• Childhood Kidney Diseases
• /
• v.11 no.2
• /
• pp.152-160
• /
• 2007

Twenty-six renal allograft biopsies which showed acute rejection and had renal capsule and medulla in the same specimen were selected in order to compare the severity of acute rejection between superficial cortex, deep cortex and medulla. Disregarding the mid cortical region, the superficial cortex was considered as being one-third of the distance from the renal capsule to the medulla and the deep cortex as being that one-third of the cortex which was adjacent to the medulla. Using semiquantitative histologic analysis the following parameters were compared in superficial cortex, deep cortex, and medulla: interstitial inflammation, edema, tubulitis, and acute tubulointerstitial rejection grade. Also, the presence of lymphocyte activation and polymorphonuclear leukocytes was evaluated. Significantly greater histologic changes of acute rejection were found in the deep cortex vs. supeficial cortex for the following parameters: interstitial inflammation(P=0.013), edema (P=0.023) and tubulointerstitial rejection grade(P=0.016). These findings support the view that biopsies in which deep cortex is not included may result in underestimation of the severity of renal allograft rejection.

• Childhood Kidney Diseases
• /
• v.2 no.1
• /
• pp.26-33
• /
• 1998

This retrospective study was designed to evaluate the prognostic value and histologic correlation of sonography in childhood nephrotic syndrome. Sixty-nine patients with proteinuria over 2g per day at the time of presentation who were treated at the Korea University Hospital were included in this review. They were 1 to 15 years old(mean age, 7.8 years) with 49 males and 20 females. In each patient an ultrasound examination was done using SPA 1000(Diasonics, C.A., U.S.A.) on admission. Tissue specimens were obtained from 46 patients. The paraffin-embedded specimens were reviewed with special reference to interstitial edema, interstitial fibrosis, tubular atrophy, global sclerosis or inflammatory cell infiltrates. Biopsy proven renal disease were minimal change disease(n=20), focal segmental glomerulosclerosis(n=7), membranous glomerulonephritis(n=2), membranoproliferative glomerulonephritis(n=1), $Henoch-Sch\"{o}nlein$ purpura nephritis(n=6), IgA nephropathy(n=5), poststreptococcal glomerulonephritis(n=2), systemic lupus erythematosus(n=1) and Alport syndrome(n=2). There was a significant relationship between increased cortical echogenicity and global sclerosis or tubular atrophy(P<0.05). But no significant relationship was found between increased cortical echogenicity and interstitial fibrosis, interstitial edema, or inflammatory cell infiltration. In biopsy-proven primary nephrotic syndrome(n=30), no significant relationship was found between the increased conical echogenicity and the interstitial edema, interstitial fibrosis, global sclerosis, tubular atrophy or inflammatory cell infiltration. But there was a significant relationship between increased cortical echogenicity and resistance to corticosteroid (P<0.05). These results suggest that increased cortical echogenicity may be due to tubular atrophy or global sclerosis in patients with proteinuria and may be an effective indicator of resistance to corticosteroid in primary nephrotic syndrome.(J Korean Soc of Pediatr Nephrol 2:26-33, 1998)

• The Korean Journal of Zoology
• /
• v.36 no.4
• /
• pp.529-534
• /
• 1993

흰쥐의 신피질 세포막과 소포체 막을 분리하여 카드를 및 Metallothioneln(MT)을 투여하였을 때 세포막에 존재하는 Ca-ATPase에 미치는 영향을 측정하여 다음과 같은 결과를 얻었다. 전기영동상에서 분리된 MT가 분자량 12KD 정도의 위치에 band가 나타났으며, 분리한 각 세포의 막에 카드윰을 농도별로 처리하였을 때 고농도일수록 Ca-ATPase의 활성도가 감소하였으나, MT를 처리한 경우 신피질 세포막은 거의 대조군과 유사한 결과를 나타냈고, 소포체 막에 MT를 처리한 경우는 20mg/ml의 카드윰을 처리한 경우와 유사하였다. 이와같은 결과로 보아 카드윰은 세포막의 Ca-ATPase의 활성을 저하시켜 세포내 칼슘 항상성에 영향을 미치는 MT는 Ca-ATPase의 활성을 회복시켜 카드뮴에 의한 세포독성의 방어작용에 부분적으로 작용한 것으로 생각된다.

• The Korean Journal of Nuclear Medicine
• /
• v.26 no.2
• /
• pp.327-332
• /
• 1992

$^{99m}Tc-dimercaptosuccinic$ acid (DMSA) 주사후 일정시간에 측정한 절대적 신섭취량은 기능이 살아있는 신피질량과 관계있다. 소아의 신기능은 출생후 계속 성숙되어 생후 약 $1\sim2$년에 성인의 기능에 도달하는데 DMSA섭취도 성인과는 다른 양상을 보일 것으로 기대되며 신질환에서 절대적 신섭취율의 평가는 연령을 고려해야 할 것이다. 저자들은 DMSA 스캔을 시행한 소아 환자를 대상으로 스캔상 피질 결손이 없으며 양측신의 섭취율이 비슷하고 혈중 크레아티닌치가 정상인 경우를 대조군으로 하여 연령별 DMSA의 절대적 신섭취율을 구하였고 방광요관역류를 가진 환아를 대상으로 DMSA스캔을 시행하고 신섭취율을 조사하였다. 1) 대조군은 모두 65명으로 좌우측 신섭취율의 유의한 차이는 없었으며 연령에 따라 2세경에 플라토에 도달하였는데 한쪽 신장의 평균섭취율은 3개월 미만이 $14.5{\pm}3.1%$ ID, 3개월에서 6개월 미만이 $17.2{\pm}2.1%$ID, 6개월에서 1년 미만이 $18.4{\pm}1.3%$ID, 1년에서 1년6개월 미만이 $19.3{\pm}1.1%$ID, 1년 6개월에서 2년 미만이 $21.9{\pm}2.0%$ID, 2세이상 15세이하가 $20.1{\pm}0.6%$ID였으며 전체 평균섭취율은 $19.4{\pm}0.5%$ID (injected dose, $mean{\pm}S.E.$)였다. 2) 방광요관역류를 가진 환아는 55명 (일측성 56명, 양측성 29명)으로 109신장을 대상으로 하였다. 방광요관역류의 정도와 피질결손의 수와는 대체로 비례관계가 있었으나 방광요관역류가 없으면서 피질결손이 있는 경우가 25신장중 2예 (8%)였으며, 방광요관역류가 있는 84신장중 27예 (32.1%), 이중에서 방광요관역류가 3도 이상인 62신장중 13예 (21%)에서는 피질결손이 없었다. 3) 이환신의 DMSA 섭취율을 연령에 따른 대조군의 섭취율에 대한 비(섭취율비)로 나타내면 한쪽에 역류가 있을 때 이환신의 경우 $0.55{\pm}0.06$, 정상신의 경우 $1.34{\pm}0.05$이었으며, 양쪽에 역류가 있을 때는 평균 $0.82{\pm}0.08$ $(mean{\pm}S.E.)$ 이었다. 4) 피질결손이 있는 신장의 절대 DMSA 신섭취율은 감소되어 있었고 상대측 신장의 섭취율은 피질 결손이 있더라도 대상적인 증가의 경향을 보였다. 이상의 결과로 소아에서 DMSA 절대적 신섭취율의 연령에 따른 변화를 알 수 있었으며 방광요관역류의 정도와 피질결손의 정도가 반드시 비례하지만은 않아서 시간경과에 따른 추후 검사가 필요하리라 생각된다. 또한 방광요관역류가 있는 환아에서 DMSA 섭취율로 신기능을 평가할 때, 특히 영유아에서 연령에 따른 고려가 있어야 할 것으로 보인다.

• Journal of the korean veterinary medical association
• /
• v.38 no.6
• /
• pp.549-558
• /
• 2002

3.5살짜리 래브라도 리트리버(Labrador Retriever)는 매일 처방되는 피질스테로이드제에 무반응으로 비계절적, 심한 소양증을 2년간 앓고 있는 병력을 갖고 있었다. 공기유래 알레르겐(알러젠; Allergens)들에 대한 시험관내 RAST1(Radioallergosorbent testing; 방사선 알레르기 흡착 시험법)에 양성으로 나타난 것을 기초로 한 면역요법(Immunotherapy)을 18개월 동안 시행했으나 성공적이지 않았다. 부신피질호르몬(Adrenocorticotropic Hormone, ACTH)자극 시험법은 이것이 본래 임상수의사에 의해 발생(Iatrogenic)된 것임을 예시하여준다. 피부 찰과물(Skin scrapings)을 검사한 결과 개 천공개선충(Sarcoptic mange)이라는 진단이 내려졌다. 이버맥틴(Ivermectin)치료효과와 피질스테로이드(Corticosteroid)의 투약중지에 대한 반응이 극적으로 나타났다. 10개월 추적기간(10-month follow-up period)동안에 이 질병은 재발되지 않았다. 이것은 비록 계절적인 알레르겐을 배제하기 위해 긴 기간동안 추적이 필요하였으나 개 천공개선충이 오히려 피질스테로이드요법에 대한 2차적인 것보다는 1차적인 질병이라는 것을 말해준다. 아토피의 진단을 위해 혈청학적 시험법의 이용이 논의되었다.

• The Korean Journal of Physiology
• /
• v.22 no.1
• /
• pp.55-62
• /
• 1988

가토 신피질 절편에서 p-aminohippurate (PAH) 이동에 대한 카드뮴 이온(Cd)의 영향을 조사하여 다음과 같은 결과를 얻었다. 조직절편과 용액내의 PAH 농도비(S/M PAH)는 용액내에 Cd이 0.1 mM이상 존재할 때에 현저히 감소되었다. PAH influx에 대한 동력학적 분석결과 Cd에 의하여 influx의 최대이동율(즉 $V_{max}$)은 심하게 감소되지만 운반체와 기질간의 친화력(즉 $K_{m}$)에는 변화가 없었으며, 수동적 influx 역시 변화되지 않았다. 신피질조직의 산소 소모율은 1 mM Cd에 의하여 35% 가량 억제되었으며, 신피질 microsome 분획의 Na-K-ATPase 활성도는 Cd 농도가 $10^{-7}M$ 이상일 때 의의있게 억제되었다. 이상의 결과로 미루어 볼 때 신장조직이 카드뮴이온에 직접 노출될 경우 유기음이온의 능동적 이동능이 심하게 저해된다고 사료된다.

• Clinical and Experimental Pediatrics
• /
• v.49 no.3
• /
• pp.278-286
• /
• 2006

Purpose : Although suprapubic bladder aspiration(SBA) is the most reliable technique for identifying bacteriuria in young infant, no report has been published about the clinical manifestations of urinary tract infection(UTI) diagnosed by aspirated urine in Korea. This study was performed to examine clinical manifestations and related factors of UTI confirmed by a positive urine culture obtained by SBA in young infants. Methods : We reviewed medical records of 159 infants younger than six months of age, who had been admitted for UTI to Korea University Ansan Hospital from January 2002 to June 2005. Results : The male:female ratio was 5.1 : 1. The most common pathogen in urine culture was Escherichia coli(92.5 percent). Most of the gram-negative pathogens had high sensitivity to amikacin, or third generation cephalosporins and had low sensitivity to ampicillin, trimethoprim-sulfamethoxazole, or gentamicin. Hydronephrosis and vesicoureteral reflux(VUR) were present in 32.7 percent and 27.7 percent respectively. Renal cortical defects observed on DMSA scans were detected in 37.1 percent. Prolonged fever duration and hospital day, high erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) levels, hydronephrosis and VUR were related to the renal cortical defects(P<0.05). Rates of UTI-associated bacteremia and aseptic meningitis were 8.3 percent and 6.6 percent. Conclusion : Early differential diagnosis is very important in infants younger than 6 months of age with UTI because the clinical findings are non-specific and UTI-associated bacteremia and aseptic meningitis are concomitantly found. Because prolonged fever and higher ESR and CRP levels are risk factors of the renal cortical defects, radiologic evaluations and nephrologic follow-up were needed in identifying the predisposing congenital abnormalities and chronic renal scarring.

• The Korean Journal of Physiology
• /
• v.21 no.2
• /
• pp.273-282
• /
• 1987

가토 신피질에서 분리한 brush border membrane (BBM)과 basolateral membrane vesicle (BLM)에서 유기 음이온인 p-aminohippuric acid (PAH)와 유기 양이온인 tetraethylammonium (TEA)의 이동에 대한 동력학적 분석을 하였다. BLM에서 PAH에 대한 Km과 Vmax값은 각각 $0.34{\pm}0.02\;mM$과 $0.22{\pm}0.07\;nmol/mg\;protein/20s$였으며 BBM에서 각 값은 $8.46{\pm}0.57\;mM$과 $4.43{\pm}0.40\;nmol/mg\;protein/20s$였다. BLM에서 용액내 Na의 제거는 PAH에 대한 Km 값에는 영향없이 Vmax 값을 변화시켰다. BBM에서 TEA이동에 대한 Km과 Vmax 값은 각각 $0.55{\pm}0.15\;mM$과 $1.04{\pm}0.23\;nmol/mg\;protein/20s$였으며 BLM에서 각 값은 $0.46{\pm}0.04\;mM$과 $0.61{\pm}0.06\;nmol/mg\;protein/20s$였다. BLM에서 측정한 유기 이온들의 이동에 대한 Km 값이 신절편이나 분리된 tubule에서 보고된 값과 일치함을 보였으며 이러한 결과는 신세뇨관 세포막을 통한 유기 이온들의 이동 특성이 membrane vesicle을 분리하는 과정에서 변하지 않았음을 가르킨다.

• Clinical and Experimental Pediatrics
• /
• v.49 no.6
• /
• pp.653-658
• /
• 2006

Purpose : Because voiding cystourethrography(VCUG) is an invasive method, we studied whether VCUG could be postponed through evaluation of alternative non-invasive tests including renal ultrasonography and $^{99m}Tc$-DMSA renal scan. Methods : We reviewed the medical records of 175 patients initially diagnosed with febrile urinary tract infection during the one year period of 1999, and compared 3-tests : renal ultrasongraphy, $^{99m}Tc$-DMSA renal scan, and VCUG. Results : Renal ultrasonography didn't contribute to the prognostication of pyelonephritis(photopenic areas) or vesicoureteral reflux(VUR). Presentation of photopenic areas in $^{99m}Tc$-DMSA renal scan was related to VUR. If both findings of renal ultrasonography and $^{99m}Tc$-DMSA renal scans were normal, this condition was closely related to normal results in VCUG. And if both examinations were abnormal, the condition was closely related to VUR. But this state could not always guarantee the normal result from VCUG because of low sensitivity in finding VUR. Conclusion : In cases in which acute phyelonephritis is demonstrated by $^{99m}Tc$-DMSA renal scan, VCUG is required. In addition to this, if the conditions of hydronephrosis, vesicoureteral dilatation, increases of renal volume, and changes of echogenesity are shown by renal ultrasonography, VCUG should be performed. If a patient has difficulty undergoing VCUG, temporary postponement of VCUG can be taken into consideration, but only in cases where both examinations of renal ultrasonography and $^{99m}Tc$-DMSA renal scan are normal. Nevertheless, close observation is be advised even in this case.

• The Korean Journal of Physiology
• /
• v.19 no.2
• /
• pp.203-213
• /
• 1985

This study was carried out to investigate whether the K-pNPPase activity in renal cortical slices can be used as an index for measuring the activity of $Na^+-K^+$ exchange pump. The K-pNPPase activity, Ouabain-sensitive oxygen consumption add intracellular electrolytes content in slices, and Na-K-ATPase activity in microsome were measured and the effects of ouabain and vanadate on these were observed. The results are as follows : 1) p-NPPase activity in slices increased linearly with incubation time during 60 minutes, and $K^+$-dependent, ouabain-sensitive fraction was about 55% of total p-NPPase activity. This value was almost the same through out the incubation time. 2) The concentrations of ouabain and vanadate for 50f inhibition of K-pNPPase activity were$7.0{\times}10^{-6}M$ and $1.3{\times}10^{-5}M$, respectively. 3) The ouabain-sensitive oxygen consumption in slices was reduced to 50% of control value by $6.3{\times}10^{-6}M$ ouabain or $2.5{\times}10^{-5}M$ vanadate. These concentrations were similar to those for 50% inhibition of K-pNPPase activity. 4) The trends of intracellular electrolytes change by ouabain and vanadate were similar to those of the change in K-pNPPase activity. 5) The Na-K-ATPase activity in microsome prepared from renal cortex was completely inhibited by $10^{-3}M$ ouabain or $10^{-3}M$ vanadate and the concentration for 50% inhibition was $1.2{\times}10^{-6}M$ in ouabain and $1.6{\times}10^{-6}M$ in vanadate, which were much lower than those for K-pNPPase activity or ouabain-sensitive oxygen consumption in slices. These results indicate that K-pNPPase activity measured in renal cortical slices is a better index for evaluating $Na^+-K^+$ exchange pump activity than Na-K-ATPase activity measured in microsome.