단백뇨와 대사증후군의 연관성

오명주,이미지,이기혁,박민선,고정아 대한가정의학회 2010 Korean Journal of Family Medicine Vol.31 No.6

Background: Proteinuria is a predictor of chronic kidney disease and a common risk factor for cardiovascular disease. Previous studies have reported that a urinary albumin-creatinine ratio and a glomerular filtration rate was related to the metabolic syndrome. However, there have been few studies on association between the metabolic syndrome and proteinuria by the urine dip-stick test. We examined the association between the metabolic syndrome and the proteinuria by the urine dip-stick test. Methods: The subject of this study included 20,075 adults aged more than 18 years old who visited the Health Promotion Center of the Seoul National University Hospital from April 2001 to March 2007. The metabolic syndrome was defined according to the criteria of the American Heart Association and National Heart, Lung and Blood Institute, and proteinuria was defined as a dipstick test above the ‘1+’ level. The crude and multivariated-adjusted odds ratios of proteinuria were calculated by using logistic regression models with each component of the metabolic syndrome. Results: Proteinuria was noticed in 5.7% of the subjects with metabolic syndrome, and 2.7% without metabolic syndrome. The multivariate-adjusted odds ratios of proteinuria in participants with elevated blood pressure level, elevated plasma glucose level and high triglyceride level were 2.23 (95% confidence interval [CI], 1.95 to 2.55), 2.33 (95% CI, 2.06 to 2.62), 1.64 (95% CI, 1.45 to 1.84). The multivariate-adjusted odds ratio of proteinuria in participants with the metabolic syndrome compared with participants without the metabolic syndrome was 2.30 (95% CI, 1.91 to 2.76), respectively. Conclusion: These findings suggest that proteinuria by the urine dip-stick test might be an important predictor in the metabolic syndrome. 연구배경: 단백뇨는 만성신질환 및 말기신부전의 중요한 예측인자이며 심혈관계질환 사망의 위험인자로 알려져 있다. 요 알부민 크레아티닌비 또는 사구체여과율과 대사증후군의상관관계에 대하여는 알려져 있으나 요 시험지검사를 통한단백뇨와 대사증후군의 관계에 대한 연구는 거의 없다. 본 연구는 외래에서 쉽게 시행할 수 있는 요 시험지검사를 통해 발견된 단백뇨와 대사증후군의 관련성 및 만성질환 예측인자로서의 단백뇨의 의미에 대하여 조사하였다. 방법: 2001년 4월부터 2007년 3월까지 일개 대학병원 건강증진센터를 방문한 18세 이상 성인 남녀 20,075명을 대상으로 하였다. 대사증후군은 American Heart Association/National Heart,Lung, and Blood Institute 진단기준에 따라 정의하였고 단백뇨는 요 시험지검사에서 알부민 1+ 이상인 경우로 정의하였다. 대사증후군 및 각 구성요소에 대한 단백뇨의 비교위험도를단변량 및 다변량 로지스틱 회귀분석으로 시행하였다. 결과: 전체 환자 중 30.8%가 대사증후군에 속하였으며 3.4%가 단백뇨를 보였다. 대사증후군 유무에 따른 단백뇨 유병률은 각각 5.7%, 2.7%이었다(P-value<0.001). 연령, 성별, 흡연, 혈청 크레아티닌, 체질량지수로 보정한 상태에서의 대사증후군의 각 구성 요소에 대한 단백뇨의 비교위험도를 보았을 때 높은 혈압, 고혈당, 고중성지방혈증에 대한 비교위험도가 각각2.23 (95% 신뢰 구간[CI], 1.95-2.55), 2.33 (95% CI, 2.06-2.62),1.64 (95% CI, 1.45-1.84)로 나타났다(P<0.001). 다변량 로지스틱 회귀분석을 통한 대사증후군의 단백뇨에 대한 비교 위험도는 2.30 (95% CI, 1.91-2.76)이었다(P<0.001). 결론: 요 시험지검사를 통해 발견된 단백뇨는 연령, 흡연, 성별, 체질량지수, 혈장 크레아티닌을 보정한 상태에서도 대사증후군과 높은 관련성을 보였다.

의학강좌 : 단백뇨의 감별진단 및 치료

김형종 ( Hyung Jong Kim ) 대한내과학회 2013 대한내과학회지 Vol.85 No.4

단백뇨의 감별진단 및 치료 방법에 대해 간단히 기술해 보았다. 단백뇨는 여러 가지 신장 질환에서 발생할 수 있으며 전신 질환의 신장 합병증의 초기에 관찰되는 중요한 검사소견이다. 또한 최근 연구에서는 단백뇨의 발생이 심혈관계 질환의 합병증의 발생빈도를 증가시킨다는 결과를 보여주고있다. 따라서 초기 단백뇨의 진단과 치료는 신장 기능의 악화 방지뿐 만 아니라 심혈관계 질환, 더 나아가서는 사망률 감소에 중요한 역할을 할 것으로 생각된다.

류마티스관절염에서 발생하는 신장 증상

박수경 ( Su Kyoung Park ),이영철 ( Young Chul Lee ),김지현 ( Jee Hyun Kim ),박준성 ( Joon Sung Park ),이창화 ( Chang Hwa Lee ),배상철 ( Sang Cheol Bae ),유대현 ( Dae Hyun Yoo ),강종명 ( Chong Myung Kang ),김근호 ( Gheun Ho Kim 대한내과학회 2008 대한내과학회지 Vol.74 No.1

목적: 류마티스관절염 환자에서 간혹 신장 증상이 동반하지만 그 인과관계를 규명하기가 쉽지 않다. 대부분의 경우 약물과 관련한 사구체병증이나 세관간질질환을 의심하고, 드물게 이차성 아밀로이드증을 경험한다. 그러나 류마티스관절염 자체가 혈관염의 형태로 신장을 직접 침범한다는 보고도 있다. 저자들은 류마티스관절염 환자에서 발생하는 신장 증상의 양상과 그 원인을 조사하고자 하였다. 방법: 2001년부터 2005년까지 5년간 한양대학교병원에 입원한 환자 중 류마티스관절염으로 진단받은 457명을 대상으로 후향적 분석하였다. 300 mg/day 이상의 단백뇨 또는 혈청 크레아티닌 1.7 mg/dL 이상의 질소혈증을 신장 증상으로 정의하였고, 단독 혈뇨는 제외하였다. 결과: 총 457명 중 신장 증상을 동반한 경우는 82명(17.9%)이었다. 그 중 81명(17.7%)에서 단백뇨가 있었고, 37명(8.1%)에서 질소혈증이 발견되었으며, 35명(7.7%)에서는 단백뇨 혹은 질소혈증과 함께 혈뇨를 동반하였다. 1일 단백뇨는 1353±207 (평균±표준편차) mg였고, 단백뇨 양과 류마티스관절염의 유병 기간 사이에 유의한 상관관계는 없었다. 질소혈증의 분포는 혈청 크레아티닌 3.98±0.35 mg/dL였고, 질소혈증 여부에 따른 류마티스관절염의 유병 기간(14.4±1.5 vs. 11.6±1.2년)에도 유의한 차이가 없었다. 신장 증상의 원인을 임상 소견에 따라 일차성과 이차성 신질환으로 구분하였을 때, 이차성 신질환의 원인은 당뇨병 13예(15.9%), 고혈압 8예(9.8%), 약물에 의한 독성 신병증 11예(13.4%), AA 아밀로이드증 2예였다. 일차성 신질환 중 10예에서 신생검이 시행되었고, 그 결과 IgA 신병증 3예, 막성 신병증 2예, 사구체간질 증식성 사구체신염 1예, 초점분절 사구체경화증 1예, 만성 경화 사구체신염 3예로 확진되었다. 결론: 류마티스관절염이 직접 신장을 침범하여 신장 증상을 유발하는 경우는 매우 드물지만, 류마티스관절염 환자에서 만성콩팥병의 유병율이 높다. 신장 증상의 원인이 다양하므로 적극적으로 신생검을 시행하여 감별 진단하는 것이 유용할 것이다. Background/Aims: Although renal manifestations are often involved in patients with rheumatoid arthritis (RA), the causal relationship between RA and renal manifestations has not been clearly defined. The prevalence and causes of renal manifestations in patients with RA were investigated in this study. Methods: The clinical data from 457 patients with RA and who were admitted to Hanyang University Hospital between 2001 and 2005 were retrospectively analyzed. Renal manifestations were defined as proteinuria (≥300 mg/day) or azotemia (serum creatinine ≥1.7 mg/dL), with or without hematuria. Results: Renal manifestation was present in 82 (17.9%) out of 457 RA patients. Among them, proteinuria was observed in 81 (17.7%), azotemia in 37 (8.1%) and hematuria with either proteinuria or azotemia in 35 (7.7%). For the cases with proteinuria, the amount of preteinuria was 1353±207 (mean±SD) mg/day. There was no significant correlation between the degree of proteinuria and the duration of RA. For the cases with azotemia, the serum creatinine was 3.98±0.35 mg/dL. The presence of azotemia had no significant association with the duration of RA (14.4±1.5 vs. 11.6±1.2 years, respectively). When the etiology of the renal manifestation was classified into primary and secondary renal disease, the latter included diabetic nephropathy in 13 (15.9%), hypertensive nephrosclerosis in 8 (9.8%), drug-induced chronic tubulointerstitial disease in 11 (13.4%) and AA amyloidosis in 2. Renal biopsy revealed 10 cases of primary glomerulopathy, including IgA nephropathy in 3, membranous nephropathy in 2, mesangial proliferative glomerulonephritis in 1, focal segmental glomerulosclerosis in 1 and chronic sclerosing glomerulonephritis in 3. Conclusions: The prevalence of chronic kidney disease in patients with RA is high, although direct renal invasion by RA is very rarely encountered. Renal biopsy would be of great help to identify the various causes of renal manifestations in patients with RA. (Korean J Med 74:75-80, 2008)

단백뇨가 동반된 성인 비박형 사구체 기저막 질환

신현주 ( Hyun Joo Shin ),심광연 ( Kwang Yeon Shim ),박무용 ( Moo Yong Park ),최수정 ( Soo Jeong Choi ),김진국 ( Jin Kuk Kim ),황승덕 ( Seung Duk Hwang ),권계원 ( Kye Won Kwon ) 대한내과학회 2007 대한내과학회지 Vol.73 No.4

Background: Proteinuria is rarely observed in patients who suffer from thin basement membrane nephropathy (TBMN). Our study was performed to evaluate the clinical characteristics and prognosis of TBMN patients with proteinuria. Methods: We conducted a retrospective study on 231 kidney biopsies. A urine protein level more than 500 mg for the 24-hour urine excretion was considered as significant proteinuria. We studied the clinical characteristics, the pathological findings and the response to treatment of these patients. Results: Ten (4 males and 6 females) of 17 cases of TBMN had significant proteinuria (59%). The mean patient age was 35 years. Six patients had hypertension and 1 patient had nephrotic syndrome. Two patients had proteinuria only, and 8 patients had both hematuria and proteinuria. At the time of biopsy, the amount of urine protein was 1,881 mg per day, and all the patients except one showed normal renal function. The GBM thickness ranged from 201 to 252 nm. Nine patients were treated with angiotensin receptor blocker, and 1 patient suffering from nephrotic syndrome was treated with prednisolone and cyclophosphamide. Marked improvement of the proteinuria (659 mg per day) was observed in 8 patients during the follow-up period. Conclusions: Thin basement membrane nephropathy is one of the causes of proteinuria. Therefore, reduction of the proteinuria should be considered for treating these patients.(Korean J Med 73:407-414, 2007)

단백뇨가 있는 기관지 확장증 환자에 발생한 이차성 신장 유전분증

남현경 ( Hyun Kyung Nam ),나서희 ( Seo Hee Rha ),이수걸 ( Soo Gul Lee ),이성원 ( Seong Won Lee ),안원석 ( Won Suk An ),김성은 ( Seong Eun Kim ),김기현 ( Ki Hyun Kim ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

Secondary amyloidosis is a disorder characterized by the deposition of amyloid A (AA) in multiple organs and tissues in the body. We report a case of bronchiectasis-related secondary renal amyloidosis with proteinuria. A 29-year-old male was admitted to our hospital for evaluation of foamy urine. He has been bothered from a large amount of mucopurulent sputum since 11 years. He had medical history of bronchiectasis and maxillary sinusitis. He had adenomatous goiter and showed hypothyroidism. Immunoelectrophoresis of serum and urine were nonspecific. Serum amyloid A level was high (243.0 ug/mL, reference value ; 0-8 ug/mL) and C-reactive protein was increased (3.8 mg/dL, reference value ; 0-0.5 mg/dL). Renal, thyroid and rectal biopsy revealed infiltration of homogenous material and showed apple-green birefringence in Congo-red stain. Apple-green birefringence in Congo-red stain of kidney, thyroid and rectum after potassium permanganate pretreatment was disappeared for the most part. We treated him with colchicine (1.2 mg per day). After a year, his proteinuria was persisted, but renal function was normal. (Korean J Med 69:S900-S905, 2005)

임상신질환 : 혈청빌리루빈이 단백뇨의 유병률에 미치는 영향

박재윤 ( Jea Yoon Park ),허남주 ( Nam Joo Huh ),송영림 ( Young Rim Song ),유선진 ( Sun Jin You ),진호준 ( Ho Jun Chin ),나기영 ( Ki Young Na ),채동완 ( Dong Wan Chae ),김성권 ( Suhng Gwon Kim ),정은숙 ( En Suk Jeong ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

몽골의 수도 울란바토르에서 고혈압의 역학적 특징 및 심전도와 단백뇨의 평가

도영석,전민영 대한의료커뮤니케이션학회 2010 의료커뮤니케이션 Vol.5 No.2

During medical support activities in Ulaanbaatar city of Mongolia, we found out that hypertension is prevalentand we investigated the epidemiological characteristics of hypertension in this region. According to JNC-VII,490 medical patients over 18 years of age that were treated at Hanuul district hospital for 6 days from 30thApril 2009 were classified in the order of normal (normal group), prehypertension (group 1), 1st stage hypertension(group 2), and 2nd stage hypertension (group 3). Age, Body Mass Index (BMI), diabetes, sex, clinical symptoms,electrocardiogram, proteinuria of each group were compared with data from studies conducted in East Asia. Age, BMI, frequency of chest pain were significantly different between groups. The proportions of abnormalECG in each group were high and showed increasing tendency as blood pressures were higher but wasnot statistically significant due to the limitations of the study. In patients with chest pain, the proportionof abnormal ECG findings in each group showed a sharp increase in the order of 0%, 17%, 29%, 53%, respectively(p <0.05). In patients with chest pain, systolic and diastolic blood pressure, mean blood pressure, pulse pressure,hypertension, male sex were statistically significant risk factors for abnormal ECG findings (p<0.05). But age,BMI, diabetes did not show statistically significant relationship. Meanwhile, as the blood pressure increases,proteinuria ('1+' or higher: 30 mg/dL or greater) ratio was significantly higher (p<0.05) and heavy proteinuria('2+' or higher: 100 mg/dL or greater) ratio increased more rapidly. The proteinuria prevalence was higherthan that of Korea and other countries. This study was conducted with hospital patients in certain area ofthe city and the female proportion was high. However, it could be concluded that the more abnormal ECGsand the heavier proteinuria are accompanied with the higher blood pressure group in Mongolia by a higherproportion compared with reports of the other studies with primary healthcare in East Asia.

임신성 고혈압에서 단백뇨의 임상적 의의

김동호(Dong Ho Kim),이영일(Young Il Lee),윤성준(Sung Jun Yoon),이상훈(Sang Hoon Lee),배도환(Do Hwan Bae),허민(Min Hur) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.5

Objective : Proteinuria is a major clinical manifestation as well as hypertension and generalized edema in pregnancy-induced hypertension(PIH) and it should be considered an important marker of perinatal outcome. We studied the impact of proteinuria on maternal and perinatal outcome according to the degree of urine protein in PIH. Methods : Maternal urine protein and serum albumin levels were studied in 64 cases of PIH who were admitted to Department of Obstetrics and Gynecology, Pil-Dong Hospital, College of Medicine, Chung-Ang University for the period of 10 years from January 1, 1989 to December 31, 1998. Results : Serum albumin level was 2.9±0.7g/dL in mild preeclampsia group and 2.7±0.7g/dL in severe peeclampsia group and there was a significant difference between them. Birth weight of infant was 3001±659g in mild preeclampsia group and 2446±878g in severe peeclampsia group, and there was a significant difference between them. 1 minute Apgar score was 8.4±2.4 and 7.6±3.4, respectively and there was a significant difference between them. 5 minute Apgar score was 9.5±1.8 and 8.4±2.9, respectively and there was a significant difference between them. There were several maternal complications above 2(+) urine protein and no maternal complications below 1(+) urine protein. Small for gestational age infant was more common above 2(+) urine protein than below 1(+) urine protein and fetal death was more common in 3(+) urine protein. Conclusion : There was a decreasing trend in gestational weeks at delivery as proteinuria become more severe and also in birth weight, 1 minute Apgar score and 5 minute Apgar score. Maternal and fetal complications were more common as proteinuria become more severe.

중년 여성에서 단백뇨로 발현한 Fabry병 1예

김민옥 ( Min Ok Kim ),장은희 ( Eun Hee Jang ),이정은 ( Jung Eun Lee ),박승우 ( Seung Woo Park ),김윤구 ( Yoon Goo Kim ),진동규 ( Dong Gyoo Jin ),권기영 ( Gee Young Kwon ) 대한내과학회 2006 대한내과학회지 Vol.70 No.2S

중년 여성에서 단백뇨로 발현한 Fabry병 1예

김민옥 ( Min Ok Kim ),장은희 ( Eun Hee Jang ),이정은 ( Jung Eun Lee ),박승우 ( Seung Woo Park ),김윤구 ( Yoon Goo Kim ),진동규 ( Dong Gyoo Jin ),권기영 ( Gee Young Kwon ) 대한내과학회 2006 대한내과학회지 Vol.70 No.-