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정해혁 대한신장학회 2022 Kidney Research and Clinical Practice Vol.41 No.5
Background: Certain pharmacotherapies have shown to be effective for both cardiac and kidney outcomes. Although risk prediction is important in treatment decision-making, few studies have evaluated prediction models for composite cardiovascular and kidney outcomes. Methods: This study included 2,195,341 Korean adults from a nationwide cohort for chronic kidney disease and a representative sample of the general population, with a 9-year follow-up. This study evaluated prediction models for a composite of major cardiovascular events or kidney disease progression that included albuminuria and estimated glomerular filtration rate (eGFR) and/or traditional cardiovascular disease predictors. Results: The addition of albuminuria and eGFR to a model for the composite outcome that included age, sex, and traditional predictors increased a C statistic by 0.0459, while the addition of traditional predictors to age, sex, albuminuria, and eGFR increased a C statistic by 0.0157. When age and sex-adjusted incidence rates were calculated across the combined Pooled-Cohort-Equations (PCEs) and Kidney Disease: Improving Global Outcomes (KDIGO) risk categories in diabetic or hypertensive participants, the incidence of ≥10 per 1,000 person-years was observed among all categories with high or very high KDIGO risk and among categories with moderate (or low) KDIGO risk and a PCEs 10-year risk of ≥10% (or ≥20%), accounting for 36% of diabetic and 18% of hypertensive populations. Conclusion: This study strongly supports the utility of the KDIGO risk matrix combined with a conventional cardiovascular risk score for the prediction of composite cardiovascular and kidney outcome and provides epidemiologic data relevant to the development of efficient treatment strategies.
Transforming Growth Factor-β1이 복막증피세포의 Vascular Cell Adhesion Molecule-1 발현에 미치는 영향
정해혁 ( Hae Hyuk Jung ),양원석 ( Won Seok Yang ),김순배 ( Soon Bae Kim ),김병식 ( Byung Sik Kim ),박수길 ( Su Kil Park ),박정식 ( Jung Sik Park ) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.6
배 경 :복막염이 발생하면 다형핵백혈구 외에도 대식세포와 같은 단핵구가 복강내로 급속히 유입되어 염종반응의 진행에 중요한 역할을 한다. 단핵구의 유입에는 복막중피세포의 vascular cell adhesion melecyle-1 (VCAM-1) 발현이 관여할 것으로알려져 있다. 본 연구에서는 tumor necrosis factor-α (TNF-α)와 interleukin-1β (IL-β1)의 작용을 알아보고자 하였다. 방 법 : 사람의 장간막에서 복막중피세포를 분리, 배양하였다. VCAM-1 mRNA 양은 northern blot assay로 측정하였다. 세포내 VCAM-1 단백질 양과 세포 표면의 VCAM-1 단백질 발현은 각각 western blot 과 cellular ELISA로 비교하였다. 결 과 : 복막중피세포를 TNF-α(10 ng/mL), IL-1β (1 ng/mL)로 자극하였을 때 VCAM-1 mRNA 양이 증가하였고, TGF-β1 (0.1, 1, 10 ng/mL)은 TNF-α, IL-1β 자극에 의한 VCAM-1 mRNA 양 증가를 억제하였다. TGF-β1 (10 ng/mL)은 자극을 하지 않은 상태의 복막중피세포에서도 VCAM-1 mRNA 양을 감소시켰다. Total cell lystate에서 western blot으로 측정한 VCAM-1 단백질 양이나, cellular ELISA로 측정한 세로 표면의 VCAM-1 단백질 발현도 TNF-α와 IL-1β에 의해 증가하였으나, TGF-1β은 그 증가를 억제하였다. 자극을 하지 않은 상태의 복막중피세포의 VCAM-1 단백질 양이나 발현도 TGF-β1에 의해 억제되었다. TNF-α나 IL-1β로 자극한 세포에서 actinomycin D 처리 후 mRNA aid을 시간별로 측정하여 비교한 VCAM-1 mRNA 분해 속도는 TGF-β1 투여에 의해 영향을 받지 않았다. 결 론 : TGF-β1은 복막중피세포에 작용하여 TNF-α와 IL-1β 자극에 의한 VCAM-1 mRNA 양 및 단백질 생성 및 발현 증가를 억제하였고, 이는 VCAM-1 mRNA 생성을 억제함으로써 작용할 것으로 생각된다. Background : In early phase of peritonitis, mononuclear cells as well as polymorphonuclear leukocytes migrate rapidly into peritoneal cavity. For the migration of mononuclear cells, the expression of VCAM-1 on peritoneal mesothelial cells is important. In this study, we investigated the effect of TGF-β1 on tumor necroses factor-α (TNF-α) or interleukin-1β(IL-1β) induced VCAM-1 expression in the cultured HPMCs, Methods :HPMCs were cultured in the presence of TNF-α, IL-1β and/or TGF-β1. VCAM-1 mRNA level was measured by Northern blot. VCAM-1 in total cell lysate and VCAM-1 expressed on cell surface were measured by Western blot and cellular FLISA, respectively. Results : Incubation of the cultured HPMCs with TNF-α (10 ng/mL) or IL-1β (1 ng/mL) caused an increased level of VCAM-1 mRNA, VCAM-l. protein in total cell lysate, and VCAM-1 expressed on cell surface. This stimulatory effects of TNF-α or IL-1β were inhibited by TGF-β1 (0.1, 1, 10 ng/mL), dose-dependently. The level of VCAM-1 mRNA, VCAM-1 protein in total cell lysate, and VCAM-1 expressed on cell surface in the unstimulated cells were also inhibited by TGF-βI (10 ng/mL). The rate of VCAM-1 mRNA degradation after an application of actinomycin D was not affected by TGF-β1 Conclusion : TGF-β1 inhibited inflammatory cytokine induced VCAM-1 production and expression in the cultured HPMCs. Treatment of the cells with TGF-β1 seems to suppress TNF-α or IL-1β induced VCAM-1 mRNA transcription rather than decrease stabilization of VCAM-1 mRNA.
정해혁(Hae Hyuk Jung),김경조(Kyung Jo Kim),장재원(Jae Won Jang),서장원(Jang Won Seo),김형호(Hyeong Ho Kim),양원석(Won Seok Yang),박정식(Jung Sik Park),한덕종(Duck Jong Han),문대혁(Dae Hyuk Moon) 대한내과학회 1996 대한내과학회지 Vol.50 No.4
N/A Objectives : The GFR of transplanted kidney has been studied in human, which has been reported to be around 50% to 70% of the donor total GFR before nephrectomy. The magnitude of hyperfiltration in the transplanted kidney is 0% to 40% on the assumption that each donor kidney functions 50% of the total GFR. These studies, however, did not take the relative function of the donated kidney into consideration. This study was performed to evaluate the magnitude of hyperfiltration in the transplanted kidney by measuring the GFR of the donated kidney before nephrectomy, and to determine factors that affect the GFR of the transplanted kidney. Methods The author measured GFR using 51Cr-EDTA clearance (CEDTA) and creatinine clearance (Ccr) in 70 donors of llving related renal transplantation performed in Asan Medical Center from December 1992 to January 1994. With relative kidney function measured by DMSA scan, the auther calculated the GFR of the donated kidney before nephrectomy(D'CEDTA and D'Ccr, respectively). When renal function was stable, usually 3 months after transplantation, the author repeated CEDTA and Ccr(R'CEDTA and R'Ccr, respectively) in 61 recipients. Nine patients were excluded because they did not maintain stable renal function within 2 months of transplantation. Results: The relative renal function of the donated kidney ranged 33 to 56% (mean 49%) The GFR of donated kidney before nephrectomy (D'CEDTA and DCcr) ranged 39 to 85m1/min(mean 59) and 26 to 80ml/min(mean 49), respectively. As expected, there was a close correlation between R'CEDTA and D'CEDTA with RCEDTA=0.72×D'CEDTA+26ml/min (r=0.59, p<0.01) and the geometric mean of R'CEDTA/DCEDTA was 115% (n=47). There was a significant correlation between R'Ccr and O'Ccr with R'Ccr=0.43×D'Ccr+48mVmin (r=0.44, p<0,01) and the mean of R'Ccr/D'Ccr was 140Fo(n=43). D'CEDTA (p<0.01) and the donor age(p=0.02) related independently with R'CEDTA on multiple regression analysis(n=47). Conclusion: With these results, we conclude that: 1) The relative function of the donated kidney was distributed in a wide range. 2) Transplanted kidney functions at 15 to 40N above the prenephrectomy level in about 3 months after transplantation. 3) The GFR of the donated kidney before nephrectomy and the donor age affect the GFR of the transplanted kidney.