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Jenq-Wen Huang

Publications and source records attributed to Jenq-Wen Huang.

15 recordsLinked to original sources
PubMed2006

Spontaneous bilateral bacterial empyema in a patient with nephrotic syndrome.

Spontaneous bacterial empyema (SBEM), a rare infectious complication among liver cirrhosis patients, is characterized by infection in the presence of pleural effusion without evidence of pre-existing pneumonia. The prevalence of SBEM in cirrhotic patients with hydrothorax is about 13%. However, it has previously not been reported in medical literature in patients with nephrotic syndrome. The most common microorganism identified is Escherichia coli, followed by Streptococcus species, Enterococcus species, Klebsiella pneumoniae, and Pseudomonas stutzeri. We present a patient with a history of nephrotic syndrome caused by membranous nephropathy, who received steroids and cyclophosphamide. He developed bilateral SBEM due to Aeromonas hydrophila and E. coli, which were isolated from the left- and right-side pleural fluid, respectively. The detailed clinical course, treatment, and outcome are described.

Adult↗
PubMed2006

Human immunodeficiency virus-associated nephropathy.

Human immunodeficiency virus-associated nephropathy (HIVAN) is characterized by high-grade proteinuria and rapid progression to end-stage renal disease (ESRD). Despite the large numbers of HIV-infected cases in Asian countries, data on HIVAN in this area are limited. We report a 54-year-old Taiwanese man with HIVAN who presented with cytomegalovirus retinitis, renal insufficiency (serum creatinine, 3.8 mg/dL) and nephrotic range proteinuria with a daily protein loss of 10.8 g. Despite highly active antiretroviral therapy (HAART) for 31 months, renal failure developed requiring maintenance hemodialysis. Renal biopsy showed collapsing focal segmental glomerular sclerosis, podocyte proliferation and tubulointerstitial nephritis with mononuclear cell infiltration. These features were compatible with HIVAN. Although hemodialysis was instituted, he died 2 months later due to nosocomial pneumonia complicated with multiple organ failure. In summary, this case of HIVAN in a Taiwanese patient shows that the condition may progress to ESRD despite successful viral suppression with HAART.

AIDS-Associated Nephropathy↗
PubMed2006

Acute renal failure caused by mushroom poisoning.

Despite the abundance of wild mushrooms growing in a variety of habitats in Taiwan, mushroom poisoning is rarely reported. Here, we report two cases of mushroom poisoning, possibly due to Amanita smithiana or a related species. A 54-year-old man and his 52-year-old wife presented with acute anuric renal failure 1 day after ingesting some white mushrooms they had collected when mountain climbing; they made a full recovery following hemodialysis and supportive treatment. Although rare, mushroom poisoning should be considered in the differential diagnoses of acute renal failure.

Acute Kidney Injury↗
PubMed2006

Levamisole-induced multifocal inflammatory leukoencephalopathy: clinical characteristics, outcome, and impact of treatment in 31 patients.

Levamisole (LEV) has been used as an immunomodulating medication in patients with recurrent aphthous ulcers and as an adjuvant for chemotherapy. LEV, with or without 5-fluorouracil (5-FU), induces multifocal inflammatory leukoencephalopathy (MIL). We identified 31 patients with LEV-induced MIL: 7 from our institution and 24 from a MEDLINE search. Twenty-one patients (67.7%) had been treated with a combination of LEV and 5-FU, while 10 patients had been treated with LEV alone. The onset of MIL was delayed in patients who took LEV and 5-FU in combination compared with the patients treated with LEV alone (11.7 +/- 3.7 vs. 4 +/- 2.5 wk, p < 0.001). Colon cancer (67.7%) was the most common indication for LEV administration. Gait ataxia occurred in 20 (64.5%) patients, and dysphagia was noted in 16 (51.6%) patients. Imaging studies revealed periventricular enhancement in 17 (54.8%) patients and supratentorial lesions in 16 (51.6%) patients. Cerebrospinal fluid studies showed lymphocytic pleocytosis in 10 of 21 (47.6%) patients. Early diagnosis of MIL and discontinuation of LEV is essential, yielding good recovery in most cases. Treatment with corticosteroids and/or intravenous immunoglobulin may be needed for this serious inflammatory encephalopathy. Twenty-nine patients exhibited improved clinical status and imaging findings after initial steroid or immunoglobulin treatment. Plasmapheresis may be an alternative regimen for patients with steroid resistance.

Adult↗
PubMed2006

Clinical characteristics of patients with segmental renal infarction.

BACKGROUND: Renal infarction is usually an underestimated disease due to its rare and non-specific presentations; the renal survival of these patients is not well studied. The aim of the present analysis is to study the clinical features and outcome in patients who had documented renal infarction. METHODS: Twenty-two patients (12 men and 10 women, mean age of 57.7 +/- 3.44 years (28.4-83.3 years)) with image-confirmed segmental renal infarction in the past 15 years were enrolled. All patients were followed up at outpatient department with a median of 4 years (1-14 years). Initial and follow-up clinical characteristics and laboratory results were recorded. RESULTS: The most common underlying disease was cardiovascular disease. Renal infarction often presented with non-specific symptoms, including flank pain (55%), vague abdominal pain (50%), nausea/vomiting (46%) and fever (27%). The levels of leucocytes, lactate dehydrogenase, blood urea nitrogen and serum creatinine were all elevated at admission. The early diagnosis group (12/22) had more obvious flank pain, nausea/vomiting (P < 0.001) and higher alanine transaminase (P = 0.02). It also predisposed to undergo antiplatelet or anticoagulant therapy (all P < 0.04). During follow up, there was no recurrence in the whole study group, and a trend of better recovery of renal function was noted in the early diagnosis group. CONCLUSION: The serum creatinine level correlates with longer hospitalization length (P < 0.05). As regards long-term prognosis, no definite factor or treatment was found to have significant effect in segmental renal infarction patients. However, early diagnosis and early initiation of treatment seems to have a positive effect on future renal outcome.

Adult↗
PubMed2005

Peritoneal fibrosing syndrome: pathogenetic mechanism and current therapeutic strategies.

Peritoneal dialysis (PD) has been established as a main renal replacement therapy for approximately 20 years. However, long-term peritoneal exposure to high glucose and other unphysiologic contents in the PD solution may potentiate the development of peritoneal fibrosing syndrome (PFS) in PD patients. PFS is composed of a wide spectrum of peritoneal alterations, which has been observed in PD patients. Molecular studies have shown that the fibrogenic effect of peritoneal mesothelial cells and the accompanying accumulation of extracellular matrix in the peritoneum are key events leading to PFS. In this review, we highlight the impact of PFS and its pathogenetic factors, including bioincompatible PD solution, multidisciplinary inflammatory mediators, and stimulatory cytokines in the peritoneal cavity. Current therapeutic strategies based on both clinical and basic evidence for the prevention or treatment of PFS are also reviewed.

Dipyridamole↗
PubMed2005

Renal hypouricemia is an ominous sign in patients with severe acute respiratory syndrome.

BACKGROUND: The purpose of this study is to determine the incidence and significance of hypouricemia in patients with severe acute respiratory syndrome (SARS). Pulmonary lesions in patients with SARS are thought to result from proinflammatory cytokine dysregulation. Acute renal failure has been reported in patients with SARS, but whether cytokines can injure renal tubules is unknown. METHODS: Sixty patients diagnosed with SARS in Taiwan in April 2003 were studied. Patients were identified as hypouricemic when their serum uric acid (UA) level was less than 2.5 mg/dL (<149 micromol/L) within 15 days after fever onset. Urine UA and creatinine levels were available for 43 patients; the serum cytokines interleukin-6 (IL-6), IL-8, and tumor necrosis factor-alpha (TNF-alpha) were measured in 16 patients. RESULTS: Sixteen patients (26.7%) had hypouricemia (UA, 1.68 +/- 0.52 mg/dL [100 +/- 31 micromol/L]). No differences in age, sex, symptoms, vital signs, hemogram, or other biochemistry data existed between the hypouricemic and normouricemic groups. Fractional excretion (FE) of UA (FE UA) in 12 hypouricemic patients was 39.6% +/- 23.4%, significantly greater than that of 31 normouricemic patients (16.4% +/- 11.4%; P < 0.0001). After adjustments for age and sex, high FE UA was significantly associated with the lowest blood oxygenation (P = 0.001; r = -0.624). The number of catastrophic outcomes (endotracheal intubation and/or death) adjusted for older age and sex showed that hypouremic patients had an odds ratio of 10.57 (confidence interval, 2.33 to 47.98; P = 0.002). Kaplan-Meier curves for catastrophic outcome-free results showed significant differences between patients with normouricemia or hypouricemia (P = 0.01). Serum IL-8 levels correlated significantly with FE UA (P < 0.001; r = 0.785) and inversely with serum UA level (P = 0.044; r = -0.509); neither IL-6 nor TNF-alpha level showed such correlations. CONCLUSION: One fourth of patients with SARS developed hypouricemia, which might result from a defect in renal UA handling and was associated with a high serum IL-8 level. Renal hypouricemia is an ominous sign in patients with SARS.

Carrier Proteins↗
PubMed2005

CAPD-related peritonitis due to Salmonella enteritidis in a patient with SLE.

Patients with systemic lupus erythematosus are prone to various infections, often associated with high mortality. Salmonella species are a rare cause of continuous ambulatory peritoneal dialysis (CAPD) peritonitis, but patients with lupus are susceptible to infection caused by Salmonella species. A 47-year-old woman who had systemic lupus erythematosus with end-stage renal disease and was undergoing CAPD presented with fever, watery diarrhea, abdominal pain, and turbid dialysate effluent. The effluent culture yielded Salmonella enteritidis. Although she was administered antibiotics to which the organism was susceptible in vitro, peritonitis was not cured. Her clinical condition stabilized after removal of the Tenckhoff catheter and prolonged antibiotic use. In Salmonella-related CAPD peritonitis, early catheter removal may be necessary to achieve complete treatment.

Catheterization↗
PubMed2005

Acute renal failure in patients with severe acute respiratory syndrome.

BACKGROUND AND PURPOSE: Severe acute respiratory syndrome (SARS) is caused by a new coronavirus, and results in respiratory failure. Acute renal failure (ARF) may also occur and/or complicate the disease course, however, its incidence, causes and impact in SARS patients are not known. METHODS: ARF patients were identified from a total of 78 (33 men and 45 women) probable SARS cases admitted to a single hospital. The clinical features of patients with ARF were characterized, and the etiologies analyzed. RESULTS: Patients were assigned to ARF (n = 13; 17%) and non-ARF groups (n = 65). Patients with ARF were older than their non-ARF counterparts. ARF developed 7.2 +/- 4.3 days after admission. The incidence of ARF was higher in males (77% vs 35%; p < 0.05). Comorbidities of diabetes and heart failure were more common in patients who developed ARF (38% vs 6%, p < 0.01 and 38% vs 2%, p < 0.001, respectively) and the incidence of respiratory failure (85% vs 26%, p < 0.001) and mortality (77% vs 8%, p < 0.001) were also higher. Multiple organ system failure usually accompanied ARF. Hypotension (77%) caused by nosocomial infections, gastrointestinal bleeding, or SARS per se, and rhabdomyolysis (43%) was associated with ARF in addition to pre-renal factors. Five patients in the ARF group and 1 female patient with end-stage renal failure underwent renal replacement therapy during hospitalization; however, both eventually died. Of the 16 medical staff performing renal replacement therapy, none was subsequently infected with SARS coronavirus. CONCLUSIONS: Development of ARF during the disease course in SARS patients is associated with catastrophic outcome. The cause of ARF in SARS patients is often associated with pre-renal factors, hypotension, rhabdomyolysis, and previous comorbidities including diabetes and old age. Universal precautions to prevent viral transmission are mandatory for medical staff performing renal replacement therapy.

Acute Kidney Injury↗
PubMed2004

Factors associated with increased plasma homocysteine in patients using an amino acid peritoneal dialysis fluid.

BACKGROUND: Although amino acid peritoneal dialysate (AAPD) substitution is thought to improve protein-energy malnutrition in patients undergoing peritoneal dialysis (PD), it may also increase plasma homocysteine (Hcy) levels due to the methionine load in the dialysate. However, it is still unclear which factors are important for elevating Hcy in patients treated with AAPD. METHODS: Sixteen malnourished PD patients (age 48+/-18 years) were treated daily with one exchange of 1.1% AAPD for 3 months. The effects of AAPD on nutrition, Hcy, methionine, leptin and insulin resistance were studied. We also analysed factors that influenced plasma Hcy levels. RESULTS: We found a transient increase in serum albumin (P<0.01) after 1 month treatment, especially in patients with serum albumin < or = 3.5 g/dl. Total plasma Hcy increased markedly after AAPD (the peak at month 2, P<0.001) and returned to baseline after ceasing AAPD, despite no changes in dietary methionine intake and serum methionine levels. Eight patients with Hcy increments >5.65 microM (the median) had lesser dietary intakes of protein (P = 0.01) and methionine (P = 0.028), lower body fat mass (P = 0.05) and lower aspartate transaminase (AST) (P = 0.008) before AAPD treatment than patients with lower increments. DeltaHcy was inversely correlated with baseline dietary methionine intake (r = -0.61), protein intake (r = -0.54) and AST (r = -0.51) (all P<0.05). There was no change in leptin or insulin resistance. AAPD treatment significantly increased Kt/Vurea (P<0.001), weekly creatinine clearance (P<0.05) and peritoneal glucose transport (P<0.05). CONCLUSIONS: Treatment with 1.1% AAPD transiently increased serum albumin in malnourished PD patients. However, the methionine load from the dialysate in this study significantly elevated plasma Hcy levels, especially in patients with lower protein and methionine intakes, and lower AST levels. Further long-term studies will be needed to clarify potential nutritional benefits and adverse effects of AAPD.

Adult↗
PubMed2004

Adiponectin in peritoneal dialysis patients: a comparison with hemodialysis patients and subjects with normal renal function.

BACKGROUND: Adiponectin, a cytokine with anti-inflammatory properties that is secreted from adipose tissue, is associated with insulin resistance. Adiponectin has been shown to be a predictor of cardiovascular events in both the general population and patients undergoing hemodialysis (HD); however, its role in peritoneal dialysis (PD) analogues remains unclear. METHODS: Serum adiponectin levels, measured by means of enzyme-linked immunosorbent assay in subjects with normal renal function and patients undergoing HD or PD (28 subjects in each group), were analyzed to establish the relationship between adiponectin and lipid levels, as well as insulin resistance. In the second study, 104 PD patients were recruited to analyze the relationships between serum adiponectin level and residual renal and peritoneal function and C-reactive protein (CRP) level. Independent factors for serum adiponectin level were determined from multiple linear regression. RESULTS: No significant difference was shown comparing serum adiponectin levels of PD and HD patients; however, both were significantly greater than those of control subjects (P < 0.01). Negative associations were shown between adiponectin and triglyceride (TG; P < 0.01) and insulin levels (P < 0.05) and homeostatic model assessment of insulin resistance (P < 0.01) for the former 2 groups; however, a positive association was shown for high-density lipoprotein (HDL) level (P < 0.05). Neither HD nor PD removed adiponectin significantly, with levels for the PD group negatively associated with residual renal function (P < 0.01) and CRP level (P < 0.001). PD patients administered glucose-lowering agents had lower adiponectin levels; however, lipid-lowering agents and renin-angiotensin blockades did not appear to affect them. Independent determinants for serum adiponectin level in PD patients were TG, HDL, and CRP levels and body mass index, after adjustment for age, sex, PD therapy duration, and diabetes. Adiponectin levels were not associated with left ventricular mass or ejection fraction. As for HD patients, PD patients had high adiponectin levels; adiponectin was not removed effectively using either of the studied dialysis modalities. In addition to a significant relationship with the components of insulin resistance, adiponectin level was associated with CRP level in these patients. CONCLUSION: These results indicate that adiponectin level in PD patients may be a good indicator of cardiovascular disease risk.

Adiponectin↗
PubMed2004

The effect of iron stores on corrected QT dispersion in patients undergoing peritoneal dialysis.

BACKGROUND: Arrhythmia and sudden death represent striking features in patients with end-stage renal disease (ESRD). Increased QT dispersion has been shown to be associated with arrhythmias. Abnormal excitability and heterogeneous cardiac iron deposition may cause the arrhythmogenesis of human siderotic heart disease. Iron overload and precipitation with its toxicity in cardiac muscles may, therefore, cause QT prolongation in dialysis patients. METHODS: A total of 102 (65 women, 37 men; mean age, 47.7 +/- 13.4 years) nondiabetic patients undergoing peritoneal dialysis (PD) were enrolled in this study. Another 102 subjects with a serum creatinine level less than 1.5 mg/dL (133 micromol/L) were used as matched control subjects. The PD patients were divided into 2 groups according to whether their computerized measurements of corrected QT (QTc) dispersion were longer than 74 ms. A value of 74 ms has been associated with risk for serious arrhythmias related to sudden death in dialysis patients. RESULTS: The QTc dispersion of PD patients was significantly longer than that of the control subjects (69.8 +/- 40.0 versus 55.2 +/- 33.6 ms; P < 0.01). Thirty-eight PD patients with QTc dispersion longer than 74 ms had lower blood pressure ( P = 0.01), fewer left ventricle masses ( P = 0.036), and lower serum albumin levels (P = 0.046) but higher levels of serum calcium (P = 0.038) and transferrin saturation (TSAT; P = 0.022) than the other patients. Multivariate analysis identified TSAT as an independent factor for QTc dispersion (r = 0.432, P < 0.001). A linear relationship showed that at 74 ms of QTc dispersion, TSAT was 35.2%. CONCLUSION: Long-term PD patients have longer QTc dispersion than subjects with normal renal function. The high body iron stores in these patients increase the risk of increased QT dispersion. The concern over iron overload in dialysis patients is not only because of its oxidative toxicity, but also its precipitation of arrhythmias, which may be measured by the surrogate marker of QTc dispersion.

Adult↗
PubMed2003

Pentoxifylline modulates intracellular signalling of TGF-beta in cultured human peritoneal mesothelial cells: implications for prevention of encapsulating peritoneal sclerosis.

BACKGROUND: Peritoneal matrix accumulation is a major characteristic of encapsulating peritoneal sclerosis (EPS), which is a serious complication in long-term peritoneal dialysis (PD) patients. We reported previously that TGF-beta stimulates collagen gene expression in cultured HPMC, and is attenuated by pentoxifylline (PTX). The SMAD family and the mitogen-activated protein kinase (MAPK) (ERK1/2, JNK and p38(HOG)) pathways have been shown to participate in TGF-beta signalling. However, how PTX modulates the intracellular signalling downstream to TGF-beta remains undetermined in HPMC. In this study, we explored these signalling pathways in HPMC, and investigated the molecular mechanisms involved in the inhibitory effects of PTX on TGF-beta-induced collagen gene expression in HPMC. METHODS: HPMC was cultured from human omentum by an enzyme digestion method. The expression of collagen alpha1(I) mRNA was determined by northern blotting, while the SMAD proteins and the MAPK kinase activity were determined by western blotting. RESULTS: TGF-beta-stimulated collagen alpha1(I) mRNA expression of HPMC was inhibited by PTX. The Smad2, ERK1/2 and p38(HOG) pathways were activated in response to TGF-beta. However, TGF-beta displayed no activation of the JNK pathway in HPMC. The addition of PD98059 and SB203580, which blocked the activation of ERK1/2 and p38(HOG), respectively, suppressed the TGF-beta-induced collagen alpha1(I) mRNA expression. At a concentration (300 micro g/ml) that inhibited the collagen gene expression, PTX suppressed the ERK1/2 and p38(HOG) activation by TGF-beta. In contrast, PTX had no effect on the TGF-beta-induced activation of Smad2, under the same concentration. CONCLUSION: PTX inhibits the TGF-beta-induced collagen gene expression in HPMC through modulating the ERK1/2 and p38(HOG) pathways. Our study of PTX may provide the therapeutic basis for clinical applications in the prevention of EPS.

Blotting, Northern↗
PubMed2002

Association between serum aspartate transaminase and homocysteine levels in hemodialysis patients.

BACKGROUND: Hyperhomocysteinemia is a common metabolic abnormality in patients undergoing hemodialysis (HD). An impairment of remethylation of homocysteine (Hcy) is seen in these patients but cannot account completely for hyperhomocysteinemia. Homocysteine is derived from transmethylation of methionine that can be metabolized through transamination pathway alternatively. However, the significance of transamination in the metabolism of Hcy in HD patients is not studied. METHODS: A total of 145 patients undergoing HD for more than 3 months were enrolled in the study. Vitamins B were not prescribed routinely to these patients. Among them, 49 patients had positive test results for hepatitis B surface antigen or antihepatitis C virus antibody. Serum Hcy, folic acid, vitamin B12, pyridoxal 5' -phosphate, methionine, and transaminase were measured, and parameters of dialysis adequacy were calculated. Multiple linear regression model was used to analyze the factors determining Hcy levels. RESULTS: All patients had higher Hcy levels (40.3 +/- 28.3 micromol/L) than the upper limit of reference range 15 micromole/L. The levels of vitamin B(12) were all higher than 160 pg/mL (118 pmol/L). Only 9 patients had serum folic acid lower than 3 ng/mL (6.8 nmol/L). The predialysis Hcy levels were correlated with age, HD duration, folic acid, vitamin B12, and aspartate transaminase (AST) levels among all patients or the subgroup of hepatitis noncarriers with linear multiple regression analysis. In hepatitis carriers, AST levels were not associated with Hcy. A cutoff value of AST less than 14 U/L predicted a predialysis Hcy level higher than 27 micromol/L in noncarriers, with a sensitivity of 83.9% and a specificity of 50.2%. CONCLUSION: In addition to vitamin B12 and folic acid, the serum AST levels correlated inversely with predialytic Hcy levels independently in hepatitis noncarrier HD patients. The results suggest that transamination may play an important role in the development of hyperhomocysteinemia when impaired transmethylation is encountered in uremic patients.

Aspartate Aminotransferases↗