5년이상 장기 지속적 외래 복막투석 환자의 영양상태와 투석 적절도

김용림(Yong Lim Kim),조동규(Dong Kyu Cho),김성호(Sung Ho Kim),조영준(Young Jun Cho),신용봉(Yong Bong Shin) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3

N/A CAPD may have many negative impacts on nutritional status. Protein and caloric malnutrition are highly prevalent in chronic CAPD patients. In order to evaluate the relationship between nutritional and dialysis adequacy of long-term CAPD patients, twenty patients treated for aver 5 years on CAPD, with a mean age of 50.5±12.2 years and dialysis duration of 82.6±19.5 months(range 60-116) were studied. Four-teen of the twenty patients(70%) had no residual renal function(RRF). In these twenty patients the mean weekly Kt/Vurea and Ccr were 1.85±0.24 and 58.110.8L/week/1.73m²with the median body surface area(BSA) of 1.61m². Female(n=7) patients had lower BSA(1A7 vs 1.69m²), TBW(27.7 vs 35.6L), and higher serum albu-min(4.01 vs 3.41g/dL), weekly Kt/Vurea(2.02 vs 1.76) than male(n=13) patients. Six patients had nPCR0.9 and nPCR was negatively correlated with age(r= -0.53, p<0.05), BSA(r=-0.54, p<0.05) and positively correlated with serum albumin(r=0.53, p<0.05). Serum albumin was not changed during 5 years of CAPD. Fourteen patients were well nourished and six patients were mild to moderately malnourished on SGA score. Fourteen of the twenty patients had nor- mal serum albumin(≥3.5g/dL) and 6 had hypoalbu- minemia(<3.5g/dL). Serum albumin was positively correlated with nPCR(r=0.53, p<0.05) and negatively with BSA(r=-0.6S, p<0.001) and total body water (TBW)(r=-0.69, p<0.001). Hypoalbuminemia patients had high peritoneal membrane transport characteristics(24h D/Pcr 0.84 vs 0.74, p<0.05). Four patients had weekly Kt/Vurea>2.0 and Kt/Vurea was nega-tively correlated with BSA(r=-0.61, p<0.001). In conclusion, for Korean patients on long-term CAPD, small body size is the key for adequate dialysis and nutrition. Low serum albumin levels may be related with high peritoneal transport.

CAPD 환자의 출구 감염의 분류에 따른 치료경과

김용림(Yong Lim Kim),조동규(Dong Kyu Cho),김준철(Jun Chul Kim),백미영(Mi Young Baek),조영준(Young Jun Cho),박선희(Son Hee Park),이동욱(Dong Wook Lee) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2

N/A Exit-site infection(ESI) is a troublesome catheter related complication of CAPD that may lead to peri-tonitis and require catheter removal, ESI is variably defined and classified. The rate of ESI and the out-come of treatment are also variably reported in literature. We conducted a retrospective study of 58 episodes of ESI(40 patients) between August 1997 and February 1999, and evaluated the episodes and types of ESI, organism isolated from ESI and their sensitivity, outcome of ESI, number and reason for catheter loss, and the current modality. The mean age was 48.9±11.5 years(31-70) and the male to female ratio was 22:18. The mean dura-tion of CAPD before ESI was 34.1±29.6 months (1.5-114.2), and diabetic nephropathy was the cause of ESRD in 17.5% of cases. The types of catheter were two-cuff, coiled Tenckhoff in 17 patients, two- cuff, coiled swan-neck in 10 patients, two-cuff, straight swan-neck in 10 patients, and two-cuff, straight Tenckhoff in 3 patients. According to Twardowski's classification, acute infection in 33 patients and chronic infection in 25 patients were noted. Causative organisms of ESI were S. aureus, S. epidermidis, Pseudomonas, and E. cali in diminishing order of frequency. S. aureus was the most common organism in acute infection, and S. epidermidis was the most common organism in chronie infection. The mean duration of CAPD before ESI was 27.6±27.2 months in acute infection, and 42.8±30.8 in chronic infection (p<0.05). The duration of antibiotic treatment was 19.9±14.4 days in acute infection, and 42.7±27.2 days in chronic infection(p<0.05). In acute infection, peri-tonitis developed in 2 patients and 1 catheter was removed. In chronic infection, peritonitis developed in 1 patient and the catheter was removed. Three patients had the external cuff shaved due to persistent ESI which was unresponsive to antibiotics and local care. By the end of the study, 36 patients(90%) were still on CAPD, 2 patients(5%) had transferred to hemodialysis, and 2 patients(5%) had died. The cause of death was peritonitis in 1 patient, and cachexia in the other patient. In conclusion, exit-site infection responded rela-tively well to conservative treatment. However, exit- site infection is one of the major causes of catheter failure in CAPD. Therefore, careful exit-site care and examinations are needed.

연령에 따른 유아의 컴퓨터쓰기와 연필쓰기

김영실(Kim Young-Sil),함은숙(Ham Yun-Suk),김용림(Kim Yong-Lim) 한국어린이미디어학회 2003 어린이미디어연구 Vol.2 No.-

본 연구에서는 유아의 컴퓨터쓰기와 연필쓰기가 연령에 따라 차이가 있는지, 그리고 이들 간에 상관이 있는지를 알아보았다. 3세, 4세, 5세 유아 61명에게 개별면접을 실시하여 컴퓨터쓰기 표본과 연필쓰기 표본을 수집하였다. 컴퓨터쓰기는 양연임과 김영실(2001)의 컴퓨터쓰기 단계를, 연필쓰기는 Sulzby(1990)의 쓰기체제를 근거로 하여 분석하였다. 분석 결과 유아의 컴퓨터쓰기와 연필쓰기는 연령에 따라 차이가 있었으며, 연령이 증가함에 따라 발달하는 경향을 보였다. 컴퓨터쓰기와 연필쓰기는 4세 유아에게서 통계적으로 유의미한 상관관계가 있었다. This study examines whether age difference affects children's performance on writing with the computer and writing with the pencil and whether there is a relationship between the two writing skills. For this study, 61children aged 3 to 5 were interviewed individually and their computer and pencil writing samples were collected. Computer writing samples were analyzed on the basis of "Level of Children's Computer writing(Yang & Kim, 2001); pencil writing samples were analyzed on the basis of "Six Categories of Writing(Sulzby, 1990). The analysis showed that children on different age groups displayed different levels of competency in the computer writing and pencil writing skills and that the competency developed with the advancement in age. It also showed that there was a statistically meaningful correlationship between computer and pencil writing in the case of 4-year-old children.

C4d 강 양성을 보인 BK 바이러스 신병증 1예

이은영 ( Eun Young Lee ),박선희 ( Sun Hee Park ),최지영 ( Ji Young Choi ),조지형 ( Ji Hyung Cho ),김찬덕 ( Chan Duck Kim ),김용림 ( Yong Lim Kim ),김용진 ( Yong Jin Kim ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.2

C4d deposition in peritubular capillaries in renal allograft biopsies is a significant marker for diagnosis of antibody-mediated rejection. However, it is unclear whether C4d deposition could be derived from BK virus infection. We present a case of BK virus nephropathy with strong C4d deposition 10 months after kidney transplantation. The diagnosis of BK virus nephropathy was missed out, whereas strong C4d deposition was noted in the first biopsy and therefore anti-rejection therapy was started. The deterioration of renal function led to a evaluate the possibility of BK virus nephropathy with second graft biopsy and further studies of BK virus replication status. Second graft biopsy revealed BK virus nephropathy without rejection. Finally, discontinuation of immunosuppressants and addition of anti-viral therapy for BK virus resulted in recovery of renal function, despite development of pancytopenia and subsequent fungal infection after leflunomide therapy. As in this case, initial focal pathologic changes from BK virus nephropathy could be overlooked by light microscopy. In addition, even though C4d positivity in peritubular capillaries is a good marker for diagnosis of antibody-mediated rejection, the meticulous examinations of the localization of C4d is needed, considering BK virus activates complement pathways and therefore leads to deposition of C4d mainly in tubular basement membrane. Based on our case of BK virus nephropathy with strong C4d deposition, we suggest that C4d deposition could be derived from BK virus nephropathy and therefore, it should be differentiated from acute antibodymediated rejection in a renal allograft recipient.

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.

지속성 외래 복막투석 환자에서 갑상선 기능의 변화

이현희 ( Hyun Hee Lee ),김대중 ( Dae Jung Kim ),김정아 ( Jung Ah Kim ),이영기 ( Young Ki Lee ),윤수진 ( Su Jin Yoon ),허우성 ( Woo Seong Huh ),김윤구 ( Yoon Goo Kim ),오하영 ( Ha Young Oh ),김용림 ( Yong Lim Kim ),신석균 ( Sug Kyu 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.1

목적 : 말기신부전으로 투석 중인 환자에서 C반응단백 (C-reactive protein, CRP)은 이환률과 사망률의 주요한 원인으로 알려진 관상동맥질환을 예견하는 지표로 알려져 있으며, 최근 여러 연구에서 맥압의 증가가 정상인에서 심혈관 질환과 사망률의 위험인자로 대두되고 있다. 따라서 본 연구는 복막투석 환자에서 이 두 가지 지표를 함께 측정하여 관상동맥질환의 위험도를 예견하는 지표로서의 가치를 알아보고자 시행되었다. 방법 : 복막투석을 시행하는 환자 중 thallium single photon emision computed tomography (thallium SPECT)를 시행하고 6개월 이상 추적관찰이 가능하였던 총 71명의 환자 (남자 42명, 여자 29명)를 대상으로 하였다. 나이, 성별, 흡연, 당뇨, 고혈압, 맥압, 체질량 지수에 대하여 조사하였으며 혈중 알부민, 총 콜레스테롤, 섬유소원, lipoprotein (a), C반응단백을 검사 하였다. 결과 : Thallium SPECT 양성군과 음성군으로 분류하여 비교한 결과 thallium SPECT 양성군에서 C반응단백, 맥압, 흡연율, 섬유소원의 값이 의의있게 높았다 (p<0.05). 맥압이 1 mmHg 증가시 관상동맥질환의 상대 위험도는 1.017배 (95% 신뢰구간 1.011-1.023), C반응단백이 0.01 mg/dL 증가시 관산동맥질환의 상대 위험도는 1.014배 (95% 신뢰구간 1.008-1.019) 증가하였다. 다증회귀분석 결과 C반응단백과 맥압이 심근 허혈에 영향을 주는 독립인자였다. Log C반응단백과 맥압간에는 양의 상관관계가 있었다. (p<0.01>. 결론 : 복막투석 환자에서 C반응단백과 맥압은 모두 관상동맥 질환을 예측하는데 유용한 지표로 이용할 수 있을 것으로 기대된다. 그러므로 복막투석 환자에서 뚜렷한 원인 없이 지속적으로 C반응단백과 맥압이 상승되어 있는 경우 허혈성 심질환에 대하여 검사가 이루어져야 할 것으로 생각된다. Background : Atheroclerotic vascular disease is the major cause of morbidity and mortality in dialysis patients. C-reactive protein (CRP) appears to be clinically useful in prediction of coronary heart disease. Elevated pulse pressure has been associated with an increased risk of cardiovascular disease among apparently healthy adults. Therefore, we evaluated the association between a persistent elevation of C-reactive protein level, pulse pressure and the presence of ischemic heart disease in patients with continuous ambulatory peritoneal dialysis (CAPD). Methods : A total of 71 CAPD patients (42 males 29 females) who underwent thallium SPECT and followed up more than 6 months were included. We collected the data about age, sex, smoking, diabetes, hypertension, pulse pressure and body mass index. Blood levels of albumin, total cholesterol, fibrinogen, lipoprotein (a) and C-reactive protein were measured. Results : The values of C-reactive protein, pulse pressure, smoking and fibrinogen were significantly higher in thallium SPECT positive group (p<0.05). A 0.01 mg/dL increase in C-reactive protein was associated with a 1.014 increase in the odds of having an elevated risk of coronary artery disease (95% confidence interval 1.008-1.019) and a 1 mmHg increase in pulse pressure was associated with a 1.017 increase in the odds of having an elevated risk of coronary artery disease (95% confidence interval 1.011-1.023). By multivariate logistic regression analysis, C-reactive protein and pulse pressure were independent risk factors for ischemic heart disease. Log CRP level was positively correlated with pulse pressure level (p<0.01). Conclusion : The baseline level of CRP and pulse pressure independently predicts the risk of coronary heart disease in CAPD patients. For patients who have a persistent elevation of CRP and pulse pressure without an apparent cause, we recommend a workup for ischemic heart disease.

신이식 환자에서 Cyclosporine (CsA)+Mycophenolate mofetil (MMF)+steroid와 Tacrolimus (TAC)+MMF+steroid 병합요법의 심혈관계 위험성과 이식신 기능저하를 반영하는 표지자들에 대한 비교 연구

최지영 ( Ji Young Choi ),진미경 ( Mi Kyung Jin ),전주현 ( Joo Hyun Chun ),현승혜 ( Seung Hyea Hyun ),허인경 ( In Kyong Hur ),이은영 ( Eun Young Lee ),조지형 ( Ji Hyung Cho ),박선희 ( Sun Hee Park ),김용림 ( Yong Lim Kim ),김찬덕 ( 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.5

증례 : 신장 ; 비스테로이드 소염제 복용 후 발생한 신경색

윤세희 ( Se Hee Yoon ),김용림 ( Yong Lim Kim ),박선희 ( Sun Hee Park ),김찬덕 ( Chan Duck Kim ),최지영 ( Ji Young Choi ),윤성로 ( Sung Ro Yun ) 대한내과학회 2012 대한내과학회지 Vol.82 No.5

Nonsteroidal anti-inflammatory drugs (NSAIDs) are popular in general practice. Their adverse renal effects have been well documented. Common NSAID-related renal side effects range from dysfunctional renal hemodynamic responses, nephrotic syndrome, electrolyte disturbances, acute interstitial nephritis, chronic interstitial nephritis with papillary necrosis, and acute flank pain syndrome to acute renal failure. Decreased prostaglandin synthesis can lead to renal ischemia and hemodynamically related acute renal failure. Cases of acute renal failure syndrome accompanied by severe loin pain after anaerobic exercise (ALPE) or binge drinking have previously been reported in individuals taking NSAIDs. However, severe flank pain after high-dose NSAID treatment in the absence of other conditions (exercise or volume contraction) is rare. We report a case of a 51-year-old man who suffered from severe pain in both flanks after NSAID treatment. Computed tomography revealed hypodense lesions in both kidneys. (Korean J Med 2012;82:618-622)

이식 : 신이식 수혜자의 G-137C IL-18 유전자 다형성이 급성거부반응에 미치는 영향

김찬덕 ( Chan Duck Kim ),류혜명 ( Hye Myung Ryu ),최지영 ( Ji Young Choi ),최희정 ( Hee Jeong Choi ),최혁준 ( Hyuk Joon Choi ),조지형 ( Ji Hyung Cho ),박선희 ( Sun Hee Park ),김용림 ( Yong Lim Kim ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

당뇨병을 가진 복막투석 환자에서 더 높은 농도의 포도당 투석용액이 필요한 이유 분석

이승현 ( Seung Hyun Lee ),도준영 ( Jun Young Do ),김용림 ( Yong Lim Kim ),배동운 ( Dong Woon Bae ),김태우 ( Tae Woo Kim ),박종원 ( Jong Won Park ),윤경우 ( Kyung Woo Yoon ),박선희 ( Sun Hee Park ) 대한신장학회 2005 Kidney Research and Clinical Practice Vol.24 No.4