188 WCIM 2014

(1)

188 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014

PS 0546 Nephrology

Body Composition Measurements Using Bioimpedance Analysis in Peritoneal Dialysis Patients are Affected by the Resence of Dialysate

Kyu Hyang CHO¹, Seok Hui KANG¹, Jong Won PARK¹, Kyung Woo YOON¹, Jun Young DO¹ Yeungnam University Mecical Center, Korea¹

Background: We report a rare case of CAPD peritonitis caused by Ochrobacterium anthropi.

Introductions: Among the continuous ambulatory peritoneal dialysis(CAPD) patients, peritonitis is one of the most commonly taken complications, and also the general cause of dialytic modality exchange to hemodialysis. Usual pathogens of CAPD peritonitis may be bacteria, fungi, mycobacteria. Coagulase negative staphylococci, S.

aureus, campylobacter, pseudomonas are common reported pathogens among the bacteria, of CAPD peritonitis cases, meanwhile candida is among fungi. Ochrobacteri- um anthropi is one species of Brucellaceae, which is rare pathogen of human disease.

Case (Methods and results): 73 years old female, who was on CAPD due to diabetic end stage renal disease visited Kyung-Hee University hospital with intermittent ab- dominal pain. Body fl uid analysis showed increased white blood cell(WBC) count of 26,750/mm³ with her peritoneal fl uid. Culture study with peritoneal fl uid suggested O.

anthropi, and DNA sequencing with PCR was consistent with O. anthropi. Intraperito- neal ceftazidime and cefazolin were administrated as empirical antibiotics. Ceftazidime resistance was noted with the result of antibiotics sensitivity test at 7th day of hospi- talization, and antibiotics were changed into intraperitoneal gentamicin, which showed sensitivity to the pathogen. CAPD catheter removal and antibiotics re-exchange into imipenem and cefazolin, which were other sensitive antibiotics by the sensitivity test, were done since clinical manifestation and peritoneal ﬂ uid WBC count was repeatedly improved and aggravated. The patient discharged with improved lab test results and resolving clinical symptoms afterward.

Conclusions: We presentators report rare case of CAPD peritonitis with pathogen of O. anthropi. The pathogen of the case conﬁ rmed by classical microbiologic, and mo- lecular biologic Methods: The patient was unable to treat only with antibiotics, thus CAPD catheter, which might be act as colonizing source, was removed, and the disease resolved.

PS 0547 Nephrology

Geriatric Nutritional Risk Index May be a Signifi cant Nutritional Factor in Renal Transplantation Patients According to the Presence or Absence of Chronic Kid- ney Disease

Hark RIM¹, Sunmin KIM¹, Gyoung-Hoon KANG¹, Ye Na KIM¹, Ho Sik SHIN¹, Yeon Soon JUNG¹, Hyun Yul RHEW²

Department of Internal Medicine, Kosin University Gospel Hospital, Korea¹, Department of Urology, Kosin University Gospel Hospital, Korea²

Background: We report a rare case of CAPD peritonitis caused by Ochrobacterium anthropi.

Introductions: Among the continuous ambulatory peritoneal dialysis(CAPD) patients, peritonitis is one of the most commonly taken complications, and also the general cause of dialytic modality exchange to hemodialysis. Usual pathogens of CAPD peritonitis may be bacteria, fungi, mycobacteria. Coagulase negative staphylococci, S.

aureus, campylobacter, pseudomonas are common reported pathogens among the bacteria, of CAPD peritonitis cases, meanwhile candida is among fungi. Ochrobacteri- um anthropi is one species of Brucellaceae, which is rare pathogen of human disease.

Case (Methods and results): 73 years old female, who was on CAPD due to diabetic end stage renal disease visited Kyung-Hee University hospital with intermittent ab- dominal pain. Body fl uid analysis showed increased white blood cell(WBC) count of 26,750/mm³ with her peritoneal fl uid. Culture study with peritoneal fl uid suggested O.

anthropi, and DNA sequencing with PCR was consistent with O. anthropi. Intraperito- neal ceftazidime and cefazolin were administrated as empirical antibiotics. Ceftazidime resistance was noted with the result of antibiotics sensitivity test at 7th day of hospi- talization, and antibiotics were changed into intraperitoneal gentamicin, which showed sensitivity to the pathogen. CAPD catheter removal and antibiotics re-exchange into imipenem and cefazolin, which were other sensitive antibiotics by the sensitivity test, were done since clinical manifestation and peritoneal ﬂ uid WBC count was repeatedly improved and aggravated. The patient discharged with improved lab test results and

resolving clinical symptoms afterward.

Conclusions: We presentators report rare case of CAPD peritonitis with pathogen of O. anthropi. The pathogen of the case conﬁ rmed by classical microbiologic, and mo- lecular biologic Methods: The patient was unable to treat only with antibiotics, thus CAPD catheter, which might be act as colonizing source, was removed, and the disease resolved.

PS 0548 Nephrology

Onodera’s Prognostic Nutritional Index May be a Sig- nifi cant Nutritional Factor in Renal Transplantation Pa- tients According to the Presence or Absence of Chronic Kidney Disease

Gyoung-Hoon KANG¹, Jiin KANG¹, Ye Na KIM¹, Ho Sik SHIN¹, Yeon Soon JUNG¹, Hark RIM¹, Hyun Yul RHEW²

Background: Evaluation of nutritional status is essential clinical procedures for man- aging renal transplantation patients, especially in status of chronic kidney disease (CKD). However, no standard method for assessing the nutritional status in renal transplantation patients exists. Onodera’s Prognostic Nutritional Index (OPNI) is a method that considers serum albumin level and total lymphocyte count. This simple method may involve common measures and can be applied rapidly in a large number of patients. Validation of OPNI has been performed for patients with end-stage liver disease, active tuberculosis, and gastrointestinal malignancies.

Methods: We examined the OPNI scores of 184 renal transplantation patients (50.2

± 11.3 years; 115 men and 69 women). The OPNI is calculated based on the serum albumin level and total lymphocyte count and uses the following equation: OPNI = 10

× serum albumin (g/dL) + 0.005 × total lymphocyte count (/mL). Logistic regression analysis was performed for predicting malnutrition in renal transplantation patients.

Results: The average OPNI value was 48.9 ± 7.1, and OPNI values were normally distributed. According to logistic regression for predicting malnutrition, male, total lymphocyte count and chronic kidney disease predicted malnutrition.

Conclusions: These results suggest that OPNI may be a signiﬁ cant nutritional marker in renal transplantation patients. The simple OPNI method is a clinically useful marker for the assessment of nutritional status in renal transplantation patients

(2)

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 female 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

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.