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.

리튬에 의해 유발된 막성신병증 1예

조성태,고진석,윤인상,김진철,전로원,노정우,남은숙 대한내과학회 2002 대한내과학회지 Vol.63 No.6

The lithium is widely employed as a psychotropic agent, specially in manic illness. Lithium nephrotoxicity can be divided into three main categories: nephrogenic diabetes insipidus, acute intoxication, chronic nephropathy including interstitial nephropathy and glomerulopathy manifested as nephrotic syndrome. But, nephrotic syndrome induced by lithium is very rare. We reported a nephrotic syndrome induced by lithium in a 27-year-old woman who was taking lithium carbonate for 11 years due to bipolar disorder. Renal biopsy showed membranous nephropathy. After withdrawal of lithium, clinical symptoms and proteinuria significantly improved.

혈액투석복수의 특서과 발새기전에 관한 연구 : 혈액투석의 적절도(Kt/V urea) 및 혈청복수알부민농도경사(Serum ascites albumin gradient:SAAG)를 중심으로 Hemodialy sis adequacy(Kt/V urea) and serum ascites albumin gradient(SAAG)

구자룡,양익,채동완,김근호,박규용,노정우,김형직,전로원,육청미,김현태 대한내과학회 2000 대한내과학회지 Vol.59 No.3

Background : The aim of this study was to characterize the nature and elucidate the pathogenesis of hemodialysis ascites(HA), especially with regard to the levels of Serum Ascites Albumin radient(SAAG) and the degrees of hemodialysis adequacy(Kt/Vurea). Methods : In the study group, seven cases of HA which had developed in 6 patients from Feb. 1997 through July 1998 were included. In the control group, 24 cases which had not developed HA were included. The study design was a retrospective. Analysis of ascites on WBC, total protein and albumin, cytology, ADA(Adenosine deaminase), osmolality, SAAG and routine work-up were performed in HA group. Serum total protein and albumin, C-reactive protein(CRP), osmolality, and routine liver function test were also checked. Kt/Vurea and weekly Kt/Vurea were calculated in both group. In statistical analyses, t-test and chi-square test were used. Results : Mean SAAG of HA was $gt;1.1(1.49±0.40) gm/dL, and mean concentration of total protein of HA was $gt;2.5(4.26±0.58) gm/dL. T mean of weekly Kt/Vurea of patients with HA(2.61±0.85) was significantly lower than that of patients without HA(3.48±0.90)(p$lt;0.05). Positive ratio of CRP in patients with HA was higher than that of patients without HA(p$lt;0.05). Mean concentration of serum total protein was significantly higher in patients with HA than that of patients without HA but with comparable weekly Kt/Vurea levels(p$lt;0.05). Conclusion : It is regarded that the nature of HA is an exudate having high SAAG over 1.1 gm/dL. Low weekly Kt/Vurea is suggested as a cause of HA. Chronic inflammation was also regarded as an important factor causing HA.(Korean J Med 59:283-289, 2000)

Erythropoietin 투여중인 만성 신부전 환자에서 발병한 급성 골수성 백혈병 1예

박수현,김현태,구자룡,채동완,김근호,박규용,노정우,이준상,여미애,김형직,전로원,권성희 대한내과학회 2000 대한내과학회지 Vol.59 No.6

Recombinant human erythropoietin is a synthetic glycoprotein hormone and has the effect on bone marrow erythroid progenitor cells. Therefore, recombinant human erythropoietin has been frequently used as an agent treating anemia in chronic renal failure patients. However, Stockenhuber reported that recombinant human erythropoietin also affected other bone marrow progenitor cells (colony- forming unit-granulocyte-erythrocyte-macrophage, colony-forming-gra-nulocyte-macrophage). This reports may suggest a possible casual relationship between acute myeloid leukemia and erythropoietin. Acute myeloid leukemia is a rare disease in patients with chronic renal failure especially on erythropoietin treatment. By this time only a case of acute leukemia in chronic renal failure was reported by Campistrus in 1995. Campistrus's case was on the remission state of acute myeloid leukemia, and erythropoietin was administered to treat anemia of chronic renal failure. Also no previous case of acute myeloid leukemia developed in chronic renal failure patients on erythropoietin treatment was yet reported in Korea. So, we report a case of acute myeloid leukemia developed in a pre-dialysis chronic renal failure patient but on erythropoietin treatment.(Korean J Med 59:674-678, 2000)

혈액투석으로 전환하여 성공적으로 치료한 복막투석치료중인 당뇨병성 만성신부전환자에서 발생한 고삼투압성 혼수

구자룡,이형철,김형직,채동완,박규용,노정우,권성희,이준상,전로원,고경식,박경창,윤정이,김근호 대한내과학회 1999 대한내과학회지 Vol.57 No.5

Continuous ambulatory peritoneal dialysis(CAPD) is now the most important and effective therapeutic modality as well as hemodialysis(HD) and renal transplantation in patients with chronic renal failure. It is frequently recommended to diabetic renal failure patients because of poor, athersclerotic vascularity of them. Hyperglycemia and obesity are not uncommon complications of CAPD therapy. But there were only few reports of very severe hyperglycemia or hyperosmolar coma in CRF patients on CAPD therapy, especially with 7% dextrose CAPD dialysate in foreign countries in the past. Moreover, no specific management for hyperosmolar coma is established in those situations yet. In Korea, only three cases of hyperosmolar coma in non diabetic renal failure patient on CAPD therapy have been reported in one case report. And only one case among them whose CAPD therapy was changed to HD survived. Authors also experienced a case of diabetic hyperosmolar coma treated successfully with conversion to HD in chronic renal failure patient on CAPD therapy. So we report this case with a review of literature. Taken together with this case and review of literature, changing CAPD therapy to HD is regarded to be an important part of treatment when hyperosmolar coma develops in chronic renal failure patients. (Korean. J. Med 57:946-949, 1999)

조기위암에 병발한 미세변화 신증후군양 IgA 신병증 1 예 : 국내외 보고 예 고찰

김진철,이상무,구자룡,정성원,김우중,이현순,조성태,윤종우,오흥영,채동완,김근호,노정우,김형직,전로원,육청미 대한내과학회 2001 대한내과학회지 Vol.61 No.3

The nephrotic syndrome has been reported in association with a wide variety of neoplastic disease. The relationship between early gastric cancer and glomerulonephritis has not been well elucidated. Only 6 cases (5 cases in Korea and 1 case in Japan) have been reported associated with glomerulonephritis by this time. 5 cases in Korea included three cases of membranous glomerulonephritis, one case of IgA nephropathy and membranoproliferative glomerulonephritis. Four out of six cases including presented case were mucin secreting adenocarcinomas of stomach. Minimal change disease associated with solid tumors has been reported very rarely. Three cases of colon adenocarcinoma have been reported in association with minimal change disease by this time. Complete remission of nephrotic syndrome with tumor resection without corticosteroid therapy was reported in one of three cases, but two of them had to be on corticosteroid therapy in addition to tumor resection to get complete remissions. We report a 44-year-old man case with nephrotic syndrome associated with early gastric cancer. Renal biopsy findings were indicative of minimal change disease but with scanty IgA deposition. Low grade IgA nephropathy was suggested. Endoscopic biopsy on stomach demonstrated the adenocarcinoma with signet ring cells. Serum IgA concentration was 543 mg/dL, and decreased to 336 mg/dL after tumor resection. But, owing to persistent proteinuria and acute renal failure complicated, corticosteroid therapy was applied on the 30th day after operation. So we could not prove definite relationship between early gastric cancer and the development of IgA nephropathy mimicking minimal change disease. But, it is regarded that normalized serum IgA level and the complete remission of nephrotic syndrome with tumor resection and corticosteroid therapy can be indirect evidences for the relationship between early gastric cancer and the development of IgA nephropathy mimicking minimal change disease.(Korean J Med 61:286-292, 2001)

카드뮴 중독과 연관된 성인형 Fanconi 증후군 1 예

박수현,한진석,구자룡,남은숙,여미애,곽성재,채동완,김근호,박규용,노정우,김형직,전로원,김현태,전은실 대한내과학회 2001 대한내과학회지 Vol.61 No.3

Adult Fanconi syndrome is a very rare disease characterized by renal glycosuria, generalized aminoaciduria, hypophosphatemia, hypouricemia and proximal renal tubular acidosis. It is divided into inherited and acquired forms. Proximal tubular transport defect in acquired Fanconi syndrome has been known to be resulted from multiple myeloma, dysproteinemias, heavy metal poisoning and chemical intoxications. A 50-year-old woman was admitted because of nausea for 2 weeks and body weight loss for 4 months. Leukocyte count, hemoglobin level and platelet count were 7,870/mm3, 11.7 g/dL 404,000/mm3 each. The urinalysis showed pH of 7.0, 3 positive for glucose and 3 positive for protein. The serum calcium, phosphate, uric acid and potassium were low to 8.9 mg/dL, 1.0 mg/dL, and 1.7 mEq/L. Serum creatinine level was 1.3mg/dL. The arterial blood gas analysis showed that the pH was 7.292 and bicarbonate was 14.7 mmol/L. Determination of amino acids in 24 hour urine specimen revealed the generalized aminoaciduria. Renal biopsy showed degeneration and necrosis of proximal tubules with normal glomeruli. Some tubular epithelial cells had enlarged nuclei and prominant nucleoli with vacuolated large mitochondrias. Cadmium concentrations of blood and urine were definitely higher than normal. The concentration of β2-microglobulin in urine was also high. Bicarbonate loading tests showed increased fractional excretions of bicarbonate in urine (6.129% at blood pH 7.248 and plasma HCO3 18.8 mEq/L, 13.7% at blood pH 7.315 and plasma HCO3 21.8 mEq/L). 24 hour urine protein electrophoresis showed no monoclonal gammopathy. This case of adult Fanconi syndrome was regarded to be related with cadmium intoxication. But no case of adult Fanconi syndrome related with cadmium toxicity has been reported yet in Korea. So authors report this case with brief review of literatures. (Korean J Med 61:276-280, 2001)