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혈액투석 중인 말기신부전 환자에서 발생한 양측 신장의 자발성 파열
정사라 ( Sa Rah Chung ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),설종구 ( Chong Koo Sul ),이강욱 ( Kang Wook Lee ),신영태 ( Young Tai Shin ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.5
Bilateral spontaneous renal rupture is a rare event that has been documented in only a few reports. We report a spontaneous, but not simultaneous rupture of both kidneys in a 64-year-old man with end-stage renal disease who had been treated with hemodialysis for 78 months. He complained of sudden left flank pain. Abdominal computed tomography (CT) revealed a huge perirenal hematoma with multiple renal cysts. The patient underwent an urgent left nephrectomy and was diagnosed as multiple acquired renal cysts with rupture and focal incidental papillary renal cell carcinoma. Twentytwo days after the left nephrectomy, he complained of sudden right flank pain and abdominal CT showed another massive perirenal hematoma. The patient underwent a right nephrectomy and was diagnosed as renal cyst rupture with perirenal hemorrhage. However, there was no evidence of renal cell carcinoma in the right kidney. Postural hypotension and frequent hypotensive episodes developed during hemodialysis several months after both nephrectomies. He was diagnosed as primary adrenal insufficiency with rapid adrenocorticotropic hormone (ACTH) stimulation test and the level of plasma ACTH and was treated with prednisolone and fludrocortisone. The patient died of acute myocardial infarction 32 months after bilateral nephrectomies.
Recombinant Human Erythropoietin 및 N-acetylcysteine의 방사선 조영제에 의한 신독성 예방효과
정사라 ( Sa Rah Chung ),김의식 ( Eui Sik Kim ),정지윤 ( Ji Yoon Jung ),김난희 ( Nan Hee Kim ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),이강욱 ( Kang Wook Lee ),신영태 ( Young Tai Shin ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.6
Purpose : We investigated the effects of recombinant human erythropoietin (EPO) and N-acetylcysteine (NAC) in the prevention of radiocontrast-induced nephrotoxicity in patients with underlying renal ysfunction, who are regarded as a high risk group. Methods : This study included 77 individuals with renal insufficiency, defined by a serum creatinine concentration above 1.2 mg/dL or creatinine clearance of more than 15 mL/min/1.73m2 and less than 60 mL/min/1.73m2. These patients who needed radiologic interventions including the use of radiocontrast materials from August 2006 to May 2007 were randomly assigned to one of four groups, which were treated with EPO only, NAC only, EPO plus NAC and placebo respectively. The serum creatinine and cystatin-C were measured before, 24 hours and 48 hours after the intervention. The creatinine clearance was obtained using the Cockcroft-Gault equation. Results : The serum level of creatinine in EPO plus NAC group was not significantly elevated 24 and 48 hours after radiocontrast exposure compared to control group (p=0.012). Also, the creatinine clearance of EPO plus NAC group was not significantly decreased after radiocontrast exposure compared to control group (p=0.046). The serum level of creatinine in EPO and NAC group increased less than control group, but there were no significant differences between the groups. Also, the creatinine clearance in EPO and NAC group decreased less than control group, but there were no significant differences between the groups. Conclusion : EPO plus NAC showed a renoprotective effect on radiocontrast study in patients with underlying renal dysfunction.
C-phycocyanin Attenuates Renal Inflammation and Fibrosis in UUO Mice
이강욱 ( Kang Wook Lee ),정사라 ( Sa Rah Chung ),정진영 ( Jin Young Jeong ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),신영태 ( Young Tai Shin ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6
It has been reported that Spirulina, a blue-green algae with potent antioxidant properties, affords significant protection against inflammation and fibrosis in the liver in vivo. The aim of the present study was to establish the possible protective role of C-phycocyanin, one of the active ingredients of Spirulina, in an experimental model of fibrosis in the kidney. Methods: The study was carried out using male C57BL6 mice. Mice were divided into the following four groups: sham-operated group; C-phycocyanin (PC)-treated sham group; unilateral ureteral obstruction (UUO) group; and PC with UUO group. We evaluated renal TGF-β mRNA, MCP-1, and osteopontin using real-time RT PCR. We evaluated renal TGF-β, α-SMA, and CD68 by immunohistochemistry. We recorded light microscopic findings of kidney specimens. Results: PC significantly decreased the expression of MCP-1 and α-SMA mRNA. Renal gene levels of expression of TGF-β, MCP-1, and osteopontin in the UUO group were significantly higher than the sham-operated group (p<0.01). The levels of expression of TGF-β, MCP-1, and osteopontin mRNA of kidneys in the PC-treated UUO group were significantly lower than the untreated UUO group (p< 0.05). The magnitude of expression of TGF-β and α-SMA protein in the kidneys of the PC-treated UUO group was significantly less than the untreated UUO control group (p<0.05). Conclusion: The results of the present study suggest that PC has anti-inflammatory and anti-fibrotic effects in an experimental UUO murine model.
침술 및 근육 내 자극치료 (Intramuscular Stimulation)에 의한 콩팥주위 혈종
김설영 ( Seul Young Kim ),장원익 ( Won Ik Jang ),정사라 ( Sa Rah Chung ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),이강욱 ( Kang Wook Lee ),신영태 ( Young Tai Shin ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.2
Acupuncture therapy has been widely performed by staffs of oriental medicine in Korea, and intramuscular stimulation (IMS) therapy has been introduced recently and used for controlling myofascial pain in the field of orthopedics, rehabilitation, and pain clinics. To penetrate human tissues, relatively long needles are used in both procedures and these these may have some risks to puncture blood vessels. However, there were few reports about sequelae or complications after such procedures in Korean literatures. Recently, we experienced two cases of perirenal hematoma in patients without blood coagulation abnormalities (one case induced by acupuncture in oriental medicine clinic, and the other case induced by IMS in orthopedic clinic and was also accompanied by perirenal abscess).
신증후성 출혈열 후에 발생한 Henoch-Schonlein 자반증성 신염과 비골신경 마비
김의식 ( Eui Sik Kim ),장원익 ( Won Ik Jang ),정지윤 ( Ji Yoon Jung ),정사라 ( Sa Rah Chung ),최대은 ( Dae Eun Choi ),임범진 ( Bum Jin Im ),나기량 ( Ki Ryang Na ),이강욱 ( Kang Wook Lee ),서광선 ( Kwang Sun Suh ),신영태 ( Young Ta 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.6
In the course of hemorrhagic fever with renal syndrome (HFRS), mild neurological symptoms such as headache, vertigo and nausea are common. Peripheral neuropathy in HFRS is very rare. Henoch-Schonlein purpura (HSP) is an immunologically medicated systemic vasculitis of small blood vessels affecting the skin, gastrointestinal tract, joints and kidneys, predominantly. Neurological complications in HSP include headache, focal cerebral deficit, coma, convulsion, subarachnoid hemorrhage and chorea. Peripheral neuropathy is also very rare. However there was no case report about HSP and peroneal nerve palsy after HFRS. With a brief review of the literature, we report a case of HSP and peroneal nerve palsy following HFRS.
만성 신부전 환자에서 신장이식 전, 후 고유신장에서 발생한 신세포암
김난희 ( Nan Hee Kim ),박지원 ( Ji Won Park ),황재희 ( Jae Hee Hwang ),정사라 ( Sa Rah Chung ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),이강욱 ( Kang Wook Lee ),신영태 ( Young Tai Shin ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.5
One of the major risk factors of renal cell carcinoma is acquired cystic kidney disease (ACKD) developed in course of end-stage renal failure (ESRF) and the incidence of ACKD increases with the duration of dialysis. Moreover, the overall incidence of renal cell carcinoma after renal transplantation has been reported to be being more than 8 times higher compared with that of general population. But renal cell carcinomas occurred in native kidneys before and after renal transplantation in ESRF patient with ACKD are very rare. We experienced a case of renal cell carcinoma occurred in native kidneys 14 months before and 5 months after renal transplantation in an ESRF patient with ACKD.
동정맥 이식편을 통해 혈액투석치료를 받는 환자에서 발생한패혈성 폐색전증
이강욱 ( Kang Wook Lee ),권오경 ( Oh Kyung Kwon ),배홍진 ( Hong Jin Bae ),장원익 ( Won Ik Jang ),정사라 ( Sa Rah Chung ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),신영태 ( Young Tai Shin ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6
Purpose: Septic pulmonary embolism (SPE) is different from non-infectious thromboembolism in that it causes pulmonary arterial obstruction and inflammation by infectious emboli from various sources. There are increased risks of SPE in patients with chronic kidney disease because of decreased immunity and frequent venous puncture with the use of indwelling venous catheters or arterio-venous graft (AVG). However, SPE related with AVG infection in end-stage renal failure patient is very rare. Recently, we experienced a typical case of septic pulmonary embolism occurring in a 57-year-old man with infected AVG during hemodialysis. The patient had started hemodialysis 10 years ago due to diabetic end stage renal failure. Due to functional failure of the arterio-venous fistula, hemodialysis had been performed through an AVG on the upper left arm 3 years before admission. One week before admission, the patient complained of fever, chill, and painful swelling on the AVG site. Chest x-ray and computerized tomography showed variable sized multiple nodules and some cavity formation, suggestive of septic pulmonary embolism on both lung fields. Methicillin-resistant Staphylococcus aureus (MRSA) was identified from blood and wound culture studies. The AVG was removed along with continued use of vancomycin administration for 8 weeks. Complete clinical and radiological recovery was attained 2 months after initiation of antibiotic treatment.