신장이식 후 스테로이드 투여로 인한 근력 및 일상생활활동의 변화

안경주,최명애 서울대학교 간호대학 간호과학연구소 1997 간호학 논문집 Vol.11 No.2

The purpose of study was to explore the changes of muscle strength and activities of daily living(ADL) by steroid medication following the renal transplantation. The subjects for this study were 25 patients. Their average age was 38.6 years and their average dialysis duration was 20 months. Muscle strength-grip strength, flexor and extensor strength of hip and knee joint, flexor and inversor strength of ankle joint-and ADL were measured on 2 days prior to and on 12,16 weeks following the renal transplantation. Grip strength was determined by hand dynamometer(Lafayette Instrument, USA). The data were analyzed by percentages, mean standard deviation, repeated measure MANOVA and multiple regression analysis using the SPSSWIN program. The results were summarized as follows: 1. Mean steroid dose following the renal transplantation was loading dose(240mg/day) during the first week and was decreased to the maintenance dose(29.7-13.3mg/day) from the 4th week to the 16th week after the renal transplantation. 2. Knee extensor muscle strength decreased significantly at 12 weeks following the renal transplantation by steroid medication. No significant changes were observed in muscle strength except knee extensor muscle strength. Muscle strength and ADL at 12 weeks after the renal transplantation demonstrated to have a tendency to decrease compared with those of pre-renal transplantation. 3. Knee extensor muscle strength increased significantly at 16 weeks rather than at 12 weeks following th renal transplantation. No significant changes were observed i muscle strength except knee extensor muscle strength. Muscle strength and ADL at 16 weeks after the renal transplantation tended to increase compared with those of after the renal transplantation. 4. The changes of muscle strength and ADL after the renal transplantation were mostly influenced by muscle strength ADL of pre-renal transplantation rather than steroid medication following the renal transplantation. The results suggest that muscle strength and ADL at 12 weeks following the renal transplantation may decrease and those at 16 weeks may increase compared with those at 12 weeks following the renal transplantation.

신장이식장애인의 취업에 영향을 미치는 요인에 관한 연구

복춘희 한국장애인고용촉진공단 고용개발원 2004 장애와 고용 Vol.14 No.3

신장이식장애인들이 신장이식 후 정상적인 활동능력에도 불구하고 그들이 원하는 취업에 많은 어려움을 겪고 있는 실정이다. 따라서 본 연구의 목적은 신장이식장애인의 취업에 영향을 미치는 요인을 찾기 위해 로지스틱 회귀분석을 실시 하였으며, 그 결과 성별, 총가구소득, 이식 후 경과기간, 심리불안 정도가 신장이식 장애인의 취업에 영향을 미치는 요인으로 나타났는데, 이 중 의료사회복지사의 전문적 개입이 가능한 영역은 이식 후 경과시간, 심리불안 정도이다. 이상의 연구 결과를 토대로 신장이식장애인의 취업률을 향상시킬 수있는 방안을 제시하였다. 첫째, 신장이식전 준비단계에서부터 의료사회복지사는 신장이식 대상자나 가족들의 심리사회적 문제를 사정해야하며, 이런 사정이 case conference 등공식적인 협력 절차를 걸쳐 의료진들이 신장이식장애인의 심리적 문제에 대응할 수 이도록정보를 제공해야할 것이다. 둘째, 의료사회복지사는 신장이식장애인의 심리적 불안을 감소시키기 위한 교육프로그램의 개발과 자조집단을 활성화시켜야 한다. 셋째, 신장장애인의 신장이식 기회를 제공하기 위해 적극적인 방법으로 뇌사장기 등의 기증자 발굴 및 홍보를 통해 신장이식을 활성화 시켜야 한다. 경제적으로 어려운 신장장애인을 위해 수술비 지원단체와의 연계를 통해 이식수술을 받을 수 있는 기회를 제공해 주어야 할 것이다. 넷째, 이식 후 심리적응기간을 단축시키기 위해서는 신장이식장애인을 대상으로 개인의 스트레스 해소와 지역 사회에 적응할 수 있게 옹호자와 대변자로서의 역할을 수행해야 할 것이다. 다섯째, 신장이식장애인을 도울 수 있는 1차 집단인 가족들을 치료에 개입시켜 신장장애인 발생 시 환자 및 그 가족들에게 질환의 특성과 이식에 대한 정확한 정보를 제공하여 시낭이식장애인들이 향후 직장생활을 할 때 당면할 수 있는 어려움을 해결해 줄 수 있도록 강화?야 할 것이다. 여섯째, 신장이식장애인의 직업기회 개발을 위해 지역사회의 다양한 직업재활프로그램이나 노동청 직업훈련 프로그램 등 직업관련 프로그램과의 연계 및 지원이 필요하다. 또한 신장이식장애인이 발병 전 취업을 하지 않았거나 이식 전 본래의 직장으로 돌아갈 수 없는 경우, 개별상담, 집단상담, 케이스메니지먼트등과 같은 전문적인 프로그램을 통해 신장이식장애인의 직업선호도를 평가하고 이들의 업무수행능력을 증진시켜야할 것이다. Although most people with renal transplantation are able to work, it is difficult for them to find a job that they want. The purpose of this study is to find out which factors may have effects on the employment of people with renal transplantation. This study used logistic regression. In result, it was found that the factors affecting the employment of people with renal transplantation included gender, total household income, time elapsed after transplantation and degrees of psychological anxiety. Out of these factors, the factors that may permit certain professional intervention of medical social workers were time elapsed after transplantation and degrees of psychological anxiety. Based on these survey results hereof, this study suggests these measures to improve employment of the people with renal transplantation : First, it is essential that medical social workers assess differenct social-psychological problems of people with renal transplantation and their family even from the preparatory steps before renal transplantation. Furthermore, with this assessment medical staffs can deal with the psychological problems of people with renal transplanation through formulated cooperation procedures including case conference. Second, medical social workers can develop education programs and facilitate self-help groups in an effort to relieve any psychological anxiety of people with renal transplantation. Third, in order to increase opportunities of kidney transplant for people with end renal diseases, it is necessary to promote internal organ donations from people with brain death. It is also important to give more opportunities of renal transplantation to those who are under very difficult financial conditions. Medical social workers can use thier networking skills with associations or groups that can afford to support medical expenses. Fourth, in order to reduce the duration of psychological self-adjustment after transplantation, medical social workers need to play a role as advocates and spokesmen for people with renal transplantation, so that they may feel relieved from personal stress and adjust themselves to local community. Fifth, the family of people with renal transplantation should be more intensively intervened throughout their treatment. Moreover, people with renal transplantation and their family should be informed with possible renal disorders. They must be provided with correct information on renal transplantation if any renal disorders occurred. In result, they may feel considerably relieved from potential challenges upon working in near future.

아시아 소아 신장이식 현황

김지홍,최용,김병길,Kim Ji-Hong,Choi Yong,Kim Pyung-Kil 대한소아신장학회 2002 Childhood kidney diseases Vol.6 No.2

목적 : 아시아 각 국가들간의 소아 신이식 성적은 많은 수준 차이가 존재하고, 몇몇 선두그룹을 제외하고 전체적으로 서구에 비하여 많이 뒤떨어지는 것은 사실이지만 소아 신이식 성적에 영향을 미치는 관련 조건들이 서로 비슷한 경향을 가지고 있기에, 아시아 각국의 소아 신이식 경험의 축적과 관련 자료의 비교분석이 앞으로 신이식성적의 향상에 있어 서구의 자료보다 더욱 많은 도움을 줄 수 있을 것이고, 이번 조사를 계기로 이러한 공동 연구의 바탕이 될 수 있는 국가별 신이식 등록사업과 국가간 자료 교환 사업의 활성화가 원활하게 이루어지기를 기대하여 본 연구를 시작하게 되었다. 대상 및 방법 : 이식현황에 대한 자료수집은 아시아 각국의 소아신장학회에 보낸 설문과 각국에서 보내온 여러 다른 기준과 형식의 자료를 총괄하여 시행하였고 총 11개국이 본 조사에 참여하였으며 우리나라 국내 소아 신이식 현황은 KONOS(Korean Network for Organ Sharing)의 자료와 국내 최대 신이식 증례를 보유하고 있는 2개 단일기관의 자료를 기준으로 알아보았다. 결과 : 아시아 각국의 소아 신이식 상황을 비교한 결과 매년 시행되는 소아 신이식례의 숫자는 해마다 증가하고 있으며 현재 아시아에서 소아 신이식이 가장 활발하게 이루어지고 있는 한국, 일본의 경우 최근3년간 연간 40-50례 정도가 시행되고 있다. 소아 신이식 등록사업은 한국, 일본, 싱가폴, 홍콩, 말레이시아 등에서 시행되고 있으나 서구에 비하여 참여도가 낮고, 체계적인 자료수집과 추가자료의 보충과정의 미비로 신이식 전반에 걸친 완벽한 국가적 소아 신이식 통계의 보유가 어렵고, 국가간의 자료를 수시로 교환하여 비교할 수 있는 통일된 프로그램의 운용은 더욱 생각하기 어려운 실정이다. 결론 : 통일된 프로토콜이 아닌 부분적으로 수집된 자료이지만 이번 아시아 각국의 소아 신이식 자료의 비교 연구는 아시아 신이식 현 수준을 파악하고 이식성적의 향상을 위한 등록사업과 자료교환사업의 필요성을 촉구하는데 충분히 도움이 될 수 있을 것으로 생각되었다. Purpose : Renal transplantation which allows children normal growth and development and a return to normal life. is now proven to be the best modality for children with ESRD Up to Recently, the number of renal transplantations in Asia has rapidly increased and the outcome has also improved. This investigation was planned to estimate the current status of pediatric renal transplantation in Asia and to find the keys for better improvement of outcome in pediatric renal allograft in Asian countries. Material and methods : The participating countries and institutions for this investigation were China, Hong Kong, India, Indonesia, Japan, Malaysia, Pakistan, Philippines, Singapore, Thailand, Korea, KSPN (Korean Society of Pediatric Nephrology), KONOS (Korean Network for Organ Sharing). Results : Many countries in Asia still do not have a well organized nation wide renal transplantation registration system independently in the pediatric field. So it's very difficult to evaluate the real state of pediatric transplantation among Asian countries. According to the estimation with fragmented data from each countries, in the front running countries of pediatric renal transplantation in Asia, about 40 or more transplants were performed in each country per year and the five year actuarial renal allograft survival was around 80% which is similar to that of western countries. But there were large gaps among the behind groups. Conclusion : Vigorous attempts to perform renal transplantation for children especially younger than 5 years old would be encouraged as well as organ donation from brain dead donor and non heart beating cadaveric donor also should be activated to cope effectively with the shortage of living donor supply. Large number of recent reports shows the favorable outcome of pre-emptive renal transplantation, we should make more efforts toward pre-emptive renal transplantation. First of all, in order to improve the outcome and to narrow the gap between Asian countries in pediatric renal transplantation, effective and continuous efforts to establish nationwide pediatric renal transplantation registration program as well as official, nation-to-nation data sharing program should be needed.

말기신질환 환자에서 성기능장애의 기전과 신이식수술이 성호르몬에 미치는 영향

최병길(Bung Kil Choi),김영훈(Yeong Hoon Kim),이태원(Tae Won Lee),임천규(Chun Gyoo Ihm),김명재(Myung Jae Kim) 대한내과학회 1989 대한내과학회지 Vol.36 No.5

N/A Sexual dysfunction is a common problem in male patients with end stage renal disease. The pathogenesis of this disorder has been attributed to many of metabolic disturbances of uremia, most notably zinc deficiency, PTH excess, and vitamin D deficiency. To evaluate the effect of renal transplantation on sex hormones, serum LH, FSH, testosterone and prolactin were measured by the method of RIA before and after renal transplantation in male uremic patients with sexual dysfunction. The results were as follows: 1) The basal level of serum LH was significantly higher in patients with end stage renal disease (17.7±5.0 mIU/ml, p < 0.01) compared with the normal range and dropped to the normal range after renal transplantation (7.0±4.1 mIU/ml), 2) The basal level of serum FSH was higher in patients with end stage renal disease (14.4±5.4 mIU/ml) but was not significant statistically. After renal transplantation, the serum FSH was elevated (21.3±9.4 mIU/ ml) but there was a significant change compared with the pretransplantation state (p>0.1). 3) On LH-RH stimulation test, the response of LH was delayed and prolonged in patients with end stage renal disease, and after renal transplantation, the response of LH was improved but still blunted. 4) On LH-RH stimuilation test, there was a normal pattern of FSH response before and after renal transplantation. 5) The basal level of serum testosterone decreased significantly in patients with end stage renal disease (2.87±0.3 ng/ml, p<0.01) compared with the normal range, and recovered to the normal range after renal transplantation (5.23±1.89 ng/ml). 6) The basal level of serum prolactin was significantly higher in patients with end stage renal disease (29.9±20.0ng/ml, p<0.01) and dropped to the normal range after renal transplantation (1.5±0.3ng/ml). 7) The impotence and depressed sexual desire was not improved after 1 month of renal transplantation. Finally, the abnormalites of sex hormones in uremic patients with sexual dysfunction are improved partially after 1 month of renal transplantation, therefore it is necessary for these patients to follow up sex hormones periodically.

말기 신질환 환자에서의 신장 이식술후 골대사 지표의 변화

유진상(Jin Sang Yoo),최병길(Byung Kil Choi),김명재(Myung Jae Kim),임천규(Chun Gyoo Ihm),이태원(Tae Won Lee),김영훈(Yeong Hoon Kim) 대한내과학회 1989 대한내과학회지 Vol.36 No.1

N/A Renal osteodystrophy includes a11 skeletal abnormalities in end stage renal disease, i.e., osteitis fibrosa, osteomalacia, osteosclerosis and growth failure in children. Patients who undergo kidney transplantation may continu to have evidence of disease of the skeletal system, frequently associated with abnormalities in the homeostasis of calcium and phosphorus. The authors measured the bone metabolism indox with the purpose of determining the usefulness of renal transplantation in patients with renal osteodystrophy. This was accomplished by observing the changes in the serum levels of calcium, phosphorus, alkaline phosphatase, PTH, and osteocalcin, and in the bone scintigraphy and degree of bone loss by scanning densitometry before and 1 month after renal transplantation in 9 patients with end renal disease and renal osteo dystrophy. The results were as follows: 1) The serum calcium level was significantly increased to the normal range one month after kidney transplantation (7.28±0.96 mg/dl vs 9.12±0.14 mg/dl, p<0.01), 2) One month after kidney transplantation, the serum level of phosphorus, PTH and osteocalcin were significantly decreased compared with pretransplantation values (phosphorus : 3.17±0.74 mg/dl vs 7.92±1.66mg/dl, p<0.01; PTH: 0.47±0.11 ng/ml vs 4.67±3.79ng/ml p<0.05; osteocalcin : 3.47±0.87ng/ml vs 24.41±9.04 ng/ml p<0.01) 3) There was a significant decrease in the bone scan score after renal transplantation compared with the pretransplantation value (- 0.2±0.4 vs 1.1±0.3, p<0.05). 4) There were no differences in serum alkaline phosphatase (ALP) activity and the index of bone density before and after renal transplantation (ALP: 56,67±23.02IU/L vs 40.33±17.27IU/L, p>0.1; bone density △Gmax 3.43±0.19 vs 3.46±0.85 △Gmin 2.83±0.41 vs 2.76±0.73, and MCI 0.62±0.08 vs 0.67±0.03, all p>0,1). In conclusion, renal osteodystrophy with end stage renal disease is corrected by successful renal transplantation.

신이식후 발생하는 감염에 대한 고찰

김재필(Jae Phil Kim),조대옥(Dae Ok Cho),고경식(Kyung Sik Ko),안재형(Jai Hyung Ahn),이태원(Tae Won Lee),임천규(Chun Gyoo Ihm),김명재(Myung Jae Kim) 대한내과학회 1995 대한내과학회지 Vol.49 No.1

N/A Objectives: Renal transplantation is a major therapeutic advance for patients with chronic renal failure. But recipients of renal transplantation are prone to infection with both common and unusual organisms. And infectious diseases remain a major cause of morbidity and mortality in renal transplant recipients. This study was to analyze the infections in renal transplant recipients; its occurrence according to sites and organisms; comparison among immunosuppressive agents; prognostic differences of urinary tract infections(UTI) between those developed during 1 month after transplantation and those not developed; graft outcome; and patients mortality. Mothods: 181 renal transplant recipients were examined. They received renal transplantion between january 1979 and December 1992 at the Kyung-Hee University Hospital. 158 of them received transplantation from living-related donors, 22 from living-unrelated donors, and 1 from cadaver donor. Their age at the time of transplantation ranged from 14 to 66 years(mean 35.6 years), and the male to female ratio was 2.3: 1. The observation period ranged from 1 to 144 months(41.26±31.71, mean±S. D.). Results: 1) 110 recipients(60.7% of total) had 232 episodes of infectious complications whereas 71(39.3% of total) had no infectious episodes. About half of infectious episodes(128 episodes, 55.2% ) occurred during 1 month after transplantation. 2) The most common site of infection was urinary tract(138 episodes, 59.2%) whth the next sites coming in this order, bacteremia(32 episodes, 13.8%), pulmonary(21 episodes, 9.1%), and skin(21 episodes, 9.1%). 3) The causative organisms of UTI ranked in this order E. coli 21.7%, staphylococcus spp 14.5%, and pseudomonas spp 13.0%. 4) The causative organisms of bacteremia ranked in this order E. coli 34.4% salmonella spp 18.8%, pseudomonas spp 12.5 %, and staphylococcus spp 12.5%. 5) There was no significant differences of infectious episodes among immunosuppressive regimens. 6) Early UTI group(UTI occurred during 1 month after transplantation) recorded significantly higher incidence of urinary tract infections after 1 month that followed than non-UTI group. But there was no differences between two groups on graft and patients outcome. 7) The major cause of death was life-threatening infections(63.2 %). Conclusion: Most infections due to various organisms may occur during 1 month after transplantation. And still they constitute a major cause of death in renal transplant recipients.

Renal Cell Carcinoma in Kidney Transplant Recipients and Dialysis Patients

이형호,최경화,양승철,한웅규 대한비뇨의학회 2012 Investigative and Clinical Urology Vol.53 No.4

Purpose: In a group of surgery patients diagnosed with renal cell cancer, those who underwent dialysis were compared with those who received a kidney transplant. Materials and Methods: The 43 subjects included in this study were patients who had been undergoing dialysis because of end-stage renal disease or had undergone kidney transplantation. The patients were diagnosed with renal cell carcinoma (RCC) during follow-up and underwent radical nephrectomy from May 1996 to December 2010. Their medical records were retrospectively analyzed as part of the study. Results: In the transplantation group, the renal replacement therapy period averaged 54 months, and the period from transplantation to RCC averaged 119 months (range, 0 to 264 months). In the dialysis group, RCC was observed after an average of 124 months (range, 2 to 228 months) of dialysis, and nephrectomy was then conducted. Acquired cystic kidney disease (ACKD) was found more frequently in the dialysis group, and it had a statistically relevant effect on the occurrence of RCC by comparison with the transplantation group (p<0.01). Conclusions: Although the incidence rate of ACKD was significantly higher in the dialysis group among patients undergoing surgery for RCC, cancer was found even without ACKD development in some transplant recipients. Considering that the transplant recipients also underwent dialysis, an informative prospective study will be necessary to determine whether other immunosuppressive agents besides ACKD may function as a cancer risk factor. Purpose: In a group of surgery patients diagnosed with renal cell cancer, those who underwent dialysis were compared with those who received a kidney transplant. Materials and Methods: The 43 subjects included in this study were patients who had been undergoing dialysis because of end-stage renal disease or had undergone kidney transplantation. The patients were diagnosed with renal cell carcinoma (RCC) during follow-up and underwent radical nephrectomy from May 1996 to December 2010. Their medical records were retrospectively analyzed as part of the study. Results: In the transplantation group, the renal replacement therapy period averaged 54 months, and the period from transplantation to RCC averaged 119 months (range, 0 to 264 months). In the dialysis group, RCC was observed after an average of 124 months (range, 2 to 228 months) of dialysis, and nephrectomy was then conducted. Acquired cystic kidney disease (ACKD) was found more frequently in the dialysis group, and it had a statistically relevant effect on the occurrence of RCC by comparison with the transplantation group (p<0.01). Conclusions: Although the incidence rate of ACKD was significantly higher in the dialysis group among patients undergoing surgery for RCC, cancer was found even without ACKD development in some transplant recipients. Considering that the transplant recipients also underwent dialysis, an informative prospective study will be necessary to determine whether other immunosuppressive agents besides ACKD may function as a cancer risk factor.

소아 신장이식 28례의 임상 분석

김정현,김광세 大韓泌尿器科學會 2002 Korean Journal of Urology Vol.43 No.7

Experiences of renal transplants from donors with renal cell carcinoma after ex vivo partial nephrectomy

Sung Yoon Lim,Myung Gyu Kim,Kwon Tae Park,Cheol Woong Jung 대한외과학회 2017 Annals of Surgical Treatment and Research(ASRT) Vol.92 No.5

Purpose: Routine evaluation of kidney donors occasionally reveals an incidental renal mass with an otherwise satisfactory kidney function. The use of such a kidney with an enhancing mass for transplantation is a matter of debate owing to a possible risk of transmission of donor malignancies. We report our experience of kidney transplants from donors with renal cell carcinoma, after ex vivo resection of the renal mass. Methods: Two women aged 44 and 56 years were diagnosed with enhancing renal masses measuring 0.9 cm and 0.7 cm, respectively, during donor evaluation for kidney transplantation. Both patients and their families were informed of a potential risk of recurrent renal cell carcinoma following transplantation. Results: Renal function test results of both donors satisfied the living donor selection criteria. Laparoscopic live donor nephrectomy was performed with ex vivo resection of renal masses on the bench table. Immediate pathological analysis revealed a renal cell carcinoma with a margin of normal renal parenchyma before transplantation. Regimens based on mammalian target of rapamycin inhibitors, which are known for their antitumoral properties, were used for immunosuppression in both recipients. None of the recipients showed recurrence or metastasis during the follow-up period, which was longer than 3 years after transplantation. Conclusion: In light of the ongoing shortage of kidney donors, kidneys with small renal cell carcinoma could be considered for transplantation after appropriate removal of the lesion, with a very low risk of recurrent disease.

신장이식 수술로 치험한 Oligomeganephronia 3례

배현철,김지홍,김병길,김유선,박기일,정현주,최인준,Bae Hyun-Chul,Kim Ji-Hong,Kim Pyung-Kil,Kim Yoo-Seon,Park Ki-Il,Jeong Hyun-Ju,Choi In-Jun 대한소아신장학회 1997 Childhood kidney diseases Vol.1 No.2

Oligomeganephronia is a rare congenital form of bilateral renal hypoplasia histologically characterized by reduction in number and hypertrophy of nephrons. Clinically, this condition is presented in early infancy with vomiting, polyuria, polydipsia and dehydration. The problems are readily corrected, but slowly progressive renal failure follows accompanied by failure to thrive, short stature, and renal osteodystrophy. We experienced three cases of oligomeganephronia. Case 1. : A 3 2/12 years old female child was incidentally diagnosed as renal failure at age of 2 months when she was hospitalized due to pneumonia. She had open renal biopsy and was diagnosed as bilateral dysplastic kidney. On OPD follow-up, she progressed to end-stage renal failure (BUN/Cr 114/4.6 mg/dl) and had renal transplantation. The specimen was shrunk remarkably and light microscopy showed oligomeganephronia. Case 2. : A 14 8/12 years old female child with proteinuria was detected in an annual urine screening program for school children, she was diagnosed as renal failure (BUN/Cr 33.9/4.1 mg/dl), and had $5{\times}4{\times}3\;cm$ sized mass on abdominal CT scan. She had renal biopsy, and the specimen showed oligomeganephronia. She had hemodialysis for six months, and renal transplantation along with bilateral nephrectomy was performed. Case 3. : A 14 8/12 years old male child was diagnosed having chronic nephritis and chronic renal failure at 3 years old, progressed to end-stage renal failure (BUN/Cr 87/9.6 mg/dl) on OPD follow-up, and had a rephrectomy and renal transplantation. The biopsy specimen showed oligomeganephronic hypoplasia, secondary focal segmental glomerolosclerosis, and chronic interstitial nephritis. We report 3 cases of oligomeganephronia that progressed to end-stage renal failure and had successful renal transplantation with a brief review of related literatures.