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조원용(Won Yong Cho),김인옥(In Ok Kim),정동국(Dong Guk Chung),김형규(Hyoung Kyu Kim),원남희(Nam Hee Won),박희봉(Hee Bong Park) 대한내과학회 1987 대한내과학회지 Vol.33 No.5
N/A To assess the clinical significance of immune doposits in the clinical course of minimal change nephrotic syndrome, we have studied 27 patients with minimal change nephrotic syndrome, aged from 13 to 51 years. The clinical course of 13 patients with mesangial immune deposits was compared with those of 14 patients without mesangial immune deposits. The results obtained in this study were as follows 1) In IF positive group, serum abumin level was 1.57±0.25 gm/dl and 24 hour urine protein 9.50±4.45 gm/day. In IF negative group, serum albumin level was 1.40±0.34 gm/dl and 24 hour urine protein 11.44±8.67 gm/day. There were no significant differences between two groups. 2) The presenting symptoms such as hypertension, hematuria, and azotemia were appeared in variable ratio, but no significant difference in two groups were noted. 3) In IF positive group, all cases had IgM deposits in mesangium, and two cases had IgA deposits in mesangium. There were no significant differences in symptoms, signs and responses to therapy according to varieties of immunoglobulin or complement deposits. 4) In the clinical course along the steroid therapy, there were no significant differences in the two groups, namely, in IF positive group, complete remission occurred in 46%, and in IF negative group complete remission occurred in 61.5%, somewhat higher ratio, but had no significant difference. There were no difference in any particular clinical onset, histologic pattern on light microscopy, therapy response or clinical course in two groups in our relatively short follow up period. So we concluded that immune deposits is not a marker for response to therapy in patients with idiopathic nephrotic syndrome and that to define new disease entity, IgM nephropathy, further study and follow up were required.
조원용(Won Yong Cho),이은주(Eun Joo Lee),김용섭(Yong Sup Kim),권현민(Hyun Min Kim),권영주(Young Joo Kwon),김형규(Hyung Kyu Kim),원남희(Nam Hee Won) 대한내과학회 1991 대한내과학회지 Vol.40 No.5
N/A To evaluate the relationship between derangement of renal function and the pathological findings in hemorrhagic fever with renal syndrome (HFRS), renal biopsy and functional studies were performed in 23 cases of HFRS. To correlate the pathologic findings with renal funtion, serum creatinine, creatinine clearance, and proteinurea were measured, and also an immunohisto-chemical study in kidney tissue was performed. The results were as follows: 1) The study population included 9 oliguric HFRS cases and 14 nonoliguric HFRS cases. Clinical manifestations at admission were more severe in oliguric cases. 2) Serum creatinine in oliguric cases at admission were 12.5±4.5 mg/dl, higher than the nonoliguric cases, 8.4±3.9 mg/dl (p<0.05). 3) There were no significant differences in the pathologic findings between oliguric and nonliguric HFRS. Pathologic findings were focal infiltration of inflammatory cells and edema of interstitium and destructive changes of tubular structure. 4) The infiltrating inflammatory cells were mostly T-lymphocytes. From the above findings, we can conclude that renal functional changes in HFRS are not related with the severity of the pathologic lesion. It is also sugsseted that infiltrating T-lymphocytes in the interstitium may be related with renal functional derangement ant the pathogenesis of proteinuria.
Combined Primary IgA nephropathy and Membranous Glomerulonephritis in a Child
김미경,최정훈,원남희,유기환,Kim Mi-Kyung,Choi Jeong-Hoon,Won Nam-Hee,Yoo Kee-Hwan Korean Society of Pediatric Nephrology 1999 Childhood kidney diseases Vol.3 No.2
IgA 신병증은 사구체 중맥에 IgA가 침착하는 것이 특징적인 질환이며 막성 사구체 신염은 IgG가 사구체 기저막의 상피하에 미만성으로 침착하는 질환이다. 원발성 사구체 질환중 IgA 신병증과 막성 사구체신염은 비교적 흔한 질환이나 전체적인 빈도는 낮은 편으로, 한 환자의 사구체에서 두 질환이 동시에 발생하는 경우는 매우 드물다. IgA 신병증과 막성 사구체신염의 중복 신염은 Doi등이 1983년 원발성 신질환으로서 처음 보고한 이래, 성인에서 20여례가 보고되었다. 저자들은 신증후군이 발생한 환아에서 신생검을 시행한 결과 원발성 신질환으로서 IgA 신병증과 막성 사구체신염의 소견이 동시에 보이는 중복신염의 드문 예를 경험하였기에 보고하는 바이다. 환아는 7세된 남아로 내원 한달 전부터 발생한 전신부종을 주소로 내원하였다. 가족력과 과거력상 특이 소견없었으며, 내원시 이학적 소견상 전신적인 허약감과 안와부종, 복부팽만, 하지의 함요부종이 관찰되었고, 검사소견에서는 WBC $19,800/mm^3$, Hb 14.1g/dL, Platelet $397,000/mm^3$, BUN/Cr 10/0.4mg/dL, protein/albumin 4.43/2.73g/dL, cholesterol 429mg/dL, IgA 85mg/dL, $C_3$ 68.8mg/dL, $C_4$ 13.4mg/dL, ANA(-), ANCA(-), RF(-), HBsAg/Ab(-/-)이었다. 뇨검사에서는 RBC many/HPF, WBC 2-3/HPF, protein ${\le}\;300mg/dL$ 였으며, 24시간 소변 검사상 protein 9.18g/day, Ccr 66.67ml/min의 소견을 보였다. 신생검을 시행한 결과 광학현미경상에서 몇몇 사구체의 분절성 경화와 중맥역의 증식이 관찰되었고, 면역형광현미경검사에서는 IgA(3+)가 과립상으로 미만성 분포를 보이며 중맥역에 침착되어 있고, 미세한 과립상과 위선의 양상으로 IgG(1+)가 모세혈관벽에 침착되어 있었으며, 전자현미경 소견상 중맥역과 모세혈관 기저막 상피하에 소량의 전자 고밀도 침착이 함께 관찰되었다. 환아는 prednisolone을 경구 투여 받았으나 단백뇨와 혈뇨가 지속되어 solumedrol pulse therapy, captopril과 cyclophophamide로 치료 받은 후, 전신 상태 호전되고, 혈뇨가 사라졌으며, 24시간 소변 검사상 단백뇨가 487.5mg/day로 감소하여 외래에서 추적 관찰 중이다.