만성신부전 환자에서의 초기 투석 시작시와 장기 투석 후의 임상적, 실험적 특징의 고찰

김호중(Ho Jung Kim),박일규(Ile Kyu Park),한상웅(Sang Woong Han),양성규(Seong Kyu Yang),유준호 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2

N/A Objective: We examined clinical and laoratory features retrospectively in 56 patients at the start and after the chronic maintenance hemodialysis in order to provide a more complete picture of the uremic symdrome in the dialysis era. for deciding the time when chronic hemodialysis must be started. Methods: The records of 56 patients began chro-nic hemodialysis treatment at the Han Yang University Hospital from 1995 august until 1997 august were reviewed retrospectively. The information gathered in-cluded demographic data, renal diagnosis, uremic symptoms, biochemical values. Results: The most prevalence of manifestation of uremia was general weakness(67.9%). Unexpected fin-dings were the wide ranges of serum creatinine levels(3.5 to 19.4mg/dL) and blood urea nitrogen levels (19 to 204mg/dL), creatinine clearance rate(1.2-17.4mL/ min), and the frequency of hyponatremia(19.6%), hypo-albuminemia(69.6%), and the anion gap above 14mByL was(66.7%). There was higher potassium leve1 in dia-betes mellitus patients than non-diabetes mellitus pa-tients(6.2±1.6mEq/L VS. 4.9±1.0mEq/L,p=01). Patients laboratory values were changed after the chronic main- tenance hemodialysis-Albumin(3.2±0.8 to 3.6±0.5gm/dL, p=0.01), calcium(7.6±1.2 to 8.7±1.9mg/dL, p=0.01), he-matocrit(23.0±4.7 to 27.7±4.2% , p=0.01), phosphorus (5.6±2.1 to 4,6±1.4mg/dL, p=0.01), pH(7.30±0,1 to 7.35±0.2, p>0.05), anion gap(22,0±11.0 to 12.1±8.8mg/dL, p>0.05). Conclusion: Finally, uremic symptoms were ex-pressed mainly gastro-intestinal and respiratory sym-ptoms. Chronic renal failure associated with diabetes mellitus was earlier on set of uremic symptoms and higher level of serum potassium level than other underlying diseases. Uremic symptoms and laboratory values were almost corrected but metabolic acidosis was not corrected significantly after the chronic main- tenance hemodialysis.

Trimethoprim / Sulfamethoxazole ( TMP / SMX ) 을 복용 중인 외래 환자에서 발생하는 경구 칼륨 투여 후 칼륨 대사 장애

최춘식(Chun Sik Choi),유영조(Young Jo Yoo),김태영(Tae Young Kim),민경환(Kyung Hwan Min),한상웅(Sang Woong Han),노광호(Kwang Ho Roh),양성규(Seong Kyu Yang),유준호(Jun Ho Yoo),오석중(Suk Joong Oh),문중돈(Jung Don Mun),김호중(Ho Jung Ki 대한내과학회 1999 대한내과학회지 Vol.57 No.1

N/A TMP/SMX has been shown to cause hyperkalemia in a few outpatients on standard-dose. This prospective study was aimed at investigating other associated factors inducing clinically important hyperkalemia in outpatients on standard-dose of TMP/SMX. Methods : Age-matched diabetic(n=22) and non-diabetic (n=20) patients with UTI on standard dose of TMP/SMX for 5 days were given acute oral intake of 40 mEq of potassium chloride(KCl). Results : Before the intake of TMP/SMX, basal levels of serum potassium(K), serum BUN and creatinine, plasma renin activity(PRA), aldosterone(PA), and transtubular potassium gradient(TTKG) were comparable between diabetic and non-diabetic subjects. Also after TMP/SMX was taken, all parameters didnt reveal any overt changes except a slightly increased serum K but not significantly (from 4.20±0.15 to 4.14±0.21mEq/L in non-diabetics; from 4.13±0.18 to 4.25±0.13mEq/L in diabetics). Following acute oral KCl load, however, the peak increases of serum K changes were significantly higher in diabetics compared to non-diabetics(0.34 0.06 vs 0.62 0.09mEq/L, p<0.01). Furthermore, 8 out of 22 diabetics but none of non-diabetics after acute KCl load developed hyperkalemia(> 5.0 mEq/L). After KCl load, PRA did not show any significant changes, whereas PA was increased simultaneously with the increments of serum K in both diabetic subgroups hyperkalemic(n=8) and normokalemic (n=14) diabetics. But increment was blunted in hyperkalemic diabetic subgroup. TTKG was increased prominently in normokalemic diabetic subgroup(9.20 from 4.50), while it was slightly increased in hyperkalemic diabetic subgroup(4.63 from 3.79mEq/L). There was statistical difference between two subgroups(p < 0.05). In conclusion, Besides the known effect of blocking sodium channels in distal K secreting cells by TMP/SMX, insulinopenia(DM). Hypoaldosteronism with its decreased tubular bioactivity, and increased exogenous K intake in concert could cause clinically overt hyperkalemia on standard-dose of TMP/SMX. When standard- dose of TMP/SMX is administered to patients with deranged K homeostasis, especially to diabetics with hypoaldosteronism, blood K level should be monitored meticulously to avoid hyperkalemia.

저나트륨혈증 환자에서 저나트륨혈증의 치료에 영향을 미치는 요인에 대한 연구

민경환(Kyung Hwan Min),한상웅(Sang Woong Han),김호중(Ho Jung Kim),유준호(Jun Ho Ryu),강석우(Seok Woo Kang),양성규(Seong Kyu Yang) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3

N/A Hyponatremia, well known as a serious medical condition, is the most frequent electrolyte disorder in clinical medicine. The aim of this study is to bring to readers affecting factors in hyponatremia treatment and to suggest effective treatment guideline. We studied general characteristics, associated se-rum potassium change, relationship of sodium concentration in urine, and affecting factors on serum sodium correction in 76 hyponatremic patients who had admitted Hanyang University Kuri Hospital. These 73 hyponatremic patients were divided into 10 groups according to cause and treatment by retrospective analysis(1 group : G-I origin, 2 group : CRF, 3 group : CHF, 4 group: LC, 5 group : adrenal origin, 6 group : diuretics use, 7 group : CHF with di- uretics use, 8 group : LC with diuretics use, 9 group : polydypsia, 10 group : SIADH). Serum sodium were 124.2±6.9mEq/L in initial diagnosis, 125.6 ±7.7mEq/L after 48 hour, and 129.8±6.3mEq/L in final evaluation. Among these hyponatremic patients, thirty patients' (41.1%) sodium correction rate were below 0.5mEq/ L/hr during initial 48 hour and fifteen patients(20.5%) were corrected above 135mEq/l in serum sodium Initial serum potassium was average 4,07mEq/L, and 15 patients in 73 hyponatremic patients were hy- pokalemic feature. Eight patients of 15 hypokalemic patients were corrected to normal potassium level and in addition, four patients of 8 corrected patients were corrected to normal sodium level above 135mEq/L. The disease frequency were highest in GI origin (31.5%), followed by SIADH(20.5%) and LC(12.3%). In our study, hyponatremia correction was not related to patient sex, age, and initial serum sodium concentration. In conclusion, Hyponatremia prognosis was not related to initial serum sodium concentration and cor-ection rate, but related to treatment of underlying disease. And hypokalemia acompanied by hyponetre-mia was corrected after correction of hyponatremia.

Ethylnitrosourea 에 의한 마우스 간소엽내 전암 병소의 중심정맥주변구역 편향성

김종철,김병훈,정철헌,이동후,이숭환,조용현,조영중,양성규,유병무 대한간학회 1997 Clinical and Molecular Hepatology(대한간학회지) Vol.3 No.3

Background/Aims: Hepatocytes on the hepatic lobule mipate from portal zone to centrilobular mea as the DNA synthesis within it. And also, the xenobiotic reactions reveal characteristic differences associated with zone specific metabolism in the liver acinus. In this study, the zonal distribution of ethylnitrosourea (ENU)-induced hepatic precancerous lesion was stereologically investigated. Methods: Nine B6C3F1 mices were given I.p. injection of ENU (60 ㎍/pn body weight) when the pups were 15 days old prior to sacrifices at 8 weeks of life. All the 150 consecutive sections, 3 p m in thickness, were stained with hematoxylin and eosin and identified the basophilic precancerous lesions with 80-165 p m diameter in equatorial plane by the Zeiss microprojector. And then the distances from the center of selected foci to terminal hepatic vein or portal vein branches were estimated under the microscopic fields. As a control group, the same estimations were performed from the random points by the appointments of random digit table. Results: Mean distance between ENU-induced 52 hepatocellular foci and the nearest terminal hepytic vein was 181.15±112.39 p m (Mean±SD), but that of randomly selected 104 points was 291.73±157.98pm (Mean+5D) (Students t-test, p$lt;0.0005). Substantially, 52.7% of ENU-induced 52 hepatocellular foci were within 300 p m from the terminal hepatic vein, but randomly selected 104 points were only 50.9% (Shapiro Wilk W test, w=0.819857, p=0.048038). Mean distance from ENU-induced 52 foci to portal vein was 398.85±149.98pm (Mean+SD), but that from the randomly selected 104 points was 315.87±145.79 pm (Mean±SD)(Students t-test, p$lt;0.0005). Conclusion: Stereologically, ENU-induced mice liver cell foci distribute non-randomly to Zone III, centrilobular zone of mouse hepatic acini where promote invasion toward terminal hepatic veins. (Korean J Hepatol 1997;6:227 240)

만성 간염, 간경변 및 간세포암종 환자 혈청에서 상피성 성장인자 농도의 변동

김병훈,최정혜,김홍주,이동후,조용현,권기운,유용걸,조영중,이제,양성규 대한간학회 1997 Clinical and Molecular Hepatology(대한간학회지) Vol.3 No.1

Background/Aims. Epidermal growth factors (EGF) is known to activate mitogen activated protein kinase (MAP kinase) in hepatocytes by the route of both Raf-dependent and Raf-indefendent pathways. And this is likely to play important role in normal liver cell growth and regeneration. EGF is also reported as a potent mitogen and one of the angiogenic factors. To elucidate the dynamic changes of the serum concentration of epidermal growth factor in chronic liver disease and its correlation with role of EGF and mechanism of tumor development, this study is intended to employ an ELISA in 38 biopsy-proven cases. Methods '. Sera taken out of 5 patients with chronic persistent hepatitis. 4 patients with chronic active hepatitis, 19 patients with liver cirrhosis, 10 patients with hepato- cellular carcinoma that pathological diagnosis was proven later were tested for EGF employing Quantikine ELISA Kits (R & D Systems Inc. Minneapolis, MN). The statistical analysis was evaluated by student's t-test. Results . EGF concentration was 253.33±69.5pg/ml(Mean±SE) in hepatocellular carcinoma, 246.60±91.19pg/ml(Mean±SE) in chronic active hepatitis, 222.71±115.97pg/ml (Mean±SE) in chronic persistent hepatitis, 141.15±23.12pg/ml(Mean±SE) in liver cirrhosis in orders. Serum EGF concentration in hepatocellular carcinoma was significantly higher than that in liver cirrhosis(p value=0.021695). However, comparing to the remaining other groups, no significant difference was found. Conclusion .' These results support that the reconstruction of the capillary networks in liver cirrhosis resplts in down-regulation of the EGF in comparison to chronic hepatitis. But it is suggested that revaluation of EGF stimulates MAP kinase activity eventually playing in tumorigenesis of the liver with neoangiogenesis.