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정인권,박양생 고신대학교 의학부 1989 高神大學校 醫學部 論文集 Vol.5 No.1
임상에서 면역억제제로 사용되고 있는 cyclosporine A(CsA)의 신독성 기전을 연구하기 위하여 동물재료로 Sprague-Dawley계 웅성백서를 사용하여 CsA(Sandimmun, Sandoz, Basel, Switzerland)를 25㎎/㎏.day용량으로 4주간 피하주사하여 신독성을 유발하면서 1주 간격으로 각종 신장기능의 병화를 조사하여 대조군(식염수 주입군)의 성적과 비교하였다. 1. 혈장내 creatinine, 요소, K^(+) 및 삼투질 농도는 CsA처지(4주)에 의해 의의잇게 증가 되었으나 Na^(+)농도는 크게 변화되지 않았다. 2. CsA처치 3주 후부터 요배설량은 의의있게 증가했으나 요삼투농도는 감소되었다, 3., 요중으로의 creatinine 배설량은 CsA처치 2주 때까지 급격히 감소되다가 그 후에는 그대로 유지되었으며, 처치 4주 후에 산출한 creatinine제거율(Ccr)은 대조군에 비해 60%정도 낮았다. 4. 요중으로서 Na^(+), K^(+), 요소 및 총 삼투질의 배설량은 CsA처치 1주 후에 모두 의의있게 감소되었으나 2주째부터는 대조군의 수준으로 회복되었다. 5. CsA처치 4주 후에 측정된 물, Na^(+), K^(+) 요소 및 삼투질의 fractional excretion은 대조군의 값보다 의의있게 높았다. 6. CsA처치 3~4주 후에는 신세뇨관의 free water 재흡수가 현저히 감소되었으며, 신수질조직의 Na^(+) 및 요소농도가 의의있게 감소되었다. 7. CsA처치 후에는 Pitressin 주사 후에도 요농축능이 회복되지 않았다. 8. 신피질조직의 산소소모능은 CsA처치로 약 20% 감소되었으나 p-aminohippurate 능동적 이동은 CsA에 의해 영향을 받지 않았다. 이상과 같은 결과는 CsA처치시 사구체여과율이 감소되며, 다뇨증 및 요농축능의 저하가 일어나는데, 다뇨증과 요농축능의 저하 기전은 Henles loop 상행각의 Na^(-) 펌트기능이 억제되어 세뇨관으로부터 free water의 재흡수가 감소되기 때문임을 시사한다. Changes in the renal function were studied in rats (Sprague-Dawley) treated with cyclosporine A (CsA), an immunosuppressive agent, to elucidate the mechanism of CsA-induced nephrotoxicity Animals were subcutaneousely injected with CsA (Sandimmun, Sandoz, Basel, Switzerland) at a dose of 25㎎/㎏?day for 4 weeks. Renal functions were tested at 1-week intervals and compared with those observed in control animals(saline-treated). The results are summarized as below 1. CsA treatment for 4 weeks resulted in a significant elevation of the plasma creatinine, urea and K^(+) concentrations and osmolality with no significant change in the Na^(+) level. 2. The daily urine volume was significantly increased and the urine osmoality was decreased after 3 weeks of CsA treatment. 3. The urinary excretion of creatinine decreased drastically during the first 2 weeks of CsA treatment, and then remained unchanged during the rest of treatment period. The creatinine clearance determined at the end of 4-week treatment of Cs A appeared to be 60% lower than that in the control. 4. The urinary excretions of Na^(+), K^(+), urea and the total osmotic substance decreased significantly after 1-week treatment of CsA, but they returned to the control level thereafter. 5. The fractional excretions of water, Na^(+), K^(+), urea and the total osmotic substances at the end of 4-week treatment of CsA were significantly higher than the control level. 6. The free water reabsorption and renal medullary Na^(+) and urea contents appeared to be significantly reduced by 3-4 weeks of CsA treatment. 7. Injection of Pitressin to CsA-treated rats did not restore urine concentration ability. 8. The renal cortical tissue oxygen consumption was significantly reduced, but the active transport capacity of aminohippurate was not altered in CsA-treated animals. It is concluded from these results that CsA treatment in rats attenuates glomerular filtration rate and impairs the Na^(+) pump system in the ascending Henles loop, and the latter effect leads to a urinary concentrating defect and polyuria.
정인권,박양생 고신대학교(의대) 고신대학교 의과대학 학술지 1989 고신대학교 의과대학 학술지 Vol.5 No.1
Changes in the renal function were studied in rats(Sprague-Dawley) treated with cyclosporine A(CsA), an immunosuppressive agent, to elucidate the mechanism of CsA-induced nephrotoxicity. Animals were subcutaneousely injected with CsA(San-dimmun, Sandoz, Basel, Switzerland) at a dose of 25mg/kg·day for 4 weeks. Renal functions were tested at 1-week intervals and compared with those observed in control animals(saline-treated). The results are summarized as below 1. CsA treatment for 4 weeks resulted in a significant elevation of the plasma creatinine, urea and K⁺ concentrations and osmolality with no significant change in the Na⁺ level. 2. The daily urine volume was significantly increased and the urine osmoality was decreased after 3 weeks of CsA treatment. 3. The urinary excretion of creatinine decreased drastically during the first 2 weeks of CsA treatment, and then remained unchanged during the rest of treatment period. The creatinine clearance determined at the end of 4-week treatment of CsA appeared to be 60% lower than that in the control. 4. The urinary excretions of Na⁺, K⁺, urea and the total osmotic substances decreased significantly after 1-week treatment of CsA, but they returned to the control level thereafter. 5. The fractional excretions of water, Na⁺, K⁺, urea and the total osmotic substances determined at the end of 4-week treatment of CsA were significantly higher than the control level. 6. The free water reabsorption and renal medullary Na⁺ and urea contents appeared to be significantly reduced by 3-4 weeks of CsA treatment. 7. Injection of Pitressin to CsA-treated rats did not restore urine concentration ability. 8. The renal cortical tissue oxygen consumption was significantly reduced, but the active transport capacity of aminohippurate was not altered in CsA-treated animals. It is concluded from these results that CsA treatment in rats attenuates glomerular filtration rate and impairs the Na⁺ pump system in the ascending Henle's loop, and the latter effect leads to a urinary concentrating defect and polyuria.
다양한 원인에 의한 윤부 부전으로 인해 발생한 지속 각막상피결손
정인권,한동진,서지원,이종현,최헌진,이도형 대한안과학회 2022 대한안과학회지 Vol.63 No.4
Purpose: We report the process of treating persistent corneal epithelial defects due to limbal deficiency in a patient who underwent surgery for ptosis, recurrent pterygium, and senile cataract for 3 weeks. Case summary: A 65‐year‐old male patient underwent cataract surgery 4 months ago and visited this hospital with persistent inflammation of the left cornea that started 2 months ago. The patient underwent blepharoplasty and pterygium surgery at the same time 3 weeks before cataract surgery. At the first visit, severe conjunctival injection and an oval‐shaped corneal epithelial defect with a size of 3 × 5 mm in the center of the cornea were seen. As the result of the eyelid eversion test, fibrotic scar tissue due to the non‐absorbable suture used during the upper eyelid blepharoplasty was observed and surgically removed. The corneal epithelial defect site became smaller, but the atrophy of the corneal stroma was sustained, and the amniotic membrane was tripled and permanent amniotic membrane transplantation was performed. Corneal epithelial defects have improved with postoperative best‐corrected visual acuity of 0.15. Conclusions: Sufficient recovery period between serial multiple surgeries is required to reduce the occurrence of complications like persistent epithelial defects.