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박자용 ( Ja Yong Park ),조장희 ( Jang Hee Cho ),윤영득 ( Young Deuk Yoon ),송은주 ( Eun Joo Song ),진미경 ( Mi Kyung Jin ),류정훈 ( Chung Hoon Yu ),정희연 ( Hee Yeon Jung ),임정훈 ( Jeong Hoon Lim ),신용봉 ( Yong Bong Shin ),최지 대한내과학회 2011 대한내과학회지 Vol.80 No.4
Background/Aims: The Korean Network for Organ Sharing (KONOS) was established in 2000, and the KONOS criteria for expanded- criteria donors (ECD) have since been applied to kidney allocation from deceased donors. The outcome of cadaveric kidney transplantation from ECD according to KONOS criteria has not been investigated. Methods: Seventy-seven cadaveric kidney transplants from January 2003 to December 2009 were recruited retrospectively. Factors that influence the glomerular filtration rate (GFR) of graft kidneys up to 36 months after transplantation were evaluated. Postoperative renal function and allograft and patient survival in the ECD group (n = 28) were compared with those in the standard- criteria donor (SCD) group (n = 49). Results: The GFR of graft kidneys was different according to donor GFR, age, hypertension history, and cause of brain death. In the ECD group, GFR was lower than that in the SCD group by KONOS criteria. No differences in allograft or patient survival were observed until 3 years after kidney transplantation. Conclusions: Cadaveric kidney transplantation using the ECD by KONOS criteria is acceptable in term of graft and 3-year patient survival, although the GFR was lower in the ECD than in the SCD group. (Korean J Med 2011;80:408-418)
중증의 급성신손상 환자에서 지속적 신대체요법 대체치료로서의 지속성 순화 혈액투석
신용봉 ( Yong Bong Shin ),조장희 ( Jang Hee Cho ),박자용 ( Ja Yong Park ),최지영 ( Ji Young Choi ),박선희 ( Sun Hee Park ),김찬덕 ( Chan Duck Kim ),김용림 ( Yong Lim Kim ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.5
Purpose: Although continuous renal replacement therapy (CRRT) is commonly used as a renal replacement therapy in critically ill patients with acute kidney injury, it has some disadvantages such as inconvenience, intensive labor, expensiveness and high bleeding risk. Recent studies have shown that sustained-low efficiency dialysis (SLED) can overcome these shortages of CRRT and also has the advantages of CRRT. We prospectively compared the efficiency, safety, cost and convenience between SLED and CRRT, and evaluated whether SLED could be a complementary substitute to traditional CRRT. Methods: Forty-six critically ill patients with acute kidney injury (AKI) from 2003 to 2005 were treated with SLED (n=25) and CRRT (n=21). The modality was tended to be selected randomly and based largely on availability of equipments and not on the clinical status of patients. Mann-Whitney rank-sum test, Fisher`s exact test and chi-square test were used for statistics, and data were described as median value, range from 25th to 75th. Results: The Acute Physiology and Chronic Health Evaluation (APACHE) II score at the point of ICU admission was 27 for SLED (range 17-3 25-75th percentile) and 26 for CRRT group (range 19-31) (p= NS). There were no significant differences between the two groups in mean arterial blood pressure when measured pre-dialysis (83 for SLED vs. 85 for CRRT; p=NS), mid-dialysis (90 vs. 84; p=NS) and at the end of treatment (88 vs. 80; p=NS). Incidences of hypotension also did not differ between the two groups (p=NS). Ultrafiltration volume per treatment day was similar in two treatment modalities (000 mL for SLED vs. 400 mL for CRRT; p=NS). Heparin was used to thirty-one patients (SLED: 18 patients, CRRT: 13 patients). The dosage of heparin tended to be lower in SLED (900 unit per day for SLED vs. 6,000 unit per day for in CRRT, p=0.065). Total clotting number was 4 for SLED and 11 for CRRT (p=NS). There was also no significant difference in hospital mortality between the two groups (56% for SLED vs. 42.9% for CRRT; p=NS). SLED was superior to CRRT in the aspect of cost and convenience. Conclusion: Our data suggest that SLED can be used as a useful substitute to traditional CRRT in critically ill patients with AKI.
p-ANCA 연관 신염의 임상적 고찰: 단일 임상기관 연구
강혁주 ( Hyeock Joo Kang ),박선희 ( Sun Hee Park ),박자용 ( Ja Yong Park ),신용봉 ( Yong Bong Shin ),김찬덕 ( Chan Duck Kim ),탁우택 ( Woo Taek Tak ),이정호 ( Jeong Ho Lee ),김용림 ( Yong Lim Kim ) 대한내과학회 2008 대한내과학회지 Vol.74 No.5
Background/Aims: We evaluated the clinical characteristics and prognostic value of the clinical, laboratory, pathologic features, at time of diagnosis, and the renal survival of patients with ANCA (anti-neutrophil cytoplasmic antibody)-related nephritis. Method: We retrospectively analyzed 17 patients who were diagnosed with ANCA-related nephritis at a single center. The risks of progression to ESRD or death according to the clinical parameters, the ANCA pattern and the renal pathologic findings were evaluated. Results: The major symptoms were hematuria (100%), proteinuria (100%), uremic symptoms (41.2%), edema (35.5%), upper respiratory symptoms (29.4%) and oliguria (23.5%), which were not correlated with renal survival. All the patients showed a p-ANCA pattern. The BUN level (p=0.032) and GFR (p=0.023) at the time of diagnosis were different between the improved and the progressed patients in terms of renal function. The pathology indices were not predictive factors of both renal and patient survival. Eight patients (47.1%) were treated with steroid IV pulse, 4 (23.5%) with steroid IV pulse and cyclophosphamide IV pulse, 2 (11.8%) with steroid IV pulse, cyclophosphamide IV pulse and plasma exchange, and 2 (11.8%) with steroid IV pulse and plasma exchange. Fourteen patients (82.4%) needed hemodialysis. There were 3 (17.6%) disease-related deaths, 13 patients (76.5%) reached ESRD and 4 (23.5%) showed recovery of renal function. The mean percent of patients who survived was 80.2% and the mean percent of renal survival was 33.3% at the 1st and 3rd year, respectively. Conclusions: Poor renal function at presentation was associated with a high risk for disease progression, but age, gender, the clinical patterns of presentation and the pathologic findings were not associated with the prognosis. Early diagnosis and treatment seems to be essential to improve the renal outcomes.(Korean J Med 74:523-530, 2008)
송은주 ( Eun Joo Song ),조장희 ( Jang Hee Cho ),윤영득 ( Young Deuk Yoon ),박자용 ( Ja Yong Park ),최지영 ( Ji Young Choi ),윤세희 ( Se Hee Yoon ),김연수 ( Yon Su Kim ),김찬덕 ( Chan Duck Kim ),김용림 ( Yong Lim Kim ),박선희 ( Sun 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.6
Primary hyperoxaluria is a rare disorder of glyoxylate metabolism in which hepatic enzyme deficiencies result in overproduction of oxalate. The resulting elevation of urinary oxalate excretion leads to recurrent urolithiasis and progressive nephrocalcinosis. End-stage renal disease frequently occurs and is accompanied by systemic oxalate deposition along with its harmful effects. With the rarity and various clinical heterogeneity of the disease, the high proportion of patients in whom diagnosis is made after advanced renal failure have developed it. On account of its high rate of graft loss associated with primary hyperoxaluria, isolated kidney transplantation has been replaced by combined liver/kidney transplantation. In this report, we describe a case of primary hyperoxaluria with kidney graft failure who had a history of recurrent renal stones.
지속성 외래복막투석 환자들의 예후에 영향을 미치는 요인들에 관한 고찰
권혁만 ( Kwon Hyeog Man ),김찬덕 ( Kim Chan Deog ),조지형 ( Jo Ji Hyeong ),장민화 ( Jang Min Hwa ),최혁준 ( Choe Hyeog Jun ),이현철 ( Lee Hyeon Cheol ),박자용 ( Park Ja Yong ),박선희 ( Park Seon Hui ),김용림 ( Kim Yong Lim ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.2
배 경 : 복막투석은 신이식 및 혈액투석과 함께 말기신부전 환자의 신대체요법으로 널리 사용되고 있다. 복막투석 환자들의 예후는 전통적으로 요소 역동모델로 표현된 투석량에 가장 많은 영향을 받는다고 알려져 왔으나 최근 여러 연구들에 의하면 적절한 투석에는 단순한 투석량의 증가이외의 것들이 필요하다고 한다. 이에 본원에서 복막투석을 시행증인 환자들을 대상으로 영양상태와 투석량, 잔여 신기능, 복막투과특성 등을 평가하고 4년 이상 추적관찰을 하여 복막투석 환자의 생존율 및 기술생존율에 영향을 미치는 요인들을 살펴보았다. 방 법 : 복막투석 환자들 중 1998년 3월부터 1999년 2월까지 영양상태, 투석적절도, 잔여 신기능, 복막상태를 평가받고 2003년 1월까지 경과추적이 가능하였던 127명의 환자를 대상므러 하여 먼저 이들 요인들이 복막투석의 환자생존율 및 기술생존율에 미치는 영향을 살펴보았다. 또 이들 중 투석적절도의 재평가가 가능하였던 41명에서는 시간에 따른 요인들의 변화가 환자 생존율과 기술생존율에 미치는 영향을 알아보았다. 결 과 : 전체 대상환자군 (남:여 72:55)의 평균투석시작 연령은 47±12.9세, 평균추적기간은 44.5±1.8개월, 평균 기술생존 기간은 42.2±1.8개월이었다. 초기 분석시 환자들의 평균 혈청알부민은 3.7±0.5 g/dL, nPCR은 0.8±0.2 g/㎏/d, %LBM는 68.4±14.3, 주당 Kt/V는 2.0± 0.7, Ccr는 64.5±28.8 L/wk/1.73 ㎡, 잔여 신기능은 1.1±2.3 mL/min, 24 hours D/Pcr은 0.74±0.12이au Kt/V, Ccr이 2.0, 60/wk/1.73 ㎡ 이상인 군이 각각 40.9%, 43.3%, 그리고 잔여 신기능이 0.5 mL/min 이상인 경우를 잔여 신기능이 있다고 가정할 경우 33.9%의 환자에서 잔여 신기능이 관찰되었다. Kaplan-Meier 생존율 분석 및 Cox regression model로 분석한 결과 환자생존율에 영향을 미치는 요인들은 당뇨병성 신병증, 혈청알부민, 잔여 신기능의 유무 등이었으며 nPCR, SgA, %LBM, Kt/V, Ccr 등은 영향이 없있고 기술생존율에 영향을 미치는 요인들은 연령, 당뇨병성 신병증, 혈청알부민, 잔여 신기능의 유무, 그리고 복막투과 특성 등이었다. 투석적절도를 추적 관찰하였던 환자들 중 사망군과 기술실패를 보였던 군에서 혈청일부민의 감소속도가 빨랐고 복막투과특성의 증가소견을 보였다. 결 론 : 환자들의 영양상태 및 잔여 신기능의 유지가 환자의 장기적인 생존 및 기술생존에 중요하며 혈청알부민의 감소와 복막투과특성의 증가는 장기적인 환자생존 및 기술생존에 부정적인 영향을 미치는 것으로 사료된다. Purpose : Several factors including dialysis adequacy are now known to be related to clinical outcomes of CAPD patients. In our study, the long term effects of dialysis adequacy, residual renal function, nutritional indices, and peritoneal membrane transport characteristics on the outcomes of CAPD patients were evaluated. Methods : Prevalent or incident 127 patients were enrolled from February 1998 to January 1999. Follow-up was terminated in January 2003. In 41 patients, parameters of adequacy were reevaluated, and the effects of parameter change over time on patient outcomes were analyzed. Results : Seventy-two were male. Twenty-nine (23%) were diabetic. Mean age was 47±12.9 years, and the mean follow up period was 45±1.8 months. The baseline serum albumin was 3.7±0.5 g/dL. nPCR was 0.8±0.2 g/kg/d, and %lean body mass was 68.4±14.3 Kt/V was 2.0±0.7, and Ccr was 64.5±28.8 L/자/1.73 m². The estimated GFR was 1.1±2.3 mL/min. The multivariated analysis demon strated that diabetes, serum albumin, and the patent residual renal function were independent factors of the patient and technique survival. Membrane transport characteristic was a predictor of technique survival. Among patients for whom the parameters of adequacy were reevaluated, a more rapid decrease of serum albumin and a more rapid increase of membrane transport characteristics were associated with increased risk of either death or technique failure. Conclusion : Nutritional indices and presence of residual renal function have a significant impact on the clinical outcome. The decrease of serum albumin and the increase of membrane transport characteristic have negative impacts on patient and technique survival. (Korean J Nephrol 2004;23(2):325-334)