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김진수(Jin Soo Kim),문경협(Kyoung Hyoub Moon),김민정(Min Jeong Kim),마상수(Sang Soo Ma),이후석(Hu Seok Lee),김미영(Mi Young Kim),노용호(Young Ho Rho) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1
목적 : 척수 손상환자에서 신질환에 의한 유병율과 사망률은 매우 높다고 알려져 있으며 이들 환자에서 신 질환은 미세 단백뇨를 동반한 세뇨관성신실질 형태가 주된 질환인데 단백뇨를 가진 만성 척수 손상환자의 임상적 특징과 신부전에 이르기 전 단백뇨의 유발 위험요인에 대한 국내 조사가 없어 본 연구를 시작하였다. 방법: 1999년 12월부터 2000년 5월까지 6개월 동안 한국보훈병원에 입원 또는 외래진료 중인 척수 손상으로 인한 하반신 또는 전신마비 환자를 대상으로 하였으며, 환자는 연구기간 중 입원 중이거나 내과, 비뇨기과 외래진료 중인 환자를 대상으로 하였고, 24시간 채뇨와 일반적인 검사실 검사를 시행하였다. 신 초음과 검사는 24시간 체뇨 전후 6개월 이내에 시행하였다. 결과: 1g 이상의 병적인 단백뇨를 보였던 군에서 더 고령이었고, 더 오랜 척수 손상기간을 가졌으며 욕창에 대한 수술적 처치가 더 많았고, 흉수 이하 및 하반신마비 환자에서 더 많았으며, 수신증을 보이고 있었으나, 방광내 도관 삽입은 관계가 없었다. 당뇨환자는 통계적 차이는 보이지 않았으나 모두 병적인 단백뇨를 보이고 있었다. 결론: 척수 손상 환자에서 단백뇨는 욕창 치료 증가와 수신증 및 척수 손상 기간과 연관성을 보였으며, 사지마비보다 하지마비환자에서 더 유의하게 많았는데 이는 하지마비환자에서 척수 손상기간이 더 많았기 때문으로 생각된다. 만성 척수 손상환자의 신 기능을 보존하기 위하여는 정기적으로 수신증의 발생을 확인하여 대처하며, 무엇보다도 욕창의 발생을 피하고, 욕창에 대한 철저한 치료로 만성염증을 피하는 데에 더욱 노력하여야 한다. Background: Patients with spinal cord injury have a significant degree of morbidity and mortality caused by renal disease. Tubulointerstitial form of renal disease with minimal proteinuria predominate in this population. A retrospective study was performed to investigate the risk factors that may contribte to the development of proteinuria in patient with chronic spinal cord injury. Methods : Between December 1999 and May 2000, 40 spinal cord injury patient in Korean Veterans Hospital were recurited retrospectively into the study. The information was gathered included medical record, laboratory data, and radiological study. Results: Proteinuric subjects were older, had a longer duration of injury, had undergone a greater number of decubitus ulcer procedures and hydronephrosis. Conclusion : Proteinuria in the patients with spinal cord injury was related to the increase of the therapy for the decubitus ulceration, hydronephrosis, and the duration of the spinal cord injury, and it developed significantly more in paraplegia patients than in quadriplegia patients, which might be due to the more duration of the spinal cord injury in paraplegia patients. Therapeutic efforts directed toward preserving renal function should focus on avoidance of hydronephrosis, and decubitus ulceration.
혈액투석중인 만성 신부전 환자에서 혈청 Neopterin 농도에 관한 연구
박용현(Yong Hyun Park),문경협(Kyung Hyub Hyub),박광기(Kwang Ki Park),조규웅(Kyu Woong Cho),음선홍(Sun Hong Eum),김광선(Kwang Sun Kim),최기철(Ki Chul Choi),강영준(Young Joon Kang) 대한내과학회 1990 대한내과학회지 Vol.39 No.2
N/A Neopterin is a low-molecular-weight product released by human macrophages upon stimulation with interferon gamma. It permits the quantification of the level of cellulalr immune activation in vivo. We measured the level of serum neopterin and creatinine concentrations in 20 patients before and after hemodialysis in order to test whether hemodialysis induces specific activation of the T-lymphocyte macrophage axis. The results were as follows: 1) In normal adults, the serum neopterin level was 6.7±1.3 nmol/L with no sex difference. 2) In 20 hemodialysis patients, the serum neopterin level before hemodialysis was 246.2±97.6 nmol/L and increased significantly compared to normal adults (p<0.001). 3) In 20 hemodialysis patients, the serum neopterin level was 163.0±76.7 nmol/L after hemodialysis and decreased significantly (p<0.001), the neopterin/creatinine ratio was 25.4±14.7, 32.8±23.7 before and after hemodialysis, respectively, and there was no significant difference between both groups. 4) In groups of short-term hemodialysis (less than three months), the serum neopterin level was 248.4±100.6, 181.7±91.2nmol/L before and after hemodialysis, respectively. In groups of long-term hemodialysis (more than one year), the neopterin level was 244.0±99.9, 144.2±57.6 nmol/L before and after hemodialysis, respectively, and decreased significantly after hemodialysis in both groups (p<0.001), and there was no significant difference between both groups. 5) In 12 male hemodialysis patients, the serum neopterin level was 226.4±97.6, 145.5±60.5nmol/L before and in after hemodialysis, respectively, and in eight female hemodialysis patients, the serum neopterin level was 275.9±96.0, 189.1±94.4 nmol/L before and after hemodialysis, respectively, and decreased significantly in both groups (p<0,05, respectively). There was no significant difference between both groups.Neopterin is a low-molecular-weight product released by human macrophages upon stimulation with interferon gamma. It permits the quantification of the level of cellulalr immune activation in vivo. We measured the level of serum neopterin and creatinine concentrations in 20 patients before and after hemodialysis in order to test whether hemodialysis induces specific activation of the T-lymphocyte macrophage axis. The results were as follows: 1) In normal adults, the serum neopterin level was 6.7±1.3 nmol/L with no sex difference. 2) In 20 hemodialysis patients, the serum neopterin level before hemodialysis was 246.2±97.6 nmol/L and increased significantly compared to normal adults (p<0.001). 3) In 20 hemodialysis patients, the serum neopterin level was 163.0±76.7 nmol/L after hemodialysis and decreased significantly (p<0.001), the neopterin/creatinine ratio was 25.4±14.7, 32.8±23.7 before and after hemodialysis, respectively, and there was no significant difference between both groups. 4) In groups of short-term hemodialysis (less than three months), the serum neopterin level was 248.4±100.6, 181.7±91.2nmol/L before and after hemodialysis, respectively. In groups of long-term hemodialysis (more than one year), the neopterin level was 244.0±99.9, 144.2±57.6 nmol/L before and after hemodialysis, respectively, and decreased significantly after hemodialysis in both groups (p<0.001), and there was no significant difference between both groups. 5) In 12 male hemodialysis patients, the serum neopterin level was 226.4±97.6, 145.5±60.5nmol/L before and in after hemodialysis, respectively, and in eight female hemodialysis patients, the serum neopterin level was 275.9±96.0, 189.1±94.4 nmol/L before and after hemodialysis, respectively, and decreased significantly in both groups (p<0,05, respectively). There was no significant difference between both groups.
정상 신기능의 좌측 복통 환자에서 진단된 원인 불명의 일측성 후복막 섬유화증 1예
이문형 ( Moon Hyoung Lee ),문경협 ( Kyoung Hyoub Moon ),김범 ( Beom Kim ),이동영 ( Dong Young Lee ),시원근 ( Won Keun Si ),황진아 ( Jin Ah Hwang ),최보경 ( Bo Kyoung Choi ),서강흠 ( Kang Hum Seo ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.3
Retroperitoneal fibrosis is a disease characterized by proliferation of fibro-inflammatory tissue, which mainly encloses the abdominal aorta, iliac arteries and (enlarges to the retroperitoneum to surrounds) ureters. Two leading pathogenesis are an exacerbated local inflammatory reaction to aortic atherosclerosis and a manifestation of systemic autoimmune disease. Because of insidious disease course, most cases are diagnosed late when bilateral urinary obstruction caused oliguria and symptoms related to uremia. In this case, the patient complained left flank pain which might have been caused by left ureter stone, but through abdominal CT scan, the patient was diagnosed as left unilateral retroperitoneal fibrosis. Abdominal CT scan showed encircling mass around abdominal aorta and left ureter with hydronephrosis. The patient had no underlying disease and didn`t take any medication; she was diagnosed as idiopathic unilateral retroperitoneal fibrosis and started prednisolone, 40 mg daily. Three months have passed since the therapy was started; most fibrous tissue was disappeared, hydronephrosis was resolved and flank pain was relieved.