Patients undergoing maintenance hemodialysis(HD) potentially have an increased risk of exposure to viral hepatitis. The reported prevalence of antiHCV in hemodialysis patients varied widely form 7.6-54% according to dialysis center and there were there were many reports that showed the correlation between the prevalence of antiHCV and duration of HD or transfusion amount.

Fifty-four patients on regular hemodialysis at our hospital were evaluated for the presence of hepatitic C antibody(antiHCV) with the comparison of various parameters such as duration of HD, amount of transfusion, past history of hepatitis, serologic markers of hepatitis B and current liver function. AntiHCV using second-generation enzyme linked immunosorbant assay were found in six of 54HD patients(11.1%). Among six antiHCV(+) percent four patients were found to have HCV-RNA in their plasma detected by PCR. The percent of male patients were significantly higher in antiHCV(+) group(66.7 vs 31.3%, p<0.05). The positivity of antiHCV did not correlated with the duration of HD and amount of transfusion(p>0.05), but prevalence increased over 2 years (5.9% in 1991, 11.1% in 1993) and HBsAg prevalence remained unchanged(9.8% in 1991, 9.3% in 1993).

Therefore, regular follow-up of liver function test and use of separate machine for antiHCV positive patients may be needed to prevent the transmission of the hepatitis C virus during the hemodialysis process itself.

Endothelin is a 21-residue peptide vasoconstrictor produced by endothelium. The exact role of endothelin in the pathophysiology of renal disease has not yet been extensively demonstrated. Thus, to elucidate the pathophysiological significance of plasma and urinary endothelin-1 (ET-1) in patients with lupus nephritis. we studied 7 patients diagnosed as lupus nephritis by kidney biopsy and 7 healthy volunteers. Serum and urinary biochemical studies including creatinine and ET-1 were done, and urinary excretion of N-acetyl-β-D-glucosaminidase(NAG) was also measured.

The results were as follows ;

1) Patient poop and control group showed no significant differences in their clinical characteristics, basic biochemical studies, serum creatinine, plasma ET-1, urinary excretion of protein. NAG and creatinine and ET-1 clearance. Of 7 lupus nephritis patients, only 2 patients showed abnormal serum complement and anti-dsDNA.

2) In lupus nephritis patients, plasma ET-1 level showed no correlation with serum creatinine, complement and anti-dsDNA(p>0.05).

3) ET-1 clearance showed no significant correlaticn with creatinine clearance rate, complement anti-dsDNA ana urinlary NAG excretion.

Plasma ET-1 level and its clearance rate could not reflect the lupus nephritis activity. But our study included small number of patients and only 2 patients of pathologically proven lupus nephritis showed active disease, biochemically and clinically, ana the majority of patients has alreday been in remission state after treatment. Above factors probably acted as a bias against the results, leading to statistical limitations. In further studies, we should broaden our subject group in number and to other renal diseases than limiting to lupus nephritis and prospective long term follow up study is indicated to further investigate the role of urinary excretion of ET-1 and their mechanism of action on renal disease.

We evaluated the clinical manifestations, laboratory findings including renal biopsies and treatments in 30 cases of lupus nephritis who were seen between jan., 1981 to Dec., 1991 in Ewha Womans University Hospital.

The results were as follows:

1) Among 72 patients. 11 cases were men and 61 were women(M:F=1:5.5). The onset of disease were developed between 2nd and 3rd decades in 76% of cases. Their median age was 26.9 years.

2) The study of ARA criteria for SLE showed that the incidence of the renal disease was 81.8%, anemia 50% and antinuclear antibody(ANA) 77.3%.

3) At the time of the diagnosis. among 30 patients with lupus nephritis. 25% of patients had serum creatinine over 1.2mg/dl and 25% had proteiuria over 3.5g/day.

4) According to the WHO classification. 12 patients(66%) belonged to class IV and 2 patients(11.1 %) to class III. Among patients classified as class IV. the 33% showed nephrotic syndrome and 66.7% had serum creatinine over 1.2mg/dl.

5) At the time of the diagnosis, among 30 patients with lupus nephritis. the incidence of anti-DNA antibody was 66.7%. decreased C3 titer was 73.3 % and decreased C4 titer was 76.7%.

6) Among 18 patients with oral prednisolone alone, the rate of complete remission was 11.1% and deterioration including death was 33.3%. Among 7 patients with prednisolone plus cyclophophamide. the rate of complete remission was 14.3% and deterioration including death was 28.8%.

7) Among 30 patients with lupus nephritis. 6 patients died. Most common cause of death was cardiovascular disease with 3 cases, followed by infection, 2 cases and renal failure, 1 case.

Oral aluminum salt intake has been implicated in aluminum intoxication in patients suffering from chronic renal failure. We studied to observ a level of serum aluminum in patients with maintenace dialysis and their relationship with oral aluminum salt intake.

The results are as follows ;

1) Serum aluminum concetration was 40± 12.0ug/1.

2) Average daily dose of aluminum salt was 34± a2/12.2mg/kg.

3) Recent daily dose of aluminum salt was 32a8± 18.9mg/kg.

4) Total does of aluminum salt was 22± 23.2g/kg.

5) Correlation coefficient between serum aluminum concentration and total dose was 0.32.

6) Correlation coefficient between serum aluminum concentration and mean corpuscular volume of erythrocyte was -0.27.

7) Correlation coefficient between serum ferritin and mean corpuscular volume of erythrocyte was 0.3.

8) There was no correlation between serum aluminum concentration and several other variables including serum ferritin, daily dose of aluminum salt and serum creatinine.

9) There was no correlation between mean corpuscular volume of erythrocyte and dose of aluminum salt.

We studied prospectively 48 patients with end stage renal disease on chronic dialysis (hemodialysis or chronic ambulatory peritoneal dialysis). Of these 48 patients, 9(19%) had urinary tract infection (UTI), 4(8%) had symptomatic UTI, and 14(29%) had sterile pyuria. Among 16 patient who had documented previous UTI, 8(50%) had repeated UTI at presentation compared to 1 of 32 patients who had not documented previous UTI. Daily urine out put in all patients with sterile pyuria was lesser than 500ml. No significant correlation was seen between frequences of UTI and duration of dialysis therapy. Successful cure with oral antibiotic treatment for 1-2 weeks achieved in 6 of 9 patients with UTI. However, recurrence of infection occurred in 3, one patient was diabetic with neurogenic bladder, another was patient with chronic pyelonephritis who had experienced perinephric abscess. Third was patient with chronic pyelonephritis complicated with chronic UTI, paraplegia, and vesico-renal reflux. This patient was admitted to hospital for intravenous gentamycin therapy.

From April 1981 to March 1985, a clinical study was made at the Intcrnal Medicine department of Ewha Womans University Hospital on 13 patients with IgA nephropathy. The following results were obtained. 1) The mean age of patients was 27 years, the male to femle ratio was 1.2:1. The most common chief complaint was gross hematuria(38%). 2) In urinalysis, hematuria and proteinuria were noted 100% and 92%, respectively. Creatinine clearance was decreased than normal range of creatinine clearance. ASO titer, immunoglobulin and C3 level were normal range. 3) Kidney biopsy finding showed minor mesangeal change in 62% of patients. IgA deposition was noted in all patients.

A case of PNH-like secondary myelofibrosis associated gastric cancer is presented with brief literal view. This 45 years old Korean male who had gastric cancer, was admitted to Ewha University hospital with marked pallor and bone pain. On hematologic examination, hemoglobin 4.0 gm/dl, hematocrit 8%, and RBC count was 92×10⁴/mm³. WBC count was 16,200/mm³, with normal differentiation and platelet count was 18,000/mm³. Reticulocyte count was 5%. Peripheral blood smear showed anisocytosis, poikilocytosis and schistocytes including tear-drop cell. Two attempts of bone marrow biopsy disclosed island-shape of gastric cancer call infiltration and reticulin strands. After transfusion with 4 units of whole blood over the night, his early morning urine color was dark reddish-brown. The HAM test was positive and the value of the leukocyte alkaline phosphatase was very high. But there was no specific change of urine after administration of Iron-dextran. The author assure that this case was accompanied by Paroxysmal Nocturnal Hemoglobinuria-like red cell defect rather than microangiopathic hemolytic anemia.