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혈액투석 ( HD ) 과 복막투석 ( CAPD ) 환자에서 임상경과의 비교 관찰
김중경(Joong Kyung Kim),김창석,윤대현(Dae Hyun Yun),박용기(Yong Ki Park),신용훈(Yong Hoon Shin),감복규(Bok Gyu Gam),허동,장익득(Ik Deuk Jang),김미선(Mi Sun Kim),이시래(Shi Rae Lee) 대한내과학회 1998 대한내과학회지 Vol.55 No.3
N/A Objective: The selection of dialysis modalities for end-stage renal disease patient is often a complex decision process involving considerations of efficacy in terms of life maintenance, quality of life, convenience and cost. In order to facilitate informed decisions, we have compared the clinical outcome of CAPD and HD patients. Methods: From May 1992 to May 1997, we observed the followings: patients` survival rate, the causes of death in CAPD and HD patients, the frequency of CAPD peritonitis, CAPD catheter survival rate and the causes of catheter removal. Patients were categorized in the following ways: DM and non-DM, alive or expired, above and below the age of 60 years, and treatment duration of more or less than 5 years. Six items(serum albumin, serum creatinine, hemoglobin, BMI, NFCR and KT/V) were measured, their values were evaluated and compared with each group using univariated statistics. Results: The total number of patients was 508 (369 CAPD, 139 HD). 58 of them expired during the observation period. The overall 5 year patient survival rate was 81.4% for CAPD, 80.5% for HD, and 57.8% for CAPD with DM and 25% for HD with DM using the Kaplan-Meier method. In the CAPD group, the frequency of peritonitis was 0.52/pt, yt; the 5 year technical survival of the catheter was 80.5%. 42(88%) of 48 technical failures of the catheter were removed due to peritonitis. Regardless of the modes of replacement therapy used to treat DM and non-DM groups, the DM patients had longer duration of admission, older age, lower serum albumin and serum creatinine levels, and a lower 5 year patient survival rate than the non-DM group. Death in CAPD and HD was positively correlated with a long duration of admission and old age; CAPD patients who expired had lower serum albumin, smaller BMI and mare frequent peritonitis than the surviving group. Conclusion: 1. There was no significant difference in the 5 year patient survival rate between CAPD and HD(81.4% in CAPD, 80.5% in HD). 2. DM patients had lower serum albumin, creatinine and BUN levels than non-DM patients. 3. The mortality rate was positively correlated with old age and duration of admission in CAPD and HD; frequent CAPD peritonitis, lower serum albumin and small HMI in CAPD were also positively correlated with the death rate. 4. The higher the serum albumin and NPCR, the higher the survival rate for CAPD patients. 5. The serum creatinine was lower in patients above 60 years old and in those treated more than 5 years. 6. The DM group had a higher mortality rate than the non-DM group, the DM CAPD group had a higher 5 year survival rate than the DM HD group but it was not statistically significant.
ABO 부적합 신장 이식 후 발생한 가역적 후백질 뇌병증 증후군 1예
김종인 ( Jong In Kim ),최안숙 ( An Sook Choi ),김수진 ( Su Jin Kim ),지병훈 ( Byoung Hoon Ji ),오준석 ( Joon Seok Oh ),손영기 ( Young Ki Son ),신용훈 ( Yong Hun Shin ),김중경 ( Joong Kyung Kim ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.2
Reversible posterior leukoencepalopathy syndrome (RPLS) was noted by a reversible syndrome of headache, altered mental status, seizure, and visual loss associated with findings indicating predominantly posterior leukoencephalopathy on imaging studies. We report a successful treatment of RPLS after secondary ABO incompatibility kidney transplantation with blood pressure control. A 41-year-old female whose primary kidney disease was chronic glomerulonephritis had graft failure developed after living donor kidney transplantation (1st kidney transplantation). She was admitted to our hospital for 2nd ABO incompatibility kidney transplantation. She had undergone 6 times of plasmapheresis and received additional two doses of rituximab (375mg/m2) and intravenous immunoglobulin (0.5g/kg) before kidney transplantation. She received basiliximab induction therapy, tacrolimus, steroid and mycophenolate mofetile after transplantation. The ABO antibody titer had been low (below 1:1) and evidences of rejection were not detected. Generalized tonic clonic type seizure, eyeball deviation, facial cyanotic change and loss of consciousness occurred at post operation 7th day. Several minutes later, she recovered her consciousness without disability and neurologic deficit. She did not represent attacks any more after we controlled blood pressure without withdrawal of immunosuppressants or dose reduction.
이식신에서 발생한 허탈성사구체병증 (Collapsing Glomerulopathy)
김지환 ( Ji Hwan Kim ),정정임 ( Jung Im Jung ),남주연 ( Ju Yeon Nam ),김종인 ( Jong In Kim ),김중경 ( Joong Kyung Kim ),정연순 ( Yeon Soon Jung ),임학 ( Hark Rim ),정민정 ( Min Jung Jung ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.1
Collapsing glomeruopathy (CG) is a clinicopathologic variant of focal segmental glomerulosclerosis (FSGS) and is characterized by severe nephrotic syndrome, rapid progression to end stage renal disease, and features of visceral epithelial cell injury and glomerular capillary collapse. Such characteristics closely resemble those of HIV associated nephropathy. The frequency of CG has increased over the last decade. The cause of CG is unknown. The lesion has rarely been described in renal allografts with features similar to CG in native kidney. We recently identified allograft CG in a 44 year-old male patient who underwent biopsy for graft dysfunction after autodermic graft. The biopsy showed typical characteristics of CG. Serologically, the patient had no evidence of HIV infection. The renal function was not restored to normal in spite of methylprednisolone pulsing therapy. Now he is on conservative treatment with a functioning graft.
신장 이식 환자와 말기 신부전 환자의 심박수 변이도 비교
김성민 ( Sung Min Kim ),최승호 ( Seung Ho Choi ),오준석 ( Joon Seok Oh ),홍택종 ( Taek Jong Hong ),신용훈 ( Yong Hun Sin ),배우형 ( Woo Hyung Bae ),김중경 ( Joong Kyung Kim ),이희룡 ( Hee Ryong Lee ),정필 ( Peel Jung ),류태현 ( T 대한내과학회 2012 대한내과학회지 Vol.83 No.5
Background/Aims: Heart rate variability (HRV) is a method for evaluation of autonomic nervous system activity by expressing the balance of sympathetic and parasympathetic tones. Some studies of HRV in patients with end-stage renal disease (ESRD) have been performed in Korea. However, few have examined kidney transplantation (KT) patients. Therefore, we investigated autonomic nervous system activity by means of HRV in patients with KT due to ESRD. Methods: We compared the pattern of cardiac sympathetic and parasympathetic activity by time- and frequency-domain analysis of HRV with 24-h Holter monitoring of 23 KT and 56 dialysis patients. Patients underwent KT between January, 2008 and June, 2011. Results: The mean ages of KT and dialysis patients were 54.2±12.3 and 53.7±12.6 years, respectively. The KT group showed increased time- and frequency-domain HRV (including HRV index), very low frequency (VLF), means and standard deviations of all normal R-R intervals for all 5-min segments of the entire recording (SDNNi), low frequency (LF), LF in normalized units (LF norm), and LF to high-frequency power ratio, compared with the dialysis group. Conclusions: Autonomic tone in patients with KT is higher than that in patients with ESRD on dialysis. (Korean J Med 2012;83:606-612)
신장 ; 이식신에서 단회뇨 단백/크레아티닌비와 일일 요단백량과의 비교 봉생병원 내과
김수진 ( Su Jin Kim ),최안숙 ( An Sook Choi ),이진호 ( Jin Ho Lee ),유성민 ( Seong Min Yu ),오준석 ( Joon Seok Oh ),김성민 ( Sung Min Kim ),신용훈 ( Yong Hun Sin ),김중경 ( Joong Kyung Kim ) 대한내과학회 2011 대한내과학회지 Vol.81 No.1
목적: 사구체 신염 등의 환자에서 단회뇨를 이용한 단백/크레아티닌 농도비(P/C ratio)가 24시간 요단백량과 밀접한 상관관계가 있음은 수차례 보고된 바 있다. 서구의 신이식 환자에서도 이러한 상관관계가 관찰되었으나 동양인 신이식 환자에 대해서는 연구가 부족하다. 이에 저자들은 한국의 신이식 환자에서 24시간 요단백량과 단회뇨 P/C ratio를 비교하고, 두 값의 상관관계에 영향을 미치는 요인들에 대하여 알아보고자 하였다. 방법: 2005년 1월부터 2010년 7월까지 본원 신장내과에 내원한 66명의 신이식 환자를 대상으로 소변 채집을 하였다. 24시간 요 수집 단백량과 수집을 시작하는 날 아침 채집한 단회뇨 P/C ratio를 비교하였다. 24시간 요단백량과 단회뇨 P/C ratio 사이의 상관관계에 영향을 끼칠 수 있는 인자로 성별, 면역억제제 종류, 기저질환, 이식 기간, 사구체 여과율, 일일 요단백량, 나이에 대해 분석하였다. 결과: 대상 환자의 평균 연령은 47±14.1세였으며, 평균혈청 크레아티닌은 1.53±0.58 mg/dL, 사구체 여과율은 55.75±22 mL/min/1.73 m2, 평균 이식 기간은 74±80개월이었다. 24시간 평균 요단백량은 1.31±1.69 g/day이었고, 단회뇨의 P/C ratio 1.29±1.70이었으며 높은 상관계수를 보였다(r=0.95). 성별이 단회뇨 PCR를 이용한 24시간 요단백 예측에 영향을 끼치는 요인으로 고려된다(p=0.003). 단회뇨 P/C ratio와 24시간 요단백량은 남성에선 각각 1.05±1.51, 1.26±1.68 g/day이었고(p=0.005), 여성에선 1.57±1.88, 1.36±1.72 g/day이었다(p=0.047). 결론: 본 연구에서 단회뇨 P/C ratio는 24시간 요단백량을 가늠할 수 있는 방법으로 사용될 수 있을 것으로 생각한다. Background/Aims: Many studies have reported the correlation between the spot urine protein to creatinine (P/C) ratio and 24-hoururinary protein amounts in patients with glomerulonephritis. This correlation has also been reported in Western patients with kidney transplants, but no prior study has reported on this association in Eastern populations. We compare the correlation between the spoturine P/C ratio and 24-hour urinary protein amounts and the associating factors in Korean patients with kidney transplants. Methods: The study included 66 patients with kidney transplants from our hospital. The subjects had urine samples evaluated between January 2005 and July 2010. We compared 24-hour urinary protein amounts with a spot urine P/C ratio collected in the morning and analyzed the factors affecting the correlation in each group. Results: The 24-hour urinary protein amounts were 1.31±1.69 g/day and the spot urine P/C ratio was 1.29±1.70 in all subjects. A strong positive linear correlation was observed between the 24-hour urinary protein amounts and the spot urine P/C ratio (r=0.95).The primary factor affecting accurate quantitation of proteinuria using the spot urine P/C ratio was gender (p=0.003). The spot urine P/C ratio and the 24-hour urinary protein levels were 1.05±1.51 and 1.26±1.68 g/day in males (p=0.005) and 1.57±1.88 and 1.36±1.72 g/day in females (p=0.047), respectively. Conclusions: We determined that the spot urine P/C ratio provides an accurate estimate of 24-hour urinary protein levels in Korean patients with kidney transplants. (Korean J Med 2011;81:82-88)
Polyoma Virus Nephropathy로 이식신 소실 후 시행한 사체 재이식
전지민 ( Jee Min Jeon ),김지환 ( Ji Hwan Kim ),박미정 ( Mi Jung Park ),박창수 ( Chang Sue Park ),김성민 ( Sung Min Kim ),오혜주 ( Hyae Joo Oh ),박용기 ( Yong Kee Park ),신용훈 ( Yong Hun Shin ),김중경 ( Joong Kyung Kim ),허길 ( K 대한신장학회 2005 Kidney Research and Clinical Practice Vol.24 No.3