A unique type of rapidly progressive interstitial fibrosis of the kidney, the Chinese Herb Nephropathy (CHN) has been reported in Belgian woman after intake of Chinese herbs. CHN contains several characteristics that include variable clinical features from progressive renal failure to Fanconi's syndrome, histologic finding of extensive interstitial fibrosis, high risk of urothelial malignancy. We are reporting a case of33 year-old female patient who was diagnosed as CHN. The patient visited our hospital with symptoms of nausea. Laboratory investigation showed metabolic acidosis with normal anion gap, hypokalemia, hypophosphatemia, proteinuria, glycosuria consistent with Fanconi's syndrome. She took Chinese herbs for slimming 4 months before. Renal biopsy showed the features of tubular cell injury with interstitial edema, accompanied by interstitial fibrosis on following biopsy, compatible with Chinese Herb Nephropathy. After 5 months, her renal function was progressed rapidly, therefore peritoneal dialysis was started. This case shows that we should consider Chinese herb as a cause of renal failure.

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• Update of aristolochic acid nephropathy in Korea
  Tae Hyun Ban, Ji-Won Min, Changhwan Seo, Da Rae Kim, Yu Ho Lee, Byung Ha Chung, Kyung-Hwan Jeong, Jae Wook Lee, Beom Seok Kim, Sang-Ho Lee, Bum Soon Choi, Jin Suk Han, Chul Woo Yang
  The Korean Journal of Internal Medicine.2018; 33(5): 961.     CrossRef

Acute bilateral renal cortical necrosis is a rare cause of acute reanl failure, occuring in about 2% of patients and it's prognosis is fatal. The pathophysiology of this condition is complex, but ultimately leads to the destruction of the renal cortex with sparing of the renal medulla and a thin tissue rim of under the capsule.

In this report we describe a 23-year-old female patient in whom the diagnosis was made using MR imaging during the acute initial phase of the disease. On T1-weighted images, the signal intensity of the renal cortex was increased, but the signal intensity of the renal cortex was demarcated by a rim of low signal intensity in the region of the corticomedullary junction. MR imaging is useful, noninvasive, and specific modality for an early diagnosis of acute bilateral renal cortical necrosis.

We reached the following conclusions from analyzing survival rates and causes of death of 71 patients who received hemodialysis at our hemodialysis center from January 1983 to December of 1990 using life-table method.

1) The 5-year survival rate of the whole patients was 52%.

2) The survival rate decreased significantly with increasing age after 3 years from commencement of dialysis. The 5-year survival rate of patients under the age of 30 was 89%, the rate of patients between the age of 31 and 50 was 70% . and the rate of patients above the age of 51 years was 30%.

3) Diabetes Mellitus had no slgnificant influence on survival rate in patients over the age 51.

4) The survival rates according to sex revealed no significant difference.

5) The leading cause of death was cardiovascular disease including cerebrovascular accident amounting 47.6% and next was infectious disease 23.8%.

Additional study on survival rate in age group over 51 with or without Diabetes Mellitus is required in the future.

Since its first introduction by Popovich in 1976. Continuous Ambulatory Peritoneal Dialysis(CAPD) has estabilished itself as an effective method maintaining the patients with end stage renal disease. But recurrent peritonitis remains the most frequent cause of the CAPD failure. So clinical studies were carried on the 15 patients on CAPD who had been treated from June 1989 to march 1991.

The following results were obtained.

1) The incidence of peritonitis was 1.73 episode/patient/year.

2) Peritonitis incidence according to the sex showed 1.93 episode/patient/year with female patients and l.46 episode/patient/year with male patients.

3) Peritonitis incidence according to the underlying disease showed 1.94 episode/patient/year with diabetic patients and 1.45 episode/patient/year with non-diabetic patients.

4) The subjective symptom and sign were as follows; abdominal pain(95%). cloudy dialysate(95%). nausea(55%), abdominal tenderness(95%). decreased dialysate drainage (59%), fever(50%), and peripheral leukocytosis(18%).

5) The positive rate in Gram stain of dialysate drainage fluid was 13.6% and the positive rate in culture was 31.8%. of which staphylococcus was 42.9%.

6) The rate of catheter removal due to peritonitis was 22.7%. The most common cause was persistent peritonitis, which accounted for 60% of cases. And all cases of catheter removal were developed in female patients.

7) The complications related to catheter were as follows ; catheter exit site infection(20%), external cuff extrusion(20%), leakage of dialysate fluid(6.7%) and crack on Tenckhoff catheter(6.7%)

A patient with severe active systemic lupus erythematosus, who had not responded to conventional therapy, was treated with plasmapheresis and subsequent pulse cyclophosphamide. There was the reduction of anti-ds DNA level was deteced after plasmapheresis in conjunction with the immunosuppressive therapy could be and effective modality of management in patients with rapidly deteriorating SLE who are responding inadequately to the conventional therapy.

The utilization of acetate & bicarbonate dialysate and their effects on acid-base balance, blood pressure, pulse rate, serum cholesterol, triglyceride, HDL and free fatty acid were investigated during regular hemodialysis.

Eight patients with chronic renal failure were studied during two successive dialysis treatments for which either acetate or bicarbonate were used as a buffer anion in the dialysate.

The result obtained as follows :

1) There was no significant difference in arterial pH between acetate and bicarbonate hemodialysis patients.

2) Arterial HCO₃ was higher significantly in patients with bicarbonate hemodialysis than acetate hemodialysis from 60 to 240 minutes (p<0.01)

3) Arterial pCO₂ fell significantly from 34.0 mmHg to 31.7 mmHg during acetate hemodialysis patient (p<0.01)

4) Heart rate rose signifificantly from 69 b.p.m to 82 b.p.m. during acetate hemodialysis(p<0.01).

5) Serum fatty acid increased significantly during acetate and bicarbonate hemodialysis, but no difference between two groups.

6) There were no significant changes in systolic and diastolic blood pressure in two groups during hemodialysis.

7) There were no significant changes in serum cholesterol, triglyceride and HDL in two groups during hemodialysis.

Phosphate binders that contain aluminum are usually prescribed to treat hyperphosphatemia in patients with chronic renal failure, but an accumulation of aluminum can lead to osteomalacia, encephalopathy and anemia. To evaluate the effect of CaCo₃ on serum calcium and phosphorus as a alternative phosphate binder, we studied 13 patients on regular hemodialysis treatment. In basal period, some patients were administered Al(OH)₃ and CaCO₃, others only the former or the latter and others nothing. Al(OH)₃ was stopped in all patients and CaCO₃ was started or increased in all patients. A better control of sCa, sPi and sCa-Pi product was observed during only Ca supplementation, despite Al(OH)₃ discontinuation. Some patients developed a mild hypercalcemia and hypophosphatemia, especially in those who had a normal predialytic sPi. Therfore considering the dialysate Ca concentration according to individual need and the adjustment of amount of CaC₃ to avoid these risks can be recommanded with the dual objective of keeping a positive Ca balance and correcting hyperphosphatemia.

We presented here a patient of autoimmune hemolytic anemia associated with systemic lupus erythematosus. This 38 year old female was admitted because of dizziness and dyspnea. In peripheral blood and bone marrow study, characteristics of autoimmune hemolytic anemia were seen. And she was well treated with prednisolone only. The general concept of autoimmune hemolytic anemia with the brief review of literature is discussed.

The nonfunctioning islet cell tumors of pancreas are not associated with obvious sign and symptoms of hormone overproduction. Symptoms, most commonly pain and jaundice, are due to the mass effect of the tumor and invasion of the surrounding structures, and unlike functioning tumors, the location of the tumor has a direct bearing on the patient's symptoms. We have experienced a case of benign nonfunctioning islet cell tumor of the pancreas in 47-year-old female. She was admitted to our hospital due to palpable large mass of her abdomen. She had no obvious sign and symptoms of hormone overproduction. The exploratory laparatomy was done under the impression of retroperitoneal tumor with the information of radiologic finding and abdominal C-T scan. The pathologic diagnosis was benign nonfunctioning islet cell tumor of the pancreas.

The infiltrative carcinoma of stomach is reported to difficult to diagnosis by gastroscopic examination only, because of a few change of mucosa. So the tumor is diagnosed with the aid of gastroscopic multiple biopsy findings. We experienced a case of infiltrative carcinoma of stomach, which was similar to hypertrophic gastritis. The tumor was confirmed by the biopsy and operation finding. The general concept of infiltrative carcinoma of stomach with the brief review of literature is discussed here.

The purpose of this study was to observe the correlation between the severity of esophageal varices and various clinical findings.

Thirty-four patients with esophageal varices were selected for the study from Jan. 1981 to Sept. 1983 at the Ewha Womans University Hospital.

The varices were classified by the Sesoko's method into 3 grades according to severity. The grade I or mild varices are those with unequivocal distension and tortuosity of the vein forming fold-like elevations. The grade II or moderate varices look like hemispherical or nodular prominance in some parts of the elevated structure below the 2nd narrowing. The grade III or severe varices are the longitudinally aligned, nodular or beads-like bulging of highest degree of veins, usually throughout the entire length of the esophagus.

The observed results are summerized as follows.

1) The ratio between male and and female was 4:1. In age ditribution, the incidence was most prevalent in 4th to 5th decade.

2) Underlying liver diseases were liver cirrhosis(23 cases), carcinoma of the liver(9 cases) and chronic hepatitis(2 cases).

3) Esophagoscopy is good method for observing the variceal morphology, number, location, degree and bleeding sites in this study. Esophagoscopy is the far better method in the diagnosis of esophageal varix than esophagography. Almost the mild varices were not demonstrated by esophagography and one third of moderate varices were not detected by the routine esophagography.

4) There was no significant correlation between the size, number, location or color of the varices and variceal bleeding.

5) There was no correlation between the severity of esophageal varices and hepatomegaly. But there was a tendency for some correlation among the severity of esophageal varices, splenomegaly and ascites.

We had experienced one case of amyloidosis, especially involving kidney associated with nephrotic syndrome and liver who was admitted to Ewha University Hospital due to abdominal distension and extremities edema.

Diagnozis was made characteristic clinical and histopathologic finding with crystal violet and congo red staining produced green birefringence under polarized light.

We sdiscussed this case with review of literatures.