• Childhood Kidney Diseases
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• 제14권2호
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• pp.223-229
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• 2010

신성 고혈압은 신동맥의 협착 혹은 폐색으로 인해 유발되는 전신성 고혈압이다. 최근에는 신동맥의 재개통을 위해 PTRA가 선호되고 있지만, 복잡한 경우에 있어서는 신 자가이식이 대안적인 치료방법으로서 시행되어 왔다. 저자들은 심각한 고혈압 증상을 보인 14세 남자 환아를 PTRA 및 신 자가이식을 시행하여 성공적으로 치료하였기에 보고하는 바이다. 도플러 초음파 검사와 CT 혈관조영술상 우측 신동맥 기시부에서 약간의 좁아짐과 다발적인 측부순환을 동반한 좌측 신동맥 기시부의 완전폐색이 확인되었다. 우측 신동맥 협착의 치료를 위해 PTRA와 스텐트 삽입술을 시행하였으나 좌측 신동맥은 완전폐색으로 인해 시술이 불가능하여 좌측 신장을 절제한 후 동측 장골와에 자가이식하였다. 수술 후 시행한 도플러 초음파 검사와 MAG-3 신주사 검사상 신혈류와 신기능은 정상이었다. 혈압은 정상화되었으며 항고혈압제 투여도 점차 중단하였다. 임상적인 특성을 고려할 때 신성 고혈압의 원인은 섬유근성 형성이상으로 생각되었다. 결론적으로 신 자가이식은 혈관내 중재적 시술이 실패하였거나 불가능한 경우에 선택할 수 있는 치료방법이다.

• Childhood Kidney Diseases
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• 제23권1호
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• pp.36-42
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• 2019

Purpose: We investigated whether a renal size discrepancy on a renal sonogram (US) in children with febrile urinary tract infection (UTI) was correlated with the presence of cortical defects on their dimercaptosuccinic acid (DMSA) renal scan. Methods: We examined 911 children who were admitted consecutively to our hospital with their first episode of febrile UTI from March 2001 to September 2014. All enrolled children underwent a US and DMSA scan during admission. According to the US findings, including the renal size discrepancy, data were compared between children with positive and negative DMSA scan results. A positive DMSA scan result was defined as reduced or absent tracer localization and indistinct margins that did not deform the renal contour. Results: Mean renal lengths of the right and left kidneys were larger in children with positive DMSA scan results than in children with negative DMSA scan results ($63.2{\pm}11.3mm$ vs. $58.4{\pm}7.8mm$, P<0.001; $64.9{\pm}11.2mm$ vs. $59.9{\pm}7.9mm$, P<0.001; respectively). A significant difference was observed in both renal lengths between children with positive and negative DMSA scan results ($4.6{\pm}3.8mm$ vs. $3.3{\pm}2.6mm$, P<0.001). A multiple logistic regression analysis, revealed that a small kidney, cortical thinning, and a renal length discrepancy on US findings were significant factors for predicting the presence of cortical defects on an acute DMSA scan [P=0.028, 95% confidence interval (CI) 1.054-2.547; P= 0.004, 95% CI 1.354- 4.810; P<0.001, 95% CI 1.077-1.190, respectively]. Conclusion: In conclusion, a renal size discrepancy on US findings in children with their first episode of febrile UTI was a helpful tool for predicting the presence of cortical defects on an acute DMSA scan.

• Korean Journal of Radiology
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• 제22권8호
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• pp.1323-1331
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• 2021

Objective: To identify the association between renal tumor complexity and pathologic renal sinus invasion (RSI) and evaluate the usefulness of computed tomography tumor features for predicting RSI in patients with renal cell carcinoma (RCC). Materials and Methods: This retrospective study included 276 consecutive patients who underwent radical nephrectomy for RCC with a size of ≤ 7 cm between January 2014 and October 2017. Tumor complexity and anatomical renal sinus involvement were evaluated using two standardized scoring systems: the radius (R), exophytic or endophytic (E), nearness to collecting system or sinus (N), anterior or posterior (A), and location relative to polar lines (RENAL) nephrometry and preoperative aspects and dimensions used for anatomical classification (PADUA) system. CT-based tumor features, including shape, enhancement pattern, margin at the interface of the renal sinus (smooth vs. non-smooth), and finger-like projection of the mass, were also assessed by two independent radiologists. Univariable and multivariable logistic regression analyses were performed to identify significant predictors of RSI. The positive predictive value, negative predictive value (NPV), accuracy of anatomical renal sinus involvement, and tumor features were evaluated. Results: Eighty-one of 276 patients (29.3%) demonstrated RSI. Among highly complex tumors (RENAL or PADUA score ≥ 10), the frequencies of RSI were 42.4% (39/92) and 38.0% (71/187) using RENAL and PADUA scores, respectively. Multivariable analysis showed that a non-smooth margin and the presence of a finger-like projection were significant predictors of RSI. Anatomical renal sinus involvement showed high NPVs (91.7% and 95.2%) but low accuracy (40.2% and 43.1%) for RSI, whereas the presence of a non-smooth margin or finger-like projection demonstrated comparably high NPVs (90.0% and 91.3% for both readers) and improved accuracy (67.0% and 73.9%, respectively). Conclusion: A non-smooth margin or the presence of a finger-like projection can be used as a preoperative CT-based tumor feature for predicting RSI in patients with RCC.

• Journal of Yeungnam Medical Science
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• 제4권2호
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• pp.179-184
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• 1987

저자들은 신증후군의 증상으로 본 영남대학교 의과대학 부속병원에 내원한 환자에서 임상증상과 임상검사 소견 및 초음파, 신주사, 신동맥조영술 등의 소견으로 신정맥 혈전증을 의심하였고 신정맥조영술을 시행하여 신증후군과 동반된 신정맥 혈전증임이 확진된 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• 대한약리학회지
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• 제16권2호
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• pp.1-7
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• 1980

As it has been reported that morphine induce antidiuresis, and antinatriuresis along with decrease in renal hemodynamics when given intracerebroventricularly[ivt], the renal action of nalorphine, a partial antagonist of morphine action, and its influence upon the morphine action were investigated in this study. $10{\mu}g/kg$ of nalorphine given into the lateral ventricle of the rabbit brain tended to decrease renal plasma flow and glomerular filtration rate and increase the reabsorption of free water in the tubules. $100{\mu}g/kg$ ivt significantly decreased urine flow rate and increased free water reabsorption, and tended to increase electrolyte excretion in spite of decrease in renal plasma flow and glomerular filtration, suggesting that ADH also involved in the antidiuresis. Morphine hydrochloride, $10{\mu}g/kg$, ivt, produced marked decrement in renal hemodynamics along with decreased excretions of sodium, potassium and water, and these morphine actions were alleviated by nalorphine given 20 min later. The natriuretic action of ivt nalorphine manifested itself uninfluenced by the morphine. These observations indicate that nalorphine ivt produces renal actions similar to those of morphine, though less potent, and that it can antagonize the latter action. It is suggested that morphine influences renal hemodynamics through nerve by stimulating the 'morphine receptor' in the brain, whereas nalorphine liberates ADH by the agonistic action on the 'nalorphine receptor'.

• Childhood Kidney Diseases
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• 제19권2호
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• pp.71-78
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• 2015

The incidence of acute kidney injury (AKI) in critically ill pediatric patients has been reported as increasing to 25 %, depending on population characteristics. The etiology of AKI has changed over the last 10-20 years from primary renal disease to the renal conditions associated with systemic illness. The AKI in pediatric population is associated with increased mortality and morbidity, and prevention is needed to reduce the consequence of AKI. It is known that the most important risk factors for AKI in critically ill pediatric patients are clinical conditions to be associated with decreased renal blood flow, direct renal injury, and illness severity. Renal hypoperfusion leads to neurohormonal activation including renin-angiotensin-aldosterone system, sympathetic nervous system, antidiuretic hormone, and prostaglandins. Prolonged renal hypoperfusion can result in acute tubular necrosis. The direct renal injury can be predisposed under the condition of renal hypoperfusion, and appropriate treatment of volume depletion is important to prevent AKI. The preventable causes of AKI include contrast-induced nephropathy, hemodynamic instability, inappropriate mediation use, and multiple nephrotoxic insults. Given the evidence of preventable factors for AKI, several actions such as the use of protocol for prevention of contrast-induced nephropathy, appropriate treatment of volume depletion, vigorous treatment of sepsis, avoidance of combinations of nephrotoxic medications, and monitoring of levels of drugs should be recommended.

• 대한약리학회지
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• 제19권1호
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• pp.93-99
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• 1983

Hydrocortisone 5 mg/kg which exerts minimal effect on the renal function and furosemide 1 mg/kg which induces moderate amount of diuresis were injected intraperitoneally to study their effects on the renal cyclic nucleotides content in rats. 1) The renal tissue levels of cAMP were significantly increased by administration of hydrocortisone, but there was no significant change in the furosemide group compared with that of saline treated control group. Moderate elevation in renal cAMP level was noted by the combined administration of hydrocortisone and furosemide, but this elevation was less than that of hvdrocortisone treated group. 2) The renal cGMP level did not show nay remarkable change after the administration of hydrocortisone, however, there were a significant increase by the administration of furosemide alone or combination of both drugs. The level of renal cGMP was higher and maintained longer in the combined treated group than furosemide treated group. The result of this experiment indicates that the potentiating effect of hydrocortisone on the diuretic action of furosemide nay be related to the renal levels of cGMP rather than that of cAMP.

• 약학회지
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• 제35권2호
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• pp.85-98
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• 1991

Verapamil, $Ca^{2+}$-channel blocker, when given into vein or into carotid artery, produced the decrease of urine flow accompanied with the decreased amounts of Na$^{+}$ and $K^{+}$ excreted in urine ($E_{Na}, E_{K}$) and with the decreased clearances of free water (C$_{H_2O}$) and osmolar substance (C$_{osm}$), and then increased reabsorption of Na$^{+}$ and $K^{+}$ in renal tubules (R$_{Na}$, R$_{N}$), glomeruler filtration rate (GFR) and renal plasma flow (RPF) were inhibited when verapamil was given into carotid artery, but were only tendency of reduction when given intravenously. Verapamil, when infused into a renal artery, exhibited diuresis accompanied with the increased GER, RPF, E$_{Na}$ and E$_{K}$, with the decreased filtration fraction (FF) in only infused kidney. At the same time, $C_{H_2O}$ was not changed, R$_{Na}$ and R$_{K}$ were reduced. Antidiuretic action by verapamil administered into vein or into carotid artery in normal kidney was reversed to diuretic action in denervated kidney. At this time, parameters of renal function exhibited the opposite phenomena compared to that elicited by verapamil in normal kidney, wherease renal denervation did not influence the action of verapamil infused into a renal artery. Above results suggest that verapamil produce both antidiuresis through nervous system centrally, not endogenous substances and diuresis by direct action in the kidney. Diurectic action are caused by hemodynamic improvement through dilatioon of vas efferense and by greatly inhibited reabsorption of electrolytes in distal tubules.

• 약학회지
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• 제44권3호
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• pp.205-212
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• 2000

The effect of BRL 34915, a $K^{+}$ channe$Na^{+}$l opener, on renal function was investigated in anesthetized dog. BRL 34915, when given into the vein, elicited the decrease of urine volume accompanied with the reduction of renal plasma flow (RPF), osmolar clearance ($C_{osm}$) and amounts of sodium excreted into urine ($E_{na}$), whereas reabsorption rate of sodium in renal tubules ($R_{na}$), ratio of $K^{+}$ against $Na^{+}$ in urine ($K^{+}$ /$Na^{+}$) were elevated significantly with a partial fall of mean arterial pressure (MAP). BRL 34915 injected into a renal artery produced the diuretic action along with the increase in RPF $C_{osm}$, $E_{na}$ and amounts of potassium excreted in urine ($E_{k}$), and the decrease in $R_{na}$, reabsorption rate of potassium in renal tubules ($R_{k}$), free water clearance ($C_{H20}$) and $K^{+}/Na^{+}$ ratio in only ipsilateral kidney, however changes of the renal function were not observed in control kidney. BRL 34915 given into carotid artery exhibited the same aspect as changes of renal function induced by intravenous BRL 34915. These results suggest that BRL 34915 has dual effects, renally acting diuretic and centrally acting antidiuretic action.n.

• Childhood Kidney Diseases
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• 제1권2호
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• pp.183-188
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• 1997

Familial juvenile hyperuricemic nephropathy is an autosomal dominant disease characterized by progressive renal disease and hyperuricemia or gout, affecting young people of either sex equally. There are two biochemical markers of this disorder. The first is hyperuricemia disproportionate to the degree of renal dysfunction; the second is a grossly reduced clearance of uric acid relative to creatinine, dispropotionate to age, sex and degree of renal failure. We experienced 2 family members with hyperuricemia. One family member, a 13-year-old girl who had suffered from tophaceous gout and chronic renal failure. Her younger brother also had hyperuricemia and moderately reduced renal function. Their urinary excretion fractions of uric acid($FE_{uric\;acid}$) were reduced and renal biopsy specimens showed interstitial fibrosis with tubular atrophy and interstitial urate crystal deposition. We have treated these two patients with allopurinol but we have done renal transplantation because she progressed to end stage renal disease at 16 year old age.