사례보고 : 백선 복용 후 발생한 독성 간손상 4예

장종순 ( Jong Soon Jang ),서의근 ( Eui Geun Seo ),한철 ( Cheol Han ),채희복 ( Hee Bok Chae ),김순제 ( Soon Je Kim ),이재동 ( Jae Dong Lee ),왕준호 ( Joon Ho Wang ) 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.2

급성 신손상의 감별진단에 있어서 요산 및 요소 분획 배설율의 임상적 유용성

장종순 ( Jong Soon Jang ),김희성 ( Hee Sung Kim ),이신영 ( Shin Young Lee ),이승호 ( Seung Ho Lee ),김승준 ( Seung Jung Kim ),권순길 ( Soon Kil Kwon ),김혜영 ( Hye Young Kim ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.3

목적: 소디움 분획 배설율은 급성 신손상의 감별에 널리 사용되고 있지만, 이뇨제나 식염수를 투여한 후에 측정하면 변화할 수 있으므로 임상적 적용에 제한점을 가지고 있다. 요산 및 요소 분획 배설율은 이뇨제에도 영향을 받지 않아 급성 신손상의 감별에 유용할 것으로 기대되고 있다. 본 연구는 급성 신손상의 감별에 있어서 요산 및 요소 분획 배설율의 유용성을 확인하고자 하였다. 방법: 급성 신손상 환자 70명을 대상으로 하였으며, 신전성 급성 신손상 (PR, n=40)은 체액량 교정 후 3일 이내에 혈청 크레아티닌 수치가 기저치 이하로 호전되어 7일 이내에 정상화 되는 경우로 정하였다. 소디움 분획 배설율과 요산 및 요소 분획 배설율을 진단 당시, 1일 후, 2일 후에 연속적으로 산출하였다. 결과: 요산 분획 배설율은 신전성 급성 신손상군에서 급성 세뇨관 괴사군에 비하여 유의하게 낮았으며 (PR 13.9±8.7% vs. ATN 33.2±27.0%, p<0.05), 요소 분획 배설율도 신전성 급성 신손상군에서 급성 세뇨관 괴사군에 비하여 유의하게 낮았다 (PR 32.1±18.9% vs. ATN 50.6±41.3%, p<0.05). 신전성 급성 신손상을 진단하는 소디움 분획 배설율의 한계치를 1% 이하로 하였을 때 민감도는 51.4%, 특이도는 96.4%이었다. 요산 분획 배설율은 한계치 15%을 기준으로 하면 민감도 57.8%, 특이도 86.0%이었으며, 요소 분획 배설율은 한계치 35%을 기준으로 하였을 때 민감도 52.6%, 특이도 60.7% 이었다. 급성 신손상의 감별 진단에 세 진단 지표를 병합하여 사용할 경우, 민감도는 84%, 특이도는 100%로 지표를 단독으로 사용할 때에 비하여 민감도와 특이도가 증가하는 결과를 보였다. 소디움 분획 배설율 1%이하 신전성 급성 신손상군에서 진단 당일, 치료 후 1일, 2일에 소디움 분획 배설율은 유의하게 증가하였으나 (0.4±0.1% vs. 1.2±0.3% vs. 1.5±0.4%, p<0.05), 요산 분획 배설율과 요소 분획 배설율은 통계적으로 유의한 차이가 없었다. 결론: 요산 및 요소 분획 배설율은 신전성 급성 신손상과 급성 세뇨관 괴사를 감별할 수 있으며, 소디움 분획 배설율과 병합하여 사용할 경우 민감도와 특이도를 높일 수 있으므로 급성 신손상의 감별진단에 유용할 것으로 생각된다. 진단시점에 수액 치료가 시작된 급성 신손상의 감별에 있어서 요산 및 요소 분획 배설율을 병용하는 것은 급성 신손상의 감별에 도움이 될 수 있을 것으로 생각된다. Purpose: Fractional excretion of sodium (FE(Na)) has been used in the differentiation of acute kidney injury (AKI) into traditional categories of prerenal azotemia (PR) and acute tubular necrosis (ATN). However, many patients with PR have already received diuretics or saline at the time of diagnosis, which increase FE(Na). In contrast, the fractional excretion of uric acid (FE(UA)) and urea (FE(UN)) is less influenced by diuretics. We investigated the diagnostic significance of the FEUA and FEUN in differentiating between PR and ATN. Methods:The FENa, FEUA, and FEUN were calculated in 40 patients with PR and 30 patients with ATN at day 0 (D0), day 1 (D1) and day 2 (D2), sequentially. Results: FEUA (PR 13.9±8.7% vs. ATN 33.2±27.0%, p<0.05) and FEUN (PR 32.1±18.9% vs. ATN 50.6±41.3%, p<0.05) were lower in PR than in ATN patients. At the cut-off value of 1% FE(Na), sensitivity and specificity for the detection of PR was 51.4% and 96.4%, respectively. When FE(Na), FE(UA) and FE(UN) were combined, sensitivity and specificity was 84% and100%, respectively. In the PR with FE(Na) less than 1%, FE(Na) significantly increased after treatment (D0 0.4±0.1% vs. D1 1.2±0.3% vs. D2 1.5±0.4 %, p<0.05), but FE(UA) and FE(UN) did not changed after treatment. Conclusion: FE(UA) and FEUN may be useful in differentiating between PR and ATN. The combination of FE(Na), FE(UA) and FE(UN) might increase diagnostic sensitivity and specificity in the differential diagnosis of AKI.

신경이완제 악성 증후군에 동반된 급성신부전 1예

장종순 ( Jong Soon Jang ),권순길 ( Soon Kil Kwon ),김혜영 ( Hye Young Kim ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

말기 신부전 환자에서 Acyclovir 사용 후 발생한 급성 뇌병증 2예

이승호 ( Seung Ho Lee ),장종순 ( Jong Soon Jang ),이신영 ( Shin Young Lee ),조영심 ( Young Shim Cho ),주혜진 ( Hye Jin Joo ),권순길 ( Soon Kil Kwon ),김혜영 ( Hye Young Kim ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.6

Acyclovir is an anti-viral nucleoside analogue that was discovered in 1972. Since it was put to use in clinical practice, some adverse events had been reported. Renal dysfunction and disturbance of central nervous system are the two major adverse effects. A 60-year-old man who was being treated with peritoneal dialysis was admitted for sudden onset of sensory-neural hearing loss. A 67-year-old man who was being treated with hemodialysis was also admitted for Bell`s palsy. After two days of treatment with intravenous acyclovir and oral prednisolone, they had hallucinations, myoclonus, disoriented mentality and agitation. Furthermore, the latter had stupor. We did some laboratory examination, brain MRI and electroencephalography (EEG), but there was no cause for neurologic abnormality. In the clinical suspicion of acyclovir neurotoxicity, we discontinued acyclovir and went on dialysis therapy. They fully recovered after several days. Our cases further reinforces the claim that the dose of acyclovir should be reduced in patients with renal failure and dialysis is a good form of treatment for overdosage.

증례 : 신장 ; 하대정맥과 양쪽 신정맥의 혈전으로 발견된 루푸스 신염 1예

이승호 ( Seung Ho Lee ),장종순 ( Jong Soon Jang ),이신영 ( Shin Young Lee ),권순길 ( Soon Kil Kwon ),김혜영 ( Hye Young Kim ),류동희 ( Dong Hee Ryu ) 대한내과학회 2010 대한내과학회지 Vol.78 No.1

전신홍반루푸스는 신증후군과 관련하여 또한 질환 자체에 의해서도 혈액응고 이상을 초래하여 혈전증이 발생할 수 있다. 저자들은 측복부 동통으로 내원한 평소 건강하였던 21세 여자 환자에게 여러 가지 검사를 통하여 루푸스 신염에 의한 신증후군 및 양측 신정맥과 하대정맥의 대량의 혈전증을 진단하고 항 응고치료 및 하대정맥 필터를 사용하여 치료하였기에 문헌고찰과 함께 보고하는 바이다. Renal vein and inferior vena cava thrombosis are possible complications of nephrotic syndrome related to either primary glomerulonephritis or glomerulonephritis associated with systemic disease. However, renal vein and inferior vena cava thrombosis associated with systemic lupus erythematosus are rare. We experienced a case of bilateral renal vein and inferior vena cava thrombosis associated with systemic lupus erythematosus. A previously healthy 21-year-old female developed sudden flank pain without edema. Abdominal computed tomography (CT) showed bilateral renal vein and inferior vena cava thrombosis. She was diagnosed with systemic lupus erythematosus with nephrotic syndrome based on the clinical manifestations and laboratory findings. After anticoagulation therapy with heparin and insertion of an inferior vena cava filter, the thrombus improved markedly. There is a possibility of renal vein and inferior vena cava thrombosis in the clinical course of nephrotic syndrome caused by lupus nephritis. (Korean J Med 78:122-126, 2010)

증례 : 알레르기 ; 에리트로마이신에 의한 아나필락시스 1예

박재근 ( Jae Geun Park ),서의근 ( Eui Keun Seo ),조영심 ( Young Shim Cho ),장종순 ( Jong Soon Jang ),주혜진 ( Hye Jin Joo ),이승호 ( Seung Ho Lee ),김미경 ( Mi Kyeong Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.5

내원 21년 전 목에 있는 농양을 제거하기 위해 수술을 받았을 당시 에리트로마이신에 노출되었고, 내원 13년 전 편도염 치료를 위해 에리트로마이신 정맥투여를 하던 중 현기증과 가슴답답함, 천명과 저혈압을 경험한 환자에게 에리트로 마이신에 함유된 부용제와 보존제로 피부검사를 시행하여 피내검사에서 에리트로마이신 자체에만 강양성 반응을 나타내었으며 동시에 어지러움, 가슴답답함, 전신 소양감과 머리로 뻗치는 열감 등의 증상과 두드러기 및 천명이 나타났으며, 효소면역법으로 혈청 내 에리트로마이신 특이 IgE 항체를 확인하여 에리트로마이신 자체에 의한 제1형 과민반응인 아나필락시스임을 확인하였다. 동일 계열인 스피라마이신으로 시행한 피내 반응검사에서 양성 소견을 보여 두 항생제간의 교차항원성을 확인하였다. Macrolides antibiotics synthesized by Streptomyces strains are prescribed widely and seldom produce hypersensitivity reactions, even when administered topically. Consequently, they are considered very safe drugs. We report the case of a 32-year-old woman who developed anaphylactic shock after ingesting erythromycin, which she had taken twice before. The previous exposure to erythromycin, clinical findings, and a positive skin intradermal test with erythromycin (10 mg/mL) support the postulate that anaphylaxis was induced by erythromycin. (Korean J Med 78:660-663, 2010)

간흡충으로 인한 총담관의 양성 협착과 감별이 어려운악성 협착

김현 ( Hyun Kim ),한정호 ( Joung Ho Han ),박선미 ( Seon Mee Park ),김정태 ( Jeong Tae Kim ),장종순 ( Jong Soon Jang ),이희승 ( Hee Seung Lee ),이승호 ( Seung Ho Lee ),연명호 ( Myeong Ho Yeon ) 대한췌장담도학회 2015 대한췌담도학회지 Vol.20 No.1

Accurate and early diagnosis of indeterminate bile duct stricture is difficult. There are numerous cases suggesting similarity between benign tumors and malignancy. Therefore, meticulous evaluation with endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound and computed tomography (CT) is necessary. A 50 year-old male presented with painless jaundice. Abdominal CT scan showed distal biliary stricture without definite pancreatic mass. Repeated brush cytology and endobiliary biopsy during ERCP did not reveal malignancy except for eggs of Clonorchis sinensis. The patient declined surgical resection without definite evidence of malignancy. Abdominal CT scan one month later showed progressive parenchymal atrophy and pancreatic duct dilatation. The patient underwent pylorus preserving pancreatoduodenectomy. Pathology revealed pancreatic adenocarcinoma in the head portion. Since accurate preoperative diagnosis of malignant biliary obstruction can be evasive, patients with biliary stricture should undergo evaluation with high index of suspicion.

위장관 ; 혈류가 유지된 채 분리된 흰 쥐 결장에 대한 Urocortin 1의 영향

유일영 ( Il Young You ),이승호 ( Seung Ho Lee ),김기배 ( Ki Bae Kim ),이희승 ( Hee Seung Lee ),장종순 ( Jong Soon Jang ),연명호 ( Myeong Ho Yeon ),한정호 ( Joung Ho Han ),윤순만 ( Soon Man Yoon ),채희복 ( Hee Bok Chae ),박선미 ( S 대한소화기학회 2015 대한소화기학회지 Vol.65 No.5

Background/Aims: Urocortin 1, a corticotropin-releasing factor related peptide, increases colonic motility under stressful conditions. We investigated the effect of urocortin 1 on colonic motility using an experimental model with isolated rat colon in which the blood flow and intestinal nerves were preserved. Furthermore, we assessed whether this effect was mediated by adrenergic or cholinergic nerves. Methods: Colonic motility was measured in the proximal and distal parts of resected rat colon. The colon resected from the peritoneum was stabilized, and then urocortin 1 (13.8, 138, 277, and 1,388 pM) was administered via a blood vessel. Motility index was measured in the last 5 min of the 15 min administration of urocortin 1 and expressed as percentage change from baseline. Subsequently, the change in motility was measured by perfusing urocortin 1 in colons pretreated with phentolamine, propranolol, hexamethonium, atropine, or tetrodotoxin. Results: At concentrations of 13.8, 138, 277, and 1,388 pM, urocortin 1 increased the motility of proximal colon (20.4±7.2%, 48.4±20.9%, 67.0±25.8%, and 64.2±20.9%, respectively) and the motility of distal colon (3.3±3.3%, 7.8±7.8%, 71.1±28.6%, and 87.4±32.5%, respectively). The motility induced by urocortin 1 was significantly decreased by atropine to 2.4 2.4% in proximal colon and 3.4±3.4% in distal colon (p<0.05). However, tetrodotoxin, propranolol, phentolamine, and hexamethonium did not inhibit motility. Conclusions: Urocortin 1 increased colonic motility and it is considered that this effect was directly mediated by local muscarinic cholinergic receptors. (Korean J Gastroenterol 2015;65:283-290)