235
￭S-391￭
일측성 요관폐쇄로 유발된 신장 섬유화에서 oleanolic acid의 효과
가톨릭대학교 의과대학 내과학교실
*
이경수, 정성진, 윤혜은, 고은실, 박철휘, 장윤식, 신석준
Background: Interstitial fibrosis is the final common finding in the progression of renal diseases, leading to end-stage renal disease. Antioxidant therapy has a therapeutic potential toward interstitial fibrosis. As nuclear factor-erythroid-2-related factor 2 (Nrf2) has been known to play a crit- ical part in basal activity and coordinated induction of genes encoding numerous antioxidant enzyme, we investigated the effect of oleanolic acid, known as Nrf2 activator, on renal fibrosis and inflammation in mice with obstructive nephropathy. Methods: Renal fibrosis was induced in C57BL6/J mice by unilateral ureteral obstruction (UUO). Treatment with oleanolic aicd was initiated 1 week before and continued until 3, 7 and 14 days after creation of the UUO. Results: Oleanolic acid attenuated UUO-related increases in total collagen deposition and infiltration of mac- rophages compared with vehicle treatment. TUNEL assay showed clear reduction of apoptosis in the obstructed kidney of UUO mice treated with oleanolic acid. UUO-induced kidneys showed a significant decrease of nuclear Nrf2 and heme oxygenase 1 (HO-1). By contrast, treatment with oleanolic aicd induced nuclear Nrf2 abundance and increased HO-1, without increases of total Nrf2 and Keap1, indicating that oleanolic aicd in- duces nuclear translocation of Nrf2. Conclusion: Our results suggest that oleanolic acid may exert its beneficial effect in renal fibrosis by nuclear translocation of Nrf2 and subsequent upregulation of the antioxidant enzyme.
￭S-392￭
Polyuria with concurrent manifestation of central diabetes insipidus and type 2 diabetes mellitus
1Department of Internal Medicine, Gunggi Geriatric Siheung Hospital, 2Division of Nephrology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
*
Hyun-Jong Shin
1, Joo-Hark Yi
2, Sang-Woong Han
2, Ho-Jung Kim
2Background: The coexistence of DI and DM in the same patient is rare but has been reported in Wolfram syndrome (known as DIDMOAD), a congenital genetic disorder in the pediatric age group, in which central diabetes insipidus (CDI) occurs together with type 1 diabetes mellitus (DM) and is accompanied by optic atrophy, deafness, and infantilism. The coexistence of CDI and type 2 DM has been noted in less than 10 adult patients, most of whom had 2 to 15 yr histories of type 2 DM before developing CD. An exception was a patient with Klinefelter’s syn- drome who had CDI for more than 5 years before presenting with hyperosmolar coma due to type 2 DM. We report here a unique case in which CDI and type 2 DM arose simultaneously. Case: A 56 year-old man was diagnosed as type 2 DM on the basis of hyperglycemia with polyuria and polydipsia in a local clinic 2 months previously. He was started on oral hypoglycemic medication, but there was no symptomatic improvement. Upon admission to the university hospital with initial fasting blood sugar level of 140 mg/dL, the polydipsia and polyuria of more than 8 L/d, persisted despite control of the hyperglycemia with metformin and diet. Further investigations including a water deprivation test con- firmed the coexisting DM with CDI of unknown origin, and the patient’s symptoms, including an intense thirst, were markedly improved by a desmopressin nasal spray (10 µg/d). The possibility of a common origin of central CDI and type 2 DM is raised in a review of the few relevant adult cases in the literature. We report a rare case of concurrent manifestation of central diabetes insipidus (CDI) and type 2 diabetes mellitus (DM).
