칼슘길항제가 급성 허혈성 신손상후 Renin 유전자 발현에 미치는 효과

이규백(Kyu Beck Lee),차대룡(Dae Ryong Cha),김용섭(Yong Seop Kim),조원용(Won Yong Cho),김형규(Hyoung Kyu Kim) 대한내과학회 1997 대한내과학회지 Vol.53 No.3

N/A Objectives: lschemic acute renal failure(ARF) is characterized by an abrupt and sustained decline in GFR within minutes to days after renal ischemia and not immediately reversed on restoration of renal blood flow. The typical delay of a few days to a few weeks suggests reversible parenchymal damage awaiting cell regeneration for functional recovery. Many potentially cell damaging factors, such as ATP depletion, plasma membrane phospholipid degradatian and superoxide-induced membrane damage, play a central part in ischemic injury. More recently, much attention has been focused on the role of calcium, especially ischemic cell injury and the possible therapeutic role of calcium channel blockers emerged from studies conducted several years ago. In the past, it was thought that activation of renin-angiotensin system plays a role in the pathogenesis of ARF. Now the role of angiotensin in human renal ischemia also appears to be controversial. The following study was done in order to investigate the effect of a calcium channel blocker, nifedipine, on gene expression of renin during acute ischemic renal injury. Methods: The Sprague-Dawley rats were divided into 4 groups, group I(n=3) as the control, group II (n=3) as the sham operation group, group III(n=15) as the ischemic renal injury group without nifedipine pretreatment, and group IV(n=15) as the ischemic renal injury model by right nephrectomy and left renal artery clamping for 40 minutes with systemic nifedipine pretreatment(10mg/kg), 1n ischemic renal injury model(group III and IV), rats were further divided into three subgroups according to reperfusion time of 1,24,72 hours. The non-ischemic right kidney removed at the time of initial procedure served as paired control. Total renal RNA was extracted by Chomczynskis method and electrophoresis was done in a 1% agarose gel containing 2,2M formaldehyde. Northern was performed at 42℃ with isotope labeled renin probe for 18 hours, Autoradiographs were obtained and quantitated by a densitometer measured at 530nm. Results: 1) The expression of renin gene was markedly decreased after renal ischemia and slowly recovered to one half of the control level after 72 hours of reperfusion. 2) Renin gene expression pattern of ischemic renal injury with prior nifedipine treatment was similar to the ischemic group without nifedipine pretreatment. Conclusion: These findings suggest that the renin gene expression was markedly decreased after renal ischemia and slowly recovered. Systemic nifedipine pretreatment does not have a significant effect on gene expression pattern of renin in ischemic renal injury.

만성 염증성 탈수초 다발성 신경근병증이 동반된 낭창성 신염

이규백(Kyu Beck Lee),김향(Hyang Kim),이상종(Sang Jong Lee),박찬필(Chan Pil Park),박문향(Moon Hyang Park),박범준(Bum Joon Park),김현승(Hyun Seung Kim),이한보(Han Bo Lee),이준(Jun Lee),오재인(Jae In Oh) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3

Systemic lupus erythematosus(SLE) is a multisys-temic disease. Peripheral neuropathy occurs in about 10% of patients with SLE. Chronic inflammatory demyelinating polyneurpathy has been reported rarely in SLE. We experienced a case of chronic inflammatory polyneuropathy in lupus nephritis. 32-year-old housewife presented to chronic progressive muscle weakness and heavy proteinuria. Kidney biopsy showed compatible with lupus nephritis (WHO Class V, membranous nephropathy). Nerve conduction studies showed reduction in conduction velocity and sural nerve biopsy revealed demyeli-nating polyneuropathy. Steroid therapy led to improvement in clinical symptoms and proteinuria.

루프스 신염의 치료

이규백 ( Kyu Beck Lee ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.2

상염색체 우성 다낭신 환자에서 신장 해부학적 지표에 따른 고혈압과 신기능의 변화

이규백(Kyu Beck Lee),김향(Hyang Kim),이영래(Young Rae Lee) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.2

상염색체 우성 다낭신(ADPKD)은 다낭신 유전자를 받은 환자에서 점진적으로 신장에 낭종들의 수와 크기가 커져서 신혈관과 신실질을 압박하여 고혈압, 신부전을 발생시킨다. 그리고 ADPKD 환자에서 고혈압과 신부전 발생 이전부터 신장의 해부학적 변화가 발생한다. 따라서 오랜 기간의 임상경과를 가진 ADPKD에서 신장 해부학적 지표에 따른 고혈압과 신기능 변화를 평가하는 것은 중요하다. 그리고 신장 해부학적 지표를 ADPKD의 임상경과를 예측할 수 있을지를 알아보는 것은 의미 있다. 본 연구에서 강북삼성병원을 내원한 ADPKD환자 가운데 복부초음파검사로 진단하고, 해부학적 구조를 정확히 볼 수 있는 복부 전산화단층촬영을 시행한 67명의 환자를 대상으로 신장 해부학적 지표에 따른 고혈압, 신기능을 비교하였다. 한명의 방사선과 전문의가 복부 전산화단층촬영 필름을 분석하여 신장의 해부학적 지표로 신장의 길이, 용적, RSI(anatomical renal severity index), 최대 신낭종직경을 측정하였다. ADPKD 환자(평균 연령 45±12세, 남녀비42:25) 가운데 고혈압은 41명(61%)에서 있었으며, 신기능 부전 (크레아티닌 청소율50mL/min/1.73m2 이하)은 15명(22%)에서 있었다. 정상 혈압 군에 비하여 고혈압 군에서 신장길이, 신장용적, RSI, 최대 신낭종직경 모두 유의하게 증가되어 있었다(p<0.01)(신장용적 360±154mL/1.73 m2 대 833±585mL/1.73 m2 ). 정상 신기능 군에 비하여 신부전 군에서 신장길이, 신장용적, RSI, 최대 신낭종직경 모두 유의하게 증가되어 있었다(p<0.01)(신장용적499±335mL/1.73 m2 대 1171±700mL/1.73m2 ). 환자의 크레아티닌 청소율은 신장 해부학적 지표인 신장길이(r= -0.39), 신장용적(r= -0.49), RSI(r= -0.39), 최대 신낭종직경(r= -0.38)과 유의한 상관관계가 있었다(p<0.01). 본 연구 결과 ADPKD 환자에서 신장 해부학적 지표인 신장길이, 신장용적, RSI, 최대 신낭종직경은 고혈압, 신기능과 상관관계를 가지고, 고혈압 군과 신부전 군에서 증가되어 있다. ADPKD에서 신장의 낭종이 많아지고, 신장이 커질수록 고혈압이 발생하고, 신기능이 감소함을 객관으로 증명하였다. 향후에 ADPKD환자의 임상경과를 보는데 이러한 신장 해부학적 지표를 유용하게 사용할 수 있을 것으로 생각된다. Autosomal dominant polycystic kidney disease (ADPKD) is a common hereditary disorder, and its major morbidities are hypertension and renal failure. It is a characteristic feature of ADPKD that renal cysts increase in size and number with age continuously. Hypertension and renal failure in ADPKD result from compression of residual normal renal parenchyma by expanding cysts, since renal tissue is trapped within the poorly distensible renal capsule. Renal structural deformities in ADPKD occur prior to hypertension and renal failure. The present study was undertaken to explore the potential role of renal cyst enlargement in initiating hypertension and renal failure in ADPKD. We therefore measured renal structural indices by computed tomography(CT) to examine the relation between clinical progression and renal structural deformities. Sixty-seven adult subjects(45±12 years, rnale-female ratio 42: 25) with ADPKD were studied at our PKD clinic from 1997 to 2000, and a complete abdominal CT was performed on all subjects. One radiologist measured the renal structural indices which were renal length, volume, RSI(anatomical renal severity index) and maximal cyst size. The renal structural indices were significantly greater in hypertensive group compared to the normotensive group (hypertensive 833±585 vs. normotensive 360±154mL/ 1.73m------------², p<0.01). The renal structural indices were significantly greater in renal failure group compared to the normal renal function group(renal failure 1,171±700 vs. normal 499±335mL/1.73m², p<0.01). The renal function in ADPKD correlated with the renal structural indices. We concluded that the clinical progression in ADPKD correlates with the renal structural indices well. These structural indices provide considerable information about the progression of ADPKD.

유지 혈액투석 환자에서 KLOTHO 유전자다형성과 혈중 osteoprotegerin치와의 관계

이용수 ( Yong Su Lee ),김향 ( Hyang Kim ),김현석 ( Hyun Sock Kim ),이규백 ( Kyu Beck Lee ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.3

목적: 최근 Klotho 변이 쥐에서는 칼슘과 비타민D 대사 이상을 보여 고인산혈증과 혈관 석회화를 나타난다고 보고되었다. Klotho 변이 쥐에서 보이는 동맥경화증은 혈관 석회화의 표지자로 알려진 Osteoprotegerin (OPG)가 결핍된 쥐에서와 유사한 표현형을 보인다. 본 연구에서는 혈액투석 중인 환자에서 Klotho promoter 부위의 G-395A와 exon 4의 C1818T 유전자다형성의 빈도를 관찰하고, OPG를 비롯한 임상지표와의 연관성을 알아보았다. 방법: 유지 혈액투석 환자 88명 (평균나이 58±13세, 남:여=47:41)을 대상으로 혈압과 체질량지수, 칼슘, 인, 부갑상선 호르몬, 알칼리 포스파타제, hs-CRP 및 지질검사를 시행하였다. 혈중 OPG는 ELISA (enzyme-linked immuno-sorbent assay)를 이용하여 측정하였고, klotho 유전자형은 실시간 중합효소 연쇄반응 (real-time polymerase chain reaction)을 이용하여 분석하였다. 결과: G-395A 유전자다형성은 각각 GG 66% (n=58), GA 23% (n=20), AA 11% (n=10)이었고, G allele의 빈도는 0.773, A allele 빈도는 0.227이었다. C1818T 유전자다형성에서는 CC 63% (n=55), CT 29% (n=26), TT 8% (n=7)이었고, C allele 빈도는 0.773, T allele 빈도는 0.227이었다. G-395A는 체질량지수와 고밀도지단백 콜레스테롤과 유의한 상관관계를 보였으나 (p<0.05), G-395A와 C1818T는 OPG를 비롯한 다른 혈관석회화의 임상변수들과 통계학적으로 유의한 상관관계는 없었다. 결론: 본 연구에서 혈액투석환자의 klotho G-395A와 C1818T 유전자다형성은 OPG 등 혈관석회화와 관련된 임상지표 사이에 유의한 상관관계가 보이지 않았으나 이에 대해서는 보다 더 연구가 필요할 것으로 생각된다. Purpose: Klotho mutant mice showed abnormal calcium and vitamin D metabolism, hyperphosphatemia and vascular calcification. We observed the frequencies of klotho gene polymorphism and investigated their relation with some clinical parameters including serum osteoprotegerin (OPG) levels in maintenance hemodialysis (HD) patients. Methods: Total 88 patients (mean age 58±13 years, male:female=47:41) on maintenance HD were enrolled. The genotypings for G-395A in promoter and C1818T in exon 4 of klotho gene were performed with real-time polymerase chain reaction. We measured blood pressure, body mass index (BMI), and serum calcium, phosphorus, parathyroid hormone (PTH), alkaline phosphatase, hs-CRP, lipid profiles and OPG. Results: In G-395A in promoter, the distribution of genotypes was GG 66% (n=58), GA 23% (n=20) and AA 11% (n=10), respectively and the allele frequencies were 0.773 for G allele and 0.227 for A allele. In C1818T in exon 4, the distribution of genotypes was CC 63% (n=55), CT 30% (n=26), and TT 7% (n=7), and the frequencies were 0.773 for C allele and 0.227 for T allele. G-395A shows correlations with BMI and HDL-cholesterol (p<0.005). G-395A and C1818T in klotho gene show no statistical correlation with other clinical parameters of vascular calcification including OPG. Conclusion: Klotho G-395A and C1818T polymorphisms are not correlated with OPG in maintenance HD patients. Further research needs for the other klotho polymorphisms on chronic kidney disease and end-stage renal disease.

유지 혈액투석 환자에서 영양실조-염증 점수와 동맥경화의 연관성

이현영 ( Hyun Young Lhee ),이규백 ( Kyu Beck Lee ),김향 ( Hyang Kim ),정찬희 ( Chan Hee Jung ),이은정 ( Eun Jung Rhee ),이원영 ( Won Young Lee ),김선우 ( Sun Woo Kim ),이영래 ( Young Rea Lee ),최경 ( Kyung Choi ) 대한내과학회 2006 대한내과학회지 Vol.71 No.6

목적: 유지 혈액투석 환자에서 영양실조-염증 복합 증후군(malnutrition-inflammation complex syndrome, MIC 증후군)은 흔하며, 나쁜 예후와 연관되어 있다. 그러나 MIC 증후군이 동맥경화의 위험인자로 작용하는지는 충분한 증거가 없다. 본 연구의 목적은 MIC 증후군을 정량적 평가하여 대동맥 석회화 정도(AAC) 및 맥파속도(PWV)와 같은 동맥경화 지표와 연관성이 있는지 알아보고자 하였다. 방법: 강북삼성병원에서 유지 혈액투석 중인 80명(남자:여자=50:30, 평균연령 58±14세)의 환자를 대상으로 하였다. 주관적 총체적 평가법(SGA), 혈청학 검사, nPNA에 기초하여 영양상태를 평가하였다 염증 지표로서 C-reactive protein (CHP)을 측정하였다. MIC 증후군의 정량적 평가를 위해 영양실조 염증 점수(Malnutrition-Inflammation Score, MIS)를 구하였다. 동맥경화 정도를 측정하기 위하여 요추 측부 단순촬영을 시행하여 AAC를 평가하였고, 상완-발목 PWV(baPWV)를 측정하였다. 결과: 영양실조군에서 정상영양군보다 MIS가 높았다(8.7±3.6 vs. 4.0±1.8, p=0.001). 염증군(CRP가 3 mg/L 이상)에서 정상군보다 MIS가 높았다(7.6±4.6 vs. 5.7±3.3, p=0.045). MIS는 동맥경화도의 지표인 AAC 지수(r=0.157, p=0.191) 및 baPWV (r=0.144, p=0.323)외 유의한 상관관계를 보이지 않았다. 결론: 본 연구에서는 MIS는 영양실조 염증반응을 잘 반영하여, MIC 증후군의 지표로 사용할 수 있다. MIS와 동맥경화 지표로서 AAC 지수 및 baPWV와 유의한 상관관계를 보이지 않았다. 혈액투석 환자에서 영양실조, 염증 및 동맥경화를 쉽고, 정확히 평가하는 지표개발이 필요하며, MIC 증후군을 치료의 목표로서 치료에 따른 동맥경화와 사망률에 대한 연구를 하여야 할 것으로 생각한다. Background: Malnutrition-inflammation complex syndrome (MICS) is common in maintenance hemodialysis (MHD) patients and may be related to a poor outcome. However, there is little evidence showing MICS to be a risk factor for all1erosclerosis. The aim of this study was to determine if MICS is associated will, the atherosclerotic markers such as abdominal aortic calcification (AAC) and pulse wave velocity (PWV) in MHD patients. Methods: Eighty MHD patients were selected in Kangbuk Samsung Hospital (male:female=50:30, age 58±14 years). The nutritional status was assessed by the Subjective Global Assessment (SGA), biochemical measurement and the normalized protein equivalent of the total nitrogen appearance (nPNA). The presence of inflammatory reaction was assessed by the C-reactive protein (CRP). The malnutrition-Inflammation Score (MIS) was used to assess MICS. A lateral lumbar radiogram was used to evaluate the AAC index. Brachial-ankle (ba) PWV using automatic device was performed. Results: Malnourished patients had a higher MIS than the well nourished patients (8.7±3.6 vs. 4.0±1.8, p<0.001). Patients with inflammation (CRP3 mg/L) showed a higher MIS than patients without inflammation (7.6±4.6 vs. 5.7±3.3, p=0.045). There was no correlation between the MIS and the AAC index (r=0.157 p=0.191) and baPWV (r=0.144, p=0.323). Conclusion: These results suggest that the MIS is a useful marker of MICS in MHD patients. However, the MIS was not directly related to the AAC index and baPWV. This report highlights the importance of assessing the MICS and atherosclerosis in MHD patients. (Korean J Med 71:635-645, 2006)

막성 사구체신염 혼자에서 스테로이드 치료 중 발생한 Kaposi 육종 치험

이호철 ( Ho Chul Lee ),김향 ( Hyang Kim ),박정식 ( Jeong Sik Park ),박현덕 ( Hyun Duk Park ),이규백 ( Kyu Beck Lee ),유재학 ( Jae Hak Yoo ),박찬필 ( Chan Phil Park ),박문향 ( Moon Hyang Park ) 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.1

Membranous glomerulonephropathy is a common cause of nephrotoc sundrome in adults. Kaposi sarcoma is a well-known entity with distinct clinical forms such as nodular cutaneous lesions, generalized lymphadenopathy and visceral involvement. Incidence of Kaposi sarcoma is greater in patients with immunosuppression, particularly those having undergone renal transplantation, but also in patients with other underlying disorders treated with immunosuppressive therapy, notably, corticosteroids. We present a case of Kaposi sarcoma in patient with membranous glomerulopathy during corticosteroid therapy. A 49-year-old man was admitted with a complain of facial and leg edema, 5-kg weight gain for 1 month and foamy urine. Kidney biopsy showed membranous glomerulopathy. We started corticosteroid therapy to the patient. Two month later, his 24 hrurinary protein was decreased to 2.1 g/day. But, the well defined, various-sized, purple-colored papules and plaque appeared on the both hands and feet. He underwent skin biopsy, which revealed abnormally proliferated and dilated vessels, vascular slits, spindle-shaped cells and extravasated erythrocytes in the dermis. The findings were in accordance with Kaposi sarcoma. So he received cryotherapy with discontinuing corticosteroid. Four months after cryotherapy, skin lesions were cleared leaving slight hypopigmentation and amount of proteinuria was preserved without definite aggravation.

혈액투석 환자에서 건강 관련 삶의 질 측정도구의 신뢰도 및 타당도

김현석 ( Hyun Sock Kim ),이규백 ( Kyu Beck Lee ),이용수 ( Yong Su Lee ),김향 ( Hyang Kim ),서병성 ( Byung Seong She ),임세원 ( Se Won Lim ),신호철 ( Ho Chul Shin ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.1

목적: 혈액투석 환자에서 QOL의 평가는 치료의 효과를 판정하는데 중요한 지표이며, 환자의 사망 및 예후를 잘 반영한다. QOL 측정은 여러 방법이 있으나, WHO-QOL와 SF-36 설문지를 사용한 방법이 간편하고, 세계적으로 널리 쓰이는 방법이다. 이러한 QOL 측정도구는 질환별, 언어적, 문화적 차이가 있을 수 있으므로, 각 질병에 따라서 각 나라마다 신뢰도 및 타당도 확인이 필요하다. 방법: 혈액투석환자 57명과 건강검진 수신자 60명을 대상으로 한국어판 WHO-QOL과 SF-36 설문지를 주어 자기 기입방식으로 조사를 하였다. 신뢰도를 보기 위하여 유지혈액투석 환자군을 대상으로 3개월 간격으로 WHO-QOL (26문항, 4개 영역)과 SF-36 (36문항, 8개 영역) 설문지를 이용한 검사-재검사 (test-retest)를 실시하고 영역 (domain) 별상관분석을 하고, 유지혈액투석 환자군을 대상으로 실시한 두 검사도구의 영역별 Cronbach α 계수를 측정하였다. 타당도를 보기 위하여 유지혈액투석 환자와 건강검진 수신자의 WHO-QOL과 SF-36 검사결과를 비교 분석하고, 유지혈액투석 환자를 대상으로 한 WHO-QOL과 SF-36의 동일한 의미를 지니는 영역간에 상관도를 분석하였다. 결과: 1. 유지혈액투석 환자에서 WHO-QOL과 SF-36은 영역별 상관분석에 있어서 SF-36의 신체적 역할제한 영역과 감정적 역할제한 영역을 제외하고 상관성이 있었으며 (p<0.01), Cronbach 계수는 WHO-QOL에서 항목별로 0.749-0.862이었고, SF-36에서는 0.666-0.944으로 각각의 검사 방법이 혈액투석 환자 삶의 질 측정에 있어 의미 있는 신뢰도를 보였다. 2. 타당도에서 유지혈액투석 환자에서 건강검진 수신자보다 SF-36의 신체적 역할제한 영역과 감정적 역할제한 영역을 제외하고 낮은 QOL을 보였고, 유지혈액투석 환자의 WHO-QOL과 SF-36의 관련 영역끼리는 높은 상관관계를 보였다. 결론: 혈액투석 환자에서 한국어판 WHO-QOL와 SF-36은 SF-36의 신체적 역할제한 영역과 감정적 역할제한 영역을 제외하고, 신뢰도와 타당도가 있는 검사로서 혈액투석 환자의 삶의 질 측정에 적합한 검사이다. 향후 우리나라 혈액투석 환자의 삶의 질 평가하는데 유용하게 사용할 수 있을 것으로 생각한다. Purpose: It is necessary to confirm of the reliability and the validity of health-related quality of life (HRQOL) methods, because there could be some difference according to the underlying diseases, languages and cultures. Methods: To assess the reliability, we did the test-retest by using the WHO-QOL (Korean version) and the SF-36 (Korean version) in the maintain hemodialysis (HD) patients (N=57). And then, we measured the Cronbach coefficient in the domains of both HRQOL methods. To assess the validity, we compared the result of both HRQOL methods in HD group with control group (N=60). We analyzed the inter-relationship of the domains which keep identical meanings in both methods. Result: 1. The test-retest showed high correlation between two tests, except the two domains of SF-36 which are the role limitation-physical activity (RP) domain and the role limitation-emotion (RE) domain. The Cronbach coefficients are range of 0.749-0.862 in the WHO-QOL, and 0.666-0.944 in the SF-36 (p<0.05). 2. We found that HRQOL of HD group was lower than that of control group except in the RP domain and the RE domain of SF-36. And there was the highest correlation between the domains which keep identical meaning of both HRQOL methods. Conclusion: The Korean WHO-QOL and SF-36 are reliable and valid to measure the QOL of ESRD patients except in the RP domain and the RE domain of SF-36. We expect these methods will be used easily in the evaluation of the HRQOL in HD patients.

투석 환자에서 연령에 따른 우울, 불안 및 긍정사고의 차이

노기원,하주원,임세원,이재은,이규백,김향,오강섭,Noh, Ki-Won,Ha, Juwon,Lim, Se-Won,Lee, Jae-Eun,Lee, Kyu-Beck,Kim, Hyang,Oh, Kang-Seob 대한불안의학회 2013 대한불안의학회지 Vol.9 No.1

본 연구는 혈액 투석 중인 성인 환자 집단과 노인 환자 집단 간의 우울, 불안 및 자율신경기능의 차이를 비교해 보고자 하였다. 정신의학적 특징들과 자율신경기능을 비교해보았을 때 만성질환에 견디어 내는 능력에 있어서 노인 환자 집단이 성인 환자 집단에 비해 취약하지 않은 결과를 보였다. 이는 만성질환을 앓고 있는 동일한 상황에서 노인들이 보다 긍정적 사고 경향을 가지고 있는 것과 관련되어 있을 것으로 생각된다. Objective : The end-stage renal disease patients who shared fear of death, functional impairment due to hemodialysis are vulnerable to depression, anxiety and other mental problems. It is possible that their psychiatric characteristics and related autonomic nervous functions have some differences depending on their age. We purpose to find the differences of psychiatric characteristics and related autonomic nervous functions between adult and elderly hemodialysis patients. Methods : Our subjects are end-stage renal disease hemodialysis patients composed of 39 adults (<65 years) and 24 seniors (${\geq}65$ years). Outcome measures included the 17-item Hamilton Rating Scale for Depression, The Hamilton Rating Scale for Anxiety, The Apathy Evaluation Scale and Mini-International Neuropsychiatric Interview by clinician. And subjects fulfilled self-report scale, The Positive thinking scale and The Snaith-Hamilton Pleasure Scale. The autonomic nervous functions are measured by heart rate variability. Results : There are no significant differences in demographic factors between two groups. The 17-item Hamilton Rating Scale for Depression, The Hamilton Rating Scale for Anxiety, The Apathy Evaluation Scale, The Snaith-Hamilton Pleasure Scale and autonomic nervous functions are also not different. But only positive thinking scale is higher in adult hemodialysis group than the elderly (F=5.395, p=0.024). Conclusion : This study compared depression, anxiety and autonomic nervous functions between adult and senior hemodialysis patients. There are no significant differences in psychiatric characteristics and autonomic nervous functions between two groups except positive thinking traits. Senior patients endured their chronic disease similar to adult patients did in spite of their old age. This result suggests that elderly's higher positive thinking traits affect their endurances about the negative situations.

거대요관과 거대방광이 동반된 선천성 신성요붕증 1 예

이은정(Eun Jung Rhee),이규백(Kyu Beck Lee),서정열(Jung Yul Suh),김향(Hyang Kim),박흥재(Heung Jae Park),김영학(Young Hak Kim),권칠훈(Chil Hun Kwon),이영래(Young Rae Lee) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4

A case of a 37 year-old man of congenital diabetes insipidus is reported. He complained of polydipsia, which began from his youth, drinking about 10 L of water every day. He didn't look ill or mentally retarded. In his family, his only brother has shown similar symptoms and his older sister had no symptom. On radiologic study, both kidneys showed severe hydronephrosis and the bladder was markedly distended. Water deprivation test was performed. The result was consistent with diabetes insipidus and the urine osmolality didn't respond to antidiuretic hormone injection, and he was diagnosed as nephrogenic diabetes insipidus. We began to treat him with thiazide and amiloride. The amount of water he's been drinking daily has decreased to 3-4 L per day. We discuss this case with a brief review of literature.