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복막 중피세포에서 사 이토카인에 의해 유도된 혈관내피성장인자의 발현
윤성로(Sung Ro Yun),이명자(Myung Ja Lee),양철우(Chul Woo Yang),김용수(Yong Soo Kim),장윤식(Yoon Sik Chang),방병기(Byung Kee Bang) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.5
목 적 : 지속적 외래 복막투석 환자에서 복막염 발상시 혈관내피 성장인자의 투석 배액내 농도변화를 관찰하고 복막중피세포를 배양 후 IL-1α, TNFα 및 IFNγ로 자극하여 혈관내피 성장인자의 발현을 관찰하였다. 방 법 : 지속적 외래 복막투석환자 30명에서 복막염 발생시와 치료 후 투석 배액을 수집하고 배양된 복막 중피세포를 IL-1α 및 TNFα 단독으로 또는 IFNγ와 병합하여 자극한 후 배양액을 수집하였다. 투석 배액관 복막중피세포 배양액에서 혈관내피 성장인자의 농도는 ELISA 방법으로, 복막중피세포에서 혈관내피 성장인자의 mRNA 발현은 Northern blot 방법으로, 복막중피세포에서 IL-1α 및 TNFα 자극 후 NF_k B 활성도는 EMSA 방법으로 측정하였다. 결 과 : 투석 배액내 혈관내피 성장인자의 농도는 복막염이 치료된 후에 비해 (245±21pg/mL) 복막염 진단시 (456±45pg/mL) 유의하게 높았다. (p<0.0001). IL-1α 및 TNFα는 복막중피세포에서 혈과내피 성장인자의 생산을 24시간부터 72시간까지 증가시켰으며 INFγ를 병합 투여한 경우 더 현저하게 증가시켰다. INF_kB 억제제인 pyrrolidine dithiocarbarnate를 전처치한 경우 IL-1α 및 TNFα에의해 유도되는 혈관내피 성장인자의 생산은 완전히 차단되었다. Nntthern blot 결과 IL-1α 및 TNFα는 농도에 비례하여 혈관내피 성장인자의 mRNA 발현을 증가시켰으며 자극 4시간 후 가장 증가시켰다. IL-1α 및 TNFα는 복막중피세포에서 NF_k B 결합 활성도를 자극 15분 후부터 증가시켰으며 1시간에 활성도가 가장 증가하였고 활성도의 증가에는 NF_k B subunit 중 p65 subunit가 관여되었다. 결 론 : 복막중피세에서 IL-1α, TNFα 및 IFNγ의 자극에 의한 혈관내피 성장인자 발현의 증가는 복막투석환자에서 복막염 발생시 복막 투과성을 증가시키는 역할을 할 것으로 생각된다. Background : The mechanism of increased peritoneal permeability during peritonitis has not been clearly determined. We studied the changes in vascular endothelial growth factor (VEGF) levels in dialysate effluents during CAPD peritonitis, and VEGF expression in cultured peritoneal mesothelial cells (MCs) stimulated with IL-1α ,TNF α, and IFNγ. Methods : In 30 CAPD patients with peritonitis, dialysate effluents were serially collected at the time of diagnosis of peritonitis and when the peritonitis was recovered. Primarily cultured MCs were incubated with IL-1α or TNFα alone or in combination with INFγ. VEGF level in dialysate effluent and MCs conditioned medium was measured by sandwich ELISA. VEGF mRNA expression was analyzed by Northern blotting. The activation of NF_K B in response to IL-lα or TNFα was measured by electrophoretic mobility shift assay (EMSA). Results : VEGF levels in dialysate effluent at the time of diagnosis of peritonitis were significantly higher (456±45 pg/mL) than those when the peritonitis was recovered (245±21 pg/mL)(p<0.00001). Both IL-1α and TNFα stimulated VEGF production in MCs, and the stimulation was significant from 24 hours to 72 hours. INFγ, in combination with IL-lα or TNFα, significantly amplified IL-lα- or TNFα- induced VEGF production. Pre-incubation of MCs with NF_K B inhibitor, pyrrolidine dithiocarbamate, totally blocked IL-lα- or TNFα induced VEGF production. Northern blot analysis revealed that IL-1α and TNFα stimulated VEGF mRNA expression in a dose dependent manner. The stimulation was peak at 4 hours. IL-1α and TNFα stimulated NF_K B binding activity in MCs as early as at 15 minutes, with a peak activity at 1 hour, and p65 subunit was supershifted. Conclusion : Our results suggest that increased expression of VEGF in peritoneal mesothelial cells stimulated with proinflammatory cytokines, IL-1α, TNFα, and IFNγ, plays a role in the increased peritoneal permeability during CAPD peritonitis.
증례 : 신장 ; 비스테로이드 소염제 복용 후 발생한 신경색
윤세희 ( Se Hee Yoon ),김용림 ( Yong Lim Kim ),박선희 ( Sun Hee Park ),김찬덕 ( Chan Duck Kim ),최지영 ( Ji Young Choi ),윤성로 ( Sung Ro Yun ) 대한내과학회 2012 대한내과학회지 Vol.82 No.5
Nonsteroidal anti-inflammatory drugs (NSAIDs) are popular in general practice. Their adverse renal effects have been well documented. Common NSAID-related renal side effects range from dysfunctional renal hemodynamic responses, nephrotic syndrome, electrolyte disturbances, acute interstitial nephritis, chronic interstitial nephritis with papillary necrosis, and acute flank pain syndrome to acute renal failure. Decreased prostaglandin synthesis can lead to renal ischemia and hemodynamically related acute renal failure. Cases of acute renal failure syndrome accompanied by severe loin pain after anaerobic exercise (ALPE) or binge drinking have previously been reported in individuals taking NSAIDs. However, severe flank pain after high-dose NSAID treatment in the absence of other conditions (exercise or volume contraction) is rare. We report a case of a 51-year-old man who suffered from severe pain in both flanks after NSAID treatment. Computed tomography revealed hypodense lesions in both kidneys. (Korean J Med 2012;82:618-622)
윤세희 ( Se Hee Yoon ),강구흠 ( Gu Hm Kang ),윤성로 ( Sung Ro Yun ),최낙원 ( Nak Won Choi ),김윤미 ( Yun Mi Kim ),임범진 ( Bum Jin Lim ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.3
A 72-year-old woman presented with generalized edema and proteinuria. Renal biopsy disclosed highly organized fibrillary deposits in subendothelial area by electron microscopy. The microfibrils were 14 nm in diameter and randomly arranged. They did not have a microtubular appearance. These materials were negative for Congo red staining. Cryoglobulinemia or paraproteinemia including light chains was not found. So we can diagnose her as fibrillary glomerulonephritis (GN). In fibrillary GN serum complement levels are usually normal except in rare cases with systemic disease. Here we present a rare case of fibrillary GN with unusual hypocomplementemia.
윤세희 ( Se Hee Yoon ),최낙원 ( Nak Won Choi ),윤성로 ( Sung Ro Yun ) 대한내과학회 2008 대한내과학회지 Vol.74 No.2
목적: GDH-PQQ를 이용한 혈당계로 icodextrin을 사용하는 복막투석 환자에서 혈당을 측정했을 경우 maltose 등의 다당류도 혈당으로 인식되어 실제 환자의 혈당보다 높게 측정될 수 있다. Accu Chek Active는 본원에서 사용하는 혈당계로 GDH-PQQ 방법을 사용하며 이를 이용하여 혈당을 측정하고 혈당 조절 중 저혈당 증세를 보이는 경우를 수 차례 경험하였다. 본 연구에서는 본원 검사실에서 측정한 혈당과 Accu Chek Active을 이용하여 측정한 혈당 수치를 비교 분석하였다. 방법: 2006년 2월 현재 건양대학교 병원에서 밤에 icodextrin으로 복막투석을 하고 있는 환자 7명을 대상으로 외래에서 12차례에 거쳐 검사실 검사와 Accu Chek Active검사를 비교하였다. 7명의 환자는 입원하여 06시, 11시, 16시, 21시에 각각 두 가지 방법으로 혈당을 검사하였다. 4명의 환자는 icodextrin을 4.25% 투석액으로 바꾸어 2일 동안 두 가지 방법으로 혈당을 측정하여 차이를 구하였다. 결과: Icodextrin으로 복막투석을 하는 환자에서 Accu Chek Active로 측정한 혈당과 검사실 검사는 평균 54±14 mg/dL(최소값: 22 mg/dL, 최대값: 85 mg/dL)의 혈당 과평가가 관찰되었다. 밤동안에 icodextrin을 사용하는 환자에서 Accu Chek Active을 이용하여 혈당 측정 시에 새벽에 icodextrin 투석액을 배액한 후에도 일중 변동은 거의 없었으며 50~56 mg/dL의 혈당 차이를 나타냈다. Icodextrin 투석액을 중단한 후 2일 동안 Accu Chek Active로 측정한 결과 48시간 후에 평균 26±30 mg/dL로 측정 값의 차이가 감소하는 것을 알 수 있었다. 결론: Icodextrin으로 투석을 하는 복막투석 환자에서 혈당 측정 시 GDH-PQQ을 이용한 혈당 측정계를 사용하면 혈당이 과평가 될 수 있으며 이를 고려하여 혈당검사 및 당조절을 해야겠다. Background/Aims: Icodextrin (glucose polymer) is metabolized by a-amylase to oligosaccharides such as maltose and maltotriose. The presence of these metabolites could have an effect on the enzymatic glucose measurement especially the glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ) based method. Patients treated with icodextrin are at risk for inaccurate blood glucose measurements. In this study we measured the blood glucose with different methods and analyzed the results to determine the test accuracy. Methods: The blood glucose was measured, in seven outpatients and in seven inpatients using icodextrin, by the glucose hexokinase laboratory technique method as well as the GDH-PQQ method (Accu Chek Active) at the same time. To estimate an icodextrin residual effect, after discontinuing icodextin, the blood glucose was measured by the two methods after 48 hours in 4 inpatients. Results: In seven outpatients the blood glucose was overestimated by the Accu Chek Active method (mean difference 68 mg/dL, p value 0.012). In seven inpatients the mean difference in the glucose was 56 mg/dL at 6am, 52 mg/dL at 11am, 52 mg/dL at 4pm, and 50 mg/dL at 9pm by the two different methods. In the four inpatients after changing their dialysate, the mean difference in the glucose was 58 mg/dL after 10 hours, 45 mg/dL after 24 hours, 24 mg/dL after 34 hours, and 26 mg/dL after 48 hours. Conclusion: Blood glucose was overestimated by the GDH-PQQ method and the inaccuracies were observed for more than 48 hours. (Korean J Med 74:170-175, 2008)
지속성 외래 복막투석 환자에서 발생한 Candida zeylanoides 복막염
윤세희 ( Se Hee Yoon ),곽엄섭 ( Om Sub Kawk ),이명준 ( Myung Jun Lee ),염윤식 ( Yoon Shick Yom ),최낙원 ( Nak Won Choi ),윤성로 ( Sung Ro Yun ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.1
Despite the frequent occurrence of peritonitis in patients with continuous ambulatory peritoneal dialysis (CAPD), fungal peritonitis is uncommon and usually associated with antibiotics and immunodeficiency. Most of the fungal isolates are usually Candida albicans, Candida parapsilosis, Candida guilliermondii or Candida torulopsis. The authors report a case of fungal CAPD related peritonitis due to Candida zeylanoides that occurred in a patient with the absence of the usual risk factors for fungal peritonitis. Treatment with intravenous fluconazole was successful.