혈장레닌활성도와 혈압에 대한 만성혈액투석의 효과

곽임수 부산의대 1991 부산의대잡지 - 부산대학교 의과대학 Vol.31 No.2

Interleukin-17이 배양된 류마티스관절염 활막세포에서 vascular endothelial growth factor 생성에 미치는 영향

곽임수 ( Ihm Soo Kwak ),남태수 ( Tae Soo Nam ),나하연 ( Ha Yeon Rha ),서정탁 ( Jeung Tak Suh ),김유선 ( Yoo Sun Kim ),김성일 ( Sung Il Kim ) 대한류마티스학회 2001 대한류마티스학회지 Vol.8 No.3

Objective: To investigate the the effects of interleukin-17 (IL-17) on the production of vascular endothelial growth factor (VEGF) from cultured rheumatoid arthritis synoviocytes. Methods: Fibroblast-like synovial cells(FLS) were prepared from the synovial tissues of rheumatoid arthritis patients and cultured in the presence of IL-17, IL-17 with or without transforming growth factor-β(TGF-β), tumor necrosis factor-α(TNF-α) and interleukin-1β(IL-1β). VEGF levels were determined in the culture supernatants by sandwitch ELISA. Results: Stimulation of FLS by serial concentration of IL-17, TGF-β, TNF-α, IL-1β increased the production of VEGF by 2.1-2.7, 2.2-3.0, 2.0-2.9, 2.3-3.1 fold over the constitutive levels of unstimulated FLS. Stimulation of FLS by IL-17 with TGF-β or TNF-α or IL-1β also increased the production of VEGF according to culture periods by 1.6-1.8, 1.1-1.9, 1.5-1.7 fold over the levels stimulated with TGF-β or TNF-α or IL-1β, respectively. This results indicated that IL-17 increased the effect of TGF-β, TNF-α, IL-1β on FLS, leading synergistic enhancement of VEGF production. Conclusion: IL-17 may be involved in the neovascularization in rheumatoid synovitis by enhancing the production of VEGF.

Bisvelcrands by Metal Coordination : Monomers for Oligovelcraplexes

Kwak, Min-Jung,Ihm, Chae-Sang,Paek, Kyung-Soo Korean Chemical Society 2007 Bulletin of the Korean Chemical Society Vol.28 No.1

사구체 신염 환자에서 Gallium-67 신티그램의 임상적 유용성

이수봉(Soo Bong Lee),이우철(Woo Chul Lee),정현철(Hyun Chul Jung),송상헌(Sang Heun Song),곽임수(Ihm Soo Kwak),나하연(Ha Yeon Rha) 대한내과학회 1999 대한내과학회지 Vol.56 No.4

N/A Objectives : Gallium 67(Ga-67) scintigraphy has been used to diagnose inflammatory and neoplastic diseases. We undertook a study to determine the clinical value of Ga- 67 renal scan in patients with various glomerular diseases. Methods : Ga-67 scintigraphy was performed in 48 patients with various biopsy proven forms of renal diseases. Renal uptake in 48 patients images was graded as follow: Grade 0 = not visualization at 48 hours : 1 = faintly visualize : 2 = equal to uptake in spine : 3 = greater than over the spine : 4 = greater than activity over the liver. Results : 1) Of the 48 patients, 31 were male, and mean age was 32 years. 11 patients had hypertension and 29 patients had hematuria. 2) Positive scintigram were seen in 40 of 48(83%) cases. In results of renal biopsy, IgA nephropathy(IgAN) was 15 patients, minimal change disease(MCD) was 14, focal segmental glomerulosclerosis (FSGS) was 8, membranoproliferative glomerulonephritis (MPGN) was 3, lupus nephritis(LN) was 3, poststreptococcal glomerulo- nephritis(PSGN) was 3 and membranous glomerulonephritis(MGN) was 2. 3) In 26 patients (54%) with nephrotic-range proteinuria, Grade 2 or higher renal uptake was observed in 9 (75%) of MCD, 5(100%) of FSGS, 2(100%) of LN and 3(75%) of IgAN. 4) In comparision nephrotics with non-nephrotics at biopsy, renal Ga-67 uptake in who patients had nephrotic- range proteinuria was correlated with clinical severity determined by serum albumin, serum total cholesterol and 24 hours urine protein excretion. Conclusions : Renal Ga-67 scintigraphy may be able to be a predictor in the assessment for severity of nephrotic syndrome.

균혈증 및 패혈증의 임상 양상 및 예후 인자에 대한 고찰

이수봉(Soo Bong Lee),이우철(Woo Chul Lee),정현철(Hyun Chul Jung),송상헌(Sang Heun Song),이동원(Dong Won Lee),김용범(Yong Bum Kim),정주섭(Joo Seop Chung),곽임수(Ihm Soo Kwak),조군제(Goon Jae Cho),나하연(Ha Youn Rha),장철훈(Chul Hun Ch 대한내과학회 1999 대한내과학회지 Vol.56 No.3

N/A Objectives : In spite of the improvement in therapeutic strategy, the mortality rate from sepsis is still high. The purpose of this study was to examine the clinical characteristics and prognostic factors of sepsis to get help in treatment and estimation of prognosis of sepsis. Methods : We analyzed the clinical and bacteriologic data of 313 admitted patients with bacteremia at Pusan National University Hospital from Jan., 1996 to Dec., 1997 retrospectively and all patients were categorized into 4 groups (bacteremia, sepsis, severe sepsis, septic shock) by the definition from American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference, 1992. Results : 1) Male to female ratio was 1.22 : 1 and mean age was 52 years. 2) The overall mortality rate was 32.3% and the mortality rates of bacteremia, sepsis, severe sepsis and septic shock were 14.9%, 22.8%, 52.0%, and 95.2%, respectively. 3) Underlying diseases predisposing to bacteremia were diabetes mellitus(14.4%), solid cancer (13.1%), hematologic malignancy(10.2%) and liver cirrhosis(9.9%), but the most common was no underlying disease. 4) Among the total 80 species of isolated microorganisms, gram-positive organisms were responsible in 169 cases, gram-negative organisms in 218 cases. E. coli was isolated most frequently, followed by S. aureus, S. epidermidis, K. pneumoniae, Enterococcus spp., Enterobacter spp., Str. viridans group, CNS, P. aeruginosa and S. typhi. 5) Although the source of bacteremia could not be identified in 28.8% of the patients, the others had the primary site of infections ; skin(17.9%), gastrointestinal tract(16.9%), respiratory tract(12.5%), urinary tract(9.9%) and biliary tract(7.3%). 6) The mortality rate in patients with gram-positive bacteremia was 39.4%, with gram-negative bacteremia was 20.9% and with polymicrobial bacteremia was 33.3%. MRSA sepsis showed the highest mortality rate(58.8%), followed by Enterococcus spp.(50.0%), K. pneumoniae (35.0%), P. aeruginosa(27.3%) and E. coli(18.8%). 7) There was significant relation between etiologic organisms of bacteremia and the primary site of infections. 8) Using logistic regression analysis, mortality was predicted by disseminated intravascular coagulation, severity of sepsis and severity of underlying diseases. Conclusion : Sepsis occurred in 16 patients among 1,000 adult admitted patients and overall mortality rate was 32.3%, still high. The mortality rate had positive correlation with the severity of sepsis. Among 16 evaluated risk factors of mortality, mortality was predicted by disseminated intravascular coagulation, severity of sepsis and severity of underlying disease.

신기능 저하 환자에서 99mTc - DMSA 신장 스캔을 이용한 신 섭취율과 사구체 여과율의 상관성

이수봉(Soo Bong Lee),정현철(Hyun Chul Jung),곽임수(Ihm Soo Kwak),나하연(Ha Yeon Rha),안승재(Seoung Jae An),정유석(Yoo Suck Jung) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.4

배 경 : 신기능 저하 환자에서 신기능을 정확히 평가하는 것은 중요하고, 다양한 방법으로 사구체 여과율(GFR)을 구하고 있다. 임상에서 흔히 ^99mTc-DTPA 신장 스캔과 99mTc-DMSA 신장 스캔이 개별 신기능의 평가에 많이 이용되고 있다. 본 연구에서는 99mTc-DMSA 신장 스캔을 이용하여 신피질 영상을 위한 1시간 상대적 신 섭취율과 사구체 여과율 사이의 상관성을 검토하고자 하였다. 방 법: 1998년 1월부터 2001년 3월까지 부산대학교병원 신장내과에 내원한 환자들 중 ^99mTc-DMSA 신장 스캔, ^99mTc-DTPA 신장 스캔, 혈청 크레아티닌, 24시간 요 중 크레아티닌을 검사한 65명의 환자들 중에서, 중증 및 중등도 신기능 저하 환자 42명을 대상으로 하였다. ^99mTc-DTPA 신장 스캔을 이용한 사구체 여과율(DTPA-GFR)에 따라 중증 신기능 저하군(A)과 중 등도 신기능 저하군(B)으로 나누었다(A군 : ≤20 mL/min/1.73㎡, n=20명, B군 : 20-50 mL/min/1.73㎡, n=22명). 99mTc-DMSA 신장 스캔을 이용하여 1시간 상대적 신 섭취율(DMSA-%uptake, TRUR)을 구하고, 이것을 99mTc-DTPA 신장 스캔을 이용한 사구체 여과율(DTPAGFR), 내인성 크레아티닌 청소율(Ccr), Cockcroft와 Gault가 고안한 추정 크레아티닌 청소율(C & G Ccr)과 Spearman rank correlation test를 이용하여 상관성을 비교하였다. 결 과 : 전체 42명의 대상 환자들 중에서 15명은 남자였고, 27명은 여자였다. 평균 나이는 54 세(28-80세)였다. 두 군에서 평균 DTPA-GFR과 평균 TRUR은 각각 통계적으로 유의한 차이 를 보였다(14.8±4.7 vs 34.9±8.4 mL/min/1.73㎡, p<0.05; 8.9±3.7 vs 16.3±7.4%, p< 0.05). 그러나 TRUR의 DTPA-GFR에 대한 상관성을 보았을 때, A군에서는 유의한 상관관계는 없었으나, B군에서는 유의한 상관관계를 보였다(0.263, p>0.05 vs 0.731, p<0.01). 또한 TRUR의 혈청 크레아티닌, Ccr, C & G Ccr에 대한 상관성을 보았을 때, 두 군 모두에서 통계적으로 유의한 상관관계를 보였다. 결 론 : ^99mTc-DMSA 신장 스캔에서 신피질 영상으로 사용되는 1시간 상대적 신 섭취율은 실제 사구체 여과율을 정확하게 측정할 수는 없지만, 신기능이 중증이하로 감소되지 않은 경우에는 사구체 여과율을 간접적으로 반영하였다. Background : Glomerular filtration rate(GFR) is an important parameter for the evaluation and monitoring of renal function. The aim of this study was to investigate the correlation between the relative 1 hour uptake of 99mTc-DMSA renal scan(DMSA-%uptake, TRUR) and GFR which was estimated by 99mTc-DTPA, serum creatinine and 24 hour-urinary creatinine excretion. Methods : Between January 1998 and March 2001, 65 patients had undergone ^99mTc-DMSA renal scan, ^99mTc-DTPA renal scan, serum creatinine and 24 hour-urinary creatinine excretion. Of them, 42 patients had moderately or severely reduced renal function(DTPA-GFR ≤50 mL/min/1.73㎡). According to the DTPA-GFR level, patients were divided into two groups : Group A(n=20) with DTPA-GFR ≤20 mL/min/1.73㎡(mean±S.D. 14.8±4.7), Group B(n=22) with DTPA-GFR 20-50 mL/min/1.73㎡(mean±S.D. 34.9±8.4). Between the TRUR and other methods to estimate renal function such as DTPA-GFR, 24 hour-urinary creatinine clearance(Ccr) and Cockcroft & Gault`s formula(C & G Ccr), the correlation coefficient was measured by Spearman rank correlation test. Results : Of 42 patients, 15 were men and 27 were women(mean age 54 years; range 28-80 years). there were significant differences between mean DTPA-GFR and mean TRUR in both groups(14.8±4.7 vs 34.9±8.4 mL/min/1.73㎡, p<0.05; 8.9±3.7 vs 16.3±7.4%, p<0.05). In group A, TRUR(mean±S.D. 8.9±3.7%) was not significantly correlated with DTPA-GFR(r=0.263, p>0.05). In group B, TRUR (mean±S.D. 16.3±7.4%) was significantly correlated with DTPA-GFR(r=0.731, p<0.01). In both group, serum creatinine, Ccr and C & G Ccr were significantly correlated with TRUR. Conclusion : Although the relative 1 hour uptake of the ^99mTc-DMSA renal scan, as a method of renal cortical image could not estimate the true GFR, it showed a good correlation with GFR in patients with moderately reduced renal function. 99mTc-DMSA renal scan seems to be helpful to evaluate the renal function in patients with moderately reduced renal function.

IgA 신병증에서 혈중 Vascular Endothelial Growth Factor 농도의 임상적 의의

이수봉(Soo Bong Lee),이동원(Dong Won Lee),김용범(Yong Bum Kim),정현철(Hyun Chul Jung),곽임수(Ihm Soo Kwak),나하연(Ha Yeon Rha) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.4

목 적: Vascular Endothelial Growth Factor(VEGF)는 혈관 내피 세포의 증식과 혈관 신생, 혈관 투과도의 증가 등을 유발하는 특이한 성장인자로서 신장에서도 생성된다고 하나 아직 완전한 기능은 밝혀지지 않은 상태이다. 이에 저자들은 원발성 사구체 질환 중에서 가장 흔한 IgA 신병증 환자를 대상으로 질병의 중증도와 관련된 여러 인자들과 혈청 VEGF 농도 사이의 상관관계를 알아보기 위해 본 연구를 시행하였다. 방 법 : 부산대학교병원 신장내과에 입원하여 신생검 시행결과 IgA 신병증으로 진단된 21명의 환자를 대상으로 혈청 VEGF를 Sandwich ELISA 방법으로 정량 하였으며 조직학적 소견을 포함한 질환의 중증도를 반영하는 인자들과 혈청 VEGF 농도와의 상관관계를 조사하였다. 결 과: 조직학적 중증도, 조직 표본중의 반월(crescent)의 비율, 혈청 중의 크레아티닌, 알부민, IgA들의 각각의 농도와 24시간 요단백 배설량, 크레아티닌 청소율을 구하여 이들과 혈청 VEGF 농도와의 상관관계를 분석한 결과 조직학적 등급(r=0.471, p<0.05), 세포성 반월의 비율 (r=0.485, p<0.05), 간질 섬유화의 정도(r=0.562, p<0.01), 24시간 요단백 배설량(r=0.439, p<0.05), 그리고 혈청 알부민 농도(r=-0.594, p<0.01)가 각각 의미 있는 상관관계를 보였다. 반월이 관찰되지 않았던 17명을 대상으로 한 조사에서는 혈청 알부민 농도만이 혈청 VEGF 농도와 의미 있는 상관관계를 보였다. 7명의 조직학적 등급 IV, V인 환자를 대상으로 혈청 VEGF의 농도를 조사한 결과 반월의 존재 여부에 따라 유의한 차이를 보였다. 결 론: IgA 신병증에서 혈중 VEGF 농도는 조직학적 소견에서 사구체 경화와 같은 만성적인 변화보다는 급성 신손상을 반영하는 세포성 반월(cellular crescent)의 형성과 의미 있는 양(positive)의 상관 관계를 보인다. 따라서 혈청 VEGF 농도는 IgA 신병증 환자에서 급성 신 손상의 정도, 그 중에서도 특히 세포성 반월 형성을 반영하는 좋은 표지자로 판단된다. Background : Vascular endothelial growth factor (VEGF) is a potent enhancer of microvascular permeability and a selective endothelial cell growth factor. In human kidney, VEGF is expressed mainly in glomerular visceral epithelial cells. We investigated the relationship between serum levels of VEGF and factors reflecting the severity of disease including histological patterns in order to elucidate the relevance of VEGF in the pathogenesis of IgA nephropathy. Methods : Serum VEGF was studied using a sandwich ELISA from 21 patients with IgA nephropathy. Histological patterns are classified to 5 grades by WHO classification and frequencies of crescent and glomerular sclerosis, degree of interstitial fibrosis were recorded. Serum concentrations of creatinine, albumin, IgA, amounts of 24 hour urine protein excretion, and creatinine clearances are also evaluated. Results : Serum VEGF levels were significantly correlated with histological grade(r=0.471, p<0.05), frequency of cellular crescent(r=0.485, p<0.05), degree of interstitial fibrosis(r=0.562, p<0.01), and 24 hour urine protein excretion(r=0.439, p<0.05), and inversely with serum albumin concentration(r=-0.594, p<0.01). Studies in 17 patients without crescent formation revealed that only serum albumin concentration showed significant correlation with serum VEGF level. Conclusion : Serum VEGF concentration is mainly correlated with cellular crescent formation reflecting activity of the disease rather than chronic structural changes such as glomerular sclerosis or interstitial fibrosis. Elevated serum VEGF concentration seems to be due to the release of relatively large amounts of stored VEGF from damaged visceral epithelial cells. Serum VEGF concentration may be a useful marker to evaluate the degree of acute renal injury, especially cellular crescent formation.

신이식 후 호전을 보인 Nephrogenic Fibrosing Dermopathy

김훈수 ( Hoon Soo Kim ),김수한 ( Su Han Kim ),고현창 ( Hyun Chang Ko ),김문범 ( Moon Bum Kim ),송상헌 ( Sang Heon Song ),김정섭 ( Jung Sup Kim ),곽임수 ( Ihm Soo Kwak ) 대한피부과학회 2010 대한피부과학회지 Vol.48 No.2

Nephrogenic fibrosing dermopathy (NFD) is a rare cutaneous fibrosing disorder that primarily affects patients with a history of renal disease. NFD manifests with induration, thickening and hardening of the skin with brawny hyperpigmentation. Lesions are typically symmetrical and usually develop on the limbs and trunk. Flexion contractures of the joints may be a feature of the disease. Histopathological features of NFD include proliferation of dermal fibroblasts and dendritic cells, thickened collagen bundles, increased elastic fibers and focal mucin deposition. Although the pathogenesis remains largely unknown, some of the factors implicated in the pathogenesis include renal dysfunction, circulating fibrocytes, vascular injury, and gadolinium which is a contrast material used in magnetic resonance imaging. Currently, no definitive or uniformly effective therapies are available for the treatment of NFD. We herein describe the case of a 44-year-old female NFD patient who undergoes significant improvement of skin lesions and associated joint contracture after renal transplantation. (Korean J Dermatol 2010;48(2):143∼147)

만성 신부전 환자의 영양평가 지표로서의 DEXA의 유용성

박성민,곽임수,나하연,송상헌,성은영,이수봉,이우철,정현철 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.2

It has been considered that the nutrition affects the mortality of chronic renal failure patients. Thus, several studies reported the method of examination about nutritional status in chronic renal failure patients. The purpose of the present study was to evaluate the nutritional status of 32 chronic renal failure patients, and recommend DEXA as a objective method. Thirty two chronic renal failure patients and 24 disease-free persons on kidney(control group) were included in this syudy. There were no difference in mean age, sex, weight, height, body mass index between two groups. We measured % total body fat, fat-free mass, limb fat, trunl fat, limb fat/trunk fat ratio with Hologic QDR 4500. The results were as follows. 1)% Total body fat of chronic renal failure patients was 20.7±7.9%. That was lower than 26.3±7.9% of control group(P$lt;0.05). 2)Fat-free mass of chronic renal failure patients revealed lower result compared with control group. Each result was 40.2±12.2kg, 46.2±9.1kg(P$lt;0.05). 3)Despite ofsignificant difference between two groups in ratio of limb fat and trunk fat, limb fat and trunk fat were statistically different(Limb fat:CRF-5.6±2.4kg, Control-7.1±1.9kg, Trunk fat:CRF- 5.2±3.0kg, Control-7.7±2.7kg)(P$lt;0.05). 4)Triceps skinfold thockness was positively correlated with % total body fat, limb fat, trunk fat, and negatively correlated with fat-free mass. Mid- arm muscle area circumference had inverse relationship above(P$lt;0.05). 6)Severe malnurished patients(SGA-C group) had lower result compared to mild-moderate malnurished patients(SGA-B group) about %TBF, LF,TF, total lymphocyte count. In addition to DEXA, we examined triceps skinfold thickness and mid-arm muscle area circumference. The result showed significant comparison between two groups, too. But albumin, cholesterol, potassium level was no statistical significant difference, except lymphcyte count. In conclusion, as suggested by above results, chronic renal failure patients has protein-calorie malnutrition. This nutritional staaffects long-term survival of chronic renal failure patients. DEXA can give objective data accompanied with simple anthropometric measurement in nutriti onal status. Thus, we recommend DEXA as objective method of nutritional examination. In future, more precise method will be discovered, and that contribute more long-term survival of chronic renal failure patients.

급성 췌장염을 동반한 용혈성 요독 증후군 1예

이우철,류수형,이수봉,신호진,곽임수,배우형,나하연,이현국 대한내과학회 2000 대한내과학회지 Vol.59 No.6

The hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. Microvascular thromboses in HUS may involve intestine, pancreas, skeletal muscle, and heart. Microinfarcts in the pancreas may cause acute pancreatitis and rarely insulin-dependent diabetes mellitus. Acute pancreatitis is a relatively common complication of HUS in children, but rare (2%) in adults. We have experienced a 43 year-old woman with HUS complicating acute pancreatitis. She presented with hemolytic anemia, thrombocytopenia and acute renal failure. During hemodialysis, she complained of left side abdominal and back pain. On laboratory study, levels of serum amylase and lipase were elavated. The size and shape of pancreas was normal on abdominal ultrasonography and computed tomography. We present this case with a review of literature.(Korean J Med 59:663-667, 2000)