsy, he was followed up at an out patient department. After 3 years, he revisited the clinic with generalized edema. His creatinine level increased up to 2.0mg/dl and 24 hour urine protein up to 3.8g. Urine PEP showed increased M-protein, and urine IFE showed monoclonal gammopathy of IgG/kappa type. Renal biopsy was performed due to progression of renal insufficiency. Pathologic finding of the kidney showed proliferative glomerulitis, with granular patterns of C3, IgG, kappa positive im- munostain with subendothelial electron dense deposits(Fig1) . On diagnosis of PGNMID, steroid was initiated per oral with a dose of 1mg/kg/d with diu- retics for symptomatic relief. During the 1-month treatment period, serum creatinine levels decreased from 2.0mg/dL to 1.35mg/dL, with 1.2mg/gcr proteinuria. Steroid is tapered down by 10mg every month and he is on regular check up. Renal insufficiency may develop in MGUS patients in many dif- ferent clinical settings. PGNMID is a glomerulopaty due to dysproteinemia that can be treatable with steroid monotherapy and should not be missed.
