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장기간 집중적인 혈장반출법으로 치유된 mitomycin C에 의한 용혈요독증후군
신동호 ( Dong Ho Shin ),이미정 ( Mi Jung Lee ),박현성 ( Hyun Sung Park ),김좌경 ( Jwa Kyung Kim ),박정탁 ( Jung Tak Park ),장태익 ( Tae Ik Chang ),강신욱 ( Shin Wook Kang ),최규헌 ( Kyu Hun Choi ),유태현 ( Tae Hyun Yoo ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.5
HUS (Hemolytic Uremic Syndrome) is characterized by acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia. In classical HUS, hemorrhagic diarrhea precedes. It is frequently associated with E. Coli O157:H7. Less frequently, HUS may also develop after various treatments such as mitomycin C, cyclosporine, quinine, and ticlopidine. Plasmapheresis is effective in most of classical HUS, which induces a complete remission in most patients with classical HUS. However, this treatment is ineffective in HUS associated with mitomycin C. Although Plasmapheresis is effective on hematologic abnormality in this atypical HUS, chronic renal insufficiency frequently persists as a sequella in HUS associated with mitomycin C. We here report on one patient who developed HUS following mitomycin C therapy due to cervix cancer. The patient was treated with intensive and prolonged plasmapheresis. There was a complete hematologic improvement and steady improvement in renal function.
증례 : 혈관염으로 인한 혈담낭염이 발생한 현미경적 다발혈관염 1예
한지숙 ( Ji Suk Han ),이성연 ( Sung Yeon Lee ),김형직 ( Hyung Jik Kim ),송영림 ( Young Rim Song ),김좌경 ( Jwa Kyung Kim ),홍은영 ( Eun Yeong Hong ),민수기 ( Soo Ki Min ) 대한내과학회 2012 대한내과학회지 Vol.83 No.1
PAN에 의한 담낭 혈관염과 혈담낭염에 대한 보고도 있으나, 현미경적 다발혈관염에 의한 담낭염 및 담낭내 출혈은 저자들이 처음으로 증례 보고하는 바이다. Microscopic polyangiitis (MPA) is a systemic necrotizing vasculitis, primarily associated with rapidly progressive glomerulonephritis and alveolar hemorrhage. Approximately 50% of MPA cases are associated with gastrointestinal involvement, but rarely do cases involve the gall bladder. We report an unusual case of MPA complicated by hemocholecystitis. A 62-year-old woman was admitted to our hospital with rapidly progressive renal dysfunction and pneumonia unresponsive to antibiotics, A chest CT scan showed bilateral diffuse alveolar consolidation, and perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) staining was positive. During the course of hospitalization, the patient complained of severe abdominal pain, and an abdominal CT scan revealed acalculous cholecystitis with hemorrhage. Cholecystectomy was performed, and a gall bladder biopsy revealed fibrinoid necrosis of small arteries without granuloma. Cholecystitis should be considered in patients with unexplained upper abdominal pain and MPA.
자가 면역성 갑상선염 환자에서 발생한 쇼그렌 증후군과 원위 세뇨관 산증 1예
안혜림 ( Hye Rim An ),배성창 ( Sung Chang Bae ),이기병 ( Ki Byung Lee ),이용규 ( Yong Kyu Lee ),김좌경 ( Jwa Kyung Kim ),박형천 ( Hyeong Cheon Park ),하성규 ( Sung Kyu Ha ),이정은 ( Jung Eun Lee ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.1
A 52-year old woman, who had hypothyroidism associated with autoimmune thyroiditis for 5 years, was hospitalized for tingling sensation and muscle weakness of both lower extremities. Her initial laboratory findings showed severe hypokalemia, metabolic acidosis, and high titer of thyroid autoimmune antibodies. She was diagnosed of distal renal tubular acidosis by bicarbonate loading test (FEHCO3-<3.0%) and renal calcifications on pre-enhanced CT scan. Since she had other symptoms of xerostomia and xerophthalmia, primary Sjogren`s syndrome was diagnosed by Schirmer test, salivary scan, and serologic findings. She was treated with potassium citrate, potassium chloride, and hydroxychlorquine. Four months later, she has remained well with those treatments. There were only a few case reports about distal renal tubular acidosis associated with Sjogren`s syndrome and autoimmune thyroiditis. In Korea, there has not been any report of such cases. Therefore, we report a case of distal renal tubular acidosis and Sjogren`s syndrome in a patient with autoimmune thyroiditis.
비당뇨병성 말기신부전 환자에서 심혈관질환 발생의 예측 인자로서 아디포넥틴의 유용성
안혜림 ( Hye Rim An ),문성진 ( Sung Jin Moon ),박형천 ( Hyeong Cheon Park ),이용규 ( Yong Kyu Lee ),김좌경 ( Jwa Kyung Kim ),김범석 ( Beom Seok Kim ),김형종 ( Hyung Jong Kim ),한대석 ( Dae Suk Han ),하성규 ( Sung Kyu Ha ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.4
Purpose: Adiponectin (ADPN) has been known to protect against cardiovascular disease (CVD) in metabolic syndrome with normal renal function for its anti-inflammatory and anti-atherogenic property. However, it is still unclear whether ADPN is associated with cardiovascular outcomes in end-stage renal disease (ESRD) patients. Methods: This study included 80 non-diabetic ESRD patients [mean age, 52.8±13.7 years; dialysis duration, 67.1±52.0 months; hemodialysis (HD), 35 pts; peritoneal dialysis (PD), 45 pts] who survived for more than 3 months after the start of dialysis, and serum ADPN levels were measured at the beginning of the study. We conducted a longitudinal follow-up to evaluate the association of serum ADPN level with cardiovascular outcomes for 29.3±6.7 months. Results: ADPN was inversely correlated with fasting serum insulin (r=-0.309, p=0.006) and HOMA-IR (r=-0.321, p=0.004) in ESRD patients. In a multiple linear regression analysis adjusted for age, gender, waist to hip ratio (WHR), and HDL-cholesterol, HOMA-IR (β=-0.880, p=0.041) was an independent factor associated with serum ADPN level. Kaplan-Meier analysis revealed that patients with higher ADPN levels (≥15.8 μg/mL) had a significantly higher survival rate compared with lowers (<15.8 μg/mL) (p=0.032). Cox proportional hazard model adjusted for age, WHR, creatinine, CRP, and previous CVD history revealed that serum ADPN level (HR, 0.899; 95% CI, 0.818-0.987; p=0.026) was an independent determinant of cardiovascular outcomes. Conclusion: These findings suggest that lower ADPN levels independently predict cardiovascular events in non-diabetic ESRD patients.