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구영선,장윤경,양종오,강민규,황평주,김종학,나기량,이강욱,신영태 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2
Acute renal failure is a frequent complication in hospitalized patients and is strongly related to the mortality. The Clinical outcome and prognostic factors of acute renal failure(ARF) have been analyzed by many authors. The present study describes the etiologic and clinical aspects, as well as other factors related to mortality. All the patients suffering from acute renal failure admitted during the period of January 1993 - August 1998 were included in the study. The average age of the patients was 52±17 years and mortality rate was 24%. The causes of acute renal failure were hemorrhagic fever with renal syndrome(HFRS), sepsis, renal hypoperfusion, urinary tract obstruction, acute tubular necrosis, etc. The etiology of ARF was a significant prognostic factor on mortality in ARF. Other significant prognostic factors were oliguria, organ failure, use of vasoconstrictors, hypotension, serum bicarbonate, premorbid conditions, sepsis, neurologic complications, gastrointestinal bleeding. On the other hands, operation, sex, anemia, thrombocytopenia, hypoalbuminemia, BUN, serum creatinine, and hyperkalemia were not significant factors for the mortality. We conclude that major prognostic factors of acute renal failure arc premorbid conditions, sepsis and multiorgan failure, and they are responsible for persistent high mortality of acute renal failure despite of advances of medical care.
포스터 발표 : 포스터 연제 ; 혈액투석증인 만성신부전환자에서 발생한 Reversible Posterior Leukoencephalopathy Sysdrome 1예
구영선 ( Gu Yeong Seon ),김도희 ( Kim Do Hui ),장윤경 ( Jang Yun Gyeong ),양종오 ( Yang Jong O ),강민규 ( Kang Min Gyu ),황평주 ( Hwang Pyeong Ju ),송창준 ( Song Chang Jun ),이강욱 ( Lee Gang Ug ),신영태 ( Sin Yeong Tae ) 대한신장학회 2000 춘계학술대회 초록집 Vol.19 No.2
혈액투석 중인 만성 신부전 환자에서 발생한 Reversible Posterior Leukoencephalopathy Syndrome
구영선(Young Sun Koo),김도희(Do Hee Kim),장윤경(Yoon Kyung Chang),양종오(Jong Oh Yang),강민규(Min Gyu Kang),황평주(Pyeong Joo Hwang),송창준(Chang June Song),이강욱(Kang Wook Lee),신영태(Young Tai Shin) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1
A Reversible Posterior Leukoencephalopathy Syndrome(RPLS) consists of neurologic symptoms and signs - headache, consciousness change, seizure, visual impairment - and brain imaging finding showing brain(espicially white matter) edema usually involving the posteior parietal-temporal-occipital areas. The causes are thought to be hypertensive encephalopathy, preeclampsia or eclampsia, renal failure with fluid overload and immunosuppressive agents such as cyclosporin A or FK506. RPLS may usually reversible if treated early by decreasing blood pressure and discontinuing offending drugs. A 23-year- old man had been hemodialyzed with chronic renal failure for two years. His blood pressure elevated to 240/150mmHg 3 days before admission and he complained of severe headache, vomiting, and total visual loss at the day of admission. Brain T2-weighted MRI imaging showed increased signal intensity involving the both parietal, posterior temporal, and occipital lobes. After antihypertensive and dexamethason treatment, a follow-up brain MRI performed on 7 days after admission showed nearly normalized findings and all symptoms including visual loss were recovered completely in one week.
김종학,구영선,강민규,황평주,나기량,이강욱,서광선,신영태 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1
Renin-angiotensin-system(RAS) has been thought to have a pivotal role in renal injury mechanism. Many reports state that the inhibition of RAS prevents the progression of renal disease in 5/6 nephrectomized rats as a typical chronic renal failure model. Angiotensin converting enzyme inhibitor blocks the conversion from Angiotensin I to Angiotensin Ⅱ (A-Ⅱ ), and ATI RA inhibits the action of A-Ⅱ at the level of AT1 receptor. Therefore the PRA and A-Ⅱ level may be influenced independently by each treatment modality with these drugs. In this study, the influence of long term treatment with ACEI or AT1RA in these models on systolic blood pressure, PRA, and A-Ⅱ level was evaluated. Male Sprague-Dawley rats weighing 270-300 grams were anesthesized with thiopental sodium(50 mg/kg) and underwent right nephrectomy and partial(approximately two thirds) infarction of the left kidney by ligation of two-three segmental arterial branches. The rats were divided into four groups : sham group, control group, 5/6 subtotal nephrectomized and ACEI treated group (enalapril 100 mg/L in drinking water), 5/6 subtotal nephrectomized and ATIRA treated group (losartan, 200 mg/L in drinking water). They were treated for twelve weeks. In the twelve weeks, both groups treated with ACEI and AT1RA ingestion demonstrated a significant decrease in systolic blood pressure(165±23 vs. 132±9, mmHg, control vs. ACEI, M±SEM, p<0.05, 165±23 vs. 124±7 mmHg, control vs. ATIRA, M±SEM, p<0.01) compare to the control group. In both group treated with ACEI and AT1RA showed a significant increase in PRA(ACEI ; 7.2±2.9, AT1RA ; 4.7±0.4, control ; 2.7±1.1, sham ; 2.7±1.4, ng/ml/hr, ACEI vs. control and sham, M±SEM, p<0.05). However no significant differences were found in the sham vs. control(p>0.05), and in ACEI vs. control. The plasma A-II level was significantly increased in AT1RA treated group compared to sham and ACEI treated group(2,753±543 vs. 484±169.3, ng/ ml, AT1RA vs. Sham, p<0.01). In conclusion, treatment with ACEI and AT1RA for twelve weeks normalized systolic blood pressure, proteinuria and increased PRA compared to the control group; whereas plasma A-II level was increased only by AT1RA treatment.
혈청 HBsAg 양성인 사구체신염의 임상상 및 신조직 소견
신영태,구영선,강민규,황평주,김종학,이강욱,서광선 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1
Hepatitis-B-associated glomerulonephritis is one of the immunologically mediated disorders associated with chronic Hepatitis B virus(HBV) infection. The frequency of HBsAg infection has been high in East Asia and it is one of the most important etiologic factors of the secondary glomerulonephritis. We reviewed the clinical and pathologic features of 29 patients with glomerulonephritis and HBs antigenemia, who were admitted to Chungnam National University Hospital from January 1988 to Febuary 1999. The results were as follows : 1) The average age of the patients was 33.8±10.4(mean±SD) and male to female ratio was 3.8. Proteinuria was present in 27 patients(93%), hematuria in 20 patients(69%) and hypertension in 17 patients(59%). Two patients(7%) manifested with renal insufficiency and 8 patients(28%) with nephrotic syndrome. 2) Renal pathology revealed membranous nephropathy(41%), membranoproliferative glomerulonephritis(21%), mesangial proliferative glomeulonephritis(21%), minimal change nephritis (14%) and focal segmental glomerulonephritis(3%). 3) The pathologic findings of liver were chronic active hepatitis(68%), chronic persistent hepatitis(38%) and liver cirrhosis(8%). 4) During the follow-up period(average:49.4 months), 7 patients(68%) presented persistent proteinuria, 5 patients(21%) progressed to renal failure and 2 patients(8%) resolved clinically. 5) The treatment was done with prednisolone to 3 patients, and with alpha-interferon to 3 patients. One patient treated with prednisolone resolved clinically, but this resolution did not coincide with disappearance of the hepatitis B antigens.