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혈관 확장술에 실패한 동정맥루의 상부정맥 폐쇄 및 협착증에 대한 혈관내 스텐트의 치료효과
김병수,김용수,박주현,김영옥,송하헌,윤선애,신미정,양철우,방병기,김기태,고기영 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.6
Although percutaneous angioplasty is effectively used in the treatment of vascular access stenosis in hemodialysis patients, it has low initial success rate and high recurrence rate for proximal vein obstruction or stenosis. We evaluated the effect of endovascular stent placement on the treatment of proximal vein obstruction or stenosis irresponsive to angioplasty in hemodialysis patients. Wallstent was placed in 8 hemodialysis patients with vascular access obstruction or stenosis. All lesions were proximal to a functioning access which had been created one month to 4 years prior to on set of symptoms. Of the total patients, 4 patients had central vein stenosis(2 subclavian, 2 innominate vein stenosis) and they all had a history of subclavian vein catheterization for hemodialysis. Seven patients presented with arm edema, one suffered from needling difficulty. Venography showed complete obstruction in 4 patients and severe stenosis in 4 patients. Angioplasty was attempted before stent placement but failed in all patients. The stent placement initially succeeded in all patients. There were no acute complications such as stent displacement, sepsis, and bleeding. After this intervention, clinical symptoms disappeared and all patients could be immediately treated with hemodialysis via corrected access. The patients were followed for 8.0±4.6 months (3-16 months). During this period, restenosis occurred in 2 patients. Of the 2 patients, one patient was successfully treated with angioplasty. In conclusion, endovascular stent placement seems to be effective on the treatment of proximal vein obstruction or stenosis irresponsive to angioplasty in hemodialysis patients.
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경구 Acyclovir를 투여 중인 환자에서 급성신부전을 동반한 급성 간질성 신염 1예
김은일,김영옥,김정선,최윤석,윤선애,서정필,방병기,백지연 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.6
Acyclovir is a remarkably safe drug with potent antiviral effect against herpes virus. The two most serious adverse effects are neurotoxicity and nephrotoxicity. We here report the case of a 64-year old woman with acyclovir induced acute interstitial nephritis. She developed non-oiliguric acute renal failure following the administration of oral acyclovir(800mg five times per day) to treat herpes zoster of left 2nd and 3rd thoracic nerves. We documented a normal serum creatinine level just before exposure to the drug. On admission, serum creatinine level was 2.4mg/dL(baseline levei; 0.8mg/dL). Percutaneous renal biopsy revealed interstitial infiltration of lymphocyte and eosinophil with interstitial edema, but there was no crystal formation in the tubules or collecting ducts. After withdrawal of the acyclovir, renal function returned to normal within 1 week.
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Hencoch-Schonlein 자반증 환자에서 발생한 단백 상실성 장병증 : 스테로이드 치험 1예
박종원,김은일,김영옥,윤선애,황수은,서정필,방병기,백지연 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.6
Although gastrointestinal manifestations are very common in patients with Henoch-Schonlein purpura, protein losing enteropathy is a rare complication. We here report a case of protein losing enteropathy in a patient with Henoch-Schonlein purpura. A 52-year old woman presented with lower abdominal pain, purpura and edema on lower extremity. Serum albumin was 1.9g/dL and 24 hour urine protein was 4.7g/day. Skin and kidney biopsy revealed leukocytoclastic vasculitis and mesangial proliferative glomerulonephritis consistent with Henoch-Schonlein purpura, respectively. Colonoscopy showed diffuse mucosal erosion at right colon. (99m)Tc-human serum albumin scintigraphy and fecal alpha-1-antitrypsin clearance confirmed protein losing enteropathy. The protein losing enteropathy improved with steroid treatment.
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루푸스 환자에서 급성 신우신염에 의해 합병된 급성 신부전과 허혈성 장질환
김영옥,김정선,최윤석,윤선애,현영근,조재형,서정필,민준기,방병기 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.4
Acute infection increases disease activity in patients with systemic lupus erythematosus(SLE) and causes life threatening complication such as acute renal failure or ischemic bowel disease. We here report a case of acute renal failure and ischemic bowel disease complicated by acute pyelonephritis in a patient with SLE. A 19-year-old woman was admitted for high fever and right flank pain. Urine examination revealed acute pyelonephritis. Thrombocytopenia, proteinuria, positive antinuclear antibody and anti-dsDNA, false positive VDRL confirmed SLE. The pyelonephritis improved with antibiotic treatment, but oliguria and abdominal pain and ascites newly developed. Kidney biopsy and abdominal computed tomography revealed lupus nephritis type IV and ischemic bowel disease, respectively. After methylprednisolone and cyclophosphamide treatment, the patient improved.
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