• ETRI Journal
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• 제45권3호
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• pp.448-461
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• 2023

This article performs a detailed data scrutiny on a chronic kidney disease (CKD) dataset to select efficient instances and relevant features. Data relevancy is investigated using feature extraction, hybrid outlier detection, and handling of missing values. Data instances that do not influence the target are removed using data envelopment analysis to enable reduction of rows. Column reduction is achieved by ranking the attributes through feature selection methodologies, namely, extra-trees classifier, recursive feature elimination, chi-squared test, analysis of variance, and mutual information. These methodologies are ranked via Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) using weight optimization to identify the optimal features for model building from the CKD dataset to facilitate better prediction while diagnosing the severity of the disease. An efficient hybrid ensemble and novel similarity-based classifiers are built using the pruned dataset, and the results are thereafter compared with random forest, AdaBoost, naive Bayes, k-nearest neighbors, and support vector machines. The hybrid ensemble classifier yields a better prediction accuracy of 98.31% for the features selected by extra tree classifier (ETC), which is ranked as the best by TOPSIS.

• Journal of Yeungnam Medical Science
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• 제29권2호
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• pp.102-105
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• 2012

Collapsing glomerulopathy (CG) has become an important cause of end-stage renal disease (ESRD). First delineated from other proteinuric glomerular lesions in the 1980s, CG is now recognized as a common, distinct pattern of proliferative parenchymal injury that portends a rapid loss of renal function and poor responses to empirical therapy. The first cases in the literature trace back to human-immunodeficiency-virus(HIV)-negative patients who underwent biopsy in 1979. A 45-year-old male patient complained of hematuria and proteinuria eight years ago. He showed an abrupt serum creatinine increase from 1.75 to 2.65 mg/dL in the last preceding months. Afterwards, his serum creatinine progressively increased up to 6.82 mg/dL. Moreover, his 24 h urine protein level was determined to have reached 6,171 mg/day, as opposed to 670 mg/day a year earlier. Consequently, renal biopsy was performed, and its result showed collapsing glomerulopathy, compatible with the diagnosis. He has undergone continuous ambulatory peritoneal dialysis as renal replacement therapy. Thus, it is reported herein that a patient clinically diagnosed with chronic kidney disease eight years ago showed a sudden renal-function decrease and was clinicopathologically diagnosed with collapsing glomerulopathy based on the results of his renal biopsy.

• Journal of Genetic Medicine
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• 제11권2호
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• pp.74-78
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• 2014

Sotos syndrome (SS, OMIM 117550) is characterized by prenatal and postnatal overgrowth with multiple congenital anomalies. However, there have been few cases of growth retardation caused by renal failure from infancy. We report a case of dysplasia of the bilateral kidneys with renal failure and poor postnatal growth. A 2-month-old boy visited the emergency room owing to poor oral intake and abdominal distension. He was born at the gestational age of 38 weeks with a birth weight of 4,180 g. After birth, he had feeding difficulty and abdominal distension. Upon physical examination, his height and weight were in less than the 3rd percentile, while his head circumference was in the 50th percentile on the growth curve. He also showed a broad and protruding forehead and high hairline. Blood laboratory tests showed severe azotemia; emergent hemodialysis was needed. Abdominal ultrasonography revealed bilateral renal dysplasia with multiple cysts and diffuse bladder wall thickening. A posterior urethral valve was suggested based on vesicoureterography and abdominal magnetic resonance findings. Results of a colon study to rule out congenital megacolon did not reveal any specific findings. The conventional karyotype of the patient was 46, XY. Array comparative genomic hybridization study revealed a chromosome 5q35 microdeletion including the NSD1 gene, based on which SS was diagnosed. We describe a case of SS presenting with end stage renal disease due to posterior urethral valve. The typical somatic overgrowth of SS in the postnatal period was not observed due to chronic renal failure that started in the neonatal period.

• Tuberculosis and Respiratory Diseases
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• 제82권4호
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• pp.335-340
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• 2019

Background: Snoring is the cardinal symptom of obstructive sleep apnea (OSA). Snoring and upper airway obstruction associated with major oxygen desaturation may occur in populations undergoing flexible bronchoscopy. Methods: To evaluate the prevalence of patients at a high risk of having OSA among patients undergoing bronchoscopy with sedation and to investigate whether snoring during the procedure predicts patients who are at risk of OSA, we prospectively enrolled 517 consecutive patients who underwent the procedure with moderate sedation. Patients exhibiting audible snoring for any duration during the procedure were considered snorers. The STOP-Bang (Snoring, Tiredness, Observed apnea, high blood Pressure-Body mass index, Age, Neck circumference and Gender) questionnaire was used to identify patients at high (score ${\geq}3$ out of 8) or low risk (score <3) of OSA. Results: Of the 517 patients, 165 (31.9%) snored during bronchoscopy under sedation. The prevalence of a STOP-Bang score ${\geq}3$ was 61.9% (320/517), whereas 200 of the 352 nonsnorers (56.8%) and 120 of the 165 snorers (72.7%) had a STOP-Bang score ${\geq}3$ (p=0.001). In multivariable analysis, snoring during bronchoscopy was significantly associated with a STOP-Bang score ${\geq}3$ after adjustment for the presence of diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, and stroke (adjusted odds ratio, 1.91; 95% confidence interval, 1.26-2.89; p=0.002). Conclusion: Two-thirds of patients undergoing bronchoscopy with moderate sedation were at risk of OSA based on the screening questionnaire. Snoring during bronchoscopy was highly predictive of patients at high risk of OSA.

• 한국임상약학회지
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• 제32권2호
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• pp.125-132
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• 2022

Background: Fixed-dose combinations have the advantage of improving patient compliance, but may increase the risk of duplicate prescriptions. As the use of fixed-dose combination antihypertensives increases, it is necessary to investigate the current status of class duplication prescriptions (CDP) in patients taking fixed-dose combination antihypertensives in Korea and to identify factors associated with CDP. Methods: We conducted a retrospective observational study using nationally representative claim data. Hypertensive patients aged 20 years or older taking fixed-dose combination antihypertensives were extracted. Among these patients, patients with CDP were identified. A chi-square test was applied to determine the differences between patients with CDP and non-CDP. The associated factors of CDP were identified through multiple logistic regression. Results: Of the 74,165 patients who were prescribed fixed-dose combination antihypertensives, 426 patients (0.6%) with CDP were identified. The most common antihypertensive class associated with CDP was calcium channel blockers (194 patients, 45.5%), followed by angiotensin II receptor blockers (136 patients, 31.9%). Patients aged 75 years or older (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.02-3.52), chronic kidney disease (OR 4.45, 95% CI 2.15-8.25), chronic heart failure (OR 2.71, 95% CI 1.93-3.72), coronary artery disease (OR 2.22, 95% CI 1.60-3.03) and Medical Aid/Patriots and Veterans Insurance (OR 1.49, 95% CI 1.04-2.07) were significantly associated with increased CDP. Conclusions: The factors associated with CDP were the elderly, comorbidities, and low socioeconomic status. Since CDP can result in negative clinical outcomes, active intervention by the pharmacist is warranted.

• Childhood Kidney Diseases
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• 제19권2호
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• pp.184-189
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• 2015

Poststreptococcal glomerulonephritis (PSGN) is one of the most well-known and important infectious renal diseases resulting from a prior infection with group A ${\beta}$-hemolytic streptococcus. The typical clinical characteristics of the disease reflect acute onset with gross hematuria, edema, hypertension and moderate proteinuria after the antecedent streptococcal infection. In children, usually PSGN is healed spontaneously but if it combines with fast progressing glomerulonephritis, it would be developed to chronic renal failure. Therefore, it is important to make a fast diagnosis and treatment by simple tools to predict the course and the prognosis of disease. Sonography is a simple tool for diagnosis but there is no typical renal sonographic finding in PSGN, so it is difficult to predict the course and the prognosis of disease by sonographic findings. In comparison between two cases of renal sonographic findings in PSGN, a patient who showed more increased echogenicity in more extended area of renal sonography had the severe results of renal pathology, prolonged treatment period and low serum C3 level. Here, we report the different findings of renal sonography and pathology depending on the degree of severity between two patients. Thus, it is necessary to gather more information from further studies to make a consensus about the relationship between the renal sonography and the prognosis of disease in PSGN.

• 대한영상의학회지
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• 제83권2호
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• pp.317-330
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• 2022

목적 본 연구는 신장종양 환자에서 시행한 고주파절제술 이후 신장 기능에 영향을 미치는 다양한 요소들에 대한 평가를 통해서 이들의 상관관계와 임상적 가치를 평가하기 위한 것이다. 대상과 방법 2010년 1월부터 2018년 12월까지 본원에서 ultrasonography, CT 유도하에 고주파절제술을 시행 받은 91명을 대상으로 선정하였다. 신기능을 평가하는 방법으로 시술 직전과 시술 이후 혈청 크레아티닌, 사구체 여과율을 측정하였다. 시술 전과 비교하여 혈청 크레아티닌 수치가 0.3 mg/dL 이상 증가하는 것을 유의미한 것으로 정하고, 이에 근거하여 두 그룹으로 분류하였다. 신장 기능 손상에 영향을 미치는 요소를 평가하기 위해서 다변수 로지스틱 회귀분석을 이용해서 그룹 간에 비교를 시행하였다. 결과 단일 신장, 3단계 이상의 만성 콩팥병, 요관 손상은 신장 기능 손상에서 통계적으로 유의한 의미가 있었다. 성별, 연령, 다른 암, 종양 크기, 위치, 성장 형태, 집합계와의 근접성 등은 통계적으로 유의하지 않았다. 신장 기능 수치의 시간에 따른 변화는 단일 신장, 3단계 이상의 만성 콩팥병, 요관 손상 유무에 따라서 통계적으로 유의하게 달랐다. 결론 고주파절제술 시행 전의 의학적 상태 중 단일 신장, 3단계 이상의 만성 콩팥병, 시술 이후 발생한 합병증 중 요관 손상은 시술 이후 발생하는 신장 기능 손상의 위험요소로 생각할 수 있다.

• 대한임상검사과학회지
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• 제52권3호
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• pp.165-171
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• 2020

본 연구의 목적은 대한민국 20세 이상(50.32±16.14세)의 당뇨질환이 없는 성인에서 만성신장질환과 인슐린저항성(homeostasis model assessment of insulin resistance, HOMA-IR) 및 베타세포기능(homeostasis model assessment of beta cell function, HOMA-B)의 관련성에 대하여 조사하였다. 본 연구는 2015년도 국민건강영양조사 자료를 이용하여 당뇨질환이 없는 20세 이상의 대한민국 성인 4,380명을 대상으로 하였다. 본 연구결과에서 중요한 결과는 다음과 같다. 첫째, 만성신장질환과 HOMA-IR와 관련하여, 관련변수를 보정한 후의 결과에서(Model 4), 그룹 1 (G1; estimated glomerular filtrationrate [eGFR], ≥90 mL/min/1.73 ㎡), 그룹 2 (G2; eGFR, 60~89 mL/min/1.73 ㎡), 그룹 3a (G3a; eGFR, 30~59 mL/min/1.73 ㎡), ≥그룹 3b (≥G3b; eGFR, <30 mL/min/1.73 ㎡)의 HOMA-IR 평균값(M±SE, 95% confidence interval [CI])은 각각 1.78±0.03 (1.73~1.83), 1.87±0.03 (1.81~1.93), 2.16±0.13 (1.91~2.42) 및 2.59±0.24 (2.12~3.06)으로 만성신장질환이 진행됨에 따라 HOMA-IR은 증가하였다(P<0.001). 둘째, 만성신장질환과 HOMA-B와 관련하여, 관련변수를 보정한 후의 결과에서(Model 4), G1, G2, G3a 및 ≥G3b의 HOMA-B 평균값(M±SE, 95% CI)은 각각 87.46±1.21 (85.08~89.84), 89.11±1.38(86.40~91.81), 104.82±5.91 (93.23~116.42) 및 123.97±10.87 (102.66~145.29)으로 만성신장질환이 진행됨에 따라 HOMA-B도 증가하였다(P<0.001). 대한민국 당뇨질환이 없는 성인에서 만성신장질환이 진행됨에 따라 인슐린 저항성이 증가하였고, 베타세포기능 또한 증가하였다.

• 한국임상수의학회지
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• 제32권5호
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• pp.440-444
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• 2015

본 케이스는 요독증이 해소되지 않는 말기 만성 신부전 환자에서의 지속적 신대체요법에 관한 보고이다. 본 원에 내원하여 만성신부전으로 진단 내려진 6마리의 환자에서 수액요법과 같은 일반적인 대증요법에 개선이 없었다. 따라서 혈액투석방법을 진행하였다. 평균 57-72%의 요소감소율을 보인 4마리의 환자와 37.3%의 요소감소율을 보인 1마리의 환자견에서 좋은 개선을 보였다. 하지만 6마리의 환자견에서의 93회 혈액투석 동안 체외흐름 폐색, 항응고제 사용에 의한 과도한 출혈등과 같은 부작용이 12회 발생하였다. 따라서 요독증이 개선되지 않는 만성 신부전 환자에서의 지속적 신대체요법은 유용하다 할 수 있으며 혈액투석동안 면밀한 부작용 관찰이 중요하다 여겨진다.

• 한국임상약학회지
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• 제21권2호
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• pp.122-130
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• 2011

Objective: Although recombinant human erythropoietin (rhEPO) has revolutionized the treatment of anemia in chronic kidney disease (CKD) receiving hemodialysis (HD) with no need of blood transfusion, some patients have a blunted or appear to be resistant to rhEPO. There is a controversy in the causes of rhEPO resistance in maintenance HD patients with anemia. This study is to examine current anemia treatment outcomes and the factors influencing the rhEPO responsiveness in HD patient with CKD. Methods: The clinical parameters or factors relating to erythrompoietin treatment outcomes and erythropoietin responsiveness were collected from the HD patients in two large dialysis centers for three months. The collected paramenters included serum iron, total iron biding capacity (TIBC), transferrin saturation rate, ferritin, albumin, intact PTH, C-reactive protein (CRP), nPCR and medications such as an angiotensin converting enzyme inhbitor, an angiotension II receptor blocker and an HMG-CoA reductase inhibitor (HMG-CoA RI). The data were analyzed to examine the degree of acheiveing the anemia treatment goal and factors relating to ERI. Results: Among total 111 patients, 42 (42.3%) and 47 (37.8%) patients achieved the target Hct and Hb based on the Health Insurance Review and Assessment Services (HIRA) reimbursement criteria. In the higher ERI group (upper quartile), the patients had higher CRP levels (0.5 mg/dl) (p=0.0096), and lower TIBC score (<$240{\mu}g/dl$) (p=0.0027), and less patients were taking HMG-CoA RI (p=0.0019). Male patients (p=0.0204), patients with high TIBC score ($R^2$=0.084, p=0.0021) and patients taking HMG-CoA RI (p=0.0052) required to administer less dose of rhEPO meaning higher erythropoietin responsiveness. Conclusion: Less than 50% of CKD patients were achieving the goals of anemia by erythropoietin administration in large hospitals in Korea even though the goals were lower than those of NKF-K/DOQI practice guideline. The factors influencing ERI were sex, TIBC and HMG-CoA RI administration status, and neither an ACEI nor an ARB did not influence ERI.