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장기간 생존한 동종이식 신장에서 새로 발생한 경쇄침착병
최미선 ( Mi Sun Choe ),장미현 ( Mi Hyun Jang ),황은아 ( Eun Ah Hwang ),이상숙 ( Sang Sook Lee ),김현철 ( Hyun Chul Kim ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.4
Light chain deposition disease (LCDD) is characterized by the deposition of abnormal immunoglobulin light chains in many organs, including kidney. It is usually associated with multiple myeloma or other lymphoproliferative disorders. Myeloma usually occurs in old age and may develop after renal transplantation thus being categorized as posttransplant lymphoproliferative disease (PTLD). Renal LCDD usually presents with variable degree of proteinuria and renal insufficiency. The diagnosis of LCDD depends on histologic findings with detection of monoclonal immunoglobulin light chain. Histologically, it is characterized by nodular glomerulosclerosis. We report the first case of de novo LCDD associated with myeloma after renal transplantation in Korea. With advancing renal transplantation and increasing old aged renal recipients, myeloma or LCDD should be included in the differential diagnoses of renal recipient patients with deteriorating renal function.
난치성 원발성 막성신염 및 초점분절성사구체경화증 환자에서 mycophenolate mofetil의 치료효과
김현철 ( Hyun Chul Kim ),장미현 ( Mi Hyun Jang ),황은아 ( Eun Ah Hwang ),여상목 ( Sang Mok Yeou ),곽충환 ( Choong Hwan Kwak ),한승엽 ( Seung Yeup Han ),박성배 ( Sung Bae Park ),최미선 ( Mi Sun Choe ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6
Purpose: This study was planned to determine the efficacy and safety of mycophenolate mofetil (MMF) as a rescue treatment in patients with membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS) who were not responsive to standard therapy with steroid and immunosuppressive regimen. Methods: We planned a prospective, non-randomized study from Oct. 2002 to Aug. 2009, including biopsy-proven MN or FSGS patients in Keimyung university Dongsan hospital. MMF was initiated at 0.5-0.75 g twice daily, and advanced as appropriate or as tolerated to 0.75-1 g twice daily. Results: 14 cases with MN and 5 cases with FSGS was enrolled. The mean age of patients was 51.7±12.3 years, and mean treatment duration was 14.4±6.5 months. Five patients (26.4%) went into complete remission and the seven (36.8%) into partial remission. The mean value of 24hr total urine protein over the follow-up 6 months` period declined significantly from 7.6±6.2 g in pre-treatment, to 4.1±3.2 g in 3 months, and 3.1±2.1 g in 6 months (p=0.011). The mean 24hr total urine protein decreased from 7.5±6.3 g in pre-MMF to 1.9±1.8 g in post-MMF (p=0.001). The mean serum albumin rose from 3.2±0.8 g/dL in pre-MMF to 3.9±0.5 g/dL in post-MMF (p=0.001). There were no significant changes in mean value for WBC, hemoglobin, serum creatinine, and total cholesterol. Side effects of MMF were infrequent and generally mild. Conclusion: MMF appears effective in 63% of patients with MN and FSGS who are resistant to other forms of treatment. Studies with more cases and multicenter controlled trials are required to establish the role and standards of MMF in these disorders.
유기농업자재 중 님과 고삼 추출물의 피부 및 안점막자극성
오진아(Jin-A Oh),최진희(Jin-Hee Choi),최미선(Mi-Seon Choe),김진효(Jin-Hyo Kim),백민경(Min-Kyoung Paik),박경훈(Kyung-Hun Park),유아선(Are-Sun You),이제봉(Je-Bong Lee),김두호(Doo-Ho Kim) 한국농약과학회 2013 농약과학회지 Vol.17 No.4
This study was performed to evaluate the acute skin and eye irritation of plant extracts (neem and sophora) against rabbit. The result of skin irritation test indicated that neem extracts and sophora extracts were not irritant. For eye irritation test, the result showed no irritation for neem extracts. Sophora extracts have a severe eye irritation and the symptoms have been reduced to day 3. Thus, safety guidelines for agricultural workers is considered to be needed when sophora extracts is used as an organic agricultural materials.
김정은 ( Jung Eun Kim ),황은아 ( Eun Ah Hwang ),윤정수 ( Jeong Soo Yoon ),장미현 ( Mi Hyun Jang ),김상현 ( Sang Hyun Kim ),한승엽 ( Seung Yeup Han ),박성배 ( Sung Bae Park ),김현철 ( Hyun Chul Kim ),최미선 ( Mi Sun Choe ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.2
목적: 루푸스 환자에서 흔히 합병되는 루푸스 신염은 이들 환자의 사망과 이병의 중요한 요인이 된다. 저자들은 단일 기관에서 약 21년간 루푸스 신염을 치료한 경험이 있어 이를 보고하고자 한다. 방법: 1985년 9월부터 2006년 1월까지 계명의대 동산병원에서 신생검을 통해 루푸스 신염으로 확진받고 스테로이드 단독 또는 CYC 병합치료를 받은 환자 100명을 대상으로 치료 효과 및 합병증을 후향적으로 조사하였다. 결과: 환자의 평균 연령은 28.3±11.6세, 남녀비는 1:9.9, 평균 추적기간은 73.2±62.8개월이었다. 신생검 당시 평균 혈청 크레아티닌 치는 1.4±1.0 mg/dL, 1일 요단백 배설량은 4.9±4.0 g, anti ds-DNA 농도는 95.7±102.9 IU/mg였으며 혈뇨 75%, 농뇨 59%, 고혈압이 22%에서 동반되어 있었다. WHO분류를 적용하였을 때 Class IV 루푸스 신염이 52 %로 가장 많았고, Class V 23%, Class II 11%, Class III 9 %순이었다. 연구 기간 동안 스테로이드 단독치료를 받은 환자가 69예, 스테로이드 및 CYC 병합치료를 받은 환자가 31예 있었다. 단독치료군과 병합치료군의 환자 연령, 남성의 비율, 신생검 당시 혈청 크레아티닌 치 및 1일 요단백 배설량에는 유의한 차이가 없었으나, Class IV의 빈도가 병합치료군에서 유의하게 높았으며 (p=0.017), anti ds-DNA역가 또한 병합치료군에서 유의하게 높았다 (p=0.003). 치료에 따른 임상 경과는 스테로이드 단독치료군은 44.9%, 병합치료군에서는 71%에서 치료에 반응을 보여 병합치료군에서 치료 반응율이 유의하게 높았다 (p=0.018). 치료에 따른 합병증의 빈도는 양 군간에 유의한 차이가 없었다. 치료법에 관계없이 치료 반응 여부에 따른 신생존율은 완전 관해 및 부분 관해를 보인 환자의 경우 5년 및 10년 신생존율이 모두 100%임에 비해, 관해를 보이지 않은 환자의 경우는 5년 및 10년 신생존율이 62.5%, 37.7%로 완전 관해 및 부분 관해 환자군에 비해 유의하게 낮았다 (p=0.000). 결론적으로 루푸스 신염 환자에서 스테로이드 및 CYC 병합치료를 받은 환자에서 치료 반응율이 높았으며, 치료 반응군에서 장기 신생존율이 유의하게 높았다. 따라서 루푸스 신염 환자에서 신생검을 통한 조기 진단과 적극적인 치료를 통한 관해 유도가 이들 환자의 예후를 향상시키는 데 도움이 될 것으로 생각한다. Purpose: Renal disease is the major cause of mortality and morbidity in systemic lupus erythematosus. The aim of this study was to examine the therapeutic outcome of patients with lupus nephritis (LN) for 21 years. Methods: We conducted a retrospective study of 100 patients with biopsy proven LN who were admitted at Keimyung University Dongsan Hospital between 1985 and 2006, and were followed with a mean of 73 months. We diagnosed renal pathology according to WHO 1995 classification, and analyzed the therapeutic and long-term outcome of patients with LN treated with steroid alone or steroid with intravenous cyclophosphamide (CYC). Results: The mean age at the time of renal biopsy was 28. 3 years and male to female ratio was 1:9.9. The initial therapy consisted of steroid alone in 69 patients and steroid with intravenous CYC in 31 patients. The proportion of diffuse proliferative LN and titer of anti ds-DNA were significantly higher in patients treated with steroid and CYC than in patients with steroid alone. The percentage of patients with clinical response was significantly higher in patients with steroid and CYC than in patients with steroid alone (p=0.018). The patients who experienced clinical response had an excellent long term outcome compared with those who had no clinical response. Conclusion: The clinical response was significantly higher in CYC combination regimen than steroid alone. The response to therapy in LN was an important factor for long-term prognosis. The early diagnosis and aggressive treatment with immunosupppressive agents are valuable for better outcome in patient with LN.
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.
p-ANCA가 동시에 검출된 항사구체 기저막 항체 질환 2예
강건우 ( Gun Woo Kang ),황은아 ( Eun Ah Hwang ),한승엽 ( Seung Yeup Han ),박성배 ( Sung Bae Park ),김현철 ( Hyun Chul Kim ),최미선 ( Mi Sun Choe ) 대한내과학회 2012 대한내과학회지 Vol.83 No.4
Anti-glomerular basement membrane antibody (anti-GBM Ab) disease is characterized by circulating antibodies to the glomerular basement membrane and the deposition of IgG or, rarely, IgA along the glomerular basement membrane. This disease accounts for 10-20% of crescentic glomerulonephritis. We report two patients with anti-GBM Ab disease who were positive for perinuclear-anti-neutrophil cytoplasmic antibody (p-ANCA). Percutaneous renal biopsies showed many crescent formations and linear deposits of IgG along the glomerular basement membrane. Serologic tests for p-ANCA were positive. They were treated with steroid pulse and cyclophosphamide and one patient also underwent plasma exchange therapy. Despite immunosuppressive therapy, their renal functions did not improve and both required regular hemodialysis. (Korean J Med 2012;83:514-519)