만성 신부전과 동반된 일차성 알도스테론증

김용수 ( Yong Soo Kim ),최훈영 ( Hoon Young Choi ),김현진 ( Hyun Jin Kim ),김동기 ( Dong Ki Kim ),정인현 ( In Hyun Jung ),김형종 ( Heung Jong Kim ),이태희 ( Tae Hee Lee ),윤수영 ( Soo Young Yoon ),최규현 ( Kyu Hyun Choi ),강신욱 ( 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.1

Background : Early detection and treatment of chronic kidney disease (CKD) are important for inhibition of kidney disease progression and prevention of cardiovascular complications. Treatment of Anemia that is frequently accompanied with CKD, are important for prevention of cardiovascular complications. The lastest K/SOQI-CKD guideline targets early detection and treatment of kidney disease, and the study for these are necessary in Korea. In Korea, until mowadays, the study for prevalence, severity of anemia and influencing factors on anemia in CKD, were rare. Thus in our center, we classified patient for severity of CKD as K/DOQI-CKD guideline and studied prevalence, severity of anemia and influencing factors on anemia. Methods : According to K/DOQI-CKD guideline, patients were staged by GFR calculated by Adbbreviated MDRD Study Equation. Anemia was defined by Hb lessl than 10.0 g/dL below which hemodynamic change develops. We examined the frequency of anemia and independent factors that influences on anemia in study patients. Results : Mean creatinine levels for stage 1 to 5 were 0.87±0.15 (0.7-1.1) mg/dL; 1.04±0.18 (0.8-1.4) mg/dL; 1.69±0.36 (1.1-2.7) mg/dL; 2.90±0.66 (1.9-4.7) mg/dL; 5.01±1.28 (3.3-8.8) mg/dL. Mean Hb levels and percentage of anemic patients in each stages were 12.95±1.46 (10.5-15.4) g/dL, 0%; 13.31±2.20 (7.8-17.7) g/dL, 10.3%; 11.32±2.07 (7.4-16.6) g/dL, 25.5%; 10.10±1.71 (6.7-14.0) g/dL, 54.8%; 9.21±1.53 (6.2-12.2) g/dL, 76.9%. The frequency of anemia were high in Diabeltes Mellitus Mellitus (DM) compared to Non-Diabeltes (Non-DM) at stage 3, 4, 5 [36.7 vs 12.0% (p=0.06); 70.6 vs 35.7% (p=0.000); 100 vs 64.7% (p=0.06)]. Multivariate logistic regression analysis revealed that DM as etiology (OR 2.53, p=0.033 compared with Non-DM), Albumin level (OR of 5.38 p=0.001 for 3.0-1.4 compared with 4.0-5.3 g/dL) were independent factor determing anemia state in addition to K/DOQI guideline stage. GFR, sex, DM, Albumin level were independent factors associated with hemoglobin levels (R^2=0.571, p<0.001). Conclusion : Anemia in CKD was developed relatively early and frequently at stage 3 (Cr, 1.69±0.36 mg/dL, 25.5%) and more aggravated as decreasing renal function (stage 4, 5; 54.8%, 76.9%). DM as underlying disease, hypoalbuminemia were, independently influenced Anemia development.

혈액투석 환자에서 발생한 폐렴의 임상적 특성에 관한 연구

김영수 ( Young Soo Kim ),김용환 ( Yong Hwan Kim ),송선화 ( Sun Wha Song ),윤선애 ( Sun Ae Yoon ),정병하 ( Byoung Ha Jung ),김길선 ( Gil Sun Kim ),김용수 ( Yong Soo Kim ),김영옥 ( Young Ok Kim ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.5

Purpose : The most common infectious diseases in hemodialysis (HD) patients are sepsis and pneumonia. Although there are many data about sepsis in HD patients, pneumonia in HD patients is rarely reported. This study was conducted to compare clinical severity of pneumonia between HD patients and healthy persons. Methods : This study enrolled 36 HD patients who were admitted for pneumonia. Age- and sex-matched 37 persons with pneumonia who did not have any other medical illness were included as a control. We compared clinical manifestations, laboratory and radiologic findings, complications, and clinical course between HD patients and controls. Results : The positive rates of blood and sputum bacterial culture in the HD patients were higher than in those in the controls (blood; 17.6% vs. 2.7%, p=0.028, sputum; 30.3% vs. 5.4%, p=0.005). Compared to the controls, the HD patients had higher incidence of thrombocytopenia (25.0% vs. 0%, p=0.001) and hypoxia (41.7% vs. 2.7%, p=0.000). The number of the lobes involved was larger and higher incidence of bilateral lesions and parapneumonic effusions were observed in the HD patients. In addition, the HD patients had higher incidence of recurrence than the controls (16.7% vs. 0%, p=0.025). Pneumonia-related mortality rate tended to be higher in the HD patients than the controls but there was no statistical differences between the two groups (11.1% vs. 0%, p=0.054). Conclusion : This study shows that pneumonia in HD patients takes a more severe clinical course than in healthy persons. It seems that pneumonia in HD patients has a higher propensity to develop bacteremia.

신장이식 후 발생한 방광암의 임상적 특징과 예후

김진영 ( Jin Young Kim ),송명준 ( Myong Jun Song ),정병하 ( Byung Ha Chung ),김민수 ( Min Soo Kim ),유혜영 ( Hyei Young You ),김영수 ( Young Soo Kim ),양철우 ( Chul Woo Yang ),김용수 ( Yong Soo Kim ),문인성 ( In Sung Moon ),고용복 대한내과학회 2003 대한내과학회지 Vol.64 No.4

목적 : 신장이식환자들은 일반인들보다 암 발생률이 높으며 이 중 방광암이 많은 비율을 차지한다1,2,4,11). 신장이식환자에서 발생한 방광암의 발생률이나 특징에 대하여 국내에서 아직 보고된 바 없어 이에 저자들은 신장이식환자들에게서 높은 발생률을 보이는 방광암에 대해서 일반인들의 방광암과 구분되는 특징을 살펴보고 조기발견 및 치료에 도움이 되고자 연구를 시작하였다. 방법:가톨릭대학교 의과대학 강남성모병원에서 1969년 3월부터 2002년 4월까지 약 Background : With the rise in the number of renal transplantation procedures in the past years, the incidence of bladder cancer in transplant recipients has increased. This study undertaken to evaluate the clinical characteristics and outcome in renal tra

말초 혈액 내 호산구증가증을 동반한 항 골수세포형과산화효소 항체 양성 초승달 사구체신염 1예

이자영 ( Ja Young Lee ),윤유선 ( Yu Seon Yun ),김영수 ( Young Soo Kim ),김영옥 ( Young Ok Kim ),윤선애 ( Sun Ae Yoon ),양철우 ( Chul Woo Yang ),김용수 ( Yong Soo Kim ),김석영 ( Suk Young Kim ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

호손의 과학자들의 기독교적 윤리

김용수 ( Young Soo Kim ) 미국소설학회 2008 미국소설 Vol.15 No.2

One of Hawthorne`s main concerns is the issue on man`s sin-secret sin, unpardonable sin, problem of conscience, recognition of sin, or its influences on individuals and community. In his major works, he criticizes the rigors or bigoted morals of his Purita

간 용적의 가상측정을 통한 두 성인 수여자로의 사체 분할 간이식의 가능성 고찰

김용수(Young Soo Kim),홍부환(Bu Hwan Hong),최상용(Sang Yong Choi) 대한외과학회 2002 Annals of Surgical Treatment and Research(ASRT) Vol.62 No.2

동결ㆍ융해 반복에 의한 화강풍화토의 화학조성변화 특성

김용수(Kim Yong Soo),이종영(Lee Jong Young),김수삼(Kim Soo Sam) 대한토목학회 2004 대한토목학회 학술대회 Vol.2004 No.10

신 이식 환자에서 B 형과 C 형 간염 바이러스 감염 환자의 15 년간 추적 조사

김용수(Yong Soo Kim),장윤식(Yoon Sik Chang),방병기(Byung Kee Bang),김형욱(Hyung Wook Kim),양철우(Chul Woo Yang),최의진(Euy Jin Choi),최범순(Bum Soon Choi),김석영(Suk Young Kim),김성권(Sung Kwon Kim) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.3

목 적 : 신 이식 후 B형과 C형 간염 바이러스 감염에 의한 간질환은 신 이식 환자의 이환율, 사망률 및 생존율 등에 나쁜 영향을 미치는 것으로 보고되고 있으나 저자에 따라서 신 이식의 예후에 미치는 영향은 다르게 보고되고 있다. 저자들은 B형과 C형 간염 바이러스에 감염된 신이식 환자와 간염 바이러스 비감염 환자를 15년 동안 추적 관찰하여 신 이식의 예후에 미치는 영향에 관하여 비교 검토하고자 한다. 방 법 : 1984년 3월부터 1998년 12월 31일까지 가톨릭대학교 의과대학 강남성모병원에서 신 이식을 받은 1,042예 중 HBs Ag 양성군(HBV(+)군) 107예, anti-HCV Ab 양성군(HCV(+) 군) 81예, HBs Ag 및 anti-HCV Ab 모두 음성인(NBNC군) 714예를 대상으로 간질환의 유병율, 임상 경과, 사망률 및 생존율에 미치는 영향을 비교 검토하였다. 대상 환자 중 anti-HCV Ab 가 측정되지 않은 140예는 비교 연구에서는 제외하였다. 결 과 : 추적 기간 동안 환자의 사망률은 HBV(+)군 32.7%, HCV(+)군 9.9%, NBNC군 8.4%로서 HBV(+)군에서 훨씬 높았다. 특히 사망 환자 중 간질환에 의한 사망률은 HBV(+)군 57.1%, HCV(+)군 0%, NBNC군 1.7%로서 HBV(+)군에서 유의하게 높았다(p=<0.001). 5년과 10년 이식신 생존율은 HBV(+)군에서 52.2%와 39.2%, HCV(+)군에서 68.4%와 47.2%, NBNC군에서 86.6%와 65.8%로서 NBNC군에서 타군에 비하여 유의하게 높았다. 5년과 10년 환자 생존율은 HBV(+)군에서 72.0%와 63.9%, HCV군에서 91.8%와 87.3%, NBNC군에서 94.4%와 88.2%로서 HBV(+)군에서 타군에 비하여 훨씬 감소하였으며 HCV(+)군과 NBNC군 간에는 큰 차이는 없었다. 결 론 : HBV(+)군은 다른군에 비하여 신 이식 후 이식신 및 환자 생존률이 현저히 낮았다. 생존율이 낮은 원인은 특히 간질환에 의한 사망률이 타군에 비하여 높기 때문이었다. HCV(+) 군은 HCV(-)군에 비하여 이식신 생존율은 낮았으나 환자 생존율에 큰 차이가 없었다. HCV (+)군의 간질환은 면역억제제의 투여량을 조절하여 간질환의 진행을 예방할 수 있었으며 간질환의 의한 사망을 감소 시킬 수 있었다. Background : The impact of hepatitis B or hepatitis C virus infection on renal transplantation outcome is controversial. The aim of this study is to assess the impact of hepatitis B and hepatitis C infection on kidney transplant over the long-term, 15 years and to compare infected patients with noninfected patients matched for factors possibly associated with graft and patient survival. Methods : We analyzed 1,042 patients who underwent renal transplantation in period from March 1984 to Dec. 1998 including 107 with positive HBsAg (HBV(+) group), 81 with positive anti-HCV antibody (HCV(+) group) and 714 noninfected recipients (NBNC group). One hundred-forty patients who had not taken ani-HCV antibody screening test were excluded. The prevalence of chronic liver disease, the patient mortality, the patient survival rate and the graft survival rate were evaluated. Results : The patient mortality during the period of follow-up was significantly higher in HBV(+) group(32.7%) than in HCV(+) group(9.9%) and NBNC group(8.4%). The cause of death related to liver desease was significantly higher in HBV(+) group(57.1%) than HCV(+) group(0%) and NBNC group(1.7%). Five year and 10 year graft survival rate were significantly lower in HBV(+) group(52.2 %, 39.2%) than in HCV(+) group(68.4%, 47.2%) and NBNC group(86.6%, 65.8%). Five year and 10 year patient survival rate of HBV(+) group(72.0%, 68.9%) was significantly lower than HCV(+) group(91.6%, 87.3%) and NBNC group(94.4%, 88.2%), but there was no significant difference in the patient survival rate between HCV(+) and NBNC group. Conclusion : Hepatitis B virus infection has a significant deleterious effect on the patient and graft survival of renal transplantation recipients. The poor survival rate was a result of the mortality from liver disorder. Hepatitis C virus infection also has a poor graft survival rate compared to NBNC group, but the patient survial rate is similar to NBNC group.

신 이식후 이식신에 발생한 급성 신우신염에 관한 임상적 고찰

김용수(Yong Soo Kim),방병기(Byung Kee Bang),박주현(Joo Hyun Park),복현정(Hyun Jung Bok),박정희(Jung Hee Park),양철우(Chul Woo Yang),김석영(Suk Young Kim) 대한내과학회 1999 대한내과학회지 Vol.56 No.6

N/A Objective : Urinary tract infections are mostly benign, but allograft pyelonephritis may induce renal dysfunction or acute rejection. The purpose of this study was to evaluate the frequency of acute allograft pyelonephritis and its influence on graft function and induction of allograft rejection. Methods : We reviewed the medical records of 1167 renal transplant recipients retrospectively. The allograft pyelonephritis was defined as pyuria with overt clinical manifestations such as fever and graft tenderness. In cases of poor response to antibiotics, abdominal CT and/or graft biopsy were done. Results : During mean follow-up period of 60.9±46.8 months, there were 100 episodes of acute allograft pyelonephritis in 65 patients(5.6%). Seventeen patients (26.2%) had recurrent pyelonephritis. Primary renal disease and recipient sex were important predisposing factors for acute allograft pyelonephritis. In patients whose primary renal disease was chronic pyelonephritis or polycystic kidney disease, the prevalance was 30.8% and 18.2% respectively, while in patients with other primary diseases the prevalance ranged from 3.8% to 5.7% (P<0.05). In female patients, the prevalance of pyelonephritis was 14%, which was much higher than that in male patients(2%) (P<0.01). Thirty one out of 100 cases showed deterioration of renal function defined as an increase in serum creatinine by more than 50% of baseline. In twenty five out of 31 cases, grafted kidney biopsy was performed. In 9 cases(36%), the biopsy showed acute rejection together with pyelonephritis, which was mainly manifested by tubulitis. Renal dysfunction occurred mostly in patients who had septicemia or whose previous serum creatinine was higher than 1.2 mg/dl. Renal CT, which was performed in 34 cases, showed findings consistent with acute focal bacterial nephritis (AFBN) in 13 cases (38.2%). Voiding cystourethrogram was performed in 11 patients and six patients (54.5%) were found to have vesicoureteral reflux. E.Coli was the most frequent causative organism (63.6%). Conclusion : Acute allograft pyelonephritis was frequently associated with acute focal bacterial nephritis and graft rejection. Imaging study and graft biopsy were helpful for accurate diagnosis and proper management of acute allograft pyelonephritis in cases of renal dysfunction. In patients who have acute rejection together with pyelonephritis, rejection therapy including methylprednisolone pulses in addition to antibiotic therapy for pyelonephritis is recommended.

신 이식후 발생한 악성종양에 관한 임상적 고찰

김용수(Yong Soo Kim),방병기(Byung Kee Bang),김석영(Suk Young Kim),장윤식(Yoon Sik Chang),양철우(Chul Woo Yang),박주현(Joo Hyun Park),김병수(Byung Soo Kim),복현정(Hyun Jung Bok) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2

N/A Objective: The aim of this retrospective analysis was to study the incidence, clinical course, treatment, prognosis of malignancy in immunosuppressed renal transplant recipients. Methods: The object were 38 cases of cancer that occured in 1,130 transplant recipients between 1969 and 1997 at Kangnam CUMC. Mean follow-up periods was 61.6±41.8 months. The incidence of can- cers was compared to the number expected in age-matched general population. This allows the calculation of a risk ratio. We used international cancer registry for comparison. Results : The incidence of de novo malignancy in 1,130 renal transplant recipients was 3.3% for 5years of mean follow-up period and there was no difference between sex. The most common cancer was stomach cancer in case of male and cervix cancer for female. This distribution was same as general population. The incidence of malignant lymphoma and Kaposi's sarcoma was higher in renal transplanted patients than the general population. Cancers with the most striking increased risk(IR) were lymphoma(IR 167), and Kaposis sarcoma. It took 55 months for the malignant lymphoma to be occurred and it developed faster than other cancer. CsA caused faster breakout of cancer than Aza did. Conclusion: The features of malignancy in renal transplant recipients are different from those of general population.