• Title/Summary/Keyword: 만성신부전환자

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혈액투석 및 복막투석 환자에서의 carumonam(AMA-1080)의 약동 학적 변화에 관한 연구

  • 김성권;조종태;신상구;이경훈
    • Proceedings of the Korean Society of Applied Pharmacology
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    • 1992.05a
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    • pp.59-59
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    • 1992
  • 간헐적 혈액투석 또는 지속적 복막투석 요법을 받고 있는 만성 신부전 환자에서 carumonam의 약동학적 변화를 분석하여 이 환자들에서 적절한 투여용법을 고안하고, 이들 특수 질환군에서의 임상시험모형을 도굴하고자 하였다. 혈액투석환자는 carumonam 1g을 20분간 지속 정주 후 약물의 분포기 종료가 예상되는 시간에 혈액투석을 4-5시간 시행하였으며, 혈액, 투석액, 뇨를 경시적으로 채취하였다. 지속적 복막투석 환자군에 있어서는 1일 3회(6, 6, 12시간) 복막 투석을 시행하는 환자를 대상으로 carumonam 1g을 정주하고 24시간동안 혈액 및 투석액, 뇨를 경시적으로 채취하였다. 혈액, 투석액 및 뇨중 carumonam의 농도는 HPLC방법으로 측정하였으며, 경시적인 혈장 carumonam 농도변화 및 투석에 따른 약물의 제거를 혈액 투석환자는 2 compartmental model, 복막투석환자에서는 bidirectional 2 compartmental model에 의해 그 약동학적 성상을 분석하였다.

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Insomnia in Patients with Chronic Renal Failure on Hemodialysis (혈액투석 중인 만성 신부전증 환자에서의 불면증에 대한 연구)

  • Kim, Gyung-Ryul;Yang, Chang-Kook;Hahn, Hong-Moo
    • Sleep Medicine and Psychophysiology
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    • v.6 no.2
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    • pp.126-132
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    • 1999
  • Objectives: The purposes of this study were to investigate 1) the incidence of insomnia, 2) the clinical characteristics of the insomniacs, 3) the correlation of severity of insomnia with somatic complaints and psychological distresses, and 4) the beliefs and attitudes about sleep in patients with chronic renal failure on hemodialysis. Methods: The author evaluated 153 patients, receiving hemodialysis therapy at the four outpatients hemodialysis units in Pusan, Korea. The patients had completed a self-administered questionnaire package, which consisted of basic demographic findings, questions characterizing insomnia, Beck Depression Inventory(BDI), Spielburger's State-Trait Anxiety Inventory(STAI), and visual analogue scales measuring quantitatively the severity of the self-perceived psychological and somatic symptoms. And several laboratory data were collected. Diagnosis of insomnia was made in the base of insomnia criteria of DSM-IV and international classification of sleep disorders. Subjects were dichotomized into those who reported any characteristics of insomnia or those who had no insomnia during the preceding two weeks. Results: Insomnia was found in 100(65.4%) of 153 patients. No statistical differences were found between the patients with and without insomnia in terms of age, gender, education, marital status, mean duration of hemodialysis and all considered laboratory findings except serum albumin. The patients with insomnia had significantly higher BDI score and predialysis systolic blood pressure, and lower serum albumin as compared to non-insomnia group. Significant differences were found between two groups in terms of self-perceived distress such as sadness, anxiety, worry, pruritus, and dysfunction of daily life. The data showed statistically significant correlation between insomnia severity and some variables such as physical dysfunction, pruritus, bone pain, sadness, anxiety, worry, dysfunction of daily life and excessive daytime sleepiness. The patients with insomnia had significantly several dysfunctional beliefs and attitudes about sleep than those without insomnia. Conclusion: These results indicate that insomnia is very common in hemodialysis patients and likely contribute to the impaired quality of life experienced by many these patients. The author suggests that physical and psychological distresses would be reduced and the quality of life could be improved if their sleep disturbances are properly ameliorated in patients on hemodialysis.

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Prognostic Factors in Childhood IgA Nephropathy (소아 IgA 신병증의 예후에 관한 고찰)

  • Park Jae-Hyun;Kim Pyung-Kil;Jeong Hyeon-Joo;Choi In-Joon
    • Childhood Kidney Diseases
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    • v.1 no.1
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    • pp.17-23
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    • 1997
  • After the first description of IgA nephropathy by Berger in 1968, the prognosis of this disease was considered favourable. However recent studies have revealed that IgA nephropathy result in end stage renal desease in 25-30% by 20 years. Heavy proteinuria, hypertension, histological high class are regarded as poor prognostic factors. In 1996, Yagame et al reported the new histopathologic grading with a strong correlation between the grading, heavy proteinuria, high s-Cr level and renal survival. The aims of this study are to determine whether the pathological grading and other clinical parameters could contribute to predicting the outcome of this disease eventhough pediatric patients. Seventy nine patients (59 males, 20 females) with IgA nephropathy were examined. Patients were 2.08-15.17 years of age ($9.85{\pm}2.83$). The mean follow-up duration were $27{\pm}28$ months. Six of seventy nine patients progressed to chronic renal failure during the follow-up periods. High 24h urinary protein excretion at diagnosis were significantly higher in chronic renal failure patients (p<0.05). Hypertension at diagnosis were the significant associated factors in progression of chronic renal failure (p<0.05). Histological changes of IgA nephropathy in light microscopy were classified into five classes by WHO classification, four grades in Yagame's gradings. Among the seventy nine patients, 24 were as class 1, 30 as class 2, 23 as class 3; 4 as class 4, 0 as class 5 by WHO classification. 23 were classified grade 1, 31 as grade 2, 24 as grade 3, 1 as grade 4 by Yagame's grading. Among six patients who progressed to chronic renal failure, 1 clssified as class 1, 1 as class 2, 3 as class 3, 1 as class 4, 0 as class 5 by WHO Classification. 1 patients were classified as grade 1, 1 as grade 2, 3 as grade 3, 1 as grade 4 by Yagame's grading. (p>0.05) In conclusion, hypertension and heavy proteinuria at initial presentation were significantly associated with progression of chronic renal failure. The classification of WHO & Yagame's grading has no significant association with the progression of chronic renal failure in pediatric patients.

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Study on Knowledge Levels of Pre-dialysis, Chronic Renal Failure Patients at Glomerular Filtration Rates (GFRs) and Their Educational Demands (사구체 여과율에 따른 투석 전 만성 신부전 환자의 질병 관련 지식 정도와 교육 요구도 조사)

  • Kim, Hye-Won;ChoiKwon, S-Mi
    • Journal of Korean Biological Nursing Science
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    • v.12 no.2
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    • pp.114-126
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    • 2010
  • Purpose: To examine the levels of the disease-related knowledge and educational demands of pre-dialysis, chronic renal failure patients at different GFRs and stages. Methods: This study used a cross-sectional survey and aimed at 116 pre-dialysis, chronic renal failure patients, who were registered and received regular treatment from December 1 to December 31, 2009 at the nephrology departments of tertiary medical centers in Seoul. Stages were classified into Stage 3, 4 and 5 depending on GFR ranges. To measure the levels of knowledge and educational demands, the tool, which were first invented by Young Ae Lim (1996) and then modified by Hyo Sun Lim (2005) to adjust the knowledge and educational demands measuring tool for hemodialysis patients to pre-dialysis patients with chronic renal failure, was used. Collected data was analyzed with the SPSS WIN 12.0 program (average, standard deviation, Pearson's correlation coefficient, t-test and ANOVA). Results: There was a significant difference in the disease-related knowledge levels of the subjects at each stage (F=24.41, p=.000). The Scheffe post hoc test confirmed that patients at higher stages had higher levels of knowledge of their disease. Also, although the results showed that patients at higher stages had higher educational demands, there was no significant difference among the groups (F=1.259, p=.288). Conclusion: As patients have different levels of knowledge of the disease and educational demands depending on their stages, it is important to develop and use a systematic education program that reflects the demands and levels of patients at each stage in order to help pre-dialysis patients with chronic renal failure with self-management and improve their quality of life.

Surgical Treatment of Pulmonary Mucormycosis -1 case report - (폐에 발생한 뮤코르진균증의 외과적 치료 - 1예 보고-)

  • Lee, Eung-Bae;Han, Won-Kyung;Kim, Shin-Woo
    • Journal of Chest Surgery
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    • v.38 no.9 s.254
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    • pp.656-659
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    • 2005
  • Pulmonary mucormycosis is very rare but has a devastating opportunistic fungal infection in immunocompromised hosts. The infection usually occurs in patients with hematologic malignancy, chronic renal failure, diabetes mellitus, or in solid organ transplant recipients. We experienced a case of pulmonary mucormycosis associated with renal cadeveric allograft recipient who had uncontrolled diabetes mellitus. The patient was successfully treated by surgical resection with Amphotericin B therapy.

Development of Potassium Concentration of Nutrient and Supply Method for Low Potassium Lettuce Production in a Closed-type Plant Factory System (완전제어형 식물공장에서 저칼륨 상추 생산을 위한 적정 칼륨 농도 조성 및 처리시기 개발)

  • Choi, Young Bae;Shin, Jong Hwa
    • Journal of Bio-Environment Control
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    • v.27 no.1
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    • pp.40-45
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    • 2018
  • Potassium in vegetables is known to have an adverse impact on a patient with chronic kidney desease. However, since vegetables also contain many other nutrient, consumption of vegetables by these patients is inevitable. The objective of this study was conducted to develop a fresh lettuce which contains low level of potassium for nephropathy in a closed-type plant factory system. Lettuce of "Charles" was used for experiment. The plants were cultivated in hydroponic system with a 16-h photoperiod at $15-21^{\circ}C$, 65% RH, $200{\mu}mol{\cdot}m^{-2}{\cdot}s^{-1}$(LED W:R, 9:1) and $600-650mg{\cdot}L^{-1}$ $CO_2$ during 28 days. Nutrient solution which contains 1%, 5% and 10% potassium compared to conventional composition were supplied at 1 week and 2 weeks before harvest. The content of potassium and macro elements in leafy vegetables were analyzed by ICP emission spectroscopy after harvest. The potassium content in leaf of the 2 weeks before harvest treatment was significantly lower at than control. There were no significant differences between control and treatments in fresh weight and number of leaves. But there were differences among treatments. Considering the vegetable amounts consumed by nephropathy patients, the supply of nutrient which contain 1% and 5% potassium at 2 weeks before harvest was suitable for low potassium lettuce production. This study indicated that low potassium lettuce could be produced by developed nutrient composition and supply method.

$^{99m}Tc$-HMDP Bone Uptake Quantification and Plasma Osteocalcin, PTH Levels in Hemodialysis Patients (만성 신부전 환자에서 $^{99m}Tc$-HMDP 골신티그램상 섭취정도와 혈중 osteocalcin, 부갑상선 호르몬치와의 상관관계)

  • Kim, Euy-Neyng;Sohn, Hyung-Sun;Bang, Chan-Young;Chung, Soo-Kyo;Kim, Choon-Yul;Shinn, Kyung-Sub;Park, Chul-Whee;Chang, Yoon-Sik
    • The Korean Journal of Nuclear Medicine
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    • v.30 no.3
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    • pp.338-343
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    • 1996
  • In this preliminary study, plasma osteocalcin, PTH level and $^{99m}Tc$-HMDP (hydro-xymetylene diphosphonate) bone uptake(BU) were measured in 14 patients with chronic end-stage renal failure who were on maintenance hemodialysis. The aim of this study was to determine the difference of bone uptake between renal failure patients and normal volunteers, and to determine the correlation between bone uptake and osteocalcin - a sensitive and specific marker of osteoblastic activity and PTH - a important hormone of bone metabolism. There was a statistically significant increase in 180 minute uptake in the patient group when compared to the normal volunteers while there was no statistically significant difference in 20 minute uptake. Plasma osteocalcin and PTH levels were also significantly elevated compared to normal values. But the correlation between osteocalcin, PTH and 20 and 180 minute bone uptake was not significant. In conclusion, our preliminary study suggests that, in chronic renal failure patients, 180 minute $^{99m}Tc$-HMDP bone uptake is increased significantly without direct correlation with serum osteocalcin or PTH levels. It seems that further study is needed to evaluate other unknown factors that may influence the direct correlation between bone uptake and plasma osteocalcin and PTH in patients with chronic renal failure.

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Development and validation of an instrument to assess quality of life for end stage renal disease (만성신부전환자의 삶의 질 간편도구 개발)

  • Kim, Sookhyun;Kim, Yong-Lim;Park, Ki-Soo;Kam, Sin;Lee, Won Kee
    • Journal of the Korean Data and Information Science Society
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    • v.26 no.3
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    • pp.707-714
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    • 2015
  • The SF-36 is the most common instrument to check the quality of life for dialysis patients with chronic renal failure. However, there were too much burden for them to answer 36 items of it. So we purposed to develop the RFQoL-K reduced type of the SF-36. Participants who had newly registered for dialysis were enrolled in 29 medical centers during 45months from 2009. We developed the RFQoL-K through 355 people who applied the SF-36 at 3 and 12 months after registration and then checked it's internal validity. External validity about it was checked via 411 people who answered only one time survey after registration. In conclusion, the RFQoL-K had total 14 items which was consisted of 8 items on physical factors and 6 items on mental factors from the SF-36. The RFQoL-K summary scores explained 91-93% of the SF-36 summary scores. The RFQoL-K was well reflected SF-36 because the correlation and the internal consistency between two tools were very high 0.96 to 0.98 and 0.96 to 0.98 respectively.

Growth Retardation in Chronic Renal Failure : Pathophysiology and Therapy

  • 김영미
    • Proceedings of the Korean Society of Applied Pharmacology
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    • 1996.11a
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    • pp.85-89
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    • 1996
  • 성장저해는 만성신부전 (chronic renal failure, CRF) 소아환자나 실험동물에게서 나타나는 합병증의 하나로, 그 발생기전이 잘 알려져 있지 않다. 성장저해를 일으키는 원인으로 비내분비적 요인 (metabolic acidosis, renal osteodystrophy, anemia)과 내분비적 요인의 복합적 결과로 생각하나, 비내분비적 요인들은 약물투여로 그 증세를 완화시켜도 성장저해에 대한 궁극적 치료효과는 나타나지 않는다. 따라서 성장 호르몬 (Growth Hormone, GH)이 관여하는 내분비적 요인의 변화에 그 병리기전이 있을 것으로 연구되어 왔다. GH는 직접적 성장 효과와 Insulin-like growth factor-1(IGF-I)을 간으로부터 유리시켜 나타나는 간접적 성장효과를 가지고 있다. 그런데 CRF환자의 GH 및 IGF-I 의 혈중 농도는 정상이거나, 흑은 오히려 증가상태에 있음에도 볼구하고 성장저해가 일어나는 것으로 보아, 환자의 말단기관 (end-organ)에 원인을 알 수 없는 저항성 (resistance)이 있다고 규정되어진다.

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Giant Venous Aneurysm after Brachiocephalic Arteriovenous Shunt for Hemodyalisis Access -A case report- (혈액투석을 위한 상완동맥-두정맥단락 수술 후 발생한 거대한 정맥의 동맥류 -1예 보고-)

  • Chon, Soon-Ho;Lee, Chul-Burm
    • Journal of Chest Surgery
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    • v.39 no.11 s.268
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    • pp.861-863
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    • 2006
  • We report a case of a 46-year-old man with end-stage renal failure who developed a giant aneurysm after a brachiocephalic arteriovenous shunt. The patient had complaints of pulsating pain and swelling of his left upper extremity The patient had abandoned use of the arteriovenous shunt and had a second arteriovenous shunt procedure over his right extremity. The giant venous aneurysm was removed just distal to his anastomosis. The patient's postoperative course was uneventful.