Hoon Yu

Urinary tract infection (UTI) is the most prevalent urological condition worldwide. Choosing appropriate antibiotics for patients who have fever before receiving a culture result is challenging. This retrospective study enrolled patients 394 patients hospitalized at Gangneung Asan Hospital for UTI from May 2017 to April 2021. Fever at 48 h of hospitalization was the analysis point, as this is when the response to antibiotic therapy manifest, although the results of antibiogram are not available. Multivariate analysis was performed to assess the correlation between ESBL producing bacteria (EPB) and fever at 48 h. Overall, 36.3% of patients had EPB and 27.9% had fever at 48 h. In multivariate analysis, a significant positive association was found between EPB and fever (odds ratio 1.17, 95% CI 1.05–1.30, P = 0.004) Female had negative association with multivariate model (OR 0.83, 95% CI 0.73–0.94, P = 0.004). Diabetes did not demonstrate a significant association with EPB. (OR 1.10, 95% CI 0.99–1.22, P = 0.072). Fever at 48 h is associated with EPB and could be considered a predictive factor for EPB infection in patients with UTI. Antibiotic escalation may be considered in patients with fever at 48 h.

Background Urinary tract infection (UTI) is the most prevalent urological condition worldwide; however, its management is increasingly challenging due to the increasing rates of antibiotic resistance. Choosing appropriate antibiotics for patients who have fever before receiving a culture result is challenging. We investigated the utility of fever at 48 h as a predictive factor for extended spectrum beta-lactamase -producing E. coli (EPEC). Method The study enrolled patients 394 patients hospitalized at Gangneung Asan Hospital for UTI from May 2017 to April 2021. Fever at 48 h of hospitalization was the analysis point, as this is when the response to antibiotic therapy manifest, although the results of antibiogram are not available. Multivariate analysis was performed to assess the correlation between EPEC and fever at 48 h. Result Overall, 36.3% of patients had EPEC and 27.9% had fever at 48 h. In multivariate analysis, a significant association was found between EPEC and fever (odds ratio 1.17, 95% confidence interval 1.05–1.30, P = 0.004) Conclusion Fever at 48 h is associated with EPEC, and could be considered a predictive factor for EPEC infection in patients with UTI. Antibiotic escalation may be considered in patients with fever at 48 h.

Idiopathic sudden sensorineural hearing loss (ISSNHL) is challenging for both nephrologists and otolaryngologists treating patients undergoing dialysis. This single-center, retrospective, observational study investigated the treatment outcomes of patients with ISSNHL undergoing dialysis, enrolling 700 patients (47 undergoing and 653 not undergoing dialysis) diagnosed with ISSNHL between January 2005 and December 2021 at Asan Medical Center, Republic of Korea. To balance pre-existing clinical characteristics, 1:5 propensity score matching (PSM) was performed with the patients who were not undergoing dialysis. Treatment included high-dose systemic steroid therapy or intra-tympanic steroid injections. The pure tone average of the groups was compared before and 2 weeks and 2 months after treatment. The hearing-improvement degree was evaluated using Siegel's criteria. Before PSM, age, prevalence of diabetes or hypertension, initial hearing threshold at each frequency level (0.5, 1, 2, and 4 kHz), and treatment strategies exhibited significant between-group differences. However, in the PS-matched cohort, none of the confounders showed significant between-group differences. Two months after steroid treatment, the non-dialysis patient group demonstrated significantly higher average improvement in pure tone audiometry (P = 0.029) and greater percentage of complete response according to Siegel's criteria. This study suggests that treatment outcomes for ISSNHL are significantly poorer for patients undergoing than for those not undergoing dialysis.

Introduction: Human epidermal growth factor receptor type 2 (HER2) overexpression is a prognostic factor and a therapeutic target for breast cancer; however, anti-HER2 therapies are ineffective in patients with bladder cancer. The authors investigated the effect of HER2 overexpression (HER2⁺) on the prognosis of muscle-invasive bladder cancer (MIBC). Materials and methods: This retrospective cohort study included patients who underwent initial transurethral resection of bladder tumors between 2005 and 2013 and were registered in the Korea National Health Insurance Database, which provides data on overall survival (OS). Sixty-one patients with clinically nonmetastatic de novo MIBC were included in this study. As a subgroup, 33 patients who underwent immediate radical cystectomy (RC) were analyzed. Univariate and multivariate Cox proportional hazards models were used to identify prognostic factors for survival. A multivariable binary logistic regression model was used to identify the favorable T stage. Results: Among the 61 patients with d-MIBC, 14 were HER2⁺ and 47 HER2^-. Age less than 70 years [hazard ratio (HR): 0.312, CI: 0.16–0.59, P+ status (HR: 0.40, CI: 0.19–0.85, P=0.02) were favorable prognostic factors for OS after adjusting for clinical variables. In the RC subgroup, HER2⁺ status was a significant predictive factor for the pT2 stage (HR): 36.8, CI: 4.83–797.41, PP+ status (HR: 0.11, CI: 0.02–0.54, P=0.01) were favorable prognostic factors for OS after adjusting for RC pathological variables. Conclusions: HER2⁺ status could be a marker for an indolent subset of MIBC and could predict favorable survival regardless of RC status. Moreover, HER2⁺ status not only consistently predicted a favorable T stage after RC, but also predicted better survival than pathological outcomes.

Idiopathic sudden sensorineural hearing loss (ISSNHL) poses a significant challenge for nephrologists in the treatment of dialysis patients. Due to limited studies comparing the treatment response between dialysis and non-dialysis patients, physicians face difficulties in managing this patient population. Therefore, this study aimed to investigate the treatment outcomes of dialysis patients with ISSNHL. This single-center, retrospective, observational study enrolled 700 patients diagnosed with ISSNHL between January 2005 and December 2021 at Asan Medical Center, Korea. Among them, 47 were dialysis patients, while 653 were non-dialysis patients. To balance pre-existing clinical characteristics, a 1:5 propensity score matching analysis was performed on the non-dialysis patients. The standard protocol involved administering high-dose systemic steroid therapy or intra-tympanic steroid injections. The pure tone average of the two groups was compared before initiating treatment, after 2 weeks, and after 2 months of treatment. The degree of improvement in the hearing was evaluated using Siegel's criteria. Before propensity score matching, the age, prevalence of diabetes or hypertension, initial hearing threshold at each frequency level (0.5, 1, 2, and 4 kHz), and treatment strategies exhibited statistically significant differences between the two groups. However, in the propensity score-matched cohort, none of the measured confounding variables showed statistically significant differences between the groups. Two months after steroid treatment, the non-dialysis patient group demonstrated a significantly higher average improvement in pure tone audiometry (P = 0.017) and a greater percentage of complete response according to Siegel's criteria compared to the dialysis patient group (26.8% vs. 6.4%). This study suggests that dialysis patients exhibit significantly poorer treatment outcomes for ISSNHL compared to non-dialysis patients.

Background: This study investigated whether administering erythropoiesis-stimulating agents (ESAs) improves endothelial function in patients with non-dialysis chronic kidney disease (CKD) and anemia. Methods: This single-center, prospective, single-arm comparison study enrolled patients with non-dialysis CKD (stages 4-5) and hemoglobin levels P = .001). Echocardiographic findings showed that the left ventricular mass index decreased by 11.9 g/m² (from 105.8 ± 16.3 to 93.9 ± 19.5 g/m², P = .006), and the left atrial volume index decreased by 10.8 mL/m² (from 50.1 ± 11.3 to 39.3 ± 11.3 mL/m², P = .004) after 12 weeks of ESA administration. There were no significant differences between pre- and post-ESA treatment 6-minute walk test results. No significant side effects were observed during the study period. Conclusions: This is the first clinical study to demonstrate that an ESA improves endothelial dysfunction, left ventricular hypertrophy, and left atrial volume in patients with non-dialysis CKD. Thus, ESAs may be considered as adjunctive therapy for reducing cardiovascular risk in these patients.

Evidence suggests that alkaline phosphatase attenuates inflammatory response in sepsis by lipopolysaccharide detoxification and adenosine triphosphate dephosphorylation. We sought to determine changes in alkaline phosphatase (AP) activity during septic acute kidney injury (AKI) and clinical parameters associated with AP activity. In this retrospective study, we investigated baseline (when initiating CRRT) and follow-up AP activity on day 3, and associated outcomes in patients who underwent continuous renal replacement therapy (CRRT) due to septic AKI. We analyzed the baseline AP activity of 155 patients and day 3 AP activity in 123 patients. Baseline AP activity was not associated with renal or inflammatory biomarkers, or outcomes. It did not significantly differ between the 75 survivors and 80 non-survivors (p = 0.155). AP activity was higher on day 3 than at baseline (105 U/L [interquartile range, 79–156] vs 90 U/L [interquartile range, 59–133]). In particular, liver and bone isoforms increased significantly (p < 0.05), but intestine isoforms did not reach statistical significance (p = 0.367). In addition, day 3 AP activity showed a weak correlation with length of ICU stay (r = 0.213, p = 0.018) and length of hospital stay (r = 0.216, p = 0.017), but not with survival (r = − 0.035, p = 0.698). Endogenous AP activity significantly increased in patients with septic AKI. However, neither baseline nor follow-up AP activity was associated with survival.

Although sudden sensorineural hearing loss (SSNHL) affects chronic kidney disease (CKD) patients more frequently than non-CKD patients, few reports have described SSNHL in dialysis patients. We aimed to review the characteristics of SSNHL in chronic dialysis patients and evaluate treatment responses to steroid therapy. We retrospectively reviewed the records of dialysis patients diagnosed with idiopathic SSNHL at Asan Medical Center between January 2000 and December 2014. Pure tone and speech audiometry analyzes were performed before and 2 weeks and 2 months after treatment onset to evaluate outcomes. Twenty-two patients (11 men, 11 women; mean age: 49.9 ± 11.7 years) were included; 16 (72%) and 6 (28%) had undergone hemodialysis and peritoneal dialysis, respectively, for a median of 49.2 ± 41.4 (1–144) months. End-stage renal disease was most frequently caused by diabetic nephropathy (11 cases), chronic glomerulonephritis (1 case) and unknown factors (7 cases). Common accompanying symptoms included tinnitus (68.2%), ear fullness (45.5%) and vertigo (27.3%). The mean pure tone audiometry threshold at the initial presentation was 82.6 ± 22.4 dB. At 2 months post-steroid treatment, 4 (18.2%), 4 (18.2%) and 6 (27.3%) patients exhibited a complete, partial, or slight recovery, respectively; 8 patients (36.3%) showed no improvement. Although we could not identify the specific cause of SSNHL in this population, our relatively large case series elucidates the precise clinical features of SSNHL in this population and demonstrates the outcomes of steroid treatment.

New-onset diabetes mellitus after transplantation (NODAT) is a serious complication following renal transplantation. The aim of this study was to identify the risk factors for the development of NODAT in Korean transplant patients. Recipients who underwent living donor kidney transplantation between January 2009 and April 2012 at Asan Medical Center were reviewed. Diagnosis of NODAT was defined according to the American Diabetes Association criteria. A total of 418 patients were enrolled. NODAT was diagnosed in 85 (20.4 %) patients within 1 year. By multivariate analysis, old age (odds ratio [OR], 1.05; 95 % Confidence interval [CI]: 1.01–1.08), family history of diabetes mellitus (OR, 2.48; 95 % CI: 1.04–5.94), pre-transplant high serum glucose level (OR, 1.04; 95 % CI: 1.01–1.08), and obesity (OR, 3.46; 95 % CI: 1.55–7.73) were independent risk factors for NODAT. Old age, family history of diabetes, pre-transplant high plasma glucose level, and obesity are independent factors associated with the development of diabetes after renal transplantation. In contrast, serum magnesium levels and the use of tacrolimus are not associated with the development of NODAT.