Journal of Yeungnam Medical Science

Case Reports

Rhabdomyolysis Induced Acute Kidney Injury in a Patient with Leptospirosis.: Yoon Jung Choi, Jeung Min Park, Yo Han Jung, Jong Ho Nam, Hyun Hee Chung, Tae Woo Kim, Kyu Hyang Cho, Jun Young Do, Kyeung Woo Yun, Jong Won Park; Yeungnam Univ J Med. 2011;28(1):54-59. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.54

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Abstract PDF: Leptospirosis is a spirochetal infectious disease caused by Leptospira interrogans, and may vary in degree from an asymptomatic infection to a severe and fatal illness. The kidney is one of the principal target organs of Leptospira. Renal disorders caused by Leptospira infection vary from an abnormality in urinalysis to acute kidney injury (AKI). Incidence of AKI in severe leptospirosis varies from 40% to 60%. AKI reflects the severity of leptospirosis and is generally accompanied by cholestatic jaundice. The pathophysiology of AKI in leptospirosis consists of hypovolemia, direct tubular toxicity, and rhabdomyolysis. Most patients with acute leptospirosis experience severe myalgias, and show laboratory evidence of mild rhabdomyolysis. However, occurrence of severe rhabdomyolysis is rare. We report here on a patient with leoptospirosis, who had severe rhabdomyolysis and acute kidney injury without jaundice.

A Case of Acute Renal Failure Associated with Non-fulminant Acute Hepatitis A.: Ji Hoon Na, Jong Won Park, Kyu Hwan Park, Myong Jin Oh, Yun Jung Choi, Jung Min Park, Woo Jin Chang; Yeungnam Univ J Med. 2010;27(2):127-132. Published online December 31, 2010; DOI: https://doi.org/10.12701/yujm.2010.27.2.127

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Abstract PDF: Acute hepatitis A is a generally self-limiting disease of the liver. Acute renal failure is rare in patients with acute non-fulminant hepatitis A. Acute tubular necrosis is the most common form of renal injury found in such patients. The 36 years old male patient visited our hospital with complaint of general weakness, fatigue, nausea, vomiting and myalgia. He was diagnosed with acute renal failure associated with acute non-fulminant hepatitis A. We report here on a case of acute renal failure associated with non-fulminant hepatitis A, and we include a review of the literature.

A Case of Adult onset Henoch-Sch?nlein Purpura with Acute Renal Failure.: Seok Min Kim, Kyung Ae Chang, Sun Young Jung, Chan Soh Park, Jong Won Park, Jun Young Do, Yong Jin Kim, Kyung Woo Yoon; Yeungnam Univ J Med. 2008;25(1):58-63. Published online June 30, 2008; DOI: https://doi.org/10.12701/yujm.2008.25.1.58

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Abstract PDF: Henoch-Schonlein purpura (HSP) is a leukocytoclastic vasculitis of small vessels with deposition of IgA, commonly resulting in skin, joint, gastrointestinal, and kidney involvement. HSP is an uncommon disorder in adults and accounts for 0.6% to 2% of adult nephropathy. We report a case of HSP with acute renal failure successfully treated with corticosteroid. In this case, the patient presented with vasculitic purpuric rash on lower extremity, arthralgia in the wrist, abdominal pain, hematochezia, oliguria and azotemia. Abdominal CT showed wall thickening of the small and large bowels. Skin biopsy revealed leukocytoclastic vasculitis. Percutaneous renal biopsy showed no crescent formation, but mesangial IgA and C3 deposits were observed by immunofluorescence. The patient was treated with corticosteroid (1mg/kg per day) and hemodialysis. After treatment, renal function improved and purpuric lesion, arthralgia and abdominal pain disappeared. Thus, when adults present with purpuric rash and rapidly progressive glomerulonephritis (RPGN), HSP should be a diagnostic consideration.

Original Article

Risk Factors of Acute Renal Failure after Colorectal Surgery.: Hae Mi Lee, Chang Jae Hwang, Jaehwang Kim, Heung Dae Kim, Dae Pal Park, Il Suk Seo, Sun Ok Song, Sae Yeon Kim, Deuk Hee Lee, Daelim Jee; Yeungnam Univ J Med. 2007;24(2):275-286. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2.275

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Abstract PDF: BACKGROUND
Acute renal failure is one of the leading causes of postoperative morbidity and mortality. The purpose of this study was to determine the risk factors that are associated with acute renal failure after colorectal surgery. MATERIALS AND METHODS: Five hundred seventy patients who operated colorectal surgery at the Yeungnam University Medical Center over three years from 2004 to 2006 were enrolled in this study. The effects of gender, age, ASA classification, concomitant disease, surgery type and duration, reoperation, urogenital manipulation, medication, hypotension, hypovolemia, transfusion, and postoperative ventilatory care on the occurrence of acute renal failure after colorectal surgery were studied. RESULTS: The major risk factors of acute renal failure after colorectal surgery were age of patients (P=0.003), ASA classification (P<0.001), concomitant disease (P<0.001), duration of the time surgery (P=0.034), reoperation (P=0.001), use of intraoperative diuretics (P=0.005), use of postoperative diuretics (P<0.001), intraoperative hypotension (P=0.018), intraoperative transfusion (P<0.001), postoperative transfusion (P<0.001), and postoperative ventilatory care (P=0.001). CONCLUSION: Multiple factors cause synergistic effects on the development of acute renal failure after colorectal surgery. Therefore, efforts to reduce the risk factors associated with acute renal failure are needed. In addition, intensive postoperative care should be provided to all patients.

Case Report

A case of Rifampin-induced Acute Renal Failure.: Dong Hwa Lee, Te Gue Park, Je Sung Lee, Heui Sik Kim, Kyoung Hyun Kim, Young Jun Ha, Sung Bok Jung, Jun Young Do, Kyung Woo Yoon; Yeungnam Univ J Med. 1998;15(1):173-181. Published online June 30, 1998; DOI: https://doi.org/10.12701/yujm.1998.15.1.173

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Abstract PDF: Rifampin is common drug to treat tuberculosis. Rifampin induced acute renal failure, hemolytic anemia and thrombocytopenia is rare and severe complication. We have experienced a case of rifampin induced acute renal failure, hemolytic anemia and thrombocytopenia. Forty-six years old male was suffered from reactivation of pulmonary tuberculosis, and had to medicate antituberculosis drugs including rifampin(600mg/day). Seven years ago, antituberdulosis medication were successfully administered to treat pulmonary tuberculosis without any side effects of drugs. But eight days after readministration of rifampin, fever, abdominal pain, vomiting, oliguria, elevated BUN and creatinine were developed. And thrombocytopenia was also identified after administration of rifampin. The patient was recovered slowly after discontinuation of rifampin & intensive medical care. The renal function was normalized at 55 days after cessation of rifampin. The renal pathologic findings were interstitial nephritis and acute tubular necrosis. And, the rifampin dependent antibodies were identified by indirect antiglobulin test in the presence of rifampin. So we report this case with a brief review of literature.

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