Renal relapse in patients with lupus nephritis (LN) is a risk factor for poor renal function. Therefore, there is a need to identify clinical and serological risk factors for renal relapse. A total of 108 patients with LN were enrolled in this study. All the subjects had achieved complete remission or partial remission following six months of induction therapy. We retrospectively analyzed their clinical and laboratory indices, final renal function, and kidney biopsy findings. The median follow-up period after LN diagnosis was 81 months. Renal relapse had occurred in 36 patients; it occurred in 38% and 46% of patients within five and 10 years after achievement of renal remission, respectively. There was no difference between the relapsed rate in patients with complete remission and that in those with partial remission. Clinical variables at LN onset and renal biopsy findings in the patients with sustained remission and relapsed patients were also not different. The probability of renal relapse was significantly higher in patients with an earlier age of onset of systemic lupus erythematosus (SLE) (≤ 28 years versus >28 years; HR 7.308, P=0.001), seronegativity for anti-Ro antibody (seronegativity versus seropositivity; HR 3.514, P=0.007), and seropositivity for anti-dsDNA antibody at six months after initiation of induction therapy (HR 8.269, P=0.001). Our study demonstrated that early onset of SLE, seronegativity for anti-Ro antibody and increased anti-dsDNA antibody following six months of induction therapy independently predict renal relapse among the LN patients.

Background/AimsThe true incidence of aristolochic acid nephropathy (AAN) is thought to be underestimated because numerous ingredients known or suspected to contain aristolochic acid (AA) are used in traditional medicine in Korea.MethodsWe collected data on cases of AAN since 1996 via a database in Korea. We evaluated the year of AAN development, route to obtaining AA-containing herbal medicine, gender, reason for taking AA-containing herbal medicine, clinical manifestations, histological findings, phytochemical analysis, and prognosis of patients with AAN.ResultsData on 16 cases of AAN were collected. Thirteen cases developed AAN before and three cases after the prohibition of AA-containing herbal medicine by the Korea Food and Drug Administration. Patients were prescribed AA-containing herbal medicine from oriental clinics or had purchased it from traditional markets. AAN was distributed in all age groups. Young females were most commonly exposed to AA-containing herbal medicine for slimming purposes and postpartum health promotion, while older adults took AA-containing compounds for the treatment of chronic diseases. The most common symptoms presented at hospitalization were nausea and vomiting, and acute kidney injury was accompanied by Fanconi syndrome in almost half of the patients. Phytochemical analysis of AA in herbal medicine was available in six cases. Progression to end stage renal disease (ESRD) was observed in seven patients (43.8%), and five patients (31.3%) had progressed to ESRD within 6 months of diagnosis.ConclusionsOur report shows that patients were still exposed to AA-containing herbal medicine and that there is a possibility of underdiagnosis of AAN in Korea. A stronger national supervision system of herbal ingredients and remedies in oriental medicine is needed to prevent AAN.

We investigated the impact of acute kidney injury (AKi) in elderly deceased-donors (DDs) vs. AKi in young DDs on post-transplant clinical outcomes. A total of 709 kidney transplant recipients (KTRs) from 602 DDs at four transplant centers were enrolled. KTRs were divided into young-DDKT and elderly-DDKT groups according to the age of DD of 60 years. Both groups were subdivided into non-AKI-KT and AKI-KT subgroups according to AKI in DDs. We investigated short-term and long-term clinical outcomes of non-AKI-DDKT and AKI-DDKT subgroups within young-DDKT and elderly-DDKT groups. The incidence of DGF in the AKI-DDKT subgroup was higher and the allograft function within 12 months after KT in the AKI-DDKT subgroup was lower than those in the non-AKI-DDKT subgroup in both young-DDKT and elderly-DDKT groups. Death-censored allograft survival rate was significantly lower in the AKI-elderly-DDKT subgroup than that in the non-AKI-elderly-DDKT subgroup, but it did not differ between AKI-young-DDKT and non-AKI-young-DDKT subgroup. In multivariable analysis, AKI-elderly-DDKT was an independent risk factor for allograft failure (hazard ratio: 2.648, 95% CI: 1.170-5.994, p = 0.019) and a significant interaction between AKI and old age in DDs on allograft failure was observed (p = 0.001). AKI in elderly DDs, but not in young DDs, can significantly affect long-term allograft outcomes of KtRs. With a tremendous increase in the number of patients with end-stage renal disease, donor shortage in kidney transplantation (KT) has become a worldwide crucial issue to solve 1-3. In this regard, the use of kidneys from elderly deceased donors (DDs) has been proposed as an important strategy for solving this donor shortage 4-7. It has been reported that the proportion of elderly brain death patients was higher than that of younger brain death patients and that KT from elderly DDs could give survival benefit in comparison with those remaining on dialysis 8. In addition, in contrast to living donor KT, kidney donation from elderly DD is fully free from donor safety issue. These reasons justify the use of kidney from elderly DDs.

Treatment with 1,25(OH)2D3 may have immunologic benefits by effectively suppressing the Th17-related immune responses in KTRs on Tac-based immunosuppression.

We investigated if clinical outcomes after kidney transplantation (KT) from deceased donors (DDs) with high Kidney Donor Profile Index (KDPI) can be different according to the age of KT recipients (KTRs). Six-hundred fifty-seven KTRs from 526 DDs were included from four transplant centers. We divided KTRs into elderly-KTR and young-KTR groups based on age 60 and each group was subdivided into high-or low-KDPI subgroup based on KDPI score of 65%. We compared short-term and long-term clinical outcomes among those four subgroups (low KDPI-young KTR, low KDPI-elderly-KTR, high KDPI-young-KTR, high KDPI-elderly-KTR). In short-term outcomes including acute rejection, BK virus and CMV infection, there was no significant difference among the four subgroups. In the long-term outcomes, the development of cardiovascular disease was higher in the high KDPI-elderly-KTR group than the other groups. In comparison of allograft survival rate, the high KDPI-young KTR subgroup showed highest risk for allograft failure and there was significant interaction between high-KDPI donors and young-KTR on allograft survival rate (P = 0.002). However, there was no significant difference in comparison of the patient survival rate. In conclusion, clinical impact of high-KDPI in DDs on posttransplant allograft survival may be less significant in elderly-KTR than in young-KTR. The number of elderly patients with end-stage renal disease (ESRD) has increased globally parallel to the increases in mean life expectancy over the past several decades 1,2. According to the Korean ESRD Registry data, only 8% of the total number of ESRD patients were older than age 60 in 2004, which increased rapidly to 43.9% in 2016. Accordingly, the proportion of elderly patients undergoing kidney transplantation (KT) showed an almost six-fold increase, from 2% in 2000 to 11.6% in 2016 3. In terms of clinical outcomes, KT offers a better quality of life, cardiovascular stability, and improved survival compared to peritoneal dialysis (PD) or hemodialysis (HD) in

Insufficiency fractures occur within weakened bones that are unable to withstand the stress of every day normal activities. The spine, pelvis, and lower long-bone extremities are common sites of insufficiency fractures. Spontaneous sternal insufficiency fracture (SIF) has rarely been reported in elderly patients. To recognise a sternal insufficiency fracture is important in selecting the adequate diagnostic procedures.

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BACKGROUND Coronary artery calcification is an established marker of risk of future cardiovascular events. Despite this, plaque calcification is also considered a marker of plaque stability, and increases in response to medical therapy. OBJECTIVES To explore the impact of plaque calcification at a lesional and patient level on the natural history of coronary artery disease. METHODS This analysis included 925 patients with 2,568 lesions from the PARADIGM (Progression of atherosclerotic plaque determined by computed tomographic angiography imaging) registry, in which patients underwent serial coronary computed tomography angiography (CCTA). Plaque calcification was examined using calcified plaque volume (CPV) and percent calcified plaque volume (PCPV), calculated as (CPV/plaque volume (PV))*100. RESULTS CPV was strongly correlated with PV (r =0.780, p < 0.001) at baseline, and plaque progression (r=0.297, p < 0.001), however this association was reversed after accounting for plaque volume at baseline (r=-0.146, p < 0.001). In contrast PCPV was an independent predictor of a reduction in PV (r=-0.11, p<0.001) in univariable and multivariable linear regression analysis. Patient-level analysis showed that CPV showed an independent association with incident MACE (HR 3.01, 95% CI:1.58-5.72), whilst an increased PCPV was an independent predictor for MACE freesurvival (HR 0.529, 95% CI:0.229-0.968) in multivariable analysis. 4 CONCLUSIONS Calcified plaque is a marker for risk of adverse event and disease progression due to its strong association with the total plaque burden. When considered as a percentage of the total plaque volume, increasing PCPV is a marker of plaque stability and reduced risk at both a lesion and patient level.