단백뇨를 보이는 사구체 질환 및 당뇨병성 신병증에서의 Lp(a)

권태환,김준홍,조성,김석재,김용림,조동규,백미영 경북대학교 병원 1998 경북대학교병원의학연구소논문집 Vol.2 No.1

Background: Recently there has been evidences that serum Lp(a), an independent risk factor to atherosclerotic cardiovascular diseases, were increased in proteinuric disorders such as nephrotic syndrome and diabetic nephropathy. Methods: We intended to search of altered concentrations of Lp(a) in proteinuric disorder measuring serum Lp(a) concentrations with ELISA in 44 glomerulonephritic patients(25 nephrotic syndrome(NS), 19 non-nephrotic range proteinuric glomerulonephritis(GN), 25 diabetic nephropathy patients(DN), and 31 healthy controls(HC). Also, we compared Lp(a) concentration between glomerulonephritis patients and diabetic nephropathy patients with proteinuria of similar degree. Results: 1) There were significantly increased levels of total choesterol, triglyceride, and LDL-cholesterol in Ns compared to GN, DN, HC. 2) There were significantly increased concentrations of serum Lp(a) in NS compared to HC, but no signiicant difference in serum Lp(a) among NS, GN, and DN. 3) There was no significant difference in serum Lp(a) concentrations between NS & DN with 24 hour urine protein greater than 3.0g. 4) There was no significant difference in serum Lp(a) concentration between GN with 24 hour urine protein greater than 0.5g and less than 1.5g and DN with proteinuria of simial degree. 5) In glomerulonephritis patients, there was negative correlation between serum Lp(a) concentration and serum albumin level but correlation with 24 hour urinary protein, total cholesterol, Ldl-cholesterol, and HDL-cholesterol was not shown. In diabetic nephropathy, there was no significant correlation among serum Lp(a) concentration and all parameters including serum albumin, 24 hour urinary protein, and other lipid profiles. Conclusion: The present study confirmed that patients with nephrotic syndrome of diverse etiologies have makedly increased plasma level of Lp(a), in conjunction with other lipid abnormalities. However, this study shows no difference in Lp(a) concentrations between diabetic nephropathy and glomerulonephritis with similar degree of proteinuria.

만성알콜올 섭취에 동반된 저칼률성 신병증 1예

권태환,김준홍,조성,방종효,김용림,조동규,곽정식 대한신장학회 1995 춘계학술대회 초록집 Vol.1995 No.-

간경변증이 동반된 말기신부전환자에서의 지속성 외래복막투석

김용림,권태환,조동규 대한신장학회 1995 춘계학술대회 초록집 Vol.1995 No.-

경화성 피낭성 복막염 ( Sclerosing Encapsulating peritonitis ) 1예

김용림,김준홍,조성,박종효,권태환,조동규 대한신장학회 1995 춘계학술대회 초록집 Vol.1995 No.-

이식신 기능소실후 시행한 지속성 외래복막투석의 예후

권태환,김용림,조동규,김영옥 대한신장학회 1995 춘계학술대회 초록집 Vol.1995 No.-

간경변증이 동반된 말기신부전환자에서의 지속성 외래복막투석

김용림(Yong Lim Kim),권태환(Tae Hwan Kwon),조동규(Dong Kyu Cho) 대한내과학회 1996 대한내과학회지 Vol.51 No.2

N/A Objectives: The spontaneous tendency to arterial hypotension in cirrhotic patients makes adequate hemodialysis therapy extremely difficult. Hemodialysis in these patients may produce intradialytic hypotension, limiting the amount of ultrafiltration. These patients are also at high risk for gastrointestinal bleeding, which can be exacerbated by anticoagulation, Recently peritoneal dialysis has been suggestad for the management of this population. Methods: Seven patients with chronic renal failure and liver cirrhosis treated by CAPD are described. Six of the seven patients were complicated by ascites on starting CAPD. Hepatocellular carcinoma was identified in one patient. Three had been transferred from hemodialysis for hemodynamic intolerance, one for vascular access problem. All PD catheters were surgically placed. Results: The hemodynamic tolerance was excellent in all patients. Four patients developed bleeding immediately after catheter insertion, Two patients developed early leaks and one patient late leak. Four patients had a decline in serum albumin level of 0.5 gm/dL or more during the course of chronic PD, Peritonitis occurred on average at 8.7 month interval. Three episodes of catheter removal occurred in 148 patient-months of PD(0.24 per patient-year). Four patients died while maintained on PD; three deaths were due to hepatic encephalopathy on PD for duration of 4 to 60 months and the fourth was due to peritonitis after 24 months of PD. One patient died due to malnutrition after 2 months on switching to hemodialysis because of peritonitis after 32 months of PD. Conclusion: Early mechanical complications after catheter insertion(bleeding, leak) were more common than usual. But CAPD was better tolerable than hemodialysis and may be a reasonable choice with an acceptable survival rate in end-stage renal disease patients with preexisting liver cirrhosis.

복막투석액내 지속적인 칼슘주입으로 치료 중인 Hungry Bone Syndrome 1예

조동규,권태환,김용림 대한신장학회 1996 Kidney Research and Clinical Practice Vol.15 No.2

Patients with chronic renal failure may require parathyroidectomy to correct the complications of hyperparathyroidism. Hut severe recalcitrant hypocalcemia and hungrI bone syndrome can complicate the postoperative course of parathyroidectomy, despite of aggressive therapy with oral calcium and vitamin D. Intravenous calcium infusion can be used to treat this condition. But generally prolongs hospitalization and has adverse side effects such as gastrointestinal disturbances and cardiac conduction abnormalities. In patients maintained on peritoneal diahsis. Intraperitoneal administration of calcium is a reasonable altemative. We report severe tertiav hyperparathI-roidism in a patient who has been receiving CAPD after renal transplant failure. He required parathyroidectomy because he demonstrated persistent elevation of the serum calcium level, elevated intact parathIroid homone level. Bone pain, and soft tissue calcification. He developed hungry bone syndrome requiring prolonged calcium therapy including intraperitoneal administration of calcium gluconate after subtotal parathyroidectomy. He has been treated for 6 months by adding OmL of 10.o calcium gluconate solution (calcium concentration 93:23mg Ml) to each bag of diah sate after subtotal parathyroidectomI. Complications such as visible diah sate precipitation. Increased rate of peritonitis. Or abdominal pain were not observed. Mean total calcium uptake was 167.36mg exchange. We conclude that the intraperItoneal calcium therapy is a safe and effective treatment in CAPD patients who require parenteral calcium for more than a few days atter operation.

혈액투석에서 저 분자량 헤파린과 표준 헤파린의 항응고효과 비교

조동규,권태환,김용림 대한신장학회 1997 Kidney Research and Clinical Practice Vol.16 No.1

Hemodialysis requires anticoagulants to prevent fibrin deposition and thrombus formation in the extracorporeal circuit. Unfractionated heparin (UFH) has been used as a conventional anticoagulant for a long time. But recently, many side effects of heparin have been documented: hemorrhage, thrombocyto- penia with or without thrombosis, osteoporosis, skin necrosis, alopecia, and hypersensitivity reactions. In the past decade, low molecular weight heparins (LMWH) have been developed. Compared with UFH, these compounds have a longer plasma half life, less variability in the anticoagulant response to fixed doses, and a more favorable antithrombotic to hem- orrhagic ratio. Thus, rationales for using LMWH as an altemative to UFH would be a reduced risk of bleeding complications and simplified routines for heparinization due to a longer half-life of the anti- coagulant activity. To evaluate the efficacy and safety of LMWH as an anticoagulant in hemo- dialysis treatment, we conducted a prospective cross- over study with paired comparison of two different heparins in 18 end-stage renal disease patients undergoing hemodiatysis. During the first two months of observation, patients received a single bolus of LMWH (Fragmin) 2,552?221 aXa IU/one dialy- sis session, Then patients were switched to UFH dose regimen comprised of a saline prime, no initial bolus and a continuous infusion of 3,174?420 IU/one dialysis session for further two months. All hemodialysis sessions were completed uneventfully. The coagulation values of an anti-factor Xa-specific clotting method (Heptest) from citrated whole blood samples taken 15 minutes after starting hemodialysis were 0.47?0.21 U/ml with LMWH and 0.12?0.03 U/ml with UFH <p<0.05). The values taken 4 hours after starting hemodialysis were 0.24?0.10 U/ml with LMWH and 0,22?0.04 U/ml with UFH (p>0.05). The prolongation of the Heptest clotting times with LMWH and UFH was 2.86 for LMWH and 2.55 for UFH using the whole blood assay. The mean frequency of clot deposition in dialyzer was simil1 vs 0.87) as well as mean venous compression time at the end of dialysis (5.96 vs 6.23 minutes). The hematologic and biochemical parameters such as hemoglobin, platelet count, triglyceride level, total cholesterol and HDL-cholesterol level did not show any differences between the two heparins. We conclude that a single dose of LMWH is effective and safe in repeated use for hemodialysis and prevents clot formation to a similar degree as UFH.

신증내과에 의뢰된 난소과자극증후군의 임상적 관찰

김준홍,방종효,권태환,김용림,조동규,이태후,전상식 대한신장학회 1995 춘계학술대회 초록집 Vol.1995 No.-

혈액투석중 발생하는 저혈압과 순환 혈액량 변화 및 혈장 Mitric Oxide의 변화

김성호,김성록,권태환,김석재,김용림,조동규 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.5

Background: Dialysis-induced hypotension is one of the most frequent acute complications during hemodialysis. It has been suggested that the inflammatory cytokines interlukin-1 and tumor necrosis factors mediate this hypotension through production of vasodilating nitric oxide. The vasodilating actions of these cytokines are also mediated by the nitric oxide in the vascular smooth muscle cells. It is also hypothesized that the blood volume changes independent of nitric oxide play an important role in intradialytic hypotension so that present study was undertaken to determine the relationship of blood volume and nitric oxide level to the intradialytic hypotensive episodes. Methods: The changes of the blood volume and the plasma level of nitrite and nitrate, the metabolic products of nitric oxide, were measured. Patients who did(hypotensive group, n=6) and did not have hypotensive episodes(normotensive group, n=13) during hemodialysis sessions were included. Hypotensive episodes during dialysis were defined as drop of systolic blood pressure $lt;90mmHg or mean arterial pressure $lt;75mmHg. The blood volume change was measured by using continuous monitor(Crit-Line: In-Line Diagnostics, UT, USA) and the plasma nitrite and nitrate level were measured using a nitrate/nitrite assay kit(Cayman Chemical Company, MI, USA). Results: The maximal mean arterial pressure change was 51.8±11.9mmHg in the hypotensive group and 5.0±11.7mmHg in the normotensive group(p$lt;0.05). The maximal blood volume change was 18.9±4.0% in the hypotensive group and 9.2±3.2% in the normotensive group(p$lt;0.05). In the hypotensive group and the normotensive group, the nitrite and nitrate levels at the beginning of hemodialysis, 2 hours after the initiation of hemodialysis and at the end of hemodialysis were 480.6±287.1μmoL/L vs. 600.6±335.5μmoL/L, 268.2±129.7μmoL/L vs. 479.2±470.6μmoL/L, 204.9±58.2μmoL/L vs. 268.7±137.5μmoL/L respectively and there were no significant differences between the two groups at each measurement time(p$gt;0.05). It wath groups that the serum nitrite/nitrate level dropped significantly at the end of dialysis(p$lt;0.05). The volume of ultrafiltration, ultrafiltration rate, serum calcium levels, hematocrit, serum albumin levels and the amount of hepariri used were not different between the two groups. Conclusion: Although it has been proposed that dialysis-induced hypotension is mediated by production of cytokine-induced nitric oxide in vascular smooth muscle cells, the nitrite/ nitrate level in plasma decreased in both groups of the patients who did or did not have hypotensive episodes during hemodialysis in present study. However, the blood volume was markedly decreased in patients who had hypotensive episodes. This suggests that the blood change rather than the plasma nitric oxide level during hemodialysis contributes to dialysisinduced hypotension.