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Case report
- Scrub typhus infection in a kidney transplant recipient: a case report
- Dongyeon Lee, Joohee Jeon, Jae Sung Ahn, Chung Hee Baek
- Kosin Med J. 2023;38(3):224-228. Published online June 9, 2023
- DOI: https://doi.org/10.7180/kmj.23.114
- 1,076 View
- 19 Download
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Abstract
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- Scrub typhus is a febrile disease that is endemic to Asia and the Pacific region. Its clinical manifestations include fever, myalgia, lymphadenopathy, and a characteristic eschar. The main manifestations of this disease are difficult to differentiate from those of other febrile illnesses; thus, a careful clinical examination and a high index of suspicion are crucial for an early diagnosis. Our case involved a 55-year-old female renal transplant recipient who presented with fever and sore throat in November. Her clinical symptoms did not improve after oral amoxicillin/clavulanate administration for 7 days, after which proteinuria and acute kidney injury were identified. After hospitalization, an eschar was found and immunoglobulin M antibodies against Orientia tsutsugamushi were detected by indirect immunofluorescence. She received oral doxycycline for 7 days and showed improvement in renal function and proteinuria. This is the first case report of scrub typhus infection in a kidney transplant patient in Korea. It is meaningful to report that the renal abnormalities associated with scrub typhus improved in a renal transplant patient through treatment of the disease. This case highlights the importance of examining the social history and symptoms of patients suspected of having scrub typhus in endemic areas. Early diagnosis and treatment are crucial in kidney transplant patients to preserve graft function and prevent fatal complications.
Original article
- Clinical significance of copeptin as an early predictor of renal graft dysfunction in renal transplant recipients
- Yoo Jin Lee, Chang Min Heo, Sihyung Park, Il Hwan Kim, Jin Han Park, Junghae Ko, Bong Soo Park, Yang Wook Kim
- Kosin Med J. 2022;37(3):220-227. Published online September 2, 2022
- DOI: https://doi.org/10.7180/kmj.22.107
- 1,116 View
- 21 Download
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Abstract
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- Background
Copeptin is the carboxyl-terminal part of the vasopressin precursor protein, and its concentration is an independent predictor of the onset of chronic kidney disease and a rapid decline in the glomerular filtration rate. The glomerular filtration rate is regarded as the best indicator of kidney transplant function and is a predictor of graft and patient survival. We investigated the clinical significance of copeptin as an early predictor of renal graft dysfunction in renal transplant recipients.
Methods
We measured serum creatinine, cystatin C, and copeptin concentrations in renal transplant recipients on the day of their operation, as well as on postoperative days 3, 7, 30, and 365. Acute rejection was defined as a sudden decrease in renal function accompanied by histological changes.
Results
Eight renal transplant recipients were enrolled in the study from July 2018 to December 2019. Four patients experienced histologically confirmed transplant rejection. All four cases involved acute T-cell rejection. No significant correlation was found between the copeptin level and the presence or absence of rejection at any time point. In subgroup analyses, changes in creatinine, the estimated glomerular filtration rate, cystatin, and copeptin did not show statistical significance.
Conclusions
We anticipated that copeptin would be useful to identify individuals at high risk of transplant rejection; however, our study failed to show an association. Further research will be needed to overcome the limitations of this study.
Case reports
- Aortoiliac Occlusive Disease as a Cause of Allograft Kidney Dysfunction and Refractory Hypertension
- HaengJin OHE
- Kosin Med J. 2019;34(2):168-172. Published online December 31, 2019
- DOI: https://doi.org/10.7180/kmj.2019.34.2.168
- 1,033 View
- 7 Download
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Abstract
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Aortoiliac occlusive disease (AIOD), especially proximal to the transplant artery, in kidney transplant patient activates the renin-angiotensin-aldosterone system by limiting graft renal perfusion and causes symptoms that can occur with transplant renal artery stenosis (TRAS) such as refractory hypertension, water retention, and graft renal dysfunction. Immediate clinical suspicion is difficult due to the nature of the progressive disease unlike TRAS. Herein, we present an interesting case of bilateral common iliac artery occlusion (AIOD, TASC II, type C) that manifested as uncontrolled blood pressure and decreased allograft function in a patient who had kidney transplant 17 years ago. The patient was successfully diagnosed with duplex scan, ankle-brachial index (ABI) and computed tomography angiography and treated with percutaneous luminal angioplasty and stent graft insertion.
- Two Cases of Listeria monocytogenes Meningitis during Immunosuppressant Therapy
- Hark Rim, Su Yul Ahn, Kyung Mu Yoo
- The Journal of Kosin Medical College. 1994;10(1):59-62.
- 284 View
- 1 Download
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