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Case Report : Crohn`s Disease in a Patient Undergoing Hemodialysis Caused by IgA Nephropathy
Bi Ro Kim,Jae Won Yang,Joung Wook Choi,Young Sub Kim,Jong Myeong Yu,Seung Ok Choi,Byoung Geun Han 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.5
IgA nephropathy is usually localized to the kidney, however, it can accompany systemic disease, including gastrointestinal disease, skin disease, connective tissue disease, and malignant tumor. In some patients with IgA nephropathy which manifested as an extraintestinal symptom of Crohn`s disease, recovery of renal function was achieved following treatment of Crohn`s disease. The pathophysiology of each disease remains unclear. According to some studies, however, immunological, genetic, and environmental factors may be involved in a complex manner. In patients receiving renal replacement therapy for treatment of renal dysfunction due to IgA nephropathy, occurrence of Crohn`s disease as an extrarenal symptom has not been reported. We experienced a case of Crohn`s disease which developed in a patient receiving hemodialysis for treatment of end-stage renal disease due to IgA nephropathy.
Coagulopathy in patients who experience snakebite
( Jae Seok Kim ),( Jae Won Yang ),( Min Soo Kim ),( Seung Tae Han ),( Bi Ro Kim ),( Myung Sang Shin ),( Jong In Lee ),( Byoung Geun Han ),( Seung Ok Choi ) 대한내과학회 2008 The Korean Journal of Internal Medicine Vol.23 No.2
Background/Aims: Coagulopathy is a common complication of snakebite, but there is little information on the clinical importance of coagulopathy. We analyzed the characteristics of coagulopathy after envenomation. Methods: Ninety-eight patients who experienced snakebite were enrolled in this study. We divided all the patients into three groups by the ISTH DIC scoring system: the normal, simple coagulopathy and DIC groups. The coagulopathy group included both the simple coagulopathy and DIC groups. We then conducted a case-control study. Results: There was a significant decrease in the Hct, protein, albumin, ALP and cholesterol levels in the coagulopathy group, and only the cholesterol level was deceased in the DIC group (p<0.05). Leukocytosis and rhabdomyolysis were significantly associated with coagulopathy, and hemolysis and rhabdomyolysis were associated with DIC (p<0.05). The presence of rhabdomyolysis was considered a risk factor for coagulopathy (p<0.05). These conditions continued for up to six to seven days after the snakebite. Conclusions: Evaluation of coagulopathy with using these characteristics is helpful to properly manage the patients who experience snakebite.
Yun Deok Kim,Jae Won Yang,Jeong Wook Choi,Bi Ro Kim,Jong Myeng Yu,Young Sub Kim,Jong In Lee,Seung Ok Choi,Byoung Geun Han 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.3
Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal disorder of the hematopoietic stem cells characterized by chronic intravascular hemolysis, venous thrombosis, deficient hematopoiesis. Kidney involvement is usually benign and secondary to chronic deposition of hemosiderin. However, acute kidney injury may rarely occur in association with a hemolytic crisis or thrombotic complication. Hemolytic crisis is precipitated by nonspecific factors, such as infection, surgery and transfusion. A 35-year-old woman, who developed hemolytic crisis and acute kidney injury was admitted to our hospital presenting with acute gastroenteritis. After being treated by hemodialysis and oral low dose steroid, she was discharged with recovered renal function. Renal biopsy demonstrated acute tubular necrosis with considerable hemosiderin deposition without evidence of vascular thrombosis. A review of Korean cases showed that most of the cases featured severe renal dysfunction to such an extent to require a hemodialysis although there were no definite etiologies other than the deposition of blood iron due to massive hemolysis unlike the foreign cases. It also showed that the disease duration was longer. It can therefore be inferred that the early diagnosis and active treatment will be mandatory for the treatment of Korean patients with PNH. We reported a case of PNH with acute kidney injury and hemolytic crisis and documented by renal biopsy with review of Korean literature.
김민수 ( Min Soo Kim ),양재원 ( Jae Won Yang ),한승태 ( Seung Tae Han ),김재석 ( Jae Seok Kim ),김비로 ( Bi Ro Kim ),한병근 ( Byoung Geun Han ),최승옥 ( Seung Ok Choi ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.6
Purpose : During hemodialysis (HD) in patients with end-stage renal disease (ESRD) and preexisting liver cirrhosis (LC), there is a risk of inadequate ultrafiltration due to either intradialytic hypotension or a coagulopathy causing complications from alteration of clotting factors and platelets. Peritoneal dialysis has several benefits over HD for cirrhotic patients including proper hemodynamic stability, avoidance of anticoagulants and direct removal of ascitic fluid. We compared the factors associated with the survival rates in patients with ESRD and LC undergoing dialysis. Methods : We analyzed 41 ESRD patients with LC (HD 23 patients, PD 18 patients). Their characteristics and laboratory findings at the beginning of dialysis, and survival rates were retrospectively analyzed. Results : There was no significant difference in survival time with the treatment modality. The patients with severe ascites at the beginning of dialysis, low albumin (serum albumin <3.0 g/dL), high modified Child-Pugh score (MCP score ≥7) and low hemoglobin (Hb) level (Hb <10 g/dL) had poor survival. The multivariate analysis showed that age, the amount of ascites, the initial Hb level and the modified Child-Pugh score were risk factors for death. Conclusion : PD was an effective renal replacement therapy for patients with ESRD and LC. Patients with a modified Child-Pugh classification of A and B were not significantly different with regard to survival rates. Therefore, PD may be a safe and effective option for patients with ESRD and LC.
김경진 ( Gyeong-jin Kim ),양애리 ( Ae-li Yang ),김진배 ( Jin-bae Kim ),진용덕 ( Yong-duk Jin ),노진호 ( Jin-ho Ro ),김단비 ( Dan-bi Kim ),류지혁 ( Ji-hyock Yoo ),오경석 ( Kyeong-seok Oh ),문병철 ( Byeong-churl Moon ),박상원 ( Sang 한국환경농학회 2017 한국환경농학회 학술대회집 Vol.2017 No.-
2016년에 대중국 쌀 수출길이 열리면서 낮은 인지도 및 고가격 대비 차별성을 극복하기 위해서 고품질 쌀 생산 및 가공기술과 더불어 안전성 확보는 필수요소가 되었다. 중국의 식품안전법에 근거로 한 새로운 食品中汚染物限量(GB2762-2012, 2013.6.1.)에 규정된 중금속 안전관리 기준에 맞는 쌀 생산을 위하여 6개 시군(철원, 이천, 청주, 서천, 군산, 해남)의 중국 수출용 쌀 생산단지에서 농경지 토양, 농업 용수 및 생산된 쌀을 채취하여 중금속을 분석하였다. 수출용 쌀 생산단지 토양의 비소 함량은 2.9~18.2 mg/kg 범위로 검출되어 환경오염 우려수준인 25 mg/kg 이하였으며, 카드뮴은 모든 시료에서 정량한계 수준인 0.006 mg/kg 이하로 검출되지 않았다. 구리는 충남 서천 지역에서 최고 25.6 mg/kg이 검출되었으나 토양오염 우려기준 250 mg/kg의 약 1/10수준으로 안전하였다. 그리고 니켈, 납, 아연, 6가크롬 등 분석한 8종의 중금속이 토양오염우려기준 보다 낮게 검출되어 안전한 수준임이 확인되었다. 농업용 수 중 비소의 잔류량은 하천수에서 최고 24.3 ug/L으로 상대적으로 많은 양이 검출되었으나, 지하수는 대부분 1~2 ug/L 수준으로 검출되어 농업용수의 수질기준(0.05 mg/kg)을 초과하지 않았다. 백미와 현 미 중 중금속 5종을 분석한 결과 수은과 크롬은 정량한계 미만이었으며, 카드뮴은 0.004~0.068 mg/kg 이 검출되어 한국과 중국의 잔류허용기준인 0.2 mg/kg 이하였다. 또한 백미 중 납은 0.002~0.136 mg/kg 범위로 우리나라의 백미 기준 0.2 mg/kg, 중국 현미 기준 0.2 mg/kg 이하로 안전하였다. 전반 적으로 쌀 중 비소 등 5종의 중금속 잔류량은 한국과 중국의 잔류허용기준의 1/10~1/20 수준으로 안전 하였다.
인산나트륨 하제를 복용 후 발생한 만성 신부전 환자 1예
김상현 ( Sang Hyun Kim ),김현정 ( Hyun Jung Kim ),장기준 ( Ki Jun Chang ),김병규 ( Byung Gyu Kim ),박원도 ( Won Do Park ),김비로 ( Bi Ro Kim ),장효정 ( Hyo Jeong Chang ) 대한내과학회 2012 대한내과학회지 Vol.83 No.5
Renal failure due to nephrocalcinosis after large-bowel cleansing with sodium phosphate preparations before endoscopic procedures is an easily overlooked diagnosis. While it has been reported that acute renal failure can result from the use of oral sodium phosphate preparations, chronic renal failure has not yet been reported. We report a case of chronic renal failure due to oral sodium phosphate, in which a kidney biopsy was performed. (Korean J Med 2012;83:659-663)
김민수 ( Min Soo Kim ),양재원 ( Jae Won Yang ),한승태 ( Seung Tae Han ),김재석 ( Jae Seok Kim ),김비로 ( Bi Ro Kim ),한병근 ( Byoung Geun Han ),최승옥 ( Seung Ok Choi ) 대한내과학회 2008 대한내과학회지 Vol.75 No.2
신이식을 받은 말기신부전증 환자들은 면역억제제의 사용으로 인해 감염의 합병증에 이환될 가능성이 높으며 급성 감염 시 면역억제제의 중단으로 인한 급성 거부반응의 위험에도 노출되어 있다. 본 저자는 고열과 전신동통을 주소로 내원한 신이식을 받은 환자에서 신증후 출혈열을 진단하였으며 면역억제제 투여의 중단 없이 보존적 치료 및 지속적 신대치술로 호전된 1예를 문헌고찰과 함께 보고하고자 한다. Hemorrhagic fever with renal syndrome is an acute disease characterized by fever, headache, bleeding tendency, and anuria. We recently treated a case of hemorrhagic fever in a renal allograft patient with renal syndrome. A 43-year-old woman presented with high fever, headache, and myalgia for 4 days. In February 1998, she had undergone allograft kidney transplantation following treatment with cyclosporine and steroids. Allograft function was stable. Hantaan virus infection was demonstrated by serology during the first hospital week. Her clinical course progressed through febrile, hypotensive, oliguria, polyuria, and recovery phases. The patient was successfully treated with continuous renal replacement therapy and supportive management with maintenance doses of immunosuppressive agents. (Korean J Med 75:225-229, 2008)
( Jae Won Yang ),( Min Soo Kim ),( Jae Seok Kim ),( Jong Myoung Yoo ),( Seung Tae Han ),( Bi Ro Kim ),( Yun Deok Kim ),( Jeong Wook Choi ),( Seung Ok Choi ),( Byoung Geun Han ) 대한내과학회 2008 The Korean Journal of Internal Medicine Vol.23 No.4
Background/Aims: Brain natriuretic peptide (BNP) levels are known to be elevated in patients with chronic kidney disease (CKD) and normal heart function. Therefore, the present study was performed to examine the effectiveness of BNP level in diagnosing heart failure in patients with CKD and to determine its effects on survival rate and prognosis. Method: A total of 182 patients with CKD who visited the hospital due to dyspnea of NYHA class II were included in the study. BNP levels were measured and echocardiography was performed to divide the subjects into groups with and without heart failure. Their BNP levels, clinical courses, and survival rates were analyzed retrospectively. Results: When BNP level was ≥858.5 pg/mL in CKD patients, heart failure could be diagnosed with sensitivity and specificity of 77% and 72%, respectively. Survival rate of the group with BNP levels of ≥858.8 pg/mL was significantly lower than that of the group with BNP level below this threshold (p=0.012) and multivariate analysis showed that BNP level, age, and sex affected survival rate in the group with BNP level ≥858.8 pg/mL. Conclusions: BNP levels of patients with CKD showed a positive correlation with creatinine levels, and the critical point of BNP level for diagnosis of heart failure was 858.5 pg/mL. As the survival rate in patients with BNP level above the critical point was significantly low, this level was a useful indicator for predicting their prognosis. Care should be taken in interpreting BNP level because patients with stage 5 CKD may show a high concentration of BNP without heart failure.