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ABSTRACT: Spontaneous perinephric hemorrhage is a clinically rare life-threatening condition, also known as Wünderlich syndrome. Presentations can be variable, but patients typically display symptoms and signs including flank or abdominal pain, abdominal mass, and hypovolemia. It is important to diagnose the syndrome early because untreated cases carry a high mortality risk, and prompt intervention with an endovascular procedure or surgery is life saving. Causes range from anatomical anomalies, including vascular diseases (vasculitides and aneurysms) and renal tumors, to functional coagulation defect (bleeding tendency). The most common causes of Wünderlich syndrome are renal angiomyolipoma and renal cell carcinoma, constituting 60%∼70% of cases. Vascular causes of Wünderlich syndrome are infrequent, and the culprit most frequently is vasculitis resulting from polyarteritis nodosa. Other vasculitides presenting as Wünderlich syndrome are infrequent. We describe a 39-year-old woman with end-stage renal disease from lupus nephritis and spontaneous renal hemorrhage, ascribed to lupus-related vasculitis after serologic testing, computed tomography, and angiographic studies.
American Journal of Kidney Diseases 09/2012; · 5.43 Impact Factor
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Chia-Ter Chao,
Vin-Cent Wu,
Chun-Fu Lai,
Chih-Chung Shiao,
Tao-Min Huang,
Pei-Chen Wu,
I-Jung Tsai,
Chun-Cheng Hou, Wei-Jie Wang,
Hung-Bin Tsai,
Yu-Feng Lin,
Wen-Chih Chiang,
Shuei-Liong Lin,
Pi-Ru Tsai,
Wen-Je Ko,
Ming-Shiou Wu,
Kuan-Dun Wu
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ABSTRACT: The RIFLE (risk, injury, failure, loss, and end-stage) classification is widely used to gauge the severity of acute kidney injury, but its efficacy has not been formally tested in geriatric patients. To correct this we conducted a prospective observational study in a multicenter cohort of 3931 elderly patients (65 years of age or older) who developed acute kidney injury in accordance with the RIFLE creatinine criteria after major surgery. We studied the predictive power of the RIFLE classification for in-hospital mortality and investigated the potential interaction between age and RIFLE classification. In general, the survivors were significantly younger than the nonsurvivors and more likely to have hypertension. In patients 76 years of age and younger, RIFLE-R, -I, or -F classifications were significantly associated with increased hospital mortality in a stepwise manner. There was no significant difference, however, in hospital mortality in those over 76 years of age between patients with RIFLE-R and RIFLE-I, although RIFLE-F patients had significantly higher mortality than both groups. Thus, the less severe categorizations of acute kidney injury per RIFLE classification may not truly reflect the adverse impact on elderly patients.
Kidney International 07/2012; 82(8):920-7. · 6.61 Impact Factor
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ABSTRACT: To compare prediction power between ICNARC model and RIFLE classification in postoperative patients receiving acute dialysis.
Between January 2002 and December 2008, 529 patients received acute dialysis during their ICU stay were enrolled. Patients' demographic, clinical and laboratory variables were analyzed as predictors of mortality. The RIFLE logistic regression and the ICNARC model on ICU admission were evaluated to predict the patient's hospital mortality.
Hospital mortality for the study group was 29.3%. Between two score systems, the ICNARC model showed better mortality prediction in this patient group by using the area under the receiver operating characteristic curve (ICNARC 0.836, RIFLE 0.702, p < 0.05). Multiple logistic regression analysis indicated that age, surgery category, metastatic carcinoma, ventilator use, and previous history of hypertension were also affecting factors for hospital mortality.
The RIFLE classification and the ICNARC model were both correlated with mortality in critically ill patient with acute dialysis. However, the ICNARC model was a better mortality predictor compared to the RIFLE classification.
Clinical nephrology 05/2012; 77(5):392-9. · 1.17 Impact Factor
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Journal of the Formosan Medical Association 01/2012; 111(1):51-2. · 1.13 Impact Factor
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ABSTRACT: Patients with end-stage renal disease (ESRD) are at particular risk for methicillin-resistant Staphylococcus aureus (MRSA) infections, especially via nasal colonization of MRSA. Surveillance cultures are recommended to identify patients colonized by MRSA.
Clinical data and screening cultures of S. aureus from the anterior nares of 541 patients on long-term dialysis in the hospitals were performed in March 2007. The follow-up survey was conducted 1 year later.
A total of 32 (5.9%) of the 541 patients were positive nasal cultures for MRSA, while 89 (16.5%) were positive for methicillin-susceptible S. aureus (MSSA). In a multivariate analysis, risk factors for ESRD patients with MRSA colonization included congestive heart failure, nursing home admission, and nasogastric tube feeding in the last 3 months. Follow-up of the 32 MRSA colonized patients showed that one (3.1%) died due to MSSA and three (9.3%) died due from MRSA infection.
We found that patients with ESRD and MRSA nasal colonization were associated with a history of congestive heart failure, nursing home admission, and nasogastric tube feeding in the last 3 months.
Journal of the Formosan Medical Association 01/2012; 111(1):14-8. · 1.13 Impact Factor
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Vin-Cent Wu,
Tao-Min Huang,
Pei-Chen Wu, Wei-Jie Wang,
Chia-Ter Chao,
Shao-Yu Yang,
Chih-Chung Shiao,
Fu-Chang Hu,
Chun-Fu Lai,
Yu-Feng Lin,
Yin-Yi Han,
Yih-Sharng Chen,
Ron-Bin Hsu,
Guang-Huar Young,
Shoei-Shen Wang,
Pi-Ru Tsai,
Yung-Ming Chen,
Ting-Ting Chao,
Wen-Je Ko,
Kwan-Dun Wu
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ABSTRACT: Preoperative proteinuria is associated with post-operative acute kidney injury (AKI), but whether it is also associated with increased long-term mortality and end-stage renal disease (ESRD) is unknown.
We studied 925 consecutive patients undergoing CABG. Demographic and clinical data were collected prospectively, and patients were followed for a median of 4.71 years after surgery. Proteinuria, according to dipstick tests, was defined as mild (trace to 1+) or heavy (2+ to 4+) according to the results of the dipstick test. A total of 276 (29.8%) patients had mild proteinuria before surgery and 119 (12.9%) patients had heavy proteinuria. During the follow-up, the Cox proportional hazards model demonstrated that heavy proteinuria (hazard ratio [HR], 27.17) was an independent predictor of long-term ESRD. There was a progressive increased risk for mild proteinuria ([HR], 1.88) and heavy proteinuria ([HR], 2.28) to predict all-cause mortality compared to no proteinuria. Mild ([HR], 2.57) and heavy proteinuria ([HR], 2.70) exhibited a stepwise increased ratio compared to patients without proteinuria for long-term composite catastrophic outcomes (mortality and ESRD), which were independent of the baseline GFR and postoperative acute kidney injury (AKI).
Our study demonstrated that proteinuria is a powerful independent risk factor of long-term all-cause mortality and ESRD after CABG in addition to preoperative GFR and postoperative AKI. Our study demonstrated that proteinuria should be integrated into clinical risk prediction models for long-term outcomes after CABG. These results provide a high priority for future renal protective strategies and methods for post-operative CABG patients.
PLoS ONE 01/2012; 7(1):e27687. · 4.09 Impact Factor
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Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases 08/2011; 17(5):286-7. · 1.19 Impact Factor
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Yen-Hung Lin,
Shuo-Meng Wang,
Vin-Cent Wu,
Jen-Kuang Lee,
Chin-Chi Kuo,
Ruoh-Fang Yen,
Kao-Lang Liu,
Kuo-How Huang,
Shih-Chieh Chueh, Wei-Jie Wang,
Lian-Yu Lin,
Kuo-Long Chien,
Yi-Lwun Ho,
Ming-Fong Chen,
Kwan-Dun Wu
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ABSTRACT: Primary aldosteronism (PA) is associated a worse cardiovascular outcome than essential hypertension. Hypokalemia, which is one major characteristic of PA, can affect both cardiac structure and function. The goal of this study is to evaluate the influence of serum potassium level on left ventricular (LV) mass and function in PA patients.
We prospectively analysed 85 PA patients from October 2006 to September 2008 and 27 essential hypertension patients as the control group (group 1). Thirty-two patients with serum potassium < 3·5 mmol L(-1) were defined as hypokalemia (group 2), and 53 patients with serum potassium ≥ 3·5 mmol L(-1) were defined as normokalemia (group 3). Echocardiography including tissue Doppler image (TDI) recordings was performed in all patients.
Group 2 patients had significant higher systolic and diastolic blood pressure (DBP), log-transformed plasma aldosterone concentration, log-transformed aldosterone-to-renin ratio and lower serum potassium level than groups 1 and 3. In echocardiographic measurement, group 2 patients had higher LV mass index (LVMI) than groups 1 and 3. In multivariate analysis for factors affecting LVMI in PA patients, only serum potassium level (P = 0·001), use of spironolactone (P = 0·004) and DBP (P = 0·005) were independent factors. In the TDI study, both groups 2 and 3 had lower e' and E/e' values than group 1.
Serum potassium level is significantly associated with LVMI in PA patients. Compared with essential hypertensive patients, PA patients had a greater impairment of cardiac diastolic function.
European Journal of Clinical Investigation 01/2011; 41(7):743-50. · 3.02 Impact Factor
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American journal of infection control 08/2010; 38(6):499-500. · 3.01 Impact Factor
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ABSTRACT: The ratio of aldosterone-to-renin activity is currently recommended as a screening test for primary aldosteronism (PA). There are many factors interfering the interpretation of aldosterone-renin ratio (ARR) and could hamper in-time diagnosis of PA. Here, we first report a patient with underlying Page phenomenon and an accidentally disclosed adrenal incidentaloma. High renin secretion from Page phenomenon had masked higher ARR into normal ARR obscuring the diagnosis of PA. However, adrenal venous sampling (AVS) confirmed the autonomous aldosterone secretion with left adrenal vein plasma aldosterone concentration (PAC) 124.1 ng/dl and a lateralization ratio 3.3. AVS may discriminate masked PA due to high renin secretion from Page kidney. It is suggested that clinicians should cautiously interpret aldosterone-renin ratio and consider diagnostic AVS if hyperaldosteronism is highly suspected especially in the background of other secondary hypertension.
Endocrine 08/2010; 38(1):6-10. · 1.42 Impact Factor
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ABSTRACT: Perfluorinated chemicals (PFCs) have been largely used for years in a variety of products worldwide. However, the toxic effect of PFCs on exposure to the liver in the general population has not yet been determined.
In this study, 2,216 adults (18 years of age or older) were recruited in a National Health and Nutrition Examination Survey (NHANES) in 1999-2000 and 2003-2004 to determine the relationship between serum level of PFCs and the levels of liver enzymes. The data were adjusted for all other confounding variants.
After performing mathematical analysis, we determined when serum log-perfluorooctanoic acid (PFOA) increases in one unit, the serum alanine aminotransferase (ALT) concentration (U/l) increases by 1.86 units (95% confidence interval (CI), 1.24-2.48; P=0.005), and the serum log-gamma-glutamyltransferase (GGT) concentration (U/l) is 0.08 unit higher (95% CI, 0.05-0.11; P=0.019). The association between PFOA and liver enzymes was more evident in obese subjects, as well as subjects with insulin resistance and/or metabolic syndromes. When dividing the serum PFOA into quartiles in the fully adjusted models in subjects with a body mass index>or=30 kg/m2, the ALT level trend across the serum PFOA quartiles was significant (P=0.003).
On the basis of these data, we conclude that a higher serum concentration of PFOA may cause liver enzymes to increase abnormally in the general population, particularly in obese individuals. Further studies are warranted to clarify the casual relationship between PFCs and these liver enzymes.
The American Journal of Gastroenterology 12/2009; 105(6):1354-63. · 7.28 Impact Factor
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Yu-Feng Lin,
Vin-Cent Wu,
Wen-Je Ko,
Yih-Sharng Chen,
Yung-Ming Chen,
Wen-Yi Li,
Nai-Kuan Chou,
Anne Chao,
Tao-Min Huang,
Fan-Chi Chang,
Shih-I Chen,
Chih-Chung Shiao, Wei-Jie Wang,
Hung-Bin Tsai,
Pi-Ru Tsai,
Fu-Chang Hu,
Kwan-Dun Wu
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ABSTRACT: The relationship between residual urine output and postoperative survival in maintenance hemodialysis patients is unknown.
To explore the relationship between amount of urine before surgery and postoperative mortality and differences between postoperative nonanuria and anuria in maintenance hemodialysis patients.
A total of 109 maintenance hemodialysis patients underwent major operations. Anuria was defined as urine output <30 mL in the 8 hours before the first session of postoperative dialysis. Propensity scores for postoperative anuria were developed.
Postoperative residual urine output was 159.2 mL/8 h (SD, 115.1) in 33 patients; 76 patients were anuric. Preoperative residual urine output and adequate perioperative blood transfusion were positively related to postoperative urine output. Propensity-adjusted 30-day mortality was associated with postoperative anuria (odds ratio [OR], 4.56; 95% confidence interval [CI], 1.16-17.96; P = .03), prior stroke (OR, 4.46; 95% CI, 1.43-13.89; P = .01) and higher disease severity (OR, 1.10; 95% CI, 1.00-1.21; P = .049) at the first postoperative dialysis. OR of 30-day mortality was 5.38 for nonanuria to anuria vs nonanuria to nonanuria (P = .03) and 5.13 for preoperative anuria vs nonanuria to nonanuria (P = .01). By Kaplan-Meier analysis, 30-day mortality differed significantly among patients for nonanuria to nonanuria, anuria, and nonanuria to anuria (log rank, P = .045).
Patients with preoperative nonanuria and postoperative anuria had higher mortality than did patients with no anuria before and after surgery and patients with anuria before surgery. Postoperative residual urine output is an important surrogate marker for disease severity.
American Journal of Critical Care 09/2009; 18(5):446-55. · 1.66 Impact Factor
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European Journal of Clinical Investigation 06/2009; 39(8):738-9. · 3.02 Impact Factor
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Vin-Cent Wu,
Chih-Hsien Wang, Wei-Jie Wang,
Yu-Feng Lin,
Fu-Chang Hu,
Yung-Wei Chen,
Yih-Sharng Chen,
Ming-Shiou Wu,
Yen-Hung Lin,
Chin-Chi Kuo,
Tao-Min Huang,
Yung-Ming Chen,
Pi-Ru Tsai,
Wen-Je Ko,
Kwan-Dun Wu
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ABSTRACT: In postsurgical acute renal failure patients with moderate unstable hemodynamics or fluid overload, the choice of dialysis modality is difficult. This study was performed to compare the outcomes between the sustained low-efficiency dialysis (SLED) and continuous veno-venous hemofiltration (CVVH) in these patients.
Sequential postsurgical acute renal failure patients undergoing acute dialysis with CVVH (2002-2003), or SLED (2004-2005) as a result of severe fluid overload or moderately unstable hemodynamics were analyzed. Multivariate analyses of comorbidity, disease severity before initiating dialysis, biochemical measurements, and hemodynamic parameters for 3 days after the first dialysis session were performed by fitting multiple logistic regression models to predict patient's 30-day after hospital discharge (AHD) mortality.
Among the 101 recruited patients, 38 received SLED and the rest received CVVH. The 30-day AHD mortality was 62.4%. The independent risk factors of 30-day AHD mortality included older age (P = .008), lower first postdialysis mean arterial pressure (MAP) (P = .021), higher first postdialysis blood urea nitrogen level (P = .009), and absence of a history of hypertension (P = .002). A further linear regression analysis found that dialysis using SLED was associated with higher first postdialysis MAP (P = .003).
Among the postsurgical patients requiring acute dialysis with severe fluid overload or moderately unstable hemodynamics, the patients treated with SLED had a higher first postdialysis MAP than those treated with CVVH, which led to lower mortality. Further multicenter randomized clinical trials of larger sample size are needed to compare the effects of SLED and CVVH on the outcomes of postsurgical acute dialysis patients.
American journal of surgery 05/2009; 199(4):466-76. · 2.36 Impact Factor
