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혈액투석중인 말기신부전 환자에서 Fludrocortisone acetate (FCA) 투여 후 혈청 칼륨 저하 효과
류봉관,강대웅,정지용,윤나라,신병철,박경희,정종훈,김현리 朝鮮大學校 附設 醫學硏究所 2005 The Medical Journal of Chosun University Vol.30 No.1
Background: Hyperkalemia is a commonly encountered problem in dialysis patients with end-stage renal disease. In this study we evaluated the effect of mineralocorticoid therapy (fludrocortisono acetate) on serum potassium level in the serum of hyperkalemic end-stage renal disease patients. Methods: Fourteen patients on hemodialysis receiving fludrocortisone acetate (FCA) 0.1 mg/day were observed for 2 months periods. Consecutive monthly biochemical profiles were compared for the druration of the pre-and post-treatment of FCA. Result: Fourteen patients with mean age (±SE) of 51.5 years (4 males and 10 females) and mean hemodialysis period of 51.9 months were studied. Mean serum potassium levels significantly fell (p<0.05) during the post-FCA period (5.2±0.66 mEq/L) compared with potassium levels during the pre-FCA (5.8±0.43 mEq/L) period. Pre-and post-FCA values were not different for sodium, chloride, protein, albumin, AST/ALT, glucose, blood nitrogen, creatinine, phosphate and calcium. Conclusions: FCA appears to decrease serum potassium value in patients with end-stage renal disease. These results suggested that FCA could be effective to treat hyperkalemia without any adverse effect in patients undergoing hemodialysis.
Carbamazepine에 의한 급성 간질성 신염 1예
류봉관,정지용,김범윤,서영욱,김정인,정종훈,김현리 대한내과학회 2004 대한내과학회지 Vol.66 No.4
저자들은 carbamazepine 복용 후 소변량 감소와 피부 발진을 주소로 내원한 환자에서 신장 조직 검사상 급성 간질성 신염으로 진단되어 유발 원인으로 보이는 약물 중단 및 부신피질 호르몬을 투여 후 증상이 완화된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Acute interstitial nephritis often caused by drugs and infection. Interstitial nephritis by drugs is a kind of idiosyncratic reaction and is caused independently of dosage. This disease developed within several days or weeks after taking medicine but improved if discontinue medication. Adrenocortical hormone may shorten the period of disease if renal dysfunction continued. Acute interstitial nephritis by carbamazepine that is used for epilepsy cure is rarely reported. A 49-year-old male was admitted to our hospital because of skin rash and decreased urine volume which developed 10 days ago. Patient was diagnosed intracranial hemorrhage 6 months ago and was taking carbamazepine because of tingling sensation to lower extremity before 2 months. At admission, blood pressure 120/80 ㎜Hg, hemoglobin 12.6 g/dL, WBC 232,000/㎣, eosinophil count 2,790/㎣, platelet 166,000/㎣. Urine findings indicated protein 1+, blood 2+ and eosinophil was observed in microscopic examination. Abdominal sonography showed increase of both kidney size, shade of renal cortex and Resistance index (RI). Renal biopsy showed inflammatory cell consisted of lymphocyte, eosinophil in parenchyme was seen with tubular necrosis parially. Renal function was improved after carbamazepine withdrawal and adrenocortical hormone medication.
신병철,김범윤,류봉관,김현리,정종훈 대한내과학회 2003 대한내과학회지 Vol.65 No.1
알도스테론 분비 선종은 대부분 일측성으로 발생하나, 드물게 양측성으로 발생한다. 저자들은 부신 피질 선종에 의한 일차성 알도스테론증의 31세 남자 환자에서 양측성의 신석회증이 동반된 1예를 경험하였으며 문헌 고찰과 함께 보고하는 바이다. Primary aldosteronism is defined as hypertension, hypokalemia, increased serum aldosteron, decreased serum renin activity. It has been known that prolonged hypokalemia, renal cyst formation and impairment of renal function. However, nephrocalcinosis associated with primary aldosteronism is rarely reported. A 31-year-old male was admitted to our hospital because of abdominal pain and uncontrolled hypertention which developed 2 years earlier. At admission, blood pressure 180/100 ㎜Hg. Biochemical findings indicated sodium 146 mEq/L, potassium 2.3 mEq/L, BUN 8.2 ㎎/dL, creatinine 1.1 ㎎/dL, calcium 10.7 ㎎/dL, phosphate 5.7 ㎎/dL, magnesium 1.8 ㎎/dL. Twenty-four hour urine collection indicated sodium 108 mEq, potassium 32 mEq, calcium 75 ㎎, phosphate 72 ㎎, magnesium 8.0 ㎎. The hormone study revealed PTH 22.7 pg/mL (normal: 9∼55 pg/mL), ACTH 8 pg/mL (normal: 6∼56.7 pg/mL), aldosterone 51.0 ng/dL (normal: 1∼16 ng/dL), plasma renin activity below 0.01 ng/mL/hr (normal: 0.15∼233 ng/mL/hr). Abdominal sonography showed homogenous increased medullary echoes and multiple calcification. The abdomen CT showed adrenal mass (1× 1 ㎝) consistent with adrenal tumor. Adrenalrectomy was performed on the 16th hospital day and clinical symptoms, blood pressure and hypokalemia improved shortly after operation.
Sheehan`s 증후군 환자에서 발생한 만성 저나트륨혈증
김범윤 ( Kim Beom Yun ),류봉관 ( Lyu Bong Gwan ),임태영 ( Im Tae Yeong ),최동현 ( Choe Dong Hyeon ),김현리 ( Kim Hyeon Li ),정종훈 ( Jeong Jong Hun ),조영신 ( Jo Yeong Sin ) 대한내과학회 2003 대한내과학회지 증례 특집호 65-5 부록3 Vol.0 No.-
Sheehan`s syndrome has been attributed to ischemic damage of the pituitary gland or hypothalamic-pituitary stalk during the peripartum period. Well-described clinical features of Sheehan`s syndrome include hypothyroidism, growth hormone deficiency, hypogo
유지 투석중인 만성 신부전환자에서 허혈성 심질환의진단 지표로서의 심장트로닌-I의 유용성
신병철,강대웅,정지용,류봉관,서영욱,김정인,김범윤,김현리,정종훈 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.1
Background : Coronary disease is highly prevalent in patient with end stage renal disease (ESRD) and account for much of their observed morbidity and mortality. Troponin-I consistently maintains a high sensitivity and specificity and is most sensitive marker for ischemic heart disease (IHD). Method : We examed 49 hernodialyzed patients (22 male, 27 female) without evidence of acute coronary syndrome (ACS) for 6 months. Biochemical markers were measured in serial predialysis blood samples. For analysis, we used two cardio-specific assays for troponin-T (cTnT) as well as for troponin-I (cTnI) and compared the results with CK-MB (reference value ≤ 4.0 ng/mL) concentration. Results : Myocardial ischemia was observed in 47% (23/49) of patients. cTnT level above 0.1 ng/mL. and cTnI level above 0.5 ng/mL, were observed in 22% (11/49) and 20% (10/49) of patients respectively. cTnI revealed significantly higher positive rate in patients with myocardial ischemia than the patients without myocardial ischemia (43 % vs 30%) (p<0.05). cTnT and CK-MB revealed no difference in positive rate between the patients with and without myocardial ischemia (cTnT : 30% vs 15% and CK-MB : 30% vs 19%). The sensitivity and specificity of cTnI to myocardial ischemia were higher than those of cTnT and CK-MB (sensitivity 43% vs 30% and 30%. specificity 100% vs 85% and 81%). Conclusion: Both cTnT and cTnI are useful in ruling out myocardial injury in chronic renal failure patients. But. cTnI is a more sensitivity and excellent specificity of ischemic heart disease than cTnT and CK-MB in hemodialyzed patients. In patients with ischemic heart disease, the presences of DM and advanced age were higher than those in patients without ischemic heart disease (p<0.05). Among the baseline characteristics old age, elevated LDH and diabeties were significant more frequent in the patients with elevation of cardiac troponin-I (p>0.5 ng/mL) than those with cardiac troponin-I (p<0.5 ng/mL), p=0.038, p=0.049, and p=0.045, respectively. Our results suggest that these cTnI is the potential diagnostic marker for the prediction of IHD in ESRD patients.