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PubMed | Soonchunhyang University, Dong - A University, Endocare Pharmacy, Kim Yong Ki Internal Medicine Clinic and 2 more.
Type: Journal Article | Journal: Journal of diabetes and its complications | Year: 2016

The potential role of soluble -klotho in diabetic kidney disease has not yet been evaluated. The aim of this study was to evaluate the association of plasma and/or urine -klotho with the progression of type 2 diabetic nephropathy.The baseline values of plasma and urine -klotho were measured in 147 patients with type 2 diabetes mellitus with an estimated glomerular filtration rate (eGFR) of 60mL/min/1.73m(2). In this prospective observational study, a total of 109 type 2 diabetic patients were followed up for 34months (8-50 months).Plasma -klotho, but not urine -klotho, was negatively correlated with the decline of eGFR (r=-0.304, P=0.001; r=0.042, P=0.068, respectively). After adjusting for several clinical parameters, baseline eGFR and urine ACR, plasma -klotho was significantly associated with the decline of eGFR (r=-0.219, P=0.008). In the normoalbuminuria group (n=63), the plasma -klotho remained significantly associated with a decline in eGFR (r=0.324, P=0.004) in the final model.It is suggested that plasma -klotho may be an early biomarker for predicting renal impairment in type 2 diabetic patients. The disappearance of a compensatory increase of plasma -klotho might be a predictive marker for the progression of type 2 diabetic nephropathy.


Lee J.H.,Haedong Hospital | Kim S.S.,Pusan National University | Kim I.J.,Pusan National University | Song S.H.,Pusan National University | And 5 more authors.
Journal of Diabetes and its Complications | Year: 2012

Objective: Chronic inflammation has emerged as being a key pathophysiology in the early stages of diabetic nephropathy. YKL-40 has been established as an inflammatory marker in chronic inflammation. The aim of this study was to evaluate the association of plasma and urine YKL-40 with albuminuria in the early stage of type 2 diabetic nephropathy. Design and methods: A total of 75 type 2 diabetic patients and 22 nondiabetic controls with estimated glomerular filtration (eGFR) ≥ 60 ml/min/1.73 m2 were enrolled. Plasma and urine concentrations of YKL-40 were analyzed by ELISA kit. Results: The plasma levels of YKL-40 were significantly higher in the normoalbuminuric group with diabetes than in the control group, and increased with increasing severity of albuminuria among diabetes. However, urine YKL-40 was only increased in macroalbuminuric state. Plasma YKL-40 was positively correlated with urine YKL-40 (r = 0.291, P = 0.011). Urinary albumin significantly correlated with both plasma and urine YKL-40 in a univariate analysis. After adjusting for several confounding factors, plasma YKL-40 was significantly correlated with albuminuria (r = 0.359; P = 0.001), whereas urine YKL-40 did not show significant correlation with albuminuria (r = 0.128, P = 0.241). Conclusions: Although urine YKL-40 has a limited role, plasma YKL-40, as an proinflammatory marker, was an independent factor associated with albuminuria in early stage of nephropathy in type 2 diabetes and might have an useful role as a noninvasive marker for the early diabetic nephropathy detection. © 2012 Elsevier Inc. All rights reserved.


Kim S.S.,Pusan National University | Song S.H.,Pusan National University | Kim I.J.,Pusan National University | Jeon Y.K.,Pusan National University | And 4 more authors.
Diabetes Care | Year: 2013

OBJECTIVEdThe aim of this study was to evaluate the association of urinary cystatin C, a tubular damage marker, with the progression of type 2 diabetic nephropathy. RESERCHDESIGNANDMETHODSdThe baseline values of serumand urinary cystatin C were measured as primary parameters and those of urinary nonalbumin protein (NAP) were measured as secondary parameters. In this prospective observational study, a total of 237 type 2 diabetic patients were followed up for 29 months (13-44 months). RESULTSdBoth the urinary cystatin C-to-creatinine ratio (CCR) and NAP-to-creatinine ratio (NAPCR) were significantly different according to the degree of albuminuria. Both markers had strongly positive correlations at baseline. After adjusting for several clinical factors, both urinary CCR and NAPCR had significant associations with the decline of the estimated glomerular filtration rate (eGFR) (r = 0.160, P = 0.021; r = 0.412, P < 0.001, respectively). Urinary CCR had positive correlations with the decline of eGFR in the subpopulation of patients with eGFR ≥60 mL/min/1.73 m2. In patients with eGFR ≥60 mL/min/1.73 m2 and normoalbuminuria, only urinary NAPCR showed a significant association with the decline of eGFR; urinary CCR did not. Inmultivariate regression analysis, the number of patients who progressed to chronic kidney disease stage 3 or greater was higher in those in the upper tertiles of both the urinary levels of cystatin C and NAP than in those in the lower tertiles. CONCLUSIONSdThe results of this study suggest that urinary cystatin C and NAP may be predictors of the progression of type 2 diabetic nephropathy. Copyright © 2013 by the American Diabetes Association.


Kim W.J.,Pusan National University | Kim S.S.,Pusan National University | Bae M.J.,Kim Yong Ki Internal Medicine Clinic | Yi Y.S.,Busan Veterans Hospital | And 5 more authors.
Journal of Diabetes and its Complications | Year: 2014

Aims We evaluated whether high-normal serum uric acid (SUA) levels can predict the development of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus and preserved kidney function at baseline. Methods This was a retrospective observational longitudinal study of patients presenting at the Department of Endocrinology and Metabolism, Pusan National University Hospital. A total of 512 patients with type 2 diabetes mellitus and preserved kidney function (estimated glomerular filtration rate [eGFR] ≥ 60 mL/min/1.73 m 2) and normouricemia were included. The main outcome was development of CKD of stage 3 or greater. The patients were divided into four groups according to quartiles of SUA levels. Results During the follow-up period, 62 (12.1%) patients had progressed to CKD 3 or greater. The group with the highest-normal range of SUA (Q4) showed a higher cumulative incidence of CKD stage 3 or greater than that of the other lower quartiles (Q4 vs. Q3; P = 0.037, Q4 vs. Q2; P < 0.001, Q4 vs. Q1; P < 0.001). In a univariate analysis, Q4 was significantly associated with the development of CKD 3 or greater (log-rank statistic, 31.93; P < 0.001). In a multivariate analysis, Q4 (hazard ratio, 2.97; 95% confidence interval, 1.15-7.71; P = 0.025) showed a significant association with CKD 3 or greater. Conclusions High-normal SUA may predict the occurrence of CKD stage 3 or greater in patients with type 2 diabetes mellitus and preserved kidney function. © 2014 Elsevier Inc. All rights reserved.


PubMed | Busan Veterans Hospital, Kim Yong Ki Internal Medicine Clinic and Pusan National University
Type: Comparative Study | Journal: The Korean journal of internal medicine | Year: 2016

The purpose of this study was to compare the diagnostic validity of two-dimensional (2D) and three-dimensional (3D) ultrasonography (US) when predicting the extrathyroidal extension of papillary thyroid cancer.All 2D data were interpreted in real time and 3D data were stored, rendered using tomographic ultrasound imaging (TUI), and then reviewed retrospectively.Extrathyroidal extension was present in 17 papillary thyroid cancers(24.3%) on pathology reports. The presence of contact was significantly associated with extrathyroidal extension on both 2D and 3D US (p = 0.007 and p = 0.003), and the sensitivity and specificity were not significantly different between 2D and 3D US (p = 1.000 and p = 0.754). The coexistence of protrusion and contact was not significantly associated with extrathyroidal extension on either 2D or 3D sonogram.Three-dimensional images rendered with TUI algorithms alone do not seem to be markedly superior to real-time 2D US in predicting the extrathyroidal extension of papillary thyroid cancer.


Kim S.S.,Pusan National University | Song S.H.,Pusan National University | Kim I.J.,Pusan National University | Yang J.Y.,Pusan National University | And 3 more authors.
Diabetes Research and Clinical Practice | Year: 2012

Aim: The aim of this study was to evaluate the association of urinary tubular markers, interleukin-18 (IL-18) and angiotensinogen with albuminuria in early nephropathy of type 2 diabetics. Methods: Urine levels of tubular markers (kidney injury molecule [KIM]-1, neutrophil gelatinase-associated lipocalin [NGAL] and liver-type fatty acid-binding protein [L-FABP]), proinflammatory marker (IL-18), and a marker of intrarenal renin-angiotensin system (RAS) status (angiotensinogen) were determined in 118 patients with type 2 diabetes mellitus and 25 non-diabetic controls with estimated glomerular filtration rate (eGFR) ≥60mL/min/1.73m2. Results: Urinary levels of KIM-1, NGAL, IL-18 and angiotensinogen were significantly higher in macroalbuminuria group compared with control and normo- and microalbuminuria groups but not significantly different between control and normoalbuminuria group. Urinary tubular markers were positively correlated with urinary IL-18 and angiotensinogen, respectively. The urinary albuminuria was correlated with all investigated urinary markers in univariate analysis. After adjusting for several clinical parameters, urinary KIM-1, NGAL and angiotensinogen were significantly associated with albuminuria. Conclusions: The results of this study suggest that urinary tubular markers may be independently associated with albuminuria in the early stage of nephropathy in type 2 diabetics (eGFR ≥60mL/min/1.73m2) and may reflect inflammatory processing and the activation of the intrarenal RAS. © 2012 Elsevier Ireland Ltd.


Kim S.S.,Pusan National University | Kim S.-J.,Pusan National University | Kim I.J.,Pusan National University | Kim B.H.,Pusan National University | And 2 more authors.
Clinical Nuclear Medicine | Year: 2012

Objective: The aim of the present study was to evaluate differences between children and young adult patients in presentation, clinical course, and outcome of well-differentiated thyroid carcinoma (DTC). Methods: We retrospectively reviewed the medical records of 61 children and young adults (50 female and 11 male; aged <25 years) with DTC who were treated with radioiodine (RI) and followed up between June 2002 and May 2010. All patients had undergone total thyroidectomy with lymph node dissection if enlarged lymph nodes were present and had been referred for initial radioiodine ablation. Recurrence-free survival was evaluated with the Kaplan-Meier method. Results: At diagnosis, extrathyroidal extension of DTC was more prevalent and mean tumor size was bigger in children than in young adults (P = 0.045 and P = 0.002, respectively). However, there was no significant difference between the 2 groups with regard to the presence of lymph node or distant metastases (P = 0.885 and P = 1.000, respectively). During follow-up, the recurrence in the thyroid bed or cervical lymph nodes occurred in 6 children (20.7%) and in 3 young adults (9.4%; P = 0.323). The recurrence-free survival rate was similar in children and in young adults (log-rank test, χ1 = 2.424, P = 0.120). Conclusions: Our result shows that, although the presentation of DTC at the time of diagnosis was more aggressive in children, intensive management elicited a similar clinical outcome in children and in young adults. © 2012 by Lippincott Williams & Wilkins.


Kim S.S.,Pusan National University | Lee B.-J.,Pusan National University | Lee J.-C.,Pusan National University | Kim S.-J.,Kim Yong Ki Internal Medicine Clinic | And 5 more authors.
Head and Neck | Year: 2011

Background The purpose of this study was to evaluate the usefulness of tumor characteristics on ultrasonography for predicting the pathologic stage of papillary thyroid carcinoma. Methods We evaluated 354 patients who underwent surgery for papillary thyroid carcinoma (≤2 cm). We analyzed the preoperative ultrasonography findings such as tumor size, shape, margin, echogenicity, calcification, vascularity, and contact with the capsule. Results Tumor size, echogenicity, and contact with the capsule were predictive for the presence of extrathyroid extension. Size and echogenicity were significantly associated with central lymph node metastasis in the multivariate analysis. Some ultrasonography characteristics such as round shape, well-defined margin, and isoechoic echogenicity were negative predictive factors for extrathyroid extension and central lymph node metastasis. Conclusion Preoperative tumor characteristics on ultrasonography correlated with several prognostic factors for papillary thyroid carcinoma and may serve as preoperative supplementary markers for determining the optimal extent of surgery. © 2011 Wiley Periodicals, Inc.


Jeon Y.K.,Pusan National University | Lee J.G.,Pusan National University | Kim S.S.,Pusan National University | Kim B.H.,Pusan National University | And 3 more authors.
Endocrine Journal | Year: 2011

Metabolic syndrome (MS) has 2 conlicting factors: obesity known to be protective against osteoporosis and an inlammation that activates bone resorption. The aim of this study was to evaluate the difference of bone mineral density (BMD) in women with or without MS according to menopausal state. This is a cross-sectional study of 2,265 women (1,234-premenopausal, 931-postmenopausal) aged over 20 years who visited the Health Promotion Center from January 2006 to December 2009. We measured BMD at the lumbar spine and femoral neck. MS was deined according to the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) criteria. The prevalence of MS was 5.5% in the premenopausal group and 13.5% in the postmenopausal group. In the postmenopausal group, C-reactive protein (CRP) was signiicantly higher in subjects with MS than those without MS, but it was not in the premenopausal group. In the postmenopausal group, women with MS had a lower BMD at the lumbar spine and femoral neck before or after adjustment. In the premenopausal group, women with MS had a lower BMD at the lumbar spine, but not at the femoral neck. In stepwise linear regression analysis, predictive variables for BMD of the lumbar spine were systolic blood pressure in the premenopausal group and HDL-cholesterol and diastolic blood pressure (DBP) in the postmenopausal group. The predictive variables for BMD of the femoral neck were DBP and waist circumference in the premenopausal group and CRP and DBP in the postmenopausal group. Inlammation might have a more important role in BMD than obesity in the postmenopausal women. © The Japan Endocrine Society.

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