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Background: The objective of this study was to determine the risk of renal failure in patients with under-recognized chronic kidney disease (CKD) in the self-pay standard medical screening program of health management centers., Methods: The abbreviated Modification of Diet in Renal Disease equation was used to calculate the estimated glomerular filtration rate (eGFR) of study subjects. Study subjects with eGFR less than 60 mL/min/1.73m(2) but with normal results of routine assessment, including serum creatinine, blood urea nitrogen, urinalysis and kidney ultrasound, were defined as having under-recognized CKD. Episodes of renal failure requiring dialysis within 2 years in subjects with stage 3 to stage 5 CKD were evaluated., Results: A total of 15,817 subjects were recruited and 28.4% of subjects were identified by routine assessments as having a kidney problem. The prevalences of CKD 3A, 3B, 4 and 5 were 8.3%, 1.9%, 0.3% and 0.2%, respectively. All subjects with stages 4 and 5 CKD had abnormal serum creatinine levels, but 48.7% of 1,507 subjects with stage 3 CKD (stage 3A, n = 713; stage 3B, n = 21) had normal routine assessments. Subjects with under-recognized stage 3B CKD had the highest risk (20%) of developing renal failure compared to subjects with stages 3-5 CKD and abnormal results of routine assessments., Conclusion: Identifying subjects with CKD stage 3 by the eGFR equation, especially in stage 3B, is advantageous in detecting the risk of renal failure over the routine clinical assessment that is currently carried out by health management institutions in Taiwan., (Copyright © 2010 Elsevier. Published by Elsevier B.V. All rights reserved.)

Tinea capitis rarely occurs in renal transplant recipients. We report this living-related renal transplant patient receiving cyclosporine-based therapy who initially presented with severe exfoliation of the scalp with yellowish-white scales and marked hair loss. The lesions extended to the frontal area and both cheeks, resulting in several skin ulcers with perifocal erythematous inflammatory changes, and palpable cervical lymph nodes. A biopsy of a skin lesion revealed fungal infection and culture yielded Microsporum canis. The patient mentioned an outbreak of ringworm in her breeding dogs during this period. After adequate treatment of the patient and her infected animals with griseofulvin and disinfection of the environment, her skin lesions resolved dramatically, with regrowth of hair.

Background: Kidney transplantation using organs from executed prisoners is a subject of controversy from the viewpoint of ethics. However, few reports have addressed the clinical outcome beyond the ethical issue., Methods: Between January 1990 and September 2004, a total of 435 kidney transplant recipients (group M) who underwent transplantation in 26 different hospitals in China were followed up at our hospital. It is believed that all the organs came from executed prisoners. The clinical data were retrieved and compared to those of 200 kidney transplant recipients (group T) who underwent transplantation in our hospital during the same period., Results: There was no significant difference between these 2 groups (T vs. M) in terms of hepatitis B virus infection (10.5% vs. 12.1%) or surgical complication rate (6.5% vs. 5.6%). The 1st-year acute rejection rate was significantly lower in group M (31.1% vs. 24.5%, p=0.015). The 1-year, 5-year, and 10-year patient survival rates were 94.3%, 89.5%, and 85.2%, respectively, for group T and 92.6%, 83.6%, and 76.7%, respectively, for group M (p>0.05); the corresponding graft survival rates were 91.4%, 82.6%, and 66.9%, respectively, for group T and 91.6%, 80.0%, and 61.4%, respectively, for group M (p>0.05). When patients were stratified according to the year of transplantation, patients who underwent transplantation between 2000 and 2004 had significantly better graft survival rates in both groups., Conclusion: We conclude that kidney transplantation using organs from executed prisoners had a clinical outcome similar to that of transplantation performed in our hospital during the same period.

Background: The treatment of immunoglobulin (Ig) A nephropathy remains a subject of controversy. To clarify if it is justified to use corticosteroid and cyclophosphamide in the treatment of IgA nephropathy patients with heavy proteinuria and/or a moderate-severe pathological grading of at least grade II, we retrospectively analyzed the medical data of IgA nephropathy patients in our hospital., Methods: Totally 60 patients from 370 cases of biopsy-proved IgA nephropathy in our hospital between 1983 and 1999 met the selection criteria and were enrolled into this analysis. These patients received either corticosteroid alone or in combination with cyclophosphamide. The analysis of the progression of renal disease by serum creatinine and changes in the level of proteinuria were based on an on-treatment approach. Kidney survival curve was by Kaplan-Meier analysis and compared among different subgroups., Results: Of the 60 patients, 20 cases (33.3%) (Group 1) reached a complete remission of proteinuria by prednisolone alone. The other cases received a combination therapy with corticosteroid and cyclophosphamide, which resulted in complete remission in 17 cases (28.3%) (Group 2), partial remission in 9 cases (15.0%) (Group 3) and complete resistance in 14 patients (23.3%) (Group 4). The renal survival rate was significantly worse in Group 4 (p < 0.05) as compared with other groups., Conclusions: We conclude that corticosteroid and combination therapy with corticosteroid and cyclophosphamide was effective treatment in 61.6% (Groups 1 and 2) of IgA nephropathy patients with heavy proteinuria and/or moderate-severe pathological lesions provided their initial serum creatinine level was < or = 3 mg/dl.

Background: This study compared the polymorphisms of angiotensin-converting enzyme (ACE), angiotensinogen (AGT) and angiotensin II type 1 receptor (AT1R) gene between type II diabetes with diabetic nephropathy (DN) in end-stage renal disease (ESRD) and those of the normal individuals in Taiwan., Methods: 129 patients with type II diabetes in ESRD from three dialysis centers were compared to 116 age and blood pressure-matched normal individuals. Polymerase chain reaction (PCR) specific for ACE gene was tested for insertion/deletion polymorphism. M235T and T174M variant polymorphisms of the AGT gene and the AT1R A1166C polymorphism were also tested according to previously described protocols., Results: Between the two groups, frequencies of the alleles and the genotypes in ACE gene polymorphism were comparable. There was no significant difference of the ACE insertion and deletion polymorphism and AT1R gene polymorphism between the two groups. The allele frequencies of AGT point mutation at 235 (M235T) was significantly higher in DM nephropathy but the genotypic frequencies were not. In the AGT point mutation at 174 (T174M), the frequencies of both of alleles and genotypes were significantly higher in the DM nephropathy patients., Conclusions: In conclusion, there were significantly higher frequencies of alleles and genotypes in AGT point mutation at 174, which had never been reported before. In AGT point mutation at 235, there were significantly higher frequencies of alleles, but not genotypes in diabetic nephropathy. Our study suggested that the AGT gene plays an important role in diabetic nephropathy.