• 한국임상약학회지
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• 제28권3호
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• pp.194-203
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• 2018

Background: Bone fractures are high in elderly patients with type 2 diabetes mellitus (T2DM). Hyperglycemia and chronic kidney disease may increase the risk of fracture prevalence via altered bone metabolism, but whether glycemic control and kidney function are associated with the risk of fracture prevalence remains unclear. This study evaluated the relationship between glycemic control and baseline estimated glomerular filtration rate (eGFR) and risk of fracture prevalence in older and middle-aged patients with T2DM. Methods: Patients who underwent a general medical check-up between 2009 and 2013 were selected from the Korean National Health Insurance Sharing Service records. Chi-square test and multiple logistic regression analysis were used to assess the relationship between glycemic control and eGFR and risk of fracture prevalence. Results: Cumulative fracture prevalence were higher in patients with T2DM, irrespective of whether they had tight or less stringent glycemic control (fasting blood glucose [FBG] ${\geq}110mg/dL$). After adjustment for baseline age and FBG, tight and less stringent glycemic control was significantly associated with increased adjusted risk of fracture prevalence in middle-aged patients with T2DM (OR=1.13, 95% CI, 1.05-1.21, p=0.0005 vs OR=1.13, 95% CI, 1.06-1.20, p=0.0001), but not in older patients. Baseline eGFR was not significantly related to fracture prevalence in either older or middle-aged patients. Conclusion: Less stringent glycemic control significantly increased the adjusted risk of fracture prevalence in middle-aged patients with T2DM. Further studies are needed to confirm the effect of tight glycemic control on fracture prevalence.

• 대한족부족관절학회지
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• 제23권1호
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• pp.18-23
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• 2019

Purpose: This study compared and analyzed the risk factors that affect a wound healing group and healing failure group. Materials and Methods: From 2010 to 2018, 39 patients who had suffered a single toe amputation were evaluated retrospectively. The patients were divided into two groups (wound healing group and healing failure group - within at least 3 months following the amputation). Regarding the possible risk factors, age, gender, Wagner and Brodsky classifications, duration of diabetes mellitus, whether the patient had peripheral arterial occlusive disease (PAOD) or cardiovascular disease, body mass index, HbA1c, total cholesterol, estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), smoking, and alcohol were investigated. Results: The mean duration of diabetes mellitus was 140 months in the healing group and 227 months in the healing failure group, and the duration of diabetes was significantly longer in the failure group (p=0.009). A significant difference in eGFR was observed between the two groups ($59.17mL/min/1.73m^2$ in the healing group and $31.1mL/min/1.73m^2$ in the failure group) (p=0.022). Sixteen patients with PAOD were found, all 10 patients in the healing failure group were PAOD patients. Conclusion: To reduce the additional complications in single toe amputation patients, the underlying disease and appropriate treatment are the most important factors. In addition, a more proximal level of amputation also should be considered in cases of patients with PAOD, high BUN and low eGFR, and patients with long-term diabetes.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제49권5호
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• pp.243-251
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• 2023

Objectives: Although a few studies have investigated the relationship between kidney and oral function (number of remaining teeth), their results remain inconclusive. Therefore, this study aimed to investigate the relationship between kidney function and oral health in community-dwelling healthy elderlies and examine the factors associated with kidney function. Materials and Methods: We used cross-sectional data from the Shimane prefecture cohort recruited by the Center for Community-Based Health Research and Education in 2019. We collected clinical data on dental status, background factors and kidney function (estimated glomerular filtration rate [eGFR], mL/min/1.73 m² and creatinine levels, mg/dL). Results: The study enrolled 481 participants, whose mean age was 66.7±7.4 years, and 223 (46.4%) participants were men. Multivariate analysis revealed significant correlations between eGFR (B=0.17, P=0.04), creatinine (B=-0.54, P<0.01), and the number of remaining teeth. The number of remaining teeth was associated with creatinine and eGFR, which are indicators of kidney function. Conclusion: This study suggests that preserving the teeth may prevent decline in kidney function. Dental professionals should provide instructions and professional care to reduce the risk of systemic diseases such as kidney dysfunction.

• Journal of Yeungnam Medical Science
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• 제38권2호
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• pp.136-141
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• 2021

Background: Postoperative acute kidney injury (AKI), which increases the risk of postoperative morbidity and mortality, poses a major concern to surgeons. We conducted this study to analyze the risk factors associated with the occurrence of AKI after orthopedic surgery. Methods: This was a retrospective study that included 351 patients who underwent total hip or knee replacement surgery at Inje University Haeundae Paik Hospital between January 2012 and December 2016. Results: AKI occurred in 13 (3.7%) of the 351 patients. The patients' preoperative estimated glomerular filtration rate (eGFR) was 66.66 ±34.02 mL/min/1.73 m² in the AKI group and 78.07±21.23 mL/min/1.73 m² in the non-AKI group. The hemoglobin levels were 11.21±1.65 g/dL in the AKI group and 12.39±1.52 g/dL in the non-AKI group. Hemoglobin level was related to increased risk of AKI (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.02-0.68; p=0.016). Administration of crystalloid or colloid fluid alone and the perioperative amount of fluid did not show any significant relationship with AKI. Further analysis of the changes in eGFR was performed using a cutoff value of 7.54. The changes in eGFR were significantly related to decreased risk of AKI (OR, 0.74; 95% CI, 0.61-0.89; p=0.002). Conclusion: Renal function should be monitored closely after orthopedic surgery if patients have chronic kidney disease and low hemoglobin level. Predicting the likelihood of AKI occurrence, early treatment of high-risk patients, and monitoring perioperative laboratory test results, including eGFR, will help improve patient prognosis.

• Journal of Yeungnam Medical Science
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• 제5권1호
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• pp.93-100
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• 1988

1985년 7월부터 1987년 6월까지 2년 동안 영남대학교 의과대학 부속병원 소아과에 입원한 환자중 신기능에 영향을 미치는 인자가 없는 1세부터 15세까지의 남녀환아 81명을 대상으로 키와 혈장 creatinine 농도를 이용한 공식 $GFR=k{\cdot}Ht/Pcr$ (k=상수)을 이용하여 실제 측정된 creatinine clearance와 Ht/Pcr에서 구해진 $k_M$ (measured k)의 적합성을 연령별로 1~5세(I군), 6~10세(II군), 11~15세(III순) 그리고 전 연령군으로 나누어 검정하였다. 1) 실제 측정된 creatinine clearance ($m{\ell}/min/1.73m^2$)는 I군에서 $109.73{\pm}9.97$, II군에서 $108.26{\pm}9.02$, III군에서 $96.20{\pm}4.72$ 그리고 전 연령군에서는 $105.48{\pm}5.23$이었다. 2) Ht/Pcr과 실제 측정된 creatinine clearance를 이용한 공식에서 얻어진 $k_M$값은 I군에서 $0.49{\pm}0.03$, II군에서 $0.48{\pm}0.02$, III군에서 $0.43{\pm}0.02$ 그리고 전 연령군에서는 $0.47{\pm}0.02$이었다. 3) Ht/Pcr(x)과 실제 측정된 creatinine clearance(y)를 이용하여 각 군별 및 전 연령군의 회귀방정식과 이들간의 얻어진 상관계수(r)는 I군에서 y=0.82x-65.63(r=0.99), II군에서 y=0.61x-23.46(r=0.72), III군에서 y=0.18x+54.44(r=0.54) 그리고 전 연령군에서는 y=0.58x-22.13(r=0.81)로 모두에게 상관관계가 높게 나왔다. 4) 이 회귀방정식을 이용하여 추정된 creatinine clearance($Ccr_E$) 값을 정리한 후, 추정된 creatinine clearance와 Ht/Pcr에서 구한 $k_E$(estimated k)값은 I군에서 $0.48{\pm}0.01$, II군에서 $0.49{\pm}0.01$, III군에서 $0.43{\pm}0.01$ 그리고 전 연령군에서는 0.47이었다. 5) 간군별 $k_M$과 $k_E$의 적합도는 I, II군에서 95~97.5%, III군에서 90~95% 그리고 전 연령군에서는 97.5%~99%로 모두에서 높게 나왔다. 이상의 연구결과를 종합해 보면 Ht/Pcr과 본 연구에서 계산된 $k_M$값을 이용한 공식을 사용하여 신속하고 간편하게 사구체여과율(GFR)을 산출하여 사구체기능을 평가할 수 있다.

• 약학회지
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• 제40권4호
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• pp.468-477
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• 1996

Vasopressin which is an antidiuretic hormone in human body produced the diuretic action in dog. This study was investigated in order to certify the diuretic action and to search out the mechanism of the action on the vasopressin. Vasopressin, when given in a dose of 10.0mU/kg, bolus+1.0mU/kg/min intravenously, exhibited the increase of urine flow(Vol), renal plasma flow(RPF), osmolar clearance (Cosm) and amounts of sodium and potassium excreted in urine ($E_{Na},\;E_K$), the decrease of reabsorption rate of sodium and potassium in renal tubules ($R_{Na},\;R_K$), and then elevated the mean arterial pressure(MAP). Vasopressin given in a increased dose to 30.0mU/kg, bolus+1.0mU/kg/min intravenously elicited the same aspect with that exhibited by a small dose in changes of Vol. and all renal function and potentiated the change rates, whereas this time MAP did not change at all when compared with control value. Vasopressin, when administered into a renal artery, did not induce the changes of Vol and all renal function in experimental (administered) kidney, but increased slightly the Vol, glomerular filtration rate(GFR), $E_{Na},\;and\;E_K$ expected the no change of $R_{Na}\;and\;R_K$ in the control (not administered) kidney. Vasopressin, when infused into carotid artery, showed the increase of Vol. GFR, $E_{Na},\;and\;E_K$ and no change of $R_{Na}\;and\;R_K$ in a dose of 1/5 of intravenous dose. Diuretic action of vasopressin administered into carotid artery was not influenced by renal denervation. Above results suggest that vasopressin produced diuretic action by hemodynamic changes in dogs. These hemodynamic changes may be mediated by central endogenous substances not associated with renal nerve.

• 생명과학회지
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• 제29권2호
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• pp.265-271
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• 2019

일반적으로 요중 카드뮴 농도는 요비중 또는 요중 크레아티닌 농도로 보정한 값을 사용해왔다. 그러나 어떤 보정방법이 더 타당한지에 대한 논란은 계속되고 있다. 본 연구에서는 비교적 큰 규모의 일반인구집단을 대상으로 요중 카드뮴농도와 각종 신장손상지표들과의 관련성을 평가함에 있어 요비중 보정 방법과 요중 크레아티닌 보정 방법 중 어느 방법이 더 타당한지 비교 평가하였다. 1,086명의 자원자 중 신장질환의 질병력이 있는 사람을 제외한 862명이 최종적으로 연구대상에 포함되었다. 대상자들로부터 측정한 요중 카드뮴 농도 및 malondialdehyde (MDA), N-acetyl-${\beta}$-D-glucosaminidase 농도, 혈중 크레아티닌을 이용하여 산출한 사구체여과율 등의 신장손상지표들간의 관련성을 평가하였다. 연구 결과, 요중 크레아티닌 농도보다는 요비중으로 보정한 카드뮴 농도가 각종 신장손상지표와 높은 상관성이 있음을 보여주었다. 특히, 요비중 보정 카드뮴 농도는 요중 MDA 농도와 양의 상관관계를, 사구체여과율과는 음의 상관관계를 보여주었다. 이러한 결과는 일반인구집단에서 카드뮴 노출이 많아질수록 사구체여과율이 감소함을 의미하며 이러한 기전에서 산화적스트레스가 관여하고 있음을 보여준다. 또한, 사구체여과율이 카드뮴 노출에 의한 유용한 신장손상지표 중 하나로 사용될 수 있음을 의미한다.

• Journal of Korean Medical Science
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• 제33권53호
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• pp.298.1-298.10
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• 2018

Background: The renal function of individuals is one of the reasons for the variations in therapeutic response to various drugs. Patients with renal impairment are often exposed to drug toxicity, even with drugs that are usually eliminated by hepatic metabolism. Previous study has reported an increased plasma concentration of indoxyl sulfate and decreased plasma concentration of $4{\beta}$-hydroxy (OH)-cholesterol in stable kidney transplant recipients, implicating indoxyl sulfate as a cytochrome P450 (CYP) inhibiting factor. In this study, we aimed to evaluate the impact of renal impairment severity-dependent accumulation of indoxyl sulfate on hepatic CYP3A activity using metabolic markers. Methods: Sixty-six subjects were enrolled in this study; based on estimated glomerular filtration rate (eGFR), they were classified as having mild, moderate, or severe renal impairment. The plasma concentration of indoxyl sulfate was quantified using liquid chromatography-mass spectrometry (LC-MS). Urinary and plasma markers ($6{\beta}$-OH-cortisol/cortisol, $6{\beta}$-OH-cortisone/cortisone, $4{\beta}$-OH-cholesterol) for hepatic CYP3A activity were quantified using gas chromatography-mass spectrometry (GC-MS). The total plasma concentration of cholesterol was measured using the enzymatic colorimetric assay to calculate the $4{\beta}$-OH-cholesterol/cholesterol ratio. The correlation between variables was assessed using Pearson's correlation test. Results: There was a significant negative correlation between MDRD eGFR and indoxyl sulfate levels. The levels of urinary $6{\beta}$-OH-cortisol/cortisol and $6{\beta}$-OH-cortisone/cortisone as well as plasma $4{\beta}$-OH-cholesterol and $4{\beta}$-OH-cholesterol/cholesterol were not correlated with MDRD eGFR and the plasma concentration of indoxyl sulfate. Conclusion: Hepatic CYP3A activity may not be affected by renal impairment-induced accumulation of plasma indoxyl sulfate.

• 동아시아식생활학회지
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• 제9권4호
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• pp.427-434
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• 1999

This study was conducted to investigate the effects of vitamin I supplementation on renal function in high fat diet and adriamycin (ADR) induced experimental nephrotic syndrome in model rats. The effects of vitamin E supplementation on renal function in high fat diet and ADR treated rats were as follows. Kidney weight was decreased by vitamin E supplementation. Serum total protein was increased by the excess supplementation. Blood urea nitrogen(BUN) was decreased by the high supplementation. However, serum albumin and creatinine showed no significant differences between groups. Urinary volume tended to increase by vitamin I supplementation. Urinary urea-N tended by vitamin I supplementation. Particularly glomerular filtration rate(GFR) was significantly decreased by vitamin E supplementation. These results suggested that vitamin E supplementation could alleviate the adverse effects caused in renal function by highfatdiet and ADR treatments.

• Investigative and Clinical Urology
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• 제59권6호
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• pp.376-382
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• 2018

Purpose: The authors performed this study to investigate the risk factors for predicting stent failure and to evaluate its impact on prognosis. Materials and Methods: Between January 2002 and March 2017, we retrospectively reviewed 117 consecutive patients who underwent retrograde ureteral stenting and exchanging at least once every 3 months for malignant ureteral obstruction. The patients were classified according to their pre-stenting chronic kidney disease (CKD) stage. The factors affecting stent failure were analyzed using a logistic regression model. Overall survival (OS) was estimated, and the prognostic significance of each variable was estimated using Cox proportional-hazards regression modeling. Results: Before stenting, 91 patients were CKD stages 1-3 and 26 patients were CKD stages 4-5. These two groups differed significantly only in pre-stenting estimated glomerular filtration rate (eGFR), bilateral obstruction, and pre-stenting pyuria. Among the 117 patients, stent failure occurred in 30 patients (25.6%), and there were no differences between the groups. Pre-stenting pyuria and post-stenting complications were significant predictors of stent failure. There were 79 deaths in total, including 56 in the CKD stages 1-3 group and 23 in the CKD stages 4-5 group. In the multivariate analysis predicting patient OS, pre-stenting eGFR and post-stenting disease progression were significant factors. Conclusions: Internal ureteral stenting was effective for maintaining renal function in malignant ureteral obstruction. However, it did not restore renal function, which is related to the prognosis of the patients. Therefore, to improve patients' renal function and prognosis, patients who require stenting must be quickly recognized and treated.