(The) trend of indication of nephrectomy in infants and children

의학과/석사[한글] 신적출술은 다양한 신장 질환의 최후 치료 방법으로써 비뇨기과영역에서 중요한 수술의 하나이다. 근래에 와서 신장을 보존하려는 노력으로 보다 정확한 신기능 평가 방법과 치료 술기의 진전이 이루어져 왔으나 신의 악성종양등 아직도 많은 질환들이 신적출술의 적응증이 되고 있다. 본 연구에서는 소아에서 이전에는 신적출술이 시행되었던 질환이었으나 보존요법에 의해 신기능의 일부 흑은 전부가 재생되었던 예들을 관찰하여 진단과 치료 방법의 발달과 향후의 진단 치료의 추이를 살펴보고자 하였다. 1968년부터 1987년까지 연세 의대 부속병원에 입원하였던 만15세 이하의 소아환자에서 신적출술이 고려될 수 있는 질환(신우요관이 행부 폐쇄, 신기형, 신결핵, 신손상, 월름씨 종양)들을 대상으로 초음파 촬영술과 동위원소 신주사가 시행된 1981년을 기준으로 그 이전을 Ⅰ기, 그 이후를 Ⅱ기로 나누어 고찰하여 다음과 같은 결과를 얻었다. 1. 신우요관이행부 폐쇄에서 신적출술은 Ⅰ기 67.6%( 34신중 23신), Ⅱ기 19.5%(41신중 8신)로 감소하였고 2기간중 치료방법의 변화를 보인 Grade Ⅳ와 Ⅴ의 수신증에서 신우성형술이 Ⅰ기 23.3%(30신중 7신)에서 Ⅱ기 74.2% (31신중 23신)으로 증가하였다. Ⅱ기에서 신우성형술 전과 후에 이뇨성 신주사를 시행한 19신중 17신(89.4%)에서 술 후 요배설 능력이 향상되었다. 2. 월름씨 종양(54신)은 신적출술이 필수적인 치료 방법이며 신결핵 (9신) 역시 변화없이 전신 파괴상이나 다발성 요관협착인예는 신적출술이 시행되었고 신기형 (28신)은 점차 미미하게나마 성형술이 시행되었고 신손상(9신)에서도 가능하면 보존요법이나 신부분절제술이 우선되기 시작하였다. [영문] The nephrectomy has been one of the important urologic surgery as the final treatment of the various renal diseases. Recently the conservative plastic surgery is preferred with the development of the better assessement of the renal function and operating techniques but the numerous renal diseases like renal malignancies are still indications of the nephrectomy. This study was performed to observe the trend of diagnosis and treatment of the pediatric renal disease which could be treated by the nephrectomy previously, by comparing and classifying the frequency of the kidney of which the function was partially or completely recovered by the conservative plastic surgery. On the patients under the age of 15 who were admitted to the Yonsei University Medical Center from 1968 to 1987, the disease entities(ureteropelvic junction obstruction, renal anomaly, renal tuberculosis, renal injury, Wilms' tumor) which could be considered the nephrectomy as a treatment method were studied with the division of 2 periods by 1981 on which the ultrasonography and 99mTc-DTPA renography were performed. The results are as follows : 1. In the ureteropelvic junction obstruction the nephrectomy was decreased from 67.6%(23 in 34 kidneys) in the period Ⅰ to 19.5%(8 in 41 kidneys) in the period Ⅱ and in the grade Ⅳ and Ⅴ hydronephrotic kidneys which showed the change in the treatment method during the 2 periods the pyeloplasty was increased from 23.3%(7 in 30 kidneys) in the period Ⅰ to 74.2%(23 in 31 kidneys) in the period Ⅱ. Of the 19 kidneys assessed by diuresis renography both before and after the pyeloplasty in the period Ⅱ, 17 kidneys(89.4%) showed improvement in the excretry function after surgery. 2. The nephrectomy is an indispensable treatment in the Wilms' tumor(54 kidneys) and was performed invariably in the renal tuberculosis(9 kidneys) which had multiple uretera strictures or destructive changes in the whole kidney. The conservative plastic surgery was performed in the renal anomaly(28 kidneys) inappreciably and the renal injury(9 kidneys) became to be preferred the conservative treatment or partial nephrectomy if possible.restrictio

(The) role of oxidative stress in development of diabetic microalbuminuria

의학과/박사[한글] Oxidative stress가 당뇨병에 수반되는 이차적 질환의 공통 발생기전이 될 것이라는 가설을 토대로, 본 연구에서는 당뇨성 콩팥 질환의 조기 지표인 미세단백뇨 발생에도 oxidative stress가 관여하는지 검색하고자 하였다. 흰쥐 정맥으로 streptozotocin 50mg/kg을 투여하여 실험적 당뇨를 유도한 후 microalbuminuria가 수반될 때, 지질파산화물과 8-hydroxydeoxyguanosine을 oxidative stress의 지표로서 정량하여 비교하였다. 더 나아가 항단백뇨효과가 있는 captopril의 항산화제로서의 역할을 알아보고자 화학적 구조가 다른 angiotensin 전환효소 억제제인 enalapril 및 항산화제인 vitamin E가 지질과산화에 미치는 영향을 비교하였을 때, 1. Streptozotocin 투여에 의하여 당뇨가 유발된 흰쥐는 대조군에 비하여 사구체 여과율은 의의있게 변동되지 않았으나 albumin 배설은 의의있게 증가하였다. 2. 당뇨 유발로 요중 지질과산화물은 현저하게 증가하였고, 이 증가의 일부는 근위세뇨관에서 형성되는 지질과산화물 뿐아니라 혈장 지질과산화물 증가에도 기인하였다. 3. 콩팥 조직내 8-hydroxydeoxyguanosine이 당뇨 유발로 의의있게 증가하였다. 4. Insulin 투여로 당뇨 유발에 의한 일반 특성및 지질과산화물과 8-hydroxydeoxyguanosine 함량 변동이 개선되었다. 5. Angiotensin 전환효소 억제제중 항산화기인 -SH기를 함유한 captopril 뿐 아니라 함유하지 않은 enalapril 모두 장기투여 했을 때 당뇨쥐에서 관찰되는 microalbuminuria를 개선하였고, 지질과산화물 증가를 억제하였다. 6. 식이를 제한하지않은 상태에서 vitamin E를 장기투여 하더라도 당뇨쥐에서 관찰되는 지질과산화물 증가에 영향을 주지 않았고 microalbuminuria에도 영향이 없었다. 본 연구의 결과 당뇨 흰쥐의 콩팥 조직내 oxidative stress가 증가되어 있음을 알 수 있었고,captopril의 항단백뇨 기전에는 angiotensin 형성 억제와 관련된 아직 규명되지 않은 항산화작용도 관여하고 있으리라 추측되는 바이다. The role of oxidative stress in development of diabetic microalbuminuria Keun Hwang Department of Medical Scoence, The Graduate School Yonsei University (Directed by Professor Kyung Hwan Kim) Based on the recent hypothesis that oxidative stress may be a common cause of diabetic complications, the present study examined possible involvement of oxidative stress in the process of diabetic nephropathy. Experimental diabetes was induced by intravenous injection of streptozotocin 50mg/kg into the tail vein of male Sprague-Dawley rats. The levels of lipid peroxides and 8-hydroxydeoxyguanosine in tissues were determined as indices of the oxidative stress in diabeticrats exhibiting microalbuminuria. Furthermore the effects of captopril, enalapril and vitamin E on microalbuminuria and lipid peroxidation in diabetic rats were compared in order to evaluate whether captopril's antiproteinuric effect is due to anti-free radical activity depending on its sulfhydryl moiety. The results are summarized as follows; 1 . Streptozotocin-induced diabetic rats excreted significantly increased urinary albumin, compared to age-matched control rats. 2. Urinary lipid peroxides in diabetic rats were increased. The source of the urinary lipid peroxides may be the lipid peroxides from renal proximal tubules and/or from plasma. 3. Level of 8-hydroxydeoxyguanosine in the kidney of diabetic rats were also increased com-pared to control rats. 4. Insulin treatment ameliorated alterations in lipid peroxides and 8-hydroxydeoxyguanosine as well as general characteristics of diabetic rats. 5. Angiotensin converting enzyme inhibitor, whether it has sulfhydryl group or not, reduced higher levels of urinary excretion of albumin or lipid peroxides associated with diabetes. 6. Chronic administration of vitamin I without controlling of diet did not cause any significant effect on urinary excretion of lipid peroxides or albumin. Above results suggest that oxidative damage is closely related in the process of diabetic nephropathy, and antiproteinuric property of captopril may be due to undefined antioxidative activity related with inhibition of angiotensin converting enzyme. [영문] Based on the recent hypothesis that oxidative stress may be a common cause of diabetic complications, the present study examined possible involvement of oxidative stress in the process of diabetic nephropathy. Experimental diabetes was induced by intravenous injection of streptozotocin 50mg/kg into the tail vein of male Sprague-Dawley rats. The levels of lipid peroxides and 8-hydroxydeoxyguanosine in tissues were determined as indices of the oxidative stress in diabeticrats exhibiting microalbuminuria. Furthermore the effects of captopril, enalapril and vitamin E on microalbuminuria and lipid peroxidation in diabetic rats were compared in order to evaluate whether captopril's antiproteinuric effect is due to anti-free radical activity depending on its sulfhydryl moiety. The results are summarized as follows; 1 . Streptozotocin-induced diabetic rats excreted significantly increased urinary albumin, compared to age-matched control rats. 2. Urinary lipid peroxides in diabetic rats were increased. The source of the urinary lipid peroxides may be the lipid peroxides from renal proximal tubules and/or from plasma. 3. Level of 8-hydroxydeoxyguanosine in the kidney of diabetic rats were also increased com-pared to control rats. 4. Insulin treatment ameliorated alterations in lipid peroxides and 8-hydroxydeoxyguanosine as well as general characteristics of diabetic rats. 5. Angiotensin converting enzyme inhibitor, whether it has sulfhydryl group or not, reduced higher levels of urinary excretion of albumin or lipid peroxides associated with diabetes. 6. Chronic administration of vitamin I without controlling of diet did not cause any significant effect on urinary excretion of lipid peroxides or albumin. Above results suggest that oxidative damage is closely related in the process of diabetic nephropathy, and antiproteinuric property of captopril may be due to undefined antioxidative activity related with inhibition of angiotensin converting enzyme.restrictio