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Tc-99m DTPA 신장스캔을 이용한 이식신의 사구체 여과율 측정의 임상적 유용성의 평가
김미선,박용기,장익득,김중경,윤대현,신용훈,감복규,이시래,윤명순 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.1
In clinical practice, Tc-99m DTPA renal scan has been using for screening for the presence of renal dysfunction to determine the need for early treatment in kidney transplantation patients. We measured glomerular filtration rate(GFR) using Gates method during the routine Tc-99m DTPA renal scan, predicted creatinine clearance estimated by Cockcroft and Gault formula and 24-hour creatinine clearance and compared each other in 88 kidney transplantation patients simultaneously. The range of renal uptake(%) of Tc-99m DTPA was from 1.8% to 10.4% and the correlation between 24-hour creatinine clearance and renal uptake showed Y=7.176X8.975Y=creatinine clearance(ml/min), X=renal uptake(%) and the correlation coefficient was 0.771. The correlation coefficient between GFR (ml/min) using Tc-99m DTPA renal scan and predicted creatinine clearance was 0.765. The correlation coefficient between predicted creatinine clearance and 24-hour creatinine clearance was 0.850. We concluded that the measurement of GFR using Tc-99m DTPA renal scan was clinically useful in kidney transplantation patients with the advantage of simplicity, low expense, opportunity for renal imaging.
배현호(Hyun Ho Bae),장익득(Ik Deuk Jang),김중경(Joong Kyoung Kim),윤명순(Meung Soon Yoon),이시래(Si Rhae Lee) 대한내과학회 1995 대한내과학회지 Vol.49 No.3
N/A Methods: From December 1984 to June 1991, 21 HBsAg positive and 248 HBsAg negative patients underwent living renal transplantation in Kosin Medical College. During follow up period of a mean 32.7 months in HHsAg positive group and 33.0 months in HBsAg negative group, HBsAg, HBsAb and anti HBc examinations were done by radioimmunoasssy and biochemical liver function tests were performed monthly. The liver function abnormality was diagnosed when aminotransferase values were above the normal range(50 I.U./L)in at least two consecutive determinations. The immunosupressant hepatic toxicity was taken into account when amino transferase elevation promptly returned to normal after reducing the drug dosage and was excluded in this study. Differences between HRsAg positive and negative patients were tested for statistical significance by the chi square test. Results: 1) There was no significant difference in patient and graft survival of HBsAg positive and HBsAg negative group and in the incidence of acute rejection in bath groups. 2) The significantly higher incidence of hepatic dysfunction in HBsAg positive group than HBsAg negative group was noted. Excluding chronic active hepatitis and liver cirrhosis from transplantation in HBsAg positive patients, no notable relation between pre-tansplantation histological changes and the patients and graft survival during follow up period of 32.7 months was found. 3) There was slightly better survival rate in HBsAg positive transplants than HBsAg positive hemodialysis patients. Conclusion: The hepatitis B antigenemia is not an absolute contraindication to renal transplantation, We recommend a pre transplantation liver biopsy in HBsAg positive patients, and if the histological findings suggest a benign form of liver disease, we would have no hesitation in providing a renal transplant in spite of an HBsAg positive status. To reduce the mortality from hepatic failure, the doses of immunosuppressive drugs should be lowered or with- drawn in patients who exhibit severe hepatic dysfunction.
혈액투석환자에서 영양 상태를 반영하는 지표들과 요소 동력학 모형(Urea Kinetic Modeling)과의 비교 관찰
박민,김미선,박용기,서경덕,허동,장익득,김중경,윤대현,신용훈,이시래 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.3
Objectives:Protein-calorie malnutrition has been shown to be prevalent among patients on long-term hemodialysis(HD) patients. And assessment of nutritional status of HD patients has assumed greater importance because of the association of protein-calorie malnutrition with increasing morbidity and mortality. So we observed the incidence and clinical effect of protein-calorie malnutrition, and we compared the indices of nutrition with dialysis adequacy utilizing urea kinetic modeling in HD patients. Methods:We performed a cross-sectional study in which eight parameters, based on anthropometry, blood chemistry and subjective symptoms, were scored according to the degree of abnormalities in 48 HD patients. A malnutrition index was derived from these scores. We also performed comparative analysis to identify significant correlations of the indices of urea kinetic modeling with the other parameters of nutritional status. Results:The malnutrition index classified 12(25 %) patients as normal, 28(58%) intermediately malnourished, and 8(17%) as severely malnourished. Malnutrition index showed a significant correlation with the body mass index(BMI), mid-arm circumference(MAC), mid-arm muscle area(MAMA), duration of HD, total lymphocyte count,trnsferrin. The malnutrition index also showed a significant correlation with renal creatinine clearance(Ccr), alkaline phosphatase. However, malnutrition index showed no meaningful correlation with TWR-Kt/V, TW-Kt/V, BUN, cholesterol,calcium, triglyceride. The value of Ccr was significantly lower in the severely malnourished and intermediately group than in the normal group. Conclusion:In assessing the nutritional status of HD patients, body weight, MAC, MAMA, duration of HD, total lymphocyte count, transferrin, alkaline phosphatase and Ccr were considered useful parameters. No meaningful relationships between TW-Kt/V and malnutrition index or between NPCR (normalized protein catabolic rate) and malnutrition index were found in this cross-sectional study. As the number of patients with longer duration of HD or negligible Ccr has increased in the malnourished patients, regular monitoring of these parameters, especially TWR-Kt/V and residual renal function may be helpful to assess dialysis adequacy to keep good nutritional status of each HD patient.
지속성 외래 복막투석환자에서 전산화 단층 촬영을 이용한 서혜부 탈장 진단 2예
이시래,이종명,정유성,윤철수,윤명순,허동,김중경,장익득,배현호,허길 대한신장학회 1995 Kidney Research and Clinical Practice Vol.14 No.2
The incidence of abdominal and inguinal hernia varies from 10 to 2% among continuous ambulatory peritoneal dialysis(CAPD) patients. We experienced two cases of marked scrotal and external genital swelling caused by indirect inguinal hernia in CAPD patients. Hy using computerized tomography(CT) scanning after intraperitoneal instillation of contrast dye via Tenckhoff catheter, we could identify precisely the two-dimensional location of anatomical defects such as the existence of a patent processus vaginalis or tearing in a hernia sac. These lesions were successfully repaired without recurrence during the 2 years follow-up period.