신장동종이식 수여자에서 나타나는 야간성 다뇨에 관한 연구

Abstract

[한글]

신장 동종이식 수여자에서 나타나는 야간성 다뇨는 아직 확실한 생리적 기전이 규명되지 않았으며 이식 후 약1년이 경과하면서 정상 뇨리듬으로 돌아온다고 알려져 있다. 본 연구자는 이러한 야간성 다뇨의 원인이 신사구체 여과율의 증가, 삼투성 이뇨, 혹은 수분

성 이뇨인지를 규명하고자 신장 동종이식 수여자 및 수술 대조군 환자들에게 소변양, 신사구체 여과율, osmolar clearance, sodium and free water clearance와 fractional excretion of water 등을 낮과 밤으로 나누어 각각 측정하여 다음과 같은 결론을 얻었다.

1. 신장 동종이식 수여자에서 정상 대조군과 비교하였을 때 이식후 14일 및 28일 모두 통계적으로 의의 있는 야간성 다뇨를 나타냈다.

2. 신장 이식 이외의 다른 수술을 받은 수술 대조군에서도 통계적으로 의의 있는 야간성 다뇨를 보였다.

3. 신사구체 여과율은 모든 환자군에서 낮과 밤 간에 차이가 없었다.

4. 신장 동종이식 수여자에서 낮에 비하여 밤에 osmolar clearance와 sodium clearance가 증가하였으며 수술 대조군에서는 낮에 비하여 밤에 free water clearance와 fractional excretion of water가 증가하였다.

5. 따라서 신장 동종이식 수여자에서 나타나는 야간성 다뇨는 주로 삼투성 이뇨에 의한 것이며 수술 대조군에서의 야간성 다뇨는 수분성 이뇨에 의한 것임을 알 수 있었다.

A study on the nocturnal polyuria in renal allograft recipients

Joon Pil Cho

Department of Medical Science, The Graduate School, Yonsei University

(Directed by Prof. Kiil Park, M.D.)

The physiologic mechanism of nocturnal polyuria in renal allograft recipients has

not yet been clarified, but it is thought that normal diurnal urinary rhythm is

achieved in about 1 year after transplantation. The author studied renal allograft

recipients and control group of patient who received operation other than renal

transplantation, in order to find out whether the cause of nocturnal polyuria is

the increase of glomerular filtration rate, osmotic diuresis, or water diuresis.

The amount of urine output, glomerular filtration rate, osmolar clearance, sodium

and free water clearance, and factional excretion of sodium and water in the day

and in the night were measured, and the following conclusions were reached:

1. Compared to the normal control group, the renal allograft recipients presented

with statistically significant nocturnal polyuria at post-transplantation day 14

and 28.

2. The control group of patients undergone surgery other than renal

transplantation also showed statistically significant nocturnal polyuria.

3. There was no significant difference between glomerular filtration rate in the

day and in the night in all the patients studied.

4. In renal allograft recipients, osmolar clearance and sodium clearance were

increased in the night compared to those in the day, while in surgical patients

control group, free water clearance and fractional excretion of water were

increased in the night.

5. Thus one can see that nocturnal polyuria found in renal allograft recipients

was mainly due to osmotic diuresis, while nocturnal polyuria in surgical patients

control group was due to water diuresis.

[영문]

The physiologic mechanism of nocturnal polyuria in renal allograft recipients has not yet been clarified, but it is thought that normal diurnal urinary rhythm is achieved in about 1 year after transplantation. The author studied renal allograft

recipients and control group of patient who received operation other than renal transplantation, in order to find out whether the cause of nocturnal polyuria is the increase of glomerular filtration rate, osmotic diuresis, or water diuresis.

The amount of urine output, glomerular filtration rate, osmolar clearance, sodium and free water clearance, and factional excretion of sodium and water in the day and in the night were measured, and the following conclusions were reached:

1. Compared to the normal control group, the renal allograft recipients presented with statistically significant nocturnal polyuria at post-transplantation day 14 and 28.

2. The control group of patients undergone surgery other than renal transplantation also showed statistically significant nocturnal polyuria.

3. There was no significant difference between glomerular filtration rate in the day and in the night in all the patients studied.

4. In renal allograft recipients, osmolar clearance and sodium clearance were increased in the night compared to those in the day, while in surgical patients control group, free water clearance and fractional excretion of water were increased in the night.

5. Thus one can see that nocturnal polyuria found in renal allograft recipients was mainly due to osmotic diuresis, while nocturnal polyuria in surgical patients control group was due to water diuresis.