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증례 : 신장 ; 신이식 후 발생한 거대 세포바이러스 위장관염: 단일기관 경험 7예
전주현 ( Joo Hyun Chun ),현승혜 ( Seung Hyea Hyun ),최지영 ( Ji Young Choi ),조지형 ( Ji Hyung Cho ),박선희 ( Sun Hee Park ),김찬덕 ( Chan Duck Kim ),김용림 ( Yong Lim Kim ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S
저자들은 신이식 후 발생한 CMV 위장관염 7예를 보고하는 바이다. 환자들은 신이식 후 위장관 통증, 발열, 혈변 등 다양한 증상으로 내원하였고, CMV early antigenemia 및 내시경을 통해 CMV 위장관염을 진단받았다. 진단 후 ganciclovir 정주로 치료하였으며 이후 증세 호전을 보이고 CMV early antigenemia 음성이 확인되어 퇴원하였다. Here we present 7 cases of Cytomegalovirus (CMV) gastrointestinal infection following renal transplantation. Patients visited the clinic with variable symptoms, such as epigastric pain, fever, and melena. Detection of CMV early antigenemia and endoscopic biopsies were performed to diagnose CMV gastrointestinal infection. After diagnosis, patients were treated with Ganciclovir and their symptoms improved. We confirmed the negative conversion of CMV early antigenemia prior to discharge. (Korean J Med 77:S1263-S1267, 2009)
서혜진 ( Hye Jin Seo ),현승혜 ( Seung Hyea Hyun ),김건현 ( Gun Hyun Kim ),전주현 ( Joo Hyun Chun ),최지영 ( Ji Young Choi ),조지형 ( Ji Hyung Cho ),김찬덕 ( Chan Duck Kim ),박선희 ( Sun Hee Park ),김용림 ( Yong Lim Kim ) 대한내과학회 2010 대한내과학회지 Vol.79 No.3
Background/Aims: Continuous ambulatory peritoneal dialysis (CAPD) is an established treatment in patients with end-stage renal disease (ESRD), and innovations in the connection system have improved the survival of peritoneal dialysis patients over the last two decades. We investigated the outcome of CAPD over a 15-year period at our institution. Methods: Patients who underwent peritoneal dialysis since 1994 were recruited retrospectively. Patients younger than 15 years at the initiation of CAPD and those who had less than 1 month of follow-up or missing data were excluded. The technique survival rate and causes of technique failure were evaluated. Results: In all, 608 CAPD patients (342 males, 56.3%) were analyzed using the Kaplan-Meier method and log-rank test. The mean age at the start of CAPD was 50.7±15.1 years and the mean duration of CAPD was 50.2±41.5 months. The most common primary renal disease was diabetes (39.6%), followed by chronic glomerulonephritis (37.2%) and hypertension (13.0%). The 1-, 3-, 5-, and 10-year death-censored technique survival rates were 97.3, 91.7, 82.8, and 67.5%, respectively. Sex or diabetic status did not affect the technique survival rate. Patients younger than 60 years at the start of CAPD had a better technique survival than older patients (p=0.005). The main cause of technique failure was peritonitis (71.6%), followed by mechanical malfunction (10.5%), ultrafiltration failure (7.4%), and inadequate dialysis (6.3%). Conclusions: Complicating peritonitis was the most common cause of CAPD technique failure at our center. To reduce the technique failure in high-risk groups, more intensive management is needed. (Korean J Med 79:258-262, 2010)
지속외래복막투석 환자에서 잔여신기능의 감소에 영향을 미치는 인자
박선희 ( Sun Hee Park ),김건현 ( Gun Hyun Kim ),현승혜 ( Seung Hyea Hyun ),서혜진 ( Hye Jin Seo ),최지영 ( Ji Young Choi ),조지형 ( Ji Hyung Cho ),김찬덕 ( Chan Duck Kim ),김용림 ( Yong Lim Kim ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6
Purpose: Preservation of residual renal function (RRF) after initiation of peritoneal dialysis (PD) is beneficial for patient survival. It is unclear that same risk factors of pre-dialysis chronic kidney disease (CKD) patients affect RRF in PD patients. This study was aimed to evaluate factors affecting RRF after commencement of PD. Methods:Data from 80 patients commencing CAPD at Kyungpook National University Hospital between January 2001 and December 2008 were retrospectively collected. After PD commencement, biochemical and clinical data at baseline (1 month), 6, and 12 month were obtained. RRF was calculated as the average of creatinine clearance and urea nitrogen clearance from 24-hour urine collection and normalized with body surface area and mean RRF decline rate was calculated by dividing RRF difference between baseline to 12 month by period. Results:Mean RRF decline rate (mL/min/1.73m2/month) was negatively correlated with left ventricular posterior wall thickness (LVPWT) (R2=0.097, p=0.023) and proteinuria (R2=0.126, p=0.003), whereas positively correlated with hematocrit (R2=0.076, p=0.013) at baseline. Comparison between the two groups divided by median RRF decline rate (-0.082 mL/min/1.73m2/ month) showed that baseline proteinuria (p<0.001), the number of antihypertensive agents (p=0.030) and LVPWT (p=0.039) were higher in the decline group. In addition, the number of antihypertensive agents was higher in the decline group at 1 year, although there was no difference of blood pressure between the two groups. Using multiple binary logistic regression, it was shown that more rapid RRF decline (<-0.082 mL/min/ 1.73m2/month) was likely to have higher proteinuria [adjusted odd ratio (AOR) 3.310, 95% confidence interval (CI) 1.363-8.041], and thicker LVPWT [AOR 1.682, 95% CI 1.043-2.711] at baseline. Conclusion:Decline of RRF during a year after commencement of PD was associated with baseline proteinuria and LVPWT.
복막투석 동물모델에서 Adenoviral vector를 이용한 Bone Morphogenic Protein-7 유전자 치료가 복막섬유화에 미치는 영향
최지영 ( Ji Young Choi ),진미경 ( Mi Kyung Jin ),전주현 ( Joo Hyun Chun ),현승혜 ( Seung Hyea Hyun ),최희정 ( Hee Jeong Choi ),최혁준 ( Hyuk Joon Choi ),조지형 ( Ji Hyung Cho ),김미형 ( Mi Hyung Kim ),류혜명 ( Hye Myung Ryu ),오 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.4
Purpose: TGF-β-induced epithelial-mesenchymal transition (EMT) is associated with peritoneal fibrosis during PD. We conducted this study to evaluate the effect of BMP-7 adenoviral gene transfer on the functional and structural changes of peritoneum and whether it is associated with peritoneal EMT using an animal PD model. Methods: Forty Sprague-Dawley rats were divided into five groups; Control (C, n=8), Dialysis (D, n= 8), Rest (R, n=8), BMP-7 (B, n=8) and LacZ (L, n=8) group. Peritoneal function was assessed on baseline, 3rd, 6th, 8th weeks after PD. Immunohistochemistry for TGF-β, VEGF, laminin and aquaporin-1 was performed in addition to morphometric analysis of peritoneum. Immunofluorescence staining with western blotting for α-SMA and E-cadherin, as markers of EMT, was performed. Results: The thickness of submesothelial matrix was highest in D and significantly decreased in B compared to D, R and L. D/D0 glucose at 8 weeks was significantly increased in B and L compared to that of at 6 weeks, but there were no significant differences among R, B and L at 8 weeks. TGF-β1 and VEGF expression was observed in submesothelial matrix in D and decreased in R, B and L. Peritoneal fibrosis and functional deterioration of peritoneal membrane were associated with EMT, which was partially reversed in R, B and L. Conclusions: BMP-7 gene transfer to peritoneum was not associated with the additive therapeutic effect on peritoneal function compared to the peritoneal rest, although it improved morphologic changes of peritoneum.
조지형 ( Ji Hyung Cho ),류혜명 ( Hye Myung Ryu ),진미경 ( Mi Kyung Jin ),전주현 ( Joo Hyun Chun ),현승혜 ( Seung Hyea Hyun ),최지영 ( Ji Young Choi ),허인경 ( In Kyong Hur ),이은영 ( Eun Young Lee ),박선희 ( Sun Hee Park ),김용림 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.4
목적: 염증반응과 섬유화에 관여하는 Transforming growth factor-β1 (TGF-β1)와 이식신에 대한 cytoprotection에 관여하는 vascular endothelial growth factor (VEGF)는 만성 이식신 신병증 (CAN)의 발생과 연관이 있을 것으로 추측되어 왔다. 이에 저자들은 한국인 신이식 수혜자를 대상으로 TGF-β1 및 VEGF 유전자 SNP과 이식신 생존율 및 CAN과의 상관관계에 대해 조사하였다. 방법: 경북대학교병원에서 신이식을 시행한 환자 중 유전자 분석에 동의한 221명과 건강한 대조군 148명을 대상으로 TGF-β1 유전자의 C-509T 및 T869C, VEGF 유전자에 있는 C-2578A, C405G의 유전자형을 분석하였다. 신이식 후 CAN이나 만성 calcineurin inhibitor 신독성으로 진단된 경우를 신병증군 (n=21)으로 그렇지 않은 경우를 정상 이식군 (n=200)으로 분류하였다. 결과: 신이식 환자군과 정상 대조군에서 확인된 TGF-β1 (C-509T, T869C) 및 VEGF 유전자의 SNP (C- 2578A, C405G)의 유전자형의 빈도는 Hardy-Weinberg 평형에 따른 기대빈도와 유의한 차이가 없었고, 신이식 환자군과 정상 대조군에 있어 TGF-β1 및 VEGF 유전자 SNP의 유전자형과 대립형질의 빈도에는 유의한 차이가 없었다. TGF-β1의 C-509T와 T869C 및 VEGF의 C-2578A와 C405G는 강한 유전적 상관 관계를 보였고 (D`=0.78-0.98), 두 군 간 각각의 일배체형 간의 빈도 차이는 없었다. 전체 신이식 환자를 대상으로 TGF-β1 및 VEGF 유전자 SNP의 유전자형에 따라 두 군으로 나누어 Kaplan-Meier 생존분석을 시행한 결과 이식신 생존율은 유의한 차이가 없었고, 저농도 혹은 고농도의 cytokine 생산과 관련된 유전자형에 따른 이식신 생존율도 각 cytokine 모두 유사하였다. 결론: 본 연구에서 조사한 TGF-β1 및 VEGF 유전자 SNP은 한국인 신이식 수혜자에서 이식신 생존 또는 만성 이식신 신병증 발생 여부에 따라 차이를 보이지 않았다. Purpose: Transforming growth factor-β1 (TGF-β1) has been associated with the promotion of renal allograft interstitial fibrosis and thereby chronic allograft nephropathy (CAN). Vascular endothelial growth factor (VEGF) has been shown to contribute to cytoprotection of the graft after kidney transplantation. We investigated the influence of single nucleotide polymorphisms (SNPs) of the TGF-β1 (C-509T and T869C) and the VEGF gene (C-2578A and C405G) on graft survival and the development of CAN. Methods: Genotyping was carried out using a real-time polymerase chain reaction which was performed on the LightCycler480 in 221 Korean renal transplant recipients and 148 healthy controls. According to the presence of CAN or chronic calcineurin inhibitor nephrotoxicity, the recipients were separated into the CAN (n=21) and the No CAN (n=200) groups. Results: The genotype frequencies of the SNPs were in Hardy-Weinberg equilibrium. The distributions of genotypes and alleles did not differ between recipients and controls. No significant differences were observed in the genotype distributions and allele frequencies between the CAN and the No CAN groups. The frequencies of haplotypes were not significantly different between the two groups, either. There were no statistically significant effects of TGF-β1 and VEGF gene polymorphisms on graft survival. Conclusion: This study did not show any statistically significant effects of four selected SNPs of the TGF-β1 and the VEGF genes on the development of CAN and graft survival in Korean renal transplant recipients.