혈액투석요법으로 치료한 급성신부전 환자의 임상상

김성수(Sung Soo Kim),강응택(Eung Taek Kang),유석희(Suk Hee Yu),이지훈(Jee Hoon Lee) 대한내과학회 1990 대한내과학회지 Vol.39 No.6

N/A Acute renal failure is a clinical syndrome characterized by a sudden decrease in renal function which was previously normal. Although there are many clinical studies on acute renal failure in Korea, those are different from one another according to inestigators because of the application of different criteria for acute renal failure. To know the clinical features of acute renal failure treted by hemodialysis, we reviewed retrospectively 70 patients with acute renal failure who had been hospitalized at Department of Intetmal Medicine, Chung-Ang University Hospital between anuary 1985 and December 1989. The results were as follows; 1) Male of female ratio was 1.8:1, and mea age was 49. 7 years. The mean age of postoperative group was 58.2 years and significantly highre than other groups (p<0. 05). 2) Acute renal failure was classified according to clinical background such as medical group 44.3% (31 cases), postoperative group 34.3% (24 cases), posttraumatic group 14.3%, (10 cases) and postrenal group 7. 1% (5 cases). 3) Indications of first hemodialysis were CNS symptoms (23 cases), massive volume overload (15 cases), gastrointestinal symptoms (13 caws), hyperkalemia and acidosis (8 cases). Prophylactic dialysis was performed in 11 cases. 4) The mean numbers of hemodialysis was 4, but 6 in postoperative group and posttraumatic groups were higher than other groups, 5) Infections as the cause of acute renal failure were 18 cases, as complications 28 cases and as the cause of death 12 cases (37.5%). 6) Bleeding as the cause of acute renal failure were 18 cases, as complications 20 cases (G-I bleeding: 9 cases) and as the causes of death 5 cases (16%). 7) 62 cases were the oliguric renal failure and 8 cases were nonoliguric renal failure. The mean duration of oliguria was 12.2 days. Those of postoperative group and posttraumatic group was l6.5 days, 15.7 days respectively and these were longer than other groups. 8) The mortality rate was 45.7 (32 cases). The highest mortlity rate wa70.0% in posttraumatic group and significantly higher than other groups (p<0.01). 9) The causes of death were infection (10 cases), underlying diseases (9 cases), cardiogenic causes (6 cases) and bleeding (5 cases). The causes of 2 cases were unknown.

안면 색윤(色潤) 분석을 통한 신장 기능 측정 방법 제안

이세환(Se-Hwan Lee),조동욱(Dong-uk Cho),강응택(Eung-taek Kang) 한국통신학회 2010 韓國通信學會論文誌 Vol.35 No.7

말기 신부전 환자에서 혈액투석 치료가 성대 및 강도의 변화에 미치는 영향

김봉현(Bong-hyun Kim),조동욱(Dong-uk Cho),강응택(Eung-Taek Kang) 한국통신학회 2010 韓國通信學會論文誌 Vol.35 No.7

한국인 악성 고혈압의 임상적 고찰

오동진(Dong Jin Oh),이준승(Jun Seung Lee),박지현(Jee Hyun Park),곽귀철(Gue Chul Gawk),강응택(Eung Taek Kang),유석희(Suk Hee Yu) 대한내과학회 1995 대한내과학회지 Vol.48 No.6

N/A Objectives: Prior to the development of effective antihypertensive regimen and renal replacement therapy, malignant hypertension regarded as a bad prognostic disease. Sine 1960 with the early detection of hypertension and the introduction of new potent antihypertensive regimens and renal replacement therapy, there were several reports of etiologic changes and improving survival rates. However there has been a few reports concerning malignant hypertension in 1990s and never reported in Korea so far. The purpose of this study is to know the cause, clinical feature and survival rate of malignant hypertension in Korean, Method: The definition of malignant hypertension is characterized as grade III or IV hypertensive retinopathy according to Keith-Wagener-Barkers classification. we reviewed 107 patients with malignant hypertension who visited our department between 1988 and 1993 retrospectively. Results: The mean age of essential hypertension was 56years, renal lesion 37years, renovascular lesion 45years, and that of unknown cause was 41years, The mean blood pressure of essential hypertension was 209mmHg/128mmHg, renal lesion 194mmHg/120mmHg, renovascular lesion 210mmHg/130mmHg, and that of unknown cause was 183mmHg/125mmHg. The initial serum creatinine of essential hypertension was 2.45±2.51mg/dl, renal lesion 8.10±7.56mg/dl, renovascular lesion 1.95±0.35mg/dl, and that of unknown cause was 15.44±10.24mg/dl. Essential hypertension was diagnosed in 56 cases (53%), secondary hypertension in 40 cases (37%) and unknown cause in 11 cases(10%). The One year patient was 92% and 5 year survival survival 51%. The 5 year patient survival of essential hypertension was 85% and that of secondary hypertension was 86%. The 5year patient survival was 92% in the group of initial serum creatinine <3mg/dl, but 81% in the group of inital serum creatinine >3mg/dl. Ten patients died. Of these, three patients died of cerebrovascular accident, three patients died of hyperkalemia. Other causes of death were pulmonary edema, hepatic encephalopathy, lung cancer, and socioeconomic factor. Conclusion: the main cause of malignant hypertension in Korea was primary hypertension and survival rates were similar to recent other reports.

만성 신부전 환자의 혈액투석중 폐기능 변화에 관한 연구

이지훈(Jee Hoon Lee),김기영(Ki Young Kim),김성수(Sung Su Kim),박인원(In Won Park),강응택(Eung Taek Kang),최병휘(Byeung Whui Choi),허성호(Sung Ho Hue),유석희(Suk Hee Yu),박선규(Sun Kyu Park),서승천(Seung Chun Seo) 대한내과학회 1990 대한내과학회지 Vol.39 No.2

N/A Hypoxemia has occurred during the first 30-60 minutes of hemodialysis in patients with chronic renal failure who bad undergone hemodialysis regularly. It is primarily caused by hypoveniilation, secondary to carbon dioxide losses via dialysates and leukopenia associated with pulmonary vascular leukostasis which was induced by complement activation due to cuprophane membrane. However, there is still controversy over whether hypoxemia might be the result of bronchoconstriction during hemodialysis. To assess the relationship between hypoxemia and the changes of peripheral white blood cell counts and pulmonary function test when cuprophane membrane and acetate buffer solution had been used, arterial blood gas analysis, white blood cell counts, pulmonary function test during the first 120 minutes of hemodialysis were measured. The results were as follows: 1) The major falls of arterial blood oxygen tension occurred 15 minutes after the start of hemodialysis(p<0.05), and the biearbonate concentration significantly and gradually increased 30 minutes and 120 minutes after the start of hemodialysis(p<0.05). 2) The pulse rate significantly increased 15 minutes and 30minutes after the start of hemodialysis(p<0.05). 3) The arterial white blood cell counts and the precentage of neutrophil significantly decreased 15 minutes after the start of hemodialysis and then gradually recovered to a predialytic level(p<0.05), but the percentage of lymphocytes significantly increased 15 minutes after the start of hemodialysis and then gradually recovered to a predialytic level (p<0.05). 4) MMF, PEFR, and FEF75 significantly increased, but no significant changes of FEV1/FVC occurred during hemodialysis. Therefore, we suggest that acute hypoxemia may occur not due to bronchoconstriction, but due to pulmonary vascular leukostasis associated with complement activation.

혈액투석으로 치료한 급성 신부전의 예후인자

곽귀철(Gue Chuel Kwak),오동진(Dong Jin Oh),이준승(Jun Seung Lee),박지현(Joe Hyoun Park),강응택(Eung Taek Kang),유석희(Suk Hee Yu) 대한내과학회 1995 대한내과학회지 Vol.48 No.4

N/A Objectives: Acute renal failure continues to be associated with a high mortality despite advances in dialysis and care of the critically ill patient. Although there have been many clinical studies on acute renal failure in Korea, none of them have investigated the prognostic factors in acute renal failure managed with hemodialysis. Methods : We reviewed retrospectively 115 patients with acute renal failure who had been hospitalized and hemodialyzed at the Department of Internal Medicine, Chung-Ang University Hospital between October 1984 and July 1993. Results: 1) The overall mortality was 50.4% with the mean age of nonsurvivors higher than that of survivors(54 ±7.2 vs 44±18.9 years, p<0.05). The mortality was higher in older age, especially patients over 60 years( p = 0.0031). 2) According to the complications, the mortality was 100% in acute myocardial infarction, 100% in coma, 93.1% in persistent hypotension, 86.2% in respiratory failure, 77.5% in infection, 73.3% in jaundice, and 38.3% in pneumonia. The presence of complications were closely related to the prognosis of acute renal failure(p<0.05). 3) The hematocrit and the increase of BUN during hemodialysis was closely related to the prognosis of acute renal failure(29.0 vs 32.3, 17.1mg/dL/day vs 11.9mg/dL/day, p <0.05). 4) According to Liano's discriminant score, our mean score was 0.343 in survivors & 0.565 in nonsurvivors, and our cutoff point was lower than that of Liano's score.(0.611 vs 0.856) Conclusion : The poor prognostic factors in acute renal failure managed with hemodialysis were old age, presence of infection, persistent hypotension, acute myocardial infarction, jaundice, respiratory failure, pneumonia, hematocrit and the increase of BUN during dialysis. Because Liano's discriminant score was insufficient as prognostic indices for itself, other objective prognostic indices should be studied.

신장 기능 이상자를 대상으로 한 투석전후의 안면색상 비교

이세환(Se-Hwan Lee),김봉현(Bong-Hyun Kim),가민경(Min-Kyoung Ka),조동욱(Dong-Uk Cho),강응택(Eung-Taek Kang) 한국통신학회 2009 한국통신학회 학술대회논문집 Vol.2009 No.11

온라인 혈액투석여과법의 임상적 유용성

이경은 ( Kyung Eun Lee ),김태영 ( Tae Young Kim ),남우진 ( Woo Jin Nam ),김선민 ( Sun Min Kim ),오동진 ( Dong Jin Oh ),강응택 ( Eung Taek Kang ),유석희 ( Suk Hee Yu ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

한탄바이러스에 감염된 사람제대정맥 내피세포에서 ICAM-1 및 VCAM-1 의 발현

설무종(Moo Jong Seol),이태우(Tae Woo Lee),김차현(Cha Hyun Kim),최재영(Jae Young Choi),유수정(Soo Jeong Yoo),오동진(Dong Jin Oh),유석희(Suk Hee Yu),강응택(Eung Taek Kang) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.5

배 경 : 신증후출혈열은 한탄바이러스에 의한 급성 발열성 질환으로 병인에 여러 가지 염증매개불질들이 알려져 있다. 방 법 : 본 연구에서는 한탄바이러스에 감염된 사람 제대정맥 내피세포에서 ICAM-1 및 VCAM-1의 발현 정도를 효소면역측정법을 이용하여 정량 측정하였다. 결 과 : 한탄항원에 대한 반응은 감염 후 48시간부터 중가하기 시작하였으며. ICAM-1의 발현은 감염 후 3시간이 지나면서 급격히 중가하였다. VCAM-1의 발현은 ICAM-1의 발현보다 약간 지연되었으며 감염 후 4시간이 지나면서 급격히 증가하였다. 이 같은 ICAM-1, VCAM-1 발현 증가는 희석되지 않은 바이러스를 감염 시켰을 때 더 현저하였으며 희석된 바이러스를 참염시켰을 때에는 반응이 미약하였다. 결 론 : 한탄바이러스가 사람제대정맥 내피세포에 감염되면 ICAM-1 및 VCAM-1의 발현이 증가됨을 관찰하였고 이를 효소면역측정법을 이용하여 정량격으로 비교하였다. Purpose: Hemorrhagic fever with renal syndrome (HFRS) is an acute febrile disease caused by Hantaan virus. It is believed that various kinds of inflammatory mediators and cytokines might be involved in its pathogenesis. Methods : We studied the expression of adhesion molecules, including ICAM-1 and VCAM-1 on Hantaan virus-infected human umbilical vein endothelial cells (HUVECs) with ELISA. Results : Hantaan antigen increased gradually 48 hours after virus infection, ICAM-1 increased rapidly 3 hours after virus infection and VCAM-1 increased rapidly 4 hours after infection, a little later than ICAM-1. The patterns of the change of reaction were similar between the different concentrations of virus solution that had been adsorbed on HUVECs, but the expression of ICAM--1 or VCAM-1 was greater when HUVECs were infected with stock virus rather than when infected with tenfold diluted virus. Conclusion : We report the quantification using ELISA of ICAM-1 and VCAM-1 expression of HUVECs that have been infected by Hantaan virus. Increase of their expression would play an important role in the pathogenesis of HFRS.

저삼투질 비이온성 조영제에 의한 신손상시 뇨중 N - Acetyl - β - D Glucosaminidase ( NAG ) 활성도의 의의

이준승(Jun Seung Lee),박지현(Jee Hyoun Park),곽귀철(Guee Chul Kwak),오동진(Dong Jin Oh),민철홍(Cheol Hong Min),강응택(Eung Taek Kang),유석희(Suk Hee Yu) 대한내과학회 1996 대한내과학회지 Vol.51 No.5

N/A Objectives: It has been claimed that the incidence of the contrast media induced nephrotoxicity (CMN) was reduced with the introduction of the nonionic low-osmolar contrast media (CM). The commonly used diagnostic tools for nephrotoxicity including serum creatinine levels, creatinine clearance and urine analysis cannot detect damage of renal proximal tubule in early stage. Urine N-Acetyl-β-D Glucosaminidase (NAG) is well documented a useful indicator for proximal tubular damage. Therefore we investigated incidence of nonionic low-osmolar CMN and whether the urine NAG activity could be used as a indicator of CMN. Methods: We studied 32 patients with normal renal functions (mean age: 58.7, M:F=23:9) and assayed their serum concentration of creatinine, urine NAG activities and SDS-PAGE profiles in the urine for 5 days after exposure to CM. Results: Mean creatinine level of 32 patients did not increase in comparison to their preexposure level on post exposure day 1, 3 and 5. But mean urine NAG activities increased significantly in comparison to their preexposure activities from day 1 to day 4 (p<0.05). Serum creatinine level increased either more than 50% or at least 1㎎/dL comparing the preexposure levels in 5 patients (15.6%) and did not in 27 patients (84.4%) and urine NAG activities increased from day 1 to day 4 in the former group and from day 1 to day 3 in latter group (p<0.05). Serum creatinine level increased either more than 20% or at least 0.3㎎/dL comparing the preexposure levels in 13 patients (40.6%) and did not in 19 patients (59.4%) and urine NAG activities increased from day 1 to day 3 in two groups (p<0.05). Serum creatinine level increased only 25% (sensitivity) of the patients with low molecular weight (LMW) protein in their urine SDS-PAGE and did not increased 90% (specificity) of the patients without LMW protein in their urine SDS-PAGE (50% or 1.0㎎/dL). The sensitivity and specificity of creatinine level were 33.3% and 55% (20% or 0.3㎎/dL) upon SDS-PAGE. Urine NAG activity revealed 76.9% of sensitivity and 52.6% of specificity. Conclusion: Nonionic low-osmolar contrast media, compared to ionic high osmolar contrast media, results in similar incidence of CMN and have the potential CMN subclinically. Urine NAG activity can be a useful indicator for CMN.