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신혈관성 고혈압 흰쥐 신장에서 Na, K-ATPase 단백 발현 감소
마성권 ( Seong Kwon Ma ),오윤화 ( Yoon Wha Oh ),김인진 ( In Jin Kim ),배은희 ( Eun Hui Bae ),이종은 ( Jong Un Lee ),김수완 ( Soo Wan Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.4
목적: 본 연구는 two kidney, one clip (2K1C) 신혈관성 고혈압을 유발한 흰쥐에서 신장의 Na,K-ATPase, 레닌-안지오텐신-알도스테론계(renin-angiotensin-aldosterone system, RAAS) 및 심방나트륨이뇨호르몬(atrial natriuretic peptide, ANP)계가 고혈압 및 신장 손상의 병태생리에 관련되어 있는지를 조사하고자 하였다. 방법: 실험재료는 Sprague-Dawley 숫쥐를 사용하였다. 2K1C 고혈압을 유발하기 위하여 ketamine (50 mg/kg, i.p.) 마취 후 왼쪽 신동맥에 0.25mm 내경의 silver clip을 끼웠다. 4주일 후에 tail-cuff 방법을 이용하여 수축기 혈압을 측정하였으며, 마취하지 않은 상태에서 단두하여 신장을 적출하였다. 신장 조직에서 Na,K-ATPase α1 subunit 단백 발현을 Western blot 분석법에 의하여 조사하였다. 또한, renin, angiotensin-converting enzyme (ACE), aldosterone synthase (CYP11B2), ineralocorticoid receptor (MR) 및 ANP계의 mRNA 발현을 real-time polymerase chain reaction으로 조사하였다. 결과: 실험군에서 수축기 혈압이 유의하게 증가하였으며, 혈장 레닌 활성도 및 혈청 알도스테론 농도가 증가하였다. 또한, 소변량 및 나트륨 분획 배설이 유의하게 증가하였다. Na,K-ATPase α1 subunit의 단백 발현은 클립 신장에서 대조군에 비하여 유의하게 감소하였고, 클립을 끼우지 않은 실험군의 반대쪽 신장의 단백 발현이 클립 신장에 비하여 증가하였다. 신장 조직의 renin, ACE1, CYP11B2 및 MR의 mRNA 발현은 실험군의 클립 신장에서 대조군에 비하여 증가하였고, 클립을 끼우지 않은 반대쪽 신장에서는 클립 신장에 비하여 유의하게 감소하였다. ACE2 mRNA 발현은 대조군, 실험군의 클립 신장 및 반대쪽 신장 모두에서 유의한 차이가 없었다. 또한, 클립 신장 및 반대쪽 신장의 ANP mRNA 발현이 대조군에 비하여 유의하게 증가하였다. 결론: 신혈관성 고혈압 유발 흰쥐에서 전신 및 신장의 국소 RAAS의 활성 증가가 고혈압 및 세뇨관 손상에 기여할 것으로 사료되며, 신장 ANP계의 활성증가는 고혈압에 대한 보상기전으로 작용할 것으로 보인다. 또한, 세뇨관 손상과 관련된 클립 신장의 Na,K-ATPase 발현 감소가 다뇨 및 나트륨 재흡수 장애에 관여할 것으로 생각된다. Background/Aims: This study investigated the role of Na,K-ATPase, the local renin-angiotensin-aldosterone system (RAAS), and atrial natriuretic peptide (ANP) system in the pathogenesis of renal tubular dysfunction and hypertension in rats with two-kidney, one-clip (2K1C) hypertension. Methods: Adult male Sprague-Dawley rats were made 2K1C hypertensive for 4 weeks. The renal expression of Na,K-ATPase was determined by immunoblotting. The mRNA expression of renin, angiotensin-converting enzyme (ACE), aldosterone synthase (CYP11B2), mineralocorticoid receptor (MR), and the ANP system were determined in the kidney using real-time polymerase chain reaction. Results: The blood pressure was increased in the 2K1C rats, compared with controls. The plasma renin activity and serum aldosterone concentrations were increased, as were the urine output and fractional excretion of sodium. The expression of Na,K-ATPase protein was decreased in the clipped kidney, as compared with the control kidney, while it remained unchanged in the contralateral kidney. The mRNA expression of renin, ACE1, CYP11B2, and MR was increased in the clipped kidney, but unchanged in the non-clipped kidney. The mRNA expression of ACE2 did not differ between the groups. The expression of ANP mRNA was increased in both clipped and non-clipped kidneys, as compared with control kidneys. Conclusions: The enhanced activity of the local RAAS may result in to ischemic tubular injury and the development of hypertension in 2K1C rats. The downregulation of Na,K-ATPase associated with tubular injury in the clipped kidney may account for the impaired tubular sodium reabsorption in 2K1C hypertension. (Korean J Med 78:477-484, 2010)
증례 : 신장 ; 16s ribosomal RNA의 염기서열 분석으로 진단된 진균 감염이 합병된 Citrobacter freundii 복막투석 복막염 1예
오태렴 ( Tae Ryom Oh ),마성권 ( Seong Kwon Ma ),김수완 ( Soo Wan Kim ) 대한내과학회 2015 대한내과학회지 Vol.88 No.5
저자들은 16s ribosomal RNA 염기서열 분석을 통해 진단된 Citrobacter에 진균 감염이 합병된 복막투석 복막염 환자를 경험하였기에 보고하는 바이다. 환자는 항생제 단독 치료에는 충분히 반응하지 않았으며 세균성 복막염의 합병증으로 진균 감염 및 복강 내 농양이 형성되어 복막투석 카테터 제거, 항진균제 사용 및 농양 배액술을 시행한 이후 호전되었다. 빠른 진단과 적절한 치료만이 환자의 예후를 호전시킬수 있기에 복막투석 복막염 환자에서 호전 속도가 일반적인 경우보다 느리다면 흔치 않은 원인균과 병발된 합병증에 대한 주의 깊은 검사가 임상의사에게 큰 도움을 줄 수 있을 것이다. We present a case of continuous ambulatory peritoneal dialysis peritonitis caused by Citrobacter freundii complicated by a fungal infection with abscess formation. A 34-year-old woman was admitted to our hospital with abdominal pain. Isolate cultures were confirmed as Citrobacter freundii by DNA sequencing of the 16s ribosomal ribonucleic acid (RNA). Antibiotic therapy was ineffective and Candida tropicalis was isolated in follow-up blood cultures. We administered an antifungal agent and removed the peritoneal catheter. A sudden fever developed, and abdominal computed tomography showed intra-abdominal abscesses. Percutaneous drainage was performed, but no bacteria were cultured. After draining the abscesses, the patient recovered. Citrobacter species are unusual pathogens in peritonitis, and fungal peritonitis is a serious complication of bacterial peritonitis. Indwelling catheters should be removed and appropriate antibiotic therapy provided. Suspicion of a fungal infection combined with bacterial peritonitis will improve the prognosis of patients on peritoneal dialysis. (Korean J Med 2015;88:593-597)
송학(松鶴) 최기철(崔錤喆) 교수(敎授) 추모(追慕) 논문(論文) : 신장에서 나트륨 수송체와 수분 통로의 병태생리
김수완 ( Soo Wan Kim ),마성권 ( Seong Kwon Ma ),배은희 ( Eun Hui Bae ),박정우 ( Jeong Woo Park ),이종은 ( Jong Un Lee ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.1
Renal sodium and water reabsorption occurs through epithelial sodium transporters and aquaporin (AQP) water channels in various segments of tubules. We have demonstrated altered regulation of these transporters and channels in various pathophysiological conditions. In nephrotic syndrome and liver cirrhosis, expression of epithelial sodium channels (ENaC) was increased in the late distal convoluted tubule, connecting tubule, and collecting duct. In spontaneously hypertensive rats, the expression of Na,K-ATPase as well as that of ENaC was increased. In contrast, AQP1-3 and sodium transporters was decreased in the kidney from deoxycorticosterone acetate-salt hypertension. In two-kidney, one clip hypertension, the expression of Na,K-ATPase, NHE3, NKCC2 and ENaC subunits was decreased in the clipped kidney while remained unchanged in the contralateral kidney. We have also shown an increased activity of renal atrial natriuretic peptide system in postobstructive natriuresis/diuresis. In acute kidney injury (cisplatin-, gentamicin- and ischemia/reperfusion-induced), the expression of Na,K-ATPase, NHE3, NKCC2 and AQP1-3 was decreased. The altered regulation of sodium transporters and AQP may be causally related with various kidney diseases and hypertension.
지속성 외래 복막투석 환자에서 혈청 부갑상선호르몬 마그네슘 치의 관계
조민석(Min Seok Cho),이균상(Kyun Sang Lee),이연경(Youn Kyoung Lee),마성권(Seong Kwon Ma),고정희(Jeong Hee Ko),김수완(Soo Wan Kim),김남호(Nam Ho Kim),최기철(Ki Chul Choi) 대한내과학회 2001 대한내과학회지 Vol.61 No.5
N/A Background : One of the most common complications in patients with end stage renal disease is renal osteodystrophy and parathyroid hormone (PTH) plays a key role in the pathogenesis of renal osteodystr ophy. It is known that patients undergoing CAPD (continuous ambulatory peritoneal dialysis ) have increased risk of low turnover bone disease and relative hypoparathyroidism is related to its pathogenesis. Fact or srelated to relative hypoparathyroidism are increased in extracellular calcium level, accumulation of aluminum, vitamin D treatment, good control of serum phosphate, diabetes mellitus, and old age. Recently it has been believed that magnesium plays an import ant role in regulating secretion of PTH. The aim of this study was to evaluate the relationship between serum PTH and serum magnesium as a factor increasing the frequency of relative hypoparathyroidism. Methods : Author studied 56 patients who had undergone CAPD for more than 6 months without any significant problems and had been followed by Chonnam National University Hospital. No patient had been previously treated with vitamin D or aluminum hydroxide. The patients had used peritoneal dialysate with the magnesium concentration of 0.5 mEq/ L. Biochemical parameters were checked. Results : 1. The mean serum magnesium level was 1.99 ±0.36 mEq/ L. Among total 56 patients, 15 patients (26.8%) showed hypermagnesemia (serum magnesium > 2.2 mEq/ L), and 5 patients (8.9%) showed hypomagnesemia (serum magnesium < 1.6 mEq/ L) 2. On all 56 patients, serum Ipth level was not correlated with serum magnesium level. But, it was inversely correlated with serum total calcium and ionized calcium levels, respectively (r =- 0.365, p =0.006; r =- 0.515 p <0.001). 3. Among the 49 patients whose serum Ipth level was less than 300 pg/ Ml, serum Ipth level was inversely correlated with serum magnesium level (r =- 0.295, p =0.039), and inversely correlated with serum total calcium and ionized calcium levels, respectively (r =- 0.546, p <0.001; r =- 0.572 p <0.001). 4. Among the 49 patient s whose serum Ipth level was less than 300 pg/ Ml, lower Ipth group (serum Ipth<120 pg/ Ml) showed higher serum magnesium level (p =0.037), higher serum total calcium level (p <0.001), and lower bone isoenzyme of alkaline phosphatase level (p <0.001) than those of higher Ipth group (120 pg/ Ml serum ≤Ipth<300 pg/ Ml). Conclusion : Among the CAPD patient s whose serum Ipth level was less than 300 pg/ Ml, there was a significantly inverse correlation between serum Ipth level and serum magnesium level. This study indicates that not only serum calcium level, but also serum magnesium level are import ant in the regulation of serum Ipth levels of CAPD patients who have been dialyzed by low-magnesium peritoneal dialysate.(Korean J Med 61:527- 536, 2001)