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증례 : 소화기 ; 마이코페놀릭산 병합요법으로 조절된 면역글로불린 G4 연관성 질환
김지은 ( Ji Eun Kim ),차진주 ( Jin Joo Cha ),김선우 ( Sun Woo Kim ),홍유아 ( Yu Ah Hong ),고강지 ( Gang Jee Ko ),권영주 ( Young Joo Kwon ) 대한내과학회 2015 대한내과학회지 Vol.89 No.6
IgG4-related disease (IgG4-RD) is a group of fibro-inflammatory diseases affecting multiple organ systems, pathologically characterized by tissue infiltration with abundant IgG4-positive cells. We here report a case of IgG4-RD that was successfully controlled by mycophenolic acid (MPA). A 62-year-old male visited complaining of dizziness and loss of appetite. He had a clinical history of autoimmune pancreatitis treated with steroids and cyclophosphamide 5 years prior, and had also been diagnosed with Hashimoto’s thyroiditis at the age of 55 years. We initially prescribed prednisolone (1 mg/kg), tapered to 5 mg/day over 8 months. However, his eosinophilia gradually deteriorated, and we added cyclophosphamide (1 mg/kg daily) for the next 7 months. His laboratory data fluctuated when he was on low-dose predinisolone and cyclophosphamide, and we thus changed his medication to prednisolone combined with MPA for the following 63 months. Currently, his laboratory findings are stable. (Korean J Med 2015;89:690-694)
김선철 ( Sun Chul Kim ),차진주 ( Jin Joo Cha ),오세원 ( Se Won Oh ),권오성 ( Oh Sung Kwon ),강영선 ( Young Sun Kang ),김형규 ( Hyeong Kyu Kim ),차대룡 ( Dae Ryong Cha ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.4
A renal infarct is too rare a disease for early diagnosis and treatment. Furthermore, it presents nonspecific symptoms in many patients. Cardiac diseases such as valvular heart disease and arterial fibrillation are the most common causes of renal infarct. Vascular disease such as renal artery dissection or aortic dissection, trauma, inflammation, vasculitis, malignancy and antiphospholipid syndrome have been also known as possible causes of renal infarct. In acute pancreatitis, adjacent vessels can be involved, and were reported to induce splenic infarction, portal vein thrombosis and superior mesenteric vein thrombosis etc. However, the renal infarct from renal artery involvement in acute pancreatitis has not yet been reported. In our case, a 46 year old male patient had an abdominal trauma due to an in-car accident to develop a rupture of pancreatic tail. The progression of acute pancreatitis caused the inflammation of left renal artery, leading to renal artery obstruction. We report a case of renal infarct developed in acute pancreatitis.
이재원 ( Jae Won Lee ),김선철 ( Sun Chul Kim ),오세원 ( Se Won Oh ),차진주 ( Jin Joo Cha ),김혜원 ( Hye Won Kim ),부창수 ( Chang Su Boo ),이지은 ( Ji Eun Lee ),권영주 ( Young Joo Kwon ),표희정 ( Heui Jung Pyo ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.2
The introduction of plasma exchange has significantly improved the outcome of thrombotic thrombocytopenic purpura (TTP) and the survival rate was increased from 10 to 80-90%. TTP refractory to plasma exchange therapy, however, is still a therapeutic challenge. We describe here a patient who partially responded to plasma exchange therapy, but remained dependent on plasma infusions. To discontinue plasma therapy, several attempts using agents such as rituximab, vincristine, and cyclosporine A had been tried, but all failed. After splenectomy, serum LDH and blood platelet count were normalized. Plasmapheresis were we able to discontinue after 2 weeks of splenectomy. Steroid and cyclosporine were tapered off after 3 months and 5 months after splenectomy respectively, and the patient has been staying in remission ever since. We suggest that splenectomy is a worthwhile treatment option in patients with refractory TTP.
혈액투석 환자의 우울 증상과 염증반응 및 심혈관 질환 위험 인자의 연관성
현영율 ( Young Youl Hyun ),김선철 ( Sun Chul Kim ),오세원 ( Se Won Oh ),차진주 ( Jin Joo Cha ),김혜원 ( Hye Won Kim ),이재원 ( Jae Won Lee ),최윤석 ( Yoon Seok Choi ),최혜민 ( Hye Min Choi ),부창수 ( Chang Su Boo ),고강지 ( Gang J 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.4
목적: 우울증 환자에서 염증 반응의 증가가 관찰되며, 심혈관계 합병증이 증가한다는 것이 알려져 있다. 또한 만성신부전 환자의 주된 사망 원인은 심혈관계 합병증이며, 우울 증상은 만성신부전 환자에서 흔히 관찰되는 증상이다. 이 연구의 목적은 유지 혈액투석을 받고 있는 만성신부전 환자에서 우울 증상과 다양한 염증 표지자 및 심혈관계 합병증의 위험 요소들과의 연관 관계를 밝히는 것이다. 방법: 고려대학교 안암 병원에서 유지 혈액투석을 받고 있는 53명의 환자들을 대상으로 연구하였다. Beck 우울증 척도(BDI)가 11 이상인 환자들을 우울 증상군으로, 10 이하인 환자들을 대조군으로 정의하였다. 의무기록을 통해 각 군의 환자들의 특성과 검사소견을 수집하였으며, 각 환자군에서 혈중 IL-10, TNF-α 농도를 측정하고, IL-10 과 TNF-α 프로모터 영역의 유전형 변이를 분석하였다. 결과: TNF-α, CRP 및 ferritin의 농도는 우울 증상군에서 유의하게 높았으며 (p=0.001, 0.04, 0.02), IL-10의 농도는 우울 증상군에서 낮게 관찰되었다 (p=0.05). 좌심실 비대의 빈도는 대조군에 비해 우울 증상군에서 높았다 (44% vs 9%, p=0.01). 프로모터 영역의 유전형 변이 분석에선, IL-10을 더 많이 생산하는 것으로 알려진 GG 유전형 변이가 대조군에 비해 우울 증상군에서 더 적게 관찰되었다 (8% vs 35.7%, p=0.039). 결론: 우울 증상을 보이는 혈액투석 환자에서 염증 반응의 증가 및 좌심실비대, 좌심실 구혈률 감소 등 심혈관계 질환 위험 인자의 증가가 관찰되며, 향후 이들 간의 인과 관계를 밝히기 위한 후향적 연구가 필요할 것으로 생각된다. Purpose: Depression is associated with increased inflammation and cardiovascular disease. And in patients with end stage renal disease (ESRD), depression is a common problem and cardiovascular disease is the main cause of death. The aim of this study is to investigate the association of depression with various inflammatory markers and with some cardiovascular risk factors in ESRD patients on hemodialysis. Methods: 53 patients with ESRD on maintenance hemodialysis were divided into depressive symptom (BDI≥11) group and control (BDI<11) group by the 21-items Becks depression inventory (BDI). We collected patients characteristics and laboratory measurements by medical records. And then, we measured the levels of IL-10 and TNF-αaand analyzed the genotype of IL-10 and TNF-αapromoter area. Results: The levels of TNF-α, CRP and ferritin were significantly higher in depressive symptom group (p=0.001, 0.04, 0.02) and IL-10 concentration tended to be lower in depressive symptom group (p= 0.05). The prevalence of left ventricular hypertrophy was higher in depressive symptom group than in the control group (44% vs 9%, p=0.01). GG genotype known as high IL-10 producer was less common in depressive symptom group than in control group (8% vs 36%, p=0.039). Conclusion: Increased inflammation, high left ventricular hypertrophy prevalence and low ejection fraction were observed in depressive hemodialysis patients. Further prospective study is needed to clarify the role of depression in the development of inflammation and cardiovascular disease in ESRD patients.
신동맥 결찰술 후 발생한 신증후군 범위의 단백뇨를 동반한 신혈관성 고혈압 ACE 억제제와 안지오텐신 2 1형 수용체 차단제 병합요법에 의한 성공적 치료
오세원 ( Se Won Oh ),김선철 ( Sun Chul Kim ),차진주 ( Jin Joo Cha ),김명규 ( Myung Gyu Kim ),우영석 ( Young Seok Woo ),부창수 ( Chang Su Boo ),조상경 ( Sang Kyung Jo ),조원용 ( Won Yong Cho ),김형규 ( Hyoung Kyu Kim ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.3
A 27-year-old woman presented with severe hypertension and nephrotic range proteinuria. She had a blunt renal trauma 4 weeks ago and was treated by the left main renal artery ligation. The plasma renin activity, angiotension II and aldosterone levels were very high and the abdominal angiography showed the occlusion of the left main renal artery with relatively preserved blood flow in upper pole of the left kidney. In captopril renal scan, relatively preserved perfusion in upper pole of left kidney was further compromised after captopril administration. The massive proteinuria and hypertension were improved after combination of ACE inhibitor and angiotensin II type 1 receptor blocker treatment.