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- 저자 : 이용진(Yongjin Yi) (검색결과 4 건)
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측정 소변검사와 24시간 소변검사에서 측정한 소디움 배설 추정량의 비교 - 소변 검사 시간대에 따른 상관도 분석
이용진 ( Yongjin Yi ),박혜인 ( Hayne Park ) 국군의무사령부 2019 대한군진의학학술지 Vol.50 No.1
Objectives; Measuring salt intake is important for monitoring salt diet in renal disease patients. 24hr urine collection is widely accepted as gold standard method for measurement of sodium intake. Due to burdensome of the 24hr collection, a single collection of spot urine has been studied to supersede 24hr urine sample. However, it is uncertain that which time period is most suite for 24hr urine sodium amount. Methods; To find out the best time to estimate 24hr urine sodium excretion, we separately collected urine aliquots at every voiding urine and examined simultaneously and conducted a correlation analysis within the samples. Urine samples were collected over 24 hours in a total of 26 renal disease patients (15 IgAN, 2 thin basement membrane disease, 8 nonspecific hematuria, 1 minimal change disease). Before putting in a urine bag, each urine specimen was examined by divided into 5~10cc of an aliquot and the remaining urine were collected in the urine bag and examined as 24hr urine specimen. We compared measured 24hr urine sodium excretion and estimated daily sodium excretion from each spot urine over the time period. Results; All urine samples were divided according to time as follows: Overnight (12 AM to first morning urine), Morning (second morning urine to 12 PM), Afternoon (12 PM to 6 PM), Evening (6 PM to 12 AM). All subjects were male and mean age was 23.0±5.5 years. Mean height and weight were 176.5±4.7 cm and 73.1±8.5 kg. Average urine excretion rate of creatinine and sodium were 2049±396 mg/day and 3492±1400 mg/day, respectively. Mean level of spot urine sodium/creatinine ratio was 1908±992 mg/g, which was significantly lower than measured urine sodium excretion (p<0.001). Compared with the measured 24hr sodium excretion, urine samples during overnight time showed the highest correlation (r=0.829, p<0.001, pairs n=31). Afternoon (r=0.748, p<0.001, pairs n=58), morning urine (r=0.506 p=0.010, pairs n=25) and evening (r=0.412, p=0.016, pairs n=34) samples also showed significant correlation coefficients. First morning urine sample in all subjects showed highest correlation with 24hr urine sodium excretion (r=0.836, p<0.001, n=26). The correlation analysis of and second morning urine (r=0.521 p=0.006, n=26) showed relatively low correlation than first morning time aliquots. Conclusions; Among the spot urine specimens, the overnight samples before second morning urine showed the highest correlation with the total 24hr measured urine sodium excretion. Most estimates from spot urine were highly correlated with 24hr urine sodium excretion. However, variations of spot sodium/creatinine ratio within participants were also high, direct comparison between measured 24hr urine sodium and spot urine sodium/creatinine ratio should be caution.
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혈뇨로 시행한 신장 조직검사에서 IgA 신증으로 진단된 환자의 임상 정보를 활용한 예측 인자 개발 연구
이용진 ( Yongjin Yi ) 국군의무사령부 2019 대한군진의학학술지 Vol.50 No.1
Objectives; The IgA nephropathy is the world's most common form of single primary PSGN. The diagnosis of IgA nephropathy is made through kidney biopsy, which is usually conducted after macrohematuria occurs due to acute stress disorder, such as microscopic hematuria or upper respiratory infection. The operation of kidney biopsy is conducted by thorough inspection of gains and losses, since it is an invasive test that can cause bleeding. Although researches on prognostic factors have been carried out, not much is known about factors that can predict the diagnosis of IgA Nephropathy among hematuria patients. Methods; The research targets patients visiting Armed Forces Capital Hospital for kidney biopsy. Each patient was classified by the reason for conducting kidney biopsy, including simple diagnosis, suspected acute glomerulonephritis that occured or rapidly progressed within 3 months, suspected chronic glomerulonephritis lasting for more than 3 months, and the cause evaluation of kidney function degradation. Logistic Regression was carried out after research of medical history, clinical indicators, and laboratory opinion. Results; Among 154 hematuria patients, 96(62%) were diagnosed of IgA nephropathy and 58(38%) were diagnosed of other disease. There were no meaninful differences among these two groups in terms of age, BMI, history of smoking, family history of hematuria, hematuria period, and the occurence of macrohematuria between the two groups. Laboratory results also showed no meaningful difference in uPCR, serum creatinine concentration, and serum uric acid concentration between the two groups. There was a singnificant difference in serum IgA concentration (293.0 [231.5-367.0] vs 188.5 [151.0-266.0], p < 0.001) between the two groups. The variables that explained the occurence of IgA diagnosis in Logistic Regression were IgA/C3 ratio and diagnostic objectives. The explanation rate of the forecasting model was 39.6%. Conclusions; The study was carried out to develop a forecasting model for IgA nephropathy among hematuria patinets based on clinical data prior to biopsy. The results showed no factor that can forecast IgA nephropathy other than IgA/C3 ratio and the circumstances under which biopsy was conducted. A forward-designed, long-term tracking observation based on thorough kidney biopsy will be required henceforth.
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