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Editorial : Niacin in patients with chronic kidney disease; Is it effective and safe?
( Cheol Whee Park ) 대한신장학회 2013 Kidney Research and Clinical Practice Vol.32 No.1
This study was supported by grants from the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea.
박철홍 ( Cheol Hong Park ),임창훈 ( Chang Hoon Lim ),장형진 ( Hyoung Jin Chang ),손상원 ( Sang Won Son ),정성진 ( Sung Jin Jung ),박철휘 ( Cheol Whee Park ),장윤식 ( Yoon Sik Chang ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.2
A 46-year-old woman with chronic renal failure due to polyarteritis nodosa was referred to the hospital for evaluation of abdominal pain. She had been treated with cathartics (magnesium oxidate 2.0 g/day) for constipation for several days. One day before the admission, the patient had been taken magnesium enema twice at another hospital. On admission, she was comatose, suffering from lethargy and respiratory failure. Her serum magnesium and amylase concentrations were markedly elevated (8.2 mg/dL and 1,698 IU/L respectively), and plain abdominal image and abdominal computed tomography revealed acute pancreatitis and non-obstuctive ileus. Thereafter, aggressive cardiopulomonary support with mechanical ventilation and continuous renal replacement therapy using continuous veno-venous hemofiltration (CVVH) applied due to cardio-respiratory failure and hypermagnesemia. After 3 days of CVVH treatment, the concentration of serum magnesium was normalized to 3.2 mg/dL, and respiratory failure and abdominal ileus were markedly improved. Four days after aggressive treatment, her hemodynamic and gastroenteric symptoms stabilized. Therefore, we report the case of hypermagnesemia with acute pancreatitis, severe hypotension and respiratory failure after cathartic ingestion and enema containing magnesium oxidate treated with CVVH.
당뇨병성 신부전의 관리와 최신 치료 ; 당뇨병성 신증의 최신 치료 -새로운 약제를 중심으로-
박철휘 ( Cheol Whee Park ) 대한내과학회 2009 대한내과학회지 Vol.77 No.6
Prevention, early detection, and treatment of renal disease in diabetic patients are becoming major healthcare issues. It is well known that hyperglycemia is a major risk factor for the development and progression of diabetic nephropathy. Therapeutic options such as strict glycemic control and early antihypertensive treatment effectively prevent or slow the progression of renal disease in both types of diabetes, depending on the clinical manifestations. The mainstay of diabetic nephropathy therapy is good glycemic control and maintaining optimal blood pressure with angiotensin converting enzyme (ACE) inhibitors and/or angiotensin receptor blockers (ARBs). Additionally, correction of dyslipidemia and cessation of smoking are additional important factors to prevent and slow the progression of diabetic nephropathy. Biochemical and hemodynamic hypotheses have been proposed and are supported by animal models as the principal causes of the development and progression of diabetic nephropathy. This review discusses new insights into the recent trend focusing on new therapies, including hemodynamic agents and biochemical agents for preventing and delaying the progression of diabetic nephropathy. (Korean J Med 77:686-694, 2009)
박철휘 ( Cheol Whee Park ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.4
1. 만성 투석환자의 가장 흔한 심혈관 합병증은 고혈압이다. 투석 환자에서의 고혈압은 체액 저류가 가장 중요한 원인이다. 투석환자에서 혈압조절의 K/DOQI 권장치는 투석 전 혈압 140/90 mmHg 미만, 투석 후 혈압 130/80 mmHg 미만을 목표로 한다. 그러나, 투석 중에 혈압 저하가 없는 범위 내에서 가능한 낮은 수치가 좋다는 의견이 있다. 투석 환자의 생존율에 관한 역학조사에서 U 커브 현상이 나타나, 과도한 혈압 저하도 생존율을 악화시킨다는 보고도 있다. 2. 투석 환자에서 저혈압의 가장 흔한 요인은 한외여과에 의한 혈액용적의 감소에 대한 혈역동학적으로 불충분한 보상 에 의한다. 투석 중의 저혈압은 원인을 알아내고, 이에 대한 예방과 치료를 시행하는 것이 중요하다고 하겠다. 특히 부정맥 또는 허혈성 심질환 등 심혈관계 이상에 의한 투석 중 저혈압은 투석 후 환자 급사와 관련이 있으므로 주의를 기울여야 한다. 3. 투석 환자에서 일반인에 비해 부정맥이 더 흔한 것으로 알려져 있고, 이는 심장비후, 판막증, 허혈성 심질환 등에 합병된 것, 요독증과 관련된 대사 및 전해질의 변화 및 혈액투석의 영향에 의한 것 등 원인이 매우 다양하다. 가장 흔한 부정맥은 심방세동으로 심방세동이 생기거나 있는 환자는 없는 환자에 현저한 사망률의 증가를 보인다. 투석 환자에서 흔한 부정맥과 치료가 필요한 부정맥의 발견 및 원인에 대한 치료가 동시에 필요하다. 4. 심근경색을 포함한 허혈성 심질환은 투석 환자에서 흔하며, 심근경색 후 1년 생존율은 50% 미만이다. 무통성 허혈성 심질환이 많으므로 주의하여야 하고 투석 시 원인 불명의 혈압 저하나 심부전이 있는 경우 심근경색을 포함한 허혈성 심질환을 의심하고 검사를 시행하여야 한다. 적극적인 심혈관 질환에 대한 위험인자의 개선과 병변 발생 시 적절한 중재술을 통한 치료가 이루어져야 한다.
신증후군과 내분비 기능저하증으로 발현된 임파종과 동반된 AA 유전분증
김희정,김기원,박석영,김석영,한충민,박관규,서광선,박용현,방병기,안석주,윤성로,박철휘 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.5
Amyloidosis is a rare complication of nonhodgikin's lymphoma. In review of the literature, almost all amyloidosis in lymphoma are the AL type and they are resulted frorn monoclonal light chains synthesized by the lymphoma cells. But we want to describe the AA type in patient with small lymphocytic lymphoma. A 60-year-old male patient admitted due to generalized edema and asthenia. He complained anorexia and dizziness at standing. Initial laboratory test revealed nephrotic range proteinuria and hypoalbuminemia. Combined pituitary stimulation test confirmed a decreased pituitary function and the adrenal function was also regarded hypofunctioning status in view of decreased cortisol response. Serum protein electrophoresis revealed monoclonal peak in gamma globulin area. This protein was composed by IgG and Lambda. We found the monotonous cellular infiltration in bone marrow specimen. These cells were lambda positive in immunohistochemical staining and only CD 20 positive in immunophenotype study. We made a diagnosis of small lymphocytic lymphoma with bone marrow involvement. Kidney biopsy revealed amyloidosis and the electrornicroscopy showed definite randomly arranged amyloid fibril, but immunohistochemical staining was positive with AA amyloid, unexpectedly. We suggest that all amyloidosis in lymphoma patient should be explored the origin of the amyloid fibrile, that is AA type or AL type.