• 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.

• 한국임상수의학회지
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• 제29권6호
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• pp.435-440
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• 2012

이번 연구는 만성신부전이 있는 개에서 대황 추출물($Rubenal^{(R)}$)의 치료적 효과와 부작용을 평가하기 위해서 실시되었다. 보호자가 있는 만성신부전 IRIS II-III 단계의 개 40마리가 이번 연구에서 사용되었다. 개들에게 동일한 모양의 대황 추출물과 위약을 투여한 후 0, 30, 90, 180일 동안 관찰, 평가하였다: BSC, 임상적 평가(식욕, 다음/다뇨, QOL), 혈액 검사(WBC, RBC, PCV), 혈청화학검사(ALT/AST, ALP, Creatinine /BUN, Total protein, albumin), 전해질검사(Na, K, Cl, Ca, iCa, P), 혈압, 요검사(UPC, 요비중) 그리고 IRIS 단계를 평가하였다. 이번 연구에서 개들에게 대황 추출물을 적용하였을 때 부작용 없이 잘 받아들이는 것을 확인하였다. 또한, 통계학적으로 임상적 평가(수의사와 보호자의 QOL)와 혈청 BUN, creatinine 수치, 혈청 인 농도, 단백뇨의 양, 그리고 만성신부전의 IRIS 점수가 루비날치료 6개월 후에 유의성 있게 개선되었다. 이러한 발견은 대황의 추출물은 만성신부적의 임상증상(i.e., azotemia, hypertension, proteinuria, hyperphosphoremia)과 삶의 질(i.e., body condition score, appetite and PD/PU)을 향상시키고, 개에서 만성신부전의 진행을 늦출 수 있다는 것을 보여준다. 그러므로 대황 추출물은 준임상적, 그리고 임상적으로 신장 질환을 치료하고 있는 개에게 좋은 보조제가 될 수 있다. 하지만 본 연구는 작은 규모의 파일럿 연구이므로 이중 맹검법의 대규모 실험을 통해 보다 정확한 실험결과의 재현이 요구된다.

• Korean Circulation Journal
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• 제53권7호
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• pp.425-451
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• 2023

Most patients with heart failure (HF) have multiple comorbidities, which impact their quality of life, aggravate HF, and increase mortality. Cardiovascular comorbidities include systemic and pulmonary hypertension, ischemic and valvular heart diseases, and atrial fibrillation. Non-cardiovascular comorbidities include diabetes mellitus (DM), chronic kidney and pulmonary diseases, iron deficiency and anemia, and sleep apnea. In patients with HF with hypertension and left ventricular hypertrophy, renin-angiotensin system inhibitors combined with calcium channel blockers and/or diuretics is an effective treatment regimen. Measurement of pulmonary vascular resistance via right heart catheterization is recommended for patients with HF considered suitable for implantation of mechanical circulatory support devices or as heart transplantation candidates. Coronary angiography remains the gold standard for the diagnosis and reperfusion in patients with HF and angina pectoris refractory to antianginal medications. In patients with HF and atrial fibrillation, longterm anticoagulants are recommended according to the CHA₂DS₂-VASc scores. Valvular heart diseases should be treated medically and/or surgically. In patients with HF and DM, metformin is relatively safer; thiazolidinediones cause fluid retention and should be avoided in patients with HF and dyspnea. In renal insufficiency, both volume status and cardiac performance are important for therapy guidance. In patients with HF and pulmonary disease, beta-blockers are underused, which may be related to increased mortality. In patients with HF and anemia, iron supplementation can help improve symptoms. In obstructive sleep apnea, continuous positive airway pressure therapy helps avoid severe nocturnal hypoxia. Appropriate management of comorbidities is important for improving clinical outcomes in patients with HF.

• Childhood Kidney Diseases
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• 제2권2호
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• pp.125-132
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• 1998

목 적 : 초기만성신부전증에서 저단백식이를 항고혈압제와 병행 투여하였을 때 저단백식이 단독 투여 때보다 만성신부전의 진행속도 및 혈압조절에 어떠한 영향을 주는지 알기 위하여 저자들은 실험동물 백서를 이용하여 excision remnant kidney model로 만성 신부전을 유발시켰다. 방 법 : 5/6신 절제술로 만성 신부전을 유발시킨 백서를 순술 제 7일부터 무작위로 저단백식이 ($6\%$단백식이) 단독투여군, 저단백식이 enalapril 투여군 (식수 1 L당 50 mg),저단백식이 nicardipine 투여군 (사료 g당 0.2mg)로 나누어 신절제술후 4주, 12주, 16주에 단백뇨의 변화, 신 조직의 mesangial matrix expansion score 및 morphometric analysis로 분석한 사구체용적의 변화를 비교 분석하였다. 결 과 : 1)저단백식이 단독투여군은 신절제술후 계속 혈압이 증가됨을 볼 수 있었으며, 저단백식이 항고혈압제투여군은 신절제술후 8주부터 항고혈압제 투여 7주 후부터 저단백식이 단독투여군에 비해 혈압이 조절되기 시작하였다. 2)신절제술후 16주 째의 24시간 뇨단백은 세군 모두 크게 증가되지 않았으나 저단백식이 enalapril 투여군, 저단백식이 nicardipine투여군은 저단백식이 단독투여군에 비해 24시간 뇨단백의 양이 통계적으로 의미있게 낮았다. 3) 신절제술후 16주째 크레아티닌 청소 율은 저단백식이 단독투여군은 $1.57{\pm}0.11\;mL/min$, 저단백식이 enalapril 투여군 $1.37{\pm}0.14\;mL/min$, 저단백식이 nicardipine 투여군 $1.11{\pm}0.16\;ml/min$ 이었다. 4) 저단백식이 단독투여군의 잔여 신장무게는 신절제술후 4주 $1.33{\pm}0.04g$, 12주 $1.45{\pm}0.05g$, 16주 $1.44{\pm}0.16g$으로 12주 이후 잔여 신장무게의 증가를 관찰할 수 없었다. .신절제술후 16주에 관찰한 저단백식이 단독투여군과 저단백식이 항고혈압제투여군간의 잔여 신장무게는 통계적인 차이는 없었다. 5) 저단백식이 단독투여군의 mesangial matrix expansion score는 12주째 증가소견을 보였고 저단백식이 항고혈압제투여군은 항고혈압제 투여에도 불구하고 12주 이후 mesangial matrix expansion score의 의미있는 증가소견이 없었고 세군 간의 차이도 없었다. 6) 저단백식이 단독투여군의 사구체용적은 12주째 증가소견을 보였고 저단백식이 항고혈압제 투여군은 항고혈압제 투여에도 불구하고 12주 이후 사구체용적의 의미있는 증가소견이 없었고 세군 간의 차이도 없었다. 결 론 : 초기만성신부전증에서 저단백식이는 혈압을 조절시키지 못하였고 저단백식이 항고혈압제투여군은 저단백식이 단독투여군보다 혈압조절 및 단백뇨의 감소 소견은 유의한 차이를 보였으나, mesangial matrix expansion score,대상성 사구체비대는 통계적으로 유의한 차이를 보이지 않았다. 그러므로 만성신부전의 진행을 지연시키는데 있어서 저단백식이와 함께 항고혈압제를 추가하였을 때 항고혈압제에 의한 추가적인 지연 효과는 관찰되지 않았다.

• Journal of Korean Neurosurgical Society
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• 제58권4호
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• pp.389-392
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• 2015

Brown tumors also called as osteoclastomas, are rare nonneoplastic lesions that arise in the setting of primary or secondary hyperparathyroidism. Parathyroid adenomas or hyperplasia constitute the major Brown tumor source in primary hyperparathyroidism while chronic renal failure is the leading cause in secondary hyperparathyroidism. Most of the patients with the diagnosis of primary hyperparathyroidism present with kidney stones or isolated hypercalcemia. However, nearly one third of patients are asymptomatic and hypercalcemia is found incidentally. Skeletal involvement such as generalized osteopenia, bone resorption, bone cysts and Brown tumors are seen on the late phase of hyperparathyroidism. The symptoms include axial pain, radiculopathy, myelopathy and myeloradiculopathy according to their locations. Plasmocytoma, lymphoma, giant cell tumors and metastates should be ruled out in the differential diagnosis of Brown tumors. Treatment of Brown tumors involve both the management of hyperparathyroidism and neural decompression. The authors report a very rare spinal Brown tumor case, arisen as the initial manifestation of primary hyperparathyroidism that leads to acute paraparesis.

• Childhood Kidney Diseases
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• 제20권2호
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• pp.74-78
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• 2016

Purpose: Early diagnosis and treatment of urinary tract infection have been emphasized to prevent renal scarring. If untreated, acute pyelonephritis could cause renal injury, which leads to renal scarring, hypertension, proteinuria, and chronic renal failure. The purpose of this study was to assess risk factors of renal scarring after treatment of acute pyelonephritis (APN). Methods: The medical records of 59 patients admitted at Daegu Fatima Hospital because of APN between March 2008 and April 2015 whose renal cortical defects were confirmed by using initial technetium-99m dimercaptosuccinic acid (DMSA) scans were reviewed retrospectively. We divided 59 patients into 2 groups according to the presence of renal scar and assessed risk factors of renal scar, including sex, age at diagnosis, feeding method, hydronephrosis, bacterial species, vesicoureteral reflux, and vesicoureteral reflux grade. Results: Of 59 patients (41%), 24 showed renal scar on follow-up DMSA scan. No significant differences in sex, hydronephrosis, bacterial species, and fever duration were found between the renal-scarred and non-scarred groups. As for age at diagnosis, age of >12 months had 5.8 times higher incidence rate of renal scarring. Vesicoureteral reflux (VUR) affected renal scar formation. VUR grade III or IV had 14.7 times greater influence on renal scar formation than VUR grade I or II. Conclusion: Our data suggest that the presence of VUR and its grade and age at diagnosis are risk factors of renal scar on follow-up DMSA scan after APN.

• 중환자간호학회지
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• 제4권2호
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• pp.47-60
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• 2011

Purpose: The purpose of this study was to develop a standardized education protocol for peritoneal dialysis patients. Methods: First, the demand for education was investigated from the 27 patients on peritoneal dialysis and 16 guardians, and later, the standardized nursing education protocol has been developed through the comprehensive literature review and the critical analysis of the related studies. Contents validity and applicability have been tested through the expert group survey. Results: The standardized peritoneal dialysis nursing education protocol with 9 areas and 20 items has been developed. The content validity for timing and duration, contents, method, and place of education proposed by the protocol were all above than 0.8. In terms of the applicability of the protocol, the experts scored between 4.20 to 4.93 for all items except one. The item on home visit education acquired the lowest applicability score, because there might exist potential restrictions in visiting patient's home. Conclusion: The standardized education protocol developed in this study turned out to be adequate by representing high content validity for all items and the applicability also was high except the item on home visit education. Further researches to test the effects of this education protocol should be done.

• 근관절건강학회지
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• 제30권1호
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• pp.25-35
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• 2023

Purpose: This study was conducted to examine the effects of ethyl chloride spray during arteriovenous fistula puncture on pain, depression, and noncompliance in hemodialysis patients. Methods: This study used a randomized controlled trial design on adults with chronic renal failure who received hemodialysis treatment through arteriovenous fistula. Ethyl chloride spray was applied to 20 subjects in the experimental group during arteriovenous fistula puncture, and a placebo spray was applied to 20 subjects in the control group; the intervention was conducted 12 times for 4 weeks. A total of 33 participants were used in the final analysis. The outcomes were measured using the face pain rating scale, Center for Epidemiological Studies Depression Scale (CES-D), and modified United States Renal Data System tools. Results: As a result of the pre-homogeneity test between the two groups, it was confirmed that the sexes were not homogeneous. Therefore, sex was treated as a covariate and analyzed. Puncture pain was significantly reduced in the experimental group (p<.001). However there was no significant difference between the groups in depression and noncompliance. Conclusion: Ethyl chloride spray was convenient and effective pain management intervention for both hemodialysis patients and medical staff.

• Childhood Kidney Diseases
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• 제13권2호
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• pp.99-117
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• 2009

당뇨병성 신병증은 최근 우리나라를 포함한 서구 사회에서는 만성 신부전의 가장 많은 원인 중 하나이며, 꾸준히 증가추세이다. 조직학적으로는, 사구체, 세뇨간질, 소동맥 등 신장의 주요 부위에 병변이 나타나는데, 특징적으로 사구체 기저막의 비후와 족세포의 변화와 함께 사구체 경화, 소동맥의 유리질 경화와 세뇨간질 부위에 섬유화 등이 나타난다. 당뇨병성 신병증은 혈역학적 인자들과 대사성 인자들 간의 복잡한 상호작용의 결과로 일어난다. 고혈당은 혈류역학적 요소로 고혈압과 함께 사구체내압의 증가와 혈관활성물질의 활성화에 함께, 비혈역학적 경로들, 예를 들면, 후기 당화합 최종생성물 생성, 세포 내 신호전달체계와 물질, 시토카인, 산화 스트레스 등 다양한 원인들을 활성화시킨다. 이러한 대사적, 혈류역학적인 인자들은 신장의 알부민 투과성을 증가시키고 세포 외 기질의 축적을 일으키며 결과적으로 증가된 단백뇨, 사구체경화와 세뇨관간질의 섬유화를 일으키게 된다.

• 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.