지속성 복막투석의 동물 모델에서 복막휴식이 용질 수송과 복막 섬유화에 미치는 영향

김석재(Seog Jae Kim),김용림(Yong Lim Kim),조동규(Dong Kyu Cho),김용진(Yong Jin Kim),김준홍(Jun Hong Kim),김성호(Sung Ho Kim),김찬덕(Chan Duck Kim),남직화(Jick Hwa Nam) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3

N/A Ultrafiltration failure has been known as a major cause of dropout from long-term peritoneal dialysis and is often related to peritoneal hyperpermeability. This can be explained in part by progressive peritoneal fibrosis. The present experiment has been under- taken to evaluate the effects of peritoneal rest on peritoneal transport and morphology in rat model of peritoneal dialysis. Twenty-four male rats(Sprague-Dawley, 250-300g) were used and divided into three groups : group 1 (control, n=6) without dialysis, group 2(n=9) sacrificed immediately after 3 weeks of dialysis, and group 3 (n=9) sacrificed after 4 weeks of peritoneal rest after 3 weeks of dialysis. Peritoneal dialysis was performed twice a day with 25mL of 3.86% dextrose solution for 3 weeks. Peritonitis was induced by supplementing lipopolysaccharide(5μg/mL) in the dialysis fluid on days 8, 10 and 12 of peritoneal dialysis. Peritoneal equilibration tests were performed before dialysis and repeated on the 4th and 8th week of dialysis. Mor-phometric analysis of the peritoneal membrane and immunohistochemistry for collagen type I and type III were done in tissue specimens obtained at the time of sacrifice. The D/Do ratio for glucose at two hours in groups 2 and 3 at the beginning of week 4 were signifi-cantly lower than baseline value, indicating increase in the peritoneal penneability to glucose after 3 weeks of dialysis. D/Do in group 3 at the beginning of week 8, after 4 weeks of peritoneal rest, was significantly higher than at week 4. The drained dialysate volumes in groups 2 and 3 at week 4 were significantly lower than at baseline; however, The drained dialysate volume in group 3 at week 8 was significantly greater than at week 4. The thickness of the parietal peritoneal membraoe in group 2 and 3 were significantly greater than in group 1. Severity of the thickness of the parietal peritoneal membrane in group 3 was not much than that of group 2(group 1, 11.4±7.6; group 2, 37.5±18.4; group 3, 21.4±12.1 pm). Histologically, the thickened peritoneum in group 2 showed a monolayer of mesothelial cells and under-lying multilayer of curled collagen bundles. Mononu-ciear cells and fibroblasts were embedded in these collagen layers and capillary proliferation was present. Immunohistochemistry for collagen type I and Z demonstrated that the distribution of collagen type llI was richer than that of collagen l in group 2 at fibrotic area of submesothelial region. These findings were decreased in group 3. Ultrastructural examination of the peritoneum showed thicker fibrotic zone and the activated fibro-blasts in group 2 compared to group 1 and 3. Meso-thelial cells were plump and the number of meso-thelial microvilli was decreased in group 2. Nucleus was enlarged and irregular. Intracytoplasmic orga-nelles were also richer than those of group I or 3. In conclusion, peritoneal rest improves ultrafil- tration in rats by decreasing the hyperpermeability of glucose and also reduces the degree of peritoneal fibrosis. These data suggest that dialysis-induced changes in peritoneal transport and morphology are reversible under the condition of peritoneal rest in this experimental model.

HLA 일배체 부적합 혈연관계 생체 신이식에서 공여자 연령이 이식신 및 환자 생존율에 미치는 영향

김준홍(Jun Hong Kim),김찬덕(Chan Duk Kim),김석재(Seog Jae Kim),백미영(Mi Young Baek),권태환(Tae Hwan Kwon),김용림(Yong Lim Kim),조동규(Dong Kyu Cho),김영욱(Young Wook Kim),권태균(Tae Gyun Kwon),장세국(Sae Kook Chang) 대한내과학회 1998 대한내과학회지 Vol.54 No.3

N/A Objectives: Renal transplantation has become the therapy of choice for patients suffering from end-stage renal disease. But because of progressive disparity between the number of patients in needs of a transplant and the number of ideal kidneys available for transplantation, increasing numbers of kidneys are recovered for transplantation from donors that are not considered ideal, especially from donors over the age of 55. In country such as Korea, the number of cadaveric transplants is limited due to cultural and religious prejudices of the population, poor legal definition and deficient organization of cadaveric donor work-up. Therefore the main source is living related donors(LRD), especially the parent. But in Korea, there is few reports about the influence of donor age on outcome in living related kidney transplantation. Thus we performed this study to estimate the influence of donor age in itself on the outcome of the one HLA-haplotype mismatched living related kidney transplantation. Methods: The effect of donor age on the outcome of One HLA-haplotype mismatched living related kidney transplantation was studied in 71 recipients who under- went kidney transplantation from January 1981 to March 1995. The outcomes of 25 recipients from the older age group(?55 years: Group A) and 46 recipients from the younger age group(<55 years: Group B) were retrospectively reviewed. Patient death with a functioning graft was considered graft loss. Results: Demographic characteristics between 2 groups were similar, The 1-year and 3-year patient survival rates in recipients(group A and B) were similar regardless of donor age(96.0% and 90.8% vs.97.4% and 90.3%, respectively). The 1-year and 3-year graft survival rates in recipients(group A and B) were not significantly different (91.4% and 63.9% vs 92.7% and 79.3%, respectively). The mean levels of serum creatinine at discharge were significantly higher in group A. Short-term and intermediate-term renal function, as assessed by serum creatinine, was inferior in the group A throughout the follow-up periods of 3 years. The causes of graft loss in the first 3 years after transplantation were irreversible rejection(71%) and the patient death with functioning graft(29%) in group A, while the causes of graft loss in group B were irreversible rejection(50%), patient death with a functioning graft(40%) and technical reason(10%). Conclusion: These results of our analysis suggest that similar outcome can be achieved after living related renal transplantation from older donor. Therefore the kidneys may be used from donors over 55 years old on condition that the donors undergo complete and exhaustive work-up.

거창군 수돗물불소농도조정사업 실시를 위한 지역사회 기초조사

이세홍 ( Se Hong Lee ),신희재 ( Hi Jae Shin ),배광학 ( Kwang Hak Bae ),이선미 ( Sun Mi Lee ),강석재 ( Seog Jae Kang ),김진범 ( Jin Bom Kim ) 대한예방치과·구강보건학회 2005 大韓口腔保健學會誌 Vol.29 No.3

수돗물불소농도조정사업에 대한 거창군 거창읍 주민의 인식과 사업시행 찬성여부에 미치는 요인

권수진 ( Su Jin Kwon ),이선미 ( Sun Mi Lee ),강석재 ( Seog Jae Kang ),김진범 ( Jin Bom Kim ) 대한예방치과·구강보건학회 2006 大韓口腔保健學會誌 Vol.30 No.4

당뇨병이 없이 당뇨병성 망막증과 전형적인 당뇨병성 결절성 사구체 경화증을 보인 1예

김성호,박선희,김준철,조동규,김석재,백미영,김준홍,김용림,김찬덕 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.6

Nodular glomerulosclerosis was first described by Kimmelstiel and Wilson in 1936. Diabetic retinopathy and nephropath y are manifestation of the microangiopathy associated with diabetes. The severity of diabetic nephropathy and the occurrence of retinopathy correlate with the duration of clinical diabetes. However, there have been few reports of patients presents presenting with the classic lesions of diabetic microangiopathy in the absence of a known history of diabetes. These reports raise questions regarding the relationship and significance of carbohydrate intolerance to these pathologic abnormalities. A 34-year-old male patient clinically characterized by massive proteinuria and hypertension without evidence of systemic disease is reported. Renal biopsy showed the nodular glomerulosclerosis(Kimmelstiel-Wilson lesion) characteristic of diabetes. Direct opthalmoscopy and fluorescein angiography demonstrated a picture of advanced proliferative diabetic retinopathy. The patient had no history of diabetes mellitus and upon testing had normal glucose values in response to an oral glucose tolerance test. It is concluded that the nodular glomerulosclerosis lesions and proliferative retinopathy, thought to be specific for diabetes mellitus, may present in the absence of either overt clinical diabetes or impaired glucose tolerance.

유기용제에 장기간 폭로된 근로자의 정신의학적 기능과 삶의 질

김석재,강순아,유지숙,국승희,윤진상,문재동,이형영 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.5

연구목적: 본 연구는 Y공단의 제조공정에서 저농도의 유기용제(solvent)에 장기간 노출된 근로자의 정신의학적 기능과 삶의 질을 평가하고자 하였다. 방법: 총 142명의 남성근로자 중 유기용제에 폭로된 군(이하 폭로군) 82명과 폭로되지 않는 군(이하 비폭로군) 60명에게 간이정신진단검사(Symptom Checklist-90-R, SCL-90-R), 인지 및 정신운동성검사 (Critical Flicker Fusion Threshold. CFFT; Choice Reaction Time, CRT;Compensatory Tracking Task, CTT;Digit-Symbol Substitution, DDS) 및 한국판 스미스클라인 비챰 삶의 질 척도(Korean version of the SmithKline Beecham 'Quality of Life' Scale, KvSBQOL) 등을 적용하였다. 두 군간의 비교는 평가치의 평균에 대해 t-검증을 하였고 또한 연령과 학력을 공변인으로한 공변량분석(ANCOVA)을 하였다. 결과: SCL-90-R의 9개 증상 차원과 3개 전체 지표 점수는 두 군이 각각 정상범위였다. 그러나 신체화 (Somatization, SOM), 우울(Depression, DEP), 적대감(Hostility, HOS), 공포불안(Phobic anx-iety, PHOB)의 증상차원과 전체심도지수(Global Severity Index, GSI), 표출증상합계(Positive Symptom Total, PST)의 전체 지표는 폭로군이 비폭로군보다 유의하게 높았다. 인지 및 정신운동성 검사와 삶의 질은 두 군간에 유의한 차이는 없었다. 결론: 이상의 결과는 유기용제가 허용치 이하일지라도 장기간 폭로되는 경우에는 정신의학적 문제를 다소 일으킬 수 있음을 시사하였다. 중심단어:유기용제·근로자·정신건강·정신운동성 기능·삶의 질. Objectives: The aim of this study was to evaluate the psychiatric function and quality of life of the chemical workers who had been exposed to long-term, low-level organic solvents in the Y industrial complex. Method: A total of 144 male workers, of whom 82 were in the exposed group and 60 in the unexposed-control group, were evaluated by using Symptom Checklist-90-R(SCL-90-R), series of neuropsychological tests(critical flicker fusion threshold, CFFT) ; choice reaction time, CRT ; compensatory tracking task, CTT) ; digit symbol substitution test, DSS), and the Korean version of the SmithKline Beecham Quality Of Life scale(KvSBQOL). For the statistical analyses, comparisons of the means of the two groups were performed for each variable with two-tailed t-test as well as ANCOVA including age and education as covariates. Results: For the SCL-90-R, the nine symptom scales and the three global indices were clinically within normal range in both groups. However, the scores on the symptom scales of 'somatization','depression','hostility' and 'phobic anxiety', and those on the global indices of 'global severity index' and 'positive symptom total', were significantly higher in the exposed group than in the unexposed group. In terms of the neuropsychological function and the quality of life, there wes no significant difference between the two groups. Conclusion: These findings suggested that the long-term eposure to mixed organic solvents, even at the low level below the permissible exposure limit, might induce some psychiatric problems. KEY WORDS: Organic solvent·Worker·Mental health·Psychomotor function·Quality of life.

만성신부전증 및 신장이식환자에서의 Lipoprotein(a) 및 기타 지질상의 변화

조동규,조성,김석재,권태환,김용림,방종효,백미영,김준홍 대한신장학회 1995 Kidney Research and Clinical Practice Vol.14 No.3

단백뇨를 보이는 사구체 질환 및 당뇨병성 신병증에서의 Lp(a)

권태환,김준홍,조성,김석재,김용림,조동규,백미영 경북대학교 병원 1998 경북대학교병원의학연구소논문집 Vol.2 No.1

Background: Recently there has been evidences that serum Lp(a), an independent risk factor to atherosclerotic cardiovascular diseases, were increased in proteinuric disorders such as nephrotic syndrome and diabetic nephropathy. Methods: We intended to search of altered concentrations of Lp(a) in proteinuric disorder measuring serum Lp(a) concentrations with ELISA in 44 glomerulonephritic patients(25 nephrotic syndrome(NS), 19 non-nephrotic range proteinuric glomerulonephritis(GN), 25 diabetic nephropathy patients(DN), and 31 healthy controls(HC). Also, we compared Lp(a) concentration between glomerulonephritis patients and diabetic nephropathy patients with proteinuria of similar degree. Results: 1) There were significantly increased levels of total choesterol, triglyceride, and LDL-cholesterol in Ns compared to GN, DN, HC. 2) There were significantly increased concentrations of serum Lp(a) in NS compared to HC, but no signiicant difference in serum Lp(a) among NS, GN, and DN. 3) There was no significant difference in serum Lp(a) concentrations between NS & DN with 24 hour urine protein greater than 3.0g. 4) There was no significant difference in serum Lp(a) concentration between GN with 24 hour urine protein greater than 0.5g and less than 1.5g and DN with proteinuria of simial degree. 5) In glomerulonephritis patients, there was negative correlation between serum Lp(a) concentration and serum albumin level but correlation with 24 hour urinary protein, total cholesterol, Ldl-cholesterol, and HDL-cholesterol was not shown. In diabetic nephropathy, there was no significant correlation among serum Lp(a) concentration and all parameters including serum albumin, 24 hour urinary protein, and other lipid profiles. Conclusion: The present study confirmed that patients with nephrotic syndrome of diverse etiologies have makedly increased plasma level of Lp(a), in conjunction with other lipid abnormalities. However, this study shows no difference in Lp(a) concentrations between diabetic nephropathy and glomerulonephritis with similar degree of proteinuria.

단백뇨를 보이는 사구체 질환 및 당뇨병성 신병증에서의 Lp (a)

조동규,조성,김석재,백미영,김준홍,권태환,김용림 한국지질학회 1997 韓國脂質學會誌 Vol.7 No.1

Background: Recently there has been evidences that serum Lp(a), an independent risk factor to atherosclerotic cardiovascular diseases, were increased in proteinuric disorders such as nephrotic syndrome and diabetic nephropathy. Methods: We intended to search of altered concentrations of Lp(a) in proteinuric disorder measuring serum Lp(a) concentrations with ELISA in 44 glomerulonephritic patients(25 nephrotic syndrome(N5), 19 non-nephrotic range proteinuric glomerulonephritis(GN), 25 diabetic nephropathy patients(DN), and 31 healthy controls(HC). Also, we compared Lp(a) concentration between glomerulonephritis patients and diabetic nephropathy patients with proteinuria of similar degree. Results: 1) There were significantly increased levels of total cholesterol, triglyceride, and LDL-cholesterol in NS compared to GN, DN, HC. 2) There were significantly increased concentrations of serum Lp(a) in NS compared to HC, but no significant difference in serum Lp(a) among NS, GN, and DN. 3) There was no significant difference in serum Lp(a) concentrations between NS & DN with 24 hour urine protein greater than 3.0g. 4) There was no significant difference in serum Lp(a) concentration between GN with 24 hour urine protein greater than 0.5 g and less than 1.5g and DN with proteinuria of similar degree. 5) In glomerulonephritis patients, there was negative correlation between serum Lp(a) concentration and serum albumin level but correlation with 24 hour urinary protein, total cholesterol, LDL- cholesterol, and HDL-cholesterol was not shown. In diabetic nephropathy, there was no significant correlation among serum Lp(a) concentration and all parameters including serum albumin, 24 hour urinary protein, and other lipid profiles. Conclusion: The present study confirmed that patients with nephrotic syndrome of diverse etiologies have markedly increased plasma level of Lp(a), in conjunction with other lipid abnormalities. However, this study shows no difference in Lp(a) concentrations between diabetic nephropathy and glomerulonephritis with similar degree of proteinuria.