WCIM 2014 SEOUL KOREA 189
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0549 Nephrology
Vitamin D Defi ciency is an Independent Risk Factor of Urinary Tract Infection after Kidney Transplantation
Young Eun KWON1, Hyunwook KIM2, Yung Ly KIM1, Kyoung Sook PARK1, Han Jak RYU1, Mi Jung LEE1, Hyung Jung OH1, Jung Tak PARK1, Seung Hyeok HAN1, Tae-Hyun YOO1, Shin-Wook KANG1
College of Medicine, Yonsei University, Korea1, College of Medicine, Wonkwang University, Korea2 Background: Vitamin D plays indispensable roles in the immune system, and there may be an association between vitamin D defi ciency and infection in patients with kidney transplantation (KT). Therefore, this study was aimed to investigate the impact of pre-KT vitamin D defi ciency on the development of urinary tract infection (UTI) after KT.
Methods: 25-hydroxyvitamin D [25(OH)D] levels were measured in 410 patients with- in two weeks before KT. Vitamin D defi ciency was defi ned as 25(OH)D < 10 ng/mL. The primary outcome was the occurrence of UTI after KT. Cox proportional hazard analysis was performed to determine the independent association of vitamin D defi ciency with UTI.
Results: The mean 25(OH)D levels were 12.8±6.9 ng/mL, and 171 patients (34.4%) were defi cient in vitamin D. Vitamin D defi ciency was signifi cantly associated with fe- male gender [ß=2.30, 95% confi dence interval (CI) = 1.41 to 3.77, P=0.001], hemoglo- bin (ß=0.83, 95% CI = 0.72 to 0.95, P=0.006) and serum albumin concentrations (ß=0.17, 95% CI = 0.10 to 0.30, P <0.001), and the season of KT operation (summer, ß=0.22, 95%
CI = 0.11 to 0.42, P <0.001; autumn, ß=0.32, 95% CI = 0.17 to 0.63, P=0.001, spring as a reference). During a median follow-up duration of 7.1 years, the incidence rates of UTI were signifi cantly higher in patients with vitamin D defi ciency compared to those with- out defi ciency [52 (30.4%) vs. 40 patients (16.7%), P=0.001). Moreover, multivariate Cox analysis showed that vitamin D defi ciency was a signifi cant independent predictor of UTI after KT (hazard ratio=1.81, 95% CI = 1.11 to 2.97, P=0.018).
Conclusions: Vitamin D defi ciency was an independent risk factor for UTI after KT, suggesting that determining 25(OH)D levels might be helpful to predict infectious complications after KT.
PS 0552 Nephrology
Acute Pyelonephritis in a Patient with Kidney Trans- plantation Misdiagnosed as Having Acute Rejection
Seo Young YUN1, Haeng Il KOH1, Ho Seok KOO1 Inje University Seoul Paik Hospital, Korea1
Regularly treated with immunosuppressants, maintaining the creatinine levels within 1.5 mg%. In the admission battery, the level of creatinine was increased to 7.74 mg%, and metabolic acidosis was suspected. In addition, his body weight was increased by 7 kg within a week and urine output was decreased. He showed urinary frequency for two days, but there was no tenderness on his graft area. Urinalysis showed 3+
protein, and many WBCs and RBCs. Spot urine protein to creatinine ratio was 3.09 g/
g cr. Ultrasonography exhibited that the size of graft was slightly increased. The renal arterial resistive index was increased by 0.84-0.90, and his cyclosporine level was in therapeutic level. Under the impression of acute rejection, steroid pulse therapy was started together with graft biopsy on hospital day 2. By light microscopy, the graft showed the features of acute pyelonephritis with many pus casts and microabscess.
E.coli was isolated in his blood and urine culture. After medical treatments (antibiotic ceftriaxone), the creatinine level was decreased to 2.26 mg% within two months.
PS 1626 Nephrology
Relationship Between Geriatric Nutritional Risk Index and Subpopulation Lymphocyte Counts in Hemodialysis and Peritoneal Dialysis Patients
Ho Sik SHIN1, Gyoung-Hoon KANG1, Son Ok LEE1, Ye Na KIM1, Yeon Soon JUNG1, Hark RIM1, Hyun Yul RHEW2
Department of Internal Medicine, Kosin University Gospel Hospital, Korea1, Department of Urology, Kosin University Gospel Hospital, Korea2
Background: No standard method for assessing the nutritional status in dialysis patients. In the present study, we undertook an evaluation to determine whether esti- mation of geriatric nutritional risk index (GNRI) and lymphocyte subset counts can be helpful in diagnosis of malnutrition in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients.
Methods: We examined the GNRI and lymphocyte subset counts of 50 HD patients (55.8 ± 12.7 years; 28 men and 22 women) and 16 CAPD patients (49.8 ± 14.5 years;
10 men and 6 women). The GNRI is calculated based on the serum albumin level and total lymphocyte count and uses the following equation: GNRI= [14.89 Χ albumin (g/
dL)]+[41.7 Χ (weight/ideal body weight)]. Logistic regression analysis was performed for predicting malnutrition in dialysis patients.
Results: The average GNRI value was 100.1 ± 8.4 in HD patients and 99.2 ± 8.1, and GNRI values were normally distributed. lymphocyte subset counts were not different between HD patients and CAPD patients. Lymphocyte subset counts were lower in patients with higher GNRI (GNRI = 100). According to logistic regression for predicting malnutrition according to GNRI, age, female and CD 19 count predicted malnutrition in hemodialysis and peritoneal dialysis patients
Conclusions: These results suggest that GNRI and lymphocyte subset counts (especially CD 19 count) may be a signifi cant nutritional marker in HD and CAPD patients.
