만성 신부전과 동반된 일차성 알도스테론증

김용수 ( Yong Soo Kim ),최훈영 ( Hoon Young Choi ),김현진 ( Hyun Jin Kim ),김동기 ( Dong Ki Kim ),정인현 ( In Hyun Jung ),김형종 ( Heung Jong Kim ),이태희 ( Tae Hee Lee ),윤수영 ( Soo Young Yoon ),최규현 ( Kyu Hyun Choi ),강신욱 ( 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.1

Background : Early detection and treatment of chronic kidney disease (CKD) are important for inhibition of kidney disease progression and prevention of cardiovascular complications. Treatment of Anemia that is frequently accompanied with CKD, are important for prevention of cardiovascular complications. The lastest K/SOQI-CKD guideline targets early detection and treatment of kidney disease, and the study for these are necessary in Korea. In Korea, until mowadays, the study for prevalence, severity of anemia and influencing factors on anemia in CKD, were rare. Thus in our center, we classified patient for severity of CKD as K/DOQI-CKD guideline and studied prevalence, severity of anemia and influencing factors on anemia. Methods : According to K/DOQI-CKD guideline, patients were staged by GFR calculated by Adbbreviated MDRD Study Equation. Anemia was defined by Hb lessl than 10.0 g/dL below which hemodynamic change develops. We examined the frequency of anemia and independent factors that influences on anemia in study patients. Results : Mean creatinine levels for stage 1 to 5 were 0.87±0.15 (0.7-1.1) mg/dL; 1.04±0.18 (0.8-1.4) mg/dL; 1.69±0.36 (1.1-2.7) mg/dL; 2.90±0.66 (1.9-4.7) mg/dL; 5.01±1.28 (3.3-8.8) mg/dL. Mean Hb levels and percentage of anemic patients in each stages were 12.95±1.46 (10.5-15.4) g/dL, 0%; 13.31±2.20 (7.8-17.7) g/dL, 10.3%; 11.32±2.07 (7.4-16.6) g/dL, 25.5%; 10.10±1.71 (6.7-14.0) g/dL, 54.8%; 9.21±1.53 (6.2-12.2) g/dL, 76.9%. The frequency of anemia were high in Diabeltes Mellitus Mellitus (DM) compared to Non-Diabeltes (Non-DM) at stage 3, 4, 5 [36.7 vs 12.0% (p=0.06); 70.6 vs 35.7% (p=0.000); 100 vs 64.7% (p=0.06)]. Multivariate logistic regression analysis revealed that DM as etiology (OR 2.53, p=0.033 compared with Non-DM), Albumin level (OR of 5.38 p=0.001 for 3.0-1.4 compared with 4.0-5.3 g/dL) were independent factor determing anemia state in addition to K/DOQI guideline stage. GFR, sex, DM, Albumin level were independent factors associated with hemoglobin levels (R^2=0.571, p<0.001). Conclusion : Anemia in CKD was developed relatively early and frequently at stage 3 (Cr, 1.69±0.36 mg/dL, 25.5%) and more aggravated as decreasing renal function (stage 4, 5; 54.8%, 76.9%). DM as underlying disease, hypoalbuminemia were, independently influenced Anemia development.

산 당화액 중화 염기 종류에 따른 발효 특성

이재성(Jai-Sung Lee),윤수영(Su-Young Yoon),송우용(Woo-Yong Song),신수정(Soo-Jeong Shin) 한국펄프·종이공학회 2015 한국펄프·종이공학회 학술발표논문집 Vol.2015 No.10

깊은 정맥혈전증이 합병된 이식신의 신대체 지방종증 1예

이상철 ( Sang Choel Lee ),김윤지 ( Yoon Ji Kim ),이상헌 ( Sang Hun Lee ),박형복 ( Hyung Bok Park ),현여경 ( Yu Kyung Hyun ),동시헌 ( Shi Heon Dong ),윤수영 ( Soo Yong Yoon ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6

Purpose: Replacement lipomatosis of the kidney is a rare disorder in which a massive fatty tissue proliferation occurs within the renal sinus, hilum and perirenal region. Clinical symptoms includes flank pain, hematuria, fever usually associated with urinary tract infection and renal stone. But deep vein thrombosis due to mass effect has not been reported to be associated with replacement lipomatosis of kidney. A 37-year-old male was referred for the initiation of hemodialysis due to chronic rejection of allograft kidney. Collateral superficial veins were observed on his anterior abdominal wall and firm mass was palpable in the right lower quadrant abdomen. Abdominal-pelvis computed tomography revealed huge fatty mass originated from allograft kidney and non-visualization of inferior vena cava with lower density thrombus at both the common femoral veins. We report a rare case of replacement lipomatosis of the kidney complicated by deep vein thrombosis after renal transplantation.

지속성 외래 복막투석 환자에서 아미노산 투석액 ( Nutrineal(R) ) 의 장기간 사용이 영양상태에 미치는 영향 - 반응군과 비반응군의 비교

최소래(So Rae Choi),송영수(Yong Soo Song),윤수영(Soo Young Yoon),윤도식(Do Sik Yun),안수현(Soo Hyun Ahn),박형천(Hyung Cheon Park),이종호(Jong Ho Lee),강신욱(Shin Wook Kang),최규헌(Kyu Hun Choi),하성규(Seong Kyu Ha),이호영(Ho Yung Lee 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.5

배 경 : 복막투석 환자에서 아미노산 복약투식액 (IPAA)의 사용이 영양학적 지표를 단기적으로는 개선한다고 보고되고 있으나, 장기적으로 투여하였을 때 영양상태에 미치는 영향에 대해서는 아직 보고된 바가 없다. 이에 저자들은 IPAA의 장기간 사용이 환자의 영양상태에 미치는 영향을 평가하고, IPAA의 사용으로 영양상태의 호전을 보이는 환자들의 특성을 규명하고자 하였다. 방 법 : 영양실조 소견을 보이는 지속성 외래 복막투석 환자 46명을 대상으로 하여 아미노산 복막투석액 (Nutrineal^ )을 1일 1회 12개월간 사용하면서 영양학적 지표를 12개월 동안 측정하였으며, 크레아티닌 배설량으로부터 계산된 제지방무게 (LBMCr)가 2.0 ㎏ 이상 증가하거나 전체 체중에 대한 제지방무게의 비율 (%LIBMCr)이 5% 이상 증가한 환자들을 반웅군으로 정의하여, 반응군과 비반응군 두 군에서 여러 지표를 비교하였다. 결 과 : IPAA를 12개월 사용 후 혈청 요소질소, 크레아티닌, IGF-1은 기저치와 비교하여 지속적으로 유의하게 증가하였으며, 단백질과 알부민은 의미있는 변화를 보이지 않았다. 혈청 총 CO_2는 IPAA 투여 후 점차 감소하여 대사성산증의 정토가 심화되는 경향을 보였다. LBMCr, 표준 단백질소 발현을, 주관적 영양상태 평가, 운동 능력은 아미노산 투석액 투여 후 지속적으로 유의하게 증가하여, 영양 상태의 호전을 보여주었다. IPAA 사용 후 혈청 요소질소, 단백질소 발현을, 표준화 단백질소 발현을과 주관적 영양상태평가는 반응군과 비반응군 모두에서 기저치에 비해 유의하게 상승하였으나, 반응군에서의 상승이 비반옹군보다 더욱 현저하였다. 그러나 혈청 크레아티닌, LBMCr와 %LBMCr은 반웅군에서만 유의하게 증가하였다. 또한, 운동능력은 기저치에서부터 반응군이 비반응군에 비해 유의하게 높았으며, IPAA 사용 후 반웅군에서만 유의하게 증가하였다. IPAA 사용 이전부터 감소하는 경향을 보이던 혈청 알부민은 비반웅군에서는 계속 감하였으나, 반응군에서는 감소하는 경향이 둔화되어 안정화되는 경향을 보였다. 결 론 : 1일 1회 1.1% TPAA의 장기간 사용은 영양실조 상태의 복막투석 환자에서 영양상태의 호전을 초래하는 것으로 생각할 수 있었다. 영양실조가 진행된 환자보다 영양실조가 경한 상태에서부터, 특히 기저치 운동능력이 보전된 환자와 IPAA 사용 후에 IGF-1, LBMCr와 운동능력이 증가하는 환자에서 IPAA을 지속적으로 사용하는 것이 영양상태의 호전을 더 기대할 수 있을 것으로 예상된다. Background : IPAA provide nutritional benefit, at least in the short term. However, the long-term efficacy of IPAA in PD patients remains unclear. An attempt was made to evaluate long-term efficacy of IPAA and to ascertain possible factors associated with improved nutritional status after IPAA. Methods : The 46 malnourished CAPD patients were treated with IPAA (one exchange of Nutrineal daily) for one year. Various nutritional, boichemical variables, urea kinetic study and measurement of lean body mass based on creatinine excretion (LBMCr) were carried out at baseline, and at 3month interval thereafter. Responders was defined as those patients who had an increment of mean LBMCr more than 2.0 ㎏ and/or an increase in mean %LBMCr (LBMCr/Body weight) more than 5% during IPAA treatment. Results : After administration of IPAA, BUN, Cr, LBMCr, %LBMCr, nPNA, SGA, and exercise capacity increased significantly. But, protein and albumin level showed no significant change. Increment of GF-1 level was significant. At baseline, responders had a significantly higher hand grip and back lift strength compared to non-responders. IPAA treatment significantly increased in BUN, PNA and nPNA in both groups, but the increment of them was pronounced in responders. IPAA resulted in a significant increase in serum creatinine (10.6±2.1 vs. 11.8±2.6 ㎎/dL, p<0.05) and %LBMCr (70.8±8.9 vs. 76.4±9.2%, p<0.05), hand grip strength (23.2±7.3 vs. 24.3±7.7 ㎏, p<0.05) and back lift strength (67.0 27.4 vs. 75.3±26.6 ㎏, p<0.05) only in responders. Serum albumin level remained stable after IPAA treatment in responders. Conclusion : IPAA treatment for 12 months provided some nutritional benefits in malnourished CAPD patients. And, our data suggest that response to IPAA is more pronounced in CAPD patients with a better preserved nutritional status, `especially in those patients with higher back lift and hand grip strength at baseline.

급성 허혈성 신손상 백서에서 α-melanocyte stimulating hormone이 intercellular adhesion molecule-1의 발현 및 신기능에 미치는 영향에 관한 연구

조상경(Sang Kyung Jo),윤종우(Jong Woo Yoon),차대룡(Dae Ryong Cha),조원용(Won Yong Cho),김형규(Hyoung Kyu Kim),원남희(Nam Hee Won),윤수영(Soo Young Yoon),장경현(Kyung Hyun Chang) 대한내과학회 2000 대한내과학회지 Vol.59 No.6

N/A Background : Acute renal failure is a reversible process in majority of cases but mechanisms of renal injury or recovery are poorly understood. Recently neutrophil infiltration is reported to potentiate inflammatory and cytotoxic cascade in ischemic renal injury and α-melanocyte stimulating hormone has been reported to have a potent anti-inflammatory properties in a variety of animal models. We examined the beneficial effects of α-MSH in acute ischemic renal injury in rats and tried to clarify its action mechanism. Methods : After unilateral nephrectomy, renal artery of contralateral kidney was clamped for 40 minutes and reperfused in female Sprague-Dawley rats. α-MSH (50μg) and vehicle was injected intraperitoneally immediately after and 6, 24 hours after reperfusion. Biochemical, histological data, ICAM-1 mRNA, protein expressions and polymorphonuclear cell infiltration were examined. Results : α-MSH significantly attenuated the renal injury, measured by plasma BUN and creatinine level and also the degree of severity of histological injury (BUN 125.2±14.6 mg/dL : 46±19.6 mg/dL (p=0.004), creatinine 3.65±0.81 mg/dL : 1.47±0.5 mg/dL (p=0.005) at 24 hours after reperfusion, BUN 88±12.5 mg/dL : 25.5±15.8mg/dl (p=0.002), creatinine 2.76±0.5 mg/dL : 0.93±0.2 mg/dL (p=0.002) at 72 hours after reperfusion and 5.4±1.94/ 2.6±0.77 (p=0.006) at 24 hours after reperfusion in histilogical grading system). In the α-MSH treated groups, ICAM-1 mRNA expression decreased significantly compared to the vehicle treated ischemic group in 72 hours after reperfusion (0.49±0.01/0.31±0.2, p<0.008). ICAM-1 protein expression also decreased in α-MSH treated group, but it was not statistically significant. Polymorphonuclear cell infiltration showed a significant decrease in the α-MSH treated group at 24 hours after reperfusion (5.05±1.8/1.59±0.4, p=0.009). Conclusion : α-MSH attenuates ischemic renal injury by inhibiting the expression of ICAM-1 and subsequent polymorphonuclear cell infiltration. These results provide a rationale of α-MSH as a potential therapeutic drug in acute renal failure.(Korean J Med 59:641-650, 2000)

자탈형 콤바인의 탈곡통 시뮬레이션 모델 개발 및 분석

전현호(Jeon Hyeon-Ho),이준호(Lee Jun-Ho),오현준(Oh Hyun-Jun),손모아(Son Mo-A),백승윤(Baek Seung-Yun),윤수영(Yoon Soo-Young),김용주(Kim Yong-Joo) 대한기계학회 2022 대한기계학회 춘추학술대회 Vol.2022 No.5

급성 허혈성 신손상 백서에서 α-Melanocyte Stimulating Hormone이 아포프토시스와 Fas 발현에 미치는 영향에 대한 연구

김형규,조원용,윤종우,차대룡,윤수영,원남희,조상경,장경현,김경욱 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.5

Apoptosis frequently occurs in acute renal injury but molecular mechanisms responsible for this distinct form of cell death are largely unknown. Fas belongs to the TNF/nerve growth factor superfamily and engagement by Fas ligand induces apoptosis in various epithelial cells. To investigate the role of apoptosis and associated molecular mechanisms, we examined the occurrence of apoptosis and Fas expression as well as the therapeutic effect of α-MSH, a potent anti-inflammatory cytokine in ischemic ARF rat model as well as its effect on Fas expression. The expression of Fas was studied by western blot analysis and semiquantitative RT-PCR. Apoptosis was assessed by the TUNEL method and the degree of apoptosis and Fas expression, as well as biochemical, histological data were compared between the α-MSH and the vehicle treated groups in 40 minute renal artery clamping ischemic ARF rat models. Intraperitoneally administered α-MSH significantly reduced renal injury, measured by plasma blood urea nitrogen, creatinilevel and the degree of tubular necrosis(106.5±13.3/54.7±5.45mg/dL for BUN, 1.77+0.29/1.03±0.06mg/dL for creatinine 24 hours after ischemia)(p=0.003, p=0.01), (5.4±1.94/2.6±0.7 for injury score 24 hours after ischemia)(p=0.01). Ischemia caused significant upregulation of Fas mRNA and protein and was accompanied by morphological evidence of apoptosis. α-MSH significantly reduced the degree of apoptosis, as well as Fas[(mean apoptotic cell: 23.7±12.5/11.0±5.7 per 200 field at 4 hours after ischemia(p=0.04), 31.6±24.7/18.1±11.5 per 200 field at 24 hours after ischemia(p=0.25)]. (Fas protein expression: sham: 1409±355DI(densitometric index)) 2818.3±1100/1306±643.4DI at 24 hours and 5541.5±1597.5/2866.7±788.9DI at 72 hours after ischemia)(p=0.07, 0.047). These results suggest that Fas upregulation induced tubular cell apoptosis may contribute to the pathogenesis of ischemic ARF and the beneficial effect of α-MSH is partially mediated by these inhibitory effects on Fas system.