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박종욱(Jong Wook Park),백윤웅(Yun Woong Paek),염충호(Chung Ho Yeum),나명윤(Myong Yun Nah),김수완(Soo Wan Kim) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1
N/A Background: Although being associated with an elevated plasma atrial natriuretic peptide(ANP), its precise role in the postobstructive diuresis has not been fully under- stood. Evidence has been provided suggesting that the locally-synthesized ANP in the kidney contributes to the regulation of urinary sodium excretion. The present study was aimed to investigate whether an altered regulation of local ANP system is involved in the postobstructive diuresis. Methods: Male Sprague-Dawley rats were used. Both proximal ureters were ligated for 48 hours, after which the kidneys were taken without releasing the ligature, being designated as bilateral ureteral obstruction(BUO) group; or the ligature was released and 4 or 24 hr later, urinary data were collected, being designated as BUR-4 or BUR-24, respectively. Sham operated rats were used as control. Plasma ANP levels were determined by radioimmunoassay. The expression of ANP and natriuretic peptide receptor(NPR)-A mRNAs was determined by reverse transcription-polymerase chain reaction(RT-PCR). To further examine whether the altered renal ANP system, if any, was associated with an altered biological effects of guanylyl cyclase, ANP- stimulated cGMP accumulation was determined in membrane preparations of the glomeruli and papillae by radioimmunoassay. Results: The plasma ANP level was increased in BUO group compared with that in the control(260.5±32.5 vs. 133.3±23.5pg/mL, p<0.05), decreased in BUR-4 group(3.6±0.5 vs. 143.5±42.8pg/mL, p<0.01), while not significantly different in BUR-24 group. In BUR- 4. the urinary flow rate increased compared with that in the control(1598±370 vs. 215<34 DμL/hr, p<0.01), along with increases of FENa(11.5±64.1 vs. 0.25±0.02%, p<0.05) and UNaV (153.7±23.7 vs. 36.5±9.3 μEq/hr, p<0.01). In BUR-24, the urinary parameters were normalized. Renal tissue expression of ANP mRNA was increased in BUO as well as in BUR-4, while not changed in BUR-24. NPR-A mRNA expression was decreased in the kidney of BUO. The ANP-stimulated accumulation of cGMP in the isolated glomeruli and papillae in BUO was significantly reduced. The guanylyl cyclase activities were partly recovered in BUR-4 and completely in BUR-24. Conclusion : An enhanced local activity of ANP in the kidney may be causally related to the postobstructive diuresis.
FK506 처리 흰쥐에서 신장 및 혈관 조직 산화질소 함량 감소
정권(Kwon Jung),김수완(Soo Wan Kim),이종은(Jong Un Lee),백윤웅(Yun Woong Paek),염충호(Chung Ho Yeum),나명윤(Myong Yun Nah),김남호(Nam Ho Kim),강종명(Chong Myung Kang),최기철(Ki Chul Choi) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1
N/A The present study was aimed at investigating whether FK506 alters the regulation of nitric oxide(NO) system. Male Sprague-Dawley rats were treated with FK506(1 mg/kg/day, i.m.) for 3 weeks. Control group was without treatment of FK506. Plasma levels and urinary excretion of NO metabolites(nitrite/nitrate, NOx) were measured. The protein expression of NO synthases(NOS) and tissue contents of NOx were determined in the kidney and thoracic aorta. The aorta was also examined of its changes in isometric tension in responses to acetylcholine and sodium nitroprusside. The arterial pressure did not significantly differ between FK506-treated and control groups. Plasma NOx levels remained unaltered, while urinary NOx excretion was significantly decreased in FK 506-treated group. Tissue contents of NOx were significantly decreased, although the expression of ecNOS and iNOS proteins was significantly altered neither in the kidney nor in the aorta. Acetylcholine-induced relaxation of the isolated aortic ring was significantly attenuated, whereas sodium nitroprusside-induced relaxation was not significantly affected. These results suggest that FK506 decreases the tissue contents of NO, without significantly affecting the expression of NOS.
박미정(Mi Jung Park),이균상(Kyun Sang Lee),조민석(Min Seok Cho),김정기(Jeong Ki Kim),박병석(Byoung Seok Park),마성권(Seong Kwon Ma),고정희(Jung Hee Ko),나명윤(Myong Yun Nah),염충호(chung Ho Yeum),김수완(Soo Wan Kim),김남호(Nam Ho Kim 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4
Objective : It has been reported that hyperhomocysteinemia is an independent risk factor for atherosclerotic complications, although the mechanisms re- main unclear. The major determinents of total fasting plasma homocysteine(tHcy) concentrations have been recently reported but there are still conflicting data on the influence of those in peritoneal and hemodialysis patients. Therefore, we evaluated the prevalence and association of vascular complications and the determinents of hyperhomocysteinemia in chronic renal failure patients receiving conservative treatment(predialysis), peritoneal dialysis(PD) and hemodia-lysis (HD) patients. Methods We measured the factors, including fasting plasma vitamine levels(folate, vitamin E4 and vitamin B12), serum creatinine concentration, dialysis adequacy-related varibles as well as associated risk factors for vascular diseases that might affect tHcy concentrations in 37 predilysis, 30 PD, 34 HD patients and 21 normal persons. Continuous variables were compared using independent sample t-test. Spearman's correlation was used to determine the strength of association between tHcy and other predictive varia41es. Percentages were compared using Pearson's chi-square test or Fisher's exact test, depending on the frequencies. Independent determinents of tHcy concentration and atherosclerotic vascular complications were identified using multiple regression analysis. Results : The prevalence of hyperhomocysteinemia was 83.8, 72, 88% among predialysis, PD and HD patients, respectively(Odds ratio was 103.33, 81.43, 150.0 vs. controls, respectively). tHcy values in pre- dialysis, PD and HD patients are significantly higher than those in controls(24.68±9.01, 21.04±8.82, 23.62± 9.46 vs. 8.80±2.07 ㎛oL/L, repectively, p<0.01). Pre- dialysis, PD and HD patients with atherosclerotic vascular complications had higher tHcy concentrations than did predialysis, PD and HD patients with- out vascular complications(21.93±8.71 vs. 32.09±4.71 ㎛oL/L, p<0.01, 17.57±5.85 vs. 28.74±9.70 ㎛oL/L, p<0.01, 19.00±4.29 vs. 33.28±10.13, p<0.01 respectively). We also observed increasing odds ratios of vascular events with increasing tHcy concentrations. For predialysis, PD and HD patients, fasting plasma folate level had negative correlation with tHcy concentrations by spearman's simple correlaltion. And using muliple regression analysis, we recognized hyperhomocysteinemia is an independent risk factor for atherosclerosis and fasting plasma folate is a major determinent of tHcy concentrations in predialysis, PD and HD patients. Conclusions: Hyperhomocysteinemia in predialysis, PD and HD patients was more prevalent than that in norrnal controls. Risk of atherosclerotic vascular complications increased with increasing tHcy concentrations. Hyperhomocysteinemia is an independent risk factor for atherosclerosis and fasting plasma folate is a major determinent of tHcy concentrations in predialysis, PD and HD patients.
지속성 외래 복막투석 환자에서 영양상태와 투석의 적절도
박미정(Mi Jung Park),이균상(Kyun Sang Lee),조민석(Min Seok Cho),김정기(Jeong Ki Kim),박병석(Byoung Seok Park),마성권(Seong Kwon Ma),고정희(Jung Hee Ko),나명윤(Myong Yun Nah),염충호(chung Ho Yeum),정권(Jung Gwon),김수완(Soo Wan Kim) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4
Purpose - Malnutrition is common in CAPD patients and depends on many factors such as dialysis-related and nondialysis-related factors. The present study aimed to assess nutritional status, dialysis adequacy and their relationships with overall mortality and morbidity. Methods - We studied 102 patients who had been receiving CAPD for at least 6 months. Dialysis adequacy was assessed by parameters derived from urea kinetic modeling(UKM) and nutritional status was assessed by serum biochemical measurement, normalized protein catabolic rate(nPCR), normalized protein equvalent of total nitrogen appearance(nPNA) and urea kinetic studies. Spearman's simple correlation and multiple linear stepwise regression analysis were used to assess correlation between dialysis adequacy and nutritional status in CAPD patients. We compared the differences between patients who suffered morbid events, defined as either an infectious complication or hospitalization, and patients who remained well. Results : The results showed that the total dialysis dose(total weekly Kt/Vurea ) has statistically significant correlation with nPCR(r=0.234, p=0.028), nPNA (r=0.246, p=0.021), total weekly creatinine clearance (WCC)(r=0.479, p=0.0001), serum albumin levels(r= 0.233, p=0.029), serum cholesterol(r=0.266, p=0.013), serum BUN(r=-0.290, p=0.006) and serum creatinine levels(r=-0408, p-0.0001). nPNA was positively correlated with serum cholesterol(r=0.217, p=0.045), serum transferrin(r=0.218, p=0.042) and serum ferritin levels(r=0.220, p=0.043). Patients who suffered morbid events had an old age(p=0.001), long duration of CAPD(p=0.0001), higher CRP(p=0.021), lower serum albumin level(p=0.020), lower hematocrit(p=0.049) and lower WCC(p=0.017). Conclusions: These results indicate that adequate dialysis is very important for the maintenance of adequant nutrition because nutritional status positively correlated with dialysis dose, which is best assessed by UKM. In addition, assessment of nutritional status and dialysis adequacy are important in predicting clinical outcomes in CAPD patients.