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장규만(Kyu Man Jang),하기수(Ki Soo Ha),문현창(Hyun Chang Moon),이문철(Moon Chul Lee),유병희(Byung Hee Yu),이홍순(Hong Soon Lee),문성수(Seong Soo Moon) 대한내과학회 1988 대한내과학회지 Vol.35 No.6
N/A Plasma atrial natriuretic peptide (ANP) has been known to be a kind of peptide hormone and to have actions of natriuresis, diuresis and vasodilatation. It has been suggested that plasma ANP may be secreted from the cardiac atrium in response to extracellular fluid volume expansion to maintain blood volume homeostasis, and its level may be raised in volume overloaded conditions, such as congestive heart failure, chronic renal failure and the syndrome of inappropriate antidiuretic hormone secretion. We investigated the effect of fluid removal by sequential ultrafiltration and hemodialysis on circulating plasma ANP in 14 volume overloaded patients with chronic renal failure. The results were as follows: 1) The mean dry weight of patients was 58.3±0.4 kg and the predialytic weight gain was 3.4±0.9 kg. The amount of fluid removal by sequential ultrafilt-ration was 1176±31.7 ml (about 2% of predialytic body weight) and postdialytic weight loss was 3.1±0.3 kg. Systolic and diastolic blood pressures were not significantly changed during sequential ultrafiltration and hemodialysis, Plasma osmolality, BUN and K+ levels were not significantly changed after ultrafiltration but were significantly decreased after hemodialysis. 2) Plasma ANP levels were raised in all patients (mean±SE 205.3±30.7pg/ml, n=l4) compared with healthy contro1s (40.9±4.4 pg/ml, n=16), but showed considerable interpatient variability. 3) Plasma ANP levels fell with fluid removal during ultrafiltration (123.4±4.2 pg/ml, p<0.025) and again as fluid was removed during hemodialysis (88.7±3.1 pg/ml, p<0.05). 4) There was no significant correlation between predialytic weight gain and plasma ANP levels, and between postdialytic weight loss and plasma ANP levels. In conclusion, this study showed that the plasma ANP level was raised as body fluid volume increased in patients with chronic renal failure and fell with fluid removal after dialysis. These findings suggest that changes in body fluid volume play an important role in the regulation of ANP secretion.
급성 신부전이 합병된 진통제성 신증(Analgesic Nephropathy) 1 예
김지윤,강신주,이현순,문성수,유병희,하기수,문언수 대한내과학회 1990 대한내과학회지 Vol.39 No.5
Analgesic nephropathy is a form of chronic renal disease characterized by renal papillary necrosis and chronic interstitial nephritis(100%), uroepithelial tumors (8%), and atheromatous renal artery stenosis (4%) due to prolonged and excessive consumption of analgesic mixtures. We experienced a case of analgesic nephropathy complicated with acute renal failure in a 52-year-old woman who ingested analgesics for 30 years (aspirin and Saridonⓡ) due to headaches during menstrual period (total cummulative dose:1.25kg). Laboratory findings showed non-oliguric acute renal failure with sterile pyuria and proteinuria. Renal biopsy showed typical findings of chronic interstitial nephritis of analgesic nephropathy. In this cases of analgesic nephropathy, we considered that acute renal failure was complicated by the continuous administration of certain nonsteroidal anti-inflammatory drugs taken for persistent headaches during the last six weeks. It was speculated that enhanced renal vasoconstriction induced by nonsteroidal anti-inflammatory drugs may play a role in the development of acute renal failure.