임상신질환 : Megsin 2093T-2180C haplotype이 한국인의 IgA 신병증과의 관계

이하정 ( Ha Jeong Lee ),임춘수 ( Chun Soo Lim ),김선문 ( Sun Moon Kim ),오윤규 ( Yun Kyu Oh ),주권욱 ( Kwon Wook Joo ),김연수 ( Yon Su Kim ),한진석 ( Jin Suk Han ),김성권 ( Suhng Gwon Kim ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

급성 신손상을 동반한 중환자에서 지속성 신대체요법의 최적시기 결정을 위한 임상적 인자

김용철 ( Yong Chul Kim ),황진호 ( Jin Ho Hwang ),조은진 ( Eun Jin Cho ),이하정 ( Ha Jeong Lee ),오국환 ( Kook Hwan Oh ),주권욱 ( Kwon Wook Joo ),김연수 ( Yon Su Kim ),안규리 ( Curie Ahn ),한진석 ( Jin Suk Han ),김성권 ( Suhng Gwon 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.6

Purpose: The aim of this study was to evaluate the clinical parameters to determine the optimal time for continuous renal replacement therapy (CRRT) in critically ill patients with severe acute kidney injury (AKI). Methods: A single center retrospective study was performed using data from 166 AKI patients who received CRRT in intensive care unit (ICU) between October 2007 and January 2010. We compared mortality rate at 90 days after the initiation of CRRT, ICU-free and CRRT-free days between "early CRRT" and "late CRRT" groups stratified by blood urea nitrogen (BUN), serum creatinine, urine output and RIFLE criteria. Results: The 90-day mortality rate was significantly lower in the early group compared with the late group when stratified by median value of BUN at the start of CRRT and mean hourly urine output during 6 h, 12 h, and 24 h before CRRT. In addition, the 90-day mortality rate was also significantly lower in patients who received CRRT in the "injury" stage of RIFLE criteria compared with those in "failure" or "loss" stage. ICU-free and CRRT-free days during the first 28 days were significantly longer in the early group when stratified by median level of BUN. However, in terms of creatinine, ICU-free and CRRT-free days were significantly shorter in the early group compared with the late group. CRRTfree days during the first 28 days were also longer in early group stratified by median value of mean hourly urine output during 6 h, 12 h before CRRT. After adjusting for covariates, 90-day mortality was independently lower in the early group defined by median level of BUN (OR=1.65 (1.10- 2.47), p=0.015) and mean hourly urine output during 12h before CRRT (OR=1.56 (1.05-2.33), p=0.027). Conclusion: Our data suggest that early CRRT may have a survival benefit in critically ill patients with severe AKI, and BUN and urine output at the initiation of CRRT may be important parameters to determine the optimal time for CRRT.

임상 연구 : 입원 환자에서 발생한 중증 저나트륨혈증의 임상상 및 경과 분석; 간질환 유무에 따른 비교

김효상 ( Hyo Sang Kim ),이하정 ( Ha Jeong Lee ),박혜인조 ( Hayne Cho Park ),정지용 ( Ji Yong Jeong ),손민정 ( Min Jeong Son ),오국환 ( Kook Hwan Oh ),김연수 ( Yon Su Kim ),안규리 ( Cu Rie Ahn ),한진석 ( Jin Suk Han ),김성권 ( Suhng 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.6

목적: 간질환은 저나트륨혈증의 가장 흔한 원인 중 하나이며, 저나트륨혈증의 정도가 심할 경우 적절한 치료가 이루어지지 않으면 심각한 합병증이 발생할 수 있다. 이에 저자들은 중증 저나트륨혈증 환자의 발생 빈도와 임상상을 간질환의 유무에 따라 알아보고자 하였다. 방법: 2005년 1년 동안 3차 단일 의료 기관에 입원한 환자 중 저나트륨혈증이 관찰된 12,729명의 환자를 대상으로 후향적 연구를 진행하였다. 저나트륨혈증은 혈청 나트륨이 135 mmol/L 미만인 경우로, 중증 저나트륨혈증은 2회 이상 125 mmol/L 이하인 경우로 정의하였다. 결과: 저나트륨혈증이 확인된 12,729명의 환자 중 711명 (0.13%)에서 중증 저나트륨혈증이 관찰되었으며, 중증 저나 트륨혈증 환자 중 290명 (40.8%)은 간질환 환자였다. 중증 저나트륨혈증의 주된 원인은 간질환 환자군에서는 간부전 (69.7%)이었으며, 간질환이 없는 환자군에서는 과도한 저장성 수액 공급 (37.3%)이었다. 양 군 모두에서 고장성 식염수를 투여하는 것이 가장 흔히 사용된 치료 방법이었다. 간질환 환자군에서 입원과 퇴원 시 혈청 나트륨이 간질환이 없는 환자들보다 낮았으며 (입원 시 128.8±7.1, 퇴원 시 127.1±8.4 vs 132.1±7.5, 131.5±8.3 mmol/L), 중증 저나트륨혈증의 지속 시간도 간질환 환자군에서 더 길었다 (5일 vs 3일). 중증 저나트륨혈증에 대해 치료를 받은 589명의 환자 중 261명이 정상 나트륨 수준으로 교정되었으며, 교정된 비율은 간질환 환자군이 간질환 없는 환자들에 비해 낮았다. 결론: 간부전은 입원 환자에서 발생한 중증 저나트륨혈증의 가장 흔한 원인이었다. 간질환 환자에서 발생한 중증 저나트륨혈증은 간질환이 없는 환자들에 비해 나쁜 임상상을 보였다. Purpose: Liver disease is one of the most common causes of hyponatremia and improper management of severe hyponatremia may result in serious complications. We evaluated the prevalence and clinical characteristics of severe hyponatremic patients according to the presence of liver disease in hospitalized patients. Methods: We studied 12,729 hyponatremic patients during hospitalization in single tertiary referral hospital for 1 year. Hyponatremia was defined as serum sodium level <135 mmol/L and severe hyponatremia as ≤125 mmol/L at least twice. Results: Of 12,729 hyponatremic patients, 711 (0.13%) patients had severe hyponatremia and 290 (40.8%) patients with severe hyponatremia had liver disease. The main cause of severe hyponatremia was liver failure (69.7%) in patients with liver disease and excessive administration of hypotonic fluid (37.3%) in non-liver disease patients. The administration of hypertonic saline was the most common treatment both in liver and non-liver disease group. In severe hyponatremic liver disease patients, the serum sodium level was lower (128.8±7.1 at admission, 127.1±8.4 at discharge vs 132.1±7.5, 131.5±8.3 mmol/L) and the duration of severe hyponatremia (5 days vs 3 days) was longer than those in non-liver disease group. Of 589 patients with severe hyponatremic patients who had been treated for the sodium correction, 261 patients were recovered from severe hyponatremia to normal range of serum sodium, and lower correction rate was observed in liver disease group. Conclusion: Liver failure was the most common cause of severe hyponatremia in hospitalized patients. Severe hyponatremia in patients with liver disease had poor clinical outcomes.

최근 18년간 단일 기관 진료 자료를 바탕으로 분석한 복막투석 환자의 생존율 및 예후 인자 탐색

윤현배 ( Hyun Bae Yoon ),박혜인조 ( Hayne Cho Park ),이하정 ( Ha Jeong Lee ),한승석 ( Seung Suk Han ),김세중 ( Se Joong Kim ),주권욱 ( Kwon Wook Joo ),김연수 ( Yon Su Kim ),안규리 ( Cu Rie Ahn ),한진석 ( Jin Suk Han ),김성권 ( Suhn 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.1

목적: 복막투석은 말기신부전증의 신대체요법으로 널리 사용되고 있으나, 국내 생존 관련 자료가 부족한 실정이다. 이에 저자들은 1990년 이후 서울대병원에서 시행한 복막투석 환자의 생존 및 복막염 관련 자료를 분석함으로써, 향후 진료와 연구에 기초 자료로 활용하고자 하였다. 방법: 1990년 1월 1일부터 2007년 6월 30일 사이에 서울대병원에서 복막투석을 시작한 15세 이상의 환자 가운데, 3개월 이상 복막투석을 시행한 670명을 대상으로, 2007년 12월 31일까지 관찰하였다. 이들의 성별, 나이, 신부전의 원인, 당뇨병, 심혈관 질환, Davies Comorbidity Score, 사망이나 복막투석 중단의 원인, 그리고 복막염에 대한 자료를 분석하였다. 생존율은 Kaplan-Meier 방법으로 분석하였고, 생존율에 영향을 미치는 독립적인 인자들을 구하기 위하여 multivariate Cox proportional hazard model을 이용하였다. 결과: 말기신부전증의 원인은 당뇨병이 33.7%로 가장 많았고, 심혈관계 질환은 20.4%에서 동반되었다. 사망 원인을 알 수 있는 58명 중, 심혈관계 질환이 24명 (41.3%), 감염이 20명 (34.4%)이었으며, 복막투석 중단의 원인으로는 복막염이 66.1%로 가장 많았다. 1995년부터 2007년까지 전체 연간 환자당 복막염 발생률은 0.270회였고, 1995년부터 1999년까지 0.365회인 반면, 2000년부터 2007년까지의 발생률은 0.230회로 감소한 것으로 나타났다. 복막염의 원인균은 그람 양성균이 42.6%로 가장 많았고, 그람 음성균이 23.8%, 균이 동정되지 않는 경우는 26.9%를 차지하였다. 평균 생존 기간은 107.5±4.2개월이었고, 5년 환자 생존율은 71.7%, 10년 생존율은 48.2%이었다. 한편, 평균 복막투석 기간은 106.5±4.3개월이었고, 5년 기술 생존율은 72.8%, 10년 기술 생존율은 43.8%였다. 복막투석 환자 사망에 영향을 미치는 독립적인 인자는 당뇨 (HR 1.973, p=0.001), 심혈관 질환 (HR 2.040, p<0.001), 복막투석을 시작할 당시 나이인 것으로 나타났으며, 40세 미만에 비하여 40세 이상 60세 미만의 위험도는 2.427 (p=0.016), 60세 이상의 위험도는 7.397 (p<0.001)이었다. 한편, 기술 실패에 영향을 미치는 독립적인 인자는 60세 이상의 나이 (HR 1.791, p=0.025)와 0.270회/년보다 높은 복막염 발생률 (HR 2.361, p<0.001)이었다. 결론: 서울대병원에서 시행한 복막투석의 환자 및 기술 생존율과 복막염 발생률은 국내외 보고에 비하여 비슷하거나 우수하였고, 당뇨병, 심혈관계 질환, 그리고 복막투석 시작 당시 나이가 환자 생존율에 영향을 미치는 독립적인 인자로 나타났으며, 나이와 복막염 발생률이 기술 생존율에 영향을 미치는 독립적인 인자로 나타났다. Purpose: We investigated the survival rate, factors associated with survival, and peritonitis incidence in PD patients who commenced PD at our center since 1990. Methods: We investigated 670 patients who started PD between January 1990 and June 2007. Data for sex, age, etiology of ESRD, comorbidities, follow-up duration, cause of death, and peritonitis were analyzed. Kaplan-Meier method was used to determine patient survival and technique survival rate. Results: The most common cause of death was cardiovascular disease, while peritonitis was the main reason for technique failure. The overall incidence of peritonitis between 1995 and 2007 was 0.270 episodes per patient-year, and there was a significant drop of peritonitis rate from 1995-1999 (0.365) to 2000-2007 (0.230). Patient survival after 5 and 10 years was 71.7% and 48.2% respectively. Technique survival after 5 and 10 years was 72.8% and 43.8%. Older age (age 40-59: HR 2.427, p=0.016; age≥60: HR 7.397, p<0.001), diabetes (HR 1.973, p=0.001), and cardiovascular disease (HR 2.040, p<0.001) were the independent risk factors of mortality, while older age (age≥60: HR 1.791, p=0.025) and higher peritonitis rate (HR 2.361, p<0.001) were the independent risk factors of technique failure. Conclusion: The patient survival, technique survival and peritonitis incidence of PD patients in our center showed outcomes comparable to other centers worldwide. Older age, diabetes, and cardiovascular disease were associated with lower patient survival, while older age and higher peritonitis rate were associated with higher technique failure.

신정맥 혈전증을 동반한 일측성 신 림프관확장증

이세한(Se Han Lee),이정표(Jung Pyo Lee),김세중(Se Joong Kim),김성균(Seong Gyun Kim),김연수(Yon Su Kim),하종원(Jong Won Ha),안규리(Curie Ahn),김승협(Seung Hyup Kim),한진석(Jin Suk Han),김성권(Suhng Gwon Kim),이현순(Hyun Soon Lee),이정상( 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.5

Renal lymphangiectasia is a rare cystic kidney disorder. This disorder has been termed renal lymphangioma, renal lymphangiomatosis, pararenal lymphatic cyst. We report on a 32-year-old man admitted with complaints of abdominal discomfort, in whom unilateral renal lymphangiectasia with renal vein thrombosis was diagnosed. Abdominal computed tomography revealed left perirenal fluid collection with multiloculation. Left renal vein was completely obliterated due to thrombosis and inferior vena cava (IVC) was partially obliterated. Perirenal fluid collection and renal vein thrombosis were treated initially with percutaneous drainage and anticoagulation therapy. The biochemical features of the drained fluid were compatible with lymphatic fluid. Since there was no decrease in the amount of daily drainage, left nephrectomy and IVC thrombectomy was performed on the 34th day of hospitalization. Left kidney was enlarged (15×10×18 ㎝, 750 g) and composed of numerous smooth, thin-walled cysts. Pathologic diagnosis was renal lymphangiectasia.

건강검진을 받은 대상에서 만성 신질환의 빈도와 관련 이상

진호준 ( Ho Jun Chin ),오국환 ( Kook Hwan Oh ),오윤규 ( Yoon Kyu Oh ),나기영 ( Ki Young Na ),주권욱 ( Kwon Wook Joo ),임춘수 ( Chun Soo Lim ),김연수 ( Yon Su Kim ),채동완 ( Dong Wan Chae ),안규리 ( Cu Rie Ahn ),한진석 ( Jin Suk Ha 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.2

목적: 말기 신부전을 포함한 만성 신질환은 세계적으로 지속적으로 증가하고 있으며 사회적인 의료 부담을 증가시키고 있으나 국내에서는 만성 신질환에 대한 대규모 역학조사 결과가 없는 실정이다. 방법: 분당서울대학교 병원에서 최근 2년간 건강검진을 받은 18세 이상의 14,856명을 대상군으로 정하였다. 미국신장협회의 만성 신질환 진단기준을 이용하였으며 사구체 여과율은 수정된 MDRD 공식으로 계산하였다. 결과: 대상군의 평균 사구체 여과율은 83.3 mL/min/1.73 m2이었으며 연령이 10년 증가할 때마다 5.0 mL/min/1.73 m2씩 감소하였다. 만성 신질환 1기에 해당되는 대상군은 3.2% 이었고 2기와 3기 이상인 군은 각각 9.4%와 3.5%이었다. 만성 신질환의 빈도는 고혈압 혹은 당뇨가 있는 군에서 없는 군보다 많았다. 만성 신질환과 연관된 고혈압, 심혈관계 질환 병력, 고요산혈증, 고칼륨혈증, 고인산혈증과 고중성지방혈증은 사구체 여과율이 정상인 만성 신질환인 경우에서도 그 빈도가 신질환이 없는 군에 비하여 높았다. 만성 신질환을 가진 대상군에서 만성 신질환을 인지하고 있었던 경우는 6.3%이었으며, 혈압과 혈당이 비신질환자에 비하여 적절하게 조절되는 비율이 낮았다. 결론: 건강검진을 받은 대상자들에서 만성 신질환과 유관 질환은 의미있게 높게 조사되었으나 신질환에 대한 인지도와 적절한 혈압과 혈당이 유지되는 비율이 비신질환자에 비하여 낮았다. Purpose: The prevalence of chronic kidney disease (CKD) is increasing in Korea. Considerable resources have been consumed for patients with CKD. This study investigated the prevalence, the associated disorders, and the awareness of CKD and the current status of appropriate control for blood pressure and blood sugar in subjects with CKD. Methods: We included 14,856 subjects who underwent a health check-up in Seoul National University Bundang Hospital during the last 2 years. We selected K/DOQI guideline of CKD. We used the modified MDRD equation to estimate the glomerular filtration rate (eGFR). Results: The mean eGFR was 83.3 mL/min/1.73m2 and it decreased with aging at the rate of 5 (mL/min/1.73m2)/10 years. The prevalences of CKD stage 1, stage 2, and stage more than 3 were 3.2%, 9.4%, and 3.5%, respectively. The prevalence of CKD was higher in subjects with hypertension or diabetes mellitus than in subjects without it. The CKD was associated with disorders of hypertension, cardiovascular diseases, hyperuricemia, hyperphosphatenemia, hyperkalemia, and hypertriglyceridemia. The prevalence of reported kidney disease was only 6.5% in subjects with eGFR less than 60 mL/min/1.73m2. The frequency of adequate control of blood pressure and blood sugar in subjects with CKD was lower than in subjects without CKD. Conclusion: The subjects were rarely aware of CKD whereas the frequencies of CKD and the associated diseases were considerably high. We have to pay more attention to diagnose and treat the CKD.

각종 신질환에서의 혈청 β2 - microglobulin 측정의 의의

한진석,이정상,궁성수,오하영 대한핵의학회 1985 핵의학 분자영상 Vol.19 No.1

To evaluate change of serum beta₂-microglobulin concentration (sβ₂-MG) and the usefulness of sβ₂-MG and sβ₂-MG/serum creatinine concentration (sCr) ratio in various renal diseases, sβ₂-MG and sCr were measured in 25 normal controls and 90 patients of various renal diseases (16 cases of glomerulonephritis, 12 cases of acute renal failure, 8 cases of chronic renal failure, 24 cases of nephrotic syndrome, 15 cases of tubulointerstitial diseases and 15 cases of lupus nephritis) using Phadebasⓡ Beta₂-Micro Test kits. The results were as follows; 1) In normal control, the mean value of sβ₂-MG was 1.65±0.41 ㎎/ι and the mean value of sβ₂-MG/sCr ratio was 0.14±0.05. 2) In various renal diseases, the mean value of sβ₂-MG was 6.74±5.47 mg/ι. The mean value of sβ₂-MG/sCr ratio was 0.24±0.11 and significantly elevated than that of normal contro1. (P〈0.05). 3) The correlation between sβ2-MG and sCr in glomerular and tubulointerstitial disease was log sβ₂-MG=0.90 log sCr-0.48 and its correlation coefficie5). 4) In glomerular disease, the correlation between sβ2-MG and sCr was log sβ2-MG=0.89 log sCr-0.46 (r-0.76) and in tubulointerstitial disease, it was log sβ2-MG=0.95 1og sCr-0.59 (r-0.87). There was no significant difference between the two groups (p〈0.05). 5) Among 32 cases of glomerular and tubulointerstitial disease patients, whose sCr was within normal range, 17 cases showed elevated sβ₂-MG. The mean values of sβ2-MG/sCr ratio in these patients was 0.30±0.14 and significantly elevated than that of normal control (p〈0.05). 6) In 15 cases of lupus nephritis, 12 cases showed elevated sβ2-MG with normal sCr and 12 cases showed elevated sβ₂-MG/sCr ratio. With above results, It was found that the sβ₂-MG can be used as an index of glomerular filtration rate as in the case of sCr and thats sβ₂-MG/sCr ratio can be used as a tool in early detection of slightly decreased glomerular filtration rate and in detection of the renal disease of increased β₂-MG production.

말기 신부전 환자에서 Furosemide와 Hydrochlorothiazide의 병용 요법의 효과

허우성,김혜영,엄재호,오하영,한진석,이정상,장인진 大韓臨床藥理學會 1998 臨床藥理學會誌 Vol.6 No.2