신장이식 후 BK 바이러스 관련 신병증에서의 Leflunomide의 임상경험

손영기 ( Young Ki Son ),오준석 ( Joon Seok Oh ),오혜주 ( Hyae Ju Oh ),신용휸 ( Yong Hun Shin ),김중경 ( Joong Kyung Kim ),정현주 ( Hyeon Joo Jeong ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.3

목적: BK 바이러스 관련 신병증 (BK virus associated nephropathy, BKVAN)은 새로운 면역억제재 도입 이후 이식신 소실의 주요한 원인중의 하나로 부각되고 있다. Leflunomide는 류마티스관절염의 치료제로 개발된 이후 강력한 면역억제작용과 시험관 시험자료에서 BK virus의 억제 작용을 동시에 지님이 알려져 있다. 이에 저자들은 신장이식환자에서 발생한 BKVAN의 치료제로서 leflunomide의 효과에 대해서 알아보고자 하였다. 방법: 신장이식 후에 BKVAN pattern B로 진단된 환자 6명을 대상으로 하였다. 모든 환자들은 진단 당시 소변 내 decoy 세포 양성소견을 보였고 혈액 내 BK 바이러스 중합연쇄반응 양성이었으며 신 조직검사상 BKVAN에 합당한 소견을 보였다. 진단과 동시에 MMF를 중단하였고 tacrolimus의 혈중최저농도를 5 ng/mL 이하로 유지하였고 steroid의 투여양은 하루 5 mg으로 조절하였다. Leflunomide는 초기 하루 100 mg을 5일간 사용하였고 유지용량으로 하루 40 mg을 투여하였다. Leflunomide의 치료기간은 6-16개월 이었다. 결과: Leflunomid투여 전 평균 혈청 크레아티닌은 2.8±0.7 mg/dL에서 경과관찰종료 시점까지의 평균 혈청 크레아티닌은 2.3±0.5 mg/dL로 비교적 안정된 상태를 보이는 경향이었고 신기능소실은 관찰되지 않았다. Leflunomide투여 전 3명의 환자에서 빈혈이 관찰되었으나 약물투여 후 악화되는 경향은 관찰되지 않았고 간기능저하, 용혈성빈혈의 발생, 간질성 폐질환등 약물용량을 조절하거나 약물중단을 일으킬만한 심각한 부작용은 없는 것으로 조사되었다. 결론: 신장이식환자에서 발생한 BKVAN의 치료에 있어서 leflunomide의 사용이 도움이 될 수 있을 것으로 생각되나 항 바이러스작용과 안정성 등에 있어서 더 많은 연구가 있어야 할 것으로 생각된다. Purpose: BK virus associated nephropathy (BKVAN) affects 1-10% of kidney transplant (KT) patients and it produces a progressive destruction of allograft. Reducing immunosuppression is the only way to save the graft, while it needs tight monitoring of the graft rejection and graft survival is poorer in advanced case. Leflunomide has immunosuppressive effect and also antiviral activity. Addition of leflunomide may improve BK virus clearance and graft survival. Methods: 6 KT patients with biopsy proven BKVAN (Histological pattern B) were treated with leflunomide and reduced immunosuppression. All patients were monitored with serial determination of viral load in blood and graft function. Results: BKVAN was diagnosed at 14 months (7-28) post transplant, at that time median serum creatinine concentration was 2.8 mg/dL (1.8-3.6). 12.5 months (6-16) later of leflunomide treatment, median serum creatinine was 2.3 mg/dL and no graft loss was found. Conclusion: Leflunomide therapy with reduced immunosuppression may be effective in the treatment for BKVAN.

세탁기용 VCM 강판 성형시 PET 필름층 찢김 저감 방법

손영기(Young-Ki Son),이찬주(Chan-joo Lee),김병민(Byung-Min Kim) 대한기계학회 2010 대한기계학회 춘추학술대회 Vol.2010 No.5

This paper concentrates on the suppression of PET tearing occurrence at the press forming of the VCM that are used for panel of the washer. The defect rate sometimes come up to 50% depending on coating types, which results in direct increase of production costs. In the conventional manufacturing, tools are being used for both PCM and VCM without distinction of material types, and no process parameters are determined for those materials respectively. The forming process are being carried out depending on site engineer's knowledge and experiences. In this study, in order to find factors minimizing of PET tearing, FE analysis are performed and results are evaluated about the drawing depth, the flange length, the thickening etc. For this verification, tool clearances had been adjusted to produce products. It was found that tearing of the PET were minimized when the clearance was maintained within 5% of the thickness of VCM.

간 절제술의 술후 합병증

손영기(Young Ki Son),박호철(Ho Chul Park),홍성화(Sung Wha Hong) 대한외과학회 1990 Annals of Surgical Treatment and Research Vol.39 No.6

마그네슘 합금 판재의 정적-내연적 성형해석에 관한 연구

손영기(Young-Ki Son),정동원(Dong-Won Jung) 한국기계가공학회 2008 한국기계가공학회지 Vol.7 No.4

The characteristic of magnesium alloy is the most light in utility metal, the effect of electromagnetic wave interception, excellent specific strength and absorptiveness of vibration. Although magnesium alloy with above characteristic is a subject matter which is suitable in world-wide tendency of electrical component frame, sheet magnesium alloy is difficult to process. Therefore, forming analysis of sheet magnesium alloy and applying warm-working to process are indispensable. Among Finite element method, the static implicit finite element method is applied effectively to analyze sheet magnesium alloy stamping process, which include the forming stage. In this study, it was focused on the crack, wrinkling and spring back on sheet magnesium alloy stamping by the static implicit analysis. According to this study, the result of simulation will give engineers good information to access the forming technique on sheet magnesium alloy. And its application is being increased especially in the production of electrical component frame for the cost reduction, saving of defective ratio, and improvement of Productivity.

Tramadol HCl/acetaminophen 복합제에 의한 급성신부전을 동반한 신증후군

손영기 ( Young Ki Son ),남영희 ( Young Hee Nam ),이수미 ( Su Mi Lee ),김혜인 ( Hye In Kim ),안원석 ( Won Suk An ),김성은 ( Seong Eun Kim ),김기현 ( Ki Hyun Kim ),나서희 ( Seo Hee Rha ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.5

Analgesics are used commonly because of their beneficial effects on various disease processes and pain control, and so the population of patients who are at risk for adverse effects of these drugs is rapidly expanding. A number of renal problems have been associated with the use of these drugs, including electrolyte imbalance, acute renal failure, nephrotic syndrome, and interstitial nephritis. We experienced a 65-year-old female patient who developed general edema and oliguria for 4 days and diagnosed as focal segmental glomerulosclerosis with interstitial nephritis. She had taken tramadol HCl/acetaminophen (Ultracet(R)) for 15 days before admission. Renal biopsy revealed that focal tubular atropy, focal interstitial fibrosis and evidence of diffuse inflammatory cell infiltrations. Tramadol HCl/ acetaminophen (Ultracet(R)) was discontinued on admission because of the likelihood the renal disease was drug-related and the patient improved after discontinuation of this drug without remained renal damage. This case suggests that Ultracet(R) must be an agent that causes nephrotic syndrome with acute renal failure. Therefore clinicians should use it with caution in high risk patients.

신장 ; 당뇨병성 말기 신부전 환자에서 시행한 신장이식의 단일센터 임상성적

손영기 ( Young Ki Son ),오준석 ( Joon Seok Oh ),오혜주 ( Hyae Ju Oh ),신용훈 ( Yong Hun Shin ),김중경 ( Joong Kyung Kim ) 대한내과학회 2009 대한내과학회지 Vol.77 No.3

목적: 당뇨병성 말기 신부전으로 신대체요법을 시행하여야 하는 환자군이 점차 늘어나고 있는 추세이다. 당뇨병성말기 신부전 환자에서 신장이식이 중요한 치료법으로 자리잡고 있지만 여전히 당뇨 합병증에 따른 여러 가지 문제점으로 인해 여전히 기피되고 있다. 본 연구에서는 단일기관에서 당뇨병성 말기 신부전으로 신장이식을 시행한 환자들의 임상양상과 생존율을 조사하였고, 비당뇨군과 비교하였다. 방법: 1998년 3월부터 2008년 8월까지 본원에서 신장이식을 시행한 425명의 환자 중 당뇨병성 말기 신부전을 이식을 시행한 70명의 환자를 대상으로 임상양상과 이식신 및 환자 생존율을 조사하였고, 이를 비당뇨병성 말기 신부전으로 신장이식을 시행한 355명과 비교하였다. 결과: 수혜자의 평균 연령은 당뇨군에서 50.6±10.5세로 비당뇨군의 39.8±10.8세보다 높았고, 공여자의 연령은 당뇨군에서 33.2±9.0세로 비당뇨군의 37.5±1.3세보다 낮았다. 이식 후 1년 이내의 급성거부반응은 양 군 간에 유의한 차이가 없었다. 이식 후 발생한 심혈관계 질환의 빈도가 당뇨군에서 유의하게 많은 것으로 조사되었다(p=0.00). 당뇨군과 비당뇨군에 있어서 이식신의 평균 생존기간은 각각 124, 120개월로 양 군 간에 유의한 차이가 없었다. Kaplan-Meier 누적 이식신 생존곡선과 환자 생존곡선을 비교해 볼 때 당뇨군과 비당뇨군 사이에서는 유의한 차이가 없었다. 결론: 본 연구에서 당뇨병성 말기 신부전 환자군에서 신장이식 후 이식신 생존율과 환자생존율이 비당뇨병성 말기신부전 환자군과 비교해 볼 때 큰 차이를 보이지 않음을 보여주고 있다. 따라서 당뇨병성 말기 신부전 환자에서 심혈관계 질환 등 합병증에 대한 적극적인 관리가 동반될 때 신장이식이 당뇨병성 말기 신부전 환자에서의 신대체요법의 일환이 될 수 있을 것으로 생각된다. Background/Aims: Diabetic nephropathy is a growing cause of end-stage renal failure, and renal transplantation is considered the best option for survival in patients who experience such renal failure. Patients with diabetes are older and frequently have comorbidity, and only a minority of these patients is considered for renal transplantation. The survival rate of patients having diabetes treated with transplantation has improved, although the long-term prognosis has not been determined. This study examined the clinical outcome of renal transplantation in patients having diabetes compared to that in nondiabetic patients. Methods: We compared diabetic (n=70) and nondiabetic (n=355) groups of patients for whom medical records were available for more than 3 months at our hospital from March 1998 to August 2008. Results: The recipients were significantly older in the diabetic group (50.6±10.5 vs. 39.8±10.8 years), while donor age was significantly younger in that group (33.2±9.0 vs. 37.5±1.3 years). Cardiovascular events occurring after transplantation were more frequent in the diabetic group (11/70 vs. 10/355). Kaplan-Meier curves for cumulative survival of the renal allograft and patient survival revealed no difference between the two groups. The allograft survival rate in the diabetic group was 100% at 5 years and 79% at 10 years posttransplantation. In the nondiabetic group, the renal allograft survival rate was 98% at 5 years and 75% at 10 years. The patient survival rates did not differ significantly: 100% vs. 99% at 5 years and 91% vs. 91% at 10 years for the diabetic and nondiabetic groups, respectively. Conclusions: In our study, the long-term survival of renal transplantation in patients with diabetes equaled that of nondiabetic patients. Graft survival was also comparable between the two groups. Therefore, kidney transplantation may be another therapeutic option for end-stage diabetic nephropathy. (Korean J Med 77:321-327, 2009)

세탁기용 VCM 강판 성형시 PET 코팅층 찢김 저감방법

손영기(Young-Ki Son),이찬주(Chan-Joo Lee),변상덕(Sang-Doek Byeon),김명덕(Myong-Dok Kim),김병민(Byung-Min Kim) 대한기계학회 2011 大韓機械學會論文集A Vol.35 No.9

VCM 강판은 용융아연도금강판 위에 PET/PVC 코팅하여 가전제품의 외판 소재로 사용되고 있다. 본 연구에서는 VCM 강판의 프레스 성형 중 발생하는 PET 코팅층의 찢김을 저감하기 위해 프레스 성형공정변수를 재설계하였다. 프레스 공정변수들이 PET 코팅층의 찢김에 미치는 영향을 분석하기 위해 유한요소해석을 수행하였다. PET 코팅의 찢김 현상은 드로잉 성형시 제품의 코너부 소재두께의 증가로 인해 금형과 소재 사이의 과도한 마찰에 의해 발생한다. 이를 해결하기 위해 블랭크 형상의 변경을 통해 드로잉 성형시 코너부의 소재두께 증가를 저감하였으며, 트리밍 공정시 플랜지부의 과도한 두께 증가부분을 제거하여 플랜지 성형시 소재두께가 금형간극 이하로 분포하도록 하였다. 또한 성형실험과 유한요소해석을 통해 재설계된 공정변수들을 검증하였다. 이를 통해 PET 코팅의 찢김이 없는 양호한 최종제품의 성형이 가능함을 확인하였다. A VCM sheet is a metal sheet on which PET/PVC is coated for outer panels of home appliances. The purpose of this study is to obtain methods for suppressing PET tearing that occurs during the press forming of the VCM sheet. In order to identity the factors that minimize PET tearing, an FE analysis was performed. The occurrence of PET tearing cannot be predicted using the conventional forming limit diagram. PET is torn by friction between a die and sheet, which is caused by the thickening of material at a die corner. To reduce the thickening of material, the blank shape was re-designed and the thickened material at a flange was removed by a trimming process. The results of the FE-analysis involving modified process parameters showed that the thickness of the product at a die corner is distributed within the clearance of drawing and flangeforming process. A forming experiment was conducted to verify the proposed process parameters. A good final product was obtained without PET tearing of the VCM sheet.

퀴놀론과 비스테로이드소염제 투여 후 발생한 급성 간질성 신염이 동반된 DRESS 증후군

김수진 ( Soo Jin Kim ),남영희 ( Young-hee Nam ),정지영 ( Ji Young Juong ),김은영 ( Eun Young Kim ),이수미 ( Su Mi Lee ),손영기 ( Young Ki Son ),남희주 ( Hee-joo Nam ),김기호 ( Ki-ho Kim ),이수걸 ( Soo-keol Lee ) 영남대학교 의과대학 2016 Yeungnam University Journal of Medicine Vol.33 No.1

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and severe drug-induced hypersensitivity syndrome characterized by hematological abnormalities and multiorgan involvement. Liver involvement is the most common visceral manifestation. However, renal failure has been rarely described. The common culprit drugs are anticonvulsants and allopurinol. We experienced a patient with DRESS syndrome with acute interstitial nephritis caused by concomitant administration of quinolone and non-steroidal anti-inflammatory drugs (NSAIDs). A 41-year-old man presented with a diffuse erythematous rash and fever which developed after administration of quinolone and NSAIDs for a month due to prostatitis. He was diagnosed with DRESS syndrome. Skin rash, fever, eosinophilia, and elevations of liver enzymes improved with conservative treatment and discontinuation of the causative drugs. However, deterioration of his renal function occurred on day 8 of admission. The levels of blood urea nitrogen and serum creatinine increased and oliguria, proteinuria and urinary eosinophils were observed. Ultrasonography showed diffuse renal enlargement. The clinical features were compatible with acute interstitial nephritis. Despite intravenous rehydration and diuretics, renal function did not improve. After hemodialysis, his renal function recovered completely within 2 weeks without administration of systemic corticosteroid.

신장을 침범한 단일클론성 감마병증 7예

손영기 ( Young Gi Son ),주희린 ( Hee Rin Joo ),정석희 ( Seuk Hee Chung ),나서희 ( Seo Hee Rha ),안원석 ( Won Suk An ),김성은 ( Seong Eun Kim ),김기현 ( Ki Hyun Kim ) 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.1

일반 요검사상 단백뇨가 없는 IgA 신병증의 예후

김기현 ( Ki Hyun Kim ),김종빈 ( Jong Bin Kim ),김정민 ( Jung Min Kim ),손영기 ( Young Ki Son ),이수미 ( Su Mi Lee ),김혜인 ( Hye In Kim ),안원석 ( Won Suk An ),김성은 ( Seong Eun Kim ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6

Purpose: In patients with IgA nephropathy, more than 1 g/day of proteinuria is a risk factor to develop end-stage renal failure. Uncommonly, patients with IgA nephropathy exhibit negative proteinuria on routine dipstick test during follow-up examination, spontaneously or after use of ACEI or ARB. We evaluated whether no proteinuric patients have good prognosis or not. Methods: 41 patients who had no proteinuria on routine urinalysis for more than 6 months, were classified into spontaneous remission group (25 cases, SR) without any treatment and drug-induced remission group (16 cases, DR) with treatment of ACEI/ARB or both, were analyzed for clinical findings and renal function, retrospectively. We examined spot urine protein/creatinine ratio (Up/c) to evaluate exact amount of proteinuria and GFR was estimated by MDRD equation. Results: Twenty eight percent of cases in SR and 50 percent in DR showed spot Up/c 0.3-1 g/g. After follow-up of 58±41 (9-192) months in SR and 79±56 (35-192) months in DR, the stages of CKD shifted to advanced levels as follows; in SR group, 11, 10, 4 patients in stage 1 (GFR≥90 ml/min/ 1.73m2), 2 (GFR 60-89 ml/min/1.73m2), 3 (GFR 30-59 ml/min/1.73m2) to 7, 13, 5 patients, respectively; in DR, 7, 8, 1 patients in stage 1, 2, 3 to 3, 8, 5 patients, respectively. There was a tendency of slow decreasing GFR in both groups but no case progressed to CKD stage 4 and 5. Conclusion: Of IgA nephropathy patients with no proteinuria on routine urinalysis, 30-50% of patients have proteinuria 0.3-1.0 g/g on spot Up/c and there was also a risk of progression.