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Lee J, Cho DH, Min HJ, Son YB, Kim TB, Oh SW, Kim MG, Cho WY, Jo SK, Yang J. Higher sclerostin is associated with pulmonary hypertension in pre-dialysis end-stage kidney disease patients: a cross-sectional prospective observational cohort study. BMC Pulm Med 2024; 24:78. [PMID: 38341544 PMCID: PMC10858562 DOI: 10.1186/s12890-024-02871-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a complication of chronic kidney disease (CKD) that contributes to mortality. Sclerostin, a SOST gene product that reduces osteoblastic bone formation by inhibiting Wnt/β-catenin signaling, is involved in arterial stiffness and CKD-bone mineral disease, but scanty evidence to PH. This study explored the relationship between sclerostin and PH in CKD 5, pre-dialysis end-stage kidney disease (ESKD) patients. METHODS This cross-sectional prospective observational cohort study included 44 pre-dialysis ESKD patients between May 2011 and May 2015. Circulating sclerostin levels were measured using an enzyme-linked immunosorbent assay. PH was defined as an estimated pulmonary artery systolic pressure > 35 mmHg on echocardiography. RESULTS Patients with higher sclerostin levels ≥ 218.18pmol/L had echocardiographic structural cardiac abnormalities, especially PH (P < 0.01). On multivariate logistic analysis, sclerostin over 218.19pmol/L was significantly associated with PH (odds ratio [OR], 41.14; 95% confidence interval [CI], 4.53-373.89, P < 0.01), but multivariate Cox regression analysis showed the systemic vascular calcification score over 1 point (Hazard ratio [HR] 11.49 95% CI 2.48-53.14, P = 0.002) and PH ([HR] 5.47, 95% CI 1.30-23.06, P = 0.02) were risk factors for all-cause mortality in pre-dialysis ESKD patients. CONCLUSIONS Serum sclerostin and PH have a positive correlation in predialysis ESKD patients. The higher systemic vascular calcification score and PH have an association to increase all-cause mortality in pre-dialysis ESKD patients.
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Affiliation(s)
- Jonghyun Lee
- Department of Internal Medicine, Korea University Anam Hospital, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Dong-Hyuk Cho
- Department of Internal Medicine, Korea University Anam Hospital, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Hyeon-Jin Min
- Department of Internal Medicine, Korea University Anam Hospital, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Young-Bin Son
- Department of Internal Medicine, Korea University Anam Hospital, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Tae Bum Kim
- Department of Internal Medicine, Korea University Anam Hospital, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Se Won Oh
- Department of Internal Medicine, Korea University Anam Hospital, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Myung-Gyu Kim
- Department of Internal Medicine, Korea University Anam Hospital, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Won Yong Cho
- Department of Internal Medicine, Korea University Anam Hospital, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Sang-Kyung Jo
- Department of Internal Medicine, Korea University Anam Hospital, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Jihyun Yang
- Department of Internal Medicine, Korea University Anam Hospital, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea.
- Division of Nephrology, Department of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, 29 Saemunan-ro, Jongno-gu, 03181, Seoul, Korea.
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Kim TB, Ahn SY, Oh J, Bae EH, Chin HJ, Kim MG, Jo SK, Cho WY, Oh SW. The Impact of Obesity on Kidney Disease: Observational Cohort Study Analyzing 14,492 Kidney Biopsy Cases. J Korean Med Sci 2024; 39:e12. [PMID: 38258359 PMCID: PMC10803208 DOI: 10.3346/jkms.2024.39.e12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/10/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The obesity epidemic is associated with the emergence of new kidney diseases including obesity-related glomerulopathy (ORG) and metabolic syndrome-associated disorders. However, the effects of obesity on prevalence and outcome of biopsy-proven kidney disease are not well known. METHODS We analyzed 14,492 kidney biopsies in 18 hospitals from 1979 to 2018 in Korea. Obesity was defined as a body mass index value of ≥ 30 kg/m². RESULTS The most common disease was IgA nephropathy (IgAN) in both obese and non-obese participants (33.7% vs. 38.9%). Obesity was associated with a higher risk of focal segmental glomerulosclerosis (FSGS) and hypertensive nephropathy (HT-N) (odds ratio [OR], 1.72, 95% confidence interval [CI], 1.37-2.17; OR, 1.96, 95% CI, 1.21-3.19) and a lower risk of IgAN (OR, 0.74, 95% CI, 0.62-0.88). During the median follow up of 93.1 ± 88.7 months, obesity increased the risk of end-stage kidney disease (ESKD) in patients with IgAN (relative risk [RR], 1.49, 95% CI, 1.01-2.20) and lupus nephritis (LN) (RR, 3.43, 95% CI, 1.36-8.67). Of 947 obese individuals, ORG was detected in 298 (31.5%), and 230 participants had other kidney diseases, most commonly, IgAN (40.9%) followed by diabetic nephropathy (15.2%). Participants with ORG, when combined with other renal diseases, showed higher risks for developing ESKD compared to those with ORG alone (RR, 2.48, 95% CI, 1.09-5.64). CONCLUSION Obesity is associated with an increased risk of FSGS and HT-N, and also increase the ESKD risk in IgAN and LN patients. ORG in obese participants may have favorable renal outcomes if it occurs alone without any other renal disease.
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Affiliation(s)
- Tae-Bum Kim
- Department of Internal Medicine, Goesan Sungmo Hospital, Goesan, Korea
| | - Shin Young Ahn
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jieun Oh
- Division of Nephrology, Department of Internal Medicine, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Jun Chin
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Myung-Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Sang Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
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Kim MG, Cho WY, Chung SM, Choi YE, Fang Y, Park MS, Park SJ, Ko YS, Lee HY, Yang J, Oh SW, Jo SK. Altered gut microbiome plays an important role in AKI to CKD transition in aged mice. Front Med (Lausanne) 2023; 10:1238960. [PMID: 38020091 PMCID: PMC10644820 DOI: 10.3389/fmed.2023.1238960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction This study investigated the role of renal-intestinal crosstalk in the transition from acute kidney injury (AKI) to chronic kidney disease (CKD) in elderly individuals. Methods Using young and aged mice, we induced bilateral ischemia-reperfusion injury (IRI) and compared intestinal and kidney inflammation over 28 days. To determine the role of the microbiome in gut-kidney crosstalk, we analyzed the microbiome of fecal samples of the young vs. aged mice and examined the effects of probiotic supplementation. Results In the post-IRI recovery phase, prolonged intestinal and renal inflammation along with dysbiosis were evident in aged vs. younger mice that was associated with severe renal dysfunction and fibrosis progression in aged mice. Probiotic supplementation with Bifidobacterium bifidum BGN4 and Bifidobacterium longum BORI alleviated intestinal inflammation but not intestinal leakage, characterized by decreased inflammatory cytokine levels and decreased infiltration of macrophages, neutrophils, and Th17 cells. This was associated with improved M1-dominant renal inflammation and ultimately improved renal function and fibrosis, suggesting that renal-intestinal crosstalk in aged mice contributes to the transition from AKI to CKD. Discussion Our study findings suggest that exacerbation of chronic inflammation through the gut-kidney axis might be an important mechanism in the transition from AKI to CKD in the elderly.
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Affiliation(s)
- Myung-Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Suk Min Chung
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Young Eun Choi
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Yina Fang
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Myeong Soo Park
- Research Center, BIFIDO Co. Ltd., Hongcheon, Republic of Korea
| | - Sang Jun Park
- Research Center, BIFIDO Co. Ltd., Hongcheon, Republic of Korea
| | - Yoon Sook Ko
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hee Young Lee
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jihyun Yang
- Division of Nephrology, Department of Internal Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sang-Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
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Son YB, Kim TB, Min HJ, Yang J, Kim MG, Jo SK, Cho WY, Oh SW. Smoking amplifies the risk of albuminuria in individuals with high sodium intake: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008-2011 and 2014-2018. Kidney Res Clin Pract 2023:j.krcp.22.133. [PMID: 37885174 DOI: 10.23876/j.krcp.22.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 04/10/2023] [Indexed: 10/28/2023] Open
Abstract
Background Smoking and sodium intake (SI) have been evaluated as risk factors for kidney disease; however, the data are inconsistent. We assessed the association between SI and cotinine-verified smoking status and the risk of albuminuria. Methods An observational study using the Korea National Health and Nutrition Examination Survey (2008-2011 and 2014-2018) was performed. We included 37,410 adults with an estimated glomerular filtration rate of ≥60 mL/min/1.73 m2 . The smoking status was assumed based on the urine cotinine/creatinine ratio (Ucot/Ucrea). SI was estimated from spot urine sodium using the Kawasaki formula. Results Ucot/Ucrea levels were significantly higher in current smokers (920.22 ± 9.00 ng/mg) than in ex-smokers and nonsmokers (48.31 ± 2.47 and 23.84 ± 1.30 ng/mg) (p < 0.001). Ucot/Ucrea levels were significantly higher in second-hand smokers than in participants without a history of smoking (p < 0.001). Ucot/ Ucrea levels were positively associated with SI (p for trend < 0.001). Smoking status was not associated with albuminuria. SI had a linear relationship with albuminuria (p < 0.001). In groups with the highest Ucot/Ucrea levels, the highest SI quartile indicated a significantly higher risk of albuminuria than that in the lowest quartile (risk ratio, 2.22; 95% confidence interval, 1.26-3.92; p = 0.006). The risk of albuminuria was not significant in groups with the lowest and middle tertile adjusted for multiple risk factors. Conclusion Smokers consume higher dietary sodium and dietary SI was positively related to the risk of albuminuria. Smoking is not associated with albuminuria as a single factor. The risk of albuminuria is the higher in participants with smoking and high SI.
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Affiliation(s)
- Young-Bin Son
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Tae-Bum Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyeon-Jin Min
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jihyun Yang
- Division of Nephrology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung-Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Yang J, Ko YS, Lee HY, Fang Y, Oh SW, Kim MG, Cho WY, Jo SK. Mechanisms of Piperacillin/Tazobactam Nephrotoxicity: Piperacillin/Tazobactam-Induced Direct Tubular Damage in Mice. Antibiotics (Basel) 2023; 12:1121. [PMID: 37508217 PMCID: PMC10376029 DOI: 10.3390/antibiotics12071121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/24/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023] Open
Abstract
Piperacillin/tazobactam (PT) is one of the most commonly prescribed antibiotics for critically ill patients in intensive care. PT has been reported to cause direct nephrotoxicity; however, the underlying mechanisms remain unknown. We investigated the mechanisms underlying PT nephrotoxicity using a mouse model. The kidneys and sera were collected 24 h after PT injection. Serum blood urea nitrogen (BUN), creatinine, neutrophil gelatinase-associated lipocalin (NGAL), and renal pathologies, including inflammation, oxidative stress, mitochondrial damage, and apoptosis, were examined. Serum BUN, creatinine, and NGAL levels significantly increased in PT-treated mice. We observed increased IGFBP7, KIM-1, and NGAL expression in kidney tubules. Markers of oxidative stress, including 8-OHdG and superoxide dismutase, also showed a significant increase, accompanied by mitochondrial damage and apoptosis. The decrease in the acyl-coA oxidase 2 and Bcl2/Bax ratio also supports that PT induces mitochondrial injury. An in vitro study using HK-2 cells also demonstrated mitochondrial membrane potential loss, indicating that PT induces mitochondrial damage. PT appears to exert direct nephrotoxicity, which is associated with oxidative stress and mitochondrial damage in the kidney tubular cells. Given that PT alone or in combination with vancomycin is the most commonly prescribed antibiotic in patients at high risk of acute kidney injury, caution should be exercised.
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Affiliation(s)
- Jihyun Yang
- Division of Nephrology, Department of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul 03181, Republic of Korea
| | - Yoon Sook Ko
- Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Hee Young Lee
- Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Yina Fang
- Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Se Won Oh
- Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Myung-Gyu Kim
- Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Won Yong Cho
- Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Sang-Kyung Jo
- Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
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Fang Y, Jo SK, Park SJ, Yang J, Ko YS, Lee HY, Oh SW, Cho WY, Kim K, Son GH, Kim MG. Role of the Circadian Clock and Effect of Time-Restricted Feeding in Adenine-Induced Chronic Kidney Disease. J Transl Med 2023; 103:100008. [PMID: 36748191 DOI: 10.1016/j.labinv.2022.100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 01/19/2023] Open
Abstract
Most physiological functions exhibit circadian rhythmicity that is partly regulated by the molecular circadian clock. Herein, we investigated the relationship between the circadian clock and chronic kidney disease (CKD). The role of the clock gene in adenine-induced CKD and the mechanisms of interaction were investigated in mice in which Bmal1, the master regulator of the clock gene, was knocked out, and Bmal1 knockout (KO) tubule cells. We also determined whether the renoprotective effect of time-restricted feeding (TRF), a dietary strategy to enhance circadian rhythm, is clock gene-dependent. The mice with CKD showed altered expression of the core clock genes with a loss of diurnal variations in renal functions and key tubular transporter gene expression. Bmal1 KO mice developed more severe fibrosis, and transcriptome profiling followed by gene ontology analysis suggested that genes associated with the cell cycle, inflammation, and fatty acid oxidation pathways were significantly affected in the mutant mice. Tubule-specific deletion of BMAL1 in HK-2 cells by CRISPR/Cas9 led to upregulation of p21 and tumor necrosis α and exacerbated epithelial-mesenchymal transition-related gene expression upon transforming growth factor β stimulation. Finally, TRF in the mice with CKD partially restored the disrupted oscillation of the kidney clock genes, accompanied by improved cell cycle arrest and inflammation, leading to decreased fibrosis. However, the renoprotective effect of TRF was abolished in Bmal1 KO mice, suggesting that TRF is partially dependent on the clock gene. Our data demonstrate that the molecular clock system plays an important role in CKD via cell cycle regulation and inflammation. Understanding the role of the circadian clock in kidney diseases can be a new research field for developing novel therapeutic targets.
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Affiliation(s)
- Yina Fang
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang-Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Soo-Ji Park
- Department of Physiology, Korea University College of Medicine, Seoul, Republic of Korea; Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jihyun Yang
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yoon Sook Ko
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Young Lee
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyoungmi Kim
- Department of Physiology, Korea University College of Medicine, Seoul, Republic of Korea; Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Gi Hoon Son
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Myung-Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
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Son YB, Kim TB, Min HJ, Lee J, Yang J, Kim MG, Jo SK, Cho WY, Oh SW. A Case Report of Thrombotic Thrombocytopenia After ChAdOx1 nCov-19 Vaccination and Heparin Use During Hemodialysis. J Korean Med Sci 2022; 37:e75. [PMID: 35289136 PMCID: PMC8921215 DOI: 10.3346/jkms.2022.37.e75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/07/2022] [Indexed: 11/20/2022] Open
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but life-threatening complication. VITT strongly mimics heparin-induced thrombocytopenia (HIT) and shares clinical features. Heparin is commonly used to prevent coagulation during hemodialysis. Therefore, nephrologists might encounter patients needing dialysis with a history of heparin exposure who developed thrombotic thrombocytopenia after vaccination. A 70-year-old male presented with acute kidney injury and altered mental status due to lithium intoxication. He needed consecutive hemodialysis using heparin. Deep vein thrombosis of left lower extremity and accompanying severe thrombocytopenia of 15,000/µL on 24 days after vaccination and at the same time, nine days after heparin use. Anti-platelet factor 4 antibody test was positive. Anticoagulation with apixaban and intravenous immunoglobulin (IVIG) infusion resolved swelling of his left calf and thrombocytopenia. There were no definitive diagnostic tools capable of differentiating between VITT and HIT in this patient. Although VITT and HIT share treatment with IVIG and non-heparin anticoagulation, distinguishing between VITT and HIT will make it possible to establish a follow-up vaccination plan in a person who has had a thrombocytopenic thrombotic event. Further research is needed to develop the tools to make a clear distinction between the clinical syndromes.
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Affiliation(s)
- Young-Bin Son
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyeon-Jin Min
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jonghyun Lee
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jihyun Yang
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Myung-Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
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Kim JE, Choi YJ, Oh SW, Kim MG, Jo SK, Cho WY, Ahn SY, Kwon YJ, Ko GJ. The Effect of Statins on Mortality of Patients With Chronic Kidney Disease Based on Data of the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM) and Korea National Health Insurance Claims Database. Front Nephrol 2022; 1:821585. [PMID: 37674813 PMCID: PMC10479676 DOI: 10.3389/fneph.2021.821585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/29/2021] [Indexed: 09/08/2023]
Abstract
The role of statins in chronic kidney disease (CKD) has been extensively evaluated, but it remains controversial in specific population such as dialysis-dependent CKD. This study examined the effect of statins on mortality in CKD patients using two large databases. In data from the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM) from two hospitals, CKD was defined as an estimated glomerular filtration rate < 60 mL/min/m2; we compared survival between patients with or without statin treatment. As a sensitivity analysis, the results were validated with the Korea National Health Insurance (KNHI) claims database. In the analysis of CDM datasets, statin users showed significantly lower risks of all-cause and cardiovascular mortality in both hospitals, compared to non-users. Similar results were observed in CKD patients from the KNHI claims database. Lower mortality in the statin group was consistently evident in all subgroup analyses, including patients on dialysis and low-risk young patients. In conclusion, we found that statins were associated with lower mortality in CKD patients, regardless of dialysis status or other risk factors.
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Affiliation(s)
- Ji Eun Kim
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yun Jin Choi
- Biomedical Research Institute, Korea University Guro Hospital, Seoul, South Korea
| | - Se Won Oh
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Myung Gyu Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Sang Kyung Jo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Won Yong Cho
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Shin Young Ahn
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Young Joo Kwon
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Gang-Jee Ko
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
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Min HJ, Park JS, Yang J, Yang J, Oh SW, Jo SK, Cho WY, Gwon JG, Jung CW, Seol YJ, Park SY, Kim MG. The effect of periodontitis on recipient outcomes after kidney transplantation. Kidney Res Clin Pract 2022; 41:114-123. [PMID: 35108770 PMCID: PMC8816407 DOI: 10.23876/j.krcp.21.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/02/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Recent several reports have demonstrated that periodontitis is prevalent and adversely affects the survival in patients with chronic kidney disease (CKD) or end-stage kidney disease. However, its impact on transplant outcomes remains uncertain.Methods: This retrospective cohort study included 136 and 167 patients, respectively, who underwent living donor kidney transplantation (KT) at Seoul National University Hospital from July 2012 to August 2016 and Korea University Hospital from April 2008 to October 2018. We divided patients into three groups according to stages of periodontitis based on a new classification system. Results: Patients with severe periodontitis were older, had a higher prevalence of diabetes, a higher body mass index and C-reactive protein level, a lower cardiac output, and were more likely to be smokers, indicating its association with chronic systemic inflammation. After KT, stage IV periodontitis was independently associated with a lower incidence of acute T cell-mediated rejection, suggesting the possible effect of periodontitis on immune function. However, 1-year and 3-year estimated glomerular filtration rates were not different. Among the KT recipients followed up more than 3 years, new-onset cardiovascular disease occurred in nine patients, and coronary artery disease occurred more frequently in patients with stage IV periodontitis. However, diabetes was the independent predictor of new-onset coronary artery disease in multivariate logistic regression analysis.Conclusion: Our findings showed that periodontitis might be an important player in determining posttransplant outcomes in recipients. Further interventional trials to test whether treating periodontitis could modify transplant outcome are needed.
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Affiliation(s)
- Hyeon-Jin Min
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jung-Soo Park
- Department of Periodontology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jaeseok Yang
- Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jihyun Yang
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sang-Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jun Gyo Gwon
- Department of Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Cheol Woong Jung
- Department of Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Yang-Jo Seol
- Department of Periodontology, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Shin-Young Park
- Department of Dentistry, Seoul National Dental Hospital, Seoul, Republic of Korea
- Shin-Young Park Department of Dentistry, Seoul National Dental Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. E-mail:
| | - Myung-Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
- Correspondence: Myung-Gyu Kim Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea. E-mail:
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10
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Yang J, Ji GE, Park MS, Seong YJ, Go YS, Lee HY, Fang Y, Kim MG, Oh SW, Cho WY, Jo SK. Probiotics partially attenuate the severity of acute kidney injury through an immunomodulatory effect. Kidney Res Clin Pract 2021; 40:620-633. [PMID: 34922432 PMCID: PMC8685362 DOI: 10.23876/j.krcp.20.265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/06/2021] [Indexed: 01/09/2023] Open
Abstract
Background A healthy microbiome helps maintain the gut barrier and mucosal immune tolerance. Previously, we demonstrated that acute kidney injury (AKI) provoked dysbiosis, gut inflammation, and increased permeability. Here, we investigated the renoprotective effects of the probiotic Bifidobacterium bifidum BGN4 and the underlying mechanisms thereof. Methods C57BL/6 mice were subjected to bilateral renal ischemia-reperfusion injury (IRI) or sham operation. In the probiotic-treated group, BGN4 was administered by gavage once daily, starting 2 weeks before injury. Results Administration of BGN4 significantly increased gut microbiome diversity and prevented expansion of the Enterobacteriaceae and Bacteroidetes that were the hallmarks of AKI-induced dysbiosis. Further, BGN4 administration also significantly reduced other IRI-induced changes in the colon microenvironment, including effects on permeability, apoptosis of colon epithelial cells, and neutrophil and proinflammatory macrophage infiltration. Mononuclear cells co-cultured with BGN4 expressed significantly increased proportions of CD103+/CD11c+ and CD4+ CD25+ Treg cells, suggesting a direct immunomodulatory effect. BGN4 induced Treg expansion in colon, mesenteric lymph nodes (MNL), and kidney. BGN4 also reduced CX3CR1intermediateLy6Chigh monocyte infiltration and interleukin (IL)-17A suppression in the small intestine, which may have attenuated AKI severity, kidney IL-6 messenger RNA expression, and AKI-induced liver injury. Conclusion Prior supplementation with BGN4 significantly attenuated the severity of IRI and secondary liver injury. This renoprotective effect was associated with increased Foxp3 and reduced IL-17A expression in the colon, MNL, and kidney, suggesting that BGN4-induced immunomodulation might contribute to its renoprotective effects. Probiotics may therefore be a promising strategy to reduce AKI severity and/or remote organ injury.
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Affiliation(s)
- Jihyun Yang
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Geun Eog Ji
- Department of Food and Nutrition, Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea.,Research Center, BIFIDO Co. Ltd., Hongcheon, Republic of Korea
| | - Myeong Soo Park
- Department of Food and Nutrition, Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea.,Research Center, BIFIDO Co. Ltd., Hongcheon, Republic of Korea
| | - Yeong-Je Seong
- Research Center, BIFIDO Co. Ltd., Hongcheon, Republic of Korea
| | - Yoon Sook Go
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Young Lee
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yina Fang
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Myung-Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang-Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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11
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Yang J, Sun BG, Min HJ, Son YB, Kim TB, Lee J, Oh SW, Kim MG, Cho WY, Ahn SY, Ko GJ, Kwon YJ, Cha JJ, Kang YS, Cha DR, Jo SK. Impact of acute kidney injury on long-term adverse outcomes in obstructive uropathy. Sci Rep 2021; 11:23639. [PMID: 34880338 PMCID: PMC8654816 DOI: 10.1038/s41598-021-03033-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/16/2021] [Indexed: 11/09/2022] Open
Abstract
Obstructive uropathy is known to be associated with acute kidney injury (AKI). This study aimed to investigate the etiologies, clinical characteristics, consequences and also assess the impact of AKI on long-term outcomes. This multicenter, retrospective study of 1683 patients with obstructive uropathy who underwent percutaneous nephrostomy (PCN) analyzed clinical characteristics, outcomes including progression to end-stage kidney disease (ESKD), overall mortality, and the impact of AKI on long-term outcomes. Obstructive uropathy in adults was most commonly caused by malignancy, urolithiasis, and other causes. AKI was present in 78% of the patients and was independently associated with preexisting chronic kidney disease (CKD). Short-term recovery was achieved in 56.78% after the relief of obstruction. ESKD progression rate was 4.4% in urolithiasis and 6.8% in other causes and older age, preexisting CKD, and stage 3 AKI were independent factors of progression. The mortality rate (34%) was highly attributed to malignant obstruction (52%) stage 3 AKI was also an independent predictor of mortality in non-malignant obstruction. AKI is a frequent complication of adult obstructive uropathy. AKI negatively affects long-term kidney outcomes and survival in non-malignant obstructions. A better understanding of the epidemiology and prognostic factors is needed for adult obstructive uropathy.
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Affiliation(s)
- Jihyun Yang
- Department of Internal Medicine, Korea University Anam Hospital, Korea University Medical College, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Bong Gyun Sun
- Department of Internal Medicine, Korea University Anam Hospital, Korea University Medical College, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Hyeon-Jin Min
- Department of Internal Medicine, Korea University Anam Hospital, Korea University Medical College, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Young-Bin Son
- Department of Internal Medicine, Korea University Anam Hospital, Korea University Medical College, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Tae Bum Kim
- Department of Internal Medicine, Korea University Anam Hospital, Korea University Medical College, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Jonghyun Lee
- Department of Internal Medicine, Korea University Anam Hospital, Korea University Medical College, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Se Won Oh
- Department of Internal Medicine, Korea University Anam Hospital, Korea University Medical College, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Myung-Gyu Kim
- Department of Internal Medicine, Korea University Anam Hospital, Korea University Medical College, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Won Yong Cho
- Department of Internal Medicine, Korea University Anam Hospital, Korea University Medical College, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea
| | - Shin Young Ahn
- Department of Internal Medicine, Korea University Guro Hospital, Gurodong-Ro 148, Guro-Gu, Seoul, Korea
| | - Gang-Jee Ko
- Department of Internal Medicine, Korea University Guro Hospital, Gurodong-Ro 148, Guro-Gu, Seoul, Korea
| | - Young Joo Kwon
- Department of Internal Medicine, Korea University Guro Hospital, Gurodong-Ro 148, Guro-Gu, Seoul, Korea
| | - Jin Joo Cha
- Department of Internal Medicine, Korea University Ansan Hospital, Jeokgeum-Ro 123, Danwon-Gu, Ansan, Korea
| | - Young Sun Kang
- Department of Internal Medicine, Korea University Ansan Hospital, Jeokgeum-Ro 123, Danwon-Gu, Ansan, Korea
| | - Dae Ryong Cha
- Department of Internal Medicine, Korea University Ansan Hospital, Jeokgeum-Ro 123, Danwon-Gu, Ansan, Korea
| | - Sang-Kyung Jo
- Department of Internal Medicine, Korea University Anam Hospital, Korea University Medical College, Koreadae-Ro 73, Sungbuk-Gu, Seoul, Korea.
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12
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Choi E, Yang J, Ji GE, Park MS, Seong Y, Oh SW, Kim MG, Cho WY, Jo SK. The effect of probiotic supplementation on systemic inflammation in dialysis patients. Kidney Res Clin Pract 2021; 41:89-101. [PMID: 34974660 PMCID: PMC8816411 DOI: 10.23876/j.krcp.21.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/13/2021] [Indexed: 01/04/2023] Open
Abstract
Background Emerging evidence suggests that intestinal dysbiosis contributes to systemic inflammation and cardiovascular diseases in dialysis patients. The purpose of this study was to evaluate the effects of probiotic supplementation on various inflammatory parameters in hemodialysis (HD) patients. Methods Twenty-two patients with maintenance HD were enrolled. These patients were treated twice a day with 2.0 ×1010 colony forming units of a combination of Bifidobacterium bifidum BGN4 and Bifidobacterium longum BORI for 3 months. The microbiome and fecal short-chain fatty acids (SCFAs) were analyzed. The percentages of CD14+ CD16+ proinflammatory monocytes and CD4+ CD25+ regulatory T-cells (Tregs) before and after probiotic supplementation were determined by flow cytometry. Serum levels of calprotectin and cytokine responses upon lipopolysaccharide (LPS) challenge were compared before and after probiotic supplementation. Results Fecal SCFAs increased significantly after probiotic supplementation. Serum levels of calprotectin and interleukin 6 upon LPS stimulation significantly decreased. The anti-inflammatory effects of probiotics were associated with a significant increase in the percentage of CD4+ CD25+ Tregs (3.5% vs. 8.6%, p < 0.05) and also with a decrease of CD14+ CD16+ proinflammatory monocytes (310/mm2 vs. 194/mm2, p < 0.05). Conclusion Probiotic supplementation reduced systemic inflammatory responses in HD patients and this effect was associated with an increase in Tregs and a decrease in proinflammatory monocytes. Hence, targeting intestinal dysbiosis might be a novel strategy for decreasing inflammation and cardiovascular risks in HD patients.
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Affiliation(s)
- Eunho Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jihyun Yang
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Geun-Eog Ji
- Department of Food and Nutrition, Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea.,Research Center, BIFIDO Co. Ltd., Hongcheon, Republic of Korea
| | - Myeong Soo Park
- Department of Food and Nutrition, Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea.,Research Center, BIFIDO Co. Ltd., Hongcheon, Republic of Korea
| | - Yeongje Seong
- Research Center, BIFIDO Co. Ltd., Hongcheon, Republic of Korea
| | - Se Won Oh
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Myung Gyu Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Won Yong Cho
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang Kyung Jo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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13
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Oh SW, Yang JH, Kim MG, Cho WY, Jo SK. Renal hyperfiltration as a risk factor for chronic kidney disease: A health checkup cohort study. PLoS One 2020; 15:e0238177. [PMID: 32881893 PMCID: PMC7470278 DOI: 10.1371/journal.pone.0238177] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Renal hyperfiltration (RHF) has been found to be an independent predictor of adverse cardiovascular outcome. However, it remains uncertain whether it is precursor of chronic kidney disease (CKD) in a healthy population. Materials and methods To determine relative risks and identify the predictor of incident proteinuria and decline of estimated glomerular filtration rate (eGFR) in subjects with RHF. A total of 55,992 subjects aged ≥20 years who underwent health check-up during 2004–2017 were included. Among them, 16,946 subjects who completed at least two health checkups were analyzed. Results A total of 949 (5.6%) subjects developed proteinuria and 98 (0.6%) subjects showed ≥ 30% of eGFR decline. The risk of incident proteinuria was significantly higher in those with RHF (RR: 1.644; 95% CI: 1.064–2.541). Those with RHF showed 8.720 fold (95% CI: 4.205–18.081) increased risk for ≥30% decline. ESR, CRP, and monocyte count showed reversed J shaped curve according to the increase of eGFR. The adjusted mean of monocyte count was significantly higher in participants with eGFR ≥90ml/min/1.73m2 or < 60ml/min/1.73m2 compared to that in patients with eGFR 75-89ml/min/1.73m2. Compared to subjects with the lowest tertile of monocyte and no RHF, those with the highest tertile of monocyte count in the RHF group had 3.314-fold (95% CI: 1.893–5.802) higher risk of incident proteinuria and 3.822-fold (95% CI, 1.327–11.006) risk of 30% eGFR decline. Conclusions RHF had significantly increased risk of developing proteinuria and CKD in healthy subjects. Higher monocyte count might be used as a predictor of CKD in subjects with RHF.
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Affiliation(s)
- Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Yang
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Myung-Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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14
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Kim H, Jo SK, Ahn SY, Kwon YJ, Lee H, Oh J, Chin HJ, Lim K, Lee J, Yang J, Kim MG, Cho WY, Oh SW. Long-term Renal Outcome of Biopsy-proven Acute Tubular Necrosis and Acute Interstitial Nephritis. J Korean Med Sci 2020; 35:e206. [PMID: 32627439 PMCID: PMC7338216 DOI: 10.3346/jkms.2020.35.e206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/06/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Although emerging evidence suggest acute kidney injury (AKI) progress to chronic kidney disease (CKD), long-term renal outcome of AKI still remains unclear. Acute tubular necrosis (ATN) is the most common cause of AKI due to ischemia, toxin or sepsis. Acute interstitial nephritis (AIN), caused by drugs or autoimmune diseases is also increasingly recognized as an important cause of AKI. Unlike glomerular diseases, AKI is usually diagnosed in the clinical context without kidney biopsies, and lack of histology might contribute to this uncertainty. METHODS Among 8,769 biopsy series, 253 adults who were histologically diagnosed with ATN and AIN from 1982 to 2018 at five university hospitals were included. Demographic and pathological features that are associated with the development of end stage renal disease (ESRD) were also examined. RESULTS Rate of non-recovery of renal function at 6 month was significantly higher in the AIN (ATN vs AIN 49.3 vs 69.4%, P = 0.007) with a 2.71-fold higher risk of non- recovery compared to ATN (95% confidence interval [CI], 1.20-6.47). During the mean follow up of 76.5 ± 91.9 months, ESRD developed in 39.4% of patients with AIN, and 21.5% patients of ATN. The risk of ESRD was significantly higher in AIN (23.05; 95% CI, 2.42-219.53) and also in ATN (12.14; 95% CI, 1.19-24.24) compared to control with non-specific pathology. Older age, female gender, renal function at the time of biopsy and at 6 months, proteinuria and pathological features including interstitial inflammation and fibrosis, tubulitis, vascular lesion were significantly associated with progression to ESRD. CONCLUSION Our study demonstrated that patients with biopsy proven ATN and AIN are at high risk of developing ESRD. AIN showed higher rate of non-renal recovery at 6 month than ATN.
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Affiliation(s)
- Hyunseo Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Shin Young Ahn
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Joo Kwon
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hajeong Lee
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jieun Oh
- Division of Nephrology, Department of Internal Medicine, Hallym University Kandong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ho Jun Chin
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kijoon Lim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Junyong Lee
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jihyun Yang
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Myung Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
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15
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Yang J, Kim CJ, Go YS, Lee HY, Kim MG, Oh SW, Cho WY, Im SH, Jo SK. Intestinal microbiota control acute kidney injury severity by immune modulation. Kidney Int 2020; 98:932-946. [PMID: 32470493 DOI: 10.1016/j.kint.2020.04.048] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/13/2020] [Accepted: 04/13/2020] [Indexed: 12/15/2022]
Abstract
Intestinal microbiota impacts the host immune system and influences the outcomes of chronic diseases. However, it remains uncertain whether acute kidney injury (AKI) impacts intestinal microbiota or vice versa. To determine this, we investigated the mechanistic link between AKI, microbiota, and immune response in ischemia/reperfusion injury. Microbiota alteration and its biological consequences after ischemia/reperfusion injury were examined and the effect of dysbiotic microbiota on the outcome of AKI was also assessed by colonizing germ-free mice with post-AKI microbiota. The role of Th17, Th1, Tregs cells and macrophage polarization in mediating the renoprotective effect of antibiotic induced microbiota depletion in ischemia/reperfusion injury was also determined. Increase of Enterobacteriacea, decrease of Lactobacilli, and Ruminococacceae were found to be the hallmarks of ischemia/reperfusion injury induced dysbiosis and were associated with a decreased levels of short-chain fatty acids, intestinal inflammation and leaky gut. Colonizing germ-free mice with post-AKI microbiota worsened ischemia/reperfusion injury severity with exaggerated inflammation in recipient mice compared to colonizing with microbiota from sham operated mice. Microbiota depletion by oral antibiotics protected against ischemia/reperfusion injury. This renoprotective effect was associated with reduced Th 17, Th 1 response along with expansion of regulatory T cells, and M2 macrophages. Our study demonstrated a unique bidirectional relationship between the kidney and the intestine during AKI. Intestinal dysbiosis, inflammation and leaky gut are consequences of AKI but they also represent an important modifier determining post-AKI severity. Thus, targeting the intestinal microbiota might provide a novel therapeutic strategy in AKI.
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Affiliation(s)
- Jihyun Yang
- Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Chan Johng Kim
- Division of Integrative Biosciences and Biotechnology & Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Yoon Sook Go
- Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Hee Young Lee
- Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Myung-Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Sin-Hyeog Im
- Division of Integrative Biosciences and Biotechnology & Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea.
| | - Sang Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea.
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16
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Cho WY, Lim SY, Yang JH, Oh SW, Kim MG, Jo SK. Urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 as biomarkers of patients with established acute kidney injury. Korean J Intern Med 2020; 35:662-671. [PMID: 31856559 PMCID: PMC7214351 DOI: 10.3904/kjim.2018.266] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 01/30/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND/AIMS Urinary tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) have been recently discovered and validated as sensitive biomarkers that can predict stage 2 or 3 acute kidney injury (AKI) development in high-risk patients. We aimed to assess whether these biomarkers could predict adverse outcomes and renal recovery in established AKI patients. METHODS This was a single-center study prospectively enrolling 124 patients diagnosed with AKI. TIMP-2, IGFBP7, neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule 1 (KIM-1) levels were measured at the time of diagnosis and the predictive performance of short-term outcomes and renal recovery was assessed. RESULTS Patients were divided into 4 quartiles according to the initial urinary TIMP-2/IGFBP7 levels. Stage 3 AKI (odds ratio [OR], 17.86), classified by the Kidney Disease Improving Global Outcomes (KDIGO), as well as the third and fourth quartiles of TIMP-2/IGFBP7 (OR, 5.75 and 44.98, respectively), were found to be independent predictors of renal replacement therapy at the time of AKI diagnosis. In addition, KDIGO stage 3 AKI (OR, 2.468) or the third of fourth quartiles of urinary TIMP-2/IGFBP7 (OR, 1.896 and 3.622, respectively) were also found to be useful in predicting nonrecovery of renal function. In a separate analysis of patients with renal recovery at discharge, initial urinary TIMP-2/IGFBP7 or urinary IGFBP7 at discharge could also predict new-onset or progressive chronic kidney disease (CKD). CONCLUSION In AKI patients, urine TIMP-2/IGFBP7 could serve as a biomarker for predicting adverse outcomes, renal recovery, or the development and progression of CKD.
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Affiliation(s)
- Won Yong Cho
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sung Yoon Lim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji Hyun Yang
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Se Won Oh
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Myung-Gyu Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Correspondence to Myung-Gyu Kim, M.D. Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea Tel: +82-2-920-5909 Fax: +82-2-927-5344 E-mail:
| | - Sang-Kyung Jo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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17
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Lee YJ, Lee JH, Jung CW, Gwon JG, Ko SY, Lee J, Jo SK, Cho WY, Kim MG. Combination of Glomerular C4d and Morphologic Glomerular Lesions as a Possible Indicator in the Diagnosis of Acute or Chronic Active Antibody-Mediated Rejection. Transplant Proc 2019; 51:2660-2666. [DOI: 10.1016/j.transproceed.2019.03.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/19/2019] [Accepted: 03/04/2019] [Indexed: 11/16/2022]
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18
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Lim K, Lee YJ, Gwon JG, Jung CW, Yang J, Oh SW, Jo SK, Cho WY, Kim MG. Impact of Donor Age on the Outcomes of Kidney Transplantation From Deceased Donors With Histologic Acute Kidney Injury. Transplant Proc 2019; 51:2593-2597. [PMID: 31474449 DOI: 10.1016/j.transproceed.2019.03.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/25/2019] [Accepted: 03/12/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Kidney transplantation from elderly donors with acute kidney injury (AKI) has increased recently due to donor shortage, but the safety and prognosis are not well known. We examined the effect of donor age on the outcomes of kidney transplantation (KT) from donors with histologic AKI. MATERIALS AND METHODS We retrospectively analyzed the medical records of 59 deceased-donor KTs with acute tubular necrosis (ATN) on preimplantation donor kidney biopsy between March 2012 and October 2017. Histologic evaluations of ATN, inflammation, glomerulosclerosis (GS), interstitial fibrosis, tubular atrophy, and arterial sclerosis were performed. RESULTS Twenty and 39 recipients received kidneys from elderly (> 60, 68.9 ± 5.0 years) and young (≤ 60, 45.9 ± 9.6 years) donors with ATN, respectively. Among the elderly donors, significantly increased donor creatinine was observed in only 44% donors, and there were more diabetic patients and women and a higher proportion of GS than among the young donors. Six months after KT, estimated glomerular filtration rate was significantly lower in recipients who received kidneys from elderly donors compared to young donors. Donor creatinine level and AKI severity did not significantly affect the recipient outcomes in either group. However, the presence of ATN and GS were significant factors that exacerbated renal outcomes after KT from elderly donors only. On multivariate analysis, severe ATN was the strongest independent predictor of elderly recipient renal function. CONCLUSIONS Histologic injury may predict renal outcomes in KT from elderly donors. A donor allocation protocol including preimplantation renal histology should be established for KT from elderly donors.
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Affiliation(s)
- Kijoon Lim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Yoo Jin Lee
- Department of Pathology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jun Gyo Gwon
- Department of Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Cheol Woong Jung
- Department of Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jihyun Yang
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sang-Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Myung-Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea.
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Cho W, Hwang TY, Choi YK, Yang JH, Kim MG, Jo SK, Cho WY, Oh SW. Diastolic dysfunction and acute kidney injury in elderly patients with femoral neck fracture. Kidney Res Clin Pract 2019; 38:33-41. [PMID: 30743321 PMCID: PMC6481981 DOI: 10.23876/j.krcp.18.0083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 01/06/2023] Open
Abstract
Background Femoral neck fracture is common in the elderly population. Acute kidney injury (AKI) is an important risk factor for mortality in patients who have had such fracture. We evaluated the incidence of AKI in patients who had femoral neck fracture and identified risk factors for AKI and mortality. Methods This was an observational cohort study including 285 patients who were ≥ 65 years of age and who underwent femoral neck fracture surgery between 2013 and 2017. Results The mean age was 78.63 ± 6.75 years. A total of 67 (23.5%) patients developed AKI during the hospital stay: 57 (85.1%), 5 (7.5%), and 5 (7.5%) patients were classified as having stage 1, 2, and 3 AKI, respectively. Patients with AKI had a lower baseline estimated glomerular filtration rate and higher left atrial dimension, left ventricular mass index, pulmonary artery pressure, and the ratio of early mitral inflow velocity to early diastolic mitral annulus velocity (E/e’) and were more likely to have diabetes or hypertension (HTN) (P < 0.05). The presence of HTN (odds ratio [OR], 4.570; 95% confidence interval [CI], 1.632–12.797) higher E/e’ (OR, 1.105; 95% CI, 1.019–1.198), and lower hemoglobin (OR, 0.704; 95% CI, 0.528–0.938) were independently associated with a higher risk for developing AKI. Severe AKI (OR, 24.743; 95% CI, 2.822–212.401) was associated with a higher risk of mortality. Conclusion Elderly patients with femoral neck fracture had a high incidence of AKI. Diastolic dysfunction was associated with AKI. Severe AKI was associated with in-hospital mortality.
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Affiliation(s)
- Woori Cho
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae Yeon Hwang
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yoon Kyung Choi
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ji Hyun Yang
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Myung-Gyu Kim
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang-Kyung Jo
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Won Yong Cho
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Se Won Oh
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Choi YK, Yang JH, Ahn SY, Ko GJ, Oh SW, Kim MG, Cho WY, Jo SK. Retroperitoneal fibrosis in the era of immunoglobulin G4-related disease. Kidney Res Clin Pract 2019; 38:42-48. [PMID: 30754935 PMCID: PMC6481977 DOI: 10.23876/j.krcp.18.0052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/10/2018] [Accepted: 10/24/2018] [Indexed: 12/16/2022] Open
Abstract
Background Retroperitoneal fibrosis (RPF) is a rare disease characterized by fibroinflammatory tissue in the periaortic or periiliac retroperitoneum, where it frequently encases ureters. There is emerging evidence that a subset of this disease is part of a spectrum of multisystemic autoimmune diseases collectively referred to as “immunoglobulin G4 (IgG4)-related disease”. Methods We retrospectively analyzed 27 idiopathic RPF patients and identified a subset as IgG4-related RPF, which we categorized according to recently published comprehensive diagnostic criteria. We compared clinical and laboratory characteristics and response to treatment between the two groups. Results Of 27 total patients, 16 (59.3%) were diagnosed as having IgG4-related RPF, and these were predominantly male. They were also significantly older and more likely to have other organ involvement, hydronephrosis, and postrenal acute kidney injury (AKI) compared to those with idiopathic RPF. However, there was no difference in response rate to systemic steroid treatment. Conclusion IgG4-related RPF accounts for a substantial portion of RPF cases previously identified as “idiopathic RPF” in Korea. Clinical and laboratory characteristics of IgG4-related RPF are similar to those of idiopathic RPF except for a striking male predominance, older age, and higher incidence of postrenal AKI in IgG4-related RPF. More comprehensive, prospective studies are needed to clearly distinguish IgG4-related RPF from idiopathic RPF based on clinical manifestation and to further assess treatment response and long-term prognosis.
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Affiliation(s)
- Yoon Kyung Choi
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Ji Hyun Yang
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Shin Young Ahn
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Gang Jee Ko
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Se Won Oh
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Myung Gyu Kim
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Won Yong Cho
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Sang Kyung Jo
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
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Yang J, Lim SY, Ko YS, Lee HY, Oh SW, Kim MG, Cho WY, Jo SK. Intestinal barrier disruption and dysregulated mucosal immunity contribute to kidney fibrosis in chronic kidney disease. Nephrol Dial Transplant 2018; 34:419-428. [DOI: 10.1093/ndt/gfy172] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/08/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Jihyun Yang
- Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Sung Yoon Lim
- Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Yoon Sook Ko
- Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Hee Young Lee
- Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Se Won Oh
- Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Myung Gyu Kim
- Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Won Yong Cho
- Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Sang Kyung Jo
- Department of Internal Medicine, Korea University Medical College, Seoul, Korea
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Lim SY, Ko YS, Lee HY, Yang JH, Kim MG, Jo SK, Cho WY. The Impact of Preexisting Chronic Kidney Disease on the Severity and Recovery of Acute Kidney Injury. Nephron Clin Pract 2018; 139:254-268. [PMID: 29649832 DOI: 10.1159/000487492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 02/07/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Recent observational studies have shown that in chronic kidney disease (CKD) patients, a significantly smaller percentage of patients with an episode of acute kidney injury (AKI) have full recovery of renal function compared to those without CKD. However, precise mechanisms involved in the incomplete repair after AKI with preexisting CKD have not been completely ascertained. Here, we assessed the impact of preexisting CKD on the severity and recovery of AKI in a mouse model of 5/6 nephrectomy. METHODS Male CD-1 mice underwent 5/6 nephrectomy (Nx). Six weeks post surgery, ischemia reperfusion injury (IRI) or a sham operation was performed and functional, histological, and various molecular parameters were compared between them. RESULTS Serum creatinine level on day 1 after IRI was comparable between control and Nx mice. However, serum creatinine remained significantly higher throughout the recovery phase in Nx mice compared to control mice. mRNA and protein expression of the cell cycle regulatory proteins were persistently elevated in Nx mice and this was associated with significantly increased levels of the G1 cell cycle arrest markers. Treatment with a p53 inhibitor following IRI resulted in not only decreased expression of G1 arrest markers but also decreased fibrosis, suggesting that prolonged epithelial G1 cell cycle arrest might be partially responsible for impaired recovery from superimposed AKI on CKD. CONCLUSION Taken together, reduced nephron mass have a negative effect on the repair process that is partially mediated by the disruption of the cell cycle regulation.
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Kim MG, Lim SY, Ko YS, Lee HY, Jo SK, Cho WY. ADAMTS13-von Willebrand factor axis is involved in the pathophysiology of kidney ischaemia-reperfusion injury. Nephrology (Carlton) 2017; 22:913-920. [DOI: 10.1111/nep.12893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/27/2016] [Accepted: 08/07/2016] [Indexed: 01/07/2023]
Affiliation(s)
- Myung-Gyu Kim
- Department of Internal Medicine; Korea University Medical College; 5Ka, Anam-Dong, Sungbuk-Gu Seoul Korea
| | - Sung Yoon Lim
- Department of Internal Medicine; Korea University Medical College; 5Ka, Anam-Dong, Sungbuk-Gu Seoul Korea
| | - Yoon Sook Ko
- Department of Internal Medicine; Korea University Medical College; 5Ka, Anam-Dong, Sungbuk-Gu Seoul Korea
| | - Hee Young Lee
- Department of Internal Medicine; Korea University Medical College; 5Ka, Anam-Dong, Sungbuk-Gu Seoul Korea
| | - Sang-Kyung Jo
- Department of Internal Medicine; Korea University Medical College; 5Ka, Anam-Dong, Sungbuk-Gu Seoul Korea
| | - Won Yong Cho
- Department of Internal Medicine; Korea University Medical College; 5Ka, Anam-Dong, Sungbuk-Gu Seoul Korea
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Lim SY, Lee JY, Yang JH, Na YJ, Kim MG, Jo SK, Cho WY. Predictive factors of acute kidney injury in patients undergoing rectal surgery. Kidney Res Clin Pract 2016; 35:160-4. [PMID: 27668159 PMCID: PMC5025479 DOI: 10.1016/j.krcp.2016.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/30/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite major advance in surgical techniques from open surgery to robot-assisted surgery, acute kidney injury (AKI) is still major postoperative complication in rectal surgery. The purpose of this study is to compare the incidence of postoperative AKI according to different surgical techniques and also the risk factors, outcomes of AKI in patients undergoing rectal cancer surgery. METHODS A retrospective medical chart review was done in a total of 288 patients who received proctectomy because of rectal cancer from 2011 to 2013. RESULTS The mean patient age was 62 ± 12 years, and male was 64.2%. Preoperative creatinine was 0.91 ± 0.18 mg/dL. Open surgery was performed in 9%, and laparoscopy assisted surgery or robot assisted surgery were performed in 54.8% or 36.1% of patients, respectively. AKI developed in 11 patients (3.82%), 2 (18%) of them received acute hemodialysis. Incidence of AKI was not different according to the surgical technique, however, the presence of diabetes, intraoperative shock, and postoperative ileus was associated with the development of AKI. In addition, AKI patients showed significantly longer hospital stay and higher mortality than non-AKI patients. CONCLUSION Our study demonstrated that despite advances in surgical techniques, incidence of postoperative AKI remains unchanged and also that postoperative AKI is associated with poor outcome. We also found that presence of diabetes, intraoperative shock and postoperative ileus are strongly associated with the development of AKI. More careful attention should be paid on high risk patients for the development of postoperative AKI regardless of surgical techniques.
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Affiliation(s)
| | | | | | | | | | | | - Won Yong Cho
- Corresponding author. Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, 5ka, Anam-dong, Sungbuk-gu, Seoul, 136-705, Korea.Division of NephrologyDepartment of Internal MedicineKorea University Anam Hospital5ka, Anam-dongSungbuk-guSeoul136-705Korea
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Choi HM, Kim SC, Kim MG, Jo SK, Cho WY, Kim HK. Etiology and outcomes of anuria in acute kidney injury: a single center study. Kidney Res Clin Pract 2014; 34:13-9. [PMID: 26484014 PMCID: PMC4570603 DOI: 10.1016/j.krcp.2014.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/22/2014] [Accepted: 11/12/2014] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND It was previously known that anuric acute kidney injury (AKI) is uncommon and its occurrence suggests complete ureteral obstruction, shock, or a major vascular event. As the epidemiology of AKI has significantly changed over the past decade, it is possible that the incidence, etiology, or clinical characteristics of anuric AKI have also changed. METHODS A prospective cohort study was conducted that included all patients undergoing renal replacement therapy (RRT) for AKI during a 2-year period in a tertiary hospital. Patients were classified as having anuric, oliguric, or nonoliguric AKI based on their volume of urine when RRT started using the modified Acute Kidney Injury Network criteria. RESULTS Of the 203 patients included in the study, 21.2% met the criteria for anuric AKI. Septic and postoperative AKI were the main causes of anuric AKI, with 60.5% of incidences occurring in hospital. Anuric AKI was associated with a younger age, a lower prevalence of pre-morbid chronic kidney disease and diabetes, more frequent continuous RRT requirement, and multi-organ dysfunction. In addition, patients with anuric AKI had a higher rate of in-hospital mortality and long-term dependence on RRT than patients with nonanuric AKI. CONCLUSION Anuric AKI is common, with sepsis as the main etiological insult, and is associated with adverse outcomes among patients with AKI who require RRT.
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Affiliation(s)
- Hye Min Choi
- Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Sun Chul Kim
- Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Myung-Gyu Kim
- Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Sang-Kyung Jo
- Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Won Yong Cho
- Department of Internal Medicine, Korea University Medical College, Seoul, Korea
| | - Hyoung Kyu Kim
- Department of Internal Medicine, Korea University Medical College, Seoul, Korea
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Cho E, Lee JH, Lim HJ, Oh SW, Jo SK, Cho WY, Kim HK, Lee SY. Soluble CD25 is increased in patients with sepsis-induced acute kidney injury. Nephrology (Carlton) 2014; 19:318-24. [DOI: 10.1111/nep.12230] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Eunjung Cho
- Division of Nephrology; Department of Internal Medicine; Korea University College of Medicine; Seoul Korea
| | - Ji Hyun Lee
- Division of Nephrology; Department of Internal Medicine; Eulji General Hospital, Eulji University College of Medicine; Seoul Korea
| | - Hye Jin Lim
- Division of Nephrology; Department of Internal Medicine; Eulji General Hospital, Eulji University College of Medicine; Seoul Korea
| | - Se Won Oh
- Division of Nephrology; Department of Internal Medicine; Eulji General Hospital, Eulji University College of Medicine; Seoul Korea
| | - Sang Kyung Jo
- Division of Nephrology; Department of Internal Medicine; Korea University College of Medicine; Seoul Korea
| | - Won Yong Cho
- Division of Nephrology; Department of Internal Medicine; Korea University College of Medicine; Seoul Korea
| | - Houng-Kyu Kim
- Division of Nephrology; Department of Internal Medicine; Korea University College of Medicine; Seoul Korea
| | - So Young Lee
- Division of Nephrology; Department of Internal Medicine; Eulji General Hospital, Eulji University College of Medicine; Seoul Korea
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Kim HS, Kim ST, Kang SH, Sung DJ, Kim CH, Shin SW, Kim YH, Cho WY, Park KH. The use of everolimus to target carcinogenic pathways in a patient with renal cell carcinoma and tuberous sclerosis complex: a case report. J Med Case Rep 2014; 8:95. [PMID: 24612911 PMCID: PMC3976165 DOI: 10.1186/1752-1947-8-95] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 12/26/2013] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION An increased understanding of the genetic pathways involved in renal cell carcinoma has resulted in the development of various drugs that target relevant signaling cascades for the specific treatment of this disease. However, no validated predictive markers have been identified to guide the decision whether patients should receive vascular endothelial growth factor-targeted therapy or mammalian target of rapamycin-targeted therapy. We present what is, to the best of our knowledge, the first case of renal cell carcinoma in a patient with tuberous sclerosis complex who was successfully treated with everolimus. CASE PRESENTATION The patient was a 49-year-old Korean woman with tuberous sclerosis complex and recurrent renal cell carcinoma. The patient was treated with the tyrosine kinase inhibitor sunitinib followed by the mammalian target of rapamycin inhibitor everolimus. This treatment resulted in a prolonged response and significant clinical benefit. Notably, everolimus ameliorated the symptoms related not only to renal cell carcinoma but also to tuberous sclerosis complex. CONCLUSION This case provides a rationale for the use of everolimus as first-line treatment for this specific patient population in order to target the correct pathway involved in carcinogenesis.
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Affiliation(s)
- Hye Sook Kim
- Division of Oncology/Hematology, Department of Internal Medicine, College of Medicine, Korea University, Inchon-ro 73, Seongbuk-Gu, Seoul 136-702, Korea
| | - Seung Tae Kim
- Division of Oncology/Hematology, Department of Internal Medicine, College of Medicine, Korea University, Inchon-ro 73, Seongbuk-Gu, Seoul 136-702, Korea
| | - Seok Ho Kang
- Department of Urology, College of Medicine, Korea University, Inchon-ro 73, Seongbuk-GuSeoul 136-702, Korea
| | - Deuk Jae Sung
- Department of Radiology, College of Medicine, Korea University, Inchon-ro 73, Seongbuk-Gu, Seoul 136-702, Korea
| | - Chul Hwan Kim
- Department of Pathology, College of Medicine, Korea University, Inchon-ro 73, Seongbuk-Gu, Seoul 136-702, Korea
| | - Sang Won Shin
- Division of Oncology/Hematology, Department of Internal Medicine, College of Medicine, Korea University, Inchon-ro 73, Seongbuk-Gu, Seoul 136-702, Korea
| | - Yeul Hong Kim
- Division of Oncology/Hematology, Department of Internal Medicine, College of Medicine, Korea University, Inchon-ro 73, Seongbuk-Gu, Seoul 136-702, Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Korea University, Inchon-ro 73, Seongbuk-Gu, Seoul 136-702, Korea
| | - Kyong Hwa Park
- Division of Oncology/Hematology, Department of Internal Medicine, College of Medicine, Korea University, Inchon-ro 73, Seongbuk-Gu, Seoul 136-702, Korea
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Lee JW, Cho E, Kim MG, Jo SK, Cho WY, Kim HK. Proinflammatory CD14(+)CD16(+) monocytes are associated with vascular stiffness in predialysis patients with chronic kidney disease. Kidney Res Clin Pract 2013; 32:147-52. [PMID: 26877933 PMCID: PMC4714098 DOI: 10.1016/j.krcp.2013.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 07/08/2013] [Accepted: 08/08/2013] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Chronic inflammation is frequently noted in patients with chronic kidney disease (CKD) and contributes to the development and progression of cardiovascular diseases. Monocytes are heterogeneous populations of cells, and they can be divided into subtypes with different phenotypes and functions based on CD14 and CD16 positivity. This study examined whether the proinflammatory CD14(+)CD16(+) monocyte subset expands in predialysis CKD patients, and also whether the expansion of these cells is closely associated with systemic inflammation and cardiovascular risk factors. METHODS The percentages of proinflammatory CD14(+)CD16(+) monocytes were analyzed in 111 predialysis CKD patients using a flow cytometer, and they were compared with brachial-ankle pulse wave velocity as well as the cytokine plasma levels and other clinical parameters. RESULTS The proportion of CD14(+)CD16(+) monocytes was significantly higher in patients with advanced stages of CKD than in patients with the early stages. Interleukin-6 levels were also high in patients with advanced stages of CKD. The expansion of CD14(+)CD16(+) monocytes showed significant positive correlations with the high-sensitive C-reactive protein levels, and negative correlations with the levels of serum albumin, hemoglobin, and 25(OH)-vitamin D. In addition, the expansion of CD14(+)CD16(+) monocytes was an independent factor correlated with brachial-ankle pulse wave velocity in diabetic CKD patients. CONCLUSION Expansion of the proinflammatory CD14(+)CD16(+) monocyte subset partially accounts for chronic inflammation, malnutrition, and atherosclerosis in CKD.
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Affiliation(s)
- Jae-Won Lee
- Division of Nephrology, Department of Internal Medicine, Korea University, Anam Hospital, Seoul, Korea
| | - Eunjung Cho
- Division of Nephrology, Department of Internal Medicine, Korea University, Anam Hospital, Seoul, Korea
| | - Myung-Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University, Anam Hospital, Seoul, Korea
| | - Sang-Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University, Anam Hospital, Seoul, Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University, Anam Hospital, Seoul, Korea
| | - Hyoung Kyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University, Anam Hospital, Seoul, Korea
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Choi HM, Jo SK, Kim SH, Lee JW, Cho E, Hyun YY, Cha JJ, Kang YS, Cha DR, Cho WY, Kim HK. Glucocorticoids attenuate septic acute kidney injury. Biochem Biophys Res Commun 2013; 435:678-84. [PMID: 23702481 DOI: 10.1016/j.bbrc.2013.05.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 05/10/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence and mortality of septic acute kidney injury (AKI) remains high, whereas our understanding of pathogenesis for septic AKI is still limited. Glucocorticoids (GCs) have been clinically recommended for treatment of septic shock and also have showed favorable effect on septic AKI in several animal experiments. The aim of this study is to investigate the pathophysiology of septic AKI and the effect of GCs on septic AKI. METHODS We induced septic AKI using cecal ligation and puncture (CLP) model in 8-10 wk-old male C57BL/6 mice. Saline or dexamethasone (2.5 mg/kg) dissolved in saline was administered after surgery. Hemodynamic, biochemical and histological changes were examined in a time-course manner. RESULTS CLP resulted in hyperdynamic warm shock with multiple organ dysfunction including AKI. Despite renal dysfunction, light microscopy showed scanty acute tubular necrosis and inflammation. Instead, CLP induced significant increase in apoptosis of the kidney and spleen cells. In addition, septic kidneys showed mitochondrial injury and alterations in Bcl2 family proteins in the renal tubular cells. Dexamethasone treatment attenuated renal dysfunction, but it was not associated with improvement of hemodynamic parameters. Dexamethasone-induced organ protective effect was associated with reduced mitochondrial injury with preserved cytochrome c oxidase and suppression of proapoptotic proteins as well as reduced cytokine release. CONCLUSIONS Mitochondrial damage and subsequent apoptosis are thought to play important role in the development of septic AKI. GCs might be a useful therapeutic strategy for septic AKI by reducing mitochondrial damage and apoptosis.
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Affiliation(s)
- Hye Min Choi
- Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Republic of Korea
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Lee JW, Won NH, Cho E, Kim MG, Jo SK, Cho WY, Kim HK. Postoperative hemolytic uremic syndrome with renal cortical necrosis following laparoscopic hemicolectomy. Ren Fail 2013; 35:725-8. [PMID: 23560430 DOI: 10.3109/0886022x.2013.780978] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Non-Shiga-like toxin-producing Escherichia coli (STEC) or atypical hemolytic uremic syndrome (aHUS) is observed in 5-10% of all hemolytic uremic syndrome (HUS) cases, and usually develops secondary to infections, malignancies, drugs, transplantation, pregnancy, and autoimmune disease. However, there has been no report on adult onset HUS initiated by surgical procedures except transplantation. We report a 66-year-old woman who incurred renal impairment on the first day after laparoscopic hemicolectomy. Hemolytic anemia, thrombocytopenia, absence of Shiga toxin associated disease, normal ADAMTS13 activity, and low serum C3 (not C4) were consistent with a diagnosis of aHUS. We performed plasma exchange with fresh frozen plasma. Nevertheless, deteriorated renal function was not recovered after the treatment. Although it is an uncommon postoperative complication, aHUS needs to be considered as a possible cause of acute kidney injury combined with thrombocytopenia and anemia after surgical procedures, considering its different treatment modality and poor outcomes.
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Affiliation(s)
- Jae-Won Lee
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
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Young Cho J, Lee JW, Jung Cho E, Kim MG, Jo SK, Yong Cho W, Kyu Kim H. Bilateral gluteal compartment syndrome complicated by rhabdomyolysis and acute kidney injury in a patient with alcohol intoxication. Kidney Res Clin Pract 2012; 31:246-8. [PMID: 26889429 PMCID: PMC4716101 DOI: 10.1016/j.krcp.2012.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 06/19/2012] [Accepted: 07/09/2012] [Indexed: 11/03/2022] Open
Abstract
Bilateral gluteal compartment syndrome is a rare clinical entity that can be complicated by rhabdomyolysis or acute kidney injury (AKI). We report the a case of a 30-year-old woman without any comorbid diseases who was diagnosed with bilateral gluteal compartment syndrome complicated by rhabdomyolysis and dialysis-requiring AKI, which was caused by prolonged immobilization under the influence of alcohol. Although the patient's renal function recovered fully after 5 sessions of hemodialysis, sciatic neuropathy caused by gluteal compartment syndrome led to permanent foot drop.
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Affiliation(s)
- Jae Young Cho
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jae-Won Lee
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Eun Jung Cho
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Myung-Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Sang Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Hyoung Kyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
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Abstract
This study was designed to identify the causes of the development of carpal tunnel syndrome (CTS) associated with end stage kidney disease (ESKD). A total of 112 patients with ESKD, 64 on hemodialysis (HD) and 48 on peritoneal dialysis (PD), were enrolled. The duration of ESKD and dialysis, the site of the arteriovenous (A-V) fistula for HD, laboratory data such as blood urea nitrogen, creatinine, and beta-2-microglobulin were determined. Clinical evaluation of CTS and electrophysiological studies for the diagnosis of CTS and peripheral neuropathy were performed. The electrophysiological studies showed that the frequency of CTS was not different in the HD and PD groups (P = 0.823) and the frequency of CTS was not different in the limb with the A-V fistula compared to the contralateral limb (P = 0.816). The frequency of HD and PD were not related to beta-2-microglobulin levels, an indicator of amyloidosis. The frequency of CTS did not increase as the severity of the peripheral neuropathy and the duration of ESKD and dialysis increased (P = 0.307). The results of this study do not support that microglobulin induced amyloidosis or placement of an A-V fistula are associated with an increase in CTS.
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Affiliation(s)
- Hee-Kyu Kwon
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea.
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Choi HM, Woo YS, Kim MG, Jo SK, Cho WY, Kim HK. Altered monocyte-derived dendritic cell function in patients on hemodialysis: a culprit for underlying impaired immune responses. Clin Exp Nephrol 2011; 15:546-53. [PMID: 21360015 DOI: 10.1007/s10157-011-0424-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Accepted: 02/07/2011] [Indexed: 01/21/2023]
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) are known to have impaired immune function. Dendritic cells (DCs) are the major antigen-presenting cells that initiate primary immune responses, linking innate and adaptive immunity. Although suboptimal immune responses to vaccination, as frequently observed in ESRD patients, might suggest the presence of impaired DC function, the precise nature of altered DC function is not fully understood. METHODS In the current study, we compared the maturation status, viability, and function of monocyte-derived DCs (moDCs) of patients on hemodialysis (HD) with healthy controls. RESULTS Surface expression of major histocompatibility complex class II, CD83, and CD86, and chemokine receptor CCR7 in moDCs was not different between HD patients and healthy controls. No significant difference was detected in the viability of moDCs determined by expression of annexin V and propidium iodide between two groups. However, moDCs from HD patients produced significantly higher amounts of IL-6 when stimulated by cytokine cocktails compared to healthy controls. In addition, mature moDCs from HD patients showed significantly enhanced allogeneic T-cell proliferation compared to healthy controls. CONCLUSIONS Our data demonstrate aberrant DC function in HD patients and suggest that this might contribute to impaired immune responses.
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Affiliation(s)
- Hye Min Choi
- Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea
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Kim HW, Yang HN, Kim MG, Choi HM, Jo SK, Cho WY, Kim HK. Microinflammation in hemodialysis patients is associated with increased CD14CD16(+) pro-inflammatory monocytes: possible modification by on-line hemodiafiltration. Blood Purif 2011; 31:281-8. [PMID: 21242682 DOI: 10.1159/000321889] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 10/05/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND An increased percentage of pro-inflammatory CD14(+)CD16(+) monocytes might contribute to inflammation in hemodialysis (HD) patients. The purpose of the study was to evaluate the possible contribution of pro-inflammatory monocytes to inflammation in HD patients and also to evaluate the effect of on-line hemodiafiltration (HDF). METHODS Flow cytometric detection of monocytes in patients undergoing HD, on-line HDF and healthy controls as well as plasma cytokines and cytokine mRNA measurement were performed. RESULTS Percent pro-inflammatory monocytes, plasma cytokines and cytokine mRNA significantly increased in HD patients. Intracellular cytokine staining showed pro-inflammatory monocytes were the predominant source of tumor necrosis factor-α. Percent pro-inflammatory monocytes positively correlated with plasma inflammatory cytokines. Percent pro-inflammatory monocytes, plasma cytokines and cytokine mRNA significantly decreased in on-line HDF patients. CONCLUSION Increased pro-inflammatory monocytes are likely to contribute to inflammation in HD patients, and beneficial effect of on-line HDF might be partially mediated by modulating the inflammatory response.
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Affiliation(s)
- Hye Won Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Medical College, Seoul, Korea
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Kim HW, Woo YS, Yang HN, Choi HM, Jo SK, Cho WY, Kim HK. Primed monocytes: putative culprits of chronic low-grade inflammation and impaired innate immune responses in patients on hemodialysis. Clin Exp Nephrol 2010; 15:258-63. [PMID: 21152946 DOI: 10.1007/s10157-010-0379-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 10/27/2010] [Indexed: 01/01/2023]
Abstract
BACKGROUND End-stage renal disease patients are known to be in a state of chronic low-grade inflammation and to have high infection-related morbidity and mortality. However, the precise mechanisms are not understood. The purpose of this study was to determine the mechanisms underlying chronic low-grade inflammation and defects in innate immune responses in hemodialysis (HD) patients. METHOD In 33 HD patients, we measured the basal status of toll-like receptor 4 (TLR4) positivity in the CD14-positive monocyte population in the peripheral blood (not strong, i.e., CD14(low)), with plasma levels of tumor necrosis factor (TNF)-α and interleukin (IL)-1β, IL-6, IL-8, IL-10, and IL-12p70 compared with 22 healthy controls. After stimulation by lipopolysaccharide (LPS), the plasma cytokine response was also compared. RESULTS In the basal state, the percentage of peripheral blood TLR4(+)CD14(low) monocytes and plasma cytokines were significantly higher in HD patients (p < 0.05), suggesting that preactivated primed monocytes might be responsible for the chronic inflammatory state in HD patients. However, upon LPS challenge, the fold increase in plasma cytokine response was significantly reduced in HD patients (p < 0.05) compared with controls. More importantly, the fold increase of these cytokines showed a positive correlation with plasma albumin (p < 0.05) and a negative correlation with C-reactive protein (CRP) (p < 0.05), suggesting the presence of a possible link between chronic low-grade inflammation and suboptimal innate immune response. CONCLUSION Chronic low-grade inflammation due to preactivated peripheral blood CD14(+) leukocyte subset might be a mechanism for impaired innate immune responses, thus resulting in the high rates of infection-related morbidity and mortality observed in HD patients.
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Affiliation(s)
- Hye Won Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Cho E, Cha I, Yoon K, Yang HN, Kim HW, Kim MG, Jo SK, Cho WY, Kim HK. Hemophagocytic syndrome in a patient with acute tubulointerstitial nephritis secondary to hepatitis A virus infection. J Korean Med Sci 2010; 25:1529-31. [PMID: 20890439 PMCID: PMC2946668 DOI: 10.3346/jkms.2010.25.10.1529] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 01/07/2010] [Indexed: 11/20/2022] Open
Abstract
Hepatitis A virus (HAV) infection is generally a self-limited disease, but the infection in adults can be serious, to be often complicated by acute kidney injury (AKI) and rarely by virus-associated hemophagocytic syndrome (VAHS). Our patient, a 48-yr-old man, was diagnosed with HAV infection complicated by dialysis-dependent AKI. His kidney biopsy showed acute tubulointerstitial nephritis with massive infiltration of activated macrophages and T cells, and he progressively demonstrated features of VAHS. With hemodialysis and steroid treatment, he was successfully recovered.
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Affiliation(s)
- Eunjung Cho
- Department of Internal Medicine, Korea University Medical College, Korea University Anam Hospital, Seoul, Korea
| | - Inhye Cha
- Department of Internal Medicine, Korea University Medical College, Korea University Anam Hospital, Seoul, Korea
| | - Kichul Yoon
- Department of Internal Medicine, Korea University Medical College, Korea University Anam Hospital, Seoul, Korea
| | - Ha Na Yang
- Department of Internal Medicine, Korea University Medical College, Korea University Anam Hospital, Seoul, Korea
| | - Hye Won Kim
- Department of Internal Medicine, Korea University Medical College, Korea University Anam Hospital, Seoul, Korea
| | - Myung-Gyu Kim
- Department of Internal Medicine, Korea University Medical College, Korea University Anam Hospital, Seoul, Korea
| | - Sang-Kyung Jo
- Department of Internal Medicine, Korea University Medical College, Korea University Anam Hospital, Seoul, Korea
| | - Won Yong Cho
- Department of Internal Medicine, Korea University Medical College, Korea University Anam Hospital, Seoul, Korea
| | - Hyoung Kyu Kim
- Department of Internal Medicine, Korea University Medical College, Korea University Anam Hospital, Seoul, Korea
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Kim SC, Kim HW, Oh SW, Yang HN, Kim MG, Jo SK, Cho WY, Kim HK. Low iPTH can predict vascular and coronary calcifications in patients undergoing peritoneal dialysis. Nephron Clin Pract 2010; 117:c113-9. [PMID: 20693812 DOI: 10.1159/000319658] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 04/28/2010] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is substantial evidence that low levels of serum intact parathyroid hormone (iPTH) are associated with vascular calcium deposition and subsequent increased cardiovascular risk in chronic kidney disease patients. The purpose of this study was to determine the relationship between the serum iPTH level, and vascular and coronary artery calcifications (VCs, CACs) and arterial stiffness in peritoneal dialysis (PD) patients. METHODS In this cross-sectional study, 93 PD patients were included. VCs, CACs and arterial stiffness were measured by simple X-rays of the hands and pelvis, multi-slice coronary CT and brachial-ankle pulse wave velocity (BaPWV). RESULTS Patients were divided into 3 groups according to iPTH levels. The prevalence of severe VCs (VC score ≥ 3) was highest in the low iPTH group (<150 pg/ml). In multivariate analysis, the presence of diabetes mellitus and a low iPTH were shown to be significant risk factors for severe VCs. In addition, a simple VC score of ≥ 1 was a significant variable for predicting severe CACs (CAC score ≥ 400). CONCLUSION Low iPTH and the presence of diabetes mellitus are thought to be independent risk factors for predicting VCs. VCs determined by simple X-ray can further predict the coexistence of CACs that ultimately might contribute to increased cardiovascular risk in PD patients.
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Affiliation(s)
- Sun Chul Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, College of Medicine, Seoul, Korea
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Cho WY, Choi HM, Lee SY, Kim MG, Kim HK, Jo SK. The role of Tregs and CD11c(+) macrophages/dendritic cells in ischemic preconditioning of the kidney. Kidney Int 2010; 78:981-92. [PMID: 20686446 DOI: 10.1038/ki.2010.266] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Dendritic cells have the potential to induce tolerance and here we attempted to identify their role in the tolerance seen in ischemic pre-conditioning. We induced bilateral renal ischemic preconditioning in mice and then challenged them with an ischemic insult 7 days later. Compared to sham-operated controls, preconditioned mice were found to have reduced injury with less inflammation, but had an increased number of regulatory T cells (Tregs) in their kidneys after the delayed insult. Splenocytes from these mice had more Tregs and mature CD11c(+) cells, but reduced proliferative and cytokine-secretory responses, suggesting a state of immunosuppression compared to control mice. Anti-CD25 depletion followed by adoptive transfer of Tregs partially mitigated and then restored the protective effect of preconditioning. Depletion of CD11c(+) cells with liposomes containing clodronate was associated with partial loss of preconditioning benefits. The increased numbers of Tregs or impaired immune response found in splenocytes from preconditioned mice were partially reversed in splenocytes from liposome clodronate-treated animals, suggesting that CD11c(+) cells contribute to immune cell-mediated ischemic preconditioning. Hence, our results show that ischemic preconditioning of the kidney provides a negative signal to the peripheral immune system, partially mediating the tissue-protective and anti-inflammatory effects of this maneuver.
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Affiliation(s)
- Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Yang HN, Boo CS, Kim MG, Jo SK, Cho WY, Kim HK. Urine neutrophil gelatinase-associated lipocalin: an independent predictor of adverse outcomes in acute kidney injury. Am J Nephrol 2010; 31:501-9. [PMID: 20453495 DOI: 10.1159/000309841] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Accepted: 03/30/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several recent studies have shown that neutrophil gelatinase-associated lipocalin (NGAL) may be a promising biomarker for the early detection of acute kidney injury (AKI), but the role of NGAL in predicting adverse clinical outcomes has not been well addressed. The purpose of this study was to evaluate the usefulness of urine NGAL as outcome predictor in patients with AKI. METHODS This was a prospective cohort study enrolling hospitalized AKI patients. Patients were divided into four groups according to initial urine NGAL excretion quartiles. The primary clinical outcome variables were in-hospital mortality and renal function at 4 weeks. RESULTS Initial urine NGAL was identified as an independent predictor of in-hospital mortality and persistent loss of renal function. In the analysis of predictive performance of urine NGAL, the AUC was 0.882 and a cutoff value of 298.28 ng/ml predicted loss of renal function with 88.2% sensitivity and 81.0% specificity. CONCLUSION This study could suggest that urine NGAL, a new early biomarker might also be served as a reliable clinical outcome predictor in AKI patients.
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Affiliation(s)
- Ha Na Yang
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Abstract
Cisplatin, a major anti-neoplastic drug, is known to be nephrotoxic and inflammation-inducing. A peroxisome proliferator-activated receptor gamma agonist, regulating lipid metabolism, has known to have anti-inflammatory effect, but the protection mechanisms in various kidney injuries are not fully understood. The purpose of this study was to examine the reno-protective effect of rosiglitazone on cisplatin nephrotoxicity in mice focusing on inflammation and apoptosis. Male BALB/c mice were pretreated with rosiglitazone (10 mg/kg) or vehicle through daily intraperitoneal injection for 3 days and then were given a single injection of cisplatin (20 mg/kg). Cisplatin induced a significant rise in blood urea nitrogen and creatinine levels, and tubular cell damage with marked tissue inflammation. Tissue cytokines and chemokines measured by a cytometric bead array showed increased TNF-alpha, IL-6, MCP-1, and IFN-gamma levels, while IL-10, an anti-inflammatory cytokine, was significantly decreased by cisplatin treatment. However, rosiglitazone pretreatment substantially reversed the depressed IL-10 level with simultaneous suppression of proinflammatory cytokines and chemokines. This tissue cytokine and chemokine milieu was associated with marked attenuation of kidney injury elicited by cisplatin. These findings suggest that the rosiglitazone-mediated renoprotective effect in cisplatin nephrotoxicity of mice is partially mediated by upregulation of anti-inflammatory IL-10 production.
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Affiliation(s)
- Myung-Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ha Na Yang
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hye-Won Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang-Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyoung-Kyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Ko GJ, Kim MG, Yu YM, Jo SK, Cho WY, Kim HK. Association between Depression Symptoms with Inflammation and Cardiovascular Risk Factors in Patients Undergoing Peritoneal Dialysis. ACTA ACUST UNITED AC 2010; 116:c29-35. [DOI: 10.1159/000314548] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 01/21/2010] [Indexed: 11/19/2022]
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Kim S, Lim CS, Han DC, Kim GS, Chin HJ, Kim SJ, Cho WY, Kim YH, Kim YS. The prevalence of chronic kidney disease (CKD) and the associated factors to CKD in urban Korea: a population-based cross-sectional epidemiologic study. J Korean Med Sci 2009; 24 Suppl:S11-21. [PMID: 19194539 PMCID: PMC2633200 DOI: 10.3346/jkms.2009.24.s1.s11] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Accepted: 01/12/2009] [Indexed: 12/02/2022] Open
Abstract
Chronic kidney disease (CKD) is a worldwide problem. This study was designed to survey the prevalence and risk factors for CKD in Korea. The 2,356 subjects were selected in proportion to age, gender, and city. Subjects 35 yr of age or older were selected from 7 cities. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) Study equation, with albuminuria defined as a urine albumin to creatinine ratio of 30 mg/g or more. The overall prevalence of CKD was 13.7%. The prevalences of CKD according to stage were 2.0% stage 1, 6.7% stage 2, 4.8% stage 3, 0.2% stage 4, and 0.0% stage 5. The prevalences of microalbuminuria and macroalbuminuria were 8.6% and 1.6%, respectively. The prevalence of eGFR less than 60 mL/min/1.73 m(2) was 5.0%. Age, body mass index (BMI), hypertension, diabetes mellitus, systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood glucose were independent factors related to the presence of CKD. In conclusions, Korea, in which the prevalence of CKD is increasing, should prepare a policy for early detection and appropriate treatment of CKD. The present data will be helpful in taking those actions.
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Affiliation(s)
- Suhnggwon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Chin HJ, Cho HJ, Lee TW, Na KY, Oh KH, Joo KW, Yoon HJ, Kim YS, Ahn C, Han JS, Kim S, Jeon ES, Jin DC, Kim YL, Park SH, Kim CD, Song YR, Kim SG, Kim YG, Lee JE, Oh YK, Lim CS, Lee SK, Chae DW, Cho WY, Kim HK, Jo SK. The mildly elevated serum bilirubin level is negatively associated with the incidence of end stage renal disease in patients with IgA nephropathy. J Korean Med Sci 2009; 24 Suppl:S22-9. [PMID: 19194557 PMCID: PMC2633177 DOI: 10.3346/jkms.2009.24.s1.s22] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 11/17/2008] [Indexed: 11/26/2022] Open
Abstract
Oxidative stress plays various roles in the development and progression of IgA nephropathy, while bilirubin is known as a potent antioxidant. We therefore hypothesized that serum bilirubin would be associated with renal prognosis in IgA nephropathy. The study subjects comprised 1,458 adult patients with primary IgA nephropathy in Korea. We grouped patients according to the following quartile levels of bilirubin: <0.4 mg/dL (Q1), 0.4-0.5 mg/dL (Q2), 0.6-0.7 mg/dL (Q3), and >0.8 mg/dL (Q4). The outcome data were obtained from the Korean Registry of end-stage renal disease (ESRD). Eighty patients (5.5%) contracted ESRD during a mean follow-up period of 44.9 months. The ESRD incidences were 10.7% in Q1, 8.2% in Q2, 2.8% in Q3, and 2.8% in Q4 (p<0.001). The relative risk of ESRD compared to that in Q1 was 0.307 (95% confidence interval [CI], 0.126-0.751) in Q3 and 0.315 (95% CI, 0.130-0.765) in Q4. The differences of ESRD incidence were greater in subgroups of males and of patients aged 35 yr or more, with serum albumin 4.0 g/dL or more, with normotension, with eGFR 60 mL/min/1.73 m(2) or more, and with proteinuria less then 3+ by dipstick test. In conclusion, higher bilirubin level was negatively associated with ESRD incidence in IgA nephropathy.
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Affiliation(s)
- Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jin Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Woo Lee
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kook Hwan Oh
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kwon Wook Joo
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung Jin Yoon
- Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Yon-Su Kim
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Curie Ahn
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Suk Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Suhnggwon Kim
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - En Sil Jeon
- Biotechnology Center, Pohang University of Science and Technology, Pohang, Korea
| | - Dong Chan Jin
- Department of Internal Medicine, Catholic University Medical College, Seoul, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Sun-Hee Park
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Young Rim Song
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Seong Gyun Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Yoon Goo Kim
- Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Jung Eun Lee
- Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Yoon Kyu Oh
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Korea
| | - Chun Soo Lim
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Korea
| | - Sang Koo Lee
- Department of Internal Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Won Yong Cho
- Department of Internal Medicine and the Institute of Renal Disease, Korea University College of Medicine, Seoul, Korea
| | - Hyoung Kyu Kim
- Department of Internal Medicine and the Institute of Renal Disease, Korea University College of Medicine, Seoul, Korea
| | - Sang-Kyung Jo
- Department of Internal Medicine and the Institute of Renal Disease, Korea University College of Medicine, Seoul, Korea
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Sung SA, Ko GJ, Jo SK, Cho WY, Kim HK, Lee SY. Interleukin-10 and tumor necrosis factor-alpha polymorphisms in vascular access failure in patients on hemodialysis: preliminary data in Korea. J Korean Med Sci 2008; 23:89-93. [PMID: 18303205 PMCID: PMC2526491 DOI: 10.3346/jkms.2008.23.1.89] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Neointimal hyperplasia causes vascular stenosis and subsequent thrombosis, which result in vascular access failure in patients undergoing hemodialysis. Interleukin-10 (IL-10) and tumour necrosis factor-alpha(TNF-alpha) are involved in this inflammatory process. The aim of this study was to investigate the relationship between vascular access failure and various inflammatory markers including the genetic polymorphisms of IL-10 and TNF-alpha. Seventy-five patients on hemodialysis with an arteriovenous fistula in place or an artificial graft (18 with vascular access failure and 82 without failure) and 98 healthy individuals were genotyped for IL-10 and TNF-alpha single nucleotide polymorphisms. Clinical and laboratory data including serum IL-10 and TNF-alpha levels were compared. Stimulated IL-10 levels, from in vitro incubation of blood with lipopolysaccharide, were also obtained and compared. Female gender, hypoproteinemia, and hypertriglyceridemia were associated with vascular access failure. The basal TNF-alpha level was significantly higher in patients with access failure. The distribution of IL-10 and TNF-alpha genotype did not differ among patients with or without access failure. This study could not demonstrate a relationship between genetic polymorphisms and vascular access failure. However, an altered immune response and inflammation might contribute to vascular access failure.
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Affiliation(s)
- Su Ah Sung
- Division of Nephrology, Eulji Hospital, Seoul, Korea
| | - Gang Jee Ko
- Department of Internal Medicine, Korea University Hospital, Seoul, Korea
| | - Sang Kyung Jo
- Department of Internal Medicine, Korea University Hospital, Seoul, Korea
| | - Won Yong Cho
- Department of Internal Medicine, Korea University Hospital, Seoul, Korea
| | - Hyoung Kyu Kim
- Department of Internal Medicine, Korea University Hospital, Seoul, Korea
| | - So Young Lee
- Division of Nephrology, Eulji Hospital, Seoul, Korea
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Ko GJ, Boo CS, Jo SK, Cho WY, Kim HK. Macrophages contribute to the development of renal fibrosis following ischaemia/reperfusion-induced acute kidney injury. Nephrol Dial Transplant 2007; 23:842-52. [PMID: 17984109 DOI: 10.1093/ndt/gfm694] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ischaemia/reperfusion is a major cause of acute kidney injury and can result in poor long-term graft function. Although most of the patients with acute kidney injury recover their renal function, significant portion of patients suffer from progressive deterioration of renal function. A persistent inflammatory response might be associated with long-term changes following acute ischaemia/reperfusion. Macrophages are known to infiltrate into tubulointersitium in animal models of chronic kidney disease. However, the role of macrophages in long-term changes after ischaemia/reperfusion remains unknown. We aimed to investigate the role of macrophages on the development of tubulointerstitial fibrosis and functional impairment following acute ischaemia/reperfusion injury by depleting macrophages with liposome clodronate. METHODS Male Sprague-Dawley rats underwent right nephrectomy and clamping of left renal vascular pedicle or sham operation. Liposome clodronate or phosphate buffered saline was administered for 8 weeks. Biochemical and histological renal damage and gene expression of various cytokines were assessed at 4 and 8 weeks after ischaemia/reperfusion. RESULTS Ischaemic/reperfusion injury resulted in persistent inflammation and tubulointerstital fibrosis with decreased creatinine clearance and increased urinary albumin excretion at 4 and 8 weeks. Macrophage depletion attenuated those changes. This beneficial effect was accompanied with a decrease in gene expression of inflammatory and profibrotic cytokines. CONCLUSIONS These results suggest that macrophages play an important role in mediating persistent inflammation and fibrosis after ischaemia/reperfusion leading to a development of chronic kidney disease. Strategies targeting macrophage infiltration or activation can be useful in the prevention of development of chronic kidney disease following ischaemic injury.
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Affiliation(s)
- Gang Jee Ko
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
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Sung SA, Jo SK, Cho WY, Won NH, Kim HK. Reduction of renal fibrosis as a result of liposome encapsulated clodronate induced macrophage depletion after unilateral ureteral obstruction in rats. Nephron Clin Pract 2006; 105:e1-9. [PMID: 17106213 DOI: 10.1159/000096859] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Accepted: 06/12/2006] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/AIM Macrophages have been thought to play a role in renal tubulointerstitial fibrosis; recent reports have demonstrated an antifibrotic effect of macrophages in late-stage renal fibrosis. Liposome-encapsulated clodronate (LC) produces a selective and systemic depletion of phagocytic macrophages in vivo. To study the role of initial infiltrating macrophages in renal fibrosis, we compared the effects of pretreatment with LC and a liposome vehicle for control of the severity of renal fibrosis in a unilateral ureteral obstruction (UUO) rat model. METHODS One day after a single intravenous injection of LC or liposome vehicle, the rats underwent UUO. Following 1, 5, and 14 days, the kidneys were examined to evaluate macrophage infiltration and renal fibrosis. RESULTS LC depleted macrophages systemically and reduced renal fibrosis associated with UUO; this beneficial effect was accompanied by a decrease of transforming growth factor beta mRNA expression. The osteopontin expression was also reduced by pretreatment with LC. CONCLUSION Initial interstitial infiltration of macrophages contributes to tubulointerstitial fibrosis in UUO.
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Affiliation(s)
- Su Ah Sung
- Division of Nephrology, Eulji Hospital, Seoul, Korea
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Jo SK, Ko GJ, Boo CS, Cho WY, Kim HK. Heat preconditioning attenuates renal injury in ischemic ARF in rats: role of heat-shock protein 70 on NF-kappaB-mediated inflammation and on tubular cell injury. J Am Soc Nephrol 2006; 17:3082-92. [PMID: 17021270 DOI: 10.1681/asn.2005101077] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Although heat preconditioning has been known to be protective in various types of injury, the precise molecular mechanism for this is unclear. Recent observations that indicate that previous heat shock has an anti-inflammatory, antiapoptotic effect led to this investigation of the in vivo effect of heat preconditioning on NF-kappaB activation and inflammation and also on tubular cell injury in ischemic acute renal failure (ARF). Heat preconditioning provided marked functional protection and also reduced histologic evidence of tubular necrosis. Ischemia/reperfusion-induced NF-kappaB activation was suppressed by heat preconditioning with a subsequent decrease in monocyte chemoattractant protein-1 expression and inflammatory cell infiltration. Heat preconditioning also suppressed the accumulation of phosphorylated inhibitory kappaBalpha (IkappaBalpha) with a resultant depletion of cytoplasmic IkappaBalpha, indicating that heat preconditioning blocked the activation of the IkappaB kinase complex. Tubular cell apoptosis, determined by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling staining, also was decreased by heat preconditioning, and this was accompanied by decreased caspase 3 activation. Among several heat-shock proteins (HSP), HSP-70 was induced primarily by heat preconditioning. Inhibition of HSP-70 by quercetin almost completely reversed the functional protection that was provided by heat preconditioning. These data provide evidence that HSP-70 affords protection via inhibition of NF-kappaB-mediated inflammation and also inhibition of the cell death pathway in ischemic ARF. Further elucidation of the cytoprotective mechanism of stress proteins could facilitate new target or drug development in the treatment of ARF.
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Affiliation(s)
- Sang-Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Institute of Renal Disease, Korea University Hospital, Seoul, Korea
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Abstract
Heat stroke is a potentially fatal disorder that's caused by an extreme elevation in body temperature. We report here an unusual case of multiple organ failure that was caused by classical, nonexertional heat stroke due to taking a warm bath at home. A 68 year old diabetic man was hospitalized for loss of consciousness. He was presumed to have been in a warm bath for 3 hrs and his body temperature was 41degrees C. Despite cooling and supportive care, he developed acute renal failure, disseminated intravascular coagulation (DIC) and fulminant liver failure. Continuous venovenous hemofiltration was started on day 3 because of the progressive oligouria and severe metabolic acidosis. On day 15, septic ascites was developed and Acinetobacter baumanii and Enterococcus faecium were isolated on the blood cultures. In spite of the best supportive care, the hepatic failure and DIC combined with septic peritonitis progressed; the patient succumbed on day 25.
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Affiliation(s)
- Seung Young Kim
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Su Ah Sung
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Gang Jee Ko
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chang Su Boo
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sang Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyoung Kyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Kim SH, Song KI, Chang JW, Kim SB, Sung SA, Jo SK, Cho WY, Kim HK. Prevention of uncuffed hemodialysis catheter-related bacteremia using an antibiotic lock technique: A prospective, randomized clinical trial. Kidney Int 2006; 69:161-4. [PMID: 16374438 DOI: 10.1038/sj.ki.5000012] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As a result of the high rate of infection, the NKF-K/DOQI guidelines recommended that an uncuffed catheter (UC) should not be used for longer than three weeks. However, the findings of the Dialysis Outcomes and Practice Patterns Study recognized that 48% of new hemodialysis patients in the US and 75% in Europe used UC for temporary access during arteriovenous fistula or graft maturation. The antibiotic lock technique (ALT) has been recommended to prevent catheter-related bacteremia (CRB). Here, we prospectively evaluated the efficacy of catheter-restricted filling using an antibiotic lock solution in preventing CRB. A total of 120 new hemodialysis patients requiring a temporary catheter while waiting for placement and maturation of an arteriovenous fistula or graft were enrolled in this study. Patients with a UC were randomly assigned to receive either an antibiotic-heparin lock solution (antibiotic group: cefazolin 10 mg/ml, gentamicin 5 mg/ml, heparin 1000 U/ml) or a heparin lock solution (no-antibiotic group: heparin 1000 U/ml) as a catheter lock solution during the interdialytic period. The end point of the trial was CRB. CRB developed in seven (11.7%) patients in the no-antibiotic group (Staphylococcus aureus, two; Staphylococcus epidermidis, five) whereas only one patient in the antibiotic group had S. aureus bacteremia. CRB rates per 1000 catheter-days were 0.44 in the antibiotic group versus 3.12 in the no-antibiotic group (P=0.031). Kaplan-Meier analysis also showed that mean CRB-free catheter survival of 59 days (95% CI, 58-61 days) in the antibiotic group was greater than that in the no-antibiotic group (55 days; 95% CI, 50-59 days). The results suggest that ALT may be a beneficial means of reducing the CRB rate in hemodialysis patients with UC.
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Affiliation(s)
- S H Kim
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
BACKGROUND Although inflammation and apoptosis are known to play important roles in cisplatin nephrotoxicity, the exact intracellular signaling mechanisms are not well understood. Recent reports that extracellular signal-regulated kinase (ERK1/2) pathway mediates cisplatin-induced caspase activation and apoptosis in cultured renal tubular cells led us to investigate the effect of MAPK/ERK kinase (MEK) inhibitor, an immediate upstream of ERK1/2 in cisplatin-induced acute renal failure (ARF) in mice. METHODS The effect of MEK/ERK1/2 inhibition on kidney tumor necrosis factor-alpha (TNF-alpha (gene expression, inflammation, the activation of tissue caspases, and apoptosis were examined in addition to its effects on renal function and histology in cisplatin-induced ARF in mice. RESULTS Pretreatment of MEK inhibitor, U0126, decreased ERK1/2 phosphorylation following cisplatin administration with significant functional and histologic protection. This beneficial effect was accompanied by decrease in TNF-alpha gene expression level and inflammation, as well as in caspase 3 activity and apoptosis. CONCLUSION These data provide evidence that ERK1/2 pathway functions as an upstream signal for TNF-alpha-mediated inflammation and caspase 3-mediated apoptosis in cisplatin-induced ARF in mice and suggest that ERK1/2 can be a novel therapeutic target in cisplatin nephrotoxicity.
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Affiliation(s)
- Sang-Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University, Seoul, Korea
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