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신장 ; 다발성 골수종에서 신부전 발생의 위험인자 및 신기능 회복 예측인자
황현철 ( Hyun Chul Whang ),고은실 ( Eun Sil Koh ),김정관 ( Jeong Gwan Kim ),정성진 ( Sung Jin Chung ),신석준 ( Seok Joon Shin ),박철휘 ( Cheol Whee Park ),장윤식 ( Yoon Sik Chang ) 대한내과학회 2014 대한내과학회지 Vol.86 No.2
목적: 신부전은 다발성 골수종에서 종종 발생하며 나쁜 예후를 보인다. 아시아의 다발성 골수종의 발생빈도와 특징은 서양과는 다른 것으로 알려져 있다. 이 연구의 목적은 다발성 골수종 환자들에서 신부전 발생의 위험인자 및 치료 후 신기능 회복 인자를 찾고자 하였다. 방법: 2005년부터 2008년까지 처음 다발성 골수종을 진단 받은 환자를 대상으로 하여 신부전의 발생과 관련된 인자를 조사하였고, 12주간의 치료 후에 신부전의 회복과 관련된 인자를 찾았다. 결과: 진단 당시 221명의 환자 중 86명(39%)에서 신부전이 발생하였다. 이변량 로지스틱 회기 분석에서 낮은 헤모글로빈(OR = 0.813, p = 0.02), 높은 베타-2 마이크로글로불린(OR = 1.006, p < 0.01), ACEi (OR = 2.783, p = 0.04) 사용이 신부전 발생의 독립적인 위험인자로 나타났다. 12주간의 치료 후, 86명 중에서 25 (29%)명의 신기능이 회복되었다. 항암치료에 반응을 보인 경우(OR = 6.044, p < 0.01)와 높은 eGFR (OR = 1.084, p < 0.01)이 회복과 연관된 인자로 나타 났다. 결론: 헤모글로빈 수치, 베타-2 마이크로글로불린, ACEi의 사용이 한국 다발성 골수종 환자에 있어 신부전 발생의 독립적인 위험인자이며 항암 치료에 반응여부와 진단 시의 eGFR이 신기능 회복의 예측인자이다. Background/Aims: Multiple myeloma (MM) is frequently accompanied by renal insufficiency, which has been regarded as a poor prognostic factor for MM. It is known that the incidence and characteristics of MM in Asia differ from those in Western countries. The aim of this study was to evaluate risk factors for renal impairment and to investigate reversible factors for renal failure in patients with MM. Methods: Patients newly diagnosed with MM from 2005 to 2008 were included. We investigated factors associated with renal insufficiency and those related to recovery from renal dysfunction after 12 weeks of treatment of MM. Results: Renal failure was recognized in 86 (39%) of 221 patients at diagnosis. In the binary logistic regression analysis, low hemoglobin (odds ratio [OR], 0.813; p = 0.02), high β2microglobulin (OR, 1.006; p < 0.01), and use of angiotensin-converting enzyme inhibitors (ACEi) (OR, 2.783; p < 0.04) at initial presentation were independent risk factors for renal failure in patients with multiple myeloma. After 12 weeks of treatment, 25 of 86 (29%) patients with renal failure had recovered renal function. Good response to chemotherapy (OR, 6.044; p < 0.01) and higher eGFR (OR, 1.084; p < 0.01) were associated with renal function recovery. Conclusions: Levels of hemoglobin and β2microglobulin, and use of ACEi were independent risk factors for the development of renal failure in MM patients. The response to chemotherapy and eGFR at diagnosis significantly influenced recovery of renal function. (Korean J Med 2014;86:190-197)
그레이브스병 환자에서 Propylthiouracil 복용 후 발생한 항중성구 세포질 항체 양성 반월상 사구체신염
김정훈 ( Jeong Hoon Kim ),김형욱 ( Hyung Wook Kim ),장은철 ( Eun Chul Jang ),정웅룡 ( Woong Ryong Jung ),고승현 ( Seung Hyun Ko ),신영신 ( Young Shin Shin ),박철휘 ( Chul Whee Park ),송기호 ( Ki Ho Song ),최영진 ( Yeong Jin Cho 대한신장학회 2005 Kidney Research and Clinical Practice Vol.24 No.2
한국인에서의 IgA 신장병증과 조직적합성 항원과의 관계
신영신(Young Shin Shin),김영옥(Young Ok Kim),박철휘(Chul Whee Park),윤성노(Sung No Yoon),양철우(Chul Woo Yang),김용수(Yong Soo Kim),장윤식(Yeun Sik Jang),방병기(Byung Kee Bang),한훈(Hoon Han) 대한내과학회 1998 대한내과학회지 Vol.54 No.2
N/A designed to evaluate the pattern of histocompatibility antigens(HLA) and its association with poor prognostic factors in patients with IgAN. Methods : Study population comprised the 69 patients with IgAN which was diagnosed by clinical and pathological findings, and control groups were 202 healthy Korean people. We evaluated the HLA class I serologic typing by standard microlymphocytotoxic technique and the HLA class II genotypes by the two-step polymerase chain reaction. Results : 1. HLA-A was not associated with IgAN. 2. The phenotype frequency of HLA-B55 was 6.1% in patient group and 1.7% in normal control group. HLA- B55 was associated with IRAN(relative risk 3.47, P<0.05). 3. HLA-DQB1*04 was also associated with IgAN (relative risk 3.57, P<0.05). 4. There was no significant difference in the distribution of HLA in IgAN patients according to histologic grading, blood pressure, renal function and proteinuria. Conclusions : Frequencies of HLA-B55, HLA-DQB1*04 are higher in Korean patients with IgAN compared to general population. But we could not observe the significant relationships between HLA type and poor prognostic factors. Further study using larger population with IgAN may be necessary to identify the association of HLA locus with poor prognostic factors and progress decline in renal function in patients with IgAN.
혈액 투석시 발생하는 저혈압에 대한 Amezinium Methylsulfate(Risumic)의 예방 효과에 대한 다기관 공동연구
김용수(Yong Soo Kim),방병기(Byung Kee Bang),김영옥(Young Ok Kim),송호철(Ho Chul Song),양철우(Chul Woo Yang),박정희(Jung Hee Park),박주현(Joo Hyun Park),김병수(Byung Soo Kim),박철휘(Cheol Whee Park),안석주(Suk Ju Ahn),최의진(Eui Jin C 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1
N/A Background : Dialysis-induced hypotension is a very common but difficult complication to manage. Amezi-nium methylsulfate is a newly developed sympatho-mimetic agent which has been reported as effective in postural hypotension. We studied the preventive effect of amezinium methylsulfate on dialysis-induced hypo- tension in chronic hemodialysis patients. Methods: Twenty-five hemodialysis(HD) patients who were maintaining on hemodialysis longer than 3 months and had frequent episodes of dialysis hypoten-sion were enrolled in this study. After 4 weeks of observation period, patients received one tablet of ameziniurn 30 minutes prior to every hemodialysis session for 4 weeks. We com mean arterial pressure(MAP), number of hypotensive episodes and number of nursing interventions(defined as position change, bolus injection of saline or 50% dextrose in water, need to decrease transmembrane pressure or discon- tinuation of dialysis) between observation and medi-cation period in each patient. Results: The number of nursing interventions (mean, 2.5±0.9 interventions vs. 1.4±0.9 interventions, p<0.05) and hypotensive episodes(mean, 1.7±0.7 episodes per session vs. 0.9±0.7 episodes per session; p<0.05) decreased significantly in the medication period and the nadir MAP(57±13mmHg vs 70±15mmHg; p<0.05), mid-HD MAP(65±15mmHg vs. 79±15mmHg; p<0.05) and post-HD MAP(66±14mmHg vs 78±16 mmHg ; p<0.05) are higher in the medication period compared with observation period. Conclusion : These results show that amezinium methylsulfate is useful to prevent dialysis-induced hypotension in chronic hemodialysis patients.
만성 신부전 환자에서 99mTc - HMDP 골신티그램상 섭취정도와 혈중 osteocalcin , 부갑상선 호르몬치와의 상관관계
김춘열(Choon Yul Kim),정수교(Soo Kyo Chung),신경섭(Kyung Sub Shinn),손형선(Hyung Sun Sohn),김의녕(Euy Neyng Kim),방찬영(Chan Young Band),박철휘(Chul Whee Park),장윤식(Yoon Sik Chang) 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.3
N/A In this preliminary study, plasma osteocalcin, PTH level and Tc-99m-HMDP (hydro- xymetylene diphosphonate) bone uptake(BU) were measured in 14 patients with chronic end-stage renal failure who were on maintenance hemodialysis. The aim of this study was to determine the difference of bone uptake between renal failure patients and normal volunteers, and to determine the correlation between bone uptake and osteocalcin a sensitive and specific marker of osteoblastic activity and PTH - a important hormone of bone metabolism. There was a statistically significant increase in 180 minute uptake in the patient group when compared to the normal volunteers while there was no statistically significant difference in 20 minute uptake. Plasma osteocalcin and PTH levels were also significantly elevated compared to normal values. But the correlation between osteocalcin, PTH and 20 and 180 minute bone uptake was not significant. In conclusion, our preliminary study suggests that, in chronic renal failure patients, 180 minute Tc-99m-HMDP bone uptake is increased significantly without direct correlation with serum osteocalcin or PTH levels. It seems that further study is needed to evaluate other unknown factors that may influence the direct correlation between bone uptake and plasma osteocalcin and PTH in patients with chronic renal failure.
단기간 교육을 받은 신장내과의사가 시행한 경피적 초음파 유도 신장조직검사의 검체 적절성과 안전성
황현석 ( Hyeon Seok Hwang ),이소영 ( So Young Lee ),강석휘 ( Seok Hui Kang ),정병하 ( Byung Ha Jung ),형복진 ( Bok Jin Hyoung ),전연주 ( Youn Joo Jeon ),최범순 ( Bum Soon Choi ),박철휘 ( Cheol Whee Park ),양철우 ( Chul Woo Yang 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.2
Purpose: Specimen adequacy and safety of percutaneous ultrasound-guided native kidney biopsies performed by short-term trained nephrology fellows were evaluated. Methods: The differences in specimen adequacy and safety between nephrology fellow-performed (NP, n=67) and radiologist-performed (RP, n=82) percutaneous ultrasound-guided native kidney biopsies were retrospectively evaluated. Results: The mean age of the patients was 35±15 years old, and the M:F ratio was 1.2:1. There were no differences in age, sex, anemia, platelet count and glomerular filtration rate between NP and RP patients. The mean glomerular count was 15.9±8.4 in light microscopy and 9.9±7.2 in immunofluorescent microscopy. Ninety five percent of biopsy specimens were adequate for pathological diagnosis. Between NP and RP kidney biopsies, there were no differences in the glomerular count in light and immunofluorescent microscopy, percentage of presence of glomeruli in electron microscopy, and the specimen adequacy for the pathological diagnosis. The rates of major and minor complications were 1.5% and 6%, respectively, in NP kidney biopsies. On the other hand, the rate of major complications was 9.8% in RP kidney biopsies, which was significantly higher than that in NP kidney biopsies. The rate of decrease in hemoglobin and hematocrit levels after biopsies was significantly higher in RP biopsies than in NP biopsies. Conclusion: Short-term trained nephrology fellows perform percutaneous ultrasound-guided kidney biopsy at a level equal to or superior to radiologists.
이영신,조용균,박철휘 한서대학교 산학협력연구원 부설 환경연구소 2000 환경연구소 논문집 Vol.3 No.-
Seosan city is facing fast industrialization, urbanization, and populization growth. It speedy changes into engineering oriented area around Dae-San engineering district causefuuture increase of general sewages and industrial waste water. the environmentally hazardous materials will also aggravate water quality of neighboring rivers and ocean. Thus, this study has been performed to investigate current lever of industrial waste water, and then project future level of those environmental damages.
신이식 후 발생하는 골소실에 대한 간헐적 etidronate치료의 예방 효과
김혜수,이종민,김성권,박철휘,양철우,강무일,김석영,강성구,방병기 대한내분비학회 2001 Endocrinology and metabolism Vol.16 No.4
Background: Osteopenia or osteoporosis is one of the most frequently encountered complications in patients receiving various immunosuppressants after kidney transplantation. The few available preventive strategies for these complications tend to result in various outcomes. In this study, we evaluated the effect of intermittent etidronate therapy for the prevention of bone loss after kidney transplantation. Methods: Fifty patients who received kidney transplantation for various reasons were recruited and followed for one year. Thirty-eight of these patients commenced etidronate treatment 7 days after operation, the other 12 were followed without etidronate therapy. The treatment consisted of 400 ㎎ of etidronate administered orally for 14 days, then repeated four-times every three months. Blood chemistry, iPTH and aluminium levels were tested periodically in all patients. Also checked were bone mineral density of the lumbar spine (L2-4) and femur at baseline, 6 and 12 months after kidney transplantation, as well as D-L spine lateral x-ray at baseline and 12 months. Serum osteocalcin and urine deoxypyridinoline were measured at baseline, 7 days and then every 3 months. Results: Both the etidronate-treated and control groups showed significant decreases in bone mineral densities of the lumbar spine, femur neck and total femur at 6 and 12 months after kidney transplantation (p<0.005). Bone loss was significantly lower in the etidronate-treated group than the control at 12 months after kidney transplantation; lumbar spine (-3.54% vs. -9.51%, p<0.0005), femur neck (-5.41% vs. -8.91%, p<0.0005), total femur (-7.59% vs. -9.07%, p<0.005). Osteocalcin was decreased and deoxypyridinoline increased in both groups. No significant differences in the level or pattern of osteocalcin and deoxypyridinoline were observed in either group. New radiologic compression fractures were found in two patients of the treated group who exhibited severe osteoporosis at baseline during follow-up. Conclusions: The intermittent administration of etidronate seems to be effective in preventing rapid bone loss after kidney transplantation. Furthermore, this method is safe and convenient for administration and follow-up. Further studies will be required to elucidate the most effective treatment course for the prevention of fractures after kidney transplantation, especially in patients with established severe osteoporosis