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Tzong-Shinn Chu

Publications and source records attributed to Tzong-Shinn Chu.

10 recordsLinked to original sources
PubMed2006

Diltiazem suppresses collagen synthesis and IL-1beta-induced TGF-beta1 production on human peritoneal mesothelial cells.

BACKGROUND: After long-term treatment with continuous ambulatory peritoneal dialysis (CAPD), some patients may develop peritoneal fibrosis. Peritoneal mesothelial cells (PMCs) participate in the inflammatory reactions in the peritoneal cavity, and transforming growth factor-beta1 (TGF-beta1) and interleukin-1beta (IL-1beta) are involved in peritoneal fibrosis. Diltiazem is used frequently in patients with CAPD to treat hypertension. The objectives of this study were to examine the effects of diltiazem on collagen- and IL-1beta-induced TGF-beta1 production on human PMCs and the signalling pathway of diltiazem in this induction. METHODS: Human PMCs were cultured from the enzymatic disaggregation of human omentum. Collagen synthesis was measured by [3H]proline incorporation into pepsin-resistant, salt-precipitated collagen. The expression of collagen I and III, and TGF-beta1 mRNA was evaluated by northern blotting. The production of TGF-beta1 by human PMCs was measured by immunoassay. The changes of intracellular calcium level after adding Fura-2-AM were measured by fluorescence spectrophotometry. Western blotting was used to assess mitogen-activated protein kinase (MAPK) signalling proteins. RESULTS: We found that diltiazem (<0.2 mM) inhibited collagen I and III mRNA expression and collagen syntheses on a dose-dependent basis. Diltiazem (0.2 mM) suppressed IL-1beta- (5 ng/ml) induced TGF-beta1 production on human PMCs at both the protein and mRNA levels. Diltiazem (0.2 mM) also inhibited IL-1beta- (5 ng/ml) induced collagen I and III mRNA expression. Intracellular calcium levels did not change after the treatment with diltiazem, IL-1beta or both. The IL-1beta-treated human PMCs increased phospho-JNK (stress-activated c-Jun N-terminal kinase) and phospho-p38 MAPK expression, while diltiazem could suppress this phenomenon. CONCLUSIONS: Diltiazem suppressed collagen synthesis of human PMCs and inhibited IL-1beta-induced TGF-beta1 production on human PMCs. This signalling transduction may be through p38 MAPK and JNK pathways instead of intracellular calcium. These results suggest diltiazem to be a potential therapeutic regimen in preventing peritoneal fibrosis and support further in vivo studies.

Analysis of Variance↗
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

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

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

Vasodilator agents inhibit opossum kidney proximal tubular cell growth.

Renal tubule cell hyperplasia and hypertrophy have been regarded as antecedents of tubulointerstitial fibrosis. Dipyridamole and pentoxifylline inhibit rat glomerular mesangial cell growth. The purpose of this study was to examine the effects of pentoxifylline and other vasodilators on opossum kidney proximal tubular (OKP) cell growth. A modified 3-(4,5-dimethylthiazil-2-yl)-2,5-diphenyltetrazolium bromide assay was used to evaluate cell proliferation in OKP cells. Pentoxifylline caused a dose-dependent inhibition of serum-stimulated proliferation of OKP cells: inhibition was 17%, 25%, and 37% at 0.03 mg/mL, 0.1 mg/mL, and 0.3 mg/mL, respectively. Dipyridamole 1.7 mg/L and 6 mg/L resulted in 34% and 46% inhibition, respectively. Verapamil 10(-6) M, 10(-5) M, and 10(-4) M resulted in 34%, 46%, and 67% inhibition, respectively. These inhibitory effects may contribute to renal protection or retardation of renal disease progression.

Animals↗
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↗
PubMed2002

Dopaminergic modulation of aldosterone secretions on changes of sodium intake in aldosterone-producing adenoma.

BACKGROUND: Impairment of renal dopamine excretion on high-salt diet (HS) may account for increased blood pressure (BP) in hypertensive subjects. Whether such impairment of dopaminergic activity exists in the adrenal gland is unknown. The purpose of this study was to differentiate degrees of dopaminergic inhibition of aldosterone secretion in patients with aldosterone-producing adenoma (APA). METHODS: A total of 15 patients with unilateral APA were fed a low-salt diet (LS) for 1 week, followed by another week on HS. At the end of each diet period, 24-h ambulatory BP recording, daily urine catecholamine measurement, and a metoclopramide test were performed. RESULTS: A high-salt diet increased both daytime and nighttime BP (P < .001), and urine dopamine excretion (P < .01). Intravenous injection of 10-mg metoclopramide increased plasma aldosterone concentrations (PAC) on both diets. The areas-under-the-curve for PAC between LS and HS were not different, but the area-under-the-curve for PAC increment was greater on HS (P < .05). Six patients with increment areas on HS greater than those on LS by 50% were termed "suppressible," and the remainders as "nonsuppressible." On HS, the so-called suppressible subjects had greater urine dopamine and less urine norepinephrine excretions (P < .05). The nonsuppressible subjects had greater percentage increase of nighttime BP by HS than the suppressible (for systolic BP, 13.1% v 4.5%, P < .01; for mean BP, 12.0% v 5.1%, P < .01, respectively), but no difference in daytime BP. CONCLUSIONS: Two subtypes of APA were defined according to their responses to metoclopramide during salt manipulation. On HS, the nonsuppressible subjects, with less dopaminergic inhibition of aldosterone secretion, had less urinary DA excretion and greater BP elevation. The renal and adrenal dopaminergic activities are regulated in a parallel fashion.

Adrenal Cortex Neoplasms↗
PubMed2002

Rhabdomyolysis associated with Streptococcus pneumoniae bacteremia in a splenectomized patient.

Invasive infection due to Streptococcus pneumoniae associated with rhabdomyolysis is rare. We report the case of a 31-year-old splenectomized man with pneumococcal bacteremia and paranasal sinusitis who presented with flu-like symptoms preceding a fulminant course of sepsis and rhabdomyolysis with acute renal failure and elevated creatinine phosphokinase. Although the possible mechanisms of rhabodomyolysis associated with pneumococcal infection remain unclear, this report may serve to alert clinicians of the need to prevent fulminant pneumococcal infection by vaccination and treatment with antibiotic prophylaxis in splenectomized patients.

Acute Kidney Injury↗