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특발성 간질 치료 중 강축증 증상으로 진단된 갑상선 기능 저하증이 동반된 특발성 부갑상선 기능 저하증
장호식 ( Jang Ho Sig ),박정호 ( Park Jeong Ho ),김성헌 ( Kim Seong Heon ),장재영 ( Jang Jae Yeong ),송춘영 ( Song Chun Yeong ),박지은 ( Park Ji Eun ),권삼 ( Kwon Sam ) 대한내과학회 2003 대한내과학회지 증례 특집호 65-5 부록3 Vol.0 No.-
Idiopathic hypoparathyroidism is activating mutation of the calcium sensor receptor lead to inhibition of parathyroid hormone (PTH) secertion at inappropriately low serum ionized calcium levels and are a cause of autosomal dominant hypoparathyroidism. Thi
유지 혈액투석 환자에서 다주파수 생체전기 임피던스를 이용한 체액평가의 유용성
장재영 ( Jang Jae Yeong ),조성 ( Jo Seong ),장호식 ( Jang Ho Sig ),김성헌 ( Kim Seong Heon ),박지은 ( Park Ji Eun ),송춘영 ( Song Chun Yeong ),김성록 ( Kim Seong Log ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.3
배경 : 만성 신부전으로 혈액투석을 받고 있는 환자에 대한 투석의 적절도를 평가하기 위해서는 총체액량 측정이 필요하며, 임상적으로 Watson 공식을 이용하고 있다. 그리고 투석 후 과수분 상태를 피하기 위해서는 적절한 건체증을 알아내는 것이 중요하나 임상에서는 객관적으로 측정 도구가 없고, 임상의에 의해 주관적으로 측정되고 있다. 다주파수 생체전기 임피더스 (Multi-flequency bioelectrical impedance analysis, MFBIA)는 총체액량 측정 뿐 아니라 새포내, 외액을 분리 측정할 수 있다. 이에 저자들은 총체액량 측정에 MFBIA가 Watson 공식을 대체할 수 있는지, 그리고 세포내액과 외액의 비율을 이용하여 투석 후 건체증을 측정할 수 있는 도구로 이용될 수 있는지 알아보고자 하였다. 방법 : 주 3회 혈액투석을 하는 환자 20명과 성, 나이에 맞춘 정상대조군 21명을 대상으로 Watson 공식과 MFBIA를 이용한 총체액량 측정을 서로 비교하였고, MFBIA의 재현성을 알아보고, 환자군의 투석 전후에 세포내·외액의 비율을 측정하여 정상대조군과 비교하였다. 결과 : 투석 전 환자의 Watson 공식과 MFBIA를 이용한 총체액량의 상관관계는 0.948 (p<0.001)이었고, MFBIA를 이용한 측정 재현성 Crohach` alpha값은 0.996으로 신뢰도가 높았다. 그리고 MFBIA를 이용한 총체액량 측정이 Watson 공식을 대체할 수 있었다 (95% 신뢰도 Bland-Altman method). MFBIA를 이용한 투석 후 세포내액은 투석 전과 차이가 없었고, 세포외액은 의미있는 감소를 보였다. 투석 후 세포내액과 외액 비율은 정상인의 세포내액과 외액의 비율과 차이가 없었다. 결론 : MFBIA는 투석환자의 총체액량 측정과 새포내액 및 외액을 동시에 측정할 수 있으며, 총체액량 측정에 비침습적인 저비용의 측정도구이며, 새포내, 외액 비유을 이용하여 적절한 초여과를 하였는지 알 수 있는 도구로 이용할 수 있겠다. Background : It is necessary to measure total body water (TBW) in evaluation of the hemodialysis adequacy. Waston`s equation has been used clinically. And it is important to measure adequate dry body weight to avoid fluid overloading after hemodialysis. But there was no objective method to measure dry body weight, it was estimated subjectively by clinicians (doctors and nurses). Multi-frequency bioelectrical impedance analysis (MFBIA) has emerged as a clinical tool of the measurement of total body water (TCW) and body fluid compartment (ICW, ECW). The purpose of this study is to investigate the correlation MFBIA-TBW and Watson equation, Then intracellular water (ICW)/extracellular water (ECW) ratio (I/E ratio) usefulness in the evaluation of dry body weight. Methods : 20 HD patients treated 3 timed/week and 21 sex and age adjusted normal control subjects were studied. We measuerd and compared MFBIA-TBW to Waston equation, estimate reproducibility MFBIA-TBW measurement. Then MFBIA-ECW, ICW and I/E ratio were measured and compared dialysis patients both pre- and post dialysis to control group. Results : The correlation between Wastron-TBW and MFBIA-TBW for patients was 0.948 (p<0.001). The closeness of agreement between MFBIA-TBW and Waston-TBW is shown Bland-Altman plots. There was no difference in post-dialysis patient`s ICW/ECW ratio compared to control group. Conclusion : MFBIA is useful tool for dialysis patients` TBW measurements. Also ICW/ECW ratio measurement by MFBIA may be used to estimate the adequate ultrafiltration. (Korean J Nephrol 2004;23 (3) :446 452)
김성헌 ( Kim Seong Heon ),장호식 ( Jang Ho Sig ),정창욱 ( Jeong Chang Ug ),장재영 ( Jang Jae Yeong ),조성 ( Jo Seong ),김성록 ( Kim Seong Log ),김활웅 ( Kim Hwal Ung ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.1
We experienced a case of secondary renal amyloidosis diagnosed by renal biopsy in a patient who had been diagnosed as RA two years ago. A 62-year old man was admitted to neurology departement because of right hemiplegia. During conservative care at neurology department, he was consulted to us because of aggravated generalized edema and proteinuria. He was diagnosed as rheumatoid arthritis and ulcerative colitis two years ago, and then he had taden prednisolone, methotrexate, mesalazine regularly. At physical examination, there was no abnormal finding except pretibial pitting edema and right hemiplegia. In urinalysis, specific gravity was 1.025, pH was 5.5 protein was 4+ and RBC 0-1/HPF and WBC 0-1/HPF. Total protein of 24 hour`s urine was 5.5 g/day. The blood BUN and creatinine level were 16.4 mg/dL. The blood BUN and creatinine level were 16.4 mg/dL, 0.4 mg/dL and cholesterol level were 154 mg/dL, total protein and albumin were 4.4 g/dL and 1.9 g/dL. Serum RA factor and CRP showed high level as 94.90 IU/mL and 118.00 mg/L. On urine electrophoresis, albuminuria was dominant but M-spike was not founded. On urinalysis taken at the time of first diagnosis of rheumatoid arthritis two years ago, proteinuria was negative and serum albumin levels was 3.6 g/dL. At that time, there was no evidence of nephropathy. In renal biopsy, electron microscope showed heavy nonbranching amyloid fibrils accumulated in mesangium and polarized light microscopy after Congo-red staining revealed apple-green birefringent amyloid deposits in glomeruli and blood. So we diagnosed renal amyloidosis associated with RA. (Korean J Nephrol 2004;23(1):163-168)