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실험적 급성 허혈성 (虛血性) 신부전 (腎不全)에서 Ca++ - ATPase 의 발현양상과 칼슘길항제의 효과
신종인(Jong In Shin),변현주(Hyoun Ju Byoun),이규백(Kyu Baik Lee),최태승(Tae Seung Choe),조원용(Won Yong Cho),김형규(Hyoung Kyu Kim) 대한내과학회 1991 대한내과학회지 Vol.41 No.1
N/A Calcium has been implicated as a primary pathogenetic mediator of cellular injury under conditions of oxygen and substrate deprivation in the kidney such as ischemic acute renal failure (ARF). However, the role of Ca++-ATPase in ischemic ARF, one of the important intracellular calcium regulation machineries participating in calcium ion translocation is unclear. The authors evaluated the changes of Ca+-ATPase before and after renal ischemia. The experimental animals, cats, were divided into 3 groups. Group I (n=6) was ischemic ARF model by renal artery clamp for 60 minutes, Group II (n=5) was ischemic ARF with a verapamil pretreatment (5 ㎍/kg/ min), systemically, and Group III (n = 7) was the same as Group II but with nonsteroidal antiinflammatory drug pretreatment. The results were as followings: 1) In Group I, creatinine clearance was 10.79±7.19 ml/min/kg before clamp and decreased to 2.09±1.70 ml/min/kg, and Group II, 3.41±1.56 to 0.12±0.05 ml/min/kg, and in Group III, 6.8±5.6 to 0.8±0.7ml/min/kg, respectively. 2) Creatinine clearance decreased significantly in Group II, 96±2% compared with Group I, 61±30%. A reduction of creatinine clearance in Group III was 84±11%, not different significantly from the other groups. 3) A Ca++-ATPase of renal tubular cell in the preischemic period was almost negative. The luminal and posterobasal surface of the proxima1 tubule showed slightly increased Ca++-ATPase activities in the postischemic period but the difference of location and activity of Ca++-ATPase among each group was not significant. These results suggested that Ca++-ATPase was activated after ischemia to compensate for ischemic insults resulting in increased intracellular calcium. There were no benefits to protecing renal function from ischemia and therefore no effects on the location and activity of Ca++-ATPase by systemic pretreatment of verapamil for ischemic ARF.
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혈액투석치료를 받은 외과적 급성 신부전 환자의 임상 양상과 예후인자
박훈기(Hoon Ki Park),김동진(Dong Jin Kim),박경식(Kyoung Sik Park),강성원(Sung Won Kang),문창훈(Chang Hoon Moon),이규백(Kyu Baik Lee),김향(Hyang Kim),구자룡(Ja Ryong Koo),이영호(Young Ho Lee),장미경(Mi Kyoung Chang),권영주(Young Ju K 대한내과학회 1996 대한내과학회지 Vol.50 No.4
N/A Objectives: Acute renal failure continues to be a significant cause of postoperative morbidity and mortality, especially after operations or trauma. Post- operative renal failure carries a mortality rate over 50%. We had two goals-to identify preoperative and intraoperative risk facors for postoperative acute ranal failure in patients groups undergoing various types of surgery, and by the use of multivariate analysis, to assess the relative important of these risk factors to provide a means of estimating the probability of survival in an individual patient. Methods: Data review was carried out for the 68 adult patients with ARF treated at 6 hospitals over a 3-year period(January 1991-December 1993). These patients were surgical patients who developed ARF in the postoperative period and subsequently underwent hemodialysis. Thirty-five factors to be of potential relevance to the outcome in postoperative acute renal failure were tabulated and analyzed. Results: 1) The ratio of male to female was 2:1, and the mean age was 51±17 years. The prevalence reached peak over 60 years. The mean death rate, numbers of hemodialysis, duration of oligura, numbers of organ failed, interval from ARF to recovery and interval from ARF to death were 63%, 9±0.8, 11±1 days, 1.7±0.2, 28±2 days, 19±3 days respectively. 2) The complications which developed during ARF included pulmonary complication(57%), hypotension (51%) and sepsis(32%), etc. 3) In findings related to operation, the mean duration of operation, interval from operation to ARF, numbers of transfusion during operation, frequency of hypatension during operation and duration of hypotension during operation were 211±126 min, 3.5±4 days, 23±3pints, 55%, 39.95±8.84 min respectively. 4) In the univariate analysis, hypotension, pulmonary complication, numbers of organ faild, pH (pH<7.2 or pH>7.55), APACHE II score, sepsis, duration of operation and duration of hypotension during operation were the only factors among 35 risk factors that significantly correlated with post- operative acute renal failure. In the multivariate analysis, the only significant risk factors for postoperative renal failure were hypotension and the presence of underlying disease. Conclusion: From the above results. The physician caring for the postoperative ARF patient may depend on these risk factors to predict morbidity and mortality. Whether or not these factors help to prevent the severe morbidity and mortality associated with postoperative renal failure remains to be studied prospectively.
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