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만성신부전 환자에서 신이식 전후의 골수소견 및 생체외 CFU - GM 에 관한 연구
김홍기(Hong Khee Kim),방동수(Dong Soo Bang),이기영(Khee Yong Lee),권오선(Oh Sun Kwon),이태원(Tae Won Lee),임천규(Chun Kyu Im),윤휘중(Hwi Joong Yoon),조경삼(Kyung Sam Cho),김명재(Myung Jae Kim) 대한내과학회 1987 대한내과학회지 Vol.33 No.4
N/A We have studied bone marrow finding and inhibitory effect on the CFU-GM culture in 8 patients with chronic renal failure who had been treated with renal transplantation. Tho following results were observed, 1) There was not alteration on neutrophil count in peripheral blood but increased cellularity of bone marrow and decreased M/E ratio were observed after renal transplantation. 2) There was no difference of the CFU-GM colony count of bone marrow cell itself before and after renal transplantation. 3) The effect of serum of the patients on the CFU-GM culture showed no difference before and after renal transplantation, 4) The CFU-GM colony count did not correlate with the duration of renal failure and hemodialysis, level of renal function, or neutrophil count in petipheral blood Therefore, the results suggest that erythropoiesis can be improved, but there is no significant change in effect on the CFU-GM colony count after renal transplantation.
당뇨병성신증에서 전환효소억제제인 Captopril 이 신기능 및 단백뇨에 미치는 영향
김태용(Tae Yong Kim),이성계(Sung Gye Lee),서보원(Bo Won Suh),김수방(Su Bang Kim),양상호(Sang Ho Yang),김홍기(Hong Khee Kim),박요한(Yo Han Park),이재우(Jae Woo Lee),이시래(Si Rhae Lee) 대한내과학회 1990 대한내과학회지 Vol.39 No.4
N/A Short-term administration of captopril, a converting enzyme inhibitor, to patients with diabetic nephropathy is known to reduce proteinuria by lowering glomerular hypertension. However, clinical reports describing the long-term influence of this medication on proteinuria and renal function are hardly met with. We, therefore, investigated if long-term administration of captopril has the same effect on proteinuria and preseves renal function more effectively than other antihypertensives inpatients with diabetic nephropathy and hypertension. Twenty-two patients were divided into two groups: 11 (Group I) treated with captopril and another 11 (Group II) with conventional antihypertensives. Both groups were followed up for an average of 20 months (6-32mo). Regarding proteinuria in Group I, 24-hour urinary excretion of protein decreased from 7.4±3.4 g (N = 11) to 5.1±2.9 g (N =10) in 1 week (p <0.05), and then it slowly declined to 3.6±0.6 g (N =5) (p<0.05) at the end of a 24 month follow up period. In Group II, however, the protein excretion did not change significantly during the 18 months of treatment, after which it tended to increase. The serum albumin level started to increase (p< 0.05) in Group I after 1 week and rose from 2.7±0.4 g/dl (N=11) to 3.1±0.5g/dl (N=5) in 24 months, but it showed no apparent variation in Group II. In both groups the serum creatinine concentration increased gradually during the course of treatment, however, the rate of increment was slightly lower in Croup I (0.072 mg/dl/mo) compared with Group II (0.123 mg/dl/mo). Consequently, the rate of reduction in 1/Scr appeared to be slightly lower in the former (-0.01349 100 ml/mg/ mo) than in the latter (-0.01833 100 ml/mg/mo), although the difference was not statistically significant. Plasma renin activity increased and the plasma aldolsterone level decreased in Group I, but no apparent change was observed for both variables in Group II. In conclusion, long-term captopril treatment in patients with diabetic nephropathy and hypertension decreased proteinuria significantly and slowed the progression of renal failure compared to those patients treated with other antihypertensives, Captopril can be used relatively safely in these patients over a long-term period and may be a preferred medication to other antihypertensives.
김명재(Myung Jae Kim),김홍기(Hong Khee Kim),이시래(Si Rhae Lee) 대한내과학회 1992 대한내과학회지 Vol.43 No.5
N/A The beneficial effect of DST is now generally accepted but a considerable incidence of sensitization after DST has been the major problem. The mechanism by which DST induces allograft protection, however, is still not understood. This study was designed to investigate the sensitization rate after DST with immunosuppressant in 142 renal recipients. and the immunological alterations induced by DST with immunosuppressant in 24 HLA-HID recipients. The sensitization rate after DST was 20% in DST alone group, 3.6% in the DST+azathioprine group and 2.S96 in the DST+cyclosporin A (Cs-A) group. MLC tests were performed in 24 EILA-HID group. The value of stimulation index (SI) after DST (2.8+1.5) showed a slightly decreased response as compared to that before DST (3.6+2,0). Especially in 16 cases with DST+Cs-A group, the value of SI after DST (2.7+1.2) was significantly decreased as compared to that before DST (4.0+ 2.1). No significant changes in T cell subsets and PHA stimulation were found before and after DST. The number of cells bearing HLA-DR (+) antigens and Con -A induced suppressor cell activity showed slightly in- creased response after DST in 6 cases with decreased MLC response (SI) although the differences were not statistically significant. These results indicate that DST with immunosuppressant reduced sensitization rate, and DST with Cs-A may induce nonspecific immunoauppression considering the increased Con-A induced suppressor cell activity, in- creased HLA-DR (+) cells and decreased SI after DST.
편도철(Do Chul Pyun),김중경(Jung Kyoung Kim),공덕경(Deog Gyeong Gong),김태용(Tae Yong Kim),주운수(Woon Soo Joo),김홍기(Hong Khee Kim),이시래(Si Rhae Lee) 대한내과학회 1989 대한내과학회지 Vol.37 No.4
N/A Antibody formation against the A or B antigen in renal transp1antation resulting in autoimmune hemolytic anemia has been reported on rare occasions. We recently experienced a case of autoimmune hemolytic anemia in a blood group Rh+A male patient, who had received a kidney from his blood group Rh0 mother. He was maintained under immunosuppression with Cyclosporin-A and prednisolone. On days 12 to 13 posttransplantation, hemolysis developed. The Hb dropped from 9.6%/dl to 6.4%/dl, reticulocyte count was 3,0%, and peripheral blood smear showed spherocytosis. LDH was 580units and haptoglobin was 27 mg/dl. His direct Coomb`s test was positive with both anti-IgG and anti-complement. Anti-A was eluted from his serum. He was transfused with 2 units of compatible blood group Rh'0 washed RBCs without any incident. There was improvement of anemia after reducing Cs-A and adding azathioprine.
신장이식 57 예에서의 공여자특이수혈 및 거부억제제 치료법에 따른 이식신의 예후
황영표(Young Pyo Hwang),유홍(Hong Yoo),김영호(Young Ho Kim),표광민(Kwang Min Pyo),이상욱(Sang Uk Lee),주운수(Woon Soo Joo),최창필(Chang Pil Choi),박진석(Jin Seok Park),김홍기(Hong Khee Kim),이시래(Si Rhae Lee) 대한내과학회 1988 대한내과학회지 Vol.35 No.3
N/A 57 cases of renal transplantation from December 1984 to August 1987, of which 10 cases were HLA-identical (HLA-ID), 39 cases were HLA-haploidentical (HLA-HID) and 8 cases were living-unrelated (LUR). The mean age of recipients and donors was 35.3 years and 40.3 years, respectively, Underlying renal diseases of the recipients were mostly chronic glomerulonephritis (52 cases), and the remaining 5 cases were chronic pyelone-phritis, reflux nephropathy, hypertentsive nephrosclerosis, polycystic renal disease and diabetic nephropathy. The post donor specific transfusion (DST) sensitization rate was compared between a group treated by DST alone and a group treated by DST with Azathioprine The effect of Cyclosporine A plus prednisolone (Cs-A+P group) and Azathioprine plus prednisolone (Aza+P group) as immunosuppressive agents on renal allograft function was compared in the HLA-ID, HLA-HID and LUR group. The post-DST sensitization rate was 20.0% in the DST alone group and 4.9% in the DST with Azathio-prine group, however the difference was not statistically significant. Acute rejection after renal transplantation developed in 4 of 19 cases (21.1%) in the Cs-A+P treated HLA-HID group, in 2 of 10 cases (20.0%) in the HLA-ID group and in 7 of 17 cases (41.2%) in the Aza+P treated HLA-HID group. Again, the difference among these groups was not significant. Excluding 4 cases of graft failure due to nonimmunolgical causes, the acturial graft survival for 2 years was 10096 in the HLA-ID group, 88% in the HLA-H1D group and 71.4% in the LUR group. The number of patients with serum creatinine below 2 mg/dl was 19 of 19 cases (100%) in the Cs-A+P treated HLA-HID group during 7.68±5.18 months, and 14 of 17 cases (82.4% ) in the Aza+P treated HLA-HID group during 12.5±7.5 months, and the difference was not statistically significant. The above results suggest that the pretransplant allosensitization by DST was lower in the DST+Aza group than in the DST alone group, and the effect of Cs -A+P on renal allogrsft seemed to be better than that of Aza+P. However, further studies including more cases and longer observation periods are necessary to conclude which posttransplantation regimen is better between Aza+P and Cs-A+P, even after DST.
신이식 100예에서 이식신의 예후에 영향을 미치는 인자
편도철(Do Chul Pyun),정인권(In Kweon Jung),임창범(Chang Bum Lim),양영란(Young Ran Yang),임정식(Jeong Sik Lim),김종진(Jong Jin Kim),하봉준(Bong Jun Ha),김홍기(Hong Khee Kim),이시래(Si Rhae Lee),이승도(Sung Do Lee),류현열(Hyun Yul Rhew 대한내과학회 1989 대한내과학회지 Vol.37 No.5
N/A It has been reported that many factors other than HLA and the mode of immunosuppression influence the results of renal transplantation. The factors are constantly changing with the advances in surgical techniques and introduction of Cyclosporin-A s-A), etc. We analyzed the possible prognostic factors in 100 cases of renal allograft which were performed by the transplantation team of Kosin Medical College from Dec. 1984 to Aug. 1988. Detailed results are presented for the several factors as follows: 1) HLA and the mode of immunosuppression. Excluding 9cases of graft failure due to non-immunological causes, the actuarial graft survival in 3 years was 100% in the E3LA-II) group, 95.1% in the HLA-HID group and 84.6% in the LUR group. In the HLA-HID group, the 3 year graft survival (3YGS) was 96.8% in the Cs A+P treated group and 93.3% in the Aza+P treated group, and the difference in these 2 groups was not significant statistically (p>0.1). Numbers of patients with serum creatinine equal or above 2 mg/dl were 5 of 17cases (29.4%) in the Aza+P treated HLA-HID group, and 8 of 47cases (17.1%) in the Cs-A+P treated HLA-HID group, but the difference was not significant statistically (p>0.1). 2) Pretransplant transfusions. Twenty-seven cases which were transfused with more than 10 units of packed red cells were 100% in 3YGS and the other cases were 97.8% in 3YGS, And there was no significant difference between Aza+P and Cs A+P treated HLA-HID groups in relation to transfusion (p>0.1), 3) Donor and recipient age. The 3YGS in donors older than 50 years and in those 50 years old and under were 93.796 and 94.895, respectively, The percentages of cases with serum creatinine equal or above 2mg/dl were 26. 5% in the older than 50 years group and 12.3% in the other group, but the difference was not significant statistically (p>0.1). Thirteen cases older than 60 years were 10096 in 3YGS. Recipient age had no significant effect on 3YGS between the older than 50 years group and the other group (p>0.1). 4) Donor and recipient sex. The 3YGS was highest (100%) in the male to male group and lowest (87.5%) in the male to female group, but the difference was not significant in these 2 groups (p>0.1). 5) Minor ABO incompatibility. Seventeen cases with minor ABO incompatibility were 100% in 3YGS, and in remaining compatible 74 cases, the 3YGS was 93.4% and there was no significant difference (p>0.1). In summary, the 3YGS was higherst in the HLA-ID group, and there was no signifcant difference in 3YGS between Aza+P and Cs A+P treated HLA-HID groups. And the elder (more than 50 years or 60 years) donor group did not show lower 3YGS than the younger age group despite somewhat worse graft function. There appears to be a minimal effect with mismatch of sex and minor ABO incompatibility. And the fact that there is no significant relation between pretransplant transfusion and 3YGS seems to be due to DST, which was done in all cases except HLA-ID and 2cases of the HLA-HID group.
한국인 신이식환자에서 Cyclosporin A 의 약리역동학적 연구
김명재,최철준,임천규,권오선,김홍기 대한내과학회 1987 대한내과학회지 Vol.32 No.2
The pharmacokinetic monitoring of cyclosporin A (CsA) was performed in Korean renal transplant recipients in order to establish the optimal therapeutic regimen of cyclosporin A in Korean. 1) The pharmacokinetic parameters of CsA were calculated as follows: Volume of distribution(Vd) was 320.5±19.2 L. Clearance(C1) was 1.2±0.1 L/min. Area Under Curve(AUC) was 22733.8±3177.5ngh/ ml. The time of reaching a maximum concentration was about 2 hour and maximum serum concentration was variable between 517.9 and 1909.8ng/mt Pharmacokinetic values after multiple oral dosing with CsA were as follows: The time of reaching a maximum concentration was about 2 hour. Maximum serum concentration was variable between 1850.7 and 4351.7ng/ml. Vd was 201.3±28.9 L. Cl was 0.75k0.09 L/min. AUC was 27563.9±5240.2ngh/ml. 2) During simultaneous administration of isoniazide and rifampin with CsA, the serum concentrations of CsA dropped below the therapeutic level, as much as 9-25% of those of control. The pharmacokinetic calculation in these subjects revealed increased volume of distribution and increased clearance. 3) Successful renal function was achieved without specific complications during upto 6 month follow-up period with the new regimen in which 10 mg cyclosporin A/kg/day was loaded initially for 2 weeks and tapered off to 3mg/kg/day within 2-3 months after renal transplantation, Therefore it is concluded that small Vd, early peak concentration, and slow clearance of CsA, which might be due to the small body fat proportion and genetic difference in hepatic microsomal enzyme system, could reduce the CsA requirement and make the regimen of low does CsA with low does PDL possible and ideal in Korean renal tranaplant recipients and also speculated that RFP and INH induced increment of hepatic metabolic amount might cause the reduction of the serum level of CsA.