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단회뇨의 protein/creatinine ratio를 이용한 일일 뇨단백량 예측에 영향을 미치는 인자
강신욱(Shin Wook Kang),최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han),유태현(Tae Hyeon Yoo),류동렬(Dong Yul Ryu),신석균(Sug Kyun Shin),하성규(Sung Kyu Ha),노현진(Hyun Jin Noh),송현용(Hyun Yong Song),황재하(Jae Ha Hwang) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1
N/A It's well known that protein/creatinine ratio(P/C ratio) in random urine samples reflects 24-hour urine protein. However, the factors affecting accurate quantitation of proteinuria using random urine P/C ratio are not fully evaluated. The aim of this study is to evaluate factors affecting accurate quantitaion of proteinuria using random urine P/C ratio. 118 patients admitted in Yonsei university medical center during June 1998 and Dec. 1998 were assessed for the measurement of random urine protein/creatinine ratio from second voided urine. 118 patients(mean age 41.5year, male: female 2.36: 1) had mean creati-nine level 1.83±1.78mg/dL, 24-hour pmteinuria 6.06±7.64g/day and P/C ratio 4.80±4.48, All the patiient.s were divided into A, B, C, I, II, K, IV according to serum creatinine level and 24-hour proteinurim amount. The correlation coefficient(R value) between proteinuria and P/C ratio are shown that in all pa- tients is 0.875, group A(Cr≤1.4) 0.884, group B(1A <Cr≤4.0) 0.819, group C(4,0<Cr) 0.844, gmup I (24-hr pro'≤0.3) 0.8%, group II(0.3<24-hr pro≤1.0) 0.813, group III(1.0<24-hr pro≤3.5) 0.716, group IV (3.5<24-hr pro) 0.637. These R value were statisti-cally significant(p value<0.05).(Cr serum creatinine, mg/dL, 24-hr pro ' 24-hour urine protein amount, g/day). Greater amount of proteinuria in 24-hour urine less correlated in sensitivity, specificity and positive predictive value with random urine P/C ratio. To evaluate factors affecting accurate quantitation of proteinuria by P/C ratio, multiple regression analysis was performed. The factors affecting accurate quantitation of proteinuria using random urine P/C ratio was 24-hour urine protein amount, not serum creatinine. Especially, in the patients with 24-hour pro-teinuria less than 4.0g/day, the random urine P/C ratio predicted 24-hour urine protein amount most accurately. In conclusion, random urine P/C ratio was well correlated with 24-hour proteinuria in the non-ne-phrotic range proteinuria especially, under 4.0g/day, irrespective of serum creatinine level.
이차성 부갑상선 기능 항진증을 가진 복막투석 환자에서 경구 칼시트리올 치료 반응에 관여하는 요인
강신욱(Shin Wook Kang),최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han),신석균(Sug Kyun Shin),하성규(Sung Kyu Ha),노현진(Hyun Jin Noh),송현용(Hyun Yong Song),노현정(Hyun Jung Roh),유태현(Tae Hyun Yoo),황재하(Jae Ha Hwang) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1
N/A Calcitriol therapy is an important treatment for the prevention and control of secondary hyperparathyroidism in continuous ambulatory peritoneal dialysis (CAPD) patients. However, this often has been limited by the associated hypercalcemia and hyperphosphatemia due to increase in intestinal calcium and phosphorus absorption. Many studies reported that these limitations could be avoided by changing routes, frequency and dose of calcitriol treatment. But, there are still controversy about each methods and the results on the PTH response to conventional calcitriol treatment in CAPD patients. This study was performed to evaluate the factors affecting the response to oral calcitriol in CAPD patients. A retrospective study was done in 92 CAPD patients with secondary hyperparathyroidism(intact PTH level >200pg/ml) on oral calcitriol treatment. After baseline study of serum calcium, phosphorus, alkaline phosphatase, BUN, creatinine and intact PTH, calcitriol therapy was begun via oral rou- te, daily. Serum calcium, phosphorus, alkaline phosphatase, BUN, creatinine, intact FI'H and other bio- chemical markers were checked at 3 month, 6 month after treatment. Parathyroid gland ultrasonography was performed to detect parathyroid hypertrophy and nodule and to measure the diameter of parathymid gland. All the patients were divided into two groups according to percent reduetion of i-PTH(initial PTH PTH after 3, 6 months)×100/initial PTH(%),△PTH during oral calcitriol therapy for 3 and 6 months(group I ; △PTH >30%, group II ; △PTH <30%). Result: 1) All 92 patients(mean age 46.5 11.3yr, M: F 45: 47, mean CAPD duration 51.3 39.4 months) were administered oral calcitriol, daily. Mean calcitriol dose during 3 month was 0.43 0.22μg and during 6month 0.43 0.24μg. 2) After 3-month treament, there were significant differences in initial i-PTH, the diameter of parathyroid gland, initial phosphorus, intial total alkaline phosphatase and duration of CAPD between group I and II(406.7±196.5 vs. 871.0±478Apglml, 6.2±2.6 vs. 13.1±5.2mm, 5.0±1.3 vs. 5.7±1.3mg/dl, 93.7±4L1 vs. 171.9±137.6IU/L, 40.1±34.9 vs. 73.5±37.8months, p< 0.05, respectively). 4) After 6-month treament, there were significant differences in initial i-PTH, the diameter of parathyroid gland, intial total alkaline phosphatase and duration of CAPD between group I and II(474.1±266.6 vs. 889.7±485.4pg/ml, 6.4±2.7 vs. 14.5±5.1mm, 107.9±80.1 vs. 180.7±121.5IU/L, 40.5± 32.9 vs. 81.8±35.3months, p<0.05, respectively). 5) The significant negative correlation was shown between △PTH and the duration of peritoneal dialysis, the diameter of parathyroid gland, initial PTH level and PTH response during 3-month and 6-month oral calcitriol treatment. The response to oral calcitriol was poor when i-PTH level more than 500pg/ml(kappa 0.429, p value <0.01), the diameter of parathyroid gland more than 10.0mm(kappa 0.641, p value<0.01), the duration of CAPD more than 55months(kappa 0.524, p value< 0.01). These data suggested that initial i-PTH level, the diameter of parathyroid gland size and the duration of CAPD were independent risk factors of the poor response to oral calcitriol therapy in CAPD patients with secondary hyperparathyroidism.
전화추후관리 프로그램이 복막투석환자의 치료지속이행, 투석적절도와 감염발생도에 미치는 효과
전시자,신석균,노영숙,이숙정,박애희,박양숙,박영미,Chon, Si-Ja,Shin, Sug-Kyun,Roh, Young-Sook,Lee, Suk-Jeong,Park, Ai-Hee,Park, Yang-Sook,Park, Young-Mi 한국가정간호학회 2009 가정간호학회지 Vol.16 No.2
Purpose: The objective of this study was to identify the effects of a telephone follow-up program on patient compliance, urea kinetic modeling and incidence of infection in patients with continuous ambulatory peritoneal dialysis (CAPD). Method: A pretest-posttest design with a nonequivalent control group was used to examine the effects of a telephone follow-up program for 12 weeks in a group of 39 CAPD patients. The telephone follow-up group of 17 patients received telephone follow-up 10 min once a week for 1 month and 10 min twice a month for 2 months during 12 weeks compared to control group of 22 who patients received usual care. Results: The telephone follow-up group showed no significant changes in patient compliance and urea kinetic modeling, although patients with CAPD receiving a telephone follow-up showed reduced incidence of exit site infection during the intervention compared with the control group. Conclusion: Telephone follow-up program for CAPD patients may decrease the incidence of exit site infection. Future studies with a larger sample be done utilizing diet and exercise reinforcement program combined with telephone follow-up as a nursing intervention for patients with CAPD.
이차성 부갑상선 기능 항진증이 있는 지속성 외래 복막투석(CAPD) 환자에서 칼시트리올(칼시오) 경구 충격요법과 저용량 매일요법의 비교 연구
강신욱(Shin Wook Kang),최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han),유태현(Tae Hyeon Yoo),신석균(Sug Kyun Shin),하성규(Sung Kyu Ha),노현진(Hyun Jin Noh),류동렬(Dong Ryeol Ryu),송현용(Hyun Yong Song),황재하(Jae Ha Hwan 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3
N/A The most widely used method for treatment of secondary hyperparathyroidism(SH) in CAPD patients has been the administration of calcitriol by oral route. In this study, we compared the efficacy and safety of daily low dose calcitriol therapy with those of intermittent high dose pulse therapy. The study group consisted of 38 patients undergoing CAPD with serum intact PTH level of more than 200pg/ mL. Twenty patients were randomly administered daily low dose calcitriol(0.25μg/day for 1 month followed by 0.5μg daily dose for the next 3 mon-ths) while 18 patients were given intermittent pulse therapy(0.5μg-0.5μg-0.75μg 3 times a week for 1 month, increased to 1.0μg-1.25μg-1.25μg 3 times a week for the next 3 months). Thirty five patients completed the study : 17 on daily oral calcitriol (M: F=0.7:1, mean age=47.3±10.6 years, mean duration of CAPD=48.9±41.1 months), and 18 on oral pulse calcitriol(M: F=1.6: 1, mean age=41.5±12.7 years, mean duration of CAPD=49.2±41.6 months). The baseline serum levels of calcium, phosphorus, i-PTH, alkaline phosphatase, and total CO₂were not different be- tween daily and pulse group(9.5±0.8 vs 9.3±0.9mg/ dL, 5.8±1.3 vs 5.1±1.2mg/dL, 443.1±162.5 vs 546±385.9pg/mL, 91.8±47.7 vs 108.9±66.5IU/L, 23.7±1.9 vs 25.5±2.0mEq/L, p>0.05, respectively). The i-PTH level decreased significantly in daily calcitriol group after 1 month(332.8±214.8pg/mL, p<0.01), and at final evaluation(180.4±254.8pg/mL, p<0.01). In pulse calcitriol group, i-PTH level also decreased signi-ficantly to 400,4±225.8pg/mL(p<0.05), 89.4±122.6 pg/mL(p<0.01), respectively. The rate of decline in i-PTH level from baseline were similar(daily=25.4±22.7 vs pulse=19.5±12.6%decline/month, p>0.05). The serum calcium increased similarly in both groups after treatment(daily=10.6±0.8 vs pulse=l0.1±1.0mg/ dL, p>0.05). Hypercalcemia(>11.0mg/dL) was rarely observed in all patients(daily=5, pulse=8 episodes). In conclusion, both daily and pulse calcitriol therapy were similarly effective and safe in control of SH.
서정훈(Jung Hoon Suh),신석균(Sug Kyun Shin),이루다(Lu Tha Lee),고원기(Won Ki Ko),노현진(Hyun Jin Noh),강신욱(Sin Wook Kang),김순현(Soon Hyun Kim),이호영(Ho Young Lee),한대석(Dae Suk Han),최규헌(Kyu Heon Choi) 대한내과학회 1998 대한내과학회지 Vol.55 No.5
Systemic lupus erythematosus(SLE) is a disease of unknown etiology in which tissues and cells are damaged by pathogenic autoantibodies and immune complexes. Optic neuritis in SLE is very rare and the prevalence can be estimated to be approximately 1% of the patients of SLE. The main pathogenesis of optic neuritis with SLE is that of a vaso-occlusive disease in small vessels and the histopathologic appearance has varied from demyelination to definite vascular disease with axonal necrosis. The visual outcome of optic neuritis in SLE has often been poor. The treatments of optic neuritis in SLE are intravenous methylprednisolone, immunosuppressive agents and plasmapheresis. The authors experienced a case of lupus nephritis and CNS lupus which was complicated by optic neuritis in 18-year-old female patient who complained of sudden visual disturbance of the both eyes After treatment with plasmapheresis and systemic corticosteroid, her visual deficit was gradually recovered.
최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han),하성규(Sung Kyu Ha),류동렬(Dong Ryeol Ryu),송현용(Hyun Yong Song),신석균(Suk Kyun Shin),황재하(Jae Ha Hwang),노현정(Hyun Jung Roh),유태현(Tae Hyun Yoo),김주성(Joo Seong Kim 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1
N/A Lupus nephritis is a major cause of morbidity and mortality arising from systemic lupus erythematous. It is generally acknowledged that the presence of diffuse proliferative lupus nephritis(DPLN) is highly predictive of a poor prognosis in terms of renal and patient out- come on survival. The objective of this study was to evaluate the clinicopathologic characteristics, renal out- come according to therapeutic regimen, and prognostic factors of biopsy-proven diffuse proliferative lupus nephritis. Among the biopsy-proven lupus nephritis patients who were admitted to Yonsei University Medical Center from January 1986 to June 1997, 36 patents who were diagnosed DPLN by renal biopsy and treated for at least 6 months and regularly followed-up for at least 12 months were included. We retrospec-tively reviewed the medical recorders. Patients were treated with steroid regimen with or without cyclo-phosphamide. According to the therapeutic response, patients were divided into two groups : a therapeutic response group(n=24), and a therapeutic non-response group<n=12). The mean age of the patients was 27.4 years and the mean follow-up duration was 51 months. Lupus nephritis developed at a mean 9.7 months after SLE diagnosis and mean duration of nephritis was 39.2 months. Mean serum creatinine was 1.6mg/ dL, 24 hour proteinuria was 4,873mg, and anti-DNA antibody was positive in 8196 of patients at the time of renal biopsy. Activity index and chronicity index were 10.4 and 2.8, respectively. Overall 5 year renal survival rate was 7596 and no difference between steroid single therapy and cyclophosphamide combination therapy was observed. Factors affecting therapeutic response included delayed development of nephritis(3.1 vs 13.8 months, p<0.05) and elevated serum creatinine level(0.9 vs 1.9mg/dL, p<0.05), which were associated with poor therapeutic response. Other clinicopathologic, biochemical and immunologic parameters were not different between the therapeutic response group and the therapeutic non-response group. In conclusion, delayed development of lupus nephritis and elevated serum creatinine at nephritis presentation are poor prognostic factors of DPLN, but further randomized prospective study{including divided cytoxan intravenous pulse therapy and oral therapy, with long-term follow-up) is necessary.
혈액투석을 받는 말기 신부전 환자에서 노쪽피부정맥 변이에 의한 두경부 부종 및 동정맥루 성숙 지연
전성하 ( Seong Ha Cheon ),서용성 ( Yong Seong Seo ),강이화 ( Ea Wha Kang ),신석균 ( Suk Kyun Shin ),강신욱 ( Shin Wook Kang ),최규헌 ( Kyu Hun Choi ),이호영 ( Ho Yung Lee ),한대석 ( Dae Suk Han ),김범석 ( Beom Seok Kim ) 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.3
복막투석 환자에서 발생한 Chryseobacterium meningosepticum 복막염 1예
구향모 ( Hyang Mo Koo ),도화미 ( Fa Mee Doh ),김은진 ( Eun Jin Kim ),강이화 ( Ea Wha Kang ),신석균 ( Suk Kyun Shin ),장태익 ( Tae Ik Chang ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.3
Chryseobacterium meningosepticum is rarely encountered as a pathogen causing peritonitis in peritoneal dialysis (PD) patients. We report a case of peritonitis due to Chryseobacterium meningosepticum, which was treated successfully with intraperitoneal (IP) vancomycin and ciprofloxacin, and without PD catheter removal. Peritonitis was developed in a 53-year-old PD patient on the third hospital day. Although empirical IP treatment with cefazolin and tobramycin was initiated and maintained for 3 days, the fever and signs of peritonitis persisted. Antibiotics were changed to cefoperazone/sulbactam, amikacin, and vancomycin due to clinical deterioration. After 3 days of vancomycin use, leukocyte count in PD fluid was less than 100/mm3 and the patient became asymptomatic. On seventh day after the onset of peritonitis, Chryseobacterium meningosepticum was isolated from initial dialysate sample, and this strain was susceptible to ciprofloxacin, piperacillin, and piperacillin/tazobactam. Accordingly, we changed the antibiotics to ciprofloxacin and vancomycin, which were given for the total of 14 days. Even though Chryseobacterium meningosepticum is an uncommon causative organism of peritonitis in PD patients, this report suggests that vancomycin and ciprofloxacin are effective as empiric therapy, and early suspicion and appropriate antimicrobial therapy are crucial to the successful treatment of peritonitis due to Chryseobacterium meningosepticum without catheter removal.
IgA 신병증에 합병된 신증후군의 자연관해를 보인 증례보고
김정호 ( Jeong Ho Kim ),김하나 ( Ha Na Kim ),홍석민 ( Seok Min Hong ),기정혜 ( Jeong Hae Kie ),강이화 ( Ea Wha Kang ),신석균 ( Suk Kyun Shin ),한승혁 ( Seung Hyeok Han ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.3
Although a moderate degree of proteinuria is common in patients with IgA nephropathy (IgAN), nephrotic syndrome combined with IgAN is rare. It has been reported that approximately 5% of all patients with IgAN are complicated by minimal change disease and these patients respond well to corticosteroid therapy. However, spontaneous remission is uncommon in heavy proteinuric patients with IgAN. Recently, we experienced two cases of spontaneous remission of nephrotic syndrome combined with IgAN without use of corticosteroid. In these patients, heavy proteinuria disappeared in 1 month after the onset and no recurrence occurred during follow-up. With such limited number of cases, factors associated with spontaneous remission in these patients could not be explored. Further study with a larger number of patients is required and careful attention should be paid to these complicated cases.