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IgA 신장병의 장기 추적에 따른 임상 경과 및 예후 인자
백진혁 ( Jin Hyuk Paek ),김예림 ( Yae Rim Kim ),박하연 ( Ha Yeon Park ),황은아 ( Eun Ah Hwang ),한승엽 ( Seung Yeup Han ),박성배 ( Sung Bae Park ) 대한내과학회 2015 대한내과학회지 Vol.88 No.1
Background/Aims: Immunoglobulin A nephropathy (IgAN) is the most common type of primary glomerulonephritis worldwide. Although several studies have identified IgAN prognostic factors in Korea, the follow-up period was insufficient to evaluate thenatural history of IgAN. Methods: A total of 471 patients were diagnosed with IgAN after percutaneous renal biopsy between April 1985 and March 2003. Patients with secondary IgAN and patients with a follow-up < 10 years since their diagnosis were excluded. Thus, 184 patients wereenrolled. Results: Among the 184 patients, 97 were males (52.7%) and 87 were females (47.3%). The mean age was 33.7 ± 11.5 years, andthe mean follow-up period was 181.3 ± 46.3 months. During the follow up, 73 patients (36.9%) had progressed to end-stage renaldisease (ESRD). The mean duration to ESRD was 98.1 ± 55.9 months. The overall renal survival rate was 60.3%, the 10-years renalsurvival rate was 74.3%, and the 20-years renal survival rate was 49.3%. Univariate analyses indicated that hypertension, serumcreatinine > 1.3 mg/dL, estimated glomerular filtration rate < 60 mL/min/1.73 m2, serum albumin < 3.5 g/dL, proteinuria ≥ 1 g/day,and severe renal pathology by the Haas sub-classification were significantly associated with ESRD. When these factors wereincluded in multivariate Cox regression analyses, only severe renal pathology by the Haas sub-classification was an independentprognostic factor for IgAN. Conclusions: Careful follow-up and treatment is recommended, particularly in patients with IgAN and severe renal pathology bythe Haas sub-classification.
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최고 ( Go Choi ),황은아 ( Eun Ah Hwang ),여상목 ( Sang Mok Yeou ),백진혁 ( Jin Hyuk Paek ),박성배 ( Sung Bae Park ),한승엽 ( Seung Yeup Han ),김현철 ( Hyun Chul Kim ),최미선 ( Mi Sun Choe ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.4
Purpose: Urinalysis is one of the best methods for early detection of renal disease and recent wide- spread use of mass screening led to increasing prevalence of asymptomatic urinary abnormalities. Usually, primary chronic glomerulonephritis first presents with asymptomatic urinary abnormalities and chronic glomerulonephritis commonly causes end-stage renal disease. However, clinical outcome of asymptomatic urinary abnormalities in adults is not well known. Methods: Between Jan 1995 to Aug 2009, 333 patients with asymptomatic urinary abnormalities who underwent percutaneous renal biopsy were enrolled. A retrospective study was performed to clarify the prognostic factors and the long-term renal outcome of this disease. Results: According to clinical manifestation, there were 79 (23.7%) of isolated microscopic hematuria, 30 (9.0%) of isolated proteinuria and 224 (67.3%) of mixed hematuria and proteinuria. The patients were significantly younger in case with microscopic hematuria. Group with microscopic hematuria had significantly shorter follow up period (p=0.013). In pathologic diagnosis, IgA nephropathy was most common with 244 patients (73.3%). The proteinuria group and mixed group showed significantly higher rate of progression to chronic renal failure than the microscopic hematuria group (p=0.015). The group that 24-hour proteinuria was more than 0.5 g/day showed significantly higher progression rate to chronic renal failure (p<0.000). Using univariate regression analysis, 3 risk factors for progression to chronic renal failure were identified: age, serum creatinine, 24-hour total urine protein. In multivariate regression analysis, only 24-hour proteinuria was the independent prognostic factor for progression to chronic renal failure. Conclusion: IgA nephropathy is the most common cause of asymptomatic urinary abnormalities in adults. The group of proteinuria has higher progression rate to chronic renal failure than other groups. Over 0.5 gm of 24-hour proteinuria is a significant risk factor for progression to chronic renal failure in multivariate regression analysis.
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곽충환 ( Choong Hwan Kwak ),박하연 ( Ha Yeon Park ),김예림 ( Yae Rim Kim ),백진혁 ( Jin Hyuk Paek ),황은아 ( Eun Ah Hwang ),박성배 ( Sung Bae Park ),한승엽 ( Seung Yeup Han ) 대한내과학회 2014 대한내과학회지 Vol.86 No.4
The widespread use of colonoscopy for early detection of colorectal pathology has increased the use of osmotic laxatives for colonic cleansing. Among these, oral sodium phosphate preparations can cause renal insufficiency through the development of acute phosphate nephropathy. Acute phosphate nephropathy can be distinguished as early symptomatic and late insidious patterns. Patients whose presentation is insidious are easily overlooked and can progress to chronic kidney disease. We report a case of complete recovery from the late insidious type of acute phosphate nephropathy. (Korean J Med 2014;86:505-509)
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