• Journal of Yeungnam Medical Science
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• 제30권2호
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• pp.136-140
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• 2013

Diabetic nephropathy (DN) is a common complication and the leading cause of end-stage renal disease (ESRD) in diabetic patients. The occurrence of non-diabetic renal disease (NDRD) in diabetic patients has been increasingly recognized in recent years. Generally, renal injuries in DN are deemed difficult to reverse, whereas some NDRDs are often treatable and even remittable. Thus, the diagnosis of NDRD in patients with diabetes mellitus (DM) via a kidney biopsy would be significant for its prognosis and therapeutic strategy. According to recent studies, the most common NDRD is IgA nephropathy in type 2 diabetic patients, and some cases of minimal change disease and membranous glomerulonephritis have been reported in Korea. However, membranoproliferative glomerulonephritis (MPGN) is an uncommon condition in diabetic patients. To our knowledge, there has been no case yet of MPGN, except in a child with type 1 DM. We present an unusual case of a 27-year-old woman who had type 2 DM with MPGN, as confirmed via a kidney biopsy.

• 한국임상수의학회지
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• 제28권1호
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• pp.63-70
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• 2011

To consider the iliac fossa as the vascular anastomosis site of kidney transplantation for the short-term study of acute rejection in pigs. Twelve domestic pigs weighing 39~48 kg underwent heterotopic renal allgraft transplantation. The experimental animals were divided into 2 groups in terms of renal vascular anastomosis site; the external iliac artery and vein were used in iliac fossa model (n = 6), the abdominal aorta and the caudal vena cava inferior to the kidney were used in abdominal cavity model (n = 6). Renal function was evaluated by daily measurement of plasma creatinine and BUN concentrations. The experiments' health including postoperative complications was also assessed daily for 8 days after transplantation. After euthanazation gross and histopathologic analysis was performed. All six pigs in iliac fossa model developed neuropraxia and lameness of the ipsilateral pelvic limb. However, no necrosis was observed in any pigs. In the abdominal cavity model, durations of both the surgical operation and the vascular anastomosis were significantly longer than those in the iliac fossa model. Furthermore, ischemia injury of the transplanted kidney was increased in abdominal cavity model, which induced accelerated-acute immune response from day 4 after transplantation. Despite of pelvic limb complication, the iliac fossa model showed more advantages including not only less ischemia time related to easy vascular anastomosis, but also less immune response during the acute rejection period. The results indicate that the iliac fossa model may be appropriate to the study of acute rejection in porcine kidney transplantation.

• 중환자간호학회지
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• 제9권1호
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• pp.40-50
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• 2016

Purpose: Continuous renal replacement therapy (CRRT) has become the preferred dialysis method to support critically ill children and neonates with acute kidney injury. Using CRRT on neonates has increased, but reports about experience are limited. The aim of this study is to describe the clinical application, outcomes, and complications of CRRT in children and neonates. Methods: A retrospective review was performed in 135 children and 36 neonates who underwent CRRT at a tertiary hospital from 2008 to 2015. Results: At the initiation of CRRT, the median age of children was 72 months and the corrected age of neonates was 37.1 weeks. Median body weight of neonates was 3.2 kg. In neonates, initial degree of fluid overload [FO%], blood flow rate [BFR] and ultrafiltration rate [UFR] rate during CRRT were higher than in children. Median real time of CRRT was 90.5 and 53.5 hours in children and neonates, respectively. Downtime of CRRT was 0.7 and 1.3 hours/day. Median mortality rates (44.4% vs.47.2%) and complication rates were similar between the groups. Conclusion: CRRT can be used for a wide range of critically ill children and neonates. Different application methods of CRRT can contribute to increased survival of neonates.

• Journal of Chest Surgery
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• 제22권2호
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• pp.191-201
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• 1989

Nowadays, in spite of the remarkable development of the results of open heart surgery, the incidence of postoperative acute renal failure [ARF] has been increased due to the expansion of the candidates and prolonged operation time for complicated cases. It is also well known that ARF after open heart surgery, if once occurred, is a critical complication, therefore early diagnosis and treatment about it are very important for prognosis. Recently a low molecular weight [2 * microglobulin [[2* MG]has been used as a indicator of renal function. Because of the properties of [2 * MG, serum concentration of it is increased in glomerular dysfunction and urine excretion of it is increased in tubular dysfunction. Author studied about the perioperative changes of serum [2* MG and BUN concentration in 25 children and 30 adults for evaluation of significances of [2* MG as a parameter of postoperative renal function in open heart surgery, and the results were obtained as follows. l. In open heart surgery, the serum [2* MG concentration was elevated postoperatively in the all cases from the first postoperative day. 2. There were a significant correlation between the preoperative BUN and [2* MG concentration [P< 0.01]. The correlation factor[r] in child group was 0.8512, and in adults 0.8636. 3. The maximum level of serum [2* MG in the both child and adult groups were noticed in 4th postoperative day as 2.61*0.80mg/ 1 in child group and 3.39*1.47 mg/ 4 in adult group, and there was a significant difference between the two groups statistically[P < 0.05]. 4. The pattern of changes of serum concentration of [2* MG with time was very similar with the changes of BUN, but in a case of ARF [expired with it] the changes of [2* MG was more remarkable. 5. There was a significant differences in the maximum level of [2* MG between the 2 group according to the ECC time [groups of below and above 60 minutes] [P< 0.01].

• Korean Journal of Acupuncture
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• 제19권1호
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• pp.47-56
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• 2002

The frequency of the hypertension is increasing as the life level is improved and an average span of the life is extended since we approached modern stage. The hypertension is also dangerous disease which raises fatal complication for example with the bleeding aproplexy and the ischemic attack. The medicinal treatment about the hypertension is required patients to take continually. The acupuncture have been introduced because a medicine-chemical treatment hasn't good influence on the human body. It recently has been processed that studies acupuncture effect for blood pressure and have been found out that blood pressure go down. The object of this study observe the effect of LR3 acupuncture on hypertension in Renal Hypertension RAT induced by 2K1C. The 2K1C model was based on renin-angiotensin system. We put the silver clip in renal artery to induce renal hypertension. We try to observe that LR3 acupuncture influence on the blood pressure and c-fos expression in CVLM, NTS, RVLM. In results, the blood pressure was decreased during acupuncture than before acupuncture, after acupuncture. The heart rate was also decreased during acupuncture than before acupuncture, after acupuncture. The LR3 acupuncture significantly effects on blood pressure and heart rate (P<0.05). The increased expression of c-fos was shown in CVLM, NTS, but not in RVLM. In conclusion, LR3 was relived the action of control upon the hypertension and related with medulla, particularly CVLM, NTS. It needs to be closely examined pharmacological mechanism and studied combination with other acupoints.

• International Neurourology Journal
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• 제22권4호
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• pp.287-294
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• 2018

Purpose: Augmentation cystoplasty (AC) is a surgical procedure used in adults and children with refractory bladder dysfunction, including a small bladder capacity and inadequate bladder compliance, and in whom conservative and medical treatment has failed. This study was aimed to determine the long-term outcomes of AC in children. Methods: A retrospective analysis was conducted of 42 patients (31 males; mean age, $14.2{\pm}6.2years$) who underwent AC for neurogenic and nonneurogenic bladder dysfunction, with a median $12.0{\pm}1.5years$ of follow-up. All patients underwent AC using the ileum with or without continent reconstruction. Pre-AC, concurrent, and post-AC procedures and complications were analyzed. Patients who underwent ureterocystoplasty, were lost to follow-up, or had less than 10 years of follow-up were excluded. The primary outcomes were the complication and continence rates, the post-AC linear rate of height and weight gain, and renal function. The Student t-test was used to evaluate between-group differences and the paired t-test was used to evaluate longitudinal changes in measured variables. Results: Renal function was stable or improved in 32 of 42 patients (76.2%), with a post-AC continence rate of 88.1%. Thirty patients (71.4%) required 72 procedures post-AC. There was no statistically significant difference in the mean percentile of height (P=0. 212) or weight (P=0.142) of patients in the pre- and post-AC periods. No cases of bladder perforation or malignancy were detected. Conclusions: We consider AC to be a safe and effective procedure that does not negatively affect future physical growth, while achieving a good rate of stable renal function. Patients need long-term follow-up to address long-term complications.

• Clinical and Experimental Pediatrics
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• 제45권2호
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• pp.232-239
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• 2002

목 적 : 낭포성 신질환은 다양한 원인, 증상, 예후를 나타내며 최근 들어 영상 진단의 발전으로 조기 진단이 가능해지면서 병인, 유전, 자연 경과 등에 대한 연구가 활발히 진행되고 있다. 본 연구에서는 낭포성 신질환 환아들을 대상으로 그 빈도, 임상양상, 동반기형, 치료 및 예후 등을 분석하여 향후 진단 및 치료에 도움이 되고자 하였다. 방 법 : 1989년 10월부터 2001년 6월까지 15세 이하의 낭포성 신질환 환아 95례를 대상으로 후향적 고찰을 시행하였다. 산전 초음파로 발견된 경우 출생 후 초음파를 다시 시행하여 진단하였으며 질환에 따라 DMSA, DTPA, MAG-3 신스캔, 배뇨성 방광 요도 조영술, 전산화 단층 촬영, 자기 공명 영상 등을 시행하였다. 결 과 : 1) 대상 환아는 총 95례였고, 추적 관찰 기간은 1개월에서 8년 4개월이었다. 다낭포성 신이형성증이 55례(58.5%)로 가장 많았고, 단순 낭포신은 19례(20.2%)였으며, 그중 단일 신낭포가 15례(13.8%). 다낭포가 4례(4.2%)였다. 유전성 다낭포신은 13례(13.7%)였고, 그중 상염색체 열성 다낭포신이 7례(7.4%), 상염색체 우성 다낭포신이 5례(5.3%)였다. 수질 낭성 질환은 1례(1.0%)였고, 결절성 경화증과 동반된 신낭포는 6례(6.3%)였다. 2) 진단은 다낭포성 신이형성증의 경우 총 55례 중에서 산전 초음파로 진단된 경우가 49례(89.0%)로 가장 많았으며, 단순 신낭포는 비특이적인 증상으로 방문하여 검사 도중 우연히 발견된 경우가 18례(94.7%)로 가장 많았다. 유전성 다낭포신 환아는 산전 초음파로 진단된 경우가 5례(38.5%), 복부 종괴에 대한 검사로 발견한 경우가 3례(23.0%), 복통이나 야뇨증 등의 비특이적인 증상으로 검사 중 우연히 발견된 경우가 2례(15.4%), 혈뇨에 대한 검사 중 발견한 경우가 2례(15.4%), 가족력이 있어 발견된 1례(7.7%)가 있었다. 결절성 경화증 환아의 경우는 동반 질환 유무를 알기 위해 시행한 복부 초음파에서 신낭포가 발견되었다. 3) 동반된 요로계 기형 및 질환은 다낭포성 신이형성증 환아들의 경우 반대측 신장의 방광 요관 역류가 9례(16%)로 가장 많았으며 비뇨기계 이외의 동반기형으로는 심장 기형이 5례로 가장 흔했다. 상염색체 열성 다낭포신의 경우 방광 요관 역류, 췌장 낭포가 동반된 경우가 각각 1례가 있었고, 단순 신낭포는 2례에서 난소 낭포가 관찰되었다. 4) 임상 경과로 다낭포성 신이형성증의 경우는 추적 관찰 기간 중에 모두 합병증은 없었다. 유전성 다낭포신 질환 13례 중 상염색체 우성 다낭포신 환아 2례가 각각 6세, 8세에 말기 신부전으로 진행하였고, 상염색체 열성 다낭포신 환아 1례는 생후 5개월에 말기 신부전으로 진행하였다. 단순 신낭포의 경우 요관 신우 연결 부위 폐쇄 및 신우 압박이 관찰된 1례에서 복강경을 통한 malsupialization을 시행하였고, 1례의 수질 낭성 질환 환아는 진단 당시 이미 말기 신부전으로 진행되어 있어 신이식을 받았다. 결 론 : 낭포성 신질환은 여러 가지 임상 및 병리적인 소견을 보이며, 무증상으로 지내다가 우연히 발견되어 치료가 필요 없이 경과 관찰만 필요한 질환부터 신생아기부터 신부전으로 진행되거나, 비뇨기계 뿐만 아니라 비뇨기계 이외의 기형도 동반하는 질환까지 그 양상이 다양하다. 그러므로, 각 질환 별로 발생할 수 있는 고혈압, 신부전, 감염 등의 합병증을 적절히 치료하기 위해서는 조기 발견, 정확한 진단, 정기적인 추적 관찰이 중요할 것으로 판단된다.

• 대한핵의학회지
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• 제34권6호
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• pp.497-507
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• 2000

목적: 저자들은 이식 초기 이식신의 기능을 평가하기 위하여 시행한 $^{99m}Tc$-MAG3 신신티그라피에서 측정한 관류기 지표의 특성과 소견을 알아보고 신장 기능 이상을 초래하는 합병증의 진단에 이들 지표들이 얼마나 유용하게 이용될 수 있는 지를 규명하고자 하였다. 대상 및 방법: 신장 이식을 받은 환자 80명(남자: 48명, 여자: 32명, 평균 나이: 40.3세)을 대상으로 하였고, 조직검사, 검사실시험 소견 및 임상 경과 등을 종합하여 진단하였다. 신신티그라피는$^{99m}Tc$-MAG3, 100 MBq을 사용하여 이식 후 11일-23일 사이에 얻었다. 신전체 및 신피질 레노그람에서 측정한 신관류 지포는 Hilson관류지표(PI), 이식신 관류지표(TP)와 이식신 기능지표(TF)였고, 신기능 지표는 최대방사능 도달시간(Tmax)과 3분과 20분 방사능 비(K20/3)였다. 결과: 신신티그라피 시행 당시의 진단은 정상 신기능을 보인 경우가 44예, 급성거부가 14예, 급성 세뇨관괴사가 10예이었고 싸이클로스포린 A 신독성은 12예이었다. TP와 TF는 정상 신기능 군에 비해 합병증 군에서 통계적으로 유의하게 높았지만 PI는 유의한 차이가 없었다. 또한 정상 신기능 군에 비해 K20/3은 급성 거부와 급성세뇨관괴사에서, 신전체 Tmax은 급성거부에서 각각 유의하게 높았다. 합병증 군들 사이에서 유의한 차이를 보인 관류기 지표는 없었고 신기능 지표 중 K20/3은 싸이클로스포린 A 신독성에 비해 급성거부에서, 신피질 K20/3은 급성세뇨관괴사에서 각각 유의하게 증가하였다. 결론: $^{99m}Tc$-MAG3 신신티그라피를 이용한 이식 초기 이식신의 기능 평가에는 최초 동맥기 이후의 미세 관류와 초기 세뇨관 섭취를 나타내는 지표들인 TP와 TF가 중요한 역할을 하며, 신신티그라피 일 회 검사로 신장 기능의 이상을 초래하는 합병증의 감별은 쉽지 않지만 신 관류와 기능 지표를 연관시키고 검사 당시 질병의 진행 과정과 정도를 고려하면 진단에 도움이 되리라 생각한다.

• Journal of Yeungnam Medical Science
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• 제16권1호
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• pp.94-100
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• 1999

본 연구는 신보존수술의 임상적 가치를 알아보기 위해, 반대측 신장이 기능적으로 정상인 작은 크기의 고형 신종양 환자를 대상으로 신보존수술을 이용한 환자의 임상 경과를 후향적인 조사를 통하여 알아보고자 하였다. 21례의 환자중 술전 방사선 영상 소견상 신세포암으로 추정된 15례의 환자는 술후 병리조직학적 검사 결과 14례에서 신세포암($T_1N_0M_0$ : 14례)으로, 1례에서 호산성과립세포종으로 진단되었다. 신혈관지방종으로 추정된 4례는 역시 신혈관지방종으로 진단되었고, 또한 신세포암과 구별하기 어려웠던 2례는 선혈관지방종 및 해면상혈관종으로 각각 밝혀졌다. 신세포암의 재발, 원격 전이 및 신세포암으로 인한 사망 등은 추척 관찰 기간(평균 18.6개월, 1-103개월) 중 관찰되지 않았고 양성 신종양 환자군에서도 종양의 재발은 관찰되지 않았다(평균 추척 관찰 기간 : 43.8개월, 7-97개월). 신보존수술의 합병증으로는 1례의 신세포암에서 wedge resection을 시행한 후 술후 10일에 신출혈로 인한 육안적 혈뇨 및 혈압 저하의 소견이 나타나 근치적 신적출술을 시행하였고, 그 외 다른 환자에서는 요낭종, 후복막혈종 및 폐 색전증 등과 갈은 합병증은 관찰되지 않았다. 이상의 결과에서, 대측 신장의 기능이 정상인 작은 표기(4cm 이하)의 단일 고형 신종양 환자일 경우 신기능을 보존하기 위하여 신보존수술은 좋은 치료법으로 생각되며 일차적인 치료법으로 사용되어도 유익하리라 기대되나, 향후 보다 장기적인 추적 관찰이 필요하리라 생각된다.

• Journal of Nutrition and Health
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• 제42권8호
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• pp.673-681
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• 2009

Diabetes mellitus is a multifactorial disease. Particularly, diabetic nephropathy is a serious complication for diabetic patients, yet the precise mechanisms that underline the initial stage of diabetic renal inflammation remain unknown. However, oxidative stress induced by hyperglycemia in diabetes is implicated in diabetic renal disease. We hypothesized that dietary supplementation of antioxidants either VCE (0.5% VC + 0.5% VE) or Comb (0.5% VC + 0.5% VE + 2.5% N-acetylcysteine) improves acute diabetic renal inflammation through modulation of blood glucose levels and antioxidant and anti-inflammatory responses. Experimental animals (5.5 weeks old female ICR) used were treated with alloxan (180 mg/kg) once. When fasting blood glucose levels were higher than 250 mg/dL, mice were divided into 3 groups fed different levels of antioxidant supplementation, DM (diabetic mice fed AIN 93G purified rodent diet); VCE (diabetic mice fed 0.5% vitamin C and 0.5% vitamin E supplemented diet); Comb (diabetic mice fed 0.5% vitamin C, 0.5% vitamin E and 2.5% N-acetylcysteine supplemented diet), for 10 days and then sacrificed. Body weights were measured once a week and blood glucose levels were monitored twice a week. Lipid peroxidation products, thiobarbituric acid reacting substances were measured in kidney. NF-${\kappa}B$ activation was indirectly demonstrated by pI${\kappa}B$-${\alpna}$ and expressions of selective inflammatory and oxidative stress markers including antioxidant enzymes were also determined. Dietary antioxidant supplementation improved levels of blood glucose as well as kidney lipid peroxi-dation. Dietary antioxidant supplementation improved NF-${\kappa}B$ activation and protein expression of HO-1, but not mRNA expression levels in diabetic mice fed Comb diet. In contrast, the mRNA and protein expression of CuZnSOD was decreased in diabetic mice fed Comb diet. However, antioxidant supplementation did not improve mRNA and protein expressions of IL-$1{\beta}$ and MnSOD in diabetic mice. These findings demonstrate that acute diabetic renal inflammation was associated with altered inflammatory and antioxidant responses and suggest that antioxidant cocktail supplementation may have beneficial effects on early stage of diabetic nephropathy through modulation of blood glucose levels and antioxidant enzyme expressions.