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만성 대사성 산증에서 요 음이온차를 이용한 요 산성화능의 평가
한진석(Jin Suk Han),주권욱(Kwon Wook Joo),정윤철(Yoon Chul Jung),임춘수(Choon Soo Lim),김연수(Yon Su Kim),안규리(Cu Rie Ahn),김성권(Suhng Gwon Kim),이정상(Jung Sang Lee),김근호(Gheun Ho Kim) 대한내과학회 1993 대한내과학회지 Vol.45 No.4
N/A Objectives : The clinical usefulness of the urine anion gap as an indirect index of theammonium excretion was reported only in patients with hyperchloremic metabolic acidosis. And the significance of the urine anion gap and its relation with other indices of urine acidification are not clearly defined yet. We are aimed to evaluate the clinical usefulness of the urine anion gap and its relations with other indices of urine acidification in normal and high anion gap metabolic acidosis. Methods : We measured the urine acidification indices (ammonium, titratable acid, net acid) and the urine anion gap in 24 patients with chronic renal failure, 7 patients with dista1 renal tubular acidosis, and 8 healthy adults with acid loading (normal controls), whose arterial blood bicarbonate concentrations were 14.0 mmol/ L (7.0 to 20.0 mmol/L)(median;range), 18.1 mmol/L(15.0 to 20.0 mmol/L), 19.5 mmol/L(16.8 to 22.D mmol/L), respectively. Results: The urinary excretion of ammonium in chronic renal failure(4.5 mmol/day; 1.6 to 11.8 mmol/ day) and renal tubular acidosis (19.8 mmol/day; 6.9 to 27.2 mmol/day) were lower than in normal controls (52. 5mmol/day; 37.3 to 69.4mmol/day)(p<0.05). The urinary excretion of titratable acid in chronic renal failure (4.9 mmol/day; 0.1 to 19.7 mmol/day) and renal tubular acidosis (2.8 mmol/day; 0.1 to 20.2 mmol/day) were lower than in normal controls (6.2 mmol/day; 20.6 to 36.9mmol/day)(p<0.05) The urinary excretion of net acid in chronic renal failure(8.8 mmol/day; 0.1 to 28.2 mmol/day) and renal tubular acidosis (12.9 mmol/day; 0. 1 to 33.6 mmol/day) were also lower than in normal controls (77.9mmol/day; 62.7 to 98.9 mmol/day)(p<0. 05). The urine anion gap in chronic renal failure (22.9 mmol/L; 13.0 to 43.2 mmol/L) and renal tubular acidosis (36.0 mmol/L; 7.0 to 82.0 mmol/L) were higher than in normal controls (-14.6 mmol/L; 40.7 to 2.2 mmol/ L) (p<0.05), and had inverse relation with urine ammonium (r=-0.71, p<0.01), titratable acid (r=-0.76, p<0.01), and had inverse relation with urine ammonium (r=-0.83, p <0.01), respectively. The urine anion gap in chronic renal failure and renal tubular acidosis were all above 5.0 mmol/L. Conclusion : We concluded that the urine anion gap in chronic metabolic acidosis would be a good clinical index of the impairment of urine acidification in the distal nephron, and reflect not only urine ammmonium excretion but also urinary excretion of net acid.
Oxytocin에 의한 내수질집합관의 cAMP 생성 및 요배설의 변화
한진석(Jin Suk Han),이정상(Jung Sang Lee),김강석(Kang Seock Kim),허우성(Woo Seong Huh),김연수(Yon Su Kim),전은실(Un Sil Jeon),주권욱(Kwon Wook Joo),안규리(Curie Ahn),김성권(Suhnggwon Kim),이중건(Jung Geon Lee),나기영(Ki Young Na),정우경 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1
N/A Oxytocin, like vasopressin, has been known to act in the IMCD by the activation of adenylyl cyclase through V2 receptor, but the exact mechanism of its action remains to be elucidated. To prove whether oxytocin is involved in the activation of adenylyl cyclase in the renal collecting duct, we measured the cAMP production and urinary cAMP excretion rate. After single IMCD segments of Sprague-Dawley rats were microdissected and treated with different con- centrations of vasopressin(10pM, 10nM) and oxytocin (10pM, 10nM), cAMP production was measured. Urinary cAMP excretion rate was measured after dehydration and intraperitoneal injection of vasopressin and oxytocin. The results are as follows. 1) cAMP production in single IMCD was significantly increased in vasopressin group(10pM: 48,9±4.7(mean±SE), 10nM:94.6±5.3fmol/mm) and oxy-tocin group(10pM: 11.3±2.9, 10nM: 65.7±6.1fmol/mm) compared with that in the control(3.2±0.2fmol/ mm). 2) Urine volume was significantly decreased in dehydration group(40±7μl/hour) and vasopressin group(420±120μl/hour), but urine volume of oxytocin group(1,480±230μl/hour) was not different from that of control(1,550±120μl/hour). Urine osmolality was significantly increased in all experimental groups(control: 737.0±132.6, dehydration group : 2,463.9± 412.5, vasopressin group : 1,702±412.5, oxytocin group 1,293.4±117.9mOsm/kg). Urinary cAMP excretion rate was significantly increased in dehydration group(4,149.5±1,072.3pmol/hour) and oxytocin group(4,843.3±2,341.8pmol/hour), but not in vasopressin group(1,358.1±690.2pmol/hour), compared with that in control(49±10.7pmoVhour). These results suggest that oxytacin has anti-diuretic effect by the activation of adenylyl cyclase through V2 receptor.
만성신부전에서 염류코르티코이드 투여가 포타시움 평형과 요 암모늄 배설에 미치는 효과
한진석(Jin Suk Han),이정상(Jung Sang Lee),김강석(Kang Seock Kim),허우성(Woo Seong Huh),전은실(Un Sil Jeon),이서진(Seo Jin Lee),주권욱(Kwon Wook Joo),김성권(Suhnggwon Kim),진호준(Ho Jun Chin),조윤숙(Yun Suk Cho) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2
N/A Mineralocorticoids influences on acid-base homeo-stasis by the regulation of urine acidification. But its mechanism of acion is not well known in human. This study compared the acid-base status and the indices of urine acidification before and after mineralocorticoid administration in human, and analyzed the effect of mineralocorticoids on human acid-base homeostasis. We administered 9a-fludrocortisone in 6 chronic renal failure patients and 6 normal controls 0.5mg daily for 7 days. The results were as following ' 1) After administration of 9a-fludrocortisone in patients group, serum aldosterone level changed from 120.2±71.0pg/mL to 44.8±32.2pg/mL(mean±SD, p< 0.05). Serum HCO- level was not changed. Urine ammonium excretion was incresed from 24.6±12.3 mmol/day to 43.7±19.0(p<0.05), but there were no change in urine pH and urine anion gap, Serum potassium level decreased from 5.5±0.7mBq/L to 4.1±0.5mEq/L(p<0.05), and TTKG increased from 3.9 to 8.9(p<0.05). 2) After administration of 9a-fludrocortisone in control group, serum aldosterone level changed from 99.7±44.5pg/mL to 25.1±3 mL(p<0.05). Serum HCO- level was not changed. Urine ammonium ex-cretion was incresed from 44.3±21.6mmoVday to 76.3±19.6(p<0.05), but there were no change in urine pH and urine anion gap. Serum potassium level decreased from 4.8±0.5mEq/L to 3.9±0.2mHq/L(p< 0.05), but there was no change in TTKG. 3) No patient or control showed any discomfort after 9-fludrocortisoneadministration, and there was no elevation in diastolic blood pressure, increase in body weight, electrolyte abnormality. In summary, after 9α-fludrocortisane administration, urinary ammonium excretion increased in both patients and control group, and this phenomenon occured with correction of hyperkalemia without urine pH change. This result implies urinary ammonium excretion increase by mineralocorticoid. In human increase in renal distal acidification by mineralocorticoid is due to increase in renal ammo- niagenesis rather than stimulation on proton excretion.
통상적 99mTc - DTPA 신장스캔을 이용한 GFR측정
한진석(Jin Suk Han),이정상(Jung Sang Lee),고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이강욱(Gang Wook Yi) 대한핵의학회 1989 핵의학 분자영상 Vol.23 No.1
N/A Many previously described nuclear medicine procedures to assess glomerular filtration rate (GFR) required numerous blood samples obtained over a period of several hours to determine plasma concentrations of the injected radiopharmaceuticals. And other indirect methods of determining renal clearance have some problems due to individual variations in volume of distribution of the radionuclides used. Rescently reported Jackson's method have the great advantages that is a direct measurement method requiring less than 40 min of imaging time and single blood sampling. And it correctly accounts for individual variations in volume of distribution of the radiopharmaceuticals and can be done with routine renal scintigraphy. We measured Tc- 99m-DTPA renal clearance with Jackson's method during the routine Tc-99m-DTPA renal scintigraphy in 63 patients admitted to department of internal medicine in SNUH. In 23 cases among 63 patients creatinine clearence was accounted simultaneously. The range of ClDPDA was from 19.9 ml/min to 170 mi/min and the correlation of ClDPDA and creatinine clearance was discribed by Y=16.2570+0.7852X(X=C1DPDA, Y=creatinine clearance). And the correlation coefficient r was 0.88. We concluded that Tc-99m-DTPA renal clearance measurement with Jackson's method was clinically useful to account GFR that can be done with routine Tc-99m-DTPA renal scintigraphy simultaneously.
한국형출혈열에서 Kallikrein - Kinin 활성에 관한 연구
한진석(Jin Suk Han),이정상(Jung Sang Lee),이상구(Sang Koo Lee),김성권(Suhng Gwon Kim),고창순(Chang Soon Koh),이문호(Mun Ho Lee) 대한내과학회 1989 대한내과학회지 Vol.37 No.2
N/A Although it has been suggested that the basic lesion of hemorrhagic fever with renal syndrome in Korea (Korean hemorrhagic fever) is the vasculopathy consisted of dilatation of generalized small vessels, increased permeability, permeation of plasma components and diaphedesis of blood cells, its pathophysiologic mechanism has been under debate. We purposed to investigate the role of kallikrein-kinin in the vasculopathy and its relation with the clinical findings of Korean hemorrhagic fever. We measured serially plasma prekallikrein, kallikrein and kallikrein inhibitor activities by amidolytic assay with synthetic substrate and compared with the variable clinical indices that has been regarded as the prognostic factors. The results obtained as follows; 1) The plasma prekallikrein activities were significantly reduced and kallikrein activities were significantly elevated in the group of the 5~7th day of illness compared to those of .15~21st and over 22nd day (p<0. 05, Scheffe's test). But those of kallikrein inhibitor were elevated in the earlier day of illness without significant change during the course. 2) The plasma prekallikrein activities were significantly reduced in the hypotensive phase compared to those of the febrile phase, and in the hypotensive and oliguric phases compared to those of the diuretic and convalescent phases (p<0.05, Scheffb's test). The plasma kallikrein activities were significantly elevated in the hypotensive phase compared to those of all the other phases, and in the oliguric phase compared to the diuretic and convalescent phases (p<0.05, Scheffe's test), But those of kallikrein inhibitor were elevated without significant change in each phase. 3) The plasma prekallikrein activities were significantly reduced in the groups with primary shock, severe azotemia, leukocytosis and thrombocytopenia. Those of kallikrein were significantly elevated in the group with primary shock, hemoconcentration, leukocytosis, thrombocytopenia and higher scores of clinical severity. 4) In the 11 cases with kallikrein activation, clinical characteristics were shorter days from onset to admission, higher scores of clinical severity, hematocrit, leukocyte counts, and lower thrombocyte couots and initial creatinine. 5) The plasma Cl inhibitor were elevated without significant change in the day of illness or each phase. And there was a good correlation between plasma kallikrein inhibitor and C1 inhibitor (r=0.76, p<0.01). Thus we concluded that the activation of kallikrein-kinin in Korean hemorrhagic fever plays significant role in the pathophysiologic mechanism and is related with primary shock, hemoconcentration, leukocytosis, thrombocytopenia and clinical severity.
증식성 및 비증식성 사구체신염에서 Cytokine 과 Chemokine 유전자의 발현 양상
이서진(Seo Jin Lee),김강석(Kang Suk Kim),정수환(Shou Huan Zheng),임춘수(Chun Soo Lim),윤형진(Hyung Jin Yoon),김연수(Yon Su Kim),안규리(Cu Rie Ahn),한진석(Jin Suk Han),노정우(Jung Woo Noh),채동완(Dong Wan Chae),이정상(Jung Sang Lee),김 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4
Backgroud : Intraglomerular cellular proliferation is one of the major determinants for dividing various glomerulonephritis(GN) into two groups, such as proliferative versus nonproliferative. We hypothesized that this morphological difference could be based on the differential expression of various cytokines and chemokines. To elucidate this hypothesis we quantified the intrarenal gene expression of various cytokines and chemokines, and correlated it with clinical and histological parameters. Methods: Total RNA was extracted from 54 proliferative GN(PGN) core biopsy specimens and 42 nonproliferative GN(NPGN) specirnens. Using the internal competitors RT-PCR was instituted to quantify mRNAs. Results: The magnitude of the gene expressions of IL-2, IFN- r, and IFN- r /IL-10 ratio were signi- ficantly higher in PGN. RANTES and IL-8 had more abundant gene messages in PGN than in NPGN. It was shown that Thl cytokine was upregulated if GN was mediated by immune complexes regardless of cellular proliferation. Upregulation of the IFN- r / IL-10 ratio and TNF- αwas associated with renal dysfunction at the time of renal biopsy. Conclusion Thl, proinflammatory cytokines, and chemokines were more abundant in proliferative GN, and correlated with unfavorable clinical and histologic parameters. We propose that the clinical manifestations and diverse histologic features of human GN are associated with differential expressions of specific cytokines and chemokines. A new way of blocking the actions of these cytokines should be instituted for the treatment and prevention of the progression of GN.
정위 인공방광대체술 및 방광확대술 후 발생한 심한 고염소혈증 대사성 산증 2예
이한규 ( Han Kyu Lee ),선휘경 ( Hui Kyuoung Sun ),김동기 ( Dong Ki Kim ),오국환 ( Kook Hwan Oh ),김연수 ( Yon Su Kim ),안규리 ( Cu Rie Ahn ),한진석 ( Jin Suk Han ),김성권 ( Sunhn Gwon Kim ),곽철 ( Cheol Kwak ),오승준 ( Seung June 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.5
The use of intestinal segments in the reconstruction and plasty of urinary bladder for malignant or nonmalignant conditions is widely accepted. Metabolic derangements including hyperchloremic metabolic acidosis and malabsorption of lipid may occur after surgery. Main pathophysiology of hyperchloremic metabolic acidosis is the exchange of urinary chloride with luminal bicarbonate and duration of urine in contact with the intestinal mucosa can affect the severity of metabolic acidosis. We experienced two cases of severe hyperchloremic metabolic acidosis which developed in patients with chronic kidney disease, urinary tract infection and orthotopic neobladder or augmentation enterocystoplasty for the treatment of bladder cancer and neurogenic bladder, respectively.