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임춘수 대한의사협회 2012 대한의사협회지 Vol.55 No.4
Chronic kidney disease (CKD) is a broad term for diverse disorders affecting renal structure and function. The worldwide increase in the number of patients with CKD and consequent end-stage renal disease (ESRD) requiring renal replacement therapy is threatening to reach a global epidemic level. The economic burden is difficult to deal for both family and society. A change in the global approach to CKD from treatment of ESRD to much more aggressive primary and secondary prevention is therefore imperative. CKD can be detected with routine laboratory tests, and some treatments can prevent its development and slow disease progression, reduce complications of decreased glomerular filtration rate and risk of cardiovascular diseases, and improve survival and quality of life. In this article, I review the practical methods-including blood pressure control, anemia correction, management of mineral and bone disorders related with CKD-for the prevention of or slowing the progression of CKD. I also describe several essential drugs that are used frequently to treat the common complications of CKD.
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.