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신용훈 ( Yong Hun Sin ),김현주 ( Hyun Ju Kim ),이화목 ( Hwa Mok Lee ),오준석 ( Joon Seok Oh ),황현철 ( Hyun Cheol Hwang ),임동한 ( Dong Han Im ),김지환 ( Ji Hwan Kim ),박창수 ( Chang Soo Park ),박미정 ( Mi Jeong Park ),오혜주 ( Ho 대한내과학회 2005 대한내과학회지 Vol.69 No.4
목적 : 최근 신장이식에 있어 대기 수혜자수에 비해 공여자수가 현저히 부족함에 따라 부모-자식간 또는 형제-자매간의 이식 외에 부부간 또는 가능성 있는 비혈연간의 이식을 위한 노력들이 증가함에 따라 HLA 적합정도가 낮은 군간의 신이식 수술도 국내 여러 이식센터에서 시행되고 있으나 HLA 적합정도에 따른 이식신 및 수혜자의 임상성적은 각 이식센터에 따라 상이한 실정이다. 이에 저자들은 HLA 적합수가 0, 1, 2인 대상군을 HLA haploidentical 군과 임상 성적을 비교하여 HLA 적합수가 낮은 군의 신이식 후 성적을 예견하는 지침으로 활용키 위해 본 연구를 시행하였다. 방법 : 1984년 12월부터 2004년 3월까지 본원에서 3개월 이상 추적관찰된 HLA-A, B, DR 전체 6개 항원 중 HLA 적합수가 0, 1, 2인 군 89명과 HLA haploidentical 군 79명 간의 이식신 생존률, 급성거부반응의 빈도, 이식신 기능소실의 원인, 이식 후 1, 2, 3, 5년의 혈청 크레아티닌치 등을 후향 분석하였다. 결과 : HLA-A, B, DR 전체 6개 항원 중 HLA 적합수가 0, 1, 2인 군과 HLA haploidentical 군간의 이식신 생존률, 급성 거부반응의 빈도, 이식신 기능소실의 원인, 이식 후 1, 2, 3, 5년의 혈청 크레아티닌치의 차이는 없었다. 결론 : HLA 적합수가 0, 1, 2인 군과 HLA haploidentical 군간의 이식 후 임상성적이 유의한 차이가 없어 HLA 적합수가 0, 1, 2인 군의 신이식도 적극적으로 고려할 수 있을 것으로 보인다. Background : Poor HLA matched donors may become an additional organ source for renal transplantation. This study is conducted to predict the clinical outcomes of renal transplantation in a poor HLA matched group (0 or 1 or 2 HLA matching) by comparing them with those of HLA haploidentical group. Methods : This study compared a poor HLA matched group (N=89) with HLA haploidentical group (N=79) to analyze differences between two groups in graft survival, incidence of acute rejection, cause of graft failure, posttransplant serum creatinine at 1, 2, 3, 5 years. Total 168 cases, appeared in the medical records for more than six months in Bong-Saeng Hospital, from December, 1984 to March, 2004 were traced and identified as relevant cases for this study. Results : Allograft survival rate at 1, 3, 5, 10 years for poor HLA matched group and HLA haploidentical group were 100%, 98.6%, 95.4%, 72.5% and 100%, 100%, 96.1%, 86.2% (p=not significant) respectively. Acute rejection developed in 25.8% of poor HLA matched group versus 18.9% of HLA haploidentical group (p=not significant). The most common causes of graft failure in both groups were chronic rejection. Conclusions : It should be actively encouraged to consider renal transplantation in a poor HLA matched group as the results of this study support that the clinical outcomes of renal transplantation in a poor HLA matched group are equivalent to those of HLA haploidentical group.(Korean J Med 69:402-409, 2005)
이차성부갑상선기능항진증이 있는 복막투석환자에게 시행한 복강 내 Paricalcitol 투여 치료 1예
전지민 ( Ji Min Jeon ),박용기 ( Yong Ki Park ),오준석 ( Joon Suk Oh ),김성민 ( Sung Min Kim ),신용훈 ( Yong Hun Sin ),김중경 ( Joong Kyung Kim ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.2
Secondary hyperparathyroidism is a major complication in ESRD patients undergoing dialysis. In hemodialysis patients with secondary hyperparathyroidism, intravenous administration of paricalcitol became widely utilized. In CAPD patients, however, the intravenous administration of paricalcitol which requires frequent visits to the clinic is not practical. The subject of this study was one CAPD patient with secondary hyperparathyroidism. He had already received oral calcitriol pulse therapy for 6 months and thereafter refused parathyroidectomy and intravenous paricalcitol which required frequent visits to the hospital. Furthermore, paricalcitol capsule is not yet introduced in Korea. Consequently, intraperitoneal paricalcitol therapy was tried whereby the patient was taught how to inject the paricalcitol (5 ug) directly into the dialysate for three times per week before bedtime. Blood samples for measurement of intact parathyroid hormone (iPTH), serum ionized calcium, serum phosphate, serum total alkaline phosphatase levels were obtained at baseline and after 1, 2, 3 and 4 months of treatment. After usage of intraperitoneal paricalcitol for 2 months, there was a significant decrease in iPTH level. In conclusion, intraperitoneal paricalcitol therapy might be effective for suppressing iPTH in CAPD patients with secondary hyperparathyroidism. A large-scale and long-term study must be conducted for safety and clinical effect.
지속성외래복막투석 환자에서 발생한 Achromobacter xylosoxidans에 의한 복막염 1예
전지민 ( Ji Min Jeon ),박용기 ( Yong Ki Park ),오준석 ( Joon Suk Oh ),김성민 ( Sung Min Kim ),신용훈 ( Yong Hun Sin ),김중경 ( Joong Kyung Kim ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.2
Peritonitis is a major cause of morbidity in continuous ambulatory peritoneal dialysis (CAPD) patients. Achromobacter xylosoxidans is a rarely reported cause of peritonitis in CAPD patients. In this report, a peritonitis case due to Achromobacter xylosoxidans in a 60-year-old male patient with end-stage renal failure receiving CAPD for 7 years, has been reported. White blood cell (WBC) count in peritoneal fluid was 3,160/mm3 with 95% neutrophil. Gram staining of the peritoneal fluid yielded gram negative rod. Empirical antibiotic therapy with ceftriaxone was initiated intraperitoneally. But drug sensitivity test revealed these regimens were resistant. On fourth hospital day, Achromobacter xylosoxidans was cultured from peritoneal effluent, the antibiotic regimen was switched to piperacillin/tazobactam intraperitoneally. The patient rapidly recovered and the WBC count of the peritoneal effluent decreased. The therapy was continued for 14 days and then the patient was discharged. The peritoneal catheter was not removed.
오준석 ( Joon Seok Oh ),김성민 ( Sung Min Kim ),신용훈 ( Yong Hun Sin ),김중경 ( Joong Kyung Kim ),손영기 ( Young Ki Son ),안원석 ( Won Suk An ),김성은 ( Seong Eun Kim ),김기현 ( Ki Hyun Kim ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.3
Purpose: Quantification of the dialysis dose is an essential element in the management of hemodialysis. The author investigates the reliability of hemodialysis adequacy measured by ionic dialysance (Online clearance monitoring(R), OCM). Because OCM is a non-invasive and instantly accessible method, it could be replaced Kt/V derived from single-pool variable volume urea kinetic model (UKM). Methods: Kt/V using UKM and OCM were measured simultaneously in 51 patients who have received hemodialysis therapy via arteriovenous fistula. The analysis of the data collected from 186 hemodialysis sessions were performed. Results: Kt/V of conventional hemodialysis, high efficiency hemodialysis and hemodiafiltration measured by UKM were 1.39±0.24, 1.41±0.23 and 1.53±0.17, and by OCM were 1.24±0.17, 1.26±0.19 and 1.39±0.19, respectively. The data of UKM were significantly higher than those of OCM (p=0.00). Also, there were strong positive correlations between UKM and OCM in hemodialysis (r=0.80, p=0.00), high efficiency hemodialysis (r=0.65, p=0.00) and hemodiafiltration (r=0.67, p=0.00). Conclusion: The Kt/V using OCM measured by ionic dialysance provided slightly lower data than that of UKM derived from single-pool variable volume urea kinetic model, but it may be a reliable test to evaluate dialysis adequacy in conventional hemodialysis, high efficiency hemodialysis and hemodiafiltration.
신이식 환자에서 발생한 무증상 파종성 크립토콕쿠스증 1예
전지민 ( Ji Min Jeon ),오준석 ( Joon Suk Oh ),김성민 ( Sung Min Kim ),손영기 ( Young Ki Son ),박용기 ( Yong Ki Park ),신용훈 ( Yong Hun Sin ),김중경 ( Joong Kyung Kim ),이일선 ( Il Seon Lee ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.2
Cryptococcosis is recognized as one of the most important complications in an organ transplant recipient. Cryptococcosis occurs in 2.5-39% of renal transplant recipients. This infection generally presents as symptomatic disseminated disease with an accelerated clinical course, involves multiple sites including the central nervous system, lungs, and skin. And if diagnosis or treatment is delayed, the prognosis is generally poor. The asymptomatic infection is rare and there are no case reports of asymptomatic disseminated cryptococcosis after renal transplantation in Korea. We experienced a case of asymptomatic cryptococcal multi-organ infection detected incidentally in a 51-year-old male received a living related renal transplant 35 months earlier for end-stage renal disease due to diabetic nephropathy. We treated successfully with amphotericin B and fluconazole and hereby report this case with a review of the relevant literature.