B 형 간염 표면항원 양성인 막증식성 사구체신염 3 형 환자의 임상상

임천규(Chun Gyoo Ihm) 대한내과학회 2002 대한내과학회지 Vol.63 No.2

N/A

디클로페낙(Diclofenac Sodium)에 의한 미세변화 신증후군

임천규(Chun Gyoo Ihm),이태원(Tae Won Lee),김명재(Myung Jae Kim),박경분(Kyoung Bun Park),한요셉(Yo Seb Han),양문호(Moon Ho Yang) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3

NSAIDs are now the most widely prescribed of all drugs for the therapy of a large variety of disorders including rheumatologic disorders, and so the population of patients who are at risk for adverse effects of these drugs is rapidly expanding. A number of renal and electrolyte problems have been associated with the use of NSAIDs, including alterations in glome-rular filtration rate, hyperkalemia, acute interstitial nephritis and papillary necrosis. While the use of NSAIDs has also been associated with minimal change nephrotic syndrome, this complication has almost invariably occured in association with an acute inter-stitial nephritis. Recently, we experienced a case of minimal change nephrotic syndrome without significant interstitial inflammation associated with the use of NSAIDs. This patient is a 64-year-old female who developed the generalized edema and about 10kg of weight gain since three days ago. She had taken the anti-inflammatory drugs for five years intermittently and started taking diclofenac sodium, 25mg orally three times a day, 10 days before admission for increasing pain in her knees. Laboratory findings disclosed the following values WBC 5,200/mm³with only 0.6% eosinophils, total serum protein 4.0g/dL, albumin 1.2 g/dL, BUN 17mg/dL, creatinine 0.8mg/dL, sodium 140 mmol/L, potassium 4.0mmol/L, chloride 113mmol/L, total cholesterol 338mg/dL, triglyceride 203mg/dL; 24-hour protein excretion 3.6g, creatinine clearance 52.8 mL/min ; serologic tests were unremarkable. A renal biopsy revealed no abnormality except for focal mild interstitial infiltration of chronic inflammatory cells with a few atrophic tubules on light microscopy. Im-munofluorescence studies showed diffuse trace mesan-gial deposits of IgM, and electromicroscopy revealed diffuse obliteration of the epithelial foot process and villous transformation of the epitherial cell cytoplasms without electron-dense deposits. These findings were consistent with minimal-change disease. Diclofenac was discontinued on admission because of the likeli-hood the renal disease was drug-related and she treated with low-dose(40-80mg/d) of furosemide. Four-teen days after stopping diclofenac, her massive edema and weight gain resolved and laboratory studies showed a 24-hour urine protein excretion of 80mg and serum albumin of 2.7g/dL. There has been no relapse for five months since then.

일차성 사구체신염의 치료

임천규 ( Chun Gyoo Ihm ) 대한내과학회 2013 대한내과학회지 Vol.84 No.1

Much progress has been made in the elucidation of potential pathogenetic mechanisms of glomerulonephritis such as anti-PLA2R autoantibody in membranous nephropathy and under-galactosylated IgA1 in IgA nephropathy as well as in the fields of treatment. This knowledge is, hopefully in the future, being applied in the development of the creation of rational therapeutic approaches. Current treatment strategies for glomerular diseases recommended by many clinical studies include high-dose glucocorticoids, calcineurin inhibitors, cyclophosphamide, mycophenolate mofetil, and rituximab. Although these therapies have been effective in treating immune-mediated glomerular diseases, they all have potentially serious side effects. (Korean J Med 2013;84:13-18)

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.

Renal/Hematologic Disorders and Liver : Glomerulonephritis associated with liver disease

임천규 ( Chun Gyoo Ihm ) 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.2(S)

Pathogenesis of IgA Nephropathy

임천규(Chun Gyoo Ihm) 대한신장학회 2000 춘계학술대회 초록집 Vol.2000 No.-

N/A

종설 : IgA 신증 40여 년

임천규 ( Chun Gyoo Ihm ) 대한내과학회 2009 대한내과학회지 Vol.77 No.4

IgA nephropathy is characterized by the predominant deposition of IgA in a granular fashion diffusely in the mesangial zones of glomeruli. IgA nephropathy was first described over four decades ago and is now the most common form of primary glomerular disease. Much progress has been made in the elucidation of potential pathogenetic mechanisms such as undergalactosylated IgA1 as well as in the fields of clinical features, prognosis, and treatment. This knowledge is being applied in the development of new diagnostic methods and hopefully in the future the creation of novel and rational therapeutic approaches. (Korean J Med 77:435-443, 2009)

지질강하제에 의한 횡문근 융해증

임천규(Chun Gyoo Ihm),김명재(Myung Jae Kim),김광원(Kwang Won Kim),최영길(Young Kil Choi),고은미(Eun Mi Koh),이태원(Tae Won Lee) 대한핵의학회 1990 핵의학 분자영상 Vol.24 No.1

Bezafibrate is a lipid-lowering agent and one of the fibric acid derivatives. It is relatively safe and well tolerated and adverse reactions to bezafibrate have largely been restricted to gastrointestinal distrubances. But a few cases of rhabdomyolysis after bezafibrate administration have been reported and recently we experienced bezafibrate-induced rhabdomyolysis in patients with chronic renal failure. So we report this case with the bone scan finding and the literature review. We believe that this is the first case report of bezafibrate-induced rhabdomyolysis in Korea. AB: Bezafibrate is a lipid-lowering agent and one of the fibric acid derivatives. It is relatively safe and well tolerated and adverse reactions to bezafibrate have largely been restricted to gastrointestinal distrubances. But a few cases of rhabdomyolysis after bezafibrate administration have been reported and recently we experienced bezafibrate-induced rhabdomyolysis in patients with chronic renal failure. So we report this case with the bone scan finding and the literature review. We believe that this is the first case report of bezafibrate-induced rhabdomyolysis in Korea. AB: Bezafibrate is a lipid-lowering agent and one of the fibric acid derivatives. It is relatively safe and well tolerated and adverse reactions to bezafibrate have largely been restricted to gastrointestinal distrubances. But a few cases of rhabdomyolysis after bezafibrate administration have been reported and recently we experienced bezafibrate-induced rhabdomyolysis in patients with chronic renal failure. So we report this case with the bone scan finding and the literature review. We believe that this is the first case report of bezafibrate-induced rhabdomyolysis in Korea.

종설 : 사구체 신염에서의 백혈구의 역할과 그 기전 ( Review : The Role of Leukocytes in Glomerulonephritis )

임천규(Chun Gyoo Ihm) 경희대학교 경희의료원 1996 慶熙醫學 Vol.12 No.1

산증후군환자에 대한 사이크로스포린의 유효성 및 안전성 평가를 위한 16주 공개 다기관 제 3상 임상시험

김도현,신규태,임천규(Chun Gyoo Ihm),조동규(Dong Kyu Cho),이태원(Tae Won Lee),김명재(Myung Jae Kim),김흥수(Heung Soo Kim),이호영(Ho Yung Lee),신석균(Sug Kyun Shin),홍성표(Seong Pyo Hong),노현진(Hyunjin Noh),김용림(Young Lim Kim) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2

N/A A multicenter prospective study was done in four-university hospital to evaluate the efficacy and safety of cyclosporin A(CyA, Cipol-N) in 64 patients with adult nephrotic syndrome mean age 34.8 years, male:female 2.4:1, duration of disease 38.0±40.9months, 31 patients with MCD, 33 patients with Non-MCD(8 FSGS, 14 MGN, 7 MPGN, 2 lupus nephritis, 1 HBsAg associated GN)]. The prior steroid responses of these patients were 17 steroid dependent, 9 frequent relapser, 4 steroid resistant and 1 other in MCD patients, and 5 steroid dependent, 5 frequent relapser, 22 steroid resistant and 1 other in Non-MCD patients. After a 2-week steroid(predni-solon 10mg/day or deflazacort 12mg/day) run-in period, CyA 5mg/kg/day and prednisolone 10mg/day (or deflazacort 12mg/day) were administered for up to 16 weeks. Of the 64 patients enrolled, ll patients were dropped out prematurely due to adverse events or protocol violation. Of the 53 patients who completed the study, 27 had MCD and 26 had Non- MCD. High response(CR and PR) rate of 68%(36/53) were obtained with CyA treatment in all patients. Although the response rate in MCD was significantly higher than that in Non-MCD(89 vs. 46%, p<0.05) and response rates were significantly different according to the previous steroid responses by univariate analysis, only previous steroid responses affected the response to CyA significantly by Logistic multiple regression analysis(p=0.03, RR 7.08); responses were 84%(27/32) in steroid dependent and frequent relapser patients, and 37%(7/19) in steroid resistant patients. 24-hr proteinuria significantly decreased after 2 weeks and serum albumin and cholesteroi increased significantly after 4 weeks of treatment compared to baseline level. The serum creatinine level was not changed during the study. No serious and unexpected side event was observed. In conclusion, cyclosporine therapy is a safe and effective mode of treatment in patients with ne-phrotic syndrome, especially in those who need pro- longed administration of steroids with resulting in unavoidable steroid complications such as frequent relapser and steroid dependent type. The patients with steroid resistant type and contraidications of steroid administration such as DM, aseptic bone neerosis etc. can also be candidates for this treatment.