신증후 출혈열 백신의 임상적 효용성

임춘수 ( Chun Soo Lim ),김승육 ( Seung Yuck Kim ) 국군의무사령부 1996 대한군진의학학술지 Vol.27 No.1

신증후출혈열 환자로부터 분리된 한타바이러스의 유전자 염기서열 분석과 계통발생도

임춘수(Chun Soo Lim),조종태(Jong Tae Cho),진호준(Ho Jun Chin ),정윤철(Yoon Chul Jung ),안규리(Curie Ahn ),한진석(Jin Suk Han ),김성권(Suhnggwon Kim),이정상(Jung Sang Lee),Peters CJ 大韓微生物學會 1998 大韓微生物學會誌 Vol.33 No.2

IgA 신병증에서 신조직내 Cytokine 및 Chemokine 의 발현과 임상 및 병리학적 소견의 상관성

임춘수(Chun Soo Lim),정수환(Shou Huan Zheng),김연수(Yon Su Kim),안규리(Cu Rie Ahn),한진석(Jin Suk Han),김성권(Suhng Gwon Kim),이정상(Jung Sang Lee),이현순(Hyun Soon Lee),채동완(Dong Wan Chae) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4

IgA nephropathy is one of the most common forms of primary glomerulonephritis in adults, and the pathogenetic mechanisms seem to be diverse. Proinflammatory cytokines, Thl/Th2 cytokines, and chemokines would be involved in the pathogenetic pathways and would affect the functional and his- tologic consequences. To evaluate this hypothesis, we tried to quantify the magnitude of intrarenal gene expression of various cytokines(TNF- α, IL-1β, IL- 6, IL-15, IFN- r, IL-2, IL-10) and chemokines(IL-8, RANTES) in 61 renal core biopsy specimens con- firmed as IgA nephropathy by immunofluorescent microscopy. Semiquantitative reverse-transcriptase polymerase chain reactions(RT-PCR) using the internal competitors were done for the quantification of gene transcripts. And using the immunohistochemistry (IHC), we tried to determine the degree of expression and the location of various cytokines and chemokines in renal tissues in 29 patients among the above patients. The IFN- r /IL-10 ratio was higher in patients with renal dysfunction than that in patients with normal renal function(p=0.0483). Gene transcript levels of proinflammatory cytokines(TNF- α, IL-1 β ) were high in patients with significant proteinuria. In patients with severe glomerular sclerosis, the ratio of IFN- z /IL-10 gene transcripts was high(p=0.0363). IL-10 gene transcript level was related to the se- verity of tubulointerstitial damage. The levels of gene expression of TNF- α(p=0.0026), IL-10(p=0.0092) and IFN- r (p=0.0188) were related to the degree of mesangial matrix expansion, and the extent of intrarenal arteriolar lesions correlated with the expression of the IL-8 gene transcript(r=03828, p=0.0033). The cellular infiltration in glomeruli was related with chemokine(IL-8) gene expression, but the relation was not significant statistically. The degree of IgA deposition in glomeruli was related with the expression of IL-6 and IL-15. The expression of intrarenal gene transcripts of various cytokines and chemokines were closely interrelated. Thl or Th2 cytokine polarization was not present in IgA nephropathy. In IHC, TNF- α, IFN- r and IL-2 were immunostained dominantly in mesangial region, but not in tubulointerstitial region. In contrast, positive reactions for IL-10 were observed mainly in tubules. The significant reactions for IL-8 were noted in the periarteriolar and arteriolar areas. The results of RT- PCR and IHC showed positive relationships, but those were not significant statistically. This study suggests that proinflammatory, Thl/ Th2 cytokines and chemokines are involved in the specific processes of inflammation and immunologic injury, and their predominance and the level of expression could determine the pathogenetic processes and the severity of the clinical manifestations in IgA nephropathy.

IgA 신병증에서 Interleukin - 6 의 신조직내 발현과 - 174 G / C 유전자 다형성의 의의

임춘수(Chun Soo Lim),김연수(Yon Su Kim),안규리(Cu Rie Ahn),한진석(Jin Suk Han),김성권(Shung Gwon Kim),이정상(Jung Sang Lee),채동완(Dong Won Chae) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.4

목 적: 염증유발 싸이토카인의 하나인 interleukin-6(IL-6)는 IgA 신병증의 병태생리와 진행에 관여하는 것으로 보인다. 저자들은 IgA 신병증에서 IL-6의 신조직내 발현 정도와 임상 및 병리학적 소견의 상관성을 분석하고, IL-6의 혈중 단백 농도에 영향을 주는 promoter 부위의 유전자 다형성(G-174C)의 빈도가 정상인과 IgA 신병증 환자간에 차이가 있는지 알아보고자 하였다. 방 법: IgA 신병증 환자 56명의 신생검 조직에서 RNA를 추출하여 역전사-중합효소연쇄반응법(RT-PCR)을 이용, 반정량적으로 IL-6의 신장내 발현 정도를 측정하였고 이를 임상 및 병리학적 소견과 비교하였다. PCR-RFLP와 PCR 산물 염기분석을 통하여 이들 환자와 53명의 정상 대조군 한국인에서의 IL-6 G-174C 유전자 다형성을 검사하였다. 결 과: RT-PCR에서 IL-6의 신장내 발현 정도는 사구체 및 세뇨관간질의 병리학적 중증도와 연관이 없었고, 신조직 검사 당시의 신기능 및 단백뇨의 정도와도 상관성이 없었다. 사구체내 IgA의 침착 정도는 IL-6의 발현 정도와 양의 상관성을 보였지만 통계학적인 유의성은 없었다. IL-6 G-174C 유전자 다형성은 IgA 신병증 환자 1명과 정상 대조군 1명만 GC heterozygote 이었고, 나머지는 모두 GG homozygote이었다(C allele 빈도=0.009). 결 론: IL-6은 IgA 신병증의 병태생리와 특별한 상관성이 없는 것으로 보이며, 한국인에서 IL-6 -174 C allele 빈도는 매우 낮아 G-174C 유전자 다형성은 한국인에서의 IgA 신병증에 대한 감수성 및 질병의 진행에 영향을 주지 않는 것으로 보인다. Background : The proinflammatory cytokine, interleukin-6(IL-6), seems to be involved in the pathogenesis and progression of IgA nephropathy. The aim of this study is to elucidate the relationship between the intrarenal expression of IL-6 and the clinicopathological findings in IgA nephropathy, and to reveal whether allele-frequency differences of -174 G/C polymorphism of IL-6 gene promoter region exist between IgA nephropathy patients and the normal population. Methods : The total RNA was extracted from renal tissue of 56 IgA nephropathy patients. Semiquantitative reverse-transcriptase polymerase chain reactions(RT-PCR) using the internal competitors were done for the quantification of IL-6 transcripts. Using PCR-RFLP, we examined the -174 G/C polymorphism in IgA nephropathy patients and in 53 of the normal Korean population. Results : In RT-PCR, the degree of intrarenal IL-6 expression was not related with any clinicopathological characteristics of IgA nephropathy patients. The degree of IgA deposition in glomeruli was correlated with the expression of IL-6, but the correlation was not statistically significant. Among the 56 IgA nephropathy patients studied, 55 carried the GG wild type and only 1 carried the GC genotype. Among 53 normal controls studied, only 1 carried the GC genotype and the rest carried GG wild type(C allele frequency=0.009). Conclusion : These results suggest that IL-6 is not related with the pathophysiology of IgA nephropathy, and the -174 G to C polymorphism of IL-6 promoter region is very rare in Koreans. And, the IL-6 polymorphism at -174 is unlikely to contribute significantly to susceptibility to or the progression of IgA nephropathy in Koreans.

임상신질환 : Megsin 2093T-2180C haplotype이 한국인의 IgA 신병증과의 관계

이하정 ( Ha Jeong Lee ),임춘수 ( Chun Soo Lim ),김선문 ( Sun Moon Kim ),오윤규 ( Yun Kyu Oh ),주권욱 ( Kwon Wook Joo ),김연수 ( Yon Su Kim ),한진석 ( Jin Suk Han ),김성권 ( Suhng Gwon Kim ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

증식성 및 비증식성 사구체신염에서 Cytokine 과 Chemokine 유전자의 발현 양상

이서진(Seo Jin Lee),김강석(Kang Suk Kim),정수환(Shou Huan Zheng),임춘수(Chun Soo Lim),윤형진(Hyung Jin Yoon),김연수(Yon Su Kim),안규리(Cu Rie Ahn),한진석(Jin Suk Han),노정우(Jung Woo Noh),채동완(Dong Wan Chae),이정상(Jung Sang Lee),김 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4

Backgroud : Intraglomerular cellular proliferation is one of the major determinants for dividing various glomerulonephritis(GN) into two groups, such as proliferative versus nonproliferative. We hypothesized that this morphological difference could be based on the differential expression of various cytokines and chemokines. To elucidate this hypothesis we quantified the intrarenal gene expression of various cytokines and chemokines, and correlated it with clinical and histological parameters. Methods: Total RNA was extracted from 54 proliferative GN(PGN) core biopsy specimens and 42 nonproliferative GN(NPGN) specirnens. Using the internal competitors RT-PCR was instituted to quantify mRNAs. Results: The magnitude of the gene expressions of IL-2, IFN- r, and IFN- r /IL-10 ratio were signi- ficantly higher in PGN. RANTES and IL-8 had more abundant gene messages in PGN than in NPGN. It was shown that Thl cytokine was upregulated if GN was mediated by immune complexes regardless of cellular proliferation. Upregulation of the IFN- r / IL-10 ratio and TNF- αwas associated with renal dysfunction at the time of renal biopsy. Conclusion Thl, proinflammatory cytokines, and chemokines were more abundant in proliferative GN, and correlated with unfavorable clinical and histologic parameters. We propose that the clinical manifestations and diverse histologic features of human GN are associated with differential expressions of specific cytokines and chemokines. A new way of blocking the actions of these cytokines should be instituted for the treatment and prevention of the progression of GN.

정상 성인에서 단백뇨의 유병율과 이환율

오지은(Ji Eun Oh),박상우(Sang Woo Park),임춘수(Chun Soo Lim),김연수(Yon Su Kim),안규리(Cu Rie Ahn),한진석(Jin Suk Han),김성권(Shung Gwon Kim),이정상(Jung Sang Lee) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.3

목 적: 일반적으로 본인이 건강하다고 알고 있는, 소위 ‘정상’ 성인에서 우연히 발견된 단백뇨의 임상적 의미를 알아보고자 하였다. 방 법: 1995년 5월 1일부터 2000년 2월 11일까지 약 5년간 서울대학교병원 건강증진센터에서 검진을 받은 성인 중 혈압약을 복용하지 않고, 공복시 혈당이 126 mg/dL 미만인 22,595명에서 실시한 집단 검진 결과를 단면적 연구로 분석하였다. 결 과 : 총 대상자 22,595명(남자 11,737명, 여자 10,858명) 중 dipstick 요검사에서‘±’이상의 단백뇨의 유병율은 남자 6.7%, 여자 3.6%였다. 단백뇨의 위험 인자에 대한 단순 연관성 분석을 시행하였을 때, 나이, 성별, 몸무게, 수축기 혈압, 이완기 혈압, 공복시 혈당, BUN, 혈청 크레아티닌, 총 콜레스테롤과 흡연 여부가 임상적으로 중요한 위험인자로 나타났다. 단백뇨와 혈압의 관계를 살펴보았을 때 dipstick 요검사에 따른 단백뇨의 정도가 증가함에 따라 수축기와 이완기 혈압이 증가하였다. Cockroft 공식에 의한 크레아티닌 청소율은 단백뇨의 정도가 증가함에 따라‘++’이상에서 유의한 감소를 나타내었다. 혈압의 정도를 제 6차 Joint National Committee의 기준으로 구분하여 혈압의 증가에 따른 단백뇨의 확률을 살펴보았을 때, 전체적으로 혈압이 증가함에 따라 단백뇨의 확률도 증가하였으며, 이러한 증가 추세는 정상 혈압과 고-정상 혈압사이, 고-정상 혈압과 1단계 고혈압사이, 2단계 고혈압과 3단계 고혈압사이에서 유의한 증가를 보였다. 혈압과 크레아티닌 청소율과의 상관관계를 살펴보았을 때, 전체적으로 혈압이 증가하면 크레아티닌 청소율이 감소하는 양상을 나타내었다. 이를 단백뇨가 있는 군과 없는 군으로 나누어 분석하였을 때, 혈압이 고-정상 혈압과 1단계 고혈압에서 단백뇨가 있는 군에서 단백뇨가 없는 군에 비해 크레아티닌 청소율의 유의한 감소를 나타내었다. 결 론: 이상에서, 소위‘정상’성인에서 우연히 발견된 단백뇨라도 일반적으로 알려진 것처럼 양성의 경과를 밟는 것만은 아니며, 유의한 혈압의 증가와 신기능의 감소를 동반할 수 있음을 시사하는 결과이다. Purpose : This study was implemented to investigate the prevalence of proteinuria and its combined morbidity in apparently normal adults. Methods : We examined the mass screening data of Health Promotion Center in Seoul National University Hospital from May 1, 1995 to February 11, 2000. The random urine samples of all screenees were examined by dipstick test. Among them 22,595 adults(men 11,737 and women 10,858) who didn`t take anti- hypertensive medication and whose fasting blood sugar <126 ㎎/dL were included in this analysis. Results : The prevalence of proteinuria was 6.7% in men and 3.6% in women. Risk factors for proteinuria by simple correlation analysis were age, sex, body weight, systolic blood pressure, diastolic blood pressure, fasting blood sugar, blood urea nitrogen, serum creatinine, total cholesterol and smoking. As the degree of proteinuria increased, the systolic and diastolic blood pressures also increased significantly and creatinine clearance significantly decreased above the‘++’level of proteinuria. Probability of proteinuria was calculated at each blood pressure level graded by JNC Ⅵ. With the increase of the level of blood pressure, the probability of proteinuria increased significantly between normal and high normal, high normal and hypertension1, and hypertension 2 and hypertension 3 level. Creatinine clearance and blood pressure level showed negative correlation. When total screenees were divided to proteinuria and no proteinuria groups, proteinuria group showed significant decrease of creatinine clearance in high normal and hypertension 1 level. Conclusion : Our results suggest that proteinuria in the apparently normal adults is not a benign condition, and it can be accompanied by significantly increased blood pressures and decreased renal function.

임상화보 : 신장결핵

오윤규 ( Yun Kyu Oh ),이창훈 ( Chang Hoon Lee ),임춘수 ( Chun Soo Lim ) 대한내과학회 2009 대한내과학회지 Vol.76 No.6

증례 : 신장 ; 변연대 B세포 림프종에 동반된 초승달사구체신염 1예

이용진 ( Yong Jin Yi ),류현진 ( Hyun Jin Ryu ),박지인 ( Ji In Park ),이정표 ( Jung Pyo Lee ),임춘수 ( Chun Soo Lim ),문경철 ( Kyung Chul Moon ),오윤규 ( Yun Kyu Oh ) 대한내과학회 2014 대한내과학회지 Vol.87 No.5

저자들은 급성 신기능 저하로 내원하여 변연대 B세포 림프종에 동반된 급속진행사구체신염이 진단되고 스테로이드 충격치료로 신장 기능이 호전된 1예를 경험하여 문헌고찰과 함께 보고하는 바이다. Secondary rapidly progressive glomerulonephritis (RPGN) can be caused by many diseases and conditions, including vasculitis, systemic rheumatic diseases, infections, drugs and malignancies. Among the secondary RPGNs, malignancy-associated RPGN is extremely rare and causes renal function deterioration within several weeks to months. Thus, timely immunosuppressant therapy can improve renal outcome. Herein, we describe a case of RPGN detected simultaneously with marginal zone B-cell lymphoma. An 82-year-old male patient, who presented generalized edema and oliguria, was diagnosed with crescentic glomerulonephritis and marginal B-cell lymphoma. After the patient was given methylprednisolone pulse therapy, renal function was restored and hemodialysis was successfully discontinued without complications. (Korean J Med 2014;87:609-614)

크롬산에 의한 피부 화상 후 발생한 급성 신손상 1예

이연희 ( Yeonhee Lee ),유연실 ( Yeonsil Yu ),안정남 ( Jung Nam An ),이정표 ( Jung Pyo Lee ),임춘수 ( Chun Soo Lim ),오윤규 ( Yun Kyu Oh ) 대한내과학회 2017 대한내과학회지 Vol.92 No.1

급성 크롬산 중독은 드물지만 다양한 경로로 흡수되어 치명적인 독성을 유발할 수 있다. 저자들은 비교적 적은 범위의 크롬산에 의한 피부 화상 후 발생한 급성 신손상을 진단하고 혈액투석을 포함한 치료로 호전된 증례를 경험하여 문헌고찰과 함께 이를 보고하는 바이다. The metal chromium is widely used in industry. Hexavalent chromium is a strong oxidizing agent, and exposure to some hexavalent compounds can cause serious problems, such as skin ulcers, acute gastroenteritis, acute tubular necrosis with renal failure, and hepatic necrosis. We report a case of acute kidney injury following skin exposure to hexavalent chromium, which burned a relatively small percentage of the total body surface area (TBSA). A 49-year-old man developed oliguria and acute kidney injury 3 days after burning about 5% of his TBSA with chromic acid solution, causing second- to third-degree chemical burns. His creatinine level increased to 12.5 mg/dL. The patient underwent hemodialysis with supportive care. His renal function improved and the dialysis was discontinued. The serum and urine chromium concentrations also decreased. (Korean J Med 2017;92:70-73)