• Title/Summary/Keyword: 만성신부전환자

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In-Hospital Outcomes of Acute Renal Failure Requiring Continuous Renal Replacement Therapy in Patients with On-pump CABG (심폐기 가동하 관상동맥우회술 후 발생한 급성신부전 환자들에 있어 지속적 신대체요법의 병원 내 결과)

  • Kim, Young-Du;Park, Kuhn;Kang, Chul-Ung;Yoon, Jeong-Seob;Moon, Seok-Whan;Wang, Young-Pil;Jo, Kuhn-Hyun
    • Journal of Chest Surgery
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    • v.40 no.1 s.270
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    • pp.32-36
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    • 2007
  • Background: Although acute renal failure (ARF) after coronary artery bypass graft (CABG) is relatively rare, but devastating complication with high mortality. Our study aims to evaluate the effectiveness of early application of CRRT in patients with ARF which developed after on-pump CABG. Material and Method: Two hundred and eighty seven patients underwent isolated on-pump CABG between May 2002 and Feb. 2006 at our institution, of whom 15 (5.2%) needed CRRT (11 patients for postoperatively developed ARF and the remaining 4 patients with preexisting dialysis-dependent chronic renal failure (CRF) for postoperative hemodynamic and metabolic control). Criteria for early application of CRRT were as follows; decreased urine output less than 0.5cc/h/kg for 2 consecutive hours and elevated serum creatinine level greater than 2.0 mg/dL. Result: The incidence of ARF requiring CRRT after on-pump CABG was 3.9% (11/283) and the overall hospital mortality of patient with CRRT was 33.3% (5/15). Of 5 deaths, 4 were patients with postoperatively developed ARF, and 1 was a patient with pre-existing dialysis-dependent CRF patient. The mean time between the operation and the initiation of CRRT was $25.8{\pm}5.8$ hours and the mean duration of CRRT was $62.1{\pm}41.2$ hours. Of the 7 survivors who were not on dialysis-dependent preoperatively, 6 patients fully recovered renal function during hospital stay and 1 patient required permanent renal supportive treatment after discharge from hospital. Conclusion: Early application of CRRT could maintain stable postoperative hemodynamic status and make outcomes better than those of previous reports in patients with ARF which developed after on-pump CABG.

Diagnosis and Management of Feline Hyperthyroidism Complicated with Chronic Kidney Disease (고양이에서 만성 신부전에 병발한 갑상선 기능 항진증의 진단과 치료)

  • Kang, Min-Hee;Park, Hee-Myung
    • Journal of Veterinary Clinics
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    • v.27 no.6
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    • pp.723-725
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    • 2010
  • A 14-year-old spayed, mixed breed, female cat was admitted for evaluation of a polyphagia, hyperactivity and chronic weight loss. Physical examination revealed a tachycardia and mild elevated systemic blood pressure. This cat had azotemia and mild increased total thyroxin (TT4) and free thyroxin concentration. However triiodothyronine (T3) level was normal, the T3 suppression test for definite diagnosis were made. No changes of TT4 serum concentration before and after the exogenous T3 administration in this cat showed hyperthyroidism. This cat was diagnosed as mild hyperthyroidism concurrent with chronic kidney disease (CKD) and antithyroid drug, methimazole, was used for medical management. This is first case report describing clinical and laboratory characteristic features of feline hyperthyroidism complicated with CKD and its clinical outcome using medical management in our country.

Simultaneous Bilateral Quadriceps Tendon Rupture in Patient with Secondary Hyperparathyroidism due to Chronic Renal Failure: A Case Report (만성신부전증에 의한 이차성 부갑상선기능항진증 환자에서 양쪽 대퇴사두건 동시 파열: 증례 보고)

  • Shim, Jong-Joon;Shim, Jae-Chan;Ha, Jeong-Ju;Lee, Kyoung-Eun;Lee, Ghi-Jai;Kim, Ho-Kyun;Suh, Jung-Ho
    • Investigative Magnetic Resonance Imaging
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    • v.16 no.2
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    • pp.169-172
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    • 2012
  • Simultaneous bilateral spontaneous rupture of the quadriceps tendon is a very rare condition and only a few cases have been reported in the literature. The etiology is not clear yet. But it occurs infrequently in patients with chronic metabolic disorders, such as secondary hyperparathyroidism due to chronic renal failure. We describe a case of simultaneous spontaneous bilateral quadriceps tendon tupture in a 36-year-old male patient with secondary hyperaprathyroidism due to chronic renal failure.

The Influences of Maintenance Hemodialysis on Sleep Architecture and Sleep Apnea in the Patients with Chronic Renal Failure (만성신부전 환자에서 혈액투석 유지요법이 수면구조 및 수면 무호흡에 미치는 영향)

  • Park, Yong-Geun;Lee, Sang-Haak;Choi, Young-Mee;Ahn, Seok-Joo;Kwon, Soon-Seog;Kim, Young-Kyoon;Kim, Kwan-Hyoung;Song, Jeong-Sup;Park, Sung-Hak;Moon, Hwa-Sik
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.6
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    • pp.824-835
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    • 1999
  • Background: Sleep-related breathing disorders are commonly found in patients with chronic renal failure and particularly, sleep apnea may have an influence on the long-term mortality rates in these patients. Maintenance hemodialysis is the mainstay of medical measures for correcting the metabolic derangements of chronic renal failure but it is uncertain whether it may alleviate sleep disorders including sleep apnea. Methods: Forty seven patients on maintenance hemodialysis were surveyed with the sleep questionnaire about their clinical symptoms related to sleep disorders. Among them, 15 patients underwent the polysomnography and their blood levels of urea nitrogen, creatinine, electrolytes and the arterial blood gases in the nights before and following hemodialysis were measured. Results: Forty(85.1%) of the 47 patients complained of the symptoms associated with sleep-wake cycle disturbances, 55.3% experienced snoring and 27.7% reported witnessed apneas. The duration of REM sleep increased significantly in the nights after hemodialysis compared to the nights without hemodialysis(p<0.05) and the percentage of total sleep time comprising NREM sleep decreased significantly in the nights following hemodialysis compared to the nights before hemodialysis(p<0.05). The percentage of total sleep time consisting of the stage 1 and 2 NREM sleep showed the trend for a decrease in the nights after hemodialysis(p=0.051), while the percentage of total sleep time comprising the stage 3 and 4 NREM sleep did not change between nights. The obstructive sleep apnea was more predominant type than the central one in both nights and there were no differences in the apnea index and the apnea-hypopnea index between the nights. The decrease in the blood level of urea nitrogen, creatinine, potassium and phosphorus was observed after hemodialysis(p<0.05), but the differences of parameters measured during polysomnography between the nights did not correlate with the changes of biochemical factors obtained on the two nights. Arterial blood gas analysis showed that pH was significantly greater in the nights after hemodialysis than in the nights before hemodialysis(p<0.05), but there were no correlations between the parameters examined during polysomnography and the parameters of arterial blood gas analysis(p<0.05). Conclusion: These results suggest that chronic renal failure is an important systemic disorder which is strongly associated with sleep disorders. Maintenance hemodialysis, although it is a widely accepted measure to treat chronic renal failure, did not significantly modulate the sleep architecture and the severity of sleep apnea. Thus, taking the patients with chronic renal failure into account, it is advisable to try not only to find a substantial way for correcting metabolic derangements but also to consider the institution of more effective treatments for sleep disorders.

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특집 : 올바른 신장합병증 관리를 위해 - 신장합병증의 치료 I - 혈액투석과 복막투석으로 치료

  • Kim, Min-Ok
    • The Monthly Diabetes
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    • s.261
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    • pp.22-23
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    • 2011
  • 당뇨병은 전 세계적으로 급격하게 증가하면서 심각한 대혈관 및 미세 혈관 합병증들의 원인이 되고 있으며 대다수 선진국에서 당뇨병은 만성 신질환 및 말기 신부전의 가장 중요한 원인으로 알려져 있다. 당뇨병성 신증은 단백뇨를 특징으로 하며 30% 정도의 환자에서는 혈뇨도 관찰된다. 그래서 당뇨병성 신증의 발병 검진은 미세알부민뇨 검사로 하는 것이 가장 이상적이며 제 1형 당뇨병환자는 일반적으로 당뇨병 발병 5년 이후에 하며 위험인자가 있는 환자는 더 조기에 한다. 제 2형 당뇨병환자는 당뇨병 진단 시점부터 매년 하는 것을 원칙으로 한다.

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Structural Equation Modeling on Quality of Life in Pre-dialysis Patients with Chronic Kidney Disease (투석 전 만성 신부전 환자의 삶의 질 구조 모형)

  • Kim, Hye Won;ChoiKwon, Smi
    • Journal of Korean Academy of Nursing
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    • v.42 no.5
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    • pp.699-708
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    • 2012
  • Purpose: This study was designed to test structural equation modeling of the quality of life of pre-dialysis patients, in order to provide guidelines for the development of interventions and strategies to improve the quality of life of patients with Chronic Kidney Disease (CKD). Methods: Participants were patients who visited the nephrology outpatient department of a tertiary hospital located in Seoul. Data on demographic factors, social support, nutritional status, physical factors and biobehavioral factors and quality of life were collected between March 4 and March 31, 2011. Results: In the final analysis 208 patients were included. Of the patients 42% were in a malnourished state. Anxious or depressed patients accounted for 62.0%, 72.6%, respectively. Model fit indices for the hypothetical model were in good agreement with the recommended levels (GFI=.94 and CFI=.99). Quality of life in pre-dialysis patients with CKD was significantly affected by demographic factors, social support, nutritional status, physical factors and biobehavioral factors. Biobehavioral factors had the strongest and most direct influence on quality of life of patients with CKD. Conclusion: In order to improve the quality of life in pre-dialysis patients with CKD, comprehensive interventions are necessary to assess and manage biobehavioral factors, physical factors and nutritional status.

Immediate Effect of Hemodialysis on Pulmonary Function and Bronchodilator Response in Patients with Chronic Renal Failure (만성신부전 환자에서 혈액투석이 폐기능 및 기관지확장제에 대한 반응에 미치는 영향)

  • Jeon, Ho Seok;Lee, Yang Deok;Cho, Yongseon;Han, Min Soo
    • Tuberculosis and Respiratory Diseases
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    • v.56 no.1
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    • pp.77-84
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    • 2004
  • Background : We hypothesized that there was a relationship between body weight change and bronchodilator response (BDR) in patients with chronic renal failure (CRF) on hemodialysis (HD). Several mechanisms such as pulmonary edema due to water retention or increased permeability of alveolar capillary may play a important role in pulmonary function impairment and bronchial hyperresponsiveness in patients with CRF on HD. But, no studies have been published concerning BDR in patients with CRF on HD. This study was aimed to know the immediate effect of hemodialysis on pulmonary function and BDR in patients with CRF on HD. Methods : This study included 30 patients with CRF on HD. We collected data including age, sex, height, pretibial and pedal pitting edema, interdialysis weight gain, postdialysis weight loss, underlying diseases, duration of HD, $FEV_1$, FVC, $FEV_1/FVC$, and BDR before and after HD. Results : Interdialysis weight gain of the patients was $3.4{\pm}1.0kg$, and postdialysis weight loss was $3.2{\pm}0.7kg$. Before HD,$FEV_1$, FVC, and $FEV_1/FVC$ of the patients were $89{\pm}22%$, $86{\pm}19%$ of predicted, and $87{\pm}10%$. After bronchodilator inhalation, these parameters were changed to $95{\pm}22%$, $90{\pm}19%$ of predicted, and $88{\pm}9%$ respectively. BDR was positive in 15 patients. After HD, $FEV_1$, FVC, and $FEV_1/FVC$ of the patients were $100{\pm}23%$, $94{\pm}18%$ of predicted, and $88{\pm}11%$. After bronchodilator inhalation, these parameters were changed to $102{\pm}23%$, $96{\pm}18%$ of predicted, and $89{\pm}8%$ respectively. BDR was positive in 9 patients. Conclusion : First, HD increases $FEV_1$, FVC, and $FEV_1/FVC$ but little affects BDR. Second, there is no correlation between postdialysis weight loss and increases in $FEV_1$, FVC, and $FEV_1/FVC$ after HD. Third, there is also no correlation not only between interdialysis weight gain and BDR before HD but between postdialysis weight loss and BDR after HD.