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Tacrolimus를 근간으로 한 면역억제제를 복용하는 장이식 환자에서 이식 후 새로 발생한 당뇨병의 위험인자
허우성 ( Woo Seong Huh ),최유경 ( Yu Kyong Choi ),김예지 ( Ye Jee Kim ),최남경 ( Nam Kyong Choi ),김민영 ( Min Young Kim ),백나나 ( Na Na Baek ),염지연 ( Ji Youn Youm ),이정은 ( Jung Eun Lee ),김대중 ( Dae Joong Kim ),김윤구 ( Yoo 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6
Purpose: This study was conducted to identify risk factors for new onset diabetes after transplantation (NODAT) among renal transplant recipients treated with tacrolimus-based immunosuppressant. Methods: We selected renal transplant recipients who underwent surgery at Samsung Seoul Hospital between May 2001 and July 2009. Exclusion criteria were as follows: recipients <18 years old, history of diabetes mellitus (DM) or impaired glucose tolerance. Analysis of possible risk factors for NODAT included age, gender, body mass index, co-morbid diseases, family history of DM, infection of hepatitis B or polyomavirus, type of donors (cadaver or living) and acute rejection. Overall incidence and median value of NODAT onset day were analyzed with Kaplan-Meier curve. We calculated crude incidence rate and relative risk (RR) and 95% confidence interval (CI) for independent risk factors of NODAT using Cox proportional hazard analysis. Results: A total of 278 patients were included and the incidence of NODAT was 13.3% (5.6/100 person-year) and the median duration of NODAT onset was 28 days. In Cox analysis, risk factors for NODAT were age (45-59 years: RR=1.41, 95% CI 1.09-1.83, 60> years: RR=4.36, 95% CI 2.00-9.49), family history of DM (RR=1.62, 95% CI 1.12-2.34) and polyomavirus infection (RR=1.40, 95% CI 1.08-1.81). Conclusion: The risk factors for NODAT among renal transplant recipients treated with tacrolimus- based regimen were age (>45 years old), family history of DM and polyomavirus infection.
신증후군에 합병된 다발성 혈전증에 대한 MRA 진단 및 성공적인 혈전 용해술 1 예
최성철(Sung Chul Choi),허우성(Woo Seong Huh),도정호(Jung Ho Do),김정아(Jung Ah Kim),한혁준(Hyeok Jun Han),정시정(Shi Jung Chung),박진아(Jin Ah Park),김윤구(Yoon Goo Kim),김대중(Dae Joong Kim),오하영(Ha Young Oh),김보현(Bo Hyun Kim) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.5
The nephrotic syndrome has been considered a hypercoagulable state since it may be complicated by thromboembolic events of the venous or the arterial circulations. Diverse pathogenetic factors leading to the hypercoagulable state in nephrotic syndrome have been recognized. Renal vein thrombosis is a serious complication, which might lead to either renal failure or to secondary thromboembolic processes like pulmonary thromboembolism. Although it may present acutely with flank pain and macroscopic hematuria, the majority of cases run an indolent course. Until relatively recently, the diagnosis could only be confidently confirmed or excluded with selective renal venography but, more recently, computerized tomography and magnetic resonance imaging have been used. Anticoagulant therapy with heparin and warfarin apparently halts the natural progression of the disease and allowing for slow recovery. The possibility of more rapid and complete resolution with thrombolytic agents warranted their application. We described a case of bilateral renal vein thrombosis diagnosed by the new technique of magnetic resonance angiography and successful treatment by thrombolytic agent.
혈액투석시 바늘 사이의 거리가 가까울수록 재순환이 증가할까 ?
이영기(Young Ki Lee),허우성(Woo Seong Huh),강우헌(Woo Hyun Kang),김범(Beom Kim),윤수진(Su Jin Yoon),이현희(Hyun Hee Lee),김윤구(Yoon Goo Kim),김대중(Dae Joong Kim),오하영(Ha Young Oh) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.5
배 경 : 혈액투석 환자들이 적절한 투석을 받고 있는지 평가하기 위해 정기적으로 Kt/V를 측정한다. Kt/V가 감소하는 원인으로는 혈류 속도의 감소, 투석 시간외 감소, 재순환 등이 있다. 만약 혈액투석에 사용하는 두 바늘 사이의 거리가 짧을수록 재순환율이 증가한다면, Kt/V는 감소할 것이다. 하지만 재순환은 이론적으로 동정맥루내의 혈류 속도가 투석기의 혈류 속도보다 크다면 발생하지 않는다. 그러므로 적어도 동정맥루내의 혈류 속도가 좋은 환자에서는 바늘 사이의 거리에 따른 재순환의 차이는 없어야 한다. 이에 저자들은 바늘 사이의 거리에 따라 재순환율에 차이가 나는지 알아보고자 하였다. 방 법 : 주 3회 혈액투석을 받고 있으며 연구에 동의한 활자 35명을 대상으로 하였다. 혈액투석은 바늘 사이의 거리를 2 ㎝로 하여 ,3회, 5 ㎝로 하여 3회, 11 ㎝로 하여 3회 시행하였고, 매회 재순환율과 Kt/V를 측정하였다. 바늘 사이의 거리 외에는 혈류 속도, 투석막, 투석 시간을 일정하게 유지하였다 각각의 바늘 사이의 거리에서 인은 재순환율과 Kt/V 값을 비교하였다. 결 과 : 재순환율은 바늘 사이의 간격이 2 ㎝일 때 5.37±7.53%, 5 ㎝일 때 4.26±45.69%, 11 ㎝일 때 4.30±5.69%로 바늘 사이의 거리에 따른 차이는 없었다. 또한 Kt/V는 2 ㎝일 때 1.27±0.19, 5 ㎝일 때 1.26±0.19, 11 ㎝일 때 1.23±0.18로 세 간격 사이에 차이가 없었다. 결 론 : 동정맥루의 혈류가 안정된 환자예서 바늘 사이의 거리를 달리 하여도 재순환율과 Kt/V에 차이가 없었다. 따라서 바늘 사이의 거리가 가까운 것은 매출환에 영향을 미치지 않으며, 처방된 투석양과 전달된 투석양 사이에 차이를 나타내는 요인이 아닌 것으로 생각한다. Background : To assess the adequacy of dialysis, serial urea kinetic modeling (single-pool Kt/V) is used. The main problems that lead to impaired delivery of dialysis prescriptions are inadequate blood flow, reduced treatment time and recirculation. If it is true that the shorter distance between two needles induces the more recirculation, short needle distance would reduce Kt/V. But, usually there is no access recirculation, because upstream access supply exceeds the demand of the blood pump. So we have a question about the relationship between recirculation and needle distance. Methods :Thirty five chronic dialysis patients were enrolled. We measured access recirculation (a two-needle, slow/stop flow method) and Kt/V with needle distance of 2 ㎝, 5 ㎝, and 11 ㎝ in each patient. Three dialysis session were done with each needle distance. Treatment time, dialyzer and blood flow rate were fixed during the study period. Results : Access recirculation with needle distance of 2 ㎝ was 5.37±7.53%, with needle distance of 5 ㎝, 4.26±5.69%, and with needle distance of 11 ㎝, 4.30±0.69%. There was no difference of recirculation between three distance. Kt/V with needle distance of 2 ㎝ was 1.27±0.19, with needle distance of 5 ㎝ was 1.26±0.19, and with needle distance of 11 ㎝ was 1.23±0.18. There was no difference of Kt/V between three distance. Conclusion : There is no relationship between access recirculation and needle distance. We suggest that short distance between two needles does not increase recirculation and may not a cause of impaired delivery of dialysis prescription.
투석 중인 만성 신부전 환자에서 저분자 헤파린 사용 후 발생한 후복막강 혈종 2 예
이영기(Young Ki Lee),윤수진(Su Jin Yoon),이현희(Hyun Hee Lee),허우성(Woo Seong Huh),김윤구(Yoon Goo Kim),김대중(Dae Joong Kim),오하영(Ha Young Oh) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.3
Low molecular weight heparin has greater advantages over unfractionated heparin. It is more bioavailable, and laboratory monitoring is not necessary. Compared with unfractionated heparin, low molecular weight heparin does not result in increased risk of major bleeding. However, the bleeding tendency is not predictable in patients with renal failure, because elimination of low molecular weight heparin is delayed and it does not alter prothrombin times or partial thromboplastin times. Recently, we experienced two cases of enoxaparin-associated retroperitoneal hematoma in chronic dialysis patients. A 57-year-old woman developed retroperitoneal bleeding, during treatment with enoxaparin(1 ㎎/㎏ q 12 hours) and oral aspirin. The other patient, a 49-year-old man developed retroperitoneal hematoma after discontinuation of enoxaparin and aspirin. Both patients had inguinal pain, femoral neuropathy, anemia and hypotension. They recovered gradually and their hematoma size were decreased by conservative treatment. These results suggest that anti-Xa acivity monitoring may be warranted in renal insufficiency patients who are receiving low molecular weight heparin If anti-Xa activity test is not available, unfractionated heparin could be used with monitoring of activated partial thromboplastin time. And the possibility of retroperitoneal hematoma should be considered, whenever the acute symptoms including inguinal pain, leg pain, anemia, or hypotension occured during the anticoagulation therapy.
Anti-myeloperoxidase antineutrophil cytoplasmic antibodies 양성의 급속진행성 사구체신염이 동반된 후복막 섬유증식증
이유지 ( Yu Ji Lee ),정혜원 ( Hae Won Jung ),이정은 ( Jung Eun Lee ),허우성 ( Woo Seong Huh ),김대중 ( Dae Joong Kim ),오하영 ( Ha Young Oh ),김윤구 ( Yoon Goo Kim ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.3
Idiopathic retroperitoneal fibrosis is a rare disease characterized by the presence of retroperitoneal fibroinflammatory tissue, which often surrounds the abdominal aorta, the ureters, or other abdominal organs. There have been sporadic reports of an association with autoimmune diseases, although the pathogenesis of idiopathic retroperitoneal fibrosis is unclear. However, there are very few reports ofidiopathic retroperitoneal fibrosis associated with rapidly progressive glomerulonephritis. We report a case with idiopathic retroperitoneal fibrosis associated with rapidly progressive glomerulonephritis, and anti-myeloperoxidase antineutrophil cytoplasmic antibodies (anti MPO-ANCA), that was improved by the combination therapy of steroids and cyclophosphamide.
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.
Oxytocin에 의한 내수질집합관의 cAMP 생성 및 요배설의 변화
한진석(Jin Suk Han),이정상(Jung Sang Lee),김강석(Kang Seock Kim),허우성(Woo Seong Huh),김연수(Yon Su Kim),전은실(Un Sil Jeon),주권욱(Kwon Wook Joo),안규리(Curie Ahn),김성권(Suhnggwon Kim),이중건(Jung Geon Lee),나기영(Ki Young Na),정우경 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1
N/A Oxytocin, like vasopressin, has been known to act in the IMCD by the activation of adenylyl cyclase through V2 receptor, but the exact mechanism of its action remains to be elucidated. To prove whether oxytocin is involved in the activation of adenylyl cyclase in the renal collecting duct, we measured the cAMP production and urinary cAMP excretion rate. After single IMCD segments of Sprague-Dawley rats were microdissected and treated with different con- centrations of vasopressin(10pM, 10nM) and oxytocin (10pM, 10nM), cAMP production was measured. Urinary cAMP excretion rate was measured after dehydration and intraperitoneal injection of vasopressin and oxytocin. The results are as follows. 1) cAMP production in single IMCD was significantly increased in vasopressin group(10pM: 48,9±4.7(mean±SE), 10nM:94.6±5.3fmol/mm) and oxy-tocin group(10pM: 11.3±2.9, 10nM: 65.7±6.1fmol/mm) compared with that in the control(3.2±0.2fmol/ mm). 2) Urine volume was significantly decreased in dehydration group(40±7μl/hour) and vasopressin group(420±120μl/hour), but urine volume of oxytocin group(1,480±230μl/hour) was not different from that of control(1,550±120μl/hour). Urine osmolality was significantly increased in all experimental groups(control: 737.0±132.6, dehydration group : 2,463.9± 412.5, vasopressin group : 1,702±412.5, oxytocin group 1,293.4±117.9mOsm/kg). Urinary cAMP excretion rate was significantly increased in dehydration group(4,149.5±1,072.3pmol/hour) and oxytocin group(4,843.3±2,341.8pmol/hour), but not in vasopressin group(1,358.1±690.2pmol/hour), compared with that in control(49±10.7pmoVhour). These results suggest that oxytacin has anti-diuretic effect by the activation of adenylyl cyclase through V2 receptor.