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Hemodialysis International 05/2012; · 1.54 Impact Factor
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Archives of Iranian medicine 01/2012; 15(1):63-4. · 0.97 Impact Factor
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Chin-Chi Kuo,
Vin-Cent Wu, Ching-Wei Tsai,
Kuo-How Huang,
So-Mong Wang,
Bai-Chin Li,
Chin-Chen Chang,
Ching-Chu Lu,
Wei-Shun Yang,
Chia-Ter Chao, [......],
Yen-Hung Lin,
Chien-Yu Lin,
Hung-Wei Chang,
Wei-Jei Wang,
Wen-Chih Chiang,
Tze-Wah Kao,
Shih-Chieh Chueh,
Tzong-Shinn Chu,
Tun-Jun Tsai,
Kwan-Dun Wu
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ABSTRACT: Though aldosterone-renin ratio (ARR) is the current routine screening method for suspicious primary aldosteronism, we hypothesized that the simple formula combining body mass index (BMI) and serum potassium to urine potassium clearance (PUKC) ratio was comparable to ARR.
Records of patients who were referred to the National Taiwan University Hospital for investigation of primary aldosteronism from January 1995 through December 2007 were retrieved. Primary aldosteronism was diagnosed based on the modified 4-corners criteria, otherwise essential hypertension was diagnosed. In both groups, the PUKC/BMI ratio was determined as well as the ARR. Bland-Altman and mountain-plot analysis were used to validate the agreement between ARR and PUKC/BMI. Receiver operating characteristic (ROC) curves were used to compare the sensitivity and specificity of PUKC/BMI and ARR.
The records for urinary potassium were analyzed for 177 hypertensive patients (134 patients with primary aldosteronism). ROC curves showed comparable areas under the curves of both methods (95% CI: -0.029 to 0.183; p=0.186). Bland-Altman analysis further supported the agreement between ARR and PUKC/BMI ratio.
We found that the screening power of PUKC/BMI was as good as that of conventional ARR. With the quick and extensive availability of the PUKC/BMI method and its equivalence to ARR, this screening strategy would be a good first-line tool for massive community-based primary aldosteronism surveys.
Clinica chimica acta; international journal of clinical chemistry 08/2011; 412(17-18):1637-42. · 2.54 Impact Factor
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Chin-Chi Kuo,
Ching-Fang Wu,
Chun-Chieh Huang,
Yuan-Ju Lee,
Wei-Chou Lin, Ching-Wei Tsai,
Vin-Cent Wu,
Yung-Ming Chen,
Ming-Shiou Wu,
Tzong-Shinn Chu,
Kwan-Dun Wu
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ABSTRACT: Xanthogranulomatous pyelonephritis (XGP) is a chronic inflammatory condition of the kidneys. Nevertheless, disparities between the pre-operative and pathological diagnoses are frequently encountered. We reviewed all patients with XGP over a 17-year period to identify and characterize the pre-operative and pathological characteristics of the disease in our patients.
A comprehensive review of all nephrectomy patients with a pre-operative diagnosis of pyelonephritis at National Taiwan University Hospital from 1991 to 2008 with the pathological diagnosis of XGP was conducted to demonstrate the clinical and radiological characteristics of XGP.
XGP was diagnosed in 30 (18.6%) of the 160 nephrectomies performed for pyelonephritis. Of the 30 patients with XGP, 25 were women (83.3%) and 20 (66.7%) were overweight (body mass index >23). Their mean age was 55.17 years. The average serum creatinine level was 1.68 mg/dL. The image findings included renal calculi (56.7%), staghorn stones (26.7%), and spread of the disease to the retroperitoneum and psoas muscle (33.3%). Escherichia coli (36.7%) was the most prevalent pathogen. The mortality of the two-stage surgical treatment was zero, and morbidity developed in only 1 patient (4.8%).
The key to accurate pre-operative diagnosis is to keep risk factors in mind such as age, sex, and renal calculi. Clinicians should maintain a high suspicion of XGP for early recognition and be aware of the care of chronic kidney disease. Finally, the association between XGP and central obesity warrants further research.
International Urology and Nephrology 03/2011; 43(1):15-22. · 1.47 Impact Factor
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Chin-Chi Kuo,
Vin-Cent Wu,
Kuo-How Huang,
So-Mong Wang,
Chin-Chen Chang,
Ching-Chu Lu,
Wei-Shun Yang, Ching-Wei Tsai,
Chun-Fu Lai,
Tzong-Yann Lee, [......],
Ming-Shou Wu,
Yen-Hung Lin,
Tzong-Shinn Chu,
Chien-Yu Lin,
Hung-Wei Chang,
Wei-Jei Wang,
Tze-Wah Kao,
Shih-Chieh Chueh,
Kwan-Dun Wu,
Taipai Study Group
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ABSTRACT: Current data on primary aldosteronism (PA) from Asian populations are scarce. This cohort study clarifies the attributes of patients with PA in a typical Chinese population.
An observational cohort study.
The records of patients referred to the Hypertension Clinic from a multi-centre registration in Taiwan from January 1995 to December 2007 were reviewed. All patients with PA were classified into two subtypes: aldosterone-producing adenomas (APA) and idiopathic hyperaldosteronism (IHA); their characteristics were compared.
Our cohort consisted of 346 patients with PA, 255 with APA and 91 with IHA. The initial hypokalaemia (59% in APA vs. 27.5% in IHA, p < 0.0001) and transtubular potassium gradient (TTKG) (6.30 ± 2.41 in APA vs. 4.91 ± 2.03 in IHA, p = 0.01) were higher in the APA group. Baseline plasma aldosterone concentration (PAC) was also significantly different between the two subgroups (49.96 ± 38.15 ng/dl in APA vs. 34.24 ± 21.47 in IHA, p < 0.0001).
In typical Chinese PA patients, the APA subgroup had a higher proportion of hypokalaemia with elevated TTKG and higher PAC as compared with the IHA subgroup. This largest Asian database also demonstrated major differences between the Caucasian and Chinese populations including female predilection, frequent hypokalaemia, and common paralytic myopathy.
Journal of Renin-Angiotensin-Aldosterone System 03/2011; 12(3):348-57. · 2.44 Impact Factor
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ABSTRACT: Since the phenomenon of hyperfiltration in primary aldosteronism (PA) was first noted in 1996, subsequent clinical studies have produced conflicting results. To determine the development of relative hyperfiltration in PA, we performed a meta-analysis.
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched through to July 2009. Reference sections of original articles, meta-analyses, and reviews on hyperfiltration in PA were reviewed. Hypertensive patients provided the controlled data for hyperfiltration. Two authors independently extracted the data.
A total of seven studies were included. One study was from the data of the TAIPAI group. Overall, there was strong evidence that relative kidney hyperfiltration existed in PA (fixed-effects model: standardised mean difference (SMD), 0.13; 95% confidence interval (CI), 0.03-0.22, p = 0.007; random-effects model: SMD, 0.35; 95% CI, -0.01-0.71, p = 0.05), though with a significant heterogeneity (p < 0.0001). In the secondary meta-analysis with five top-quality studies, the relative kidney hyperfiltration was more significant. Mean age in each enrolled study was the only factor significantly associated with the existence of heterogeneity among the selected studies in the meta-regression analysis.
Current evidence suggests that relative kidney hyperfiltration is the hallmark in PA and the phenomenon is beyond the effect of hypertension of PA. Clinicians should be aware of the possibility of occult renal damage in patients with PA.
Journal of Renin-Angiotensin-Aldosterone System 03/2011; 12(2):113-22. · 2.44 Impact Factor
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ABSTRACT: Renal vascular resistance [resistive index (RI)] has been associated with albuminuria in patients with type 2 diabetes. We studied the correlations between renal artery RI and urinary albumin excretion in adolescents and young adults.
From May 2006 through September 2008, we established a cohort of adolescents and young adults based on previous history of elevated blood pressure (EBP) or normal blood pressure in childhood. This cohort was selected from the 1992-2000 nationwide mass urine screening of school children aged 6-18 years in Taiwan. From October through December 2008, we called back these adolescents and young adults living in Taipei to participate in a renal vascular stiffness study. Linear mixed regression models were applied to study the correlation between renal artery RI and urinary albumin excretion after controlling for cardiovascular (CV) risk factors.
Of the 147 subjects enrolled in this study, 67 had macroalbuminuria, 36 had microalbuminuria and 44 had normoalbuminuria. Except for high-density lipoprotein cholesterol, most CV risk factors did not differ significantly among these three groups. Mean RI were similar for the three groups. Neither log (urinary albumin concentration) nor log (urinary albumin:creatinine ratio) correlated with RI. Step-wise linear mixed regression models showed that RI was significantly associated only with male gender and diastolic blood pressure, but not with urinary albumin excretion or EBP in childhood.
Renal artery RI is not associated with urinary albumin excretion in nondiabetic adolescents and young adults.
Nephrology Dialysis Transplantation 03/2011; 26(12):3943-9. · 3.40 Impact Factor
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Canadian Medical Association Journal 11/2010; 182(17):E800. · 8.22 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: The clinical spectrum of infections caused by non-typhoid Salmonella spp. includes gastroenteritis, enteric fever, bacteremia, and extraintestinal localized complications, especially in immunocompromised hosts. Here we report a patient with severe aplastic anemia developing left iliopsoas abscess caused by non-typhoid Salmonella (NTS), which was successfully treated by prolonged antibiotic treatment and repeated debridement. Our data indicate that aplastic anemia is a risk factor for infection caused by NTS.
Yonsei medical journal 05/2010; 51(3):472-4. · 0.77 Impact Factor
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ABSTRACT: A 63-year-old man with a history of end-stage renal dis-ease, who had been receiving haemodialysis for 2 years, was diagnosed with paroxysmal nocturnal haemoglobinur-ia at age 40, with presentation of intravascular haemolysis and haemoglobinuria. His baseline haemoglobin was around 6.0 g/dl, and he received a blood transfusion every 2 weeks for refractory anaemia, although erythropoietin was being administered. After a thrombectomy for acute occlusion of the arteriovenous graft (AVG), a pseudoa-neurysm developed and was excised and replaced with polytetrafluoroethylene (PTFE) graft. However, a bulging mass developed near the graft, gradually increasing in size (Figure 1A). Vascular Doppler sonography disclosed fluid accumulating around the PTFE graft (Figure 1B). A peri-graft seroma was diagnosed. Therefore, the seroma was evacuated followed by repair with a graft–graft anastomo-sis. However, the perigraft seroma recurred immediately af-ter evacuation. The seroma enlarged gradually during the following 3 weeks and eventually ruptured (Figure 2). Next, the patient underwent total graft excision, and anoth-er AVG was created on the opposite upper arm. Perigraft seroma is defined as a sterile collection of fluid confined within a nonsecretory fibrous pseudomembrane surrounding a vascular graft. Perigraft seromas are rare complications of PTFE grafts which are difficult to treat with frequent recurrences [1]. Twenty-five percent of peri-graft seromas occurred within the first month postopera-tively. The primary suggested cause of seroma is failure of the surrounding connective tissue to incorporate the graft. "Graft wetting", or "graft weeping", is one of the contributing factors. In addition, some humoral fibroblast inhibitors may prevent the maturation and proliferation of perigraft fibroblasts, resulting in poor graft incorporation [2]. Several predisposing factors of perigraft seromas have been identified, including high pressure flow rate, low hae-matocrit, decreased oncotic pressure in malnourished pa-tients, and extensive manipulation of the graft. Surgery is generally indicated for expanding seromas before pressure necrosis and erosion through the skin occurs. Conflict of interest statement. None declared.
NDT Plus 01/2010; 3:189-190.
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Yu-Feng Lin,
Wen-Je Ko,
Tzong-Shinn Chu,
Yih-Sharng Chen,
Vin-Cent Wu,
Yung-Ming Chen,
Ming-Shiou Wu,
Yung-Wei Chen, Ching-Wei Tsai,
Chih-Chung Shiao,
Wen-Yi Li,
Fu-Chang Hu,
Pi-Ru Tsai,
Tun-Jun Tsai,
Kwan-Dun Wu
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ABSTRACT: Particular attention should be paid to postoperative patients that suffer from severe acute kidney injury (AKI) requiring renal replacement therapy (RRT).
This multicenter prospective observational study included 342 patients with postoperative AKI requiring RRT from January 2002 to December 2006.
There were 137 (40%) survivors at 90 days after the commencement of RRT. Independent predictors of 90-day mortality were older age, presence of sepsis, status post-cardiopulmonary resuscitation, necessity of continuous renal replacement therapy (CRRT), requirement of total parenteral nutrition, lower body mass index, higher Sequential Organ Failure Assessment score, and higher serum lactate level at the commencement of RRT. Further analysis among the survivors showed that lower serum creatinine at intensive care unit admission, lower Simplified Acute Physiology Score II and inotropic equivalent score at the commencement of RRT, and using CRRT were independent predictors for subsequent renal recovery.
The development of AKI requiring RRT in postoperative critical patients represents a substantial risk for mortality and morbidity.
American journal of surgery 10/2009; 198(3):325-32. · 2.36 Impact Factor
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ABSTRACT: Nosocomial meningitis is rare, and routine cerebrospinal fluid study is seldom recommended for hospitalized patients with fever and acute delirium. We present a case of Enterobacter cloacae meningitis complicated with a nontraumatic pneumocephalus. Maintaining a high index of suspicion of nosocomial meningitis is crucial in patients with acute delirium and multiple underlying comorbid conditions.
Diagnostic microbiology and infectious disease 06/2009; 66(1):108-10. · 2.45 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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European Journal Of Haematology 01/2009; 82(5):408-9. · 2.61 Impact Factor
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Case Reports 01/2009; 2009.
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Clinical Infectious Diseases 10/2008; 47(6):859-60. · 9.15 Impact Factor
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ABSTRACT: This study examined the association between hospital mortality and five illness-severity scoring systems evaluated at different time points in the intensive care unit (ICU) as well as clinical variables as predictors in critically ill patients supported by extracorporeal membrane oxygenation (ECMO) and acute dialysis.
This multicenter prospective observational study included 104 patients who received ECMO support and acute dialysis from January 2002 to December 2006. Patients' demographic, clinical and laboratory variables were analyzed as predictors of survival. The SAPS 2, APACHE II, SOFA, MODS, and SAPS 3 scores upon ICU admission and at acute dialysis commencement were evaluated to predict the patient's hospital mortality.
Hospital mortality for the study group was 76% (79/104). Among the five scoring systems, only SAPS 3 score showed a significant difference between survivors and non-survivors either upon ICU admission (p=0.038) or at dialysis commencement (p=0.001). SAPS 3 score at dialysis commencement showed the best discrimination ability by using the area under the receiver operating characteristic curve (SOFA, 0.55; SAPS 2, 0.56; MODS, 0.58; APACHE II, 0.59; and SAPS 3, 0.73). Multiple logistic regression analysis indicated that SAPS 3 score at dialysis commencement (OR: 1.070, 95% CI: 1.016-1.216) and IABP usage before ECMO (OR: 4.181, 95% CI: 1.448-12.075) were two independent risk factors for hospital mortality.
Among five common ICU scoring systems evaluated at different time points, SAPS 3 at dialysis commencement is the best risk adjustment systems to predict hospital mortality in critically ill patients supported by ECMO and acute dialysis. Furthermore, the SAPS 3 score at dialysis commencement and IABP usage before ECMO are two major independent predictors for hospital mortality in patients supported by ECMO and acute dialysis.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 09/2008; 34(6):1158-64. · 2.40 Impact Factor
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ABSTRACT: Citrullinemia is a metabolic disorder characterized by elevated plasma concentrations of citrulline and ammonia. Adult-onset citrullinemia (type II, CTLN2) has been attributed to citrin deficiency caused by mutations in the SLC25A13 gene. CTLN2 is associated with a high incidence of hepatocellular carcinoma (HCC) in Japanese. We report a 48-year-old Taiwanese man with citrullinemia, who was in good health until the age of 34 when he had repeated episodes of consciousness disturbance. Hyperammonia (201 micromol/L) was found during an episode of coma. Liver function and electrolyte levels were normal at that time. Serologic markers of viral hepatitis B and C were negative. Analysis of genomic DNA extracted from peripheral blood leukocytes showed homozygous 851del4 mutation in exon 9 of the SLC25A13 gene on chromosome 7q21.3. Fourteen years after disease onset, at the age of 48, he was admitted due to an episode of coma. Abdominal sonography and computed tomography showed a 2.5 cm tumor in the left lobe of the liver, without evidence of liver cirrhosis. Wedge resection of the tumor was performed and grade 2 HCC was diagnosed. The nontumor part of the resected specimen showed chronic persistent hepatitis with moderate steatosis. The results in this case support that both citrin deficiency and steatohepatitis may contribute to hepatocarcinogenesis.
Journal of the Formosan Medical Association 11/2006; 105(10):852-6. · 1.13 Impact Factor
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ABSTRACT: We report a patient with disseminated Mycobacterium kansasii infection, but with no underlying disease, presenting with mimicking multiple bone metastases with cancer of unknown primary site. Disseminated M. kansasii infection is rare in HIV-negative patients without underlying diseases. This patient had disseminated M. kansasii infection manifested with vertebral osteomyelitis, sacroiliitis, psoas abscess, bone marrow granuloma, liver granuloma, and possible spleen abscesses. The clinical manifestations are described and discussed in details.
Diagnostic Microbiology and Infectious Disease 04/2006; 54(3):211-6. · 2.53 Impact Factor
