• 대한한의학회지
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• 제21권3호
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• pp.119-128
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• 2000

목적 : Rhabdomyolysis에 의해 유발된 급성 신부전시 나타나는 신장세뇨관 세포에서 물질이동의 저해가 단삼 추출액에 의해 방지될 수 있는 지를 조사하였다. 방법 : 토끼에 50％ glycerol을 10ml/kg씩 대퇴근육내 주사한 후 뇨와 혈액을 채취하여 신기능을 측정하고, 신피질 절편을 분리하여 실험하였다. 결과： 토끼에 50％ glycerol을 10ml/kg씩 대퇴근육내 주사한 결과 사구체여과율의 감소와 Na 배설분율의 증가가 나타남으로서 glycerol 주입이 rhabdomyolysis에 의해 급성신부전이 유발되었음을 보였다. Glycerol을 주사하기 전 7일 동안 단삼 추출액 (0.05%)을 0.3 g/kg씩 경구 투여한 결과 glycerol에 의해 유발된 사구체여파율의 감소와 Na 배설분율의 증가가 유의하게 방지되었다. glycerol만을 주사한 동물에서는 포도당과 인산의 요배설분율이 각각 현저하게 증가하였으나, 이러한 증가는 단삼 추출액에 의해 억제되었다. 급성신부전이 유발된 신장피질에서 분리한 brush-border membrane vescicles (BBMV)에서 포도당과 인산의 이동은 정상 신장과 비교하여 유의한 감소가 나타나고, microsomal fraction에서 측정한 Na＋-K+-ATPase 활성도 억제되었다. 이러한 억제현상은 단삼 추출액을 전처치한 결과 방지되었다. 급성신부전이 유발된 신장피질 절편에서 유기 음이온인 P-aminohippurate 이동과 유기 양이온인 tetraethylammonium의 이동이 억제되었고, 이러한 변화는 단삼 추출액에 의해 방지되었다. Rhabdomyolysis에 의해 유발된 포도당과 인산의 배설분율의 증가는 항산화제로 잘 알려진 DPPD 전처치로 방지되었다. 결론 ： Rhabdomyolysis에 의한 급성신부전의 유발 과정에 반응성 산소기가 중요한 역할을 할 가능성을 보이고 있고, 단삼 추출액 전처치는 Rhabdomyolysis에 의한 급성 신부전시 나타나는 근위세뇨관에서 물질의 재흡수 장애를 방지하고 있다. 단삼 추출액의 방지 효과는 항산화작용에 기인할 것으로 사료된다.

• 대한임상독성학회지
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• 제12권2호
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• pp.92-96
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• 2014

Dabigatran is the first oral direct thrombin inhibitor approved by the US Food and Drug Administration (FDA) for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Because dabigatran is excreted mainly by the kidneys, serum levels of dabigatran can be elevated to a supratherapeutic range in patients with renal failure, predisposing to emergent bleeding. We describe the case of a 66-year-old man taking dabigatran 150 mg twice daily for atrial fibrillation and cerebral infarction who presented with hematochezia and disseminated intravascular coagulation. Laboratory evaluation showed a hemoglobin level of 6.3 g/dL, platelets of $138,000/mm^3$, activated partial thromboplastin time (aPTT) of 10 s, and an international normalized ratio (INR) of 8.17. Colonoscopy showed a bleeding anal fissure. Hemostasis was provided by hemoclips and packed red blood cells and fresh frozen plasma were transfused. Since then, there was no further hematochezia, however, bleeding including oral mucosal bleeding, hematuria, and intravenous site bleeding persisted. At presentation, his serum creatinine was 4.96 mg/dL (baseline creatinine, 0.9 mg/dL). Dabigatran toxicity secondary to acute kidney injury was presumed. Because acute kidney injury of unknown cause was progressing after admission, he was treated with hemodialysis. Fresh frozen plasma transfusion was provided with hemodialysis. At 15 days from admission, there was no further bleeding, and laboratory values, including hemoglobin, partial thromboplastin time, and prothrombin time were normalized. He was discharged without bleeding. After 2 months, he undergoes dialysis three times per week and no recurrence of bleeding has been observed.

• 동의생리병리학회지
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• 제21권5호
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• pp.1201-1209
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• 2007

The present study was designed to examine whether water extract of Acanthopanacis cortex(AC) has an effect on renal functional parameters in association with the expression of aquaporin 2 (AQP-2) and heme oxygenase-1 (HO-1) in the ischemia/reperfusion induced acute renal failure (ARF) rats. Polyuria caused by down-regulation of renal AQP 2 in the ischemia-induced ARF rats was markedly restored by administration of AC (200 mg/kg, p.o.) with restoring expression of AQP 2 in the kidney. Administration of AC lowered the renal expression of HO-1, which was upregulated in rats with ischemia/reperfusion-induced ARF. The renal functional parameters including creatinine clearance, urinary sodium excretion, urinary osmolality, and solute-free reabsorption were also markedly restored in ischemia-ARF rats by administration of AC. Histological study also showed that renal damages in the ARF rats were abrogated by administration of AC. Taken together, the present data indicate that AC ameliorates renal defects in rats with ischemia/reperfusion-induced ARF.

• Clinical and Experimental Pediatrics
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• 제58권4호
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• pp.154-157
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• 2015

Plastibell is one of the three most common devices used for neonatal circumcision in the United States, with a complication rate as low as 1.8%. The Plastibell circumcision device is commonly used under local anesthesia for religious circumcision in male neonates, because of cosmetic reasons and ease of use. Occasionally, instead of falling off, the device may get buried under the skin along the shaft of the penis, thereby obstructing the normal flow of urine. Furthermore, the foreskin of neonates is highly vascularized, and hence, hemorrhage and infection are possible when the skin is cut. Necrosis of penile skin, followed by urethral obstruction and renal failure, is a serious surgical mishap requiring immediate corrective surgery and medical attention. We report a case of fulminant urosepsis, acute renal failure, and pyelonephritis in a 4-day-old male neonate secondary to impaction of a Plastibell circumcision device. Immediate medical management was initiated with fluid resuscitation and mechanical ventilation; thereby correcting life threatening complications. Pediatricians and Emergency Department physicians should be cognizant of the complications from Plastibell circumcision device in order to institute appropriate and timely management in neonates.

• Journal of Yeungnam Medical Science
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• 제25권1호
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• pp.58-63
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• 2008

Henoch-Sch$\ddot{o}$nlein purpura (HSP) is a leukocytoclastic vasculitis of small vessels with deposition of IgA, commonly resulting in skin, joint, gastrointestinal, and kidney involvement. HSP is an uncommon disorder in adults and accounts for 0.6% to 2% of adult nephropathy. We report a case of HSP with acute renal failure successfully treated with corticosteroid. In this case, the patient presented with vasculitic purpuric rash on lower extremity, arthralgia in the wrist, abdominal pain, hematochezia, oliguria and azotemia. Abdominal CT showed wall thickening of the small and large bowels. Skin biopsy revealed leukocytoclastic vasculitis. Percutaneous renal biopsy showed no crescent formation, but mesangial IgA and $C_3$ deposits were observed by immunofluorescence. The patient was treated with corticosteroid (1mg/kg per day) and hemodialysis. After treatment, renal function improved and purpuric lesion, arthralgia and abdominal pain disappeared. Thus, when adults present with purpuric rash and rapidly progressive glomerulonephritis (RPGN), HSP should be a diagnostic consideration.

• Biomolecules & Therapeutics
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• 제11권2호
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• pp.126-132
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• 2003

Efficacy and in vivo bioassay of recombinant human erythropoietin (rh-EPO, DWP413) was investigated. Efficacy studies on erythropoiesis were conducted in normal, cisplatin-induced anemic rats and acute hemorrhage - induced anemic rats. Animals were treated intravenously with DWP413 for 5 days, the changes in the number of red blood cells (RBC), hematocrit value (Hct), hemoglobin concentration (Hb) and reticulocyte were examined. In normal rats, at the doses of 50, 250, and 1250 IU/kg/day, in cisplatin-induced anemic rats, at the doses of 50, 100 and 200 IU/kg/day, RBC, Hb, Hct and reticulocyte were increased dose-depen-dently. And in acute hemorrhage-induced anemic rats, DWP413 (150, 450 and 1350 IU/kg/day) significantly increased RBC, Hb, Hct and reticulocytes. In histopathological findings of kidney, cisplatin alone treated rats expressed severe glomerulus and tubular damage. But in the DWP413 treated rats after cisplatin treatment, these were not remarkable compared to cisplatin alone treated rats. In vivo bioassay, DWP413 had 102.43% of bioactivity compared to erythropoietin BRP(Biological Reference Product, European Directorate for the Quality of Medicines). These results suggest that DWP413 might be useful for the therapy of anemia induce by renal failure and acute blood loss.

• Childhood Kidney Diseases
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• 제20권2호
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• pp.74-78
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• 2016

Purpose: Early diagnosis and treatment of urinary tract infection have been emphasized to prevent renal scarring. If untreated, acute pyelonephritis could cause renal injury, which leads to renal scarring, hypertension, proteinuria, and chronic renal failure. The purpose of this study was to assess risk factors of renal scarring after treatment of acute pyelonephritis (APN). Methods: The medical records of 59 patients admitted at Daegu Fatima Hospital because of APN between March 2008 and April 2015 whose renal cortical defects were confirmed by using initial technetium-99m dimercaptosuccinic acid (DMSA) scans were reviewed retrospectively. We divided 59 patients into 2 groups according to the presence of renal scar and assessed risk factors of renal scar, including sex, age at diagnosis, feeding method, hydronephrosis, bacterial species, vesicoureteral reflux, and vesicoureteral reflux grade. Results: Of 59 patients (41%), 24 showed renal scar on follow-up DMSA scan. No significant differences in sex, hydronephrosis, bacterial species, and fever duration were found between the renal-scarred and non-scarred groups. As for age at diagnosis, age of >12 months had 5.8 times higher incidence rate of renal scarring. Vesicoureteral reflux (VUR) affected renal scar formation. VUR grade III or IV had 14.7 times greater influence on renal scar formation than VUR grade I or II. Conclusion: Our data suggest that the presence of VUR and its grade and age at diagnosis are risk factors of renal scar on follow-up DMSA scan after APN.

• Childhood Kidney Diseases
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• 제4권2호
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• pp.136-143
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• 2000

목 적 : 용혈성 요독 증후군은 미세혈관 병변성 빈혈, 혈소판 감소증, 급성 신부전 등이 동반되는 질환으로 소아에서 급성 신부전의 흔한 원인중 하나이나 국내에서는 보호가 매우 드문 편이다. 이에 저자들은 용혈성 요독 증후군으로 진단 받은 소아 환자들의 임상 고찰을 통하여 본 질환의 이해 및 치료에 도움을 주고자 하였다. 방 법 : 1986년 1월부터 2000년 1월까지 병원에서 소아 용혈성 요독 증후군으로 진단 닫은 환아 23명을 대상으로 입원 당시의 병인, 임상 증상, 임상 검사 소견, 치료 방법 및 예후에 대해 후향성으로 조사하였고, 사망 또는 말기 신부전으로 이행된 불량한 예후를 보인 8명 (Group A)과 투석 시행후 완전히 회복되었던 소아 15명(Group B)으로 나누어 임상 소견 및 치료시기에 따른 예후를 비교하였다. 결 과 : 연령 및 성별 분포는 4세 이하가 17명, 5세 이상 10세 이하가 4명, 11세 이상이 2명 이었고, 남녀비는 1.9:1이었다. 전구 증세를 원인별로 보면 급성 위장관염이 14예, 상기도염이 7예, 한약 복용후 발병한 경우가 1예 있었다. 치료 후 완전 회복된 경우는 15예 (65$\%$)였고, 전체적인 사망률은 22$\%$ (5명) 추신경계 합병증으로 사망한 예가 2예, 패혈증으로 사망한 예가 2예, 폐출혈로 사망한 예가 1예 있었다. 내원하여 신부전 소견을 보이고 호전없이 말기 신부전으로 이행된 경우가 3예 있었다. 불량한 예후를 보인 group A의 경우 호전된 group B보다 병이 경과함에 따라 보다 낮은 혈색소치 감소를 보였고($Hb\;4.8{\pm}1.2gm/이\;VS\;6.3{\pm}1.7gm/dl$) 발병시부터 복막 투석 시작까지 경과된 시간이 11.9${\pm}$9.1 day vs 2.8${\pm}$2.1 day로 보다 늦게 투석이 시작되었음을 알 수 있었다 (P<0.05). 결 론 : 저자의 경우 전체 환아 중 65$\%$만이 완전 회복을 보였고 35$\%$에서 사망이나 말기 신부전으로 이행하여, 병의 경과를 좋게 하고 사망률을 줄이는데 조기 진단과 조기 투석을 시행하는 것이 중요한 역할을 하는 것으로 알 수 있었다. 내원하여 시행한 검사 소견상 혈색소치가 불량한 예후를 보인 환자군에서 유의하게 감소하여, 낮은 혈색소치가 불량한 예후인자로서의 역할을 할 것으로 사료된다. 용혈성 요독 증후군은 아직 국내에서 드문 질환중의 하나이지만, 소아 영역에 있어서 급성 신부전증의 가장 흔한 원인중의 하나로 지속적인 연구가 필요할 것으로 사료된다.

• Pediatric Infection and Vaccine
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• 제22권1호
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• pp.36-39
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• 2015

장티푸스는 10-15%에서 수막염, 폐렴, 심근염, 간염, 골수염, 파종성 혈관내 응고병증등의 심각한 합병증을 유발할수 있다. 소아에서 장티푸스 병발 후 신장에 발생되는 합병증은 국내외 모두 매우 드물다. 우리는 장티푸스 병발후 단백뇨, 고혈압, 신기능 저하가 동반된 급성 사구체 신염 케이스를 경험후 보고하는 바이다. 이 케이스는 대변 배양검사에서 병원체를 확인할 수는 없었지만 상승하는 Widal 수치로 장티푸스를 진단할 수 있었다. 장티푸스는 유병률은 감소하였지만 고열이 있는 경우 여전히 고려해보아야 하는 중요한 질환이다.

• 한국임상수의학회지
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• 제24권1호
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• pp.73-75
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• 2007

Heat stroke can lead multi-organ damage with hemorrhage and necrosis in the lungs, heart, liver, kidneys, brain and Ut. Heat stroke occurs when the elevation of core body temperatures induce a failure of thermoregulatory mechanism. A four-year-old male African Lion(Panthera leo) showed clinical signs such as panting, tachycardia, hyperthermia, unconsciousness and mydriasis under He hish humidity and hot weather. Clinical treatment and pouring cool water was unsuccessful. Grossly, congestion of lungs and pleura was observed. Yellowish discoloration was observed in the renal cortex. Microscopically, the coagulative necrosis in kidney and congestion of lungs and spleen were observed. In our knowledge, this case was closely associated with acute heat stroke.