IgA 신병증의 예후인자에 대한 연구

빈기태(Ki Tai Bin),나기량(Gi Ryang Na),오선미(Seoun Mee Oh),김종섭(Jong Sub Kim),김성숙(Seong Suk Kim),이강욱(Kang Wook Lee),신영태(Young Tai Shin),서광선(Kwang Sun Seo),이정호(Jeong Ho Lee) 대한내과학회 1996 대한내과학회지 Vol.51 No.6

N/A Objectives: IgA nephropathy is the commonest glomerulonephritis in the world. In contrast to initial report indicated a favorable prognosis, subsequent reports have shown a highly variable outcome leading to end-stage renal failure in significant proportion of patients. Because IgA nephropathy is a disease with variable rate of progression to chronic renal failure, identification of clinical and pathologic prognostic indicators for these patients is very important. Methods: To evaluate the clinical features of IgA nephropathy and clinicopathological parameters that are associated with deteriorated renal function, we analyzed retrospectively 149 patients who were diagnosed as IgA nephropathy at Chungnam National University Hospital from January, 1986 to June, 1994. We also evaluated the clinicopathological fin- dings of 23 patients who were followed for more than 36 months in order to determine the prognostic signigificance of various renal histopathological alterations and clinical parameters, Results: l) IgA nephropathy was disgnosed to 149 patients(26.5%) for same period among 565 biopsied patients. 2) It is most common in the 3rd and 4th decades. The mean age of the patients was 28.9 years, and male to female ratio ratio was 1: 1,25. 3) Fifty two percents of the patients presented with gross hematuria. Upper respiratory tract infection preceded grosss hematuria in 85% of the patients. 4) At the time of renal biopsy, 9,4% of the patients showed heavy proteinuria and nephrotic syndrome, 5) In Comparison of clinicopathological parameters between 14 patients with normal renal function and 9 patients with deteriorated renal function who had a follow-up period of more than 36 months, the results of the findings are as follows: 24 hours total urine protein more than 2.0 grams, elevated BUN and serum creatinine concentration and severe degree of renal histopathologic findings, such as mesangial proliferation and sclerosis, interstitial fibrosis and tubular atrophy showed poor prognostic results. Conclusion: Clinical features such as 24 hours total urine protein more than 2 grams, higher serum blood urea nitrogen and serum creatinine and severe degree of histopathologic features such as mesangial proliferation and sclerosis, interstitial fibrosis and tubular atrophy were associated with deteriorated renal function.

신장이식후 발생된 자가면역 용혈성 빈혈 1 예

정민수,빈기태,김성숙,이존기,권계철,이강욱,신영태 대한신장학회 1994 학술대회및초록집 Vol.13 No.2

급성 신부전증 및 뇌수막염이 동반된 쭈쭈가무시병 1예

김종섭,오선미,빈기태,김성숙,이강욱,김선영,신영태 대한신장학회 1995 춘계학술대회 초록집 Vol.1995 No.-

상부 요로계 감염증에서 Isepamicin Sulfate의 임상적 연구

이강욱,김성걸,빈기태,신영태 최신의학사 1995 最新醫學 Vol.38 No.4

장티프스에 병발된 급성 신부전증 2 례

서광선,이강욱,김성숙,신영태,빈기태,오선미,나기량,김종섭 대한내과학회 1998 대한내과학회지 Vol.54 No.2

Typhoid fever, although having undergone a progressive decline in incidence in Korea, has continued to occur sporadically in this country. Renal complications are usually noted in 2-6 percent of patients and various clinical features of renal complication have been reported. However, acute renal failure has been rarely reported. We did a renal biopsy in two patients with typhoid fever who exhibited clinical evidence of acute renal failure, such as oliguria, azotemia, and mentality change. Light microscopy showed that the glomeruli were intact and some of the tubules were dilated and lined by regenerating epithelium There was mild interstitial edema. Immunofluorescent microscopy showed trace deposits of IgA in one case. Electron microscopy did not show eigther abnormal electron dense deposits or cellular proliferation. Fever and melena disappeared after chloramphenicol treatment, and with the cure of the typhoid fever, the renal symptoms also. Typhoid nephritis should be considered as a cause of acute renal failure when acute renal failure is developed in febrile patients.

신부전증과 신병증이 동반된 렙토스피라증의 임상상

김성숙(Seong Suk Kim),빈기태(Ki Tae Bin),정민수(Min Soo Jeong),이강욱(Kang Wook Lee),김선영(Sun Young Kim),신영태(Young Tai Shin),이정호(Jeong Ho Lee) 대한내과학회 1995 대한내과학회지 Vol.48 No.5

N/A Objectives: Leptospirosis is known to be one of the most frequent zoonosis in Korea in addition to hemorrhagic fever with renal syndrome. The pathologic changes of leptospirosis are widespreaded and most prominent in lung, liver, skeletal muscle, adrenals, stomach, spleen, nervous ystem, and kidney. We evaluated the prevalence and clinical findings of leptospirosis associated renal insufficiency and nephropathy. Methods: This study was performed in 103 patients with leptospirosis admitted in Chungnam National University Hospital from Jan. 1985 to Dec. 1992. We classified three group, as uremic patients (serum creatinine21.4mg/dl) with abnormal urinary finding, non-uremic patients(serum creatinine< 1.4mg/dl) with abnormal urinary finding, and non uremic patients with normal urinary finding. Results: 1) Mean age was 49.2year old(17-75years). Ratio of man to woman was 1.5: l. 2) Eighty two patients(79.6%) showed abnormal urinary findings. Twenty patients(19.4%) showed elevated serum creatinine level above 1.4mg/dl, Sixty two patients(60.2%) showed abnormal urinalysis with normal renal function. 3) Fever and chills, maculopapular rash and myalgia were most frequent symptoms and signs. Dyspnea and confused mentality occrued more frequently in uremic patients than that in non-ruemic patients (p<0.01, p<0.05). 4) Platelet counts of uremic patients were significantly lower than those of patients who showed abnormal urinalysis findings with normal level of serum creatinine(p<0.01). 5) Hypoproteinemia was more prevalent in uremic patients than in non-uremic patients(p<0.05). Elevation of serum CPK and LDH level appeared more frequent in uremic patients than in non-uremic patients(p<0.05, p<0.05). 6) All patients with renal involvement recovered completely without renal replacement therapy. Conclusion: We thout that leptospirosis is a systemic infectious disease which shows renal insufficiency in one fifth of victims, and they manifest severe clinical features such as dyspnea or confused mentality. However the outcome of the patients with renal insufficiency is relatively good.

급성신부전이 동반된 HELLP 증후군

김성숙,김종학,이강욱,신영태,빈기태,황평주 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.2

The HELLP syndrome(hemolysis, elevated liver enzymes, and low platelets) is a complication of severe preeclampsia or eclampsia and associated with increased maternal and perinatal mortality. Exact pathogenic mechanism is still unclear but the microangiopathic hemolytic anemia combined with endothelial cell damage is suspected to be closely associated with disease process. Variable degree of disseminated intravascular coagulation(DIC) may be accompanied with the HELLP syndrome. We report a case of postpartum HELLP syndrome. She is 24 year-old woman. She showed definite evidence of microangiopathic hemolytic anemia, DIC, elevated liver enzymes and acute renal failure. Liver biopsy revealed fatty change with focal fibrin like material deposition in the portal tract area. She recovered completely with conservative treatment in 2 weeks.

성인 막성 신병증에서 면역억제 치료

김성숙,이강욱,신영태,빈기태 대한신장학회 1995 Kidney Research and Clinical Practice Vol.14 No.3

Membranous nephropathy (MN) can appear in the absence of systemic disease and can be related with known precipitating factors such as carcinomas, systemic lupus erythematosus, and hepatitis B viral infection. Although there were many therapeutic trials such as corticosteroid, cyclophosphamide, cyclosporin, chlorambucil and immunoglobulin G, the therapeutic effects of those agents were inconclusive. And twenty to sixty five percent of spontaneous remission rate in patients with idiopathic mem- branous nephropathy was reported. So it is not easy to choose the therapeutic regimens. To evaluate the therapeutic effect of immunosuppressive agents such as prednisolone and/or cyclophosphamide and clinical courses in adult patients with MN, we analyzed 60 patients with MN and nephrotic syndrome who were admitted in Chungnam National University Hospital from March 1986 to April l. We reviewed the clinical findings of 48 patients for rnedian 28.2 months of follow-up period (6-92 months) after initiating immunosuppressive treatment, retrospectively. Primary and secondary MN were 65% and 53% of 60 patients, respectively. Among secondary MN, 62% was hepatitis B associated MN and 38% was lupus MN. Mean age of patients with primary MN was about 10 years older than that of patients with secondary MN. Total fourty eight patients were followed more than 6 months. Thirty patients with primary MN were treated with prednisolone and/or cyclophosphamide. Fourty three percent of them obtained complete remission after mean 1@5.2 months of treatment. Partial remission was appeared in 20% of patients. And 37% did not show clinical improvement. Seven patients with h.pus MN were treated with irnmunosuppressive agents and four patients (57%)showed complete remission after mean 9.1 months of treatment. Three patients (43%) also reached partial retnission during follow-up period. Two patients with hepatitis B virus associated MN were treated with immunosuppressive agents and one patients showed partial remission. However 63% of patients who were not treated with immunosuppressive agents also showed partial remission during follow-up period. There was no significant clinical difference between primary MN patients who showed clinical improvement and those who had no response with immunosuppressive treatment. We though that the clinical course of MN is different according to the causes of MN and res- ponse rate to the immunosuppressive treatment was better in lupus MN tnan primary MN.

신질환을 동반한 고혈압 환자에서 Lisinopril의 임상 효과

신영태,오선미,나기량,김종섭,빈기태,김성숙,이강욱 충남대학교 의과대학 지역사회의학연구소 1996 충남의대잡지 Vol.23 No.1

The antihypertensive efficacy and safety of lisinopril, a long-acting angiotensin-converting enzyme inhibitor, was assessed in 15 patients with hypertension assocciated with impaired renal function (creatinine clearance rate 60 ml/min or less) in an open study of 8 weeks duration. The starting dose was 2.5 mg in patient with creatinine clearance rate of less than 30 ml/min and 5 mg in all other patients. Mean blood pressure was significantly reduced by lisinopril treatment(163 ±25 mmHg at baseline, 137 ±19 mmHg after 8 weeks of treatment). The mean dose of lisinopril tiken was 14.0 mg daily (range 10-30 mg). The mean creatinine clearance rate and 24 hour urinary protein were unchanged during the study (30 ±10.7 ml/min and 5.9 ±7.5 gm at baseline, 26 + 8.9 ml/min and 4.5 ±5.8 gm after 8 weeks of treatment, respectively). No clinically significant hematological or biochemical changes were observed. All patients had hyperkalemic tendency but not siginificant statistically. Two patients had mild coughing and other two patients had postural dizziness but tolerable. In conclusion, lisinopril provided effective blood pressure control and was well tolerated. Significant hyperkalemia may compromise in patient with advanced renal impairment, leading to potentially dangerous hyperkalemia.

신장이식후 발생된 자가면역 용혈성 빈혈 1예

김성숙,이강욱,정민수,신영태,빈기태,권계철,이존기 대한신장학회 1994 Kidney Research and Clinical Practice Vol.13 No.2