만성 신부전 환자에서 부갑상샘 절제술 후 종격동에서 발견된 이소성 부갑상샘 1예

정덕은 ( Duk Eun Jung ),최지은 ( Jee Eun Choi ),이강원 ( Kang Won Lee ),이유민 ( Yu Min Lee ),이지은 ( Ji Eun Lee ),김현정 ( Hyun Jung Kim ),안선호 ( Seon Ho Ahn ),송주흥 ( Ju Hung Song ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.6

Hyperparathyroidism is one of the most serious complications for hemodialysis patients. Parathyroidectomy is indicated in patients with severe hyperparathyroidsm refractory to medical treatment. An 39-year-old man who were maintained by hemodialysis underwent parathyroidectomy due to tertiary hyperparathyroidism. The level of intact PTH fell after parathyroidectomy but subsequently rose. We checked up the parathyroid gland by MIBI scan and CT. As a result, a mass was found in the anterior mediastinum. So it is important to suspect the ectopic parathyroid gland when the PTH level elevation is persistent after parathyroidectomy in chronic renal failure patient.

신기능 저하 환자에서 위막성 대장염 발생의 임상적 특징

정성원 ( Sung Won Jung ),이유민 ( Yu Min Lee ),정덕은 ( Duk Eun Jung ),이재훈 ( Jae Hoon Lee ),김현정 ( Hyun Jung Kim ),이지은 ( Ji Eun Lee ),송주흥 ( Ju Hung Song ),박도심 ( Do Sim Park ),안선호 ( Seon Ho Ahn ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.2

목적: Clostridium difficile-associated diarrhea (CDAD)는 항생제 사용 후 장내세균 변화로 인해 C. difficile 독소 A에 의해 발생되는 위막성 대장염에 의한 것으로 알려져 있다. 본 연구는 대장내시경 후 조직검사를 통해 위막성 대장염으로 확진된 CDAD 환자에서 임상적 및 검사실적 소견의 분석을 통해 신기능의 저하가 CDAD 발생에 어떤 영향을 미치는지 알아보고자 하였다. 방법: 1998년 1월부터 2006년 12월까지 원광대학교 의과대학 병원에서 2일 이상 묽은 변과 고열이 발생한 환자에서 CDAD가 의심되어 C. difficile 독소 A를 시행하고 대장내시경을 통해 조직학적으로 CDCA로 확진된 환자 56명을 대상으로 신기능 저하, 당뇨 및 악성종양의 유무를 조사하여 항생제 투여 기간에 따른 CDAD 발생 빈도를 비교하였다. 결과: 연구 기간 동안 CDAD가 의심되어 C. difficile 독소 A를 검사한 환자는 452명이었으며, 이중 양성 환자 416명 (92.03%), 음성 환자 36명 (7.96%)이었다. 452명 중 대장내시경을 시행한 환자는 92명 (20.7%)이었고, 이중 조직검사에서 위막성 대장염으로 진단된 환자는 56명 (60.8%)이었다. 조직 검사로 진단된 위막성 대장염 환자 56명 (남자 26명; 여자 30명)이었고, 이중 신기능 저하 환자 8명 (14.2%), 당뇨환자 10명 (17.8%), 악성종양 환자 13명 (23.2%)이었다. 또한 독소 A가 음성인 환자는 36명 (64.3%)었다. 조직검사로 확진된 신기능 저하 환자 8명 중 5명 (62.5%)은 C. difficile 독소 A 검사에서 음성으로 신기능 저하 유무에 따른 독소 반응의 차이는 없었다 (62.5% vs. 64.6%). 신기능이 저하된 환자에서 당뇨 2명 (25%), 악성종양 환자 1명 (12.5%)이었다. CDAD 발생까지의 항생제 투여 기간은 신기능이 정상인 환자 보다 신기능이 저하된 환자에서 짧았고 (23.44±3.28일 vs. 11.13±2.386일, p=0.034), 당뇨 및 악성 종양 유무에 따른 비교에서 (20.85±2.221일 vs. 25.50±13.07일; 23.30±3.67일 vs. 16.31±2.31일) 차이가 없었다. 결론: 면역력이 저하된 당뇨 및 악성종양 환자에 비해 신기능이 저하된 환자에서 CDAD 발생까지의 항생제 투여 일수가 적어 신기능 저하 상태에서 특히 항생제 투여에 주의가 필요하다. 또한 항생제 투여 후 발생된 설사 환자에서 C. difficile 독소 A가 음성이라 할지라도 환자가 대장내시경을 시행할 수 있는 상태인 경우 반드시 대장내시경과 조직검사를 시행하여 CDAD를 감별해야 할 것으로 생각한다. Purpose: Clostridium difficile-associated diarrhea (CDAD) is a potentially life-threatening illness which has been shown to be more common and more severe in patient with chronic renal failure. The aim of this study was to investigate clinical characteristics of renal insufficiency patients with clostridium difficile-associated pseudomembranous colitis. Methods: We reviewed charts of fifty-six patients with clostridium difficile-associated pseudomembranous colitis, who have clostridial toxin A assay in stool and a diagnosis made on histology of colonic biopsies. Results: There was no difference in age, serum albumin, C-reactive protein (CRP) and negative incidence of clostridial toxin A between patients who had renal insufficiency with serum creatinine more than 1.5 mg/dL and those who did not. But duration of antibiotic use administered prior to development of the clostridium difficile infection was more shorter in patients with impaired renal function than in patients with normal renal function. Conclusion: These data suggest that it may take a short period to development of the clostridium difficile infection in patients with impaired renal function, and histologic evaluation by sigmoidoscopy should be performed to make a diagnosis in CDAD-suggested patients, who have impaired renal function and even negative clostridial toxin A.

지속적인 리팜핀 초치료와 관련된 급성 간질성 신염

김현정 ( Hyun Jung Kim ),차정민 ( Jeong Min Cha ),정덕은 ( Duk Eun Jung ),이지은 ( Ji Eun Lee ),이유민 ( Yu Min Lee ),변승재 ( Seung Jae Byun ),송주흥 ( Ju Hung Song ),안선호 ( Seon Ho Ahn ),( Jin Ho Shin ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.6

Acute renal failure caused by rifampin typically occurs on intermittent administration or reintroduction of the drug. However, acute kidney injury (AKI) due to rifampin has been rarely reported to occur in patients receiving a continuous rifampin therapy. We have experienced a case of acute interstitial nephritis during the first course of standard anti-tuberculous therapy, including continuous rifampin therapy in daily dose. Forty-five-year-old male, who had been being treated with anti-tuberculous medication including rifampin (600 mg/day), was admitted to our hospital because of generalized edema and dyspnea by acute renal failure. His past medical history was unremarkable. Since the creatinine level was still elevated in 10 days after cessation of rifampin, we performed renal biopsy. The renal pathologic findings revealed acute interstitial nephritis. After that, the patient symptom was relieved and serum creatinine level was decreased without specific therapy. The renal function was recovered at 1 month after withdrawal of rifampin. We report a case of acute interstitial nephritis complicated with the first daily rifampin therapy, along with the review of literature.

증례 : 신장 ; 신증후군 환자에서 발생한 뇌정맥혈전증 1예

김현정 ( Hyun Jung Kim ),정덕은 ( Duk Eun Jung ),변승재 ( Seung Jae Byun ),이유민 ( Yu Min Lee ),이지은 ( Ji Eun Lee ),안선호 ( Seon Ho Ahn ),송주흥 ( Ju Hung Song ) 대한내과학회 2009 대한내과학회지 Vol.77 No.4

저자들은 두통을 주소로 내원한 미세변화 신증후군 환자에서는 드물게 발생하는 뇌정맥혈전증을 진단하고 항응고 요법을 통해 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. 본 환자의 경우 혈전 재발을 예방하기 위하여, 급성기 치료가 종결된 이후에도 단백뇨 감소 및 혈청알부민이 유지될 때까지 항응고제의 지속적 투여가 필요하다. 또한 비만 및 흡연 등의 혈전의 고식적인 위험요소 조절도 동반되어야 할 것이다. 결론적으로 신증후군 환자에서 신경학적 이상을 동반하지 않더라도 두통 및 오심, 구토 등 증세가 발생하는 경우 뇌 혈전증을 고려하여 조기 검사 및 치료가 필요할 것으로 생각된다. Nephrotic syndrome is associated with proteinuria, hypoalbuminemia, edema, hyperlipidemia, and thromboembolic complications. Thromboembolic complications of nephrotic syndrome are common, especially in the renal vein, while cerebral venous thrombosis is a less frequent complication of minimal change nephrotic syndrome. The pathophysiology remains unclear, but various changes in coagulant and anticoagulant factors may be responsible. We report a case of cerebral venous thrombosis associated with nephrotic syndrome. A 19-year-old man was admitted with a headache and nausea. Cerebral thrombosis was diagnosed on brain computed tomography and magnetic resonance imaging. He recovered gradually after treatment with anticoagulants and achieved control of the nephrotic syndrome. A discussion of this case, coupled with a review of the literature, emphasizes that an early diagnosis is essential for anticoagulation therapy and a successful outcome. (Korean J Med 77:517-521, 2009)

증례 : 호흡기 ; 신세포암으로 오인한 1 cm 크기의 원발성 편평상피세포 페암의 신전이 1예

신익상 ( Ik Sang Shin ),정덕은 ( Duk Eun Jung ),황기은 ( Ki Eun Hwang ),양세훈 ( Sei Hoon Yang ),정은택 ( Eun Taik Jeong ),최금하 ( Keum Ha Choi ),김학렬 ( Hak Ryul Kim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.1

신장 종괴를 처음 발견하였을 때는 예후와 치료 방법이 달라질 수 있기 때문에 원발성 종양에 대한 고려, 영상학적 소견, 임상 소견을 충분히 고려하여 원발성 신장암인지, 전이암인지에 대한 구별이 필요하다. 저자들은 65세 남자가 좌측 하복부 통증을 주소로 내원하여 좌측 신세포암 의심하에 신 적출술을 시행하여 조직 검사에서 전이성 편평상피세포암으로 진단 후 우측 폐하부에 1 cm 크기의 폐결절 조직 검사 결과 원발성 폐암이 발견된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Symptomatic renal metastasis from a primary lung malignancy elsewhere in the body is an uncommon feature in disseminated cancer. We report a case of a 1-cm primary squamous cell carcinoma (SCC) of the lung with renal metastasis initially misdiagnosed as primary renal cell carcinoma in a 65-year-old man who presented with left lower quadrant pain. (Korean J Med 2011;80:97-101)

혈청 항중성구세포질항체 (ANCA) 양성으로 발현한 아급성 심내막염

최준호 ( Jun Ho Choi ),정덕은 ( Duk Eun Jung ),류한승 ( Han Seung Ryu ),김현정 ( Hyeon Jeong Kim ),이유민 ( Yu Min Lee ),이재훈 ( Jae Hun Lee ),이지은 ( Ji Eun Lee ),신진호 ( Jin Ho Shin ),송주흥 ( Ju Hung Song ),안선호 ( Seon Ho 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.4

Antineutrophil cytoplasmic antibodies (ANCA) directed against either proteinase-3 or myeloperoxidase are associated with a limited group of small vessel vasculitic syndromes. C-ANCA is regarded as highly specific for idiopathic ANCA-associated vasculitis (AAV). However, C-ANCA is not specific for Wegeners granulomatosis and has been reported in the course of a variety of infectious conditions. Sub-acute bacterial endocarditis is a notable concern because it may be associated with C-ANCA. The misdiagnosis of bacterial endocarditis as AAV and the administration of immunosuppressive treatment could aggravate the infection. We describe a patient with sub-acute bacterial endocarditis who presented with features mimicking vasculitis and positive C-ANCA by indirect immunofluorescence and for anti-PR3 antibodies by antigen-specific ELISA.

유지 혈액투석 중인 환자에서 특발성 쇄골하정맥 협착에 의해 발생한 유미흉

이유민 ( Yu Min Lee ),김현정 ( Hyun Jung Kim ),차정민 ( Jeong Min Cha ),정덕은 ( Duk Eun Jung ),이재훈 ( Jae Hun Lee ),이지은 ( Ji Eun Lee ),송주흥 ( Ju Hung Song ),안선호 ( Seon Ho Ahn ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.2

Chylothorax is defined as the accumulation of chyle-containing lymphatic fluid within the pleural space. The causes of chylothorax are various and usually attributable to 1 of 4 categories: malignancy, trauma (including surgery), miscellaneous disorders, and idiopathy. Occurrence of chylothorax in patients on hemodialysis is very uncommon and it may have resulted from multiple iatrogenic vascular trauma conducive to venous thrombosis and stenosis when hemodialysis catheters required frequent changes or long term indwelling. Local thrombosis and stenosis may increase the venous hydrostatic pressure and hinder the discharge of thoracic duct lymph into the venous system. Hence, chylous lymphatic fluid leak into the pleural space. Treatment of chylothorax may range from nonoperative management to elective surgery. We report a case of a patient on hemodialysis who developed chylothorax secondary to a subclavian vein stenosis without any other symptoms such as arm edema and successfully treated with nonoperative management.

단클론성 IgG 침착을 동반한 증식성 사구체 신염 1예

차정민,정덕은,송주흥,안선호 圓光大學校 醫科學硏究所 2008 圓光醫科學 Vol.23 No.2

Proliferative glomerulonephritis with monoclonal IgG deposits is a novel phenotype of glomerular injury with the diagnostic criteria of (1) the presence of glomerular monoclonal IgG deposits restricted to a single IgG subclass and a single light chain isotype, associated with endocapillary proliferative, membranoproliferative, or membranous features; (2) the presence of granular("immune complex type") deposits by electron microscopy; and (3) the absence of clinical and laboratory evidence of cryoglobulinemia. We report a case of 65-year-old man with generalized edema who was diagnosed as proliferative glomerulonephritis with monoclonal IgG deposits by renal biopsy.