Background: Effective blood pressure (BP) control is vital for preventing target organ damage, and combination therapy offers added benefits when single-agent treatment is insufficient. This cohort study examined whether Telminuvo, a single-pill combination of telmisartan and S-amlodipine, effectively maintains kidney function as a target organ in a large cohort of Korean patients. Methods: A total of 4,934 patients from 30 hospitals were treated with Telminuvo for over six months, with BP, estimated glomerular filtration rate (eGFR), electrolyte levels, and adverse events monitored throughout the study period. Results: Among the participants, 1,463 (29.7%) used Telminuvo for less than 1 year, while the remainder used it for longer. At baseline, the systolic and diastolic BP averaged 140.2 ± 18.4 mmHg and 82.1 ± 13.4 mmHg, respectively, which significantly decreased to approximately 130 and 75 mmHg after the initiation of treatment. The baseline eGFR of 79.3 mL/min/1.73 m2 remained stable over three years, regardless of the initial eGFR levels. Within the first six months, acute kidney injury (defined as either a ≥ 0.3 mg/dL increase in serum creatinine or a ≥ 50% increase from baseline) occurred in 6.6% of patients, while hyperkalemia (defined as serum potassium levels > 5.5 mmol/L) was observed in 3.2% of patients. Conclusion: This cohort study demonstrates that Telminuvo effectively reduces blood pressure without compromising kidney function. Furthermore, the findings provide additional insights into drug-related adverse events, which will be valuable for clinicians in the real-world prescribing of Telminuvo.

• Combination therapy
• Hypertension
• Kidney function
• Safety

Osmotic demyelination syndrome (ODS) is a rare neurological disorder associated with osmotic imbalances. Traditionally, ODS has been known to occur following the rapid correction of hyponatremia; however, ODS has also been reported concerning hypernatremia and hyperglycemia. Cytotoxic lesions of the corpus callosum (CLOCC), identified using transient magnetic resonance imaging, can arise from various causes, including drugs, vascular diseases, infections, and metabolic disturbances such as electrolyte imbalances and dysglycemia. The simultaneous occurrence of ODS and CLOCC is extremely rare. Here, we report a case whereby a 57-year-old male initially developed CLOCC via severe hypernatremia and hyperosmolar hyperglycemic state (HHS) was also subsequently identified with ODS. Physicians should know CLOCC may be an early radiologic finding in ODS associated with severe hypernatremia and HHS. Therefore, proactive brain imaging should be considered in these patients to facilitate the early detection of neurological complications.

• Consciousness
• Corpus callosum
• Hyperglycemia
• Hypernatremia
• Magnetic resonance imaging

Cystinuria is an autosomal recessively inherited genetic disorder, and is typically classified into type A, caused by mutations in SLC3A1 , or type B, caused by mutations in SLC7A9 . While the predominance of the genotypes varies among countries, due to lack of a large scale cohort, the characterization of mutations in SLC3A1 or SLC7A9 is still limited in East Asia. A 61-year-old male patient admitted to the department of nephrology, with a chief complaint of fever, chillness and left flank pain for a week. The patient had a past history of recurrent urolithiasis, with a frequency of at least 1 to 2 times a year. Computed tomography visualized 1 cm-sized stone at distal ureter, which was removed by retrograde ureteroscopy. The stone analysis documented 100% of cystine, indicating an underlying genetic disorder, cystinuria. Whole genome sequencing from peripheral blood unveiled 3 heterozygous missense mutations in coding exons of SLC3A1 gene, and 2 heterozygous missense mutations in coding exons of SLC7A9 gene. We here report a case of cystinuria with compound heterozygous mutations both in SLC3A1 and SLC7A9 genes, with a total of 5 mutant alleles in a patient.

• Cystinuria
• Heterozygote
• Mutation