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사춘기에 말기 신질환으로 조기 진행한 소아 제1형 당뇨병성 신병증 1례
윤지은,권순길,하태선,Yoon, Ji-Eun,Kwon, Soon-Kil,Ha, Tae-Sun 대한소아신장학회 2009 Childhood kidney diseases Vol.13 No.2
Type 1 diabetes mellitus (T1DM) commonly occurs in childhood and adolescence and diabetic nephropathy is a serious metabolic complication of T1DM that leads to serious morbidity. With poor glycemic control prepubertal diabetes duration contributes to the risk of long-term microvascular complications, however, the younger age at onset or longer prepubertal diabetes duration seems to prolong the time to development of microalbuminuria or later end-stage renal disease (ESRD). Therefore, there have been a few cases of diabetic nephropathy in prepubertal patients and therefore the ESRD cases developed during adolescence in T1DM children were very rare. Here we report an adolescent with T1DM who had poor glycemic control and was diagnosed as diabetic nephropathy in a prepubertal period and leading to end-stage renal disease during adolescence. 소아청소년기의 당뇨병은 대부분 제1형 당뇨병으로, 이 때 발생하는 혈관합병증으로서 당뇨병성 신병증은 소아에서 흔하지 않지만 신부전까지 초래할 수 있는 심각한 합병증이다. 혈당조절이 불량하고 사춘기나 그 이후에 당뇨병이 발생하는 경우에 혈관합병증의 발생이 증가하므로 소아청소년기의 당뇨병이 청소년기에 당뇨병성 신병증으로 발현하는 경우는 드물고, 더욱이 말기 신질환으로 진행하는 경우는 매우 드물다. 저자들은 혈당 조절이 불량했던 제 1형 당뇨병 소아 환자에서 혈뇨와 단백뇨가 관찰되어 조직 검사를 통해 사춘기 전에 발생한 당뇨병성 신병증을 확인하고 사춘기에 말기 신질환으로 진행한 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.
Acetazolamide에 의해 발생한 핍뇨성 급성신부전 1예
김혜영 ( Hye Young Kim ),이희승 ( Hee Seung Lee ),김선문 ( Sun Moon Kim ),권순길 ( Soon Kil Kwon ),최용혁 ( Yong Hyeok Choi ),나소영 ( So Young Rha ) 대한내과학회 2012 대한내과학회지 Vol.83 No.5
Acetazolamide is a carbonic anhydrase inhibitor commonly used to treat glaucoma. It can cause metabolic acidosis and renal failure in the elderly and patients with chronic renal insufficiency. We report oliguric acute renal failure (ARF) caused by a conventional dose of acetazolamide for glaucoma in a patient with normal renal function. A 56-year-old woman with 20-year history of diabetes had general weakness, decreased urine output, nausea, and vomiting for 3 days. For the past 2 weeks, her glaucoma had been treated with acetazolamide. Blood-gas analysis showed pH 7.02, PCO2 27 mmHg, PO2 135 mmHg, and HCO3 - 7.0 mmol/L. Her BUN was 65 mg/dL and creatinine, 9.1 mg/dL. She recovered after hemodialysis and hydration. Acetazolamide may cause severe ARF, even in patients with normal renal function, suggesting the importance of careful monitoring of renal function in patients taking acetazolamide. (Korean J Med 2012;83:664-667)
인슐린 비의존형 당뇨병 환자에서 MTHFR 유전자 다형성과 당뇨병성 합병증과의 관계
신종성(Jong Sung Shin),오광식(Kwang Sik Oh),권순길(Soon Kil Kwon),지정훈(Jeong Hoon Ji),이태원(Tae Won Lee),박영선(Young Sun Park),김미성(Mi Sung Kim),궁성수(Seong Su Koong),오태근(Tae Geun Oh) 대한내과학회 2001 대한내과학회지 Vol.61 No.4
N/A Background: Diabetic nephropathy develops in 20-30% of patients with non-insulin dependent diabetes mellitus (NIDDM). Poor glycemic control, hypertension and duration of diabetes are known as risk fact ors for the development of diabetic nephropathy and there is high prevalence of diabetic nephropathy in the patients who have familial history of diabetic nephropathy, so it has been assumed that genetic fact or is associated with the background of its occurrences. Recently it has been observed that a cytosine to thymidine substitution of the methylenetetrahydrofolate reductase (MTHFR) gene at nucleotide 677 (C677T) was related to diabetic nephropathy in patients with NIDDM and MTHFR gene polymorphism was also known to predispose to vascular disease. This study was performed to investigate whether MTHFR gene polymorphism is associated with the development of diabetic nephropathy and macrovascular disease in NIDDM patients. Methods: The study population consisted of 243 NIDDM patients (duration≥10 years). Nephropathy was defined by 24 hour urinary protein excretion of more than 500 mg. The MTHFR gene fragment was extracted using the polymerase chain reaction. The presence of the mutation was identified by HinfI digestion, which cuts at the mutation site, followed by 2.5% metaphore agarose electrophoresis and ethidium bromide staining. Statistical differences in genotype distribution and allele frequencies among the groups were assessed by the chi-square test. Results: There was no difference in clinical characteristics except the prevalence of hypertension and diabetic retinopathy between nephropathy group and non-nephropathy group. The data do not show any difference of genotype distribution or allele frequencies between patients with or without diabetic nephropathy and macrovascular disease Conclusion: With the above results, it is assumed that there are no significant relationships among MTHFR gene polymorphism, diabetic nephropathy, and macrovascular disease. (Korean J Med 61:391-398, 2001)
Di-nitro-diaza-alkane 계열 에너지 가소제를 활용한 온도 둔감 추진제 특성 연구(I)
주현혜(Hyunhye Joo),주형욱(hyung-uk Joo),권태수(Tae Soo Kwon),권순길(Sun-kil Kwon) 한국추진공학회 2011 한국추진공학회 학술대회논문집 Vol.2011 No.11
근래 추진제의 개발 동향은 온도 둔감 특성을 가지는 것을 목표로 온도에 둔감한 특성을 가진 DNDA-57을 활용한 개발이 이루어지고 있다. 이번 연구에서는 DNDA-57이 포함된 추진제에 대해 Closed Bomb Test 및 40MM 발사시험을 통해 온도 둔감 효과를 확인하였다. 현재 최적의 추진제 형상 및 조성, 그리고 작업 공정에 대한 연구가 진행 중이다. 향후 최적의 조성 및 공정을 수립하기 위한 연구를 지속적으로 수행할 계획이다. Over recent several years, researches for the less sensitive gun propellant development have been carried out with promising the product of propellants which have temperature independent characteristics using the new energetic plasticizing mixture as Di-nitro-diaza-alkanes. During this study, the promising propellant formulation having temperature ballistic properties as well as better behaviors concerning the cold brittleness of the materials was confirmed by results in tests of a closed bomb and 40mm Gun firing. On-going research on the optimized shape, formulation and processes of the propellant is progressing. From now on it should be done present study to establish the better composition and processes.
Yong-Dae Kim(김용대),Sang-Yong Eom(엄상용),Dong-Hyuk Yim(임동혁),Soon Kil Kwon(권순길),Choong-Hee Park(박충희),Guen-Bae Kim(김근배),Seung-Do Yu(유승도),Byung-Sun Choi(최병선),Jung-Duck Park(박정덕),Heon Kim(김헌) 한국생명과학회 2019 생명과학회지 Vol.29 No.2
일반적으로 요중 카드뮴 농도는 요비중 또는 요중 크레아티닌 농도로 보정한 값을 사용해왔다. 그러나 어떤 보정방법이 더 타당한지에 대한 논란은 계속되고 있다. 본 연구에서는 비교적 큰 규모의 일반인구집단을 대상으로 요중 카드뮴농도와 각종 신장손상지표들과의 관련성을 평가함에 있어 요비중 보정 방법과 요중 크레아티닌 보정 방법 중 어느 방법이 더 타당한지 비교 평가하였다. 1,086명의 자원자 중 신장질환의 질병력이 있는 사람을 제외한 862명이 최종적으로 연구대상에 포함되었다. 대상자들로부터 측정한 요중 카드뮴 농도 및 malondialdehyde (MDA), N-acetyl-β-D-glucosaminidase 농도, 혈중 크레아티닌을 이용하여 산출한 사구체여과율 등의 신장손상지표들간의 관련성을 평가하였다. 연구 결과, 요중 크레아티닌 농도보다는 요비중으로 보정한 카드뮴 농도가 각종 신장손상지표와 높은 상관성이 있음을 보여주었다. 특히, 요비중 보정 카드뮴 농도는 요중 MDA 농도와 양의 상관관계를, 사구체여과율과는 음의 상관관계를 보여주었다. 이러한 결과는 일반인구집단에서 카드뮴 노출이 많아질수록 사구체여과율이 감소함을 의미하며 이러한 기전에서 산화적스트레스가 관여하고 있음을 보여준다. 또한, 사구체여과율이 카드뮴 노출에 의한 유용한 신장손상지표 중 하나로 사용될 수 있음을 의미한다. In general, specific gravity (SG) and urinary creatinine (CR) have been used to adjust urinary cadmium (Cd) concentrations. However, the validity of correction methods has been controversial. We compared the two adjustments to evaluate associations between urinary Cd and various renal damage markers and to evaluate the relationship between urinary Cd concentration and renal disease markers, such as estimated glomerular filtration rate (eGFR), in a relatively large general population sample. Among the 1,086 volunteers who were enrolled in this study, 862 healthy volunteers who did not have kidney disease were included in the final analysis. Urinary Cd, malondialdehyde (MDA), and N-acetyl-β-D-glucosaminidase (NAG) concentrations were measured, the creatinine-based eGFR was calculated, and the relationships between these markers were subsequently analyzed. This study showed the use of urinary Cd concentration adjusted with SG rather than with urinary creatinine may be appropriate in studies evaluating renal function based on Cd exposure. Urinary Cd concentration adjusted with SG had a positive correlation with urinary MDA levels and a negative correlation with eGFR. This relationship was relatively stronger in women than in men. This study showed that urinary Cd level was associated with decreased eGFR in the general population, and oxidative stress was likely to act as an intermediator in this process. These results suggest that eGFR can be a very good indicator of kidney damage caused by Cd exposure in the general population.
신장; 일측성 요로폐쇄 흰쥐 신장에서 암모니아 운반체의 발현
김승중 ( Seung Jung Kim ),김혜영 ( Hye Young Kim ),최재현 ( Jae Hyun Choi ),이동화 ( Dong Hwa Lee ),김경민 ( Kyung Min Kim ),김선문 ( Sun Moon Kim ),권순길 ( Soon Kil Kwon ),신경섭 ( Kyung Sub Shin ),김경숙 ( Kyung Sook Kim ) 대한내과학회 2014 대한내과학회지 Vol.86 No.4
목적: 일측 요로폐쇄는 요중 산배설이 감소하는 질환으로 대부분 요 암모니아 배설의 감소에 의한 것으로 알려져 있다. 본 연구는 일측 요로 폐쇄 흰쥐에서 산배설의 변화와 암모니아 운반체인 Rh C Glycoprotein (Rhcg)의 발현 변화를 확인하여 신세뇨관산증의 병인에 암모니아 운반체의 역할을규명하고자 하였다. 방법: Sprague-Dawley계 웅성 흰쥐를 사용하였으며, 실험군은 24시간 일측 요로폐쇄를 유발시켰다. 대조군과 실험군은 대사케이지에 mineral oil을 처리하여 24시간 동안 요를수집하였다. Rhcg의 면역조직화학염색을 시행하였고 세포크기, 총 Rhcg 발현, 자유세포면의 Rhcg 발현에 대하여 면역조직화학염색법을 정량화 분석하였다. 결과: 일측 요로폐쇄군에서 혈중 tCO2 농도는 대조군 27.5± 2.8 mEq/L에 비하여 실험군은 25.2 ± 1.0 mEq/L로 감소하였다(p < 0.05). 24시간 요 암모니아 배설은 대조군 0.38 ±0.08 mmol에 비하여 실험군에서 0.19 ± 0.03 mmol로 요 암모니아 배설이 감소하였으며(p < 0.05), Urine pH는 양 군 간에차이가 없어 일측성 요로폐쇄에 의해 신세뇨관산증이 유발되었음을 확인하였다. 반정량적 immunoblot 검사에서 Rhcg의 단백 발현은 양군 간에 유의한 차이가 없었다. 면역조직화학염색과 정량화 분석 결과 일측 요로폐쇄군에서 Rhcg의면역반응성은 비폐쇄부위 콩팥에서는 차이가 없었으나 폐쇄부위 콩팥에서는 감소하였다. 결론: 일측 요로폐쇄 흰쥐에서 암모니아 배설 감소와 폐쇄부위 콩팥에서 Rhcg의 면역반응성의 감소가 동반되었다. 따라서 일측 요로폐쇄의 산성화 장애 병인에 암모니아 운반체 Rhcg가 중요한 역할을 할 것으로 생각된다. Background/Aims: Urinary tract obstruction induces a form of renal tubular acidosis with a urinary acidification defect caused by decreasing net acid excretion, which is predominantly due to a decrease in urinary ammonia excretion. The present study examined whether this decrease is associated with changes in the renal expression of an ammonia transporter family member, Rh C glycoprotein (Rhcg), in rats with a unilateral ureteral obstruction. Methods: Male Sprague-Dawley rats underwent a 24-h unilateral ureteral obstruction. Rhcg expression was then evaluated by immunoblotting and immunohistochemistry. Cell height, total cellular expression, expression in the apical 25% of the cell, and % of total expression in the apical region were quantified by immunohistochemistry with quantitative morphometric analysis. Results: After 24 h of unilateral ureteral obstruction, the serum bicarbonate level and total urinary ammonia excretion were decreased. Both light microscopy and immunohistochemistry with quantitative morphometric analysis demonstrated that the total intensity of Rhcg expression was decreased in the obstructed kidneys, whereas Rhcg expression did not change in the cortical collecting duct (CCD) and outer medullary collecting duct (OMCD) of nonobstructed kidneys in rats with a 24-h unilateral ureteralobstruction. Conclusions: The rats with a unilateral ureteral obstruction showed decreased urinary ammonia excretion associated withdecreased Rhcg expression in the CCD and OMCD. These changes suggest that the ammonia transporter Rhcg mediates a urinaryacidification defect associated with unilateral ureteral obstruction. (Korean J Med 2014;86:444-452)