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고음이온차 대사성산증에서 요 삼투질농도차와 요증 암모늄 배설의 상관성 ; 요 음이온차와 비교
정용영(Yong Young Jung),한성우(Sung Woo Han),박민숙(Min Sook Park),김권수(Gwan Soo Kim),김근호(Gheun Ho Kim),조윤숙(Yoon Sook Cho),주권욱(Kwon Wook Joo),한진석(Jin Suk Han),김성권(Suhng Gwon Kim),이정상(Jung Sang Lee) 대한내과학회 1997 대한내과학회지 Vol.53 No.1
N/A Objectives: Urine anion gap(UAG) and urine osmolal gap(UOG) were proposed as indirect measures of urine ammonium(NF4+). While the former is known to have its usefulness limited to hyperchloremic metabolic acidosis, the latter is reported to have its correlation with urine NE4+ in ketoacidosis. This study was undertaken to evaluate the correlation of urine NH with IJOG in high anion gap metabolic acidosis(AGMA) and to compare it with UAG. Methods: We measured urine NH' by enzymatic determination, UOG(=0.5×[urine osmolality-{2×(Na++K+)+urea+glucose)]), and UAG(=Na++K+-Cl-) in 18 patients(serum AG=24.4±1.6mmol/L ) with AGMA. Results: When they were grouped into those with acute disorders(n=11) and those with chronic disorder(n=7), urine Nk4+ concentration was higher (p<0.05) in the acute(35.6±7.7mmol/L) than in the chronic(3.8±0.9mmol/L) group. The UOG was higher (p<0.05) in the acute(73.2±18.9mmol/L) than in the chronic(6.3±8.7mmol/L) group, but the UAG had no difference between the two groups. When both groups of the patients were considered together, urine NH concentration correlated with the UOG (r=0.90, p<0.01), but not with the UAG. While the patients with lower urine NH4+ excretion(<30mmol/d) had the UOG<40mmol/L, those with higher urine NH' excretion(>40mmol/d) had the UOG>40mmol/L. Conclusion: In contrast to the UAG, the UOG has a significant correlation with urine NH4+ in AGMA.
김동규,박성우,김학양,배수동,임성희,임인서,정용영 대한내과학회 1996 대한내과학회지 Vol.50 No.5
Pure virilizing adrenocortical tumor in adult female is a rare disorder. We report a case of pure androgen-producing adrenocortical tumor in a 29-year-old woman who was evaluated for hirsutism and secondary amenorrhea for 18months. Her serum testosterone (4.47 ng/mL) and DHEA-S($gt;1,000㎍/ dL) levels and 24-hour-urine 17-KS excretion (84.1mg/day) were remarkblyhigh and were not suppressed by low-dose dexamethasone. Her serum cortisol level and 24-hour-urine free cortisol excretion were normal and decreased after low-dose dexamethasone administration. Abdomen CT revealed an 11 cm-sized mass with central necrosis in the right adrenal gland, On MRI, the lesion had high signal intensity on T₂-weighted image. A right adrenalectomy was performed. The tumor weighed 410gm and was 13×12×4 cm in size. The histologic examination revealed nuclear pleomorphism and high mitotic index in tumor cells without capsular invasion. Her serum testosterone and DHEA-S levels and 24-hour-urine 17-KS excretion assessed 1week after the operation were normal. The hirsutism had disappeared gradually and menstruation was observed 2 months after operation. She has been followed-up for 38 months since the operation and is at present healthy without evidence of tumor recurrence or distant metastasis.
혈액투석중인 말기신질환 환자에서 후천성낭성신질환으로부터 자연발생한 피막하 및 신주위 혈종 1 예
최철순,채동완,김근호,전노원,고종훈,정용영 대한내과학회 1995 대한내과학회지 Vol.49 No.6
Spontaneous renal subcapsular or perinephric hematoma in the patients undergoing hemodialysis is a very uncommon condition that is attributed to acquired cystic kidney disease. We report on a patient undergoing hemodialysis due to endstage renal disease who developed right spontaneous subcapsular and perinephric hematoma assoeiated with acquired cystic kidney disease. Diagnosis was ascertained by computed tomography and selective angiography. The patient was recovered by conservative treatment. This article is one of the scanty records of clinically important renal hemorrhage relieved by conservative management in a patient with welldocumented acquired cystic kidney disease. It should be concerned about renal hemorrhage when the patients undergoing chronic hemodialysis present severe flank pain of sudden onset, hypotension, and decreasing hematocrit.
간경변증 환자의 나트륨대사에 있어서 혈장 Renin 및 교감신경활동도의 역할
이진(Jin Lee),최용석(Young Suk Choi),강승식(Seung Sik Kang),정용영(Yong Young Jung),윤석부(Seok Boo Yoon),계세협(Sea Hyub Kae),곽상택(Sang Taek Kwak),주상언(Sang Aun Joo),김호중(Ho Jung Kim),기춘석(Choon Suhk Kee) 대한내과학회 1995 대한내과학회지 Vol.49 No.1
N/A Objectives: We studied to determine the changes of sodium metabolism and to evaluate the role of plasma renin and sympathetic activities in liver cirrhosis with hyponatremia. Methods: We performed measurement of serum sodium, serum albumin and other blood biochemistries, creatinine and creatinine clearance, daily urinary sodium excretion, plasma renin and aldosterone, and plasma norephinephrine level for sympathetic activity in 24 cirrhotic patients with (n;8) and without ascites(n; 16) on day 1 after admisson. We checked body weight, serum sodium and creatinine clearance again on day 10 after admission. Results: 1) The serum sodium level of the ascitic group was lower than that of the non-ascitic group(136±1.0 vs. 138±2.4 mEq/L, p<0.01). There were also significant lower values of serum albumin, creatinine clearance and 24hr urinary sodium excreation in the ascitic group as compared with non-ascitic group. 2) The plasma renin activity and norepinephrine level of the ascitic group were higher than that of the non-ascitic group(renin=3.8±1.1 vs. 557±50 pg/ mL, p<0.05). 3) On day 10 after admission, the serum sodium concentration was decreased more prominently to 132±2.6 mEq/L along with significant reduction of body weight and creatinine clearance in the ascitic group, whereas there was no change of serum sodium level in the non-ascitic group, 4) In total 24 patients, a significant positive correlation between serum sodium and albumin concentration(R=0.6, p=0.004) as well as a significant negative correlation between serum sodium concentration and plasma renin activity(R=0.7, p=0.001). Conclusion: These results suggest that changes of serum sodium concentration in cirrhotic pathents correlate closely with changes of renal function related to the presence or absence of ascites, serum albumin level, changes of body weight, increased plasma renin activity and sympathetic activity, and with alteration of sodium and water delivery to the diluting segment of renal tubules.
허우성,김연수,김성권,한진석,이정상,김근호,조윤숙,안규리,오지은,전은실,정용영 대한신장학회 1996 Kidney Research and Clinical Practice Vol.15 No.3
The plasma anion gap have several pitfalls in differential diagnosis of metabolic acidosis, New classification of metabolic acidosis based on the pathophysiologic mechanism was proposed. And urine Ph, urine anion gap and urine osmolal gap were suggested as the indirect indices of urinary ammonium excretion. But, clinical usefulness of these indices for differential diagnosis of metabolic acidosis have not been clarified. We purposed to verify clinical usefulness of various indices of metabolic acidosis in differential diagnosis of metabolic acidosis based on the pathophysiologic classification. Four diabetic ketoacidosis and seven lactic acidosis patients were included as acid overproduction group, four distal renal tubular acidosis and seventeen chronic renal failure patients were included as acid underexcretion group, and eight normal adults with acid (ammonium chloride) loaded included as control group. 1) Plasma bicarbonate was not different between acid overproduction group (13.2?1.6mmol/L) (mean standard error) and acid underexcretion group (14.6 0.7mmol/L). Phsma bicarbonate in control group was 19.6?0.6mmol/L. 2) Plasma anion gap in acid overproduction group (25.9?2.2mmol/L) was higher than in acid under excretion group (11.9±1.2mmol/L) and control group (13.5±0.6mmol/L) (p$lt;0.05). 3) △AG /△HCO₃^- was higher in acid overproduction group (1.5?0.3) than in acid underexcretion group (-0.1±0.1) and control group (0.30.2) (p$lt;0.05). There was no difference within acid over- production group (diabetic ketoacidosis: 1.20.1 and lactic acidosis -1.7±0.4). 4) Urinary ammonium excretion in acid underexcretion group (13.81.9mmoVday) was higher than in acid overproduction group (82.216.7mmoV day) and control group (52.6±3.7mmol/day)(p$lt;0.05). 5) Urine anion gap was not different between acid overproduction group (39.8±15.3mmol/L) and acid underexcretion group (37.4±3.3mmol/L) But, control group had lower urine anion gap(-16.2±5.5mmol/L) than the other two groups. 6) The fractional excretion of unmeasured anion in acid underexcretion group (37.9±4.0%) was higher than in acid overproduction group (4.6±2.0%) and control group (-1.0±0.4%)(p$lt;0.05). The cut-off value of fractional excretion of unmeaseured anion to differentiate the acid overproduction group from the acid underexcretion group was 10%. In conclusion, plasma anion gap, △AG /△HCO₃^- and fractonal excretion of unmeasured anion were useful to differentiate metabolic acidosis based on the pathophysiologic classification,