• Clinical and Experimental Pediatrics
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• 제55권10호
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• pp.367-370
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• 2012

Urinary tract infection (UTI) is a common bacterial illness in children. Acute pyelonephritis in children may lead to renal scarring with the risk of later hypertension, preeclampsia during pregnancy, proteinuria, and renal insufficiency. Until now, vesicoureteral reflux (VUR) has been considered the most important risk factor for post-UTI renal scar formation in children. VUR predisposes children with UTI to pyelonephritis, and both are associated with renal scarring. However, reflux nephropathy is not always acquired; rather, it reflects reflux-associated congenital dysplastic kidneys. The viewpoint that chronic kidney disease results from renal maldevelopment-associated VUR has led to questioning the utility of any regimen directed at identifying or treating VUR. Despite the recognition that underlying renal anomalies may be the cause of renal scarring that was previously attributed to infection, the prevention of renal scarring remains the goal of all therapies for childhood UTI. Therefore, children at high risk of renal scar formation after UTI should be treated and investigated until a large clinical study and basic research give us more information.

• Journal of Medicine and Life Science
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• 제19권1호
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• pp.14-19
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• 2022

We investigated the safety and efficacy of pemetrexed monotherapy in patients with lung adenocarcinoma and various renal conditions, including chronic kidney disease. We also analyzed whether baseline renal function affected progression-free survival (PFS). We retrospectively analyzed 71 patients who received maintenance-and second-line pemetrexed monotherapy. Patients were divided into two groups according to estimated glomerular filtration rate (eGFR): fair eGFR (>60 mL/min/1.73 m²) and lower eGFR (59 mL/min/1.73 m² or less). The safety and efficacy were evaluated for each group. Median ages were 73.2 years in the lower eGFR group (n=28) and 64.5 years in the fair eGFR group (n=43). Patients with a lower eGFR achieved a median PFS of 4.7 months, while the median PFS for patients with a fair eGFR was 2.7 months. The difference between the two groups was not statistically significant (P=0.075). Both groups showed treatment-related low-grade hematological and non-hematological adverse events. Pemetrexed monotherapy is safe and effective in patients with lung adenocarcinoma with a lower eGFR.

• Journal of Chest Surgery
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• 제49권6호
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• pp.427-434
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• 2016

Background: Recent studies have demonstrated the benefits of off-pump coronary bypass grafting over the on-pump technique in patients with chronic kidney disease (CKD). To further reduce the risk of acute kidney injury and the need for renal replacement therapy, even in patients undergoing off-pump coronary artery bypass grafting, we adopted protocol-based perioperative management for patients with CKD. Methods: From December 2012 to March 2015, 265 patients underwent isolated off-pump coronary artery bypass grafting. To analyze renal function in a stable condition, we excluded 12 dialysis-dependent end stage renal failure and 10 emergency or urgent cases. Among the remaining 243 patients, 208 patients had normal kidney function (normal group), and 35 patients had CKD (CKD group). Minimizing contrast exposure, ensuring adequate hydration, using strict drug dosage adjustment, and optimizing hemodynamic status were key elements of the protocol for the CKD group. Results: The risk of acute kidney injury was about ${\times}3$ higher in the CKD group than in the normal group (p=0.01). Estimated glomerular filtration rates and serum creatinine levels deteriorated until the third postoperative day in the CKD group. However, by adopting protocol-based perioperative management, this transient renal dysfunction recovered to preoperative levels by the fifth postoperative day without requiring renal replacement therapy in all cases. Conclusion: Off-pump coronary bypass surgery combined with this protocol-based perioperative management strategy in patients with non-dialysis-dependent CKD could mostly be performed without renal replacement therapy.

• Journal of Chest Surgery
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• 제32권6호
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• pp.588-590
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• 1999

오늘날 말기 신부전 환자에서의 심장수술은 보편화 되는 추세이며, 만성 신부전 환자들의 수가 늘어남에 따라 이들 환자에 대한 적절한 치료법 개발이 필요하게 되었다. 이 환자들에게는 관상동맥질환 뿐만 아니라 판막질환도 드물지 않다. 이들에게 시행되는 복막투석은 체외순환에 다소의 지장은 있을수 있지만 수술 전후에 적절한 대책을 준비한다면 더 이상 심장수술의 걸림돌이 되지 않는다. 저자는 심한 승모판막 폐쇄부전과 만성신부전을 동반한 33세의 무뇨증 여자환자에서 기계판막치환술을 시행하였다. 환자는 수술전에 복막투석을 주기적으로 함으로써 수분 및 전해질 균형을 적절히 유지시켰고, 수술후에도 혈액 생화학적 검사결과를 수시로 예의검토하면서 복막투석을 계속시행함으로써 무사히 회복될 수 있었다.

• 대한간호학회지
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• 제42권7호
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• pp.1070-1078
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• 2012

Purpose: The purpose of this study was to examine the effects of a face-to-face self-management educational program on knowledge, self-care practice and kidney function in patients with chronic kidney disease (CKD) before kidney replacement therapy. Methods: This study employed a nonequivalent control group, non-synchronized design. Data were collected from 61 patients with CKD visiting an outpatient department of nephrology in a university hospital in Seoul, South Korea. The experimental group (n=31) took the pre-test, then after 3 weeks, face-to-face education and individualized consultation (1st intervention), after a week of self-practice, the 1st post-test, followed by re-enforcement education and consultation (2nd intervention), and 4 weeks later, the 2nd post-test. The control group (n=30) took the pre-test and post-tests at 4 and 8 weeks. Results: Scores for knowledge of CKD and self-care practice over time improved significantly in the experimental group compared to the control group. Kidney function did not improve significantly in the experimental group. Conclusion: Health care providers can identify various and individualized needs, and provide effective education and consultation through face to face self-management for patients with chronic irreversible illnesses. Nurses can coordinate for these program by designing and providing systematic and effective education.

• Journal of Yeungnam Medical Science
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• 제40권2호
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• pp.146-155
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• 2023

Background: Despite the recent increasing trend in the prevalence of type 2 diabetes among older individuals, the relationship between diabetic retinopathy (DR) and chronic kidney disease (CKD) in these patients remains unclear. This study investigated the severity of renal dysfunction according to the degree of DR in older patients with type 2 diabetes. Methods: A total of 116 patients with diabetes and CKD stage ≥3 who visited both the nephrology and ophthalmology outpatient departments between July 2021 and January 2022 were screened. There were 53 patients in the no DR group, 20 in the nonproliferative DR (NPDR) group, and 43 in the proliferative DR (PDR) group. Results: DR severity was related to the deterioration of renal function. The proportion of patients with advanced CKD significantly increased with DR severity (p for trend <0.001). In the multivariate regression model adjusted for age of ≥80 years, male sex, poorly controlled diabetes, macroalbuminuria, insulin use, diabetes duration of ≥10 years, cerebrovascular accident, hypertension, hyperlipidemia, and cardiovascular disease history, the odds ratio compared with the no DR group was approximately 4.6 for the NPDR group and approximately 11.8 for the PDR group, which were both statistically significant (p=0.025 and p<0.001, respectively). Conclusion: DR severity in older patients with diabetes may be associated with deterioration of renal function and high prevalence of advanced CKD. Therefore, periodic examination for DR in older patients with diabetes is important for predicting renal function deterioration and CKD progression.

• 비만대사연구학술지
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• 제1권2호
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• pp.66-73
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• 2022

Obesity is an increasing public health and medical issue worldwide. It has been associated with several comorbidities, including diabetes, cardiovascular disease, stroke, and cancer. Chronic kidney disease (CKD) is another important comorbidity of obesity. Other major causes of CKD include hypertension and diabetes. However, the association between obesity and CKD is often overlooked. Among patients with CKD, patients with obesity were more vulnerable to have rapid kidney function decline than that of those with normal weight. Additionally, CKD is more prevalent among patients with obesity. These aggravations are induced through multiple mechanisms, specifically metabolic impairment of obesity and mechanical burden because of increasing intraabdominal renal pressure. Furthermore, the inflammation and lipotoxicity, caused by obesity, are critical in the CKD aggravation in patients with obesity. To prevent this, all adult patients with obesity are tested for CKD. The workup includes the estimated glomerular filtration rate and regular follow-up. Step-wise management is required for patients with obesity with CKD. Prompt reduction and management of obesity effectively delay CKD progression among patients with obesity and CKD. Therefore, weight loss is a core management for patients with obesity and CKD. Based on several studies, this article focused on the association between CKD and obesity, as well as the diagnosis and weight management of patients with obesity and CKD.

• Kidney Research and Clinical Practice
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• 제37권4호
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• pp.384-392
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• 2018

Background: A very low protein diet (VLPD) with ketoacid analogs of essential amino acids (KA/EAA) administration can remarkably influence protein synthesis and metabolic disturbances of patients with advanced chronic kidney disease (CKD), and may also slow the decline in renal function. Methods: A retrospective cohort study was carried out to monitor renal progression and metabolic and nutritional status among 140 patients with CKD stage III or IV. One group (n = 70) was on a low protein diet (LPD) with 0.6 g of protein intake, and another group (n = 70) was on a VLPD with 0.3 g of protein and KA/EAA supplementation of 100 mg/kg/day for 12 months. Results: At 12-month follow-up, estimated glomerular filtration rate (GFR) significantly decreased from $41.6{\pm}10.2$ to $36.4{\pm}8.8mL/min/1.73m^2$ (P < 0.001) and urine protein increased from $0.6{\pm}0.5$ to $0.9{\pm}1.1g/day$ (P = 0.017) in the LPD group, but no significant changes in estimated GFR and urine protein were found in the VLPD plus KA/EAA group. A significant mean difference in rate of change in estimated GFR ($-5.2{\pm}3.6mL/min/1.73m^2$ per year; P < 0.001) was observed between the two groups. After Cox regression analysis, treatment with VLPD plus KA/EAA significantly protected against the incidence of declining GFR > 10% annually (adjusted hazard ratio, 0.42; 95% confidence interval, 0.23-0.79; P = 0.006) and significant correlations were found between using VLPD plus KA/EEA and increased GFR. Conclusion: VLPD supplementation with KA/EAA is associated with delayed renal progression while preserving the nutritional status in the patients with CKD. Co-administration of VLPD and KA/EAA may prove an effective alternative to conservative management of CKD.

• Childhood Kidney Diseases
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• 제9권1호
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• pp.83-90
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• 2005

Focal segmental glomerulosclerosis(FSGS) has been detected in approximately 10% of cases of Idiopathic nephrotic syndrome in children, and exhibits a poor response to initial steroid therapy, as well as a higher rate of progression to chronic renal failure and relapse after kidney transplantation. We describe a case of an eleven year-old boy with steroid-resistant FSGS who exhibited a response to a second trial of cyclosporin h(CsA) therapy. At the age of 26 months, this patient was diagnosed with steroid-resistant FSGS. For 9 years, he had undergone a gauntlet of therapies to induce remission; oral steroids, cyclophosphamide, methylprednisolone(mehyIPd) pulse therapy, CsA, and ibuprofen therapy. Although these therapies failed to induce remission, the patient's renal function remained In the normal range during the nine years of treatment. At the age of ten years, the patient's proteinuria decreased, and complete remission was attained with a second administration of CsA, coupled with a low dose of oral steroids. This patient continues to receive CsA without relapse. Therefore, our major concern involves the possibility of relapse after the discontinuation of CsA therapy Our findings in this case suggest that, in cases of refractory FSGS, if renal insufficiency does not emerge, aggressive therapy for the amelioration of proteinuria should be continuously pursued.

• Journal of Chest Surgery
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• 제43권6호
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• pp.739-742
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• 2010

투석중인 40세의 만성 신부전 환자가 우측 쇄골하정맥 협착증으로 지역병원에서 2개의 스텐트를 삽입하였다. 경과 관찰 중 한 개의 스텐트가 우심실로 이동하면서 삼첨판막 폐쇄부전이 발생하였다. 경피적으로 스텐트 제거를 시도하였으나 실패하여 개흉 성장수술로 제거하면서 삼첨판막 성형술을 시행하여 좋은 결과를 보였기에 보고하고자 한다.