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요중 적혈구의 현미경적 손견에 의한 사구체 혈뇨와 비사구체 혈뇨의 감별
강응택,유석희,차영주 대한신장학회 1988 Kidney Research and Clinical Practice Vol.7 No.1
Differentiation of the glomerular bleeding from the nonglomerular bleeding is important in diagnosis, treat- ment and prospection of prognosis of underlying dis- eases. However, proteinuria and pathologic casts which are considered to be glomerular origin show wide range of variation in according to disease per se or during the course of disease. We examined urine samples microsocpically from 96 patients of hematuria who had been diagnosed by renal biopsies or other radioloic examinations to determine the probable sites of bleeding into urinary tract. The results were as follows: 1) Dysmorphic erythrocytes were present in 76% of patients with glomerulopathies, isomorphic erythrocytes in 15.2% and mixed forms in 8.8%. 2) Among 40 patients with nonglomerular bleeding, isomorphi feature of urinary erythrocytes were present in 38 cases. 3) In 10 patients with acute renal failure, there is no constant finding in urinary erythrocyte morphology. 4) Among patients with glomerulopathies, significant proteinuria were noticed in 63% of patients and path- ologic casts in 35% of patients. 5) The sensitivity of differetiation of glomerular and nonglomerular bleeding by light microscopic examina- tion of urinary RBC morphology was 84.8% and the specificty was 95%. Therefore, light microscopic examination of urinary RBC morphology was convenient and useful preliminary method in differentiation of glomerular hematuria from nonglomerular hematuria in despitae of acurate diagno- sis of underlying disease.
혈액투석을 위한 혈관통로 확보가 어려운 환자에서 Permcath 사용의 임상적 고찰
강응택,유석희,민철홍 대한신장학회 1997 Kidney Research and Clinical Practice Vol.16 No.2
Permanent vascular access is a prerequisite for successful treatment of patients with chronic hemodialysis. Although a number of strategies including native and synthetic arterio-venous fistulae are performed to create vascular access, they are often not available due to peripheral vascular diseases which are common in patients with diabetes and elderly patients. So, in spite of technical advance, vascular access for hemodialysis remains a significant problem confronting the nephrologists. Recently, Permcath(double lumen silicone rubber catheter) has been introduced and can provide temporary access in patients whose native fistulas have not yet matured and permanent access in patients who have difficulty in creating a arterio-venous fistula. We investigated the availability and the clinical outcome of use of Permcath as temporary or permanent vascular access. Total 16 catheters were placed in 14 patients who were admitted in Chung-Ang University Hospital between April, 1993 to March, 1996. Clinical course of the patients and outcome of the catheters were observed, retro- spectively. The mean age of the 14 patients was 56?9 (39-67) years, The indications were exhausted peri- pheral access, poor vascular system for conventional access operation, and limited life expectancy. The median survival of the catheters was 80 weeks with a range of one week to 113 weeks. The one-year actuarial catheter survival rate was 6796 and 44% at 2 year. The most common complication during use of Permcath was infection, occurred in 5 patients (31.2%). The 5 catheters were removed because of complications of catheter such as infection or malfunction. We suggest that the Permcath is a safe and durable temporary vascular access for patients with poor vascular system anticipating a long duration for arterio-venous fistula maturation and permanent access for patients who have exhausted peripheral access sites.
사람 제대정맥 내피세포의 한탄바이러스 감염이 혈액응고계에 미치는 영향
강응택,유석희 대한신장학회 1992 Kidney Research and Clinical Practice Vol.11 No.4
The pathogenesis of disseminated intravascular coag- ulation (DIC) and bleeding tendency in patients with Korean hemorrhagic fever (KHF) is not well understood. In order to study the pathogenesis of DIC and bleeding tendency in patients with KHF, cultured human unbilical vein vein endothelial cells (HUVEC) were infected with Hantaan virus, and then the procoagulant activity of infected HUVEC was investigated. The infectivity of HUVEC with Hantaan virus was revealed by immunofluorescent antibody technique. 15. 9%, 71.6% and 88.5% HUVEC was infected after 5, 7, and 9 days postinoculation. Plasma coagulation time with total procoagulant activity from infected HUVEC was markedly decreased to 46 sec, 58 sec, and 50. S sec after 6 hr, 12 hr and 18 hr respectively from the normal coagulation time of $gt; 300 sec. Prothrombinase complex formation of infected HUVEC was increased to 0.116?0.074/min (O.D.) after 12 hr from the normal control of 0.029?0.012/min (O.D.). Thrombomodulin expression in infected HUVEC was reded to 51. 7% and 45. 0%. After 6 hr and 12 hr of inoculation respectively. These results indicated that the tissue factor activity and the formation of prothrombinase complex were markedly increased in HUVEC by the Hantaan virus infection, while the thrombomodulin activity was decreased by the infection. Thus the infection of Hantaan virus to endothelial cells could partly explain the path- ogenesis of DIC and bleeding tendency in patients with KHF.
혈액투석 환자의 영양상태 판정 및 단백질 섭취량에 따른 생화학적 지표의 변화
강응택,유혜숙,우혜주,조여원 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.5
It is well recognized that malnutrition is. one of the most important reversible factors contributing to mortality in hemodialysis patients. Until recently, highprotein diets were recommended for hemodialysis patients in an attempt to increase the synthesis of albumin and to promote the anabolism of body protein. However, the appropriateness of this recommendation has recently been questioned. This study investigated the effects of low and high protein intakes on the levels of serum albumin, total protein, BUN, and creatinine in 28 hemodialysis patients fed sequentially 1.0g(LPG) or 1.5g(HPG) protein and 30-35kcal/kg/ideal body weight for four weeks. The HPG diet was associated with a significant increase in the levels of serum albumin, total protein, BUN, and creatinine however, the LPG diet was not. The serum levels of triglyceride and total cholesterol were in the normal range and did not changed by the diets. The levels of serum Hb, iron, and transferrin were lower than the normal values and did not changed by these two diets. Though individual considerations are recommended, it is possible that the high protein diet could increase the levels of serum albumin and total protein of the hemodialysis patients in Korea.
강응택,유석희,현창훈 대한신장학회 1988 Kidney Research and Clinical Practice Vol.7 No.2
Pseudoaneurysm is pulsating encapsulated hematoma communicating with a ruptured artery and resulted from improper compression following removal of the arterial catheter, from hypertension, wide pulse pressure and anticoagulation therapy. A man, 36 years old, with known chronic renal failure, was admitted to the Chung-Ang University Hospital under the impression of femoral arterial pseudoaneurysm. He complained of right inguinal pulsating mass and discomfort. He was performed the femoral artery angiography and diagnosed as right superficial femoral artery pseudoaneurysm. He has past medical history of several emergency femoral vein cathterization for hemodialysis 5 months prior to admission. We report a case of femoral arterial pseudoaneurysm following femoral vein catheterization.