상염색체우성 다낭신 환자에서 신결핵과 유사한 건락성괴사 육아종 1 예

김수완(Soo Wan Kim),염충호(Chung Ho Yeum),나명윤(Myong Yun Nah),김남호(Nam Ho Kim),최기철(Ki Chul Choi),마성권(Seong Kwon Ma),고정희(Jung Hee Ko),권동득(Dong Deuk Kwon),이민철(Min Cheol Lee) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.5

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양측 요로 폐쇄 흰쥐에서 신장 ANP 계 활성 변화

박종욱(Jong Wook Park),백윤웅(Yun Woong Paek),염충호(Chung Ho Yeum),나명윤(Myong Yun Nah),김수완(Soo Wan Kim) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1

N/A Background: Although being associated with an elevated plasma atrial natriuretic peptide(ANP), its precise role in the postobstructive diuresis has not been fully under- stood. Evidence has been provided suggesting that the locally-synthesized ANP in the kidney contributes to the regulation of urinary sodium excretion. The present study was aimed to investigate whether an altered regulation of local ANP system is involved in the postobstructive diuresis. Methods: Male Sprague-Dawley rats were used. Both proximal ureters were ligated for 48 hours, after which the kidneys were taken without releasing the ligature, being designated as bilateral ureteral obstruction(BUO) group; or the ligature was released and 4 or 24 hr later, urinary data were collected, being designated as BUR-4 or BUR-24, respectively. Sham operated rats were used as control. Plasma ANP levels were determined by radioimmunoassay. The expression of ANP and natriuretic peptide receptor(NPR)-A mRNAs was determined by reverse transcription-polymerase chain reaction(RT-PCR). To further examine whether the altered renal ANP system, if any, was associated with an altered biological effects of guanylyl cyclase, ANP- stimulated cGMP accumulation was determined in membrane preparations of the glomeruli and papillae by radioimmunoassay. Results: The plasma ANP level was increased in BUO group compared with that in the control(260.5±32.5 vs. 133.3±23.5pg/mL, p<0.05), decreased in BUR-4 group(3.6±0.5 vs. 143.5±42.8pg/mL, p<0.01), while not significantly different in BUR-24 group. In BUR- 4. the urinary flow rate increased compared with that in the control(1598±370 vs. 215<34 DμL/hr, p<0.01), along with increases of FENa(11.5±64.1 vs. 0.25±0.02%, p<0.05) and UNaV (153.7±23.7 vs. 36.5±9.3 μEq/hr, p<0.01). In BUR-24, the urinary parameters were normalized. Renal tissue expression of ANP mRNA was increased in BUO as well as in BUR-4, while not changed in BUR-24. NPR-A mRNA expression was decreased in the kidney of BUO. The ANP-stimulated accumulation of cGMP in the isolated glomeruli and papillae in BUO was significantly reduced. The guanylyl cyclase activities were partly recovered in BUR-4 and completely in BUR-24. Conclusion : An enhanced local activity of ANP in the kidney may be causally related to the postobstructive diuresis.

신이식 환자에서 골밀도에 대한 연구

최기철(Ki Chul Choi),박종욱(Jong Wook Park),유기섭(Ki Sub Yoo),이민수(Min Su Lee),염충호(Chung Ho Yeum),정유정(You Jeong Chung),이제중(Je Jung Lee),김수완(Soo Wan Kim),김남호(Nam Ho Kim),강영준(Young Joon Kang) 대한내과학회 1996 대한내과학회지 Vol.50 No.2

N/A parameters and BMD of renal transplants. Methods: Using dual-energy X-ray absorptiometry (DEXA), we assessed total body and regional (head, arm, trunk, rib, leg, spine, and pelvis) bone mineral density. Results: 1) Total body BMD of renal transplants was significantly decreased compared with that of normal controls. 2) A separate analysis of BMD in both sexes revealed that males presented marked reduction of BMD compared with the normal controls in the majority of skeletal sites except head and pelvis. Especially, at the spine, their BMD was significantly reduced compared with that of the CRF patients on receiving dialysis in addition to the normal controls. Females also presented reduction of BMD compared with the normal controls in many skeletal sites except head and ribs. 3) The correlations between BMD values and time since renal transplantation and cumulative cyclosporine doses were statistically significant (r=0.46, 0.527, respectively, and p<0.01) in nearly all skeletal sites except head and spine. Conclusion: Our results indicate that significant falls in BMD appear to be inherent to the process of renal transplantation although it achieves the rapid correction of some of the biochemical abnormalities associated with renal failure and that therapeutic strategies to prevent or reduce this damages should be established. In addition, the present study emphasizes the need to pay attention to the further evaluation of correlations between bone loss in renal transplants and some drugs, such as glucocorticoids and cyclosporine.

FK506 처리 흰쥐에서 신장 및 혈관 조직 산화질소 함량 감소

정권(Kwon Jung),김수완(Soo Wan Kim),이종은(Jong Un Lee),백윤웅(Yun Woong Paek),염충호(Chung Ho Yeum),나명윤(Myong Yun Nah),김남호(Nam Ho Kim),강종명(Chong Myung Kang),최기철(Ki Chul Choi) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1

N/A The present study was aimed at investigating whether FK506 alters the regulation of nitric oxide(NO) system. Male Sprague-Dawley rats were treated with FK506(1 mg/kg/day, i.m.) for 3 weeks. Control group was without treatment of FK506. Plasma levels and urinary excretion of NO metabolites(nitrite/nitrate, NOx) were measured. The protein expression of NO synthases(NOS) and tissue contents of NOx were determined in the kidney and thoracic aorta. The aorta was also examined of its changes in isometric tension in responses to acetylcholine and sodium nitroprusside. The arterial pressure did not significantly differ between FK506-treated and control groups. Plasma NOx levels remained unaltered, while urinary NOx excretion was significantly decreased in FK 506-treated group. Tissue contents of NOx were significantly decreased, although the expression of ecNOS and iNOS proteins was significantly altered neither in the kidney nor in the aorta. Acetylcholine-induced relaxation of the isolated aortic ring was significantly attenuated, whereas sodium nitroprusside-induced relaxation was not significantly affected. These results suggest that FK506 decreases the tissue contents of NO, without significantly affecting the expression of NOS.

Tuberculosis and Respiratory Diseases : Expression of nitric oxide synthase, aquaporin 1 and aquaporin 5 in rat after Bleomycin inhalation

장안수 ( An Soo Jang ),이종은 ( Jong Un Lee ),최인선 ( In Seon S Choi ),박경옥 ( Kyung Ok Park ),염충호 ( Chung Ho Yeum ) 대한결핵 및 호흡기학회 2002 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.95 No.-

지속적외래복막투석 환자 250 예의 임상적 고찰

최기철(Ki Chul Choi),유기섭(Ki Sud Yoo),박종욱(Jong Wook Park),하정훈(Jeong Hoon Ha),이제중(Je Jung Lee),염충호(Chung Ho Yeum),정유정(You Jeong Chung),김수완(Soo Wan Kim),김남호(Nam Ho Kim),강영준(Young Joon Kang) 대한내과학회 1996 대한내과학회지 Vol.51 No.3

N/A Objectives: CAPD has established itself as an effective therapeutic modality as hemodialysis or renal transplantation in the treatment of patients with end stage renal disease. Although much progress of technology of CAPD has been made, peritonitis or catheter-related complications have been an important problem until now. Therefore, we reviewed our experience with CAPD over 6.5 years. Methods: Retrospectively, we analysed the clinical results of 250 patients on CAPD at Chonnam University Hospital from July 1988 to December 1994. Results: 1) There were l48(59%) male and 102(41%) female patients, aged 10-73 years(mean 43±13 years). 2) Underlying disorders of end stage renal diseases consisted of mainly chronic glomerulonephritis (24.4%), followed by diabetic nephropathy(22.4%) and hypertensive nephrosclerosis(7.2%). 3) The incidence of pertionitis was 0.75 episodes per patient year and peritonitis free interval was 9.0±1.2 months. The isolation rate of microorganisms from patients with peritonitis was 34.7% and the order of frequency of isolated organisms was Staphylococcus(S.) epidermidis, S. aureus, Pseudomonas species, Candida species, Acinetobacter species and E. coli. The results of peritonitis were treatment with only antibiotics(86.0%), catheter removal(13.0%) and death(1.0%). 4) The complications other than peritonitis were exit site infection or tunnel infection, hernia, leakage, failure to drain, hydrothorax, ultrafiltration failure and others. 5) 67 of 250 catheters(26.8%) were removed and the peritonitis was the most common cause of catheter removal. The catheter survival rate was 86%, 75%, 65%, and 52% at one year, two years, four years and five years, respectively. Mean survival time of all catheters was 44.2±1.6 months. 6) The causes of death were most frequently cardiac disorders(31.8%), followed by vascular disorders (19.5%), and infections(14.6%). The patient survival rate was 94%, 83%, 74%, 69% at one year, two years, three years, four years, respectively. Mean survival time of all patients was 59.0±2.0 months. Conclusion: Although CAPD is an effective therapeutic modality in the tgeatment of patients with end stage renal disease, CAPD-induced peritonitis is the most important pitfalls of CAPD. Therefore, we must exert more effort to prevent and treat the CAPD-induced peritonitis.

만성 신부전 환자에서 고호모시스틴혈증에 관한 연구

박미정(Mi Jung Park),이균상(Kyun Sang Lee),조민석(Min Seok Cho),김정기(Jeong Ki Kim),박병석(Byoung Seok Park),마성권(Seong Kwon Ma),고정희(Jung Hee Ko),나명윤(Myong Yun Nah),염충호(chung Ho Yeum),김수완(Soo Wan Kim),김남호(Nam Ho Kim 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4

Objective : It has been reported that hyperhomocysteinemia is an independent risk factor for atherosclerotic complications, although the mechanisms re- main unclear. The major determinents of total fasting plasma homocysteine(tHcy) concentrations have been recently reported but there are still conflicting data on the influence of those in peritoneal and hemodialysis patients. Therefore, we evaluated the prevalence and association of vascular complications and the determinents of hyperhomocysteinemia in chronic renal failure patients receiving conservative treatment(predialysis), peritoneal dialysis(PD) and hemodia-lysis (HD) patients. Methods We measured the factors, including fasting plasma vitamine levels(folate, vitamin E4 and vitamin B12), serum creatinine concentration, dialysis adequacy-related varibles as well as associated risk factors for vascular diseases that might affect tHcy concentrations in 37 predilysis, 30 PD, 34 HD patients and 21 normal persons. Continuous variables were compared using independent sample t-test. Spearman's correlation was used to determine the strength of association between tHcy and other predictive varia41es. Percentages were compared using Pearson's chi-square test or Fisher's exact test, depending on the frequencies. Independent determinents of tHcy concentration and atherosclerotic vascular complications were identified using multiple regression analysis. Results : The prevalence of hyperhomocysteinemia was 83.8, 72, 88% among predialysis, PD and HD patients, respectively(Odds ratio was 103.33, 81.43, 150.0 vs. controls, respectively). tHcy values in pre- dialysis, PD and HD patients are significantly higher than those in controls(24.68±9.01, 21.04±8.82, 23.62± 9.46 vs. 8.80±2.07 ㎛oL/L, repectively, p<0.01). Pre- dialysis, PD and HD patients with atherosclerotic vascular complications had higher tHcy concentrations than did predialysis, PD and HD patients with- out vascular complications(21.93±8.71 vs. 32.09±4.71 ㎛oL/L, p<0.01, 17.57±5.85 vs. 28.74±9.70 ㎛oL/L, p<0.01, 19.00±4.29 vs. 33.28±10.13, p<0.01 respectively). We also observed increasing odds ratios of vascular events with increasing tHcy concentrations. For predialysis, PD and HD patients, fasting plasma folate level had negative correlation with tHcy concentrations by spearman's simple correlaltion. And using muliple regression analysis, we recognized hyperhomocysteinemia is an independent risk factor for atherosclerosis and fasting plasma folate is a major determinent of tHcy concentrations in predialysis, PD and HD patients. Conclusions: Hyperhomocysteinemia in predialysis, PD and HD patients was more prevalent than that in norrnal controls. Risk of atherosclerotic vascular complications increased with increasing tHcy concentrations. Hyperhomocysteinemia is an independent risk factor for atherosclerosis and fasting plasma folate is a major determinent of tHcy concentrations in predialysis, PD and HD patients.

지속성 외래 복막투석 환자에서 영양상태와 투석의 적절도

박미정(Mi Jung Park),이균상(Kyun Sang Lee),조민석(Min Seok Cho),김정기(Jeong Ki Kim),박병석(Byoung Seok Park),마성권(Seong Kwon Ma),고정희(Jung Hee Ko),나명윤(Myong Yun Nah),염충호(chung Ho Yeum),정권(Jung Gwon),김수완(Soo Wan Kim) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4

Purpose - Malnutrition is common in CAPD patients and depends on many factors such as dialysis-related and nondialysis-related factors. The present study aimed to assess nutritional status, dialysis adequacy and their relationships with overall mortality and morbidity. Methods - We studied 102 patients who had been receiving CAPD for at least 6 months. Dialysis adequacy was assessed by parameters derived from urea kinetic modeling(UKM) and nutritional status was assessed by serum biochemical measurement, normalized protein catabolic rate(nPCR), normalized protein equvalent of total nitrogen appearance(nPNA) and urea kinetic studies. Spearman's simple correlation and multiple linear stepwise regression analysis were used to assess correlation between dialysis adequacy and nutritional status in CAPD patients. We compared the differences between patients who suffered morbid events, defined as either an infectious complication or hospitalization, and patients who remained well. Results : The results showed that the total dialysis dose(total weekly Kt/Vurea ) has statistically significant correlation with nPCR(r=0.234, p=0.028), nPNA (r=0.246, p=0.021), total weekly creatinine clearance (WCC)(r=0.479, p=0.0001), serum albumin levels(r= 0.233, p=0.029), serum cholesterol(r=0.266, p=0.013), serum BUN(r=-0.290, p=0.006) and serum creatinine levels(r=-0408, p-0.0001). nPNA was positively correlated with serum cholesterol(r=0.217, p=0.045), serum transferrin(r=0.218, p=0.042) and serum ferritin levels(r=0.220, p=0.043). Patients who suffered morbid events had an old age(p=0.001), long duration of CAPD(p=0.0001), higher CRP(p=0.021), lower serum albumin level(p=0.020), lower hematocrit(p=0.049) and lower WCC(p=0.017). Conclusions: These results indicate that adequate dialysis is very important for the maintenance of adequant nutrition because nutritional status positively correlated with dialysis dose, which is best assessed by UKM. In addition, assessment of nutritional status and dialysis adequacy are important in predicting clinical outcomes in CAPD patients.

기종성 방광염 1예

마성권,나명윤,박종욱,고정희,염충호,김수완,김남호,최기철 全南大醫大 2001 전남의대학술지 Vol.37 No.2

Increased expression of aquaporin water channels in hypothyroid rat kidney

Yeum, Chung Ho,Lee, Dae Ho,Song, Byung Cheol,Jung, Joo Young,Kim, Jineseok 제주대학교 생명과학연구소 2003 제주생명과학연구 Vol.6 No.1

갑상선 기능저하증 환자에서의 수분 배설의 저하 및 수분 저류는 잘 알려져 있으며 항이뇨 호르몬의 비정상적인 증가, 사구체 여과율의 감소, 헨레 고리에서의 염분 재홉수의 감소등이 원인으로 생각되어 왔다. 지난 10여년 간에 이루어진 일련의 연구에서 세뇨관 상피에서의 삼투성 수분 이동은 Aquaporin(AQP) 수분 통로에 의한다는 것이 분명해졌다. 현재까지 신장에는 적어도 6개의 AQP (AQP1, AQP2, AQP3, AQP4, AQP6, AQP7) 동위단백이 발현된다고 알려져 있으며, 여러 가지 수분대사 장애를 동반하는 질환에서 이러한 AQP 단백발현의 변조가 일어난다는 사실이 밝혀졌다. 따라서 본 연구에서는 갑상선 기능 저하증과 관련된 수분저류의 기전으로 AQP 수분통로가 어떤 연관이 있는지를 알아보고자 하였다. 실험은 Sprague-Dawley(체중 200∼250g)숫쥐를 사용하며 0.04% methimazole을 음용수로 주어 8주간 유지하여 갑상선기능 저하증을 유발하여 실험하였다. 결과를 보면 실험군에서 혈청 갑상선 호르몬의 현저한 감소를 보였다. AQP 2 단백발현은 신장의 피질 수질 및 내수질에서 모두 유의한 증가를 보였다. AQP1 및 AQP 3 단백발현은 신장의 수질에서는 별 변화를 보이지 않는 반면 피질에서는 유의한 증가를 보였다. 혈청 arginine vasopressin (AVP) 의 농도는 변화를 보이지 않는 반면에 AVP, sodium fluoride, forskolin 등으로 자극한 adenylyl cyclase 활성도는 실험군의 신장에서 감약된 결과를 보였다. 이상의 결과로 AQP 1-3 단백발현의 증가가 갑상선 기능 저하증에 의한 수분저류에 적어도 일부나마 관여할 것으로 사료된다. The present study was aimed to determine the molecular mechanisms underlying the water retention associated with hypothyroidism. Male Sprague-Dawley rats (200 ~ 220g) were experimentally induced of hypothyroidism by treatment with methimazole in drinking water (0.04%) for 8 weeks. In the experimental group, serum concentrations of thyroxine and triliodothyronine were significantly decreased. The expression of AQP2 was significantly increased in the cortex, outer, medulla, and inner, medulla of the kidney. The expression of AQP1 and AQP3 was significantly increased in the cortex, though not in the medulla. The adenylyl cyclase activity provoked bv arginine vasopressin, sodium fluoride, or forskolin was blunted in the hypothyroid kidney. while plasma levels of arginine vasopressin were not significantly changed. The increased expression of AQP1-3 channels may in part be causally related with the water retention in hypothyroidism.