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Now showing items 33 - 48 of 57

  • Differential Signature of Obesity in the Relationship with Acute Kidney Injury and Mortality after Coronary Artery Bypass Grafting.

    Moon, Hongran   Lee, Yeonhee   Kim, Sejoong   Kim, Dong Ki   Chin, Ho Jun   Joo, Kwon Wook   Kim, Yon Su   Na, Ki Young   Han, Seung Seok  

    Background: Obesity is related to several comorbidities and mortality, but its relationship with acute kidney injury (AKI) and long-term mortality remain undetermined in patients undergoing coronary artery bypass grafting.; Methods: Data from 3,018 patients (age =E2=89=A5 18 years) who underwent coronary artery bypass graft surgery from two tertiary referral centers were retrospectively reviewed between 2004 and 2015. Obesity was defined using the body mass index, according to the World Health Organization's recommendation. The odds and hazard ratios in post-surgical, AKI, and all-cause mortality were calculated after adjustment for multiple covariates. Patients were followed for 90 =C2=B1 40.9 months (maximum: 13 years).; Results: Among the cohort, 37.4%, 2.4%, 21.1%, 35.1%, and 4.0% of patients were classified as normal weight, underweight, overweight-at-risk, obese I, and obese II, respectively. Post-surgical AKI developed in 799 patients (26.5%). Patients in the obese groups (overweight-at-risk to obese II) had a higher risk of AKI than did those in the normal-weight group. During the follow-up period, 787 patients (26.1%) died. Underweight patients had a higher risk of mortality than did normal-weight patients, whereas overweight-at-risk, obese I, and obese II patients showed better survival rates.; Conclusion: After coronary artery bypass graft surgery, obese patients encountered a high risk of AKI, and underweight patients exhibited a low chance of survival. Awareness of both obese and underweight statuses should be raised in these patients.=20
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  • Dark Side of Modernization: Bong Jun Ho\"s Memories of Murder (2003)

    Noh   Kwang Woo  

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  • Cln 3-requiring 9 is a negative regulator of Th17 pathway-driven inflammation in anti-glomerular basement membrane glomerulonephritis

    Lee, Hajeong   Lee, Jae Wook   Yoo, Kyung Don   Yoo, Joo-Yeon   Lee, Jung Pyo   Kim, Dong Ki   Chin, Ho Jun   Kim, Yon Su   Yang, Seung Hee  

    T helper 17 (Th17) lymphocytes promote renal inflammation in antiglomerular basement membrane glomerulonephritis (anti-GBM GN), and signal transducer and activator of transcription 3 (STAT3) mediates activation of Th17 lymphocytes by IL-6 and transforming growth factor-beta (TGF-beta). Cln 3-requiring 9 (Ctr9), a subunit of RNA polymerase-associated factor complex (PAFc), regulates the transcription of IL-6/STAT3-dependent genes. Here, we investigated the role of Ctr9 in regulating Th17-driven inflammation in anti-GBM GN. In mice, STAT3 beta or IL-17 knockout ameliorated anti-GBM autoantibody-induced renal injury. This phenomenon was associated with decreases in retinoic acid receptor-related orphan receptor gamma t (ROR gamma t), IL-17, phosphorylated STAT3, and proinflammatory cytokines. Compared with wild-type mice, Ctr9 increased in both STAT3 beta(-/-) and IL-17(-/-) mice injected with anti-GBM IgG, showing a negative correlation with Th17-related transcripts. Small interfering RNA (siRNA)-mediated knockdown of Ctr9 in intrarenal lymphocytes further upregulated Th17-related transcripts, consistent with repression of Th17 differentiation by Ctr9. Interestingly, Ctr9 was also expressed in human and mouse mesangial cells and downregulated in response to anti-GBM IgG or to TGF-beta plus IL-17. Ctr9 in mesangial cells was even more repressed in the presence of both anti-GBM IgG and Th17-activating cytokines. Consistent with these findings, renal biopsies obtained from patients with anti-GBM GN showed consistent downregulation of Ctr9 and upregulation of phosphorylated STAT3 and IL-17 in the glomerulus. We conclude that Ctr9 is a negative regulator of Th17 differentiation in anti-GBM GN and repressed by anti-GBM IgG and IL-17 in mesangial cells.
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  • Patient Participation in Patient Safety and Its Relationships with Nurses' Patient-Centered Care Competency, Teamwork, and Safety Climate

    Hwang, Jee-In   Kim, Sung Wan   Chin, Ho Jun  

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  • Relationship of renal morphology on 3-dimensional ultrasonography with renal pathologic findings and outcome in biopsy-proven nephropathy

    Xu, Jianwei   Hwang, Sung Il   Lee, Hak Jong   Chin, Ho Jun  

    Kidney morphology has been used to estimate renal functions. The present study investigated the usefulness of kidney length and renal parenchymal volume (RPV) measured using three-dimensional ultrasonography (3-D USG) in estimating renal pathological findings, and the outcome in patients with nephropathy who underwent renal biopsy. In this study, 94 adult patients who had native kidney biopsy with 3-D USG results were included. The mean kidney length and RPV were independent factors of, and positively correlated to the estimated glomerular filtration rate (eGFR). The mean kidney length and RPV had inverse associations with the percentage of global glomerulosclerosis. Higher mean RPV, other than longer kidney length, indicated a lower prevalence of tubular atrophy. During 63.3 +/- 19.3 months of follow-up, a mean RPV of <125 ml increased the risk of composite outcome by 4.287 fold (95% confidence interval, 1.133-16.227) as compared with a mean RPV of >=3D 125 ml (P=3D0.032). In conclusion, kidney size was inversely associated with certain nephronal damage and positively associated with eGFR in nephropathy. Furthermore, smaller RPVs predicted worse outcomes of nephropathy.
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  • Simple Postoperative AKI Risk (SPARK) Classification before Noncardiac Surgery: A Prediction Index Development Study with External Validation

    Park, Sehoon   Cho, Hyunjeong   Park, Seokwoo   Lee, Soojin   Kim, Kwangsoo   Yoon, Hyung Jin   Park, Jiwon   Choi, Yunhee   Lee, Suehyun   Kim, Ju Han   Kim, Sejoong   Chin, Ho Jun   Kim, Dong Ki   Joo, Kwon Wook   Kim, Yon Su   Lee, Hajeong  

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  • The Heme Oxygenase-1 Genotype is a Risk Factor to Renal Impairment of IgA Nephropathy at Diagnosis, Which is a Strong Predictor of Mortality

    Chin, Ho Jun   Cho, Hyun Jin   Lee, Tae Woo   Na, Ki Young   Yoon, Hyung Jin   Chae, Dong-Wan   Kim, Suhnggwon   Jeon, Un Sil   Do, Jun-Young   Park, Jong-Won   Yoon, Kyung-Woo   Shin, Young-Tai   Lee, Kang Wook   Na, Ki-Ryang   Cha, Dae Ryong   Kang, Young Sun  

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  • Proteinuria and hematuria are associated with acute kidney injury and mortality in critically ill patients: a retrospective observational study.

    Han, Seung Seok   Ahn, Shin Young   Ryu, Jiwon   Baek, Seon Ha   Chin, Ho Jun   Na, Ki Young   Chae, Dong-Wan   Kim, Sejoong  

    BACKGROUND: Proteinuria and hematuria are both important health issues; however, the nature of the association between these findings and acute kidney injury (AKI) or mortality remains unresolved in critically ill patients.; METHODS: Proteinuria and hematuria were measured by a dipstick test and scored using a scale ranging from a negative result to 3+ in 1883 patients admitted to the intensive care unit. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The odds ratios (ORs) for AKI and 3-year mortality were calculated after adjustment for multiple covariates according to the degree of proteinuria or hematuria. For evaluating the synergistic effect on mortality among proteinuria, hematuria, and AKI, the relative excess risk due to interaction (RERI) was used.; RESULTS: Proteinuria and hematuria increased the ORs for AKI: the ORs of proteinuria were 1.66 (+/-), 1.86 (1+), 2.18 (2+), and 4.74 (3+) compared with non-proteinuria; the ORs of hematuria were 1.31 (+/-), 1.58 (1+), 2.63 (2+), and 2.52 (3+) compared with non-hematuria. The correlations between the mortality risk and proteinuria or hematuria were all significant and graded (Ptrend<0.001). There was a relative excess risk of mortality when both AKI and proteinuria or hematuria were considered together: the synergy indexes were 1.30 and 1.23 for proteinuria and hematuria, respectively.; CONCLUSIONS: Proteinuria and hematuria are associated with the risks of AKI and mortality in critically ill patients. Additionally, these findings had a synergistic effect with AKI on mortality.=20
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  • Albuminuria during treatment with angiotensin type II receptor blocker is a predictor for GFR decline among non-diabetic hypertensive CKD patients.

    Yu, Mi-Yeon   Kim, Dong Ki   Park, Jung Hwan   Shin, Sung Joon   Lee, Sang Ho   Choi, Bum Soon   Lim, Chun Soo   Chin, Ho Jun  

    BACKGROUND: Albuminuria is a predictor of disease progression in patients with chronic kidney disease (CKD). However, the ability of proteinuria parameters measured at various time periods to predict renal outcomes is unclear.; METHOD: This observational cohort study included 165 non-diabetic hypertensive CKD patients who took olmesartan medoxomil. We measured the albuminuria at five different time points (0, 2, 4, 26, and 38 months) and the mean levels. The mean albuminuria levels were calculated during 0-4 months, 0-26 months, and 0-38 months. The renal outcome was defined as a decline in eGFR =E2=89=A5 40% during the entire study period.; RESULT: The albuminuria at five different time points and the mean albuminuria levels were independent risk factors for a worse renal outcome after adjusting for age, sex, and estimated glomerular filtration rate (eGFR) at enrollment and were able to predict the renal outcome, although the performance of the estimation tended to be more effective using the mean albuminuria level at the 38-month follow-up time point. The risk of a decline in eGFR =E2=89=A5 40% was increased by 1.690-folds [95% CI 1.110-2.572, P =3D 0.014] per 500 mg/day increase in the mean albuminuria at 38 months. With a cut-off value of 897 mg/day for mean albuminuria at 38 months after treatment, a decline in eGFR =E2=89=A5 40% was predicted with a sensitivity of 88.9% and specificity of 81.3%. The ability of albuminuria to predict a renal event at different measurement points does not differ in CKD patients.; CONCLUSION: The time-averaged albuminuria cut-off of 900 mg/day during the 3-year follow-up period showed high sensitivity and specificity for predicting a decline in eGFR =E2=89=A5 40% in CKD patients, although the albuminuria at different measurement points did not predict a worse renal outcome.=20
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  • Weight loss has an additive effect on the proteinuria reduction of angiotensin II receptor blockers in hypertensive patients with chronic kidney disease

    Ahn, Shin Young   Kim, Dong Ki   Han, Seung Seok   Park, Jung Hwan   Shin, Sung Joon   Lee, Sang Ho   Choi, Bum Soon   Lim, Chun Soo   Kim, Suhnggwon   Chin, Ho Jun  

    Background: Weight reduction is a lifestyle intervention that has been introduced for prevention and management of chronic kidney disease (CKD). We investigate the additive anti-proteinuric effect of weight reduction on the usage of angiotensin II receptor blockers (ARBs) and its potential mechanisms in hypertensive CKD patients. Methods: This study is a subanalysis of data from an open-label, randomized, controlled clinical trial. Among the 235 participants, 227 were assigned to subgroups according to changes in body weight. Results: Fifty-eight participants (25.6%) were assigned to group 1 (>=3D 1.5% decrease in body weight after 16 weeks), 32 participants (14.1%) were assigned to group 2 (1.5-0.1% decrease in body weight), and 136 participants (59.9%) were assigned to group 3 (>=3D 0.0% increase in body weight). Characteristics at enrollment were not different among the three groups, but mean differences in weight and percent changes in urinary sodium excretion over the period were statistically different (P < 0.001 and P =3D 0.017). Over the study period, unintentional weight loss independently increased the probability of reduced albuminuria (group 1, relative risk 6.234, 95% confidence interval 1.913-20.315, P =3D 0.002). Among urinary cytokines, only podocalyxin level decreased significantly in participants who lost weight (P =3D 0.013). Conclusion: We observed that weight loss had an additive effect on the anti-proteinuric effects of ARBs in nondiabetic hypertensive CKD patients, although it was minimal. An additive effect was shown in both obese and non-obese participants, and its possible mechanism is related to reduction of podocyte damage.
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  • Mild decrease in estimated glomerular filtration rate and proteinuria are associated with all-cause and cardiovascular mortality in the general population.

    Oh, Se Won   Baek, Seon Ha   Kim, Yong Chul   Goo, Ho Suk   Heo, Nam Ju   Na, Ki Young   Chae, Dong Wan   Kim, Suhnggwon   Chin, Ho Jun  

    BACKGROUND: A recent collaborative meta-analysis by Kidney Disease: Improving Global Outcomes reported that an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) and an albumin-to-creatinine ratio of =E2=89=A5 10 mg/g were independent predictors for mortality in the general population. However, selection bias, heterogeneity of the cohorts and measurement issues could be limitations.; METHODS: We analyzed the relationship of eGFR and proteinuria with mortality in the Korean general population, represented by 112,115 participants, aged =E2=89=A5 20 years, who had a voluntary health check-up with homogenous calibration of creatinine measurement from 2003 to 2009. Proteinuria (trace or more) was determined by urine dipstick.; RESULTS: eGFR and proteinuria were independently associated with all-cause mortality (ACM) and cardiovascular mortality (CVM), and progressive increases in risks for mortality were noted according to eGFR level and the presence of proteinuria. Compared with eGFR 90-105 mL/min/1.73 m(2), hazard ratio (HRs) for ACM were 1.60 [95% confidence interval (CI) 1.12-2.30] for eGFR 60-74 mL/min/1.73 m(2) and 3.54 (2.20-5.68) for eGFR <60 mL/min/1.73 m(2) in participants with no proteinuria. In participants with proteinuria, HRs for ACM were 2.10 (1.41-3.12) for eGFR 75-89 mL/min/1.73 m(2), 2.30 (1.50-3.53) for eGFR 60-74 mL/min/1.73 m(2) and 3.77 (2.15-6.38) for eGFR <60 mL/min/1.73 m(2). Similar findings were observed for CVM.; CONCLUSIONS: eGFR <75 mL/min/1.73 m(2) and urine dipstick trace or more were independent risk factors of ACM and CVM. The risks of adverse outcomes are greater in the general population with mild renal impairment or mild proteinuria.=20
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  • A low-salt diet increases the estimated net endogenous acid production in nondiabetic chronic kidney disease patients treated with angiotensin receptor blockade.

    Baek, Seon Ha   Kim, Sejoong   Kim, Dong Ki   Park, Jung Hwan   Shin, Sung Joon   Lee, Sang Ho   Choi, Bum Soon   Chin, Ho Jun   Kim, Suhnggwon   Lim, Chun Soo  

    BACKGROUND/AIMS: An acid-base imbalance precedes renal disease progression in patients with chronic kidney disease (CKD). Little is known about the effects of a low-salt diet (LSD) on net endogenous acid production (NEAP) levels in CKD patients using angiotensin receptor blockade.; METHODS: We enrolled a total of 202 nondiabetic CKD patients who underwent an 8-week treatment with olmesartan from the original trial [Effects of Low Sodium Intake on the Antiproteinuric Efficacy of Olmesartan in Hypertensive Patients with Albuminuria (ESPECIAL) trial: NCT01552954]. The patients were divided into good- and poor-LSD-compliance groups.; RESULTS: During the interventional 8 weeks, the NEAP in the good-compliance group increased compared to the control group (12.9 =C2=B1 32.0 vs. -2.0 =C2=B1 35.0 mmol/day, p =3D 0.002). NEAP was positively associated with the good-LSD-compliance group in the fully adjusted analyses (r =3D 0.135, p =3D 0.016). The additional reduction of 2.39 g/day of protein intake with a reduction of 1 g/day of salt intake did not increase the NEAP under angiotensin II receptor blockade (ARB) treatment with an LSD (r =3D 0.546, p < 0.001).; CONCLUSION: We found that an LSD may increase the NEAP in nondiabetic CKD patients using ARB, which suggests that additional acid producing-protein restriction should be required to prevent the NEAP from rising. =C2=A9 2014 S. Karger AG, Basel.
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  • FimAsartaN proTeinuriA SusTaIned reduCtion in comparison with losartan in diabetic chronic kidney disease (FANTASTIC): study protocol for randomized controlled trial.

    Kim, Jang-Young   Son, Jung-Woo   Park, Sungha   Yoo, Tea-Hyun   Kim, Yong-Jin   Ryu, Dong-Ryeol   Chin, Ho Jun  

    BACKGROUND: Fimasartan is the ninth angiotensin receptor blocker to be developed. However, it has not yet been evaluated for reno-protective effects in hypertensive diabetic chronic kidney disease (CKD). The target blood pressure (BP) for hypertensive diabetic CKD is also a controversial topic. This trial was designed to assess the reno-protective effects of fimasartan compared to those of losartan as a primary outcome. This study also compares the two drugs with regard to cardiovascular and renal outcomes in accordance with target systolic BP (SBP) (as secondary outcomes).; METHODS: This study is a prospective, phase III, randomized, double-blind, active-controlled, non-inferiority, four-parallel group, dose-titration, multicenter trial. We recruit patients with hypertensive diabetic CKD with overt proteinuria. Participants will be randomized into four groups (1:1:1:1): fimasartan standard SBP control (SBP<140mmHg); fimasartan strict SBP control (SBP<130mmHg); losartan standard SBP control; and losartan strict SBP control. After 24weeks, all individuals are treated with fimasartan for an additional 120weeks in an open-label design, maintaining their assigned SBP control groups as randomized. The primary endpoint is the rate of change in proteinuria, which is assessed using the spot urine albumin-creatinine ratio at 24weeks. The secondary endpoints are the cardiovascular and renal outcomes at 144weeks compared between the strict SBP and standard SBP control groups.; DISCUSSION: The FANTASTIC is a clinical study to provide: (1) the reno-protective effect of fimasartan; and (2) the target BP to reduce adverse outcomes in hypertensive diabetic CKD with overt proteinuria.; TRIAL REGISTRATION: Clinicaltrials.gov, NCT02620306. Registered on 1 December 2015.=20
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  • The effect of the World Kidney Day campaign on the awareness of chronic kidney disease and the status of risk factors for cardiovascular disease and renal progression

    Chin, Ho Jun   Ahn, Jeong Myeong   Na, Ki Young   Chae, Dong-Wan   Lee, Tae Woo   Heo, Nam Joo   Kim, Suhnggwon  

    Methods. We selected 57 718 people who had undergone a routine health check-up. Results. The average CKD awareness was 3.1% (95% CI: 2.6-3.7%) and was increased with progressing CKD stage. The awareness was increased from 1.1% before the WKD campaign to 5.8% after the campaign (P < 0.001). CKD awareness in the post-WKD period was increased in CKD stages 2 (OR 4.535: 95% CI: 2.044-10.062) and 3 (OR 6.614: 95% CI: 4.282-10.217) and profoundly increased in stage 4 (OR 13.800: 95% CI: 2.127-89.524), compared to the pre-WKD period. In the CKD-aware group compared to the CKD-unaware group, the awareness of diabetes mellitus (90.0% versus 54.2%, P < 0.001) and hypertension (87.2% versus 64.7%, P < 0.001) was higher and the levels of systolic blood pressure (116.9 +/- 1.0 versus 120.1 +/- 0.2, P < 0.01) and serum cholesterol (198.3 +/- 2.7 versus 205.0 +/- 0.5, P < 0.05) were lower by covariance analysis. Conclusions. The WKD campaign had a positive impact on the awareness and control of risk factors in CKD subjects but the absolute frequency of CKD awareness still remains undesirable in Korea. We need new campaign strategies to publicize the importance of early diagnosis and appropriate management of CKD.
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  • Aspergillus -Associated Cerebral Aneurysm Successfully Treated by Endovascular and Surgical Intervention with Voriconazole in Lupus Nephritis Patient

    Kim, Yong Chul   Lee, Hajeong   Ryu, Han Hee   Beom, Seung Hoon   Yang, Yaewon   Kim, Suhnggwon   Chin, Ho Jun  

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  • Tacrolimus Decreases Albuminuria in Patients with IgA Nephropathy and Normal Blood Pressure: A Double-Blind Randomized Controlled Trial of Efficacy of Tacrolimus on IgA Nephropathy

    Kim, Yong-Chul   Chin, Ho Jun   Koo, Ho Suk   Kim, Suhnggwon  

    Background: Treatment remains uncertain for IgA nephropathy patients with mild to moderate proteinuria, for whom antihypertensive medication or the RAS blocker is not applicable due to low blood pressure. Trial design: A double blinded randomized trial. Methods: The anti-proteinuric effect of tacrolimus was explored for 40 biopsy-proven mild IgA nephropathies for 16 weeks. We randomly assigned patients either to receive tacrolimus or placebo with stratification by using a renin angiotensin system blocker. The primary outcome was the percentage change of final UACR compared to the baseline value (pcUACR). Results: The mean value of pcUACR at 12-week and 16-week visits (primary outcome) was decreased more in the Tac group compared to the control group (-52.0 +/- 26.4 vs -17.3 +/- 29.3%, p = 0.001). At each visit, pcUACR was also decreased more in the Tac group compared to the control group. In the Tac group, the pcUACRs were -60.2 +/- 28.2%, -62.2 +/- 33.9%, -48.5 +/- 29.8%, and -55.5 +/- 24.0%, and, in the control group, -6.8 +/- 32.2%, -2.5 +/- 35.9%, -12.7 +/- 34.2%, and -21.9 +/- 30.6%, at 4-week, 8-week, 12-week, and 16-week visits, respectively. The pre-defined secondary outcomes were better in the Tac group compared to the control group. The frequency of decrease in pcUACR and percentage change of UPCR (pcUPCR) >= 50% at 16 weeks were 65.0% (13/20) and 55.0% (11/20) in the Tac group, and 25.0% (5/20) and 15.0% (3/20), in the control group, respectively (p = 0.025 for pcUACR and p = 0.019 for pcUPCR). However, tacrolimus wasn't effective with a dose of 0.05 mg/kg/day in patients taking ARB. The adverse events were tolerable. Conclusion: Tacrolimus effectively reduced proteinuria in IgA nephropathy with normal blood pressure. This suggested that tacrolimus could be an alternative to corticosteroid and RAS blocker for IgA nephropathy patients who cannot endure antihypertensive medication.
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