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만성신부전에서 염류코르티코이드 투여가 포타시움 평형과 요 암모늄 배설에 미치는 효과
한진석(Jin Suk Han),이정상(Jung Sang Lee),김강석(Kang Seock Kim),허우성(Woo Seong Huh),전은실(Un Sil Jeon),이서진(Seo Jin Lee),주권욱(Kwon Wook Joo),김성권(Suhnggwon Kim),진호준(Ho Jun Chin),조윤숙(Yun Suk Cho) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2
N/A Mineralocorticoids influences on acid-base homeo-stasis by the regulation of urine acidification. But its mechanism of acion is not well known in human. This study compared the acid-base status and the indices of urine acidification before and after mineralocorticoid administration in human, and analyzed the effect of mineralocorticoids on human acid-base homeostasis. We administered 9a-fludrocortisone in 6 chronic renal failure patients and 6 normal controls 0.5mg daily for 7 days. The results were as following ' 1) After administration of 9a-fludrocortisone in patients group, serum aldosterone level changed from 120.2±71.0pg/mL to 44.8±32.2pg/mL(mean±SD, p< 0.05). Serum HCO- level was not changed. Urine ammonium excretion was incresed from 24.6±12.3 mmol/day to 43.7±19.0(p<0.05), but there were no change in urine pH and urine anion gap, Serum potassium level decreased from 5.5±0.7mBq/L to 4.1±0.5mEq/L(p<0.05), and TTKG increased from 3.9 to 8.9(p<0.05). 2) After administration of 9a-fludrocortisone in control group, serum aldosterone level changed from 99.7±44.5pg/mL to 25.1±3 mL(p<0.05). Serum HCO- level was not changed. Urine ammonium ex-cretion was incresed from 44.3±21.6mmoVday to 76.3±19.6(p<0.05), but there were no change in urine pH and urine anion gap. Serum potassium level decreased from 4.8±0.5mEq/L to 3.9±0.2mHq/L(p< 0.05), but there was no change in TTKG. 3) No patient or control showed any discomfort after 9-fludrocortisoneadministration, and there was no elevation in diastolic blood pressure, increase in body weight, electrolyte abnormality. In summary, after 9α-fludrocortisane administration, urinary ammonium excretion increased in both patients and control group, and this phenomenon occured with correction of hyperkalemia without urine pH change. This result implies urinary ammonium excretion increase by mineralocorticoid. In human increase in renal distal acidification by mineralocorticoid is due to increase in renal ammo- niagenesis rather than stimulation on proton excretion.
신부전 만성도 평가에 있어 혈중 carbamylated hemoglobin 치의 유용성
김연수(Yon Su Kim),한진석(Jin Suk Han),진호준(Ho Jun Chin),이서진(Seo Jin Lee),조윤숙(Yun Suk Cho),안규리(Ahn Cu Rie),김성권(Suhng Gwon Kim),이정상(Jung Sang Lee),장인진(In Jin Jang),신상구(Sang Gu Shin),허우성(Woo Seong Huh) 대한내과학회 1996 대한내과학회지 Vol.51 No.3
N/A Objective: Differentiation of acute from chronic renal failure is an important but difficult task in treating the azotemic patients. It is known that the degree of carbamylation reflects the duration and the severity of the uremia. To assess the usefulness in differentiating acute(ARF) from chronic reanl failure (CRF), we measured the carbamylated hemoglobin (CarHb). Methods: We measured CarHb(measured as ㎍ of carbamyl valine per g hemoglobin) prospectively in 64 patients with azotemia (24 ARF, 40 CRF) referred to the Seoul National University Hospital. High performance liquid chromatography was used for measuring CarHb. Thirteen normal controls were also studied to match 64 patients. Results: Patients with ARF had lower median (range) CarHb concentration than those with CRF [56.0(24.6-97.1) ㎍CV/gHb vs 120.4(31.7-286.5) p<0.01]. It is not different from normal control [56.0 (24.6-97.1) vs 40.9(19,9-62.9); p<0.05]. The ratio of CarHb to serum creatinine(mg/dl) was lower in ARF than in CRF [10.5(4.9-34A) vs 18.2(4.7-52.2) p<0.01]. The cut-off value for CarHb to be CRF is 80 ㎍CV/gHb(sensitivity 70%, specificity 71%, positive predictive value 80%). Conclusion: The carbamylated hemoglobin is useful in determining the chronicity of the renal failure and it could be of clinical value in deciding the further management.
신동맥 스텐트 삽입술로 치료한 섬유근성 이형성증에 병발한 자발성 신동맥 박리
백현정 ( Hyun Jeong Baek ),김대중 ( Dae Joong Kim ),서현주 ( Hyun Joo Suh ),김민옥 ( Min Ok Kim ),여호명 ( Ho Myoung Yeo ),김정아 ( Jung Ah Kim ),김현진 ( Hyun Jin Kim ),강우헌 ( Woo Heon Kang ),김범 ( Beom Kim ),허우성 ( Woo Seo 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.5
Severely Active Class 4 Lupus Nephritis: the Prognostic Significance to Clinical Outcome
정혜원 ( Hae Won Jung ),오하영 ( Ha Young Oh ),김대중 ( Dae Joong Kim ),김윤구 ( Yoon Goo Kim ),이정은 ( Jung Eun Lee ),고은미 ( Eun Mi Koh ),차훈석 ( Hoon Suk Cha ),서진원 ( Jin Won Seo ),권기영 ( Gee Young Kwon ),허우성 ( Woo Se 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1
한진석,김정훈,전은실,양재석,이서진,허우성,이종호,안규리,김성권,이정상 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.4
Hypematremia is a rare but important medical condition and is associated with mortality rate of 40 to 70%. However, little has been known about its prognostic factors or treatment guidlines. To evaluate the prognostic factors and the outcome following treatment, we reviewed 22 available medical records among twenty five hypernatremic patients(0.2%) in 12841 admissions at medical ward from January to December 1995. We defined hyper-natremia as serum sodium concentration more than or equal to 150mEq/L. Of these patients, two had hypematrernia at admission and the remaining patients became hypernatremic during admission. Mean peak serum sodium concentration was 158(150-178) mEq/L and mean total body water deficit was 11.4 (6.7-21.3)%. Factors correlated with the development of hypernatremia were diverse and multiple, and the most frequent factor was diminished access to water. Mortality rate was 59%, but mortality was not correlated with age, correction rate of hyper- natremia, primary route of fluid loss, and the severity of hypernatremia or total body water deficit. Mortality rate was higher in patients whose serum sodium concentrations were below 130mEq/L at admission(P$lt;0.05). In our study, development of hypernatremia from initial hyponatremic state was significantly associated with poor outcome, and age, rapidity of correction, route of fluid loss, and the severity of hypernatremia or total body water deficit were not.
한국인에서 혈청 크레아티닌을 이용한 크레아티닌 청소율의 계측
김대중,오하영,오동진,김범,이숭구,서기현,강우헌,이방훈,김혜영,이윤하,허우성,김윤구 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.6
Cockcroft and Gault's formula is frequently used to estimate creatinine(Ccr) in clinical practice. To determine the accuracy of such estimation in Korean patients, we measured simultaneously, serum creatinine and 24-hour urinary creatinine excretion in 696 Korean patients(male:350, female:346). Measured Ccr was significantly different from estimated Ccr in several age groups and the decrease of creatinine excretion with age is less than Cockcroft and Gault's estimation. We assumed that this difference can be due to difference of the body habitus and difference of urinary creatinine excretion per body weight between different races. So we divided the sample population into two groups and derived the new formula in one group with regression analysis between age and 24 hour urinary creatinine excretion per body weight for estimation of Ccr as Cockcroft and Gault derived their formula and applied it to another group to compare the new formula with Cockcroft and Gault's formula in Korean patients. The new formula was Ccr(mL/min)=[(260-age)?weight(kg)]/[160?serumCr(mg/dL)] for male and Ccr (mL/min)?[(236-age)?weight(kg)]/[180?serum Cr(mg/dL)] for female. Predictive accuracy of the new formula was significantly better than the Cockcroft and Gault's formula in the other sample population and also in subgroup of the patients with azotemia.
부종 질환에서 Oxytocin이 수분대사에 미치는 영향
김혜영,이종호,한진석,이정상,전은실,김근호,안규리,이서진,주권욱,허우성,김성권 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.4
Antidiuretic action of oxytocin is confirmed by in vitro study using with rat IMCD. Vasopressin is elevated in edematous disorders and may play a pathogenetic role in the formation of edema. If oxytocin plays a sirnilar role to vasopressin in water disturbances in human, oxytocin may change as the same way as vasopressin. To verify a role of oxytocin in the regulation of water balance in human, we measured plasma and urine oxytocin with vasopressin by radioimmunoassay in thirteen patients with generalized edema(8 nephrotic syndrome, 3 liver cirrhosis, 2 acute renal failure) before and after control of edema. And they were compared them with those of seven normal controls. As a result,plasma oxytocin and vasopressin Levels of patients with edematous state were higher than those of normal controls(p$lt;0.01).Plasma oxytocin of patients decreased after control of edema(table,P$lt;0.05), but was still higher than of normal controls(table, P$lt;0.01). Plasma vasopressin did not change after control of edema and sustained at elevated level(Table) Plasma oxytocin level correlated with plasma vasopressin level(r=0.543: P$lt;0.05) and urinary oxytocin level correlated linearly with urinary vaso-pressin(r=0.983, P$lt;0.01). After control of edema, body weight of patients decreased from 65±2 to 58±2kg and fractional excretion of sodium decreased from 3.3±1.1 to 1.2±0.696(P$lt;0.05). There were no significant changes in serum and urine Na, osmolality, free water clearance, plasma renin activity, aldosterone and norepinephrine. In conclusion, oxytocin was elevated in edematous disorders, and may participate in formation of edema similar to vasopressin.
황선희,오동진,김범,김대중,오하영,최상희,안홍준,김윤구,허우성,강우헌,이방훈,서기현,이숭구,김보현 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.1
Background:The kidney size is important in differentiating many renal diseases. Some studies have been reported about the normal kidney size in the foreign countries. However, no studies were performed by using ultrasonography in Korea. Therefore, we investigated the normal kidney length, the factors affecting the kidney length and the relationship of each other. Methods:One thousand three hundred eighty eight healthy Koreans were scanned for the kidney length by ultrasonography and were measured for their body index(height, weight, body surface area, total body water, and fat free mass). We analyzed the association between kidney length and body index. Results:Eight hundred four male and five hundred eighty four female were involved in this study and their mean age was 47.8?10.3 in male, 48.1?9.5 in female. 1) The average value of left and right kidney was 10.65±0.80cm, 10.50?0.78cm respectively, and the left kidney was greater than right one(P$lt;0.01). 2) The difference between male and female was 10.77cm, 10.49±0.78cm respectively in the left kidney and 10.66±0.76cm, 10.27±0.75cm in the right kidney(P$lt;0.01). 3) The aging process nearly does not affects the kidney size from 4th decade to 7th decade. However, the kidney size is getting smaller after 8th decade. 4) The correlation coefficient between the kidney size and height, weight, body surface area, total body water, fat free mass was 0.37, 0.41, 0.43, 0.37, 0.38(P$lt;0.01) respectively. Conclusion:The kidney length showed normal distribution in normal Korean adult and the length greater than 12.36cm, smaller than 8.76cm means out of its range of normal(±2SD) irrespective of sex and position. The body surface area has the largest correlation with kidney size in both sex(r=0.38/0.44; left/right, P$lt;0.01).