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정상 신기능의 좌측 복통 환자에서 진단된 원인 불명의 일측성 후복막 섬유화증 1예
이문형 ( Moon Hyoung Lee ),문경협 ( Kyoung Hyoub Moon ),김범 ( Beom Kim ),이동영 ( Dong Young Lee ),시원근 ( Won Keun Si ),황진아 ( Jin Ah Hwang ),최보경 ( Bo Kyoung Choi ),서강흠 ( Kang Hum Seo ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.3
Retroperitoneal fibrosis is a disease characterized by proliferation of fibro-inflammatory tissue, which mainly encloses the abdominal aorta, iliac arteries and (enlarges to the retroperitoneum to surrounds) ureters. Two leading pathogenesis are an exacerbated local inflammatory reaction to aortic atherosclerosis and a manifestation of systemic autoimmune disease. Because of insidious disease course, most cases are diagnosed late when bilateral urinary obstruction caused oliguria and symptoms related to uremia. In this case, the patient complained left flank pain which might have been caused by left ureter stone, but through abdominal CT scan, the patient was diagnosed as left unilateral retroperitoneal fibrosis. Abdominal CT scan showed encircling mass around abdominal aorta and left ureter with hydronephrosis. The patient had no underlying disease and didn`t take any medication; she was diagnosed as idiopathic unilateral retroperitoneal fibrosis and started prednisolone, 40 mg daily. Three months have passed since the therapy was started; most fibrous tissue was disappeared, hydronephrosis was resolved and flank pain was relieved.
김진수(Jin Soo Kim),문경협(Kyoung Hyoub Moon),김민정(Min Jeong Kim),마상수(Sang Soo Ma),이후석(Hu Seok Lee),김미영(Mi Young Kim),노용호(Young Ho Rho) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1
목적 : 척수 손상환자에서 신질환에 의한 유병율과 사망률은 매우 높다고 알려져 있으며 이들 환자에서 신 질환은 미세 단백뇨를 동반한 세뇨관성신실질 형태가 주된 질환인데 단백뇨를 가진 만성 척수 손상환자의 임상적 특징과 신부전에 이르기 전 단백뇨의 유발 위험요인에 대한 국내 조사가 없어 본 연구를 시작하였다. 방법: 1999년 12월부터 2000년 5월까지 6개월 동안 한국보훈병원에 입원 또는 외래진료 중인 척수 손상으로 인한 하반신 또는 전신마비 환자를 대상으로 하였으며, 환자는 연구기간 중 입원 중이거나 내과, 비뇨기과 외래진료 중인 환자를 대상으로 하였고, 24시간 채뇨와 일반적인 검사실 검사를 시행하였다. 신 초음과 검사는 24시간 체뇨 전후 6개월 이내에 시행하였다. 결과: 1g 이상의 병적인 단백뇨를 보였던 군에서 더 고령이었고, 더 오랜 척수 손상기간을 가졌으며 욕창에 대한 수술적 처치가 더 많았고, 흉수 이하 및 하반신마비 환자에서 더 많았으며, 수신증을 보이고 있었으나, 방광내 도관 삽입은 관계가 없었다. 당뇨환자는 통계적 차이는 보이지 않았으나 모두 병적인 단백뇨를 보이고 있었다. 결론: 척수 손상 환자에서 단백뇨는 욕창 치료 증가와 수신증 및 척수 손상 기간과 연관성을 보였으며, 사지마비보다 하지마비환자에서 더 유의하게 많았는데 이는 하지마비환자에서 척수 손상기간이 더 많았기 때문으로 생각된다. 만성 척수 손상환자의 신 기능을 보존하기 위하여는 정기적으로 수신증의 발생을 확인하여 대처하며, 무엇보다도 욕창의 발생을 피하고, 욕창에 대한 철저한 치료로 만성염증을 피하는 데에 더욱 노력하여야 한다. Background: Patients with spinal cord injury have a significant degree of morbidity and mortality caused by renal disease. Tubulointerstitial form of renal disease with minimal proteinuria predominate in this population. A retrospective study was performed to investigate the risk factors that may contribte to the development of proteinuria in patient with chronic spinal cord injury. Methods : Between December 1999 and May 2000, 40 spinal cord injury patient in Korean Veterans Hospital were recurited retrospectively into the study. The information was gathered included medical record, laboratory data, and radiological study. Results: Proteinuric subjects were older, had a longer duration of injury, had undergone a greater number of decubitus ulcer procedures and hydronephrosis. Conclusion : Proteinuria in the patients with spinal cord injury was related to the increase of the therapy for the decubitus ulceration, hydronephrosis, and the duration of the spinal cord injury, and it developed significantly more in paraplegia patients than in quadriplegia patients, which might be due to the more duration of the spinal cord injury in paraplegia patients. Therapeutic efforts directed toward preserving renal function should focus on avoidance of hydronephrosis, and decubitus ulceration.
이상희 ( Sang Hee Lee ),이동영 ( Dong-young Lee ),문경협 ( Kyoung Hyoub Moon ),김현정 ( Hyeon Jeong Kim ),이미지 ( Mi-ji Lee ),김희서 ( Hui Seo Kim ),김범 ( Beom Kim ) 대한내과학회 2019 대한내과학회지 Vol.94 No.6
Atraumatic splenic rupture (ASR) in a patient undergoing peritoneal dialysis (PD) is uncommon, but can be life-threatening. According to recent systematic reviews, the major causes of ASR are 1) neoplastic (30.3%), 2) infectious (27.3%), 3) non-in-fectious inflammatory (20.0%), 4) iatrogenic (9.2%), 5) mechanical (6.8%), and 6) idiopathic (6.4%). It is diagnosed by imaging studies, most commonly ultrasonography and computed tomography (CT). Due to its rarity, the early diagnosis of ASR is difficult, and no standard treatment has been described. Here, we report a case of idiopathic ASR in a patient undergoing PD. The diagnosis was established by abdominal CT scan, and splenectomy was performed. Thus, hemoperitoneum in a PD patient should raise suspi-cion of ASR. Early diagnosis and appropriate treatment will lead to a better outcome. (Korean J Med 2019;94:526-529)
양서영 ( Seo Young Yang ),김도영 ( Do Young Kim ),임현정 ( Hyun Jeong Im ),김현목 ( Hyeon Mok Kim ),정수철 ( Soo Chul Jung ),김혜원 ( Hye Won Kim ),문경협 ( Kyoung Hyoub Moon ) 대한내과학회 2014 대한내과학회지 Vol.87 No.1
건선에 동반된 림프부종은 매우 드문 질환으로 아직까지 원인과 치료가 명확하게 제시되지 않았으나 건선의 만성 염증 반응과 관련되어 발생하고 염증 반응을 억제하여 호전될 수 있는 질환으로 생각할 수 있겠다. 본 증례는 건선성 관절염이 없이 건선에 동반된 림프부종으로는 국내외로도 첫 증례보고로 생각되며 향후 건선에 동반된 림프부종의 병리기전을 밝힐 때 중요한 단서가 될 수 있을 것으로 생각한다. 림프부종의 진단을 위하여 자기공명영상 검사와 혈류 초음파 검사 및 림프신티그라피를 시행하였고 사이클로스포린을 투여하여 건선과 림프부종이 함께 호전된 것을 경험하였기에 보고한다. Lymphedema is a rare but known complication of psoriatic arthritis and other inflammatory arthritides. Only a few cases associated with psoriatic arthritis have been reported, but none showed psoriasis was the sole factor. The precise etiology is, as yet, unknown, but many different mechanisms are likely to cause lymphedema in psoriatic arthritis, such as lymphatic vascular damage and perilymphatic accumulation of inflammatory material. Various immunosuppressive drugs have been assessed in treating this condition. Here, we report the case of an 85-year-old man with psoriasis presenting with a rare complication of bilateral lymphedema in the lower extremities. Lymphedema as well as psoriasis improved with cyclosporine. (Korean J Med 2014;87:115-119)
진성다혈구증에 병발한 미세변화신증을 동반한 IgA 신병증
정영종 ( Young Jong Jung ),김범 ( Beom Kim ),조영미 ( Yong Mee Cho ),김희섭 ( Hee Sup Kim ),김지호 ( Ji Ho Kim ),김수연 ( Soo Yeun Kim ),김봉석 ( Bong Seog Kim ),최윤미 ( Youn Mi Choi ),문경협 ( Kyoung Hyoub Moon ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.6
Polycythemia vera is a hematopoietic stem cell disease, characterized by sustained and excessive proliferation of erythrocytic, granurocytic and megakaryocytic cells in the bone marrow resulting in pancytosis in peripheral blood. There have been a few reports of glomerulonephritis with polycythemia vera, most of which were IgA nephropathy. We report a case of a polycythemia vera associated with proteinuria. We confirmed the polycythemia vera according to World Health Organization criteria. Renal pathology showed IgA nephropathy and minimal change disease. Periodic phlebotomy was done and hydroxyurea was administered without specific managements for renal disease. After 3-month treatment, hemoglobin level decreased and proteinurea disappeared.
혈액 투석중인 상염색체 우성 다낭성 신질환에서 발생된 요흉 1 예
소미진(Mi Jin So),나병주(Byoung Ju Na),김종률(Jong Lyul Kim),이진한(Jin Han Lee),김진수(Jin Su Kim),노용호(Young Ho Rho),김태효(Tae Hyo Kim),문경협(Kyoung Hyoub Moon) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1
Urinothorax is rare cause of pleural effusion. Urinothorax should be considered when pleural effusion occurs in patients with urinary tract obstruction accompanied by retroperitoneal urinoma. It has been reported in patients with trauma, malignancy, kidney biopsy and renal transplantation. Most cases are diagnosed retrospectively by promt resolution of symptoms after relief of urinary obstruction. But dia- gnosis can be made based on clinical suspicion, radiological findings and biochemical analysis of the effusion and most important finding is the pleural level of creatinine is higher than the serum level. We experienced right pleural effusion in autosomal dominant polycystic kidney disease hemodialyzed. The patient had right urinoma in the retroperitoneal space before pleural effusion developed. After 3month, he complained acute dyspnea. There was no effect in resolving effusion by lowering dry weight. We thou- ght alternative diagnostic possibility, urinothorax and checked the pleural fluid to serum creatinine ratio. Finally concluded that pleural effusion was urinothorax secondary to remnant left polycystic kidney rup- ture and tried left nephrectomy. The patient showed reduction of pleural effusion. It is important to alert physician to this condition and to avoid the other invasive diagnostic study.
만성 혈액투석환자에서 발생한 Perigraft Seroma 1예
김지훈,박정식,정해혁,송인숙,문경협 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.3
Perigraft seroma is uncommon complication of polytetrafluoroethylene(PTFE) grafts applied as an arteriovenous shunt for hemodialysis. It is a collection of clear, sterile fluid confined to nonsecretory fibrous pseudomembrane, most commonly localized around the middle and distal portion of graft. The possible etiologic factors of perigraft seroma include poor graft incorporation, mechanical graft damage caused by alcohol and povidone-iodine, intraoperative streching of the graft, variations in quality control at the time of manufacture and contributing factors such as anemia and coagulopathy in uremia. The best strategy for management of perigraft seroma is not clear. spiration or drainage alone is not effective, and some authors advocate graft removal. We report a case of perigraft seroma around arterial end of PTFE graft along with a brief review of the literatures.