Incidence of Upper Respiratory Diseases During the COVID-19 Pandemic: A Nationwide Data-Based Epidemiological Study / 대한이비인후과학회지

Background and Objectives@#Nonpharmacologic interventions (NPIs), such as social distancing and preventive measures, were administered during the coronavirus disease (COVID-19) pandemic, which may influence the incidence of upper respiratory diseases (URDs). The present study compared the incidence of URDs during the COVID-19 pandemic and during the years prior to COVID-19, and investigated the effect of NPIs on URD in the nationwide general population.Subjects and Method This is an epidemiologic study based on the Korean National Health Insurance Database from March 2016 to February 2021. We compared the monthly incidence of URDs from March 2020 to February 2021 (12 months) with that of the past four years. A negative binomial regression model was used to evaluate the annual difference in the incidence of each URD and adjusting temperature, humidity, and the level of particulate matter 10 (PM10). @*Results@#The monthly incidence of ‘the five common URDs’ in 2020 was significantly lower than that in the past four years. The incidence of other chronic diseases, however, such as hypertension and diabetes mellitus, was comparable or higher in the past four years. Among the five common URDs, influenza virus infections decreased most dramatically, nearing 99%, from 296.4-377.1 per 100000 people during the period of 2016 to 2019 to 3.7 per 100000 people in 2020. @*Conclusion@#The present study shows that the incidence of ‘five common URDs’ significantly decreased during the era of COVID-19 in Korea. We believe that nationwide NPI might prevent the transmission of COVID-19 as well as other infectious sources associated with URDs.

Clinical Significance of Acute Kidney Injury in Lung Cancer Patients / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Acute kidney injury (AKI) in cancer patients is associated with increased morbidity and mortality. The incidence of AKI in lung cancer seems to be relatively higher compared with other solid organ malignancies, although its impact on patient outcomes remains unclear. @*Materials and Methods@#The patients newly diagnosed with lung cancer from 2004 to 2013 were enrolled in this retrospective cohort study. The patients were categorized according to the presence and severity of AKI. We compared all-cause mortality and long-term renal outcome according to AKI stage. @*Results@#A total of 3,202 patients were included in the final analysis. AKI occurred in 1,783 (55.7%) patients during the follow-up period, with the majority having mild AKI stage 1 (75.8%). During the follow-up of 2.6±2.2 years, total 1,251 patients (53.7%) were died and 5-year survival rate was 46.9%. We found that both AKI development and severity were independent risk factors for all-cause mortality in lung cancer patients, even after adjustment for lung cancer-specific variables including the stage or pathological type. In addition, patients suffered from more severe AKI tend to encounter de novo chronic kidney disease development, worsening kidney function, and end-stage kidney disease progression. @*Conclusion@#In this study, more than half of the lung cancer patients experienced AKI during their diagnosis and treatment period. Moreover, AKI occurrence and more advanced AKI were associated with a higher mortality risk and adverse kidney outcomes.

Artificial Intelligence in Health Care: Current Applications and Issues

In recent years, artificial intelligence (AI) technologies have greatly advanced and become a reality in many areas of our daily lives. In the health care field, numerous efforts are being made to implement the AI technology for practical medical treatments. With the rapid developments in machine learning algorithms and improvements in hardware performances, the AI technology is expected to play an important role in effectively analyzing and utilizing extensive amounts of health and medical data. However, the AI technology has various unique characteristics that are different from the existing health care technologies. Subsequently, there are a number of areas that need to be supplemented within the current health care system for the AI to be utilized more effectively and frequently in health care. In addition, the number of medical practitioners and public that accept AI in the health care is still low;moreover, there are various concerns regarding the safety and reliability of AI technologyimplementations. Therefore, this paper aims to introduce the current research and application status of AI technology in health care and discuss the issues that need to be resolved.

Nationwide Epidemiologic Study of Abdominal Aortic Aneurysms in Korea: A Cross-Sectional Study Using National Health Insurance Review and Assessment Service Data

PURPOSE: The prevalence and treatment patterns of abdominal aortic aneurysm (AAA) vary according to ethnicity and region. This study analyzed nationwide data on the epidemiology, practice patterns, and mortality rates of AAA in Korea.MATERIALS AND METHODS: Data from patients treated for AAA from 2012 to 2016 were extracted from the Korean Health Insurance Review and Assessment (HIRA) database.RESULTS: A total of 30,766 patients in Korea had treatment codes for AAA and 2,618 patients were treated for ruptured AAA. Of the 6,356 patients treated surgically, 1,849 and 4,507 underwent open surgical aneurysmal repairs (OSAR) or endovascular aneurysmal repairs (EVAR), respectively. The number of surgical treatments performed annually for AAA increased from 1,129 cases in 2012 to 1,501 cases in 2016. The number of EVAR cases increased from 753 to 1,109 during these five years, while the number of OSAR cases remained similar, at 376 and 392, respectively. The 30-day mortality rates after EVAR and OSAR were 4.2% and 10.6%, respectively. The mortality rates were significantly higher in patients with hypertension, dyslipidemia, chronic renal disease, diabetes mellitus, and congestive heart failure. There were significant differences in the prevalence, proportion of EVAR, and mortality rates according to the regional area.CONCLUSION: The prevalence of AAA and the proportion of EVAR in Korea increased in the past 5 years, while the rupture rate and the proportion of OSAR remained similar. To minimize mortality and regional discrepancies, nationwide registry and treatment standardization are needed.

Mild Anemia and Risk for All-Cause, Cardiovascular and Cancer Deaths in Apparently Healthy Elderly Koreans / 가정의학회지

BACKGROUND: Being common, mild anemia is sometimes considered a mere consequence of aging; however, aging alone is unlikely to lead to anemia. Therefore, this study aimed to investigate the association between mild anemia and total mortality and cause-specific mortality in apparently healthy elderly subjects. METHODS: A retrospective cohort study was conducted on 10,114 apparently healthy elderly individuals who underwent cancer screening and routine medical check-ups at one Health Promotion Center between May 1995 and December 2007. We defined mild anemia as a hemoglobin concentration between 10.0 g/dL and 11.9 g/dL in women and between 10.0 g/dL and 12.9 g/dL in men. We assessed the relationship between the overall, cardiovascular (CV), and cancer mortality and mild anemia using Cox proportional hazard models. RESULTS: Mild anemia was present in 143 men (3.1%) and 246 women (6.1%). During an average follow-up of 7.6 years, 495 deaths occurred, including 121 CV and 225 cancer deaths. After adjustments, mild anemia was associated with a 128% increase in the risk of all-cause mortality (hazard ratio [HR], 2.28; 95% confidence interval [CI], 1.54–3.37) in men and cancer-related mortality (HR, 2.25; 95% CI, 1.22–4.13), particularly lung cancer (HR, 2.70; 95% CI, 1.03–7.08) in men, but not in women. In the subgroup analyses based on smoking status, obesity, and age, the associations were more prominent in never or former smoker groups and the older group. CONCLUSION: The present study shows that overall and cancer-related mortality was associated with mild anemia in elderly men. Future prospective studies are needed to consolidate our findings.

Blockchain Technology and Healthcare / 대한의료정보학회지

No abstract available.

Medical big data: promise and challenges

The concept of big data, commonly characterized by volume, variety, velocity, and veracity, goes far beyond the data type and includes the aspects of data analysis, such as hypothesis-generating, rather than hypothesis-testing. Big data focuses on temporal stability of the association, rather than on causal relationship and underlying probability distribution assumptions are frequently not required. Medical big data as material to be analyzed has various features that are not only distinct from big data of other disciplines, but also distinct from traditional clinical epidemiology. Big data technology has many areas of application in healthcare, such as predictive modeling and clinical decision support, disease or safety surveillance, public health, and research. Big data analytics frequently exploits analytic methods developed in data mining, including classification, clustering, and regression. Medical big data analyses are complicated by many technical issues, such as missing values, curse of dimensionality, and bias control, and share the inherent limitations of observation study, namely the inability to test causality resulting from residual confounding and reverse causation. Recently, propensity score analysis and instrumental variable analysis have been introduced to overcome these limitations, and they have accomplished a great deal. Many challenges, such as the absence of evidence of practical benefits of big data, methodological issues including legal and ethical issues, and clinical integration and utility issues, must be overcome to realize the promise of medical big data as the fuel of a continuous learning healthcare system that will improve patient outcome and reduce waste in areas including nephrology.

Unobtrusive Estimation of Cardiorespiratory Fitness with Daily Activity in Healthy Young Men

Despite the importance of cardiorespiratory fitness, no practical method exists to estimate maximal oxygen consumption (VO₂max) without a specific exercise protocol. We developed an estimation model of VO₂max, using maximal activity energy expenditure (aEEmax) as a new feature to represent the level of physical activity. Electrocardiogram (ECG) and acceleration data were recorded for 4 days in 24 healthy young men, and reference VO₂max levels were measured using the maximal exercise test. aEE was calculated using the measured acceleration data and body weight, while heart rate (HR) was extracted from the ECG signal. aEEmax was obtained using linear regression, with aEE and HR as input parameters. The VO₂max was estimated from the aEEmax using multiple linear regression modeling in the training group (n = 16) and was verified in the test group (n = 8). High correlations between the estimated VO₂max and the measured VO₂max were identified in both groups, with a 15-hour recording being sufficient to produce a highly accurate VO₂max estimate. Additional recording time did not significantly improve the accuracy of the estimation. Our VO₂max estimation method provides a robust alternative to traditional approaches while only requiring minimal data acquisition time in daily life.

The Mildly Elevated Serum Bilirubin Level is Negatively Associated with the Incidence of End Stage Renal Disease in Patients with IgA Nephropathy

Oxidative stress plays various roles in the development and progression of IgA nephropathy, while bilirubin is known as a potent antioxidant. We therefore hypothesized that serum bilirubin would be associated with renal prognosis in IgA nephropathy. The study subjects comprised 1,458 adult patients with primary IgA nephropathy in Korea. We grouped patients according to the following quartile levels of bilirubin: 0.8 mg/dL (Q4). The outcome data were obtained from the Korean Registry of end-stage renal disease (ESRD). Eighty patients (5.5%) contracted ESRD during a mean follow-up period of 44.9 months. The ESRD incidences were 10.7% in Q1, 8.2% in Q2, 2.8% in Q3, and 2.8% in Q4 (p<0.001). The relative risk of ESRD compared to that in Q1 was 0.307 (95% confidence interval [CI], 0.126-0.751) in Q3 and 0.315 (95% CI, 0.130-0.765) in Q4. The differences of ESRD incidence were greater in subgroups of males and of patients aged 35 yr or more, with serum albumin 4.0 g/dL or more, with normotension, with eGFR 60 mL/min/1.73 m2 or more, and with proteinuria less then 3+ by dipstick test. In conclusion, higher bilirubin level was negatively associated with ESRD incidence in IgA nephropathy.

The Heme Oxygenase-1 Genotype is a Risk Factor to Renal Impairment of IgA Nephropathy at Diagnosis, Which is a Strong Predictor of Mortality

The induction of heme oxygenase-1 (HO-1) ameliorates oxidative stress and inflammatory process, which play important roles in IgA nephropathy. We hypothesized length polymorphism in the promoter region of the HO-1 gene, which is related to the level of gene transcription, is associated with disease severity of IgA nephropathy. The subjects comprised 916 patients with IgA nephropathy and gene data. Renal impairment was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) at diagnosis. The short (S: 28) (GT) repeats in the HO-1 gene was determined. The frequencies of S/S, S/M, M/M, S/L, L/M, and L/L genotypes were 7.2%, 6.9%, 3.1%, 30.8%, 22.7%, and 29.4%, respectively. The baseline characteristics were not different. In the S/S genotypic group, the renal impairment rate was 18.2%, which was lower than 32.2% in the group with M/M, L/M, or L/L genotype. The odds ratio of renal impairment in S/S genotype, compared to that in M/M, L/M, or L/L genotype, was 0.216 (95% confidence interval, 0.060-0.774, p=0.019). The HO-1 gene promoter length polymorphism was related to the renal impairment of IgA nephropathy at diagnosis, which is an important risk factor for mortality in IgA nephropathy patients.

Association of Angiotensin II Type 2 Receptor Gene A1818T Polymorphism with Progression of Immunoglobulin A Nephropathy in Korean Patients

We determined the relationship between the progression of immunoglobulin A nephropathy (IgAN) and the A1818T polymorphism in intron 2 of Angiotensin II type 2 receptor (AT2R) gene, which might play protective roles in the pathogenesis of IgAN. Patients with biopsy-proven IgAN were recruited from the registry of the Progressive REnal disease and Medical Informatics and gEnomics Research (PREMIER) which was sponsored by the Korean Society of Nephrology. A1818T polymorphism of AT2R gene was analyzed with PCR-RFLP method and the association with the progression of IgAN, which was defined as over 50% increase in baseline serum creatinine level, was analyzed with survival analysis. Among the 480 patients followed for more than 10 months, the group without T allele had significantly higher rates of progression of IgAN than the group with T allele (11.4% vs. 3.9%, p=0.024), although there were no significant differences in the baseline variables such as initial serum creatinine level, the degree of proteinuria, and blood pressure. In the Cox's proportional hazard model, the hazard ratio of disease progression in the patients with T allele was 0.221 (95% confidence interval for Exp(B): 0.052-0.940, p=0.041) compared to that of without T allele. In conclusion, A1818T polymorphism of AT2R gene was associated with the progression of IgAN.

The Bilirubin Level is Negatively Correlated with the Incidence of Hypertension in Normotensive Korean Population

Reactive oxygen species have been known to be an important factor in the pathogenesis of hypertension. Bilirubin, one of the metabolites of heme degraded by heme oxygenase, is a potent anti-oxidant. We verified the effect of serum bilirubin level on the incidence of hypertension in normotensive subjects. We grouped 1,208 normotensive subjects by the criterion of the highest quintile value of serum bilirubin, 1.1 mg/dL. The incidence of hypertension was higher in group 1 with bilirubin less than 1.1 mg/ dL than in group 2 with bilirubin 1.1 mg/dL or more (186/908 vs. 43/300, p=0.018). The relative risk for hypertension was 0.71 (95% confidence interval, 0.51-0.99), p=0.048 in group 2 compared to group 1 by Cox's proportional hazard model. Among the groups stratified by gender, smoking, and liver function status, the group 2 showed a lower risk of hypertension in females and in non-smokers. In conclusion, a mild increase within the physiological range of serum bilirubin concentration was negatively correlated with the incidence of hypertension. The effect of bilirubin on the development of hypertension was more evident in females and in non-smokers.

Impact of Polymorphism of Th1 and Proinflammatory Cytokine Genes on Development and Progression of IgA Nephropathy / 대한신장학회잡지

BACKGROUND: Cytokine gene polymorphisms regulate cytokine production. Conflicting results about the impact of several cytokines gene polymorphism on the development or progression of IgAN have been reported. We evaluated the influence of polymorphism of several Th1 and proinflammatory cytokine genes on development and progression of IgAN. METHODS: Two hundred forty patients with biopsy-proven IgAN who had a minimal follow-up of 4 years, were recruited. Patients were classified according to the slope of reciprocal serum creatinine into slow progressors (> or =-0.05 dLxmg(-1) x year(-1), N=170) and fast progressors (<-0.05 dL x mg(-1) x year(-1), N=70). Three hundred fifteen healthy subjects with normal renal function and normotension were analyzed as controls. The polymorphisms of tumor necrosis factor-alpha (TNF-alpha, G-308A), interleukin-6 (IL-6, C-634G), interferon-gamma (IFN-gamma, A874T) and interleukin-2 (IL-2, T-330G) were determined by the 5' nuclease allelic discrimination assay. RESULTS: The genotype and allele frequencies of TNF-alpha, IL-6, IFN-gamma and IL-2 were not different significantly between IgAN patients and controls. Initial renal function, amount of daily proteinuria, and frequency of hypertension did not differ significantly between IgAN patients with different genotypes of all the studied cytokines. The frequencies of genotypes of the studied cytokines did not differ according to the rate of disease progression. In Kaplan-Meier analyses, the renal survival rate did not differ significantly between IgAN patients with different genotypes of the Th1 and proinflammatory cytokines. The polymorphism of the cytokines were not an independent risk factor for the progression of IgAN in Cox regression analysis. CONCLUSIONS: Our results suggest that the polymorphism of Th1 and proinflammatory cytokines are not associated with development and progression of IgAN in Korean patients.

Association of IL-10 Gene Polymorphism with Development of Atopy / 소아알레르기및호흡기학회지

PURPOSE: There has been accumulating evidence that interleukin-10 (IL-10) influences on the production of proinflammatory cytokines, regulating the development of atopic diseases. In this study, we tested the genetic association between IL-10 haplotype polymorphism and the development of atopy. METHODS: The frequency of three single nucleotide polymorphisms (SNPs) at positions- 1082 (A/G), -819 (C/T), -592 (A/C) and corresponding haplotypes in the promotor region of the IL-10 gene were analysed in 174 atopic and 130 non-atopic children using Taqman method. The data were assessed for correlations with the eosinophil count and total serum IgE concentration. RESULTS: Three haplotypes (ATA, ACC, GCC) were identified without any ambiguous phasing due to linkage disequilibrium among SNPs. The frequency of IL-10 haplotype ACC was higher in non-atopic children compared to atopic children. (P=0.04) The frequency of IL-10 haplotype ATA was higher in atopic children compared to non-atopic children, but a statistical significance was not found. (P=0.099) ATA/ATA and ATA/ACC accounted for 80 percent of six different genotypes. Although the frequency of ATA/ATA genotype was higher in atopic children, there was no statistical significance. Although medians of serum IgE level and total eosinophil count were higher among atopic children with ATA/ATA genotype than in atopic children with ATA/ACC, no statistical significance was found. CONCLUSION: These results suggest that IL-10 promotor polymorphism may be associated with a genetic risk factor for the development of atopy in Korean children.

Association between Surfactant Protein A (SP-A) Gene Polymorphism and Respiratory Distress Syndrome

PURPOSE: Not all premature infants have respiratory distress syndrome (RDS), although prematurity is the most crucial risk-factor. Since genetic factors are known to be an etiology of RDS, this dissertation examines if specific SP-A alleles/genotypes are associated with either increased or decreased risk of RDS. METHODS: Investigated for this research were 272 preterm Korean infants. Among them, 89 infants with RDS and 183 controlled infants were analyzed for SP-A genotypes by using the real- time PCR assay. RESULTS: The specific frequencies of the alleles of the SP-A1 gene among the preterm infants (n=544 alleles) turned out to be 47.6% for 6A3, 27.2% for 6A2, 23.7% for 6A4, and 1.5% for others. Those of the alleles of the SP-A2 gene were 46.9% for 1A12, 18.9% for 1A6 and 18.9% for 1A10 (n=544 alleles). Others include 3.9% each for 1A and 1.1% for 1A0. These results present great difference from previous studies. This research found new genotypes each of SP-A1 and SP-A2 genes. The 1A12/1A12 genotype has statistical relations with different gestational age under 32 weeks. The 1A12/1A12 was underrepresented (14.6% vs 26.8%) (P or =32 wk, the 1A12/1A12 acts as the only significant protective factor from the development of RDS [odds ratio 0.156 (P=0.014, 95% confidence intervals 0.035-0.691)]. CONCLUSION: The SP-A gene polymorphism is the crucial factor to the predisposition to RDS when the gestational ages of preterm infants are higher.

The Effects of Polymorphism in the MCP-1 Gene Regulatory Region on MCP-1 Expression and the Manifestation of Lupus Nephritis / 대한신장학회잡지

BACKGROUND: Monocyte chemoattractant protein- 1(MCP-1) plays an important role in progression of lupus nephritis.(LN) The genetic polymorphism in the regulatory region would influence clinical manifestations by controlling serum levels of MCP-1. METHODS: We determined the genotypes of the MCP-1 gene, the secretion of MCP-1 by pheripheral blood monocytes(PBMCs) and transcription activity according to polymorphism on ELISA and luciferase assay. We also correlated serum MCP-1 level with proteinuria according to the genotypes to evaluate the clinical implication of genetic polymorphism in LN. RESULTS: 10 patients with SLE(20%) were AA homozygous, 21(42%) GA heterozygous, and 18(38%) GG homozygous, which was similar with normal controls[AA 9(20%), GA 27(58%), GG 46(22%)](n= 46). By in-vitro stimulation of PBMCs using Phytohemagglutinin, differential expression of MCP-1 appeared according to the genotypes at -2518 position; PBMCs from AA homozygotes 22.37+/-.07 ng/mL, GA 6.98+/-.72 ng/mL, GG 5.48+/-.22 ng/mL. In the luciferase assay, the gene construct with G at -2518 site showed decreased activity to 39% of that showed by A gene construct. In addition, After cells were treated with TNF-alpha 10 ng/mL), the transcription activity of A gene construct was approximately 3 fold greater than that of G gene construct. Levels of serum MCP-1 were significantly higher in patients with SLE(n=89) than normal controls(n=21)(418.17+/-35.30 pg/mL vs. 127.78+/-14.53 pg/mL, respectively; p0.05). But, in patients with LN, levels of serum MCP-1 were significant higher in patients with AA genotype than those of GA genotyes and GG genotypes(p<0.01). CONCLUSION: MCP-1 gene polymorphism at regulatory region may be a considerable marker for LN and may modulate the level of protein expression. Our study could make it possible to screen high risk individuals, thus help us to develop a practical application of the molecular findings in clinical practice.

Up-regulation of Intragraft Gene Expression of Bcl-xL in Response to Injuries to Renal Allograft / 대한신장학회잡지

BACKGROUND: Bcl-xL and bax act as checkpoints of the apoptotic cell death. Although apoptosis is one of major mechanism of cell death in renal allografts inflicted by various events, the role of bcl-xL and bax in kidney transplantation has not been characterized yet. We therefore studied intragraft expression of bcl-x and bax and its clinical significance in renal transplantation. METHODS: We localized the expression of bcl-x, bcl-xS and bax proteins by immunohistochemistry, and measured the magnitude of the gene transcription of bax and bcl-xL by semi-quantitative RT-PCR in 37 implantation allograft biopsies(18 from 9 cadaveric donors, 19 from living donors), and 17 biopsies from patients undergoing acute rejection(AR). RESULTS: Immunoreactivities for bax, bcl-x, and bcl-xS were observed in tubular epithelial cells but not in glomeruli and vessels in implantation and AR biopsies. The infiltrating lymphocytes in AR expressed bax and bcl-xS but not for bcl-x. Comparing the intragraft gene transcript level of each allograft of a pair of recipients, who received graft from the same cadaveric donor, showed a higher bcl-xL in the patients with a higher concentration of postoperative 7th day serum creatinine. The transcript level of bcl-xL was higher in the Banff grade II and III AR biopsies than in the borderline or grade I AR, and also higher in steroid-resistant AR than in steroid-responsive patients. CONCLUSION: These results implicated the apoptotic death of infiltrating lymphocytes during rejection, and the compensatory up-regulation of bcl-xL in response to various apoptotic stimuli occurring in renal allografts.

Up-regulation of Intragraft Gene Expression of Bcl-xL in Response to Injuries to Renal Allograft / 대한신장학회잡지

BACKGROUND: Bcl-xL and bax act as checkpoints of the apoptotic cell death. Although apoptosis is one of major mechanism of cell death in renal allografts inflicted by various events, the role of bcl-xL and bax in kidney transplantation has not been characterized yet. We therefore studied intragraft expression of bcl-x and bax and its clinical significance in renal transplantation. METHODS: We localized the expression of bcl-x, bcl-xS and bax proteins by immunohistochemistry, and measured the magnitude of the gene transcription of bax and bcl-xL by semi-quantitative RT-PCR in 37 implantation allograft biopsies(18 from 9 cadaveric donors, 19 from living donors), and 17 biopsies from patients undergoing acute rejection(AR). RESULTS: Immunoreactivities for bax, bcl-x, and bcl-xS were observed in tubular epithelial cells but not in glomeruli and vessels in implantation and AR biopsies. The infiltrating lymphocytes in AR expressed bax and bcl-xS but not for bcl-x. Comparing the intragraft gene transcript level of each allograft of a pair of recipients, who received graft from the same cadaveric donor, showed a higher bcl-xL in the patients with a higher concentration of postoperative 7th day serum creatinine. The transcript level of bcl-xL was higher in the Banff grade II and III AR biopsies than in the borderline or grade I AR, and also higher in steroid-resistant AR than in steroid-responsive patients. CONCLUSION: These results implicated the apoptotic death of infiltrating lymphocytes during rejection, and the compensatory up-regulation of bcl-xL in response to various apoptotic stimuli occurring in renal allografts.

Angiotensin I Converting Enzyme Polymorphism and the Progression of IgA Nephropathy / 대한신장학회잡지

IgA nephropathy(IgAN) is the most common glomerulonephritis(GN) in worldwide, and accounts for 20% to 40% of all patients with primary GN in Korea. IgAN has diverse clinical courses, but the risk factors affecting the deterioration of renal function are not established. Recently, there were some suggestions that systemic or local expression of peptides of angiotensin system exerts several effects on the progression of renal disease, and the genetic polymorphisms may associated with peptide expression. To evaluate the role of genetic polymorphism of angiotensin I converting enzyme(ACE) polymorphism in the progression of IgAN, the genotypic distributions in 278 biopsy-proven cases of IgAN were studied, which had undergone a renal biopsy at Seoul National University Hospital, between 1979 and 2000. We also compared the genotypes with clinical manifestations to evaluate the clinical implications of genetic polymorphism. The study shows that there was no difference in the ACE genotype frequencies between the patients (II : 26.6%, ID : 55.0%, DD : 18.4%) and normal controls(II : 31.4%, ID : 57.4%, and DD : 11.2%). Seventy- two percent and 48% of patients maintained renal function for 10 years and 20 years after the initial diagnosis in 278 patients, respectively. However, in 153 patients who were followed more than 5 years, the DD genotype was more prevalent in patients with deteriorating renal function than in those with stable renal function(31.8% vs. 13.8%; p=0.0146). Presence of systemic hypertension increased the risk of renal disease progression(OR=3.3), and it was showed 7.4 fold risk whenever the creatinine was increased by 1 mg/dL. Renal disease progression is not associated with DD genotype among normotensive patients at the biopsy. But, in patients with hypertension, II and DD/ID genotypes have an increased risk for disease progression when compared with II genotype of normotensive patients(OR=1.4, OR=7.8; respectively). ACE polymorphisms did not have any interaction with the levels of serum creatinine at the time of biopsy in our patients. Our results suggested that ACE genotypes(D allele) affected the progression of IgAN, especially in hypertensive patients. One of the prospects of the present study is the potential for screening high risk individuals, thus helping to develop a practical application of the molecular findings in clinical practice.

Correlation of Liver and Kidney Pathologic Features in Patients Presented with Glomerular Disease and Positive Serum HBsAg / 대한신장학회잡지

No abstract available.