Tunneled Cuffed Catheter (Permcath(R)) 기능 장애의 Fibrin Sheath Stripping

정철성 ( Chull Sung Jung ),남대익 ( Dae Ik Nam ),박동양 ( Dong Yang Park ),김대성 ( Dae Sung Kim ),최치훈 ( Chi Hoon Choi ),이영기 ( Young Ki Lee ),김성균 ( Seong Gyun Kim ),오국환 ( Kook Hwan Oh ),윤종우 ( Jong Woo Yoon ),구자룡 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.4

유지 혈액투석환자에서의 우울증 발생의 위험인자 및 우울증이 영양지표에 미치는 영향

김진철(Jin Cheol Kim),조성태(Sung Tae Jo),윤종우(Jong Yoo Yoon),김근호(Gheun Ho Kim),전노원(Rho Won Jeon),김형직(Hyung Jig Kim),채동완(Dong Wan Chae),노정우(Jung Woo Noh),손봉기(Bong Ki Son),구자룡(Ja Roung Koo) 대한내과학회 2002 대한내과학회지 Vol.62 No.1

N/A Background: Depression is common in chronic renal failure patients and usually associated with poor appetite. Malnutrition with poor appetite is known to be associated with increased mortality in chronic hemodialysis (HD) patients. So we evaluated the prevalence, risk factors of depression and effects of depression to nutritional status in chronic HD patients. Methods: Sixty two HD patients (age 48.8±11.1 years, diabetes 29%) were investigated. Each patients were interviewed and completed the Beck depression inventory (BDI, 21 items, 0-3 point). To exclude the possible confounding effects of illness and treatment symptoms, cognitive depression index (CDI, a cognitive subset of 15 items selected from BDI) was used as a measure of depression. KT/V and nutritional parameters such as serum albumin, normalized protein catabolic rate (nPCR), subjective global assesment (SGA), body mass index (BMI), triceps skinfold thickness (TSF) and midarm muscle circumference (MAMC) were also measured. Results: Corrected BDI score (CDI score multiplied by 21/15) was 24.9±12.7 and the prevalence of depression (corrected BDI score≥21) was 64.5%. DM patient s had higher CDI score than non DM patient (22.9±7.2 vs 15.6±9.0). In univariate analysis, CDI score was correlated with age (r =0.39, p <0.01), serum albumin (r =- 0.37, p <0.005), nPCR (r =- 0.30, p <0.05), SGA (r =- 0.42, p <0.05), BMI (r =- 0.28, p <0.05), TSF (r =- 0.41, p <0.05) and MAMC (r =- 0.50, p <0.01). In multivariate analysis, CDI score was the strongest correlate of nPCR, SGA, BMI, TSF and MAMC. But KT/V, hematocrit, erythropoietin usage, plasma bicarbonate, serum parathyroid hormone, c-reactive protein concentration and HD duration had no relationship with CDI score. Conclusion: The prevalence of depression in chronic HD patients was high. Diabetes and old age were import ant risk factors for depression. It was also concluded that severity of depression was correlated with markers of malnutrition and depression could be a independent risk factors of malnutrition in chronic HD patients.(Korean J Med 62:77-82, 2002)

출혈 위험성이 있는 환자에서 지속적 정정맥 여과술 시행 시 생리식염수 주사와 nafamostat mesilate의 항응고 효과의 전향적 비교 연구

박인일 ( In Il Park ),최명진 ( Myung Jin Choi ),윤종우 ( Jong Woo Yoon ),오지은 ( Ji Eun Oh ),서장원 ( Jang Won Seo ),김성균 ( Sung Gyun Kim ),이영기 ( Young Ki Lee ),김형직 ( Hyung Jik Kim ),노정우 ( Jung Woo Noh ),구자룡 ( Ja Ry 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.3

목적: 출혈의 위험성이 있는 급성 신부전 환자에서 CVVH 치료 시 항응고 요법으로 생리 식염수 주사가 주로 사용되어 왔으나 필터의 응고를 증가시킬 수 있으며 응고장애 유무에 따라 항응고제의 효과가 다를 수 있어 그 효과가 제한적이다. 이에 비해 국소 항응고제인 nafamostat mesilate 주사는 짧은 반감기로 인해 혈액투석 환자에서 효과적이고 안전한 항응고제로 보고되고 있다. 이에 저자들은 CVVH 치료 시 혈액응고 장애 유무에 따른 nafamostat mesilate의 항응고 효과를 생리식염수 항응고 요법과 전향적으로 비교하고자 하였다. 방법: CVVH를 필요로 하는 환자들 중 (1) 수술 직전 및 직후, 뇌출혈, 위장관 출혈 등이 동반되어 항응고제로 헤파린을 사용할 수 없거나 (2) 검사실 검사상 응고 장애의 기준인 INR>2 혹은 aPTT>60 sec, 혈소판<50,000/mm3 중 한 개 이상이 존재 하는 43명의 환자들을 각각 생리식염수 주사군 (n=23)과 nafamostat mesilate 주사군 (n=20)으로 나누어 필터의 평균 사용시간으로 의 항응고 효과를 비교하였다. 결과: 필터의 평균 사용 시간은 nafamostat mesilate 군에서 생리식염수 군에 비해 12 시간 정도 유의하게 증가되었으며 (28.73±12.67 versus 16.34±7.86, p=0.001) 이러한 효과는 응고장애 존재 유무와 무관하게 지속되었다. 치료 기간 동안 양군 모두에서 임상적으로 유의한 출혈 합병증은 발생하지 않았다. 결론: Nafamostat mesilate는 CVVH를 필요로 하면서 출혈 위험성이 있는 급성 신부전 환자들에게서 응고 장애 유무와 상관없이 사용될 수 있는 효과적이고 안전한 항응고제로 생각 된다. Purpose: In patients with a higherrisk of bleeding, performing CVVH with heparin or saline anticoagulation is associated with increased bleeding or thrombotic risk. Nafamostat mesilate (NM), a serine proteinase inhibitor, while inhibiting various clotting factors in filter circuit, is characterized by short half life resulting in little systemic anticoagulation effect. Accordingly, we prospectively evaluated the anticoagulant effect and safety of NM in patients with a higher risk of bleeding who underwent CVVH. Methods: Among 43 patients with high risk of bleeding [defined by (1) INR>2, aPTT>20 sec, platelet<50,000/mm3 or (2) ongoing bleeding, major hemorrhage/surgery in the last 48 hrs], 20 patients were treated with continuous nafamostat mesilate infusion (10-20 mg/hr) and remaining 23 patients were treated with saline bolus infusion (100 mLq 1 hr) for CVVH anticoagulation. Results: As compared with saline bolus group, mean circuit life was significantly longer in NM infusion group (28.73±12.67 versus 16.34±7.86, p=0.001). There was no significant bleeding complication in either saline bolus or NMinfusion group. In subgroup analysis according to the presence of abnormal coagulation status (defined by INR>2, aPTT>20 sec, platelet<50,000/mm3), the positive effect of NM on circuit lifespan persisted irrespective of the coagulation status. Conclusion: As compared with saline bolus, nafamostat mesilate infusion was associated with higher CVVH filter life. In patients with high risk of bleeding, nafamostat mesilate can be used as a safe and effective anticoagulant for CVVH with acceptable filter life.

Sulodexide 유발 고칼륨 혈증: 증례 보고

박인일 ( In Il Park ),최명진 ( Myung Jin Choi ),윤종우 ( Jong Woo Yoon ),김수진 ( Soo Jin Kim ),박태진 ( Tae Jin Park ),송영수 ( Young Soo Song ),이영기 ( Young Ki Lee ),김형직 ( Hyung Jik Kim ),노정우 ( Jung Woo Noh ),구자룡 ( Ja 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.3

Sulodexide is composed of two glycosaminoglycans (fast-moving heparin 80%, dermatan sulfate 20%) that are capable of preventing diabetic nephropathy by correcting abnormal glycosaminoglycan metabolism. Considering heparin-like propertyof sulodexide, side effect profiles of sulodexide are expected to be similar with those of heparin. Among those side effects, we remarked on heparin-induced hyperkalemia and hereby report a case of severe hyperkalemia during the use of sulodexide. A 52-year-old man with diabetic nephroapthy and hypertension was admitted to our hospital because of severe hyperkalemia up to 7.5 meq/L. His clinical condition was stable and medications including losartan and furosemide had not been changed for last 6 months except the addition of sulodexide, which was started 30 days prior to admission. Despite intensive use of Kayexalate and immediate discontinuation of losartan, hyperkalemia aggravated up to 8.0 meq/L. After recognition of possible sulodexide-induced hyperkalemia, sulodexide was discontinued, which resulted in rapid correction of hyperkalemia. In view of the above discussed clinical consideration, we suspect sulodexide as a major cause of hyperkalmia and report this case with a review of literature.

춘천 지역에서 발생한 쯔쯔가무시병의 임상적 특징

이호권 ( Ho Gwon Lee ),민슬기 ( Seul Ki Min ),공승진 ( Seung Jin Kong ),이수정 ( Su Jung Lee ),송헌호 ( Hun Ho Song ),윤종우 ( Jong Woo Yoon ),이명구 ( Myung Goo Lee ),신동훈 ( Dong Hoon Shin ),강성하 ( Sung Ha Kang ),이정열 ( Jeo 대한내과학회 2005 대한내과학회지 Vol.69 No.2

목적 : 쯔쯔가무시병 환자의 일부는 중증감염으로 중환자실 집중치료를 필요로 하며 이 중 사망하는 환자들도 있다. 본 연구는 춘천 및 인근 지역에서 발생한 쯔쯔가무시병 환자의 임상적인 특징과 이 중 중증환자들의 특징을 분석하여 지역사회의 쯔쯔가무시병의 진단과 치료 및 교육에 도움이 되고자 하였다. 방법 : 1997년 4월부터 2002년 12월까지 한림대학교 부속 춘천성심병원에서 쯔쯔가무시 병으로 진단되었던 81예의 환자들의 의무기록 열람을 통한 후향적 분석을 시행하였다. 81예 환자들의 내원시 임상소견을 분석하였고, 이 중 본 병원에서 치료 받았던 79예의 환자들의 치료결과를 분석하였으며, 내원시 일반병실로 입원한 환자와 중환자실로 입원하였던 환자의 임상소견을 비교하여 중증환자들의 특징을 비교하였다. 결과 : 73예의 환자가 가을에 발생하였으며, 70예에서 발열이 있었고, 가피가 발견된 경우는 58예(71.6%)였다. Doxycycline 치료 후 45예의 환자가 48시간내 열이 없어졌으나 13예에서는 5일이상 열이 지속되었다. 79예 중에서 중환자실로 입원한 경우가 25예 였으며 이 중 8예에서 기계환기 치료를 받았고, 3예가 다발성 장기부전으로 사망하였다. 중환자실에 입원한 중증환자들은 백혈구수가 많았고, BUN과 크레아티닌이 높았고, 알부민 수치가 낮았다. 결론 : 쯔쯔가무시병은 중증질환으로 이환될 수 있으며 특히 고령이거나 만성질환을 가지고 있는 환자에게서는 치명적인 결과를 초래할 수 있으므로 감염발생의 위험이 있는 지역사회에서 유행 시기에 발열 등의 증상이 있을 때 조기 진단이 필수적이며 이를 위한 교육이 필요하다. 그리고 중증환자에서 백혈구수, 혈청 알부민, BUN, 크레아틴 등에서 차이를 나타내어 쯔쯔가무시 병의 예후를 예측하는 요소로 사료된다. Background : Tsutsugamushi disease is an acute febrile disease in Korea. Some patients with tsutsugamushi disease have severe illness, which needs care in intensive care unit, and may die due to the disease. We analyzed the cases with tsutsugamushi disease who lived in Chuncheon and neighboring communities to find out clinical manifestations, laboratory findings especially in severe cases. Methods : We reviewed the clinical records of the 81 cases who were diagnosed as tsutsugamushi in Chuncheon Sacred Heart Hospital from April, 1997 to December, 2002. We analyzed the clinical and laboratory findings of the 81 cases, and the treatment results of 79 cases who recieved the treatment in this hospital. We also compared the characteristics of the patients between admission to general ward and intensive care unit (ICU). Results : Seventy three cases developed the disease in autumn. Seventy cases had fever. 58 cases had eschar in their bodies. With the doxycycline treatment, forty five cases subsided the fever within 48 hours, but in 13 cases, fever continued after 5 days of treatment. Twenty five cases were admitted to ICU, 8 cases among them were treated with ventilator, 3 cases died due to the multi-organ failure. When we compared the clinical characteristics of the patients admitted to ICU with those to general wards, leukocyte count, the level of BUN and creatinine were higher, the albumin level was lower in ICU patients than those of general ward patients. Conclusion : Tsutsugamushi disease can progress to severe disease, and be fatal to the patients. So it is necessary to diagnose early and treat carefully. We suggest that leukocyte count, BUN, creatinine, or albumin can be used to predict the prognosis.(Korean J Med 69:190-196, 2005)

고농도 포도당에서 배양한 혈관사이질 세포에서 안지오텐신 ll와 안지오텐신 전환효소 억제제가 Procollagen α₁(lV) m RNA 발현에 미치는 효과

임천규(Chun Gyoo Ihm),이소영(So Young Lee),차대룡(Dae Ryong Cha),조원용(Won Yong Cho),한상엽(Sang Yup Han),김형규(Hyoung Kyu Kim),조상경(Sang Kyoung Jo),윤종우(Jong Woo Yoon),김용섭(Yong Seup Kim),이정호(Jung Ho Lee) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1

N/A Objective: Diverse glomerular disorders leadsing to progressive glomerulosclerosis share the common features of increased mRNA expression for extra- cellular matrix protein and growth factors. The precise role of angiotensin II in contributing to these disturbances is currently unknown. ACE inhibitors have been proved to be beneficial in protecting against glomerular injury in animal models and many of human glomerular diseases. Type IV collagen is a main component of extracellular matrix in the mesangium : its increased accumulation is a common pathologic finding in the glomerulosclerosis. There are some evidences that the beneficial effect of ACE inhibitor does not solely depend on the hemodynamic effect, but may be mediated by other effect. The purpose of this study is to evaluate the effects of high glucose, angiotensin II and angiotensin converting enzyme inhibitor on the expression of PCa₁(lV) in mesansial cells(MCs). Methods: Human mesangial cells were cultured with standard method. To investigate the effect of each drug and high glucose condition, MCs were cultured in the normal-glucose medium(100mg/dl) and high-glucose medium(450mg/dl), respectively. An- giotensin II and angiotensin converting enzyme inhibitor(captopril) were added to culture medium at final concentration of 10 M which is the physiologic dose in vivo. MCs were cultured in each condition for 3days, when the maximal effect of high glucose on MCs, and harvested for mesurement of the expression of PCa₁(IV) mRNA. To quantitate the PCa(1V) mRNA levels in each condition, semiquantitatine RT-PCR was done with co-amplification of house keeping gene. Results: PCa₁(IV) mRNA expression was significantly increased in high-glucose medium(30mM) compared to normal-glucose medium(5.5mM)(2.28±0.34 vs 0.96±0.08, p<0.05). Administration of angiotensin ll(10(-6)M) in culture media induced a further increment in the PC a >(IV) mRNA expression to 4.64±0.28(p<0.05). Angiotensin II in the normal-glucose medium increased the PCa₁(lV) mHNA expression as 2.69±0.23 control(p<0.05). Addition of angiotensin converting enzyme inhibitor(Capopril, 10(-6)M) in high- glucose culture medium significantly suppressed the PCar(IV) mRNA expression as 0.690.11(p<0.05). Conclusion: High glucose concentration in culture medium significantly increases the mRNA expression of procollagen alphal(IV) than normal glucose concentration. Angiotensin II increases the collagen mRNA expression directly and this effect was significantly prevented by ACE inhibitor. This result suggests that hyperglycemia in diabetic millieu can directly increase collagen production, and ACE inhibitor may inhibit progressive glomerulosclerosis by decreasing collagen production as well as reducing intraglomerular pressure.

성인 미세변화신증후군 환자에서 스테로이드 충격요법의 효과

오숙의 ( Sook Eui Oh ),이영기 ( Young Ki Lee ),김진경 ( Jin Kyung Kim ),조성태 ( Sung Tae Cho ),전로원 ( Rho Won Chun ),윤종우 ( Jong Woo Yoon ),구자룡 ( Ja Ryong Koo ),김형직 ( Hyung Jik Kim ),노정우 ( Jung Woo Noh ),남은숙 ( Eun 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.6

Purpose : The incidence of complete remission is lower and the relapse is more frequent in adult-onset minimal change nephrotic syndrome (MCNS) are observed especially when compared with those in children. This study was designed to examine the effect of methylprednisolone pulse therapy in adultonset MCNS comparing to oral steroid as an initial therapeutic modality. Methods : We have retrospectively reviewed the clinical data of 25 adult-onset MCNS patients. Twelve patients were treated with three intravenous pulses of methylprednisolone (1 g daily) followed by oral prednisolone 1 mg/kg daily for 4-8 weeks and also by low doses of oral prednisolone for 4-6 months (MP group) Thirteen patients were initially treated with oral prednisolone 1 mg/kg daily for 4-8 weeks and then with low doses of oral prednisolone (PD group). Results : The response to therapy was similar between MP and PD group, with a complete remission obtained in 83.3% and 84.6%, respectively. No statistically significant difference between the two groups was observed in the rate of response at 8 weeks (58.3% versus 69.2%). The mean time to response was not different between MP group (37.9±28.0 days) and PD group (45.5±40.2 days). No difference was recognized between the two groups with respect to relapse rate. Conclusion : These data suggest that a short course of methylprednisolone pulse therapy followed by oral prednisolone is not superior to oral prednisolone therapy as an initial therapeutic modality in adult-onset MCNS.

Clostridium difficile와 연관된 설사와 만성신질환의 관계

오숙의 ( Sook Eui Oh ),이영기 ( Young Ki Lee ),김진경 ( Jin Kyung Kim ),이동훈 ( Dong Hun Lee ),박태진 ( Tae Jin Park ),윤종우 ( Jung Woo Yoon ),구자룡 ( Ja Ryong Koo ),김형직 ( Hyung Jik Kim ),노정우 ( Jung Woo Noh ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

말기신부전 환자에서 Epoetin Alfa (에스포젠) 주 1회 요법과 주 2-3회 피하투여의 효과 비교

이영기 ( Young Ki Lee ),이형석 ( Hyung Seok Lee ),주민하 ( Min Ha Joo ),김성균 ( Seong Gyun Kim ),서장원 ( Jang Won Seo ),오지은 ( Ji Eun Oh ),윤종우 ( Jong Woo Yoon ),구자룡 ( Ja Ryong Koo ),김형직 ( Hyung Jik Kim ),노정우 ( Jung 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.2

목적: 말기 신부전 환자에서 에리스로포이에틴 (epoietin)을 주 2-3회 피하 주사 하는 방법은 자주 주사해야 하는 번거로움 뿐만 아니라 주사할 때마다 매번 통증이 발생하기 때문에, 고용량의 epoetin를 일시에 투여하여 투여 간격을 늘리는 주 1회 요법이 시도되고 있다. 본 연구에서는 혈액투석을 받는 말기 신부전 환자에서 고용량 epoetin alfa의 주 1회 요법을 주 2-3회 피하 투여와 비교하여 그 효과와 안전성을 시험하였다. 방법: Epoetin을 피하 투여 중인 혈액투석 환자 83명을 주 1회 투여군 (n=44) 또는 주 2-3회 투여군 (대조군, n=39)으로 무작위 분류하였다. 각 군의 환자는 총 10회 방문 (스크리닝 2회, 이후 8회)하여 12주간 치료 반응을 관찰하였다. 주 1회 투여군은 10,000 IU의 주사를 사용하여 정해진 용량의 epoetin alfa를 주 1회 투여하고, 대조군은 4,000 IU의 주사를 사용하여 정해진 용량의 epoetin alfa를 주 2-3회로 나누어 투여하고 혈색소 수치가 9.0-12.0 g/dL 유지하도록 용량을 조정하였다. 결과: 투여 시작시, 4주, 8주, 12주에 혈색소는 주 1회 투여군은 10.7, 11.1, 11.3, 11.0 g/dL, 대조군은 10.5, 11.3, 11.5, 11.3 g/dL로 유의한 차이가 없었다. 투여 시작시, 4, 8, 12주의 epoetin alfa의 평균 투여량은 주 1회 투여군은 142.8, 123.0, 116.7, 112.3 IU/kg/week이며, 대조군 128.4, 119.3, 103.5, 101.2 IU/kg/week으로서 주 1회 투여군에서 다소 많은 경향을 보였으나 통계적인 유의성은 없었다. Epoetin alfa의 용량을 증가시키지 않고 혈색소 수치가 유지된 환자의 비율도 주 1회 투여군 95.5%, 대조군 92.3%으로 차이가 없었다. 결론: 고용량 epoetin alfa의 주 1회 요법은 목표 혈색소를 유지하는데 있어 epoetin alfa를 2-3회 나누어 투여하는 방법과 효과와 안정성 면에서 비슷하였다. 따라서 안정적인 혈액투석 환자에서 고용량 epoetin alfa의 주 1회 요법이 효과적인 방법으로 생각된다. Purpose: Compared with the practice of administrating subcutaneous erythropoietin injection two or three times a week in end-stage renal failure, a weekly administration reduces the frequency of injection and the workload in renal units. We investigated whether subcutaneous epoetin alfa administered weekly was as effective as the same weekly dosage given in two or three divided doses. Methods: Eighty-three patients were randomized to treatment with subcutaneous epoetin alfa either once a week (n=44), or to their original dosage two or three times a week (control, n=39) for 12 weeks. If hemoglobin was out of range (9.0-12.0 g/dL), the dosage was changed. Results: Mean hemoglobin levels at randomization and after 4, 8 and 12 weeks were 10.7, 11.1, 11.3 and 11.0 g/dL, respectively, in the once weekly group compared with 10.5, 11.3, 11.5 and 11.3 g/dL, respectively, in the control group. The mean weekly epoetin alfa dosage at randomization and after 4, 8 and 12 weeks were 142.8, 123.0, 116.7 and 112.3 IU/kg, respectively, in the once-a-week group compared with 128.4, 119.3, 103.5 and 101.2 IU/kg, respectively, in the control group. No statistically significant differences between the groups were apparent in changes in hemoglobin levels or epoetin alfa dosages at week 12. There was no significant difference between the groups in number of patients who maintained stable hemoglobin levels without epoetin alfa dose increases. Conclusion: This study demonstrates that a weekly subcutaneous administration of epoetin alfa is as effective and safe as injecting it two or three times a week administration in maintaining hemoglobin levels in stable hemodialysis patients.

Salmonella enteritidis에 의한 Emphysematous Pyelonephritis 1예

김민자,조상경,김석진,이정환,박승철,김윤환,윤종우 대한감염학회 1996 감염 Vol.28 No.3

저자들은 발열과 오한 그리고 의식둔화를 주소로 내원하여 S. enteritidis에 의한 기종성 신우신염을 균배양을 통해 진단하고 항생제 투여와 경피적 농양 배액술을 통해 증상의 호전을 보인 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Emphysematous pyelonephritis is rare, life-threatening infection of the kidney associated with the production of gas, usually found in diabetic patients. We experienced a case of emphysematous pyelonephritis caused by Salmonella enteritidis in a 70 years old man with diabetes mellitus. The patient was successfully managed with percutaneous drainage and broad spectrum antibiotics. To our knowledge, this case is the first case of emphysematous pyelonephritis caused by S. enteritidis in the world. We report this case with a review of literature.