지속성 외래 복막투석 환자에서 발생한 당뇨병성 근육 경색증

정택균 ( Taek Kyun Jeong ),이연경 ( Youn Kyoung Lee ),정균호 ( Gyun Ho Jeong ),박병석 ( Byong Seok Park ),마성권 ( Seong Kwon Ma ),김수완 ( Soo Wan Kim ),김남호 ( Nam Ho Kim ),최기철 ( Ki Chul Choi ) 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.1

Diabetic muscle infarction (DMI) is a rare condition occurring in subjects with long-standing complicated diabetes mellitus. We report DMI in a 65-vear-old man with type 2 diabetes mellitus undergoing continous ambulatory peritoneal dialysis (CAPD) with review of this condition in the literature. He had been suffered from type 2 diabetes mellitus for 21 years. In 1997, he reached end-stage renal disease and had received on renal replacement therapy with CAPD since then. In June 2002, he presented with sudden and spontaneous onset of severe pain in the right thigh region. He was afebrile, and the right thigh was swollen and tender but not erythematous. Laboratory data on admission included white blood cell count of 15,800/㎣, hemoglobin 9.0g/dL, platelet count 264,000/㎣, BUN 102.3mg/dL, serum creatinine 9.9 mg/dL, fasting blood glucose 85 mg/dL, postprandial 2 hours blood glucose 162 mg/dL, hemoglobin AIC 5.84%, ESR 125 mm/h (it was 52 mm/h one month earilier), CRP 18.9 mg/dL, and normal levels of creatinine kinase. Magnetic resonance imaging (MRI) showed asymmetry of the muscle in T1-weighted images and increased signal intensity involving the medial portion of right thigh (adductor longus, adductor magnus, vastus intermedius muscle, etc) in T2-weighted images with no contrast enhancement. Radioistope venography of the ileo-femoral veins was was normal, excluding deep venous thrombosis as a cause. The right thigh was explored surgically and a biopsy taken from the vastus intermedius muscle was consistent with chronically inflammed scar tissue with no evidence of malignancy. A biopsy taken from the vastus intermedius muscle showed hemorrhagic necrosis of skeletal muscle, with lymphcytic infiltration. Most of the blood vessels appeared normal. The swelling resolved spontaneously following a few weeks of bedrest and analgesia. To our knowledge, this is the first reported case of DMI in patients undergoing renal replacement therapy in Korea.

당뇨병성 신증 환자에서 저분자량 헤파린 Dalteparin Sodium 사용 중 발생한 후복막강 혈종

정택균 ( Taek Kyun Jeong ),정균호 ( Gyun Ho Jeong ),박병석 ( Byong Seok Park ),마성권 ( Seong Kwon Ma ),김수완 ( Soo Wan Kim ),김남호 ( Nam Ho Kim ),최기철 ( Ki Chul Choi ) 대한내과학회 2003 대한내과학회지 Vol.64 No.3

Retroperitoneal Hematoma is a rare intraabdominal bleeding occurring in patients with low-molecular weight heparin anti-coagulant therapy. We report a case of dalteparin sodium-associated retroperitoneal hematoma in a 70-year-old man with diabetic nephrop

A case of autosomal dominant polycystic kidney disease in a patient with renal agenesis

마성권 ( Ma Seong Gwon ),정균호 ( Jeong Gyun Ho ),김수완 ( Kim Su Wan ),김남호 ( Kim Nam Ho ),최기철 ( Choe Gi Cheol ) 대한신장학회 2002 춘계학술대회 초록집 Vol.21 No.1

당뇨병성 신증 환자에서 발기부전

이연경 ( Youn Kyoung Lee ),박병석 ( Byoung Seok Park ),정택균 ( Taek Kyun Jeong ),정균호 ( Gyun Ho Jeong ),마성권 ( Seong Kwon Ma ),김수완 ( Soo Wan Kim ),김남호 ( Nam Ho Kim ),최기철 ( Ki Chun Choi ) 대한내과학회 2003 대한내과학회지 Vol.64 No.2

Background: Erectile dysfunction (ED) is prevalent among patients with diabetes mellitus and impaired renal function. To estimate the prevalence of ED in diabetic nephropathy and to identify its risk factors, we carried out a survey of patients with diabe

신이식 환자에서 혈청 호모시스틴 농도의 변화

김여경(Yeo Kyeoung Kim),이연경(Youn Kyoung Lee),이균상(Kyun Sang Lee),조민석(Min Seok Cho),정택균(Taek Kyun Jeong),박병석(Byoung Seok Park),정균호(Gyun Ho Jeong),마성권(Seong Kwon Ma),김수완(Soo Wan Kim),김남호(Nam Ho Kim),최기철(Ki 대한내과학회 2002 대한내과학회지 Vol.63 No.3

Background : Cardiovascular disease (CVD) after kidney transplantation is a major cause of both graft loss and patient death in kidney transplant recipeints. There are several well known risk factors of CVD, such as hyperlipidemia, hypertension, diabetes melitus, old age and smoking. Non-classic risk factors are acute rejection episode, LVH, C-reactive protein and hyperhomocysteinemia. Homocysteine is an amino acid filtered through the glomerulus and hyperhomocysteinemia is considered as a risk factor of CVD in end-stage renal disease (ESRD) and kidney transplant patients. So homocysteine lowering trials, such as folic acid and vitamine supplement therapy, are being made. We evaluated the prevelance and determinants of hyperhomocysteinemia in kidney transplant recipients. Methods : We measured serum total homocysteine concentration (tHcy) and its determinants in 21 normal persons, 37 chronic renal failure (CRF) patients with conservative treatment (predialysis) and 48 kidney transplant patients. Results : The prevalence of hyperhomocysteinemia was 4.8%, 83.8% and 45.8% among normal persons, predialysis and kidney tranplant patients, respectively. Among the kidney transplant recipients the prevelence of hyperhomocysteinemia was 18.8% in normal renal function (serum creatitine concentration male: below 1.2 mg/dL, female: below 1.1 mg/dL) group and 59.4% in abnormal renal function group. The tHcy values in kidney transplant patients are significantly lower than those in predialysis patients (16.38±6.48 μmol/L vs. 24.68±9.01 μmol/L, p<0.01), but higher than those in normal persons (16.38±6.48 μmol/L vs. 8.80±2.07 μmol/L, p<0.01). Among the kidney transplant recipients the tHcy values in normal creatinine group are significantly lower than those in abnormal creatinine group (12.02±3.68 μmol/L vs. 18.57±6.51 μmol/L, p<0.01). Using muliple regression analysis, this study showed increased serum creatinine concentration is a major determinant of tHcy concentrations in kidney transplant recipients and hyperhomocysteinemia is not correlated with whole blood trough level of cyclosporin (mean 126.26±62.19 ng/mL, range: 26∼322 ng/mL) or vitamines supplement therapy. Conclusion : In this study the serum homocysteine values in kidney transplant recipients were higher than in normal control group but significantly lower than in CRF patients with conservative treatment. The major determinant for serum homocysteine concentration is a serum creatinine concentration.(Korean J Med 63:306-313, 2002)

투석환자에서 C-reactive protein과 심혈관계 질환의 발생과의 관계

이균상 ( Kyun Sang Lee ),이연경 ( Youn Kyoung Lee ),박병석 ( Byoung Seok Park ),정택균 ( Taek Kyun Jeong ),정균호 ( Gyun Ho Jeong ),마성권 ( Seong Kwon Ma ),김수완 ( Soo Wan Kim ),김남호 ( Nam Ho Kim ),최기철 ( Ki Chul Choi ) 대한내과학회 2002 대한내과학회지 Vol.63 No.6

Background: Atherosclerosis, a major problem in patients undergoing chronic dialysis treatment, has been characterized as an inflammatory disease. Cardiovascular disease is the major cause of mortality, accouting for approximately half of all deaths in th

Recombinant Human Erythropoietin ( Epoetin ) 을 투여받는 혈액투석 환자에서 철분 결핍에 대한 Iron Sucrose ( Venofer(R) ) 의 효과 및 안전성

조민석(Min Seok Cho),이연경(Youn Kyoung Lee),박병석(Byoung Seok Park),정택균(Taek Kyun Jeong),정균호(Gyun Ho Jeong),마성권(Seong Kwon Ma),김수완(Soo Wan Kim),김남호(Nam Ho Kim),최기철(Ki Chul Choi) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.5

배 경 : 최근 국내에서는 빈혈이 지속되는 혈액투석 환자에서 보험 규제 및 경제적인 여건 때문에 충분한 양의 erythropoietin (Epoetin)이 투여되지 못하는 경우가 많으며, 철 결핍성 빈혈인 경우 iron sucrose 정주 요법이 사용되기 시작하고 있으나, 아직까지 국내에서는 이에 대한 연구가 없는 실정이다. 본 연구는 제한된 양의 Epoetin을 투며 받는 혈액투석 환자에서 iron sucrose의 정주 강화 요법 후의 빈혈 및 철분 지표, 그리고 혈압의 변화를 측정함으로써 iron sucrose의 효과 및 안전성을 알아보고자 하였다. 방 법 : 전남대학교병원에서 주 3회 혈액투석을 반고있는 성인 환자 중 Hemoglobin (Hb) 치가 10 g/dL 미만, hematocrit (Hct) 치 30% 이하이면서 혈청 ferritin 치가 100 ng/mL 미만이거나. transferrin saturation (TSAT)이 20% 미만인 총 19명의 환자를 대상으로 하였다. 총 1,000 ㎎의 iron sucrose (Venofera)를 10번에 걸쳐 생리 식염수 100 mL에 혼합하여 혈액투석 마지막 60분간에 걸쳐 정주 하였다 (강화 요법). 이후 3개월간 혈청 ferritin, TSAT 수치에 따라 용량을 주당 25-100 ㎎으로 조절하여 투여하였다 (유지 요법). 목표 Hgb 치를 10 g/dl., 목표 Hct 치를 30%로 하였다. Iron sucrose의 효과를 평가하기 위하여, 혈청 철분 지표와 빈혈 지표를 첫 번째 정주 직전 및 강화 요법 시작 1개월 후 및 이후 3개월간에 걸친 유지 요법 중 매월 측정하여 비교하였다. 안전성 평가를 위해 수축기 및 이완기 혈압을 iron sucrose 10회 강화 요법 정주 1시간 전 및 정주 종료 시에 측정하여 iron sucrose 투어 진 측정된 혈압 치와 비교하였으며, 또한 기타 부작용을 관찰하였다. 혈액학적 및 생화학적 지표를 첫 번째 정주 직전 및 강화 요법 시작 1개월 후 측정하여 비교하였다. 결 과 : Iron sucrose 1,000 ㎎ 강화 요법 후 Hgb, Hct, 혈청 iron 및 ferritin, TSAT, MCV 및 MCH 치는 유의하게 증가하였다 (각각 p<0.001, p<0.001, p<0.01, p<0.001, P<0.01, p<0.01, p<0.01). 이후 3개월간의 유지 요법 시 Hgb, Hct, 혈청 ferritin, 그리고 TSAT치는 기저 치에 비해 유의한 증가를 지속하였다. Iron sucrose 투여 시 심각한 부작용은 관찰되지 않았으며, iron sucrose 투여 1시간 전 혈압과 투여 종료시의 혈압은 유의한 차이가 없었다. Iron sucrose 투여 후 혈청 알부민 치는 유의하게 증가하였으나 (p=.037), 다른 혈액학적 및 생화학적 지표들은 유의한 차이가 없었다. 결 론 : 혈액투석 증인 철분 결점 상태를 보이는 말기 신질환 환자에서 iron sucrose의 정주는 안전하며 효과적인 철분 공급 방법으로 생각되었다. Background : The objective of the present study was to assess the efficacy and safety of iron sucrose by determining the subsequent change in hemoglobin (Hgb), hematocrit (Hct), transferrin saturation (TAST), serum ferritin values and blood pressures in hemodialysis patients receiving Epoetin. Methods : A total of 19 adult patients who had been receiving hemodialysis three times a week at Chonnam Natinal University Hospital were assigned. Their Hgb level was less than 10 g/dL and their serum ferritin level was less than 100 ng/mL, and/or TSAT was less than 20%. Iron sucrose was administered as 1,000 ㎎ in 10 divided doses diluted in 100 mL normal saline over the last 60 minutes during hemodialysis with a one-time prior test dose of 20 ㎎ on 10 consecutive dialysis sessions. Iron sucrose dosage was adjusted to 25-100 ㎎/week depending on serum ferritin level, and TSAT in the following 3 months. Epoetin administration was stopped due to insurance regulation when Hgb level was more than 10 g/dI. and Hct level was more than 30 %. To evaluate efficacy of iron sucrose, assessment of serum iron parameters and anemia indices was determined just before the first dose (baseline), at 1 month after the first dose (loading) and then, monthly for 3 months (maintenance). To evaluate safety of iron sucrose, we recorded blood pressure 1 hour before and at the time of completion of iron sucrose injection, and also recorded blood pressure during observation sessions before dialysis and at intervals of 2 hours and 4 hours after starting dialysis. We determined routine serum chemistry and hematologic results at 1 month after the first dose and compared results with those obtained at baseline. Results : 1,000 ㎎ iron surcose injection in 10 divided dose (loading) produced a significant rise in Hgb, Hct, serum iron, serum ferritin, TSAT, MCV and MCH at I month after first dose (respectively p<0.001, p<0.0.001, p<0.01, p<0.001, p<0.01, p<0.01, p<0.01). During the following maintenance period of 3 months, Hgb, Her, serrum ferritin, and TSAT level remained more elevated than at baseline respectively. In 19 enrolled patients, we experienced no serious adverse drug reactions and no significant changes in intradialytic blood pressure associated with iron sucrose administration. Serum albumin concentrations was higher at 1 month than at base line and however, changes in other serum chemistry and hematologic results were not statistically significant. Conclusion : Intravenous iron sucrose administration is an efficient and safe method to supply iron in end-stage renal disease patients receiving Epoetin with iron deficiency, who are undergoing hemodialysis.

만성 신부전 환자에서의 혈청지질과 지단백질

김현수,김남호,최기철,강정채,이성철,이태희,정익주,정민영,강영준,김수완,정권,김형준,정택균,나명윤,정균호,바종춘 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.5

We measured serum lipoprotein(a) [Lp(a)] concentrations in 304 uremic patients treated on predialysis, hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD), and compared them with those in 43 normal controls. The mean values were 46.1mg/dl in predialysis, 35.7mg/dl in HD, 54.7mg/dl in CAPD patients and 17.0mg/dl in controls, respectively. Serum Lp(a) levels were elevated both in the predialysis patients (P<0.001) and in the CAPD patients (P<0.001) compared with those in controls, and were also elevated in the CAPD patients (P<0.01) compared with HD patients. Serum Lp (a) levels tended to be higher in HD patients compared with controls, although these differences did not reach statistical significance. We observed statistically significant positive correlations of Lp(a) to serum levels of total cholesterol (TC) (r=0.279, P<0.01), LDL-cholesterol (r=0.335, P<0.01), and Apo(B) (r=0.352, P<0.01), and significant negative correlation of Lp(a) to serum level of albumin (r=-0.278, P<0.01) in 304 CRF patients. CAPD patients had a more atherogenic lipoprotein profile than did HD patients: besides significantly higher Lp(a) levels (P<0.01), total (P<0.001) and LDL (P<0.001) cholesterol, triglycerides (P<0.05), and apo (B)(P<0.001) were significantly elevated in comparison to HD patients. The marked elevation of serum Lp(a) in patients on CAPD may be due to increased hepatic synthesis as a consequence of the substantial amounts of plasma proteins lost in the dialysate. The increased serum concentrations of Lp(a) may contribute to the high risk for atherosclerosis in end stage renal disease, especially in patients treated by CAPD.