Acute toxic-metabolic encephalopathy (TME) is an acute condition of glo- bal cerebral dysfunction in the absence of primary structural brain disease. Severe hypophosphatemia leads to muscle weakness and involves the diaphragm but hypophosphatemia-induced TME is very rare. Herein, we report the case of a 43-year-old woman with encephalopathy with severe hypophosphatemia during continuous renal replacement therapy. She pre- sented with features of oliguric acute kidney injury on diabetic kidney dis- ease due to volume depletion. At admission, her mental status was alert but gradually changed to stupor mentation during continuous renal replace- ment therapy. Her phosphate level was less than 0.41 mEq/L and Glasgow coma scale decreased from 15 to 5. After phosphate intravenous replace- ment and administration of phosphate-containing replacement solution, the phosphate level increased to 2.97 mEq/L and mental state returned to alert state. This case demonstrates that the level of phosphorus should be ob- served during continuous renal replacement therapy.

Background: Several factors had been suggested to contribute to the deve- lopment of hypertension in chronic glomerulonephritis (GN). This study was conducted to find the association of baseline blood pressure (BP) with patho- physiologic findings and later renal progression in chronic GN. Methods: Clinico-pathological findings including serum creatinine (Cr), pro- teinuria, pathological findings, and urinary Na excretion were analyzed in a total of 233 patients with IgA nephropathy from The Kyung-Hee Cohort of GN. Glomerular surface area (GSA) was measured by imaging analysis and urine angiotensinogen (AGT) concentrations by human ELISA kits. Results: Systolic BP was ≥130 mmHg in 124 patients (53%). Systolic BP was negatively correlated with follow-up eGFR (r=-0.32, p

Background: Aldosterone-induced glomerular hyperfiltration can lead to mas- ked preoperative renal dysfunction in primary aldosteronism (PA) patients. We evaluated whether PA patients had a higher prevalence of acute kidney injury (AKI) after unilateral adrenalectomy. In addition, we identified risk factors for AKI in these subjects. Methods: This retrospective study included 107 PA patients, and 186 pheo- chromocytoma patients as a control group, all of whom underwent adrena- lectomy between January 2006 and November 2017 at Yonsei University Severance Hospital. The primary outcome was AKI within 48 hours after ad- renalectomy. Univariate and multivariate logistic regression analyses were performed to identify predictors of AKI after adrenalectomy. Results: Overall incidence of AKI was 49/293 (16.7%). In PA patients, the in- cidence of AKI was 29/107 (27.1%). In contrast, incidence of AKI was 20/ 186 (10.7%) in pheochromocytoma patients. Univariate and multivariate lo- gistic regression analysis both showed a higher risk of postoperative AKI in PA patients compared to pheochromocytoma patients. In addition, old age, diabetes, longer duration of hypertension, lower preoperative estimated glo- merular filtration rate, high aldosterone-cortisol ratio (ACR) and lateraliza- tion index (LI) were identified as independent risk factors for postoperative AKI in PA patients after unilateral adrenalectomy. Conclusion: Incidence and risk of postoperative AKI were significantly high- er in PA patients after surgical treatment. High ACR on the tumor side and high LI were associated with higher risk of AKI in PA patients compared to pheochromocytoma patients.

Background: The 24-hour mean blood pressure (mBP) is the best predictor of organ damage; however, it is not easily applicable in clinical practice. The APrODiTe study suggested that systolic blood pressure (SBP) values at 7:00 AM and 9:30 PM were associated with the 24-hour mSBP in pati- ents with chronic kidney disease (CKD). We investigated the association of the SBP values at these time-points with the renal outcomes in patients with diabetic CKD during 1-year follow-up. Methods: Ninety-six patients with diabetic CKD were included at 1-year fol- low-up. The renal outcomes were an increase in the random urine protein/ creatinine ratio or estimated glomerular filtration rate (eGFR) deterioration, which means a decrease in eGFR ≥5 mL/min/1.73 m2 compared to the baseline values. Results: The baseline SBP values at 7:00 AM, and 9:30 PM, and the 24- hour mSBP were 135.6±24.9mmHg, 141.7±25.6mmHg, and 136.4±20.7 mmHg, respectively. The SBP values measured at the same time-points af- ter 1 year were similar to those at baseline. The SBP at 7:00 AM was sig- nificantly associated with eGFR deterioration in the univariate and multiva- riate analyses (odds ratio [OR]: 1.032; 95% confidence interval [CI]: 1.006- 1.059; p=0.016). The SBP at 7:00AM and 24-hour mSBP did not show a concordant association with sustained proteinuria in the linear and logistic analyses. In the subgroup analysis, the association between the SBP at 7:00 AM and eGFR deterioration persisted in patients with CKD stage 3-5 (OR: 1.041; 95% CI: 1.010-1.073; p=0.010). Conclusion: The SBP at 7:00 AM, in addition to the 24-hour mSBP, is also associated with eGFR deterioration in patients with diabetic CKD, particu- larly in those with CKD stage 3-5.

Background: Although renin-angiotensin system (RAS) blockade is recom- mended for hypertensive patients with proteinuria, the effect of RAS block- ade on Korean hypertensive patients has not been investigated. Methods: Among individuals who underwent a National Health Examination between 2002 and 2003 in Korea, hypertensive patients with proteinuria (defined as a dipstick test result ≥2+) were enrolled in this study. We in- vestigated the outcomes of two groups stratified by RAS blockade pre- scription (with RAS blockade vs. without RAS blockade). Moreover, Cox pro- portional hazard regression and Kaplan-Meier analyses were performed to examine the effects of RAS blockade on mortality and end-stage renal disease (ESRD). Results: A total of 8,460 patients were enrolled in this study, of whom 6,236 (73.7%) were prescribed with RAS blockade. The mean follow-up pe- riod was 129 months. A total of 1,003 (11.9%) patients died, of whom 273 (3.2%) died of cardiovascular (CV) events. The Kaplan-Meier curves for all- cause or CV mortality showed that the survival probability was significantly higher in the RAS blockade group than in the non-RAS blockade group. Multivariate Cox analysis also revealed RAS blockade significantly reduced the all-cause and CV mortality rates by 39.1% and 33.7%, respectively, compared with non-RAS blockade, even after adjusting for age, sex, and comorbid diseases; however, ESRD was not affected. Conclusion: In this study, we found that RAS blockade was significantly associated with a reduction in mortality but not in the incidence of ESRD. However, 26.3% of the enrolled patients did not use RAS blockade. Phy- sicians need to consider the usefulness of RAS blockade in hypertensive patients with proteinuria.