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급성신우신염 환자에서 균혈증의 위험 인자 분석 -단일기관 분석-
황선덕 ( Seun Duk Hwang ),박경석 ( Kyoung Suk Park ),전병수 ( Byung Soo Jeon ),김윤지 ( Yoon Ji Kim ),이상헌 ( Sang Hun Lee ),이꽃실 ( Kkot Sil Lee ),윤수영 ( Soo Young Yoon ),이상철 ( Sang Choel Lee ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.5
Purpose: Acute pyelonephritis (APN) is among the most common infectious diseases. Most APN occurs in young women and easily treated. Bacteremia has been associated in approximately 20-30% of those with APN. But recent documents demonstrated that blood cultures provide no useful information toward the clinical management of acute pyelonephritis. Thus we compared demographic and clinical characteristics as related to the bacteremic status, and investigated the risk factors for bacteremia. Methods: One hundred sixty five patients, who visited myongji hospital for APN from January, 2004 to December, 2006 were included. Retrospective data were analyzed by medical record review. Results: Bacteremic patients (N=51, 30.9%) were significantly older than those in nonbacteremic group (p<0.0001), had elevated serum creatinine (p=0.008), decreased platelet counts (p=0.029), lower serum protein (p=0.010), and lower serum albumin (p=0.011) than those without bacteremia. Hematuria was more severe in bacteremic patients (p<0.0001). The bacteremic cases were observed more frequently in patients with complicated APN patients than uncomplicated patients (46.7% vs. 21.4%, p=0.001). No significant difference existed between the bacteremic and non-bacteremic patients in the prevalence of resistance to quinolone of E. coli. In multivariate logistic regression analysis, serum albumin (p=0.023), hematuria (p=0.003), and age (p=0.003) at presentation were found to be independent risk factors for bacteremia in acute pyelonephritis. Conclusion: Our study reveals that patients with bacteremia have different clinical characteristics compared to those without bacteremia. It is recommended to concern about the presence of bacteremia in the treatment of APN.
혈청 항기저막 항체검사에서 위양성을 보인 막증식성 사구체신염 1예
박경석 ( Kyoung Suk Park ),황선덕 ( Seun Duk Hwang ),전병수 ( Byung Soo Jeon ),최진이 ( Jin Yi Choi ),송지선 ( Ji Sun Song ),윤수영 ( Soo Young Yoon ),이상철 ( Sang Choel Lee ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.5
Anti-glomerular basement membrane (Anti-GBM) nephritis is an autoimmune disorder characterized by rapidly progressive crescentic glomerulonephritis (RPGN). The treatment of anti-GBM nephritis with plasmapheresis, steroids and immunosuppressant has improved outcomes. An early diagnosis is essential for the survival of patients and a recovery of renal function. The diagnosis of anti-GBM disease has been traditionally based on the demonstration of linear deposits of immunoglobulins along the glomerular basement membrane by immunofluorescence (IF) microscopy. However, a kidney biopsy cannot always be easily performed in such ill patients. Recent development of specific enzyme immunoassays for anti-GBM antibody in the serum has made possible a provisional diagnosis without a kidney biopsy. A 46-year-old male patient with hypertension and hepatitis B presented with generalized edema and general weakness. Laboratory findings were compatible with acute renal failure and nephritic syndrome with positive serum anti-GBM antibodies. After plasmapheresis with steroid pulse therapy, renal biopsy was performed and diagnosed as membranoproliferative glomerulonephritis (MPGN) with granular deposit of Ig G and C3. Follow-up antibody titers were negative. This case demonstrates the possibility of false-positive anti-GBM antibody in the serum. Therefore, enzyme immunoassay for anti-GBM antibody should be used only as a screening or follow-up test in patients that have been confirmed positive by IF microscopy.
혈액투석 환자에서 뼈스캔 시행 후 발생된 급성간염 1예
전병수 ( Byung Soo Jeon ),황선덕 ( Seun Duk Hwang ),이상철 ( Sang Choel Lee ),윤수영 ( Soo Young Yoon ),배문선 ( Moon Sun Pai ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.6
Bone scan is one of the most frequently performed studies in nuclear medicine with few adverse reactions for the examination of pathologic conditions of bone. Diffuse liver uptake of Technetium-99m methylene diphosphonate (Tc-99m MDP) is a rare occurrence with only a few reports in the literature. Furthermore, there is no report of Tc-99m MDP-induced liver injury. Here we report a case of acute hepatitis with diffusely increased uptake of Tc-99m MDP in a hemodialysis patient.