• 한국임상약학회지
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• 제23권2호
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• pp.151-157
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• 2013

Purpose: Warfarin is the most widely used anticoagulant drug for preventing cardiovascular diseases after ischemic stroke and thromboembolism related to atrial fibrillation, artificial heart valves, deep vein thrombosis, and pulmonary embolism. Warfarin is commonly used in combination with other drugs such as diuretics in order to treat the comorbidity. Although several warfarin-diuretics interactions have been reported, the results are conflicting. Therefore, the initial aim of this study was to identify the effects of diuretics on the warfarin response in patients with atrial fibrillation. Methods: One hundred forty six patients with atrial fibrillation who were on anticoagulation therapy with warfarin and maintained INR levels of 2-3 for three consecutive times were followed up, retrospectively. Stable warfarin doses and INR per stable warfarin dose were compared according to age, gender, comorbidity, and concurrent medication. The stable warfarin dose was defined as the maintenance dose of warfarin of the measured patient whose INR was within the target INR range more than 3 times consecutively. Results: The differences of stable warfarin doses in patients with ($3.22{\pm}1.21$ mg/day) and without ($3.58{\pm}1.14$ mg/day) diuretics were marginally significant (P=0.069). On the other hand, stable warfarin doses were $2.97{\pm}1.10$ mg/day in patients with thiazide (n=36) and $3.58{\pm}1.14$ mg/day in patients without diuretics (n=82), which was statistically significant (p=0.009). INR values per stable warfarin dose in patients with diuretics and thiazide were $0.84{\pm}0.31$ and $0.90{\pm}0.34$, respectively, which were statistically different from those without diuretics ($0.72{\pm}0.21$, P=0.010 and P=0.006, respectively). Age, gender, and concurrent use of thiazide diuretics were found to have significant influence on the warfarin response from multivariate analysis. Conclusion: Our study showed that the concurrent use of thiazide diuretics could increase the response of warfarin in patient with atrial fibrillation. Therefore, clinicians should be aware that warfarin dose needs to be adjusted when it is used with thiazide diuretics concomitantly.

• Journal of Gastric Cancer
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• 제6권3호
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• pp.198-201
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• 2006

저나트륨혈증은 항암화학요법 중에 발생하는 전해질 장애 중의 하나이며, 조기에 발견하여 치료하지 않을 경우 급사할 수 있다. 저나트륨혈증을 유발하는 여러 원인중에 항이뇨호르몬과다분비증후군(syndrome of inappropriate antidiuretic hormone, SIADH)이 항암화학요법을 시행받은 환자들에게서 발생하였다고 보고되고 있다. SIADH를 유발하는 항암제는 아직까지 몇 가지 외에는 많이 알려져 있지 않다. 본 예는 위암으로 위전절제술, 비장절제술, 횡행결장구역절제술을 시행 받은 55세 여자로 수술 후 복막전이가 발견되어 S-1 ($80\;mg/m^{2}$)과 cisplatin ($60\;mg/m^{2}$)을 이용한 항암화학요법 중 SIADH가 발생하였다. 환자는 3% 생리식염수를 투여한 후 저나트륨혈증이 정상화되어 퇴원하였다.

• Clinical and Experimental Pediatrics
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• 제45권3호
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• pp.413-417
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• 2002

증후군은 원위세뇨관 Na-Cl 공동운반체 유전자 이상으로 발생하는 상염색체 열성 유전질환으로, 저칼륨혈증, 저마그네슘혈증, 대사성 알칼리증, 그리고 저칼슘뇨증 등의 임상적 특징을 보이는 질환이다. 저자들은 Bartter 증후군과의 감별진단과 Gitelman 증후군의 확진을 위해 임상적으로 Gitelman 증후군이 의심되는 두명의 환아에서 신장청소검사를 시행하였다. 각각의 환아는 밤사이 금식을 시킨 후 물 20 mL/kg를 30분에 걸쳐 경구 투여하였고, 곧 이어 half saline을 정맥을 통해 분당 5 mL의 속도로 투여하기 시작하였다. 소변양이 분당 10 mL에 도달했을 때의 검체로 삼투질제거율, 유리수분제거율, 염소제거율, 원위분획염소재흡수율을 계산하였다. 그 후에 첫째 날은 furosemide, 둘째 날은 hydrochlorothiazide를 각각 투여하고 나서 같은 신장청소검사를 시행하였다. 이뇨제를 투여하기 전 원위분획염소재흡수율은 각각 73%, 75%로 정상범위에서 약간 감소되어 있었다. furosemide를 투여한 후 삼투질제거율은 증가하였고 유리수분제거율은 감소하였다. 염소제거율은 10배 이상 증가하였으며, 원위분획염소재흡수율은 현저한 감소를 보였다. Thiazide를 투여한 후에는 위와 같은 청소율의 변화들을 관찰할 수 없었다. 신장청소 검사의 소견은 본 연구의 환아들이 헨레의 고리 상행각의 이상보다는 원위세뇨관 Na-Cl 공동운반체의 이상이 있음을 보여주고 있어 Gitelman 증후군의 병태 생리와 잘 일치한다고 사료된다.

• Childhood Kidney Diseases
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• 제8권1호
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• pp.68-73
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• 2004

Gitelman 증후군과 Bartter 증후군은 모두 상염색체 열성으로 유전되는 신 세뇨관 질환으로 낮은 혈중 포타시움 농도, 대사성 알칼리혈증, 염분 소실, 정상 또는 낮은 혈압을 특징으로 한다. Gitelman 증후군은 thiazide-sensitive Na-Cl cotransporter(NCCT)의 유전자 돌연변이로 발생하며, 저마그네슘혈증과 저칼슘뇨증이 있는 것으로 Bartter 증후군과 구별된다. 환자들은 대개 증상이 없으며, 일정 기간 동안 근 약화, 테타니 등을 보이지만, 대부분의 경우 성인이 되어서 진단된다. 저자들은 11세된 여아에서 간질 발작의 악화로 내원하였다가 우연히 발견된 Gitelman 증후군 1례를 경험하였기에 보고하는 바이다. Gitelman 증후군의 진단은 대사성 알칼리혈증, 저칼륨혈증, 저마그네슘혈증, 저칼슘뇨증에 의해 근거하였다. 저자들은 또한 환자의 SLC12A3 유전자에서 이종접합체성 $^{642}$Arg(CGC)>Cys(TGC)변이와 동종접합체성 가성엑손을 확인하였다.

• Childhood Kidney Diseases
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• 제16권2호
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• pp.121-125
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• 2012

Gitelman 증후군은 저칼륨혈증, 대사성 알칼리혈증, 고레닌혈증, 고알도스테론혈증, 저마그네슘혈증, 저칼슘뇨증, 고마그네슘뇨증과 정상 혈압을 특징으로 하는 상염색체 열성 유전성 세뇨관 질환이며 SLC12A3 유전자 돌연변이로 인해 원위 곱슬 세뇨관의 NCCT의 결함을 유발하여 초래된다. 환아는 Rolandic 간질 및 마제신으로 진단받고 본원 외래에서 주기적으로 진료받던 환아로 혈액검사에서 저칼륨혈증 및 대사성 알칼리혈증이 지속되었지만 정상 마그네슘혈증이 관찰되어 유전자검사를 통해 SLC12A3 유전자 돌연변이를 확인하였고 Gitelman 증후군으로 진단한 증례를 경험하였기에 보고하는 바이다.

• 한국임상약학회지
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• 제22권4호
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• pp.330-339
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• 2012

Background : Hypertension is treated with both lifestyle modification and pharmacotherapy. The Seventh Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7), published in 2003, provides a streamlined management approach to hypertension for the primary care physician. The JNC-7 is the gold standard also in Korea. According to the JNC-7, special therapeutic considerations are recommended for high-risk individuals with compelling indications. The presence of compelling indications in any given patient should be considered when selecting specific pharmacotherapy to treat hypertension. However, in patients with compelling indications, it is unknown that hepatotoxicity is caused by Calcium Channel Blocker (CCB), one of 1st anti-hypertensive drugs. Now, the CCB is the most used 1st anti-hypertensive drug in Korea Therefore, we evaluated the changes in blood liver function parameters (ALT, AST, Total bilirubin, serum albumin) for the study group. Methods : We randomly collected and retrospectively analyzed Electronic Medical Record data (n=28,788) of patients, and who took calcium channel blockers(non-dihydropyridines; diltiazem, verapamil, dihydropyridines; amlodipine, barnidipine, benidipine, clinidipine, efonidipine, felodipine, isradipine, lacidipine, lercanidipine, nicardipine, nifedipine, nimodipine), with having liver function tests (LFTs) from July 1st 2009 to June 30th 2010 at the Seoul National University Hospital in Korea. Control groups are two antihypertensive agents: RAS blockade (ARB; candesartan, irbesartan, losartan, olmesartan, telmisartan, valsartan, ACE-I; cilazapril, enalapril, fosinopril, imidapril, perindopril, ramipril) and, Diuretics (loop; furosemide, torsemide, thiazide; hydrochlorothiazide[HCTZ], indapamide). Patients not having LFT results at these three standard points of time(baseline, during, medication, and after finishing medication) were excluded. The collected data were analyzed by using the SPSS (Version12.0) and Microsoft Excel (Version2007). Results : 711 patients who were treated CCB (297), RAS blockade (232) or Diuretics (182) monotherapy were selected for the study. In selected patients, liver damage degree(changes of each LFTs value) was higher in diuretics group than other groups, followed by RAS blockade and CCB. In diuretics group's was loop-diuretics group was higher than thiazide-diuretics group. In CCB group, Nondihydropyridine-CCB's damage degree was higher than Dihydropyrine-CCB's that. Conclusions : Despite the limitations due to the retrospective study, among patients with abnormal LFTs, the use of CCBs led to a less liver damage than other 1st anti-hypertensive agents. It can be recommended CCBs as one of the initial treatments of hypertension in patients with liver disease.

• Journal of Yeungnam Medical Science
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• 제34권1호
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• pp.101-105
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• 2017

Gitelman syndrome is a condition caused by a mutation of the thiazide sensitive Na-Cl cotransporter gene on the distal convoluted tubule. It results in a variety of clinical features, including hypokalemia, hypomagnesemia, hypocalciuria, and metabolic alkalosis. It is often diagnosed in asymptomatic adults presented with unexplained hypokalemia; however, it is sometimes associated with muscular cramps, numbness, fatigue, weakness, or paralysis. We experienced a case of rheumatoid arthritis accompanied by Gitelman syndrome, presented with hand tremor. We diagnosed her using renal clearance study and genetic analysis. Here, we report our experiences regarding this case along with a literature review.

• Journal of Medicine and Life Science
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• 제19권3호
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• pp.79-89
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• 2022

Whereas systolic blood pressure (SBP) continuously rises with age, diastolic blood pressure (DBP) gradually decreases after the age of 55 years. Therefore, hypertension in the elderly shows the pattern of isolated systolic hypertension. There is evidence on the benefits of controlling blood pressure (BP) in elderly patients with hypertension. The BP lowering effect has also been demonstrated in patients over 80 years of age with hypertension. The BP threshold for the initiation of antihypertensive drug treatment for older adults with hypertension is gradually decreasing. The antihypertensive treatment is recommended if, despite therapeutic lifestyle modifications, SBP ≥140 mmHg or DBP ≥90 mmHg in those aged 65-79 years old, and SBP ≥140-160 mmHg or DBP ≥90 mmHg in those aged ≥80 years old. Although there is no consensus on the target BP for older adults with hypertension, a target SBP of <130-140 mmHg and DBP of <80-90 mmHg are recommended. In older adults over 80 years of age with hypertension, the target SBP is <140-150 mmHg. When the dose of antihypertensive drugs is increased to reach the target SBP, DBP may decrease to less than 70 mmHg, but it should not be <60 mmHg. Thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers can be selected as the first-line drug for older adults with hypertension. Beta-blockers may be selected in case of compelling indications.

• Childhood Kidney Diseases
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• 제9권2호
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• pp.269-274
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• 2005

저자들은 불규칙한 발열은 주소로 내원한 5개월 된 어린 영아에서 유전자 검사를 통하여 선천성 신성 요붕증을 조기 확진하였으며 thiazide 치료에 반응을 보였기에 문헌고찰과 함께 보고하는 바이다.

• 대한한방내과학회지
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• 제35권1호
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• pp.106-110
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• 2014

Objectives : To report a case of the treatment of primary hypertension by Oryung-san (五苓散: Wulingsan in Chinese, Goreisan in Japanese) monotherapy. Methods : The blood pressure (BP) fluctuation was checked of a woman who had sudden BP elevation without a history of hypertension treatment. There were no specific history of disease and results for the laboratory examination and image diagnosis including MRI. The woman was diagnosed with primary hypertension and she was given supple of Oryung-san extract (Hanpoong Pharm Co.) 3 g, three times a day for three months. The BP has been checked with digital sphygmomanometer (HEM-7111, Omron Japan) in brachial artery at home. Results and Conclusions : The patient had had stable BP since three weeks after Oryung-san treatment was initiated. There were no subjective symptoms, then Oryung-san medication also had quit after three months treatments. This shows some possibility to control hypertension using Oryung-san, which resembles thiazide that acts on the distal convoluted tubule and inhibit sodium-chloride reabsorption. For further evaluation of the effectiveness, well-designed randomized controlled trials should be undertaken.