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류마티스 관절염 환자에서 빈뇨로 발현된 방광의 유전분증 2예
이창재 ( Chang Jae Lee ),최세웅 ( Se Woong Choi ),문승환 ( Seung Hwan Mun ),허정훈 ( Jung Hoon Huh ),김경태 ( Kyoung Tae Kim ),원종진 ( Jong Jin Won ),안원석 ( Won Suk An ),윤성국 ( Sung Kuk Yun ),홍숙희 ( Sook Hee Hong ),이성원 ( 대한류마티스학회 2004 대한류마티스학회지 Vol.11 No.3
Secondary amyloidosis is characterized by accumulation of an amorphous proteinous material in the various tissue and organs with infectious disease or inflammatory disease. Symptoms of the amyloidosis are variable according to the involved organs. Reactive amyloidosis of bladder in rheumatoid arthritis (RA) is a rare condition with hematuria in the most cases. However, we report two cases of patients with RA, who have frequency due to secondary amyloidosis of bladder without hematuria. Therefore secondary amyloidosis of urinary bladder should be considered as a possible cause of frequency in patients with long-term RA.
배성진(Sung Jin Bae),안원석(Won Suk An),박건욱(Geun Wook Park),박희승(Hee Seung Park),김구(Gu Kim),김동수(Dong Su Kim),김광동(Kwang Dong Kim),정재열(Jae Youl Jung),장광열(Kwang Yul Chang),김선택(Sun Tack Kim),김성은(Seong Eun Kim),김 대한내과학회 1997 대한내과학회지 Vol.52 No.5
Objective .We aimed to compare efficacy of treatment between steroid therapy and steroid-chlorambucil combination therapy in patients with adult-onset idiopathic membranous glomerulonephritis (MN). Methods: A series of 31 biopsy-proved idiopathic MN patients was analyzed retrospectively to estimate effect of treatment with steroid and/or cytotoxic agent. All patients (male 15, female 16, mean age of 37 years old) presented a full-blown nephrotic syndrome (proteinuria >3.0gm/day, serum albumin <3.0mg/dL, edema) at the initiation of treat- ment and were observed for at least 6 months (mean follow up period: 28±23 months). Clinical and laboratory information were obtained at the time of presentation and at last follow up. Each patient was assigned to one of the following protacols. 1) Steroid therapy prednisolone 40 or 60mg/day (single dose) for 16 weeks. 2) Steroid-Chlorambucil combination therapy: for 6 months with three cycles of methylprednisolone pulse therapy (lgm 1V for 3 days), prednisolone 0.5mg/kg/day for 27 days, then chlorambucil 0.2mg/kg/day for 28 days. 3. Cyclophosphamide 2mg/kg/day for 28 days. Results: 1) Final status in total 31 cases irrespective of therapeutic modality were complete remission in 5 (16%) cases, partial remission in 9 (29%) cases, no response in 12 (41%) cases, spontaneous complete re- mission in 1 cases, and spontaneous partial remission in 1 case. 2) After initial steroid therapy (in 25 cases), We observed no response in 17 (68%) case, partial remission in 3 (12%) cases, complete remission in 3 (12%) cases, and spontaneous partial remission in 2 (8%) cases. 3) The combination therapy (steroid and chlorambucil) tried in 10 cases results in 5 (50%) cases of partial remission, 2 (20%) cases of complete remission, 1 (10%) case of spontaneous partial remission, and 2 (20%) cases of no response. 4) During follow up period, renal functional deterioration was absent in any case and final albumin levels were significantly increased (p<0.05). Conclusion: Steroid-chlorambucil combination pro- toco1 is considered to be a more effective treatment with higher rate of overall remission compared to steroid therapy. Idiopathic MN itself seems to have a relatively benign course when considering that renal function was preserved in all cases without progression to chronic renal failure and that a few cases of spontaneous remission could be observed. For the limitation in number of cases and duration of follow up in this study, it needs prospective controlled study of more larger scale with long-term follow up to get a more reliable results.
정석희 ( Seuk Hee Chung ),문승환 ( Seung Hwan Moon ),백정환 ( Jeung Hoan Paik ),김경태 ( Kyoung Tae Kim ),최세웅 ( Se Woong Choi ),이창재 ( Chang Jae Lee ),조용락 ( Young Rak Cho ),나서희 ( Seo Heui Ra ),안원석 ( Won Suk An ),김 대한내과학회 2006 대한내과학회지 Vol.70 No.6
Background: The manifestation of Membranoproliperative glomerulonephritis (MPGN) is variable from asymptomatic hematuria, nephrotic syndrome to advanced chronic kidney disease. The etiology, pathogenesis, and treatment of MPGN are unclear. The incidence of idiopathic MPGN is also rare in Korea, and the clinical course was rarely studied. So we investigated clinical course of idiopathic MPGN type 1. Methods: From March 1990 to November 2004, renal biopsy was done in about 1500 patients in Dong-A universty hospital. Among them, 16 patients were diagnosed as idiopathic MPGN. Fourteen patients were observed over 6 months. We analyzed clinical data of these patients retrospectively. Results: Male to female ratio of total 16 patients is 2.2:1. Mean age of patients was 37.6 years (14-76years) at the time of diagnosis. Thirteen cases (81%) had nephrotic range proteinuria, 8 cases (50%) had hypertention, 12 cases (75%) had edema, and 4 cases (25%) had decreased renal fuction (serum creatinine>1.2 mg/dL) at the time of diagnosis. Average observation time was 55.7±37.4 (6-122)months. Six cases ended up with progressive renal failure. Three cases achieved complete remission. Renal survival time for 50% of cases was 92 months. In our study, edema and decreased renal fucntion at the time of diagnosis were related with later development of progressive renal failure (p<0.05). Of the total 14 cases, 4 cases ware treated conservatively, 6 cases were treated with anti-platelet agents, and 4 cases were treated with anti-platelet agents and prednisone. In conservative treatment group, 1 case ended up with progressive renal failure and 1 case achieved complete remission. In anti-platelet agents treatment goup, 4 cases ended up progressive renal failure. In combined anti-platelet agents and prednisone treatment group, 1 case ended up progressive renal failure and 2 cases achieved complete remission. However, the effect of each treatment is inconclusive because the number of the patients are too small. Conclusions: We suspect that deceased renal function and edema at the time of diagnosis may be risk factor predicting progressive renal failure in patients with idiopathic MPGN type 1.(Korean J Med 70:663-671, 2006)