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복막투석 환자에서 발생한 Chryseobacterium meningosepticum 복막염 1예
구향모 ( Hyang Mo Koo ),도화미 ( Fa Mee Doh ),김은진 ( Eun Jin Kim ),강이화 ( Ea Wha Kang ),신석균 ( Suk Kyun Shin ),장태익 ( Tae Ik Chang ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.3
Chryseobacterium meningosepticum is rarely encountered as a pathogen causing peritonitis in peritoneal dialysis (PD) patients. We report a case of peritonitis due to Chryseobacterium meningosepticum, which was treated successfully with intraperitoneal (IP) vancomycin and ciprofloxacin, and without PD catheter removal. Peritonitis was developed in a 53-year-old PD patient on the third hospital day. Although empirical IP treatment with cefazolin and tobramycin was initiated and maintained for 3 days, the fever and signs of peritonitis persisted. Antibiotics were changed to cefoperazone/sulbactam, amikacin, and vancomycin due to clinical deterioration. After 3 days of vancomycin use, leukocyte count in PD fluid was less than 100/mm3 and the patient became asymptomatic. On seventh day after the onset of peritonitis, Chryseobacterium meningosepticum was isolated from initial dialysate sample, and this strain was susceptible to ciprofloxacin, piperacillin, and piperacillin/tazobactam. Accordingly, we changed the antibiotics to ciprofloxacin and vancomycin, which were given for the total of 14 days. Even though Chryseobacterium meningosepticum is an uncommon causative organism of peritonitis in PD patients, this report suggests that vancomycin and ciprofloxacin are effective as empiric therapy, and early suspicion and appropriate antimicrobial therapy are crucial to the successful treatment of peritonitis due to Chryseobacterium meningosepticum without catheter removal.
구향모 ( Hyang Mo Koo ),김은진 ( Eun Jin Kim ),도화미 ( Fa Mee Doh ),강신욱 ( Shin Wook Kang ),최규헌 ( Kyu Hun Choi ),유태현 ( Tae Hyun Yoo ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.2
Renal anemia is a common complication of chronic kidney disease and known to be caused by erythropoietin or iron deficiency. However, erythrocytosis in patients on dialysis has rarely been reported and usually associated with renal cell carcinoma, polycythemia vera or acquired cystic kidney disease. Here we report a case of erythrocytosis in an ESRD patient with resolution after kidney transplantation. A 38-year-old man on peritoneal dialysis for 5 years was admitted for kidney transplantation. On admission, blood Hgb and Hct was 19.7 g/dL and 61.4%, respectively. Serum erythropoietin level was 347 mIU/mL. Multiple variable sized cystic lesions were identified on both kidneys without evidence of internal malignancy in abdomen and pelvis CT scan. After kidney transplantation, Hgb was 12.5 g/dL and serum erythropoietin level was 13.1 mIU/mL. Some of renal cysts on CT scan disappeared or decreased in size. This finding suggests that erythrocytosis in this patient can be associated with acquired cystic kidney disease.
도화미,김은진,구향모,이미정,신동호,최규헌,강신욱,한승혁,유태현 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1
Background: Red blood cell distribution width (RDW), expresses variation in size of circulating erythrocytes, is a part of complete blood cell count test. Recent studies have demonstrated an association between RDW and adverse outcomes in patients with heart failure and coronary heart disease. Also, it has been found to be predictive of all-cause mortality in community-based cohorts irrespective of hemoglobin levels. As increased RDW levels are frequently observed in patients with end-stage renal disease (ESRD), we sought to determine whether RDW value is associated with mortality in ESRD patients treated with continuous ambulatory peritoneal dialysis (CAPD). Methods: A retrospective analysis was undertaken in 197 incident CAPD patients, who started CAPD between January 2005 and December 2010 at Yonsei University Health System and maintained CAPD for more than 3 months. Patients were divided into 2 groups according to the RDW levels at 3-month, and all-cause and cardiovascular mortalities were compared between groups. Results: The mean age was 55.1 years and 115 patients (58.4%) were male. RDW at 3-month ranged from 11.3 to 16.8% (mean 13.6±1.1%), and 51 patients (25.8%) showed elevated RDW value (>14.5%). There were significant positive correlations between RDW levels and age (r=0.22, p<0.01), Charlson comorbidity index (CCI) score (r=0.27, p<0.01), left ventricular mass index (r=0.28, p<0.05), left atrial volume index (LAVI) (r=0.26, p<0.01), the ratio of early mitral inflow velocity to peak mitral annulus velocity (E/E`) (r=0.16, p<0.05) and left ventricular end diastolic dimension (r=0.271, p<0.01). In contrast, RDW values were negatively correlated with hemoglobin (r=-0.16, p<0.05) and albumin levels (r=-0.28, p<0.01). The all-cause mortality rates were significantly higher in the high RDW group (p<0.05). Cox regression analysis revealed that RDW was a significant independent predictor of all-cause mortality even after adjustment for age, gender, CCI score, hemoglobin, albumin, total cholesterol, LAVI, left ventricular ejection fraction (LVEF), and E/E`` (HR 1.20, p<0.05). Conclusion: This study demonstrates that RDW provide a meaningful prognostic value on all-cause mortality in incident CAPD patients.
신동호,이미정,오형중,구향모,도파미,김형래,한재현,박정탁,한승혁,최규헌,유태현,강신욱 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.4
Purpose: We undertook an observational study to investigate the effects of immunosuppressive treatment on proteinuria and renal function in 179 Korean idiopathic membranous nephropathy patients with nephrotic syndrome. Materials and Methods:The primary outcome was regarded as the first appearance of remission and the secondary outcomes as a decline in estimated glomerular filtration rate (eGFR) >50% or initiation of dialysis, and all-cause mortality. Seventy-two (40.2%) and 50 (27.9%) patients were treated with corticosteroids alone (C) and corticosteroids plus cyclosporine (C+C), respectively, whereas 57 (31.8%) did not receive immunosuppressants (NTx). Cyclosporine was added if there was no reduction in proteinuria of >50% from baseline by corticosteroids alone within 3 months. Results: There were no differences in baseline renal function and the amount of proteinuria among the three groups. Overall, complete remission (CR) was achieved in 88 (72.1%) patients by immunosuppressants. In a multivariate analysis adjusted for covariates associated with adverse renal outcome, the probability of reaching CR was significantly higher in the C [hazard ratio (HR), 4.09; p<0.001] and C+C groups (HR, 2.57; p=0.003) than in the NTx group. Kaplan-Meier analysis revealed that 5-year CR rates of C, C+C, and NTx groups were 88.5%, 86.2%, and 56.7% (p<0.001). Ten-year event-free rates for the secondary endpoints in these three groups were 91.7%, 79.9%, and 57.2% (p=0.01). Conclusion: Immunosuppressive treatment was effective in inducing remission and preserving renal function in these patients. Therefore, stepwise treatment using corticosteroids alone and in combination with cyclosporine is warranted in these patients.
증례 : 혈액종양 ; 가돌리늄 기반 조영제 주입 후에 발생한 신성 전신 섬유화증 1예
홍민희 ( Min Hee Hong ),구향모 ( Hyang Mo Koo ),최준정 ( Jun Jeong Choi ),안정련 ( Jung Ryun Ahn ),전홍재 ( Hong Jae Chon ),김찬 ( Chan Kim ),이승태 ( Seung Tae Lee ) 대한내과학회 2010 대한내과학회지 Vol.78 No.1
신성 전신 섬유화증은 가돌리늄 제제에 노출된 신부전 환자에게서 나타날 수 있는 전신성 질환으로, 예후가 불량하며 특별한 치료방법이 없으므로 예방이 중요한 질환이다. 저자들은 국내에서 최초로 보고하는 바이다. Nephrogenic systemic fibrosis is a rare multisystemic disorder mainly affecting the skin and joints in patients with underlying renal insufficiency exposed to gadolinium-based contrast. We report a patient who had renal insufficiency caused by multiple myeloma and developed nephrogenic systemic fibrosis after exposure to gadolinium-based contrast for the first time in Korea. (Korean J Med 78:127-131, 2010)
도화미 ( Fa Mee Doh ),장선정 ( Seon Jung Jang ),구향모 ( Hyang Mo Koo ),김은진 ( Eun Jin Kim ),신혜선 ( Hye Sun Shin ),한승혁 ( Seung Hyeok Han ),강신욱 ( Shin Wook Kang ),최규헌 ( Kyu Hun Choi ),유태현 ( Tae Hyun Yoo ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.4
We report a case of patient with malignant thymoma, who developed nephrotic syndrome several years after thymectomy. This 38-year-old man was diagnosed as myasthenia gravis and malignant thymoma and underwent thymectomy in 2004. Tumor resection and systemic chemotherapy were performed after recurrence in pleura in 2006. He also took pyridostigmine to control his symptoms of myasthenia gravis after thymectomy. Four years later, even though there was no evidence of recurrence of thymoma, he developed a nephrotic syndrome and was diagnosed as a minimal change disease on renal biopsy. After pulse therapy with methylprednisolone followed by oral administration of prednisolone therapy, nephrotic syndrome was improved.