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우리나라 무증상 성인에서의 신장기능 및 성인병의 발현빈도
진동찬(Dong Chan Jin),윤영석(Young Suk Yoon),신영신(Young Shin Shin),송호철(Ho Cheol Song),박철휘(Cheol Whee Park),안석주(Seog Ju Ahn),김석영(Suk Young Kim),최의진(Euy Jin Choi),장윤식(Yoon Sik Chang),방병기(Byung Kee Bang) 대한내과학회 1996 대한내과학회지 Vol.51 No.5
N/A Objectives: This report is the results of mass study on renal functions and prevalence of adult diseases in asympotmatic Korean. Methods: The subjects were 50,000 persons (male 31,633, female 18,367) who were enrolled a regular health check up program, June 1990 to Dec 1994, at Catholic Medical Center, Korea. Results: The mean serum creatinine were 1.073±0.19㎎/dl in male and 0.824±0.13㎎/dl in female. Abnormal creatinine (over mean plus 2 standard deviation) prevalence rate were 0.37% in male (1.6㎎/dl and aver) and 0.65% in female (1.2㎎/dl and over). The prevalence of urine occult blood (one positive) were 3.6% in male, 13.4% in female. The proteinuria were 3.3%, 2.1%, respectively. The differences between age group of serum creatinine were little, but that of blood pressure, cholesterol, body mass index were significant, especially before and after menopause in woman. The prevalence of hypertension were 27.1% in male and 24.2% in female. Hyperlipidemia and obesity (BMI over 25㎏/㎡) were 9.5, 9.3% in male and 28.9, 25.0% in female, respectively. Conclusion: These data were may represent overall Korean normal value and could be useful as reference value in Korea.
혈액투석중인 말기신부전 환자에서 부갑상선 호르몬에 관여하는 임상인자
송호철(Ho Cheol Song),최의진(Euy Jin Choi),김선화(Seon Hwa Kim),천지성(Ji Seong Chun),박주현(Joo Hyun Park),신영신(Shin Young Shin),김영옥(Young Ok Kim),윤선애(Sun Ae Yoon),김석영(Suk Young Kim),장윤식(Yoon Sik Chang),방병기(Byung Ke 대한내과학회 1998 대한내과학회지 Vol.55 No.5
N/A Objectives: Renal osteodystrophy has been recognized as one of the major complications in long-term hemodialysis patients. Bone histomorphology is the definite method for diagnosis but plasma intact PTH level has predictive value for diagnosis of renal osteodystrophy. We performed this study to evaluate the prevalence and correlating factors of secondary hyperparathyroidism in ESRD patients Methods: we analyzed the intact PTH level(normal value: 12-72 pg/ml) and clinical parameters in 309 maintance hemodialysis patients retrospectively. Results: The causes of ESRD were chronic glomerulonephritis(32%) diabetic nephropathy(25%) and hypertensive nephropathy(13%). In hemodialysis patients, the mean duration were 48±43 months, the serum phosphorus levels were 5.0±1.8 mg/dl, and the serum albumin levels were 3.9±0.6 gm/dl. The intact PTH levels were 175±266 pg/ml. The incidence of hypercalcemia (>10.5 mg/dl) in patients was 4.6% and the incidence of hypocalcemia (<8.5mg/dl) was 26.4%. Twenty-five percent of the patients had iPTH level more than three times normal. Another 42% had a less than normal iPTH level. In multiple regression, serum calcium(r=-0.24), age(r=-0.17) and duration of dialysis (r=0.15) correlated significantly with iPTH level, The iPTH levels between diabetic(82±139 pg/ml) and nondiabetic(229±320 pg/dl) patients were significantly different(P<0.01). But there are no significant correlation between sugar control and iPTH level. Conclusion: We conclude that the iPTH levels were significantly correlated with the age, durations of hemodialysis and the serum calcium levels, Level of intact iPTH in diabetic group were significantly lower than nondiabetes in hemodialysis.
신이식환자에서 B 형 및 C 형 간염의 유병율과 임상경과
양철우(Chul Woo Yang),신영신(Young Shin Sin),윤선애(Sun Ae Yoon),진동찬(Dong Chang Jin),안석주(Suk Joo Ahn),김용수(Yong Soo Kim),최의진(Euy Jin Choi),장윤식(Yoon Sik Chang),윤영석(Young Suk Yoon),방병기(Byung Kee Bang) 대한내과학회 1994 대한내과학회지 Vol.47 No.5
N/A Objectives: To evaluate the prevalence and clinical course of HBsAg positive and anti-HCV positive renal transplant recipients. Methods: According to serologic result, we divided the patients into HBsAg positive (HBV) and anti-HCV positive (HCV) group, and evaluated the clinical course based on duration and severity of hepatic dysfunction. Mean duration of observation was 3.8 years. Results: 1) HBsAg positivity was 11.3% and anti-HCV positivity was 13.3%, respectively. Before transplantation, in HBV group, HBsAg positivity was observed in 83.5% before renal transplantation, and 16.5% patients acquired HBsAg after renal transplantation, In HCV group, anti-HCV positivity was observed 54% before transplantation and 19.6% acquired anti-HCV after renal ransplantation. 2) The prevalence of chronic hpatitis in HBV and HCV grup was not different (25.7% vs. 25.5%). Among those with chronic hepatitis in HBV group, four cases progressed to fulminant hepatic failure, one case progressed end-stage of liver cirrhosis and one case progressed to hepatocelluar carcinoma. However, in HCV group, no case showed progression of chronic hepatitis. 3) Overall mortality of HBV and HCV group 25.3% and 7.8%, respectively (p=0.001): Among twenty fatal cases in HBV group 9 cases were liver disease-related but no liver disease-related death was observed in HCV group. Conclusion: HCV as well as HBV infection is quite prevalent and implortant cause of posttransplant chronic hepatitis, and clinical course of anti-HCV-posi- tive recipients are less aggressive than HBsAg positive recipients.
윤영석(Young Suk Yoon),구완서(Wan Suh Koo),박인석(In Suk Park),김석영(Suk Young Kim),최의진(Euy Jin Choi),방병기(Byung Kee Bang) 대한내과학회 1991 대한내과학회지 Vol.41 No.2
N/A To investigate a possible association between intracellular free calcium and blood pressure in normotensive subjects and patients with essential hypertension, intraplatelet free calcium was measured with intracellularly trapped fluorescent indicator Fura 2-AM. The results were as follows: 1) Intraplatelet free calcium levels were significantly higher in patients with essential hypertension than in normotensive subjects (222.4±58.0 vs. 119.6±10.9 nM; p < 0.0001). 2) There was a close correlation between the intraplatelet free calcium levels and the systolic, diastolic and mean blood pressure (n=45; r=0.817 for SBP, 0.728 for DBP, 0.800 for MBP; p<0.0001, respectively). 3) Antihypertensive treatment with calcium channel blookers or beta-blockers resulted in a reduction in both blood pressure and intraplatelet free calcium(p<0.0001). 4) There was a significant correlation between intraplatelet free calcium and serum cholesterol concentration (r=0.462, p<0.05). Based on the above findings, there was a close correlation between the free calcium level in platelets and blood pressure, and the serum cholesterol concentrations. Antihypertensive treatment with calcium channel blockers or beta blockers resulted in a reduction in free calcium, which correlated with the fall in blood pressure.
이화정 ( Hwa Jeong Lee ),정미향 ( Mi Hyang Jung ),정희경 ( Hee Kyoung Jeong ),김진진 ( Jin Jin Kim ),모은영 ( Eun Yeong Mo ),김용균 ( Yong Kyun Kim ),송호철 ( Ho Cheol Song ),최의진 ( Euy Jin Choi ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.1
Acute pyelonephritis is a common disease in clinical practice. Renal vein thrombosis in acute pyelonephritis has become a rare complication at present because of the advances of antibiotics. The trend in management has shifted to non-surgical therapies, particularly systemic anticoagulation, except in highly selected group of patients. Here we report the case of a 67-year-old woman who got hospitalized for fever and chilling. Acute pyelonephritis was diagnosed by clinical manifestation and positive urine and blood cultures. Computed tomography demonstrated left pyelonephritis and ipsilateral renal vein thrombosis. She was fully recovered after treatment with antibiotics, low molecular weight heparin and warfarin for 8 weeks.
신 이식 환자에서 B 형과 C 형 간염 바이러스 감염 환자의 15 년간 추적 조사
김용수(Yong Soo Kim),장윤식(Yoon Sik Chang),방병기(Byung Kee Bang),김형욱(Hyung Wook Kim),양철우(Chul Woo Yang),최의진(Euy Jin Choi),최범순(Bum Soon Choi),김석영(Suk Young Kim),김성권(Sung Kwon Kim) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.3
목 적 : 신 이식 후 B형과 C형 간염 바이러스 감염에 의한 간질환은 신 이식 환자의 이환율, 사망률 및 생존율 등에 나쁜 영향을 미치는 것으로 보고되고 있으나 저자에 따라서 신 이식의 예후에 미치는 영향은 다르게 보고되고 있다. 저자들은 B형과 C형 간염 바이러스에 감염된 신이식 환자와 간염 바이러스 비감염 환자를 15년 동안 추적 관찰하여 신 이식의 예후에 미치는 영향에 관하여 비교 검토하고자 한다. 방 법 : 1984년 3월부터 1998년 12월 31일까지 가톨릭대학교 의과대학 강남성모병원에서 신 이식을 받은 1,042예 중 HBs Ag 양성군(HBV(+)군) 107예, anti-HCV Ab 양성군(HCV(+) 군) 81예, HBs Ag 및 anti-HCV Ab 모두 음성인(NBNC군) 714예를 대상으로 간질환의 유병율, 임상 경과, 사망률 및 생존율에 미치는 영향을 비교 검토하였다. 대상 환자 중 anti-HCV Ab 가 측정되지 않은 140예는 비교 연구에서는 제외하였다. 결 과 : 추적 기간 동안 환자의 사망률은 HBV(+)군 32.7%, HCV(+)군 9.9%, NBNC군 8.4%로서 HBV(+)군에서 훨씬 높았다. 특히 사망 환자 중 간질환에 의한 사망률은 HBV(+)군 57.1%, HCV(+)군 0%, NBNC군 1.7%로서 HBV(+)군에서 유의하게 높았다(p=<0.001). 5년과 10년 이식신 생존율은 HBV(+)군에서 52.2%와 39.2%, HCV(+)군에서 68.4%와 47.2%, NBNC군에서 86.6%와 65.8%로서 NBNC군에서 타군에 비하여 유의하게 높았다. 5년과 10년 환자 생존율은 HBV(+)군에서 72.0%와 63.9%, HCV군에서 91.8%와 87.3%, NBNC군에서 94.4%와 88.2%로서 HBV(+)군에서 타군에 비하여 훨씬 감소하였으며 HCV(+)군과 NBNC군 간에는 큰 차이는 없었다. 결 론 : HBV(+)군은 다른군에 비하여 신 이식 후 이식신 및 환자 생존률이 현저히 낮았다. 생존율이 낮은 원인은 특히 간질환에 의한 사망률이 타군에 비하여 높기 때문이었다. HCV(+) 군은 HCV(-)군에 비하여 이식신 생존율은 낮았으나 환자 생존율에 큰 차이가 없었다. HCV (+)군의 간질환은 면역억제제의 투여량을 조절하여 간질환의 진행을 예방할 수 있었으며 간질환의 의한 사망을 감소 시킬 수 있었다. Background : The impact of hepatitis B or hepatitis C virus infection on renal transplantation outcome is controversial. The aim of this study is to assess the impact of hepatitis B and hepatitis C infection on kidney transplant over the long-term, 15 years and to compare infected patients with noninfected patients matched for factors possibly associated with graft and patient survival. Methods : We analyzed 1,042 patients who underwent renal transplantation in period from March 1984 to Dec. 1998 including 107 with positive HBsAg (HBV(+) group), 81 with positive anti-HCV antibody (HCV(+) group) and 714 noninfected recipients (NBNC group). One hundred-forty patients who had not taken ani-HCV antibody screening test were excluded. The prevalence of chronic liver disease, the patient mortality, the patient survival rate and the graft survival rate were evaluated. Results : The patient mortality during the period of follow-up was significantly higher in HBV(+) group(32.7%) than in HCV(+) group(9.9%) and NBNC group(8.4%). The cause of death related to liver desease was significantly higher in HBV(+) group(57.1%) than HCV(+) group(0%) and NBNC group(1.7%). Five year and 10 year graft survival rate were significantly lower in HBV(+) group(52.2 %, 39.2%) than in HCV(+) group(68.4%, 47.2%) and NBNC group(86.6%, 65.8%). Five year and 10 year patient survival rate of HBV(+) group(72.0%, 68.9%) was significantly lower than HCV(+) group(91.6%, 87.3%) and NBNC group(94.4%, 88.2%), but there was no significant difference in the patient survival rate between HCV(+) and NBNC group. Conclusion : Hepatitis B virus infection has a significant deleterious effect on the patient and graft survival of renal transplantation recipients. The poor survival rate was a result of the mortality from liver disorder. Hepatitis C virus infection also has a poor graft survival rate compared to NBNC group, but the patient survial rate is similar to NBNC group.
동위원소 ( 125I - Iothalmate ) 를 이용한 신사구체 여과율 측정의 임상적 유용성
이종규(Jong Kyu Lee),전희경(Hee Kyung Chun),김승준(Seung Jun Kim),이승헌(Seung Hun Lee),양철우(Chul Woo Yang),김용수(Yong Soo Kim),최의진(Euy Jin Choi),장윤식(Yoon Sik Chang),방병기(Byung Kee Bang),양우진(Woo Jin Yang),정수교(Soo Kyo 대한내과학회 1995 대한내과학회지 Vol.49 No.5
N/A Objectives: Creatinine clereance is a widely used method for measuring glomerular filtration rate in clinical field but has been accepted as inaccruate method because of inadequate urine sampling and method of measuring plasma creatinine. In contrast, on inulin clearance is the ideal method of measuring glomerular filtration rate but it is not used routinely because of difficulty of method. Recently, many reports of the glomerular filtration rate using isotopes showed accurate glomarular filtration rate compared to inulin clearance. Therefore, we performed this study at outpatient clinic basis to find out whether the glomerular filtration rate using isotope (125I-iothalmate) is well correlated with other parameters that are used in clinical field. Methods: We measured GFB using 125I-iothalmate(Ciot) and compared it to other methods (99mTc-DTPA(C-DTPA), creatinine clearance(Ccr), predicted creatinine clearance(PCcr)) Results: 1) Mean differences of GFR measured by Ciot showed no sighificant changes during study preiod. 2) Ciot was well correlated with PCcr(r=0.88), Ccr(r=0.83), 100/Scr(r=0.83) and C-DTPA(r=0.75). 3) C-DTPA was higher than Ciot, especially in cases with severely impaired reanl function. 4) In patients with normal renal function(Scr <1.3 mg/dl), Ccr was not higher than Ciot (88.9±26.4 vs 97.7±18.8 ml/min/1.73M(2), p=0,008), and in patients with impaired renal function, Ccr was higher than Ciot but its degree was lower than expected (42.3±21.5 vs 35.7±18.2 ml/min/1.73M(2), p=0.0004). Conclusion: These observations suggest that Ccr is underestimated because of inadequate urine collection and other laboratory errors, And the determination of glomerular filtration rate using 125I-iothalmate seems to be an adequate method.
이지은(Ji Eun Lee),김병수(Byung Soo Kim),이호일(Ho Il Lee),최민석(Min Suk Choi),정성우(Sung Woo Chung),이승헌(Seung Hun Lee),최의진(Euy Jin Choi),방병기(Byung Kee Bang) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1
The reversible posterior leukoencephalopathy syndrome usually includes seizure, headache, altered mental status, and blindness, often associated with hypertension and immunosuppressants. The authors discuss a 16-year-old female with Down syndrome who had nephrotic syndrome with severe headache, intermittent blindness, and seizures, after treated with prednisolone. The patient had a generalized tonic-clonic seizure at 8 days after prednisolone. A CT scan of the head revealed symmetrical multifocal low densities in the subcortical region of both parieto-occipital, frontal, temporal lobe. Magnetic resonance scanning revealed white matter lesions in the subcortices of the parietal, frontal and occipital lobes. The condition improved when prednisolone was discontinued. Follow-up image after 3 weeks shows nearly complete resolution of white matter and gray matter abnormalities on axial T2-weighted MR images. This episode might be caused by prednisolone because the clinical course and laboratory data revealed neither inflammation nor other causative factors.