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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.
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.
특발성 비후성 대동맥판막하 협착증에 동반된 신경색 1 예
김봉식,이준승,박지현,오동진,강응택,최창환,유석희,손창재,곽귀철 대한내과학회 1994 대한내과학회지 Vol.47 No.5
Since the first description of renal infarction by Hirschwald in 1856, renal infarction is not a rare disorder, But the diagnoais of this is often delayed due to relative low incidence, non-specific symptoms and signs, physicien's lack of familiarity, However, correct diagnosis are mandatory because of favorable outcome with anticoagulant, The causes of renal infarction is most1y related to valvular heart disease and arrhythmia. We reported a case of renal infarction associated with idiopathic hypertrophic subaortic stenosis (IHSS) in a 63-year old man confirmed by renal biopsy and echocardiography, He had suffered from angina pectoris and hypertension over 10 years and recently experienced sudden left lower quadrant abdominal pain. The M-mode echocardiography was compatible with IHSS (asymmetrical septal hypertrophy, systolic anterior motion of mitral valve and narrowing of LV outflow tract. Others were unremarkable). The abdomen CT scan showed multiple wedge-shaped low density lesion. The renal biopsy showed severe lumen narrowing and intimal proliferation of medium-sized artery and ischemic necrosis of renal glomeruli, renal tubules, interstitium. Therefore, this case highly suggested that renal infarction was caused by IHSS. We discussed this case with review of literatures.