신증후군 환자에서 알부민 병용 투여가 Furosemide 이뇨 효과에 미치는 약력학 및 약동학적 유용성 평가

김도형 ( Doe Hyeong Kim ),엄재호 ( Jae Ho Earm ),한진석 ( Jin Suk Han ),김혜영 ( Hye Young Kim ),오태근 ( Tae Geun Oh ),허우성 ( Wooseong Huh ),이정상 ( Jung Sang Lee ),장인진 ( In Jin Jang ),신상구 ( Sang Gu Shin ) 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.4

There have been controversies on the effect of albumin in treating edema in nephrotic syndrome patients. We evaluated the additive diuretic effect of coadministration of furosernide with albumin in the six patients with nephrotic syndrome. We administered 160mg of furosemide intravenously for 1 hour with 100rnl of 20% albumin or 5% dextrose by random cross-over design. The urine and plasma furosemide concentrations were measured by HPLC. After the administration of furosemide alone, urine volume, urinary excretions of sodium and chloride were increased significantly compared to those of basal state(P<0.05). But, coadministration of furose- mide with albumin did not increase significantly the urine voume(2285+-445ml vs. 3023+-715ml), urinary excretions of sodium(194+-58rnmol/day vs. 282+-85 mmol/day) and chloride(213+- 54mmoVday vs. 286+- 74mmoVday) comparing to those of furosemide only cases. Addition of albumin to furosemide did not sig- nificantly changed pharmacokinetic parameters such as AUC(28.3+-5.5ug/ml hr vs 36.0+-6.7ug/ml hr), total plasma clearance(115+-30mVmin vs 108+-41ml/min), volume of distribution(0.13+-0.02L/kg vs 0.10+- 0.01L/kg), elirnination half life(1.4+-0.3hr vs 1.5+-0.3hr), and urine furosemide excretion(44+-8% vs 43+ 10%). We concluded that albumin infusion did not enhance the diuretic action of furosemide pharmaco-dynamically and pharmacokinetically in patients with nephrotic syndrome.

말기 신부전 환자에서 Furosemide와 Hydrochlorothiazide의 병용 요법의 효과

허우성,김혜영,엄재호,오하영,한진석,이정상,장인진 大韓臨床藥理學會 1998 臨床藥理學會誌 Vol.6 No.2

신증후군에 합병된 다발성 혈전증에 대한 MRA 진단 및 성공적인 혈전 용해술 1예

최성철,허우성,도정호,김정아,한혁준,정시정,박진아,김윤구,김대중,오하영,김보현 대한신장학회 2001 대한신장학회잡지 Vol.20 No.5

설사와 관련된 성인 용혈성 요독 증후군 환자의 임상상과 혈장교환술의 치료 경과

이윤하,김혜영,김범,오하영,허우성,김대중,김윤구,강우헌 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.6

Diarrea-associated hemolytic uremic syndrome (HUS) is very rare in adults. Few reports are available on clinical features and plasma exchange in adult patients with diarrhea-associated HUS in Korea. We retrospectively examined the records of five adult patients with diarrhea-associated HUS admitted to Samsung Seoul Hospital between January 1995 and December 1997. If the patient had neurologic abnormalities, or there was rapid clinical deterioration, with the hematocrit decreasing below 20%, the platelet count falling below 10,000/mm3, the creatinine concentration increasing above 5.0mg/dl, plasma exchange was begun. There were 4 females and 1 male. Patients ranged in age from 16 to 61 years. All patients presented with diarrhea and abdominal pain, and 3 patients had bloody diarrhea. The mean time between the onset of diarrhea and thrombocytopenia was 4.4?1.9 days(range, 1 to 6). All patients received 7 to 24 plasma exchanges. The mean exchanged plasma volume was 1.1?0.2 times of patients own plasma volume. e pattern of clinical response to plasma exchange was initial normalization of platelet count (8.0?3.8 days), followed by normalization of LDH level(20.2?14.5 days) and creatinine concentration (25.8?13.8 days). Metabolic alkalosis developed in two patients undergoing daily plasma exchange. We successfully managed the metabolic alkalosis with continuous venovenous hemofiltration. The mean duration of hospitalization was 28.8?11.2days(range, 20 to 42). All patients successfully recovered without any sequale. Although this study is based on small case series, we suggested that plasma exchange may improve the outcome in adult diarrhea-associated HUS.

한국인 남자 만성신부전 환자에서의 아포E지단백 유전자형 다형성과 혈청 지질성분

이윤하,김혜영,장세호,오하영,허우성,김대중,김윤구 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.4

Accelerated atherosclerosis is not only a frequent complication but also the most common cause of death in patients with chronic renal failure(CRF). Although mechanisms are unclear, disorder of lipid metabolism may be a major factor. Since apolipo-protein (apo) E is known to play a major regulatory role in lipid metabolism, we evaluated apo E genotype in 72 male patients with CRF and compared with that in 194 rnale normal controls. In addition, we measured plasma lipid and apolipoprotein concentrations and evaluated them according to apo E genotype in patients and controls. Apo E genotype was determined with the INNO-LiPA Apo E kit (Innogenetics, Belgium), which is based on reverse hybridization. The results are as follows; 1) The distribution of the three major apo E alleles in patients with CRF( e 2: 6.2%, e 3: 80.6%, e 4: 13.2%) was not different from that in controls ( e 2: 4.1%, e 3: 87.6%, e 4: 8.3%). 2) In patients with CRF, total cholesterol, lowdensity lipoprotein(LDL) and high-density lipoprotein (HDL) levels were significantly lower and the triglyceride and lipoprotein(a) levels were significantly higher than those in controls. 3) In controls, E 4/3 group had significantly lower levels of HDL than E 3/3 and E 3/2 groups. In patients with CRF, E 4/3 group had significantly higher levels of total cholesterol and apo B lipoprotein than E3/2 group. In conclusion, although there was no significant difference in the apo E genotype frequencies between male patients with CRF and controls, apo E polymorphism may play an important role in the determination of individual differences in plasma lipids in male patients with CRF.

사구체신염에서 N-acetyl-β-D-glucosaminidase의 예후 인자로서의 유용성

김혜영,김미경,오동진,김범,김대중,오하영,김윤구,허우성 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.4

Backgrounds:N-acetyl-β-D-glucosaminidase (NAG) is one of many enzymes that exist in the renal proximal tubular cells. It is said that functional impairment of renal tubule can be detected by checking NAG in the urine. But, it has never been known whether urinary NAG value can be used as a predictor for the prognosis of patients with glomerulonephritis. In this study, we evaluated the relationship between urinary NAG level and the degree of injury in cortical interstitium which has been known to influence the prognosis of renal function in glomerulonephritis closely. Methods:Before renal biopsy was performed in each patient, urinary NAG(isoenzyme A and B), urinary β2-microglobulin, serum blood urea nitrogen (BUN), serum creatinine, serum albumin, creatinine clearance and 24 hour urinary protein excretion were measured. Then, we calculated volume density of cortical interstitium〔Vv(i/c)〕 in each specimen using point count morphometry method after getting a confirmative diagnosis from pathologist. Simple coation analysis and multivariate regression analysis were carried out. Results:The number of total patients was 32(male:16), whose median age was 60(32-80). Vv (i/c) had significant correlation with serum creatinine, creatinine clearance and serum BUN. But it was not correlated well with urinary NAG and urinary β2-microglobulin. Urinary NAG concentration(2.131 2.549unit/mmol Cr) was higher than that of normal control and showed significant correlation with urinary β2-microglobulin, serum albumin and 24 hour urinary protein excretion in patients. Conclusion:Urinary NAG had no significant correlation with Vv(i/c) that has been known as an important prognostic factor for the renal function in glomerulonephritis, but had significant correlation with urinary protein excretion. We concluded that urinary NAG was not regarded to be an appropriate marker for predicting the prognosis of renal function in patient with glomerulonephritis.

신성 저요산 혈증 환자에서 운동 후 유발된 급성신부전증

최성철,김윤구,김정아,도정호,이영기,이현희,윤수진,허우성,김대중,오하영,김보현 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.2

We have described a male patient with a episode of acute renal failure after strenuous exercise. He was found to have low serum uric acid(0.6 mg/dL, after recovery) and normal 24 hour urinary excretion in the steady state. The possibility of other diseases that cause hypouricemia could be excluded, acute renal failure associated with idiopathic renal hypouricemia was diagnosed in this case. A renal computed tomography showed the delayed wedge shaped contrast enhancement, these findings suggested that the cause of acute renal failure could be renal vasoconstriction rather than obstruction by uric acid crystals. Hypouricemia appear to play a crucial role in this reperfusion oxygen free radical induced acute renal failure. We have suggested that the renal hypouricemia should be suspected in the case of acute renal failure associated with exercise when the patient's uric acid level was within or slight alone normal range at the time of acute renal failure. (Korean J Nephrol 2002;21(2):312-316)

자발성 신동맥류 파열을 동반한 결절성 다발성 동맥염 1예

이윤하,김혜영,임영희,서연림,오은영,김춘관,오하영,허우성,김윤구,김보현 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.4

Although renal aneurysmal formation in polyarteritis nodosa is common, it is rare to form complication of perirenal hematoma caused by spontaneous rupture of renal aneurysm. It should be differentiated from renal tumor, arterio-venous malforrnation, renal infarction, coagulopathy, and acute hydronephrosis in considering the cause of perirenal hematoma. In addition to that, it is a potential life-threatening complication and its early recognition and prompt treatrnent are emphasized. We describe a patient with polyarteritis nodosa who developed spontaneous perinenal hematoma due to repture of renal aneurysm, who had nonspecific symptoms. We thought polyarteritis nodosa based on present illness and clinical background, then immediately performed angiography and coil embolization. So the patient could be treated with cyclophosphamide and steroid successfully. Polyarteritis nodosa is a relatively rare disease, but should be included as one of the differential diagnosis whenever perirenal hematoma occurs.

복막투석액의 저류가 위배출시간에 미치는 영향

오하영,오동진,김범,이숭구,김윤구,강우헌,이방훈,김혜영,허우성,김대중 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.6

We evaluated gastric emptying time(GET) by using Tc99m-sulfur colloid gastric emptying scintigraphy in 11 patients with CAPD(6 male, 5 female) and 14 healthy volunteers. We investigated the effect of dialysate dwelling on GET by studying twice, once without dialysate in the abdomen(drained) and once with 2 L of dialysate in the abdomen(full), and the relationship between body surface area(BSA) and delayed gastric emptying. 1) The mean of gastric emptying rate in 120 minute in patients with CAPD when drained(67.8±13.4%) was not different from that in healthy volunteers(65.4±8.6%) 2) The mean of gastric emptying rate in 120 minute when full(55.6±14.6%) was significantly lower than that when drained(67.8±13.4%)(P$lt;0.05). In four of the 11 patients(36.4%), gastric emptying was extremely delayed from normal to abnormal range when full. 3) The BSA(1.5±0.11m2)of patients who had extremely delayed GET from normal to abnormal range was smaller than that(1.74±0.22m2) of patients who had minimal delayed or unchaET when full. This study showed the patient with CAPD had normal gastric emptying when drained, and that gastric emptying was delayed by dialysate dwelling, especially in the patients who has less than 1.5m2 of body surface area. Therefore, we suggest that intermittent nocturnal peritoneal dialysis or a small volume of dialysate may be considered for the patient with small body surface area based on the adequacy.

한국 정상 성인에서 초음파로 측정한 신장의 크기

황선희,오동진,김범,김대중,오하영,최상희,안홍준,김윤구,허우성,강우헌,이방훈,서기현,이숭구,김보현 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.1

Background:The kidney size is important in differentiating many renal diseases. Some studies have been reported about the normal kidney size in the foreign countries. However, no studies were performed by using ultrasonography in Korea. Therefore, we investigated the normal kidney length, the factors affecting the kidney length and the relationship of each other. Methods:One thousand three hundred eighty eight healthy Koreans were scanned for the kidney length by ultrasonography and were measured for their body index(height, weight, body surface area, total body water, and fat free mass). We analyzed the association between kidney length and body index. Results:Eight hundred four male and five hundred eighty four female were involved in this study and their mean age was 47.8?10.3 in male, 48.1?9.5 in female. 1) The average value of left and right kidney was 10.65±0.80cm, 10.50?0.78cm respectively, and the left kidney was greater than right one(P$lt;0.01). 2) The difference between male and female was 10.77cm, 10.49±0.78cm respectively in the left kidney and 10.66±0.76cm, 10.27±0.75cm in the right kidney(P$lt;0.01). 3) The aging process nearly does not affects the kidney size from 4th decade to 7th decade. However, the kidney size is getting smaller after 8th decade. 4) The correlation coefficient between the kidney size and height, weight, body surface area, total body water, fat free mass was 0.37, 0.41, 0.43, 0.37, 0.38(P$lt;0.01) respectively. Conclusion:The kidney length showed normal distribution in normal Korean adult and the length greater than 12.36cm, smaller than 8.76cm means out of its range of normal(±2SD) irrespective of sex and position. The body surface area has the largest correlation with kidney size in both sex(r=0.38/0.44; left/right, P$lt;0.01).