• Journal of Trauma and Injury
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• 제24권2호
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• pp.164-167
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• 2011

Trauma is an important risk factor for a pulmonary thromboembolism, and anticoagulation is essential to prevent deep vein thrombosis (DVT) in patients with trauma. Low-molecular-weight heparin (LMWH) is excreted in the kidney; therefore, using LMWH in patients with renal insufficiency may increase the risk of bleeding complication. The following case describes a 55-year-old traffic accident victim who had massive bleeding and underwent a laparotomy for bleeding control. The patient had acute renal failure, and enoxaparin was administered for the prophylaxis of DVT. Although the patient suffered from serious complications such as pericardial hematoma, the patient recovered without sequellae and was discharged at day 84.

• Childhood Kidney Diseases
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• 제9권2호
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• pp.251-254
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• 2005

저자들은 핍뇨를 주소로 내원한 12세 남아에서 임상 소견 및 검사 소견 상 전신적 강직성 경련으로 유발뇐 횡문근융해증에 의해 초래된 급성신부전으로 진단하고 충분한 수액공급 소변의 알칼리화, 이뇨제 투여와 함께 항경련제의 사용으로 경련을 조절함으로써 급성신부전이 호전된 1례를 경험하였기에 보고하는 바이다.

• The Korean Journal of Physiology and Pharmacology
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• 제12권4호
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• pp.149-153
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• 2008

Endothelin-1 (ET-1) is unequivocally elevated in the kidney with ischemic acute renal failure (ARF), whereas ET receptors ($ET_AR$ and $ET_BR$) are variably expressed. Although renal functional and structural changes are similar between ischemic and nephrotoxic ARF, there are few reports on the alteration in the ET system in nephrotoxic ARF. This study was, therefore, undertaken to investigate changes in renal expression of ET-l and its receptors in nephrotoxic ARF induced by cisplatin. Mice were intraperitoneally injected with 16 mg of cisplatin/kg at a single dose, and the expression of mRNA and protein was then quantified by real-time RT-PCR and Western blot, respectively. Immunohistochemistry was conducted for localization. Three days after treatment, ET-1 transcript in cisplatin-treated mice was thirteen times higher than that in controls, whereas ET-1 peptide was increased by 1.5-fold. Cisplatin caused a 2-fold increase in the levels of ETAR mRNA and protein. Most of the increased immunoreactive ET-1 and ETAR were localized in damaged tubules. Neither the expression of ETBR mRNA nor the abundance and immunoreactive level of ETBR protein were changed. The findings suggest that the individual components of the renal ET system are differentially regulated in cisplatin-induced nephrotoxic ARF.

• Childhood Kidney Diseases
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• 제6권2호
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• pp.237-242
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• 2002

용혈성 요독 증후군은 용혈성 빈혈, 혈소판 감소증, 급성신부전의 임상양상을 보이는 질환으로서 전형적인 경우 EHEC에 의해 유발되며, 설사(특히 혈변) 등의 전구증상과 연관된다. 비전형적으로 드물게 폐구균 감염으로도 유발되며, 이 경우 매우 불량한 예후를 보이는 것으로 알려져 있고, 아직 국내엔 폐구균 감염과 연관된 HUS에 대해 보고된 바가 없다. 저자들은 폐구균 감염이 진단된 후 급격히 심한 비전형적 용혈성 요독 증후군이 진행되었으나 성공적으로 치료한 1례를 경험하였기에 보고하는 바이다.

• Childhood Kidney Diseases
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• 제21권1호
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• pp.26-30
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• 2017

Newborn infants with huge and highly vascular sacrococcygeal teratoma (SCT) are frequently subjected to renal hypoperfusion secondary to high-output cardiac failure. Any underlying renal dysfunction is a significant risk factor for the development of contrast-induced nephropathy (CIN). However, reports on CIN in infants are rare. I report here a case of a premature infant born at 28 weeks and 3 days of gestation with a huge SCT who survived preoperative embolization and surgical resection but presented with persistent non-oliguric renal failure that was suggestive of CIN. During radiological intervention, a contrast medium had been administered at about 10 times the manufacturer-recommended dose for pediatric patients. Despite hemodynamic stabilization and normalization of urine output immediately following surgery, the patient's serum creatinine and cystatin-C levels did not return to baseline until 4 months after birth. No signs of reflux nephropathy were observed in follow-up imaging studies. Dosing guidelines for the use of a contrast medium in radiological interventions should be provided for infants or young patients.

• Childhood Kidney Diseases
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• 제13권2호
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• pp.267-270
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• 2009

항정신병약물악성증후군은 항정신병약물의 사용과 관련하여 드물게 발생하는 부작용으로 생명을 위협하는 질환으로 의식변화, 고열증, 근육강직의 특징적 증상을 보인다. 항정신병약물악성증후군 환자에서 고열증과 근육강직으로 인하여 횡문근융해증이 발생하여 합병증으로 급성 신부전이 생기는 경우가 드물게 발생하며 심한 경우 투석 등의 치료가 필요하며 생명에 위협이 되므로 빠른 진단과 치료가 요구된다. 저자들은 소아에서 보고되지 않던 항정신병약물악성증후군에 동반하여 횡문근융해증을 보인 급성 신부전의 예를 경험하였기에 보고하는 바이다.

• 대한약침학회지
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• 제14권4호
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• pp.5-11
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• 2011

Objectives: The present study was undergone to determine whether Glycyrrhizae Radix pharmacopuncture intravenous injection exerts beneficial effect against the ischemia-induced acute renal failure in rabbits. Methods: Rabbits were treated with Glycyrrhizae Radix pharmacopuncture via i.v., followed by renal ischemia/reperfusion. The fractional excretion of glucose and phosphate were measured and the malondialdehyde content was also determined. The morphological changes of cortical part of kidney also observed with light microscope. Results: Renal ischemia/reperfusion caused increase of the fractional excretion of glucose and phosphate in ischemia-induced animals, which was prevented by Radix Glycyrrhizae extract treatment. Ischemia/reperfusion increased lipid peroxidation, which was prevented and morphological changes also altered by Radix Glycyrrhizae pharmacopuncture administration. Conclusions: These results indicate that lipid peroxidation plays a critical role in ischemia-induced acute renal failure and Glycyrrhizae Radix pharmacopuncture exerts the protective effect against acute renal failure induced by renal ischemia/reperfusion.

• Journal of Chest Surgery
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• 제55권6호
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• pp.435-441
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• 2022

Background: This study aimed to evaluate the impact of the treatment modality on post-procedural acute kidney injury (AKI) and other clinical outcomes in patients with advanced chronic kidney disease who underwent surgical or transcatheter aortic valve replacement (AVR). Methods: A total of 147 patients with advanced chronic kidney disease (stage 3 to 5) who underwent isolated surgical AVR (SAVR group; n=70) or transcatheter AVR (TAVR group; n=77) were retrospectively studied. Postprocedural AKI was defined according to the RIFLE definition (an acronym corresponding to the risk of renal dysfunction, injury to the kidney, failure of kidney function, loss of kidney function, and end-stage kidney disease). Factors associated with postoperative complications and mortality were analyzed using multivariable logistic regression models and Cox proportional hazard models. Results: Postprocedural AKI occurred in 17 (24.3%) and 6 (7.8%) patients in the SAVR and TAVR groups, respectively (p=0.006). Multivariable analyses demonstrated that the SAVR group had higher risks of AKI (odds ratio [OR], 5.63; 95% confidence interval [CI], 1.85-17.73; p=0.002) and atrial fibrillation (OR, 16.65; 95% CI, 4.44-62.50; p<0.001), whereas the TAVR group had a higher risk of permanent pacemaker insertion (OR, 5.67; 95% CI, 1.21-26.55; p=0.028). The Cox proportional hazard models showed that the occurrence of AKI, contrary to the treatment modality, was associated with overall survival. Conclusion: In patients with chronic kidney disease, the risk of postprocedural AKI might be higher after SAVR than after TAVR.

• Childhood Kidney Diseases
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• 제15권2호
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• pp.107-115
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• 2011

소아에서 급성 신손상의 흔한 원인들로는 신허혈, 신독성 약물들, 그리고 패혈증 등이 있으며, 신대체요법 시작시의 저혈압, 신대체 요법 동안 승압제의 사용, 그리고 신대체 요법 시작시의 수액 과부하 정도가 환자의 생존(소아 중환자실 퇴원)에 영향을 미치는 요인들로 알려져 있다. 지속적 신대체 요법의 빠른 시작은 급성 신손상을 가진 환자들에게서 사망률과 예후에 나쁜 영향을 미치는 수액 과부하를 감소시키는 것으로 보고되었다. 이에 저자들은 소아 환자에게서 지속적 신대체 요법의 실제 처방과 급성 신손상, 수액 과부하, 그리고 지속적 신대체 요법간의 연관성 및 치료결과를 살펴보고자 한다. 결론적으로, 급성 신손상을 가진 소아의 치료에 있어서 과도한 수액 과부하가 발생하기 전에 빠른 지속적 신대체 요법의 시작이 필요하다고 제시하는 바이다.

• Journal of Chest Surgery
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• 제49권1호
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• pp.15-21
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• 2016

Background: We aimed to evaluate the incidence, predictive factors, and impact of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR). Methods: A total of 53 patients who underwent 57 TEVAR operations between 2008 and 2015 were reviewed for the incidence of AKI as defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease risk) consensus criteria. The estimated glomerular filtration rate was determined in the perioperative period. Comorbidities and postoperative outcomes were retrospectively reviewed. Results: Underlying aortic pathologies included 21 degenerative aortic aneurysms, 20 blunt traumatic aortic injuries, six type B aortic dissections, five type B intramural hematomas, three endoleaks and two miscellaneous diseases. The mean age of the patients was $61.2{\pm}17.5years$ (range, 15 to 85 years). AKI was identified in 13 (22.8%) of 57 patients. There was an association of preoperative stroke and postoperative paraparesis and paraplegia with AKI. The average intensive care unit (ICU) stay in patients with AKI was significantly longer than in patients without AKI (5.3 vs. 12.7 days, p=0.017). The 30-day mortality rate in patients with AKI was significantly higher than patients without AKI (23.1% vs. 4.5%, p=0.038); however, AKI did not impact long-term survival. Conclusion: Preoperative stroke and postoperative paraparesis and paraplegia were identified as predictors for AKI. Patients with AKI experienced longer average ICU stays and greater 30-day mortality than those without AKI. Perioperative identification of high-risk patients, as well as nephroprotective strategies to reduce the incidence of AKI, should be considered as important aspects of a successful TEVAR procedure.