급성신손상 : 신 허혈 재관류 백서 모델에서 sildenafil의 신보호 효과

최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),장윤경 ( Yoon Kyung Chang ),정사라 ( Sa Rah Chung ),김난희 ( Nan Hee Kim ),정진영 ( Jin Young Jung ),이상주 ( Sang Ju Lee ),임범진 ( Beom Jin Lim ),이강욱 ( Kang Wook Lee ),김석영 ( S 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

혈액투석 중인 말기신부전 환자에서 발생한 양측 신장의 자발성 파열

정사라 ( Sa Rah Chung ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),설종구 ( Chong Koo Sul ),이강욱 ( Kang Wook Lee ),신영태 ( Young Tai Shin ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.5

Bilateral spontaneous renal rupture is a rare event that has been documented in only a few reports. We report a spontaneous, but not simultaneous rupture of both kidneys in a 64-year-old man with end-stage renal disease who had been treated with hemodialysis for 78 months. He complained of sudden left flank pain. Abdominal computed tomography (CT) revealed a huge perirenal hematoma with multiple renal cysts. The patient underwent an urgent left nephrectomy and was diagnosed as multiple acquired renal cysts with rupture and focal incidental papillary renal cell carcinoma. Twentytwo days after the left nephrectomy, he complained of sudden right flank pain and abdominal CT showed another massive perirenal hematoma. The patient underwent a right nephrectomy and was diagnosed as renal cyst rupture with perirenal hemorrhage. However, there was no evidence of renal cell carcinoma in the right kidney. Postural hypotension and frequent hypotensive episodes developed during hemodialysis several months after both nephrectomies. He was diagnosed as primary adrenal insufficiency with rapid adrenocorticotropic hormone (ACTH) stimulation test and the level of plasma ACTH and was treated with prednisolone and fludrocortisone. The patient died of acute myocardial infarction 32 months after bilateral nephrectomies.

성인 원발성 국소성 분절성 사구체경화증의 임상적 고찰

장윤경(Yoon Kyung Chang),최대은(Dae Eun Choi),이상주(Sang Ju Lee),박기현(Gi Hyun Park),양종오(Jong Oh Yang),나기량(Ki Ryang Na),서광선(Kwang Sun Seo),이강욱(Kang Wook Lee),신영태(Young Tai Shin) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.4

목 적 : 원발성 국소성 분절성 사구체경화증(Focal and segmental glomerular sclerosis, FSGS)은 신사구체의 국소적인 분절성경화나 초자변성을 특징으로 하는 사구체 질환으로서, 성인 환자 중 50-70%가 신증후군으로 발현하며 신증후군의 경과와 예후는 미세변화형 신증후군에 비해 좋지 않고 신장이식 후에도 재발이 잦은 것으로 알려져 있다. 저자들은 원발성 FSGS의 임상적 특징과 신증후군 환자군의 치료 및 예후인자를 규명하고자 하였다. 방 법: 충남대학교병원에서 1989년 12월부터 2000년 1월까지 원발성 FSGS로 진단을 받은 환자 54명을 대상으로 후향적으로 임상상 및 신장조직검사결과를 분석하였다. 결 과: 추적관찰기간의 중앙값은 48.7(6-123)개월이었고, 평균 연령은 36.8±14.6(15-75)세, 전체 남녀비는 1.08 : 1이었고 30세 이하에서는 2.8 : 1이었다. 원발성 FSGS 신증후군의 남녀비는 1.4 : 1이었다. 진단당시 혈뇨를 보인 예는 24명(44%), 고혈압이 동반된 예는 21명(39%), 고질소혈증을 보인 예는 8명(15%)이었고, 전체 54명 중 31명(57%)이 신증후군 환자였다. 신장조직의 소견에서 간질의 섬유화는 평균 16.89±16.2(3-70)%이었고 신증후군과 비신증후군 환자군간에 간질의 섬유화정도에 유의한 차이는 없었다. 신증후군과 비신증후군 환자군간에 만성신부전으로의 진행정도도 유의한 차이가 없었다. 신증후군을 보인 환자군에서 첫 치료에 대한 반응은 완전관해가 16명(52%), 부분관해가 7명(22%), 무반응이 8명(26%)이었고, 관해군 23명 중 18명 (78%)이 재발하였다. 관해군(23명)과 무반응군(8명)의 비교에서 무반응군이 진단시 신기능이 좋지 않았으며, 사구체의 구상경화가 더욱 심했고, 심한 간질의 섬유화를 보였다. 추적조사에서 관해군과 무반응군에서 만성신부전으로 진행한 예는 각각 2명(9%), 6명(75%)으로 유의하게 무반응군이 만성신부전으로의 진행이 많았다. 결 론 : 원발성 FSGS에 의한 신증후군 환자에서 진단당시 고질소혈증, 사구체 여과율의 감소, 사구체 구상 경화의 증가, 간질 섬유화가 증가된 환자들은 불량한 예후를 보였으며, 특히 첫 스테로이드치료에 대해 무반응을 보인 경우도 좋지 않은 예후를 보였다. N/A

단일기관에서 시행된 30년간의 신생검 결과와 임상상 분석

배홍진 ( Hong Jin Bae ),문강륜 ( Kang Ryun Moon ),김예진 ( Ye Jin Kim ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),이강욱 ( Kang Wook Lee ),신영태 ( Young Tai Shin ) 대한내과학회 2013 대한내과학회지 Vol.84 No.3

목적: 경피적 신생검은 사구체질환의 진단과 치료에 있어서 필수적인 검사 방법이다. 그러나 인구와 시기별에 따른 사구체 질환의 변화에 대한 대규모 연구는 많지 않다. 경피적 신생검을 시행받은 환자들에서 임상적 적응증과 조직병리 진단의 시대별 변화를 알아보고자 본 연구를 수행하였다. 방법: 1981년부터 2010년까지 충남대학교병원에서 경피적 신생검을 시행받은 15세 이상의 총 3,052명 중 의무기록 검토와 조직진단이 가능했던 2,412명을 대상으로 연령, 성별, 적응증, 신생검 결과 등에 대해서 I기(1981-1990년), II기(1991-2000년), III기(2001-2010년)로 나누어 시기별 변화를 비교 분석하였다. Background/Aims: This study evaluated the clinical characteristics of patients who underwent kidney biopsies, and the relative changes in pathological diagnosis, according to time periods over the last 30 years (1981-2010). Methods: This study included 3,051 patients who were older than 15 years and underwent kidney biopsies at Chungnam University Hospital between January 1981 and December 2010. For analysis, the patients were grouped into three time periods: I (1981-1990), II (1991-2000), and III (2001-2010). We reviewed the available medical records of 2,450 patients and analyzed the changes in their clinical characteristics over time. Results: The mean patient age was 35.9 (range 15-91) years and the male-to-female ratio was 1.3:1. The most common indication for a kidney biopsy was an asymptomatic urinary abnormality (64.2%) and the proportion with this indication increased significantly over time (p < 0.001). Primary glomerular diseases comprised 65.4% of all pathological diagnoses, followed by secondary (13.6%) and hereditary (12.5%) glomerular diseases. The proportion of primary glomerular diseases decreased significantly with time (p < 0.001), while the proportions of secondary and hereditary glomerular diseases increased correspondingly (p < 0.001). IgA nephropathy was the most common pathological diagnosis (36.7%) overall. The proportion of IgA nephropathy increased significantly with time (p < 0.001), while minimal change disease and acute post-streptococcal glomerulonephritis decreased significantly (p < 0.001 and p = 0.013, respectively). Conclusions: The results demonstrated that the clinical indications and pathological diagnoses in patients who underwent kidney biopsies changed significantly over the last 30 years. (Korean J Med 2013;84:379-388)

침술 및 근육 내 자극치료 (Intramuscular Stimulation)에 의한 콩팥주위 혈종

김설영 ( Seul Young Kim ),장원익 ( Won Ik Jang ),정사라 ( Sa Rah Chung ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),이강욱 ( Kang Wook Lee ),신영태 ( Young Tai Shin ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.2

Acupuncture therapy has been widely performed by staffs of oriental medicine in Korea, and intramuscular stimulation (IMS) therapy has been introduced recently and used for controlling myofascial pain in the field of orthopedics, rehabilitation, and pain clinics. To penetrate human tissues, relatively long needles are used in both procedures and these these may have some risks to puncture blood vessels. However, there were few reports about sequelae or complications after such procedures in Korean literatures. Recently, we experienced two cases of perirenal hematoma in patients without blood coagulation abnormalities (one case induced by acupuncture in oriental medicine clinic, and the other case induced by IMS in orthopedic clinic and was also accompanied by perirenal abscess).

C-phycocyanin Attenuates Renal Inflammation and Fibrosis in UUO Mice

이강욱 ( Kang Wook Lee ),정사라 ( Sa Rah Chung ),정진영 ( Jin Young Jeong ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),신영태 ( Young Tai Shin ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6

It has been reported that Spirulina, a blue-green algae with potent antioxidant properties, affords significant protection against inflammation and fibrosis in the liver in vivo. The aim of the present study was to establish the possible protective role of C-phycocyanin, one of the active ingredients of Spirulina, in an experimental model of fibrosis in the kidney. Methods: The study was carried out using male C57BL6 mice. Mice were divided into the following four groups: sham-operated group; C-phycocyanin (PC)-treated sham group; unilateral ureteral obstruction (UUO) group; and PC with UUO group. We evaluated renal TGF-β mRNA, MCP-1, and osteopontin using real-time RT PCR. We evaluated renal TGF-β, α-SMA, and CD68 by immunohistochemistry. We recorded light microscopic findings of kidney specimens. Results: PC significantly decreased the expression of MCP-1 and α-SMA mRNA. Renal gene levels of expression of TGF-β, MCP-1, and osteopontin in the UUO group were significantly higher than the sham-operated group (p<0.01). The levels of expression of TGF-β, MCP-1, and osteopontin mRNA of kidneys in the PC-treated UUO group were significantly lower than the untreated UUO group (p< 0.05). The magnitude of expression of TGF-β and α-SMA protein in the kidneys of the PC-treated UUO group was significantly less than the untreated UUO control group (p<0.05). Conclusion: The results of the present study suggest that PC has anti-inflammatory and anti-fibrotic effects in an experimental UUO murine model.

투석환자에서 Ankle-Brachial Index를 이용한 말초혈관질환의 위험인자 분석

이강욱 ( Kang Woo Lee ),정지윤 ( Ji Yoon Jung ),함영록 ( Young Rok Ham ),장원익 ( Won Ik Jang ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),신영태 ( Young Tai Shin ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6

Purpose: Peripheral arterial disease (PAD) is a predictable marker of coronary heart disease and cerebrovascular disease and its prevalence among chronic kidney disease (CKD) patients especially in end-stage renal disease (ESRD) patients undergoing dialysis is apparently increasing. Ankle-brachial index (ABI) is regarded as an easy, reliable, and noninvasive measure of the presence and severity of lower-extremity PAD (ABI<0.9). The aims of this study are to find out the prevalence of lower limb PAD measured by ABI, and to assess the risk factors of PAD in patients with ESRD. Methods: One hundred thirty eight ESRD patients from May 2005 to September 2009 who were performed ABI examination were categorized into PAD (ABI<0.9) or non-PAD (ABI≥0.9) and the prevalence of PAD was analyzed. We measured ABI with VP2000 PWV/ankle-brachial index. We also reviewed the clinical characteristics and evaluated the risk factors of PAD, retrospectively. Results: One hundred seventeen patients on hemodialysis, and twenty one patients on peritoneal dialysis were included in this study. The mean age of total patients was 60.1 (24-84) years old. Thirty five patients out of one hundred thirty eight patients had an ABI index of less than 0.9 (PAD indicative). PAD was independently associated with age (p=0.013), duration of dialysis (p=0.013), history of coronary artery disease and cerebrovascular disease (p=0.001, p=0.001 respectively), diabetes (p= 0.034), and increased LDL cholesterol (p=0.004) in univariate analysis. In multivariate logistic regression analysis, duration of dialysis, increased level of LDL-cholesterol and history of coronary artery disease were significantly related with PAD (p=0.008, p=0.019, p=0.018 respectively). Conclusion: Duration of dialysis, increased level of LDL-cholesterol and coronary artery disease were independent risk factors for PAD in patients with ESRD on dialysis.

신증후성 출혈열 후에 발생한 Henoch-Schonlein 자반증성 신염과 비골신경 마비

김의식 ( Eui Sik Kim ),장원익 ( Won Ik Jang ),정지윤 ( Ji Yoon Jung ),정사라 ( Sa Rah Chung ),최대은 ( Dae Eun Choi ),임범진 ( Bum Jin Im ),나기량 ( Ki Ryang Na ),이강욱 ( Kang Wook Lee ),서광선 ( Kwang Sun Suh ),신영태 ( Young Ta 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.6

In the course of hemorrhagic fever with renal syndrome (HFRS), mild neurological symptoms such as headache, vertigo and nausea are common. Peripheral neuropathy in HFRS is very rare. Henoch-Schonlein purpura (HSP) is an immunologically medicated systemic vasculitis of small blood vessels affecting the skin, gastrointestinal tract, joints and kidneys, predominantly. Neurological complications in HSP include headache, focal cerebral deficit, coma, convulsion, subarachnoid hemorrhage and chorea. Peripheral neuropathy is also very rare. However there was no case report about HSP and peroneal nerve palsy after HFRS. With a brief review of the literature, we report a case of HSP and peroneal nerve palsy following HFRS.

혈액투석치료를 받는 말기신부전 환자에서 체내 수분분포와 임상상

장원익 ( Won Ik Jang ),배홍진 ( Hong Jin Bae ),함영록 ( Young Rok Ham ),장동석 ( Dong Suk Chang ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),이강욱 ( Kang Wook Lee ),신영태 ( Young Tai Shin ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.3

Purpose: Maintenance of the normal hydration state is one of the major purposes of hemodialysis therapy in patients with end-stage renal disease. Overhydration is an important and independent predictor of mortality in patients with end-stage renal disease on regular hemodialysis. BCM (body composition monitor, FMC, Germany) reliably enables quantitative assessment of hydration status and body composition. The aims of this study were to investigate the relationship between hydration status and clinical features and the risk factors of overhydration. Methods: We measured hydration status and body composition of total 72 patients with end-stage renal disease on regular hemodialysis by BCM from June, 2009 to September, 2009. We also reviewed the clinical characteristics and laboratory findings and comorbidities retrospectively. Results: The hydration status measured by BCM was correlated well with interdialytic weight gain after 48 hours and 72 hours from last hemodialysis treatment (r=0.42 p<0.001, r=0.38 p<0.01, respectively). There was no statistically significant difference in comorbidities, age, sex, BMI, blood pressure, hypotensive episodes between the patients with overhydrated state (relative hydration status ≥20%) and control patients (relative hydration status <20%). In overhydrated patients, serum iron level was lower than control patients 48 hrs after last hemodialysis (p<0.05). Conclusion: This cross-sectional study showed that hydration status measured by BCM was correlated well with interdialytic weight gain although there was no significant clinical difference between overhydrated and control patients with end-stage renal disease on regular hemodialysis

Recombinant Human Erythropoietin 및 N-acetylcysteine의 방사선 조영제에 의한 신독성 예방효과

정사라 ( Sa Rah Chung ),김의식 ( Eui Sik Kim ),정지윤 ( Ji Yoon Jung ),김난희 ( Nan Hee Kim ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),이강욱 ( Kang Wook Lee ),신영태 ( Young Tai Shin ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.6

Purpose : We investigated the effects of recombinant human erythropoietin (EPO) and N-acetylcysteine (NAC) in the prevention of radiocontrast-induced nephrotoxicity in patients with underlying renal ysfunction, who are regarded as a high risk group. Methods : This study included 77 individuals with renal insufficiency, defined by a serum creatinine concentration above 1.2 mg/dL or creatinine clearance of more than 15 mL/min/1.73m2 and less than 60 mL/min/1.73m2. These patients who needed radiologic interventions including the use of radiocontrast materials from August 2006 to May 2007 were randomly assigned to one of four groups, which were treated with EPO only, NAC only, EPO plus NAC and placebo respectively. The serum creatinine and cystatin-C were measured before, 24 hours and 48 hours after the intervention. The creatinine clearance was obtained using the Cockcroft-Gault equation. Results : The serum level of creatinine in EPO plus NAC group was not significantly elevated 24 and 48 hours after radiocontrast exposure compared to control group (p=0.012). Also, the creatinine clearance of EPO plus NAC group was not significantly decreased after radiocontrast exposure compared to control group (p=0.046). The serum level of creatinine in EPO and NAC group increased less than control group, but there were no significant differences between the groups. Also, the creatinine clearance in EPO and NAC group decreased less than control group, but there were no significant differences between the groups. Conclusion : EPO plus NAC showed a renoprotective effect on radiocontrast study in patients with underlying renal dysfunction.