WCIM 2014 SEOUL KOREA 181
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0523 Nephrology
Synergic Renoprotective Effects of Green Tea Extract and Candesartan on Streptozotocin Induced Diabetic Nephropathy in Mice
Byung-Chul SHIN1, Hyun-Lee KIM1, Jong-Hoon CHUNG1 Chosun University Hospital, Korea1
Background: Diabetic nephropathy (DMN) is one of the most serious complications in diabetes mellitus and has been the most common cause of end-stage renal diseases.
Green tea extracts (GTE) have antioxidant properties. Infl ammatory cytokines, mainly IL-1 and IL-6, as well as TNF-a, are involved in the development and progression of DMN. We examined whether GTE with candesartan (CDS) could be synergic protective effects on DMN and relationship of cytokines in mice.
Methods: The mice (n=50) were divided into 5 groups (n=10 each group). Control group was given intraperitoneal injection of 0.9% saline. Streptozotocin (STZ) group was given intraperitoneal injection of STZ 200mg/kg and induced diabetic nephropa- thy. CDS group was received 30 mg/kg CDS by oral route and GTE group was received GTE 100 mg/kg by oral route. GTE+CDS group was received GTE 100 mg/kg with CDS 30 mg/kg from 4 weeks to 16 weeks. Mouse cytokine array panel A kit was used to examine the relative levels of mouse cytokines and chemokines, and histopathologic staining of mice’s kidney were performed.
Results: Compared with control group, STZ-group showed an increase in blood glu- cose, blood urea nitrogen, creatinine levels and urine protein amounts, and a decrease in body weight. All the above parameters were signifi cantly reversed with GTE treat- ment, especially GTE+CDS group. IL-1 a/ß, IL-16, TNF-a, and C5/C5a levels are signif- icantly elevated in STZ group compared with control group and reversed in GTE and GTE plus CDS groups. GTE+CDS treated mice kidney showed a reduced expression of above parameters and a reserved pathologic fi ndings.
Conclusions: These results suggest that GTE with CDS has synergic renoprotective effects on STZ-induced DMN mice by suppression of infl ammatory cytokines. The po- tential use of GTE with CDS is suggested in the treatment of diabetic nephropathy.
PS 0524 Nephrology
Resistant Hypertension and Renal Denervation
Inge Ingrid PRKACIN1, Dario KOZUL2, Iva Klara PRANJIC3, Vinko VIDJAK4
University Hospital Merkur, School of Medicine, Croatia1, Department of Internal Medicine, University Hospital Merkur, Croatia2, Department of Internal Medicine, University Hospital Merkur, Croatia3, Depart- ment of Radiology, Merkur Clinical Hospital, Croatia4
Background: Hypertension control requires joint efforts of the community, including patients themselves, their community and family physicians. Increased activation of the sympathetic nervous system is identifi ed as an important factor in the development and progression of hypertension. In this context has been developed catheter-based ap- proach to disrupt the renal sympathetic nerves-renal denervation (RDN). Among patients with resistant hypertension it is very important to select patients most likely to have benefi t from RDN, because thay represent a very mixed group of diagnoses.
Methods: RDN was performed in 7 patients using standard radiofrequency system with ablation catheter (5F system/6F guide catheter; SymplicityTM RDN System) inserted through the femoral artery, engaging the renal artery bilaterally. Five nerve ablations of 100 second duration on each side were performed without any complications. Offi ce BP measurements at 1, 3 and 6 months folow-up visits were compared to baseline values.
We used STATISTIKA 10, 2011 software, statistically signifi cant if p<0.001.
Results: From 100 patients referred because of resistant hypertension more than two- thirds of the patients (76%) did not meet the criteria of refractory resistant, or had a secondary form of hypertension (17%). Only 7 (7%) have criteria for RDN: at baseline, values were 62± 6 years, 184/106± 21/26 mmHg, 6.7±1 for number of antihypertensive drug classes. One, 3 and 6 months after procedure, only offi ce systolic BP were signifi - cantly lower (144± 13, 140 ± 17, 141± 15 mmHg, p<0.001). Six months after procedure the number of antihypertensive drug classes required was 6.5 ±1, with proteinuria ame- lioration in patient with type 2 diabetes (4 patients) and stabile chronic kidney disease (CKD stage 3).
Conclusions: The patients with type 2 diabetes and CKD may be the target population that would substantially benefi t from RDN. Further randomized clinical trials could be benefi cial in improving both renal and cardiovascular outcomes.
PS 0525 Nephrology
A Case of Antineutrophil Cytoplasmic Antibody-Associ- ated Vasculitis with Mononeuritis Multiplex
Hee Bum JO1, Yoon Jin KIM1, Seungeun LEE1, Jangwook LEE1, Sung Joon SHIN1, Kyung Soo KIM1
Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Korea1 Introduction: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides include granulomatosis with polyangiitis (Wegener’s), microscopic polyangiitis, and Churg-Strauss syndrome, which are all linked by overlapping pathology and the pres- ence of antineutrophil cytoplasmic antibodies (ANCA). Mononeuritis multiplex is a rare manifestation of ANCA-associated vasculitis and very few cases have been document- ed in published reports. We present a case of ANCA-associated vasculitis presenting with mononeuritis multiplex.
Case report: A 70-year-old female presented to our hospital with progressively wors- ening lower extremity pain and weakness for 2 months. She also had low grade fever and fatigue for 3 months. 2 months earlier, she was diagnosed as fever of unknown origin and was treated with antibiotics in other university hospital, but no renal im- pairment was found at that time. Initial laboratory exam revealed BUN of 72.6mg/dL and creatinine of 6.18 mg/dL. She did not have hypertension or diabetes mellitus and abdomen CT revealed no structural abnormality of the urinary tract system. Full evalu- ation of antoimmune diseases was initiated and myeloperoxidase-ANCA was positive.
Nerve conduction studies and electromyelogram of her lower extremities concluded evidence of common peroneal nerve neuropathy with axonal features of mononeuritis multiplex. Kidney biopsy revealed necrotizing vasculitis with few immune deposits affecting small arteries supporting the diagnosis of ANCA-associated vasculitis. The patient was started on pulse-dose steroid for 3 days followed by high dose steroid with cyclophosphamide. Hemodialysis was also initiated. She has been on therapy for 1 month currently, and she regained some strength in her lower extremities, but is still dialysis dependent.
Discussion: It is important to recognize mononeuritis multiplex as a presenting symp- tom of ANCA-associated vasculitis to avoid delay in diagnosis and treatment. Prompt recognition and intervention may have limited progression of lower extremity weak- ness and renal failure in our patient.
PS 0526 Nephrology
Outcome of Immunosuppressive Therapy in Progressive Iga Nephropathy Patients
Jung-Ho SHIN1, Ji Hyeon PARK1, Hye Ryoun JANG1, Jung Eun LEE1, Wooseong HUH1, Yoon-Goo KIM1, Ha Young OH1, Dae Joong KIM1
Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea1
Background: IgA nephropathy (IgAN) accounts for 10 % of patients on renal replace- ment therapy. Although the role of immunosuppression therapy has been questioned, some studies showed that immunosuppressive therapy might retard progression of IgAN. We analyzed IgAN patients who were treated with immunosuppressive therapy including cyclophosphamide, and confi rmed the effect of cyclophosphamide therapy in comparison with patients without immunosuppression.
Methods: Patients with biopsy-proven IgAN were reviewed who were treated between 1995 and 2013 at Samsung Medical Center. Rate of renal function decline was calcu- lated by linear regression slope through estimated glomerular fi ltration rate (eGFR). Pro- gressive IgAN was defi ned when eGFR decreased more than 4 ml/min/1.73 m2 per year.
Results: There were 69 patients who were treated with immunosuppressive regimen including cyclophosphamide. The duration of follow-up was 64 [31;116] months. The median rate of renal function decline was -3.92 [-7.03;-1.90] ml/min/1.73 m2/year before immunosuppression, then, was -3.59 [-5.61;-1.77] ml/min/1.73 m2/year after immunosuppression (p=0.287). 34 patients with progressive IgAN were compared with the others. The median rate of renal function decline in progressive patients before immunosuppression was -7.03 [-11.90;-5.19] ml/min/1.73 m2/year, and was improved to -3.58 [-5.60;-1.87] ml/min/1.73 m2/year after treatment (p=0.001). On the other hand, the median rate of renal function decline in non-progressive patients was -1.90 [-3.19;-0.39] ml/min/1.73 m2/year and -3.84 [-5.64;-1.66] ml/min/1.73 m2/year be- fore and after immunosuppression, respectively (p=0.002). Those progressive patients were compared with 65 progressive patients without immunosuppression. 14 patients without immunosuppression and 7 patients with immunosuppression were progressed to renal replacement therapy (p=0.913). The hazard ratio of immunosuppression for renal replacement were 0.38 (CI: 0.15-0.97, p=0.043) without adjustment and 0.27 (CI:
0.08-0.87, p=0.028) with adjustment.
Conclusions: Immunosuppressive therapy including cyclophosphamide could retard progression of IgAN in patients whose eGFR were decreased rapidly. This therapeutic effect also could delay renal replacement therapy compared with patients without immunosuppression.
