만성 신부전 환자에서의 무증상적 세균뇨

정유석(Yoo Suck Jung),안승재(Seoung Jae An),김성진(Sung Jin Kim),권은희(Eun Hoe Kwon),이동원(Dong Won Lee),이수봉(Soo Bong Lee),곽임수(Ihm Soo Kwak),나하연(Ha Yeon Rha) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.5

배 경 : 만성 신부전 환자의 감염은 숙주 방어 기전의 장애에 의한 것으로 질병 이환과 사망의 중요한 원인이 되고 있다 특히 요로감염은 만성 신부전 환자에서 결소혈증, 드문 배뇨, 소변 속도의 저하, 농축능의 장애 둥에 의해서 더욱 호발하는 것으로 생각된다. 이에 저자들은 무증상의 만성 신부전 환자에서 세균뇨 및 요로 감염의 빈도를 정상 대조군과 비교하여 분석하였고, 정상인에서 요로 감염의 위험인자로 알려져 있는 여러 인자들이 만성 신부전 환자에서 동일하게 적용될 수 있는지를 검토하였다. 방 법 : 2001년 1월부터 2001년 12월까지 부산대학교병원에 내원한 요로 감염의 증상이 없는 만성 신부전 환자 34명 (남 13, 여 21), 신기능이 정상인 대조군 30명 (남 11, 여 19)을 대상으로 하였다. 검체는 아침 첫 배뇨시 무균적 중간뇨 (clean catch midstream urine)를 채취하였고, 현미경적 검사를 포함한 화학 검사와 소변 배양 검사를 실시하였다. 통계적 분석은 SPSS 10.0을 이용하여 Chi square test를 시행하였고, 통계적 유의수준은 p<0.05로 하였다. 결 과 : 만성 신부전의 원인 질환으로는 고혈압 16예 (47%), 당뇨 14예 (44%), 사구체 질환 4예 (9%)였다. 그리고 만성 신부전 환자의 23명은 혈액투석, 5명은 복막 투석을 시행하는 상태였으며 나머지 4명은 투석 치료를 시작하지 않은 상태였다. 소인 배양청사 양성률은 환자군에서 20.6% (7/34), 대조군에서 3.3% (1/30)로 통계적으로 유의한 차이를 보였다 (p<0.01). 그러니 성별, 나이, 신부전의 원인 질환, 투석 방식 및 농뇨의 유무에 따라서는 양군간 유의한 차이를 보이지 않았고, 소변 배양검사에서는 E. coli, Acinetbacter baumanii, Enterococcus spp., S. aurers, P. aeruginwsa, S. epidermidis, Str. viridans 등이 검출되었다. 결 론 : 만성 신부전 환자는 건강한 사람에 비해서 더 많은 세균뇨을 갖고있는 것을 확인할 수 있었지만, 환자들의 성, 연령, 원인질환, 투석종류에 의해서는 차이가 없음을 알 수 있었다. 그리고 무증상의 세균뇨가 향후 현성 요로 감염으로 악화될 수 있으므로 만성 신부전 환자에서 무증상의 요로 감염에 대한 정기 점진 및 조기 치료에 대한 고려가 필요하리라 생각된다. Background : In patients with chronic renal failure, infection is caused by altered host defense mechanism, and contributes , significantly to their morbidities and mortalities. Especially, urinary tract infection often occurs in patients with chronic renal failure and is due to azotemia, infrequent voiding, low urinary flow rate and urinary concentration defects. This study was designed to compare the incidence of asymptomatic bacteriuria with chronic renal failure with that of normal control group. We also investigated whether risk factors for urinary tract infections in patients with chronic renal failure are similar to those in normal control groups. Methods : 34 patients (M: F=13: 21) with chronic renal failure and 30 normal control groups (M:F= 11:19) were evaluated in the Pusan National University Hospital from January 2001 through December 2001. Etiology of chronic renal failure included diabetes mellitus (n=16, 47.1%), hypertension (n=14, 41.2%) and glomerular diseases (n=4, 11.7%). 25 patients were treated with hemodialysis and 5 patients were treated with peritoneal dialysis. Others (n=4) were not treated with dialysis. Clean-catch, first voided urine was collected in the morning and examined by routine urinalysis and urine culture. Results : 7 of 34 (20.6%) patients with chronic renal failure were positive in urine cultures and only one of 30 (3.3%) from the normal control group were positive. E. coli (n=2), Acinetobacter baumanii (n=2), Enterococcus spp. (n=2), S. aureus (n=1), P. aeruginosa (n=1), S. epidermidis (n=1) and Str. viridans (n=1) are cultured from urine specimens. There was a significant difference between the incidence of asymptomatic bacteriuria in patients with chronic renal failure and that of normal control group. But there was no significant difference in the presence of bacteriuria according to sex, age, etiology of renal failure, dialysis modality and pyuria. Conclusion : Patients with chronic renal failure have higher frequency of asymptomatic bacteriuria and pyuria than healthy subjects and tend to lead to symptomatic urinary tract infections.

간을 침범한 다발성 근염

김태오 ( Tae Oh Kim ),정유석 ( Yoo Suck Jung ),김지영 ( Ji Young Kim ),배우형 ( Woo Hyung Bae ),김성일 ( Sung Il Kim ),이창훈 ( Chang Hun Lee ),곽임수 ( Ihm Soo Kwak ),나하연 ( Ha Yeon Rha ) 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.4

Polymyositis is non-hereditary, autoimmune rheumatic disease characterized by progressive symmetrical proximal muscle weakness due to chronic inflammation of skeletal muscles. Its definite causes are unknown, genetic and environmental factors including some viral infections such as hepatitis C virus were associated with development of autoimmunity. Clinical symptoms are symmetrical proximal muscle weakness, arthritis, interstitial lung disease, heart failure and gastrointestinal disturbance. We experienced a case of polymyositis which involved liver and developed chronic hepatitis confirmed by liver biopsy.

정상 혈압을 보이는 제 2 형 당뇨병 환자에서 미세단백뇨와 사구체 여과율의 상관성

안승재(Seoung Jae An),정유석(Yoo Suck Jung),김성진(Sung Jin Kim),권은회(Eun Hoe Kwon),정현철(Hyun Chul Jung),이수봉(Soo Bong Lee),곽임수(Ihm Soo Kwak),나하연(Ha Yeon Rha) 대한내과학회 2002 대한내과학회지 Vol.62 No.4

배경 : 당뇨병성 신증은 말기 신장 질환의 주된 요인이며, 미세단백뇨는 제2형 당뇨병 환자에서 당뇨병성 신증의 진행과 심·혈관계 질환의 발생에 중요한 예측 인자로 알려져 있다. 그러나 뇨 알부민 배설률과 사구체 여과율의 상관성은 아직 풀리지 않는 문제로 남아 있다. 저자들은 정상 혈압을 보이고, 현성단백뇨가 없는 제2형 당뇨병 환자에서 초기 신 기능 장애를 살펴보기 위해, 뇨 알부민 배설률과 사구체 여과율을 측정하고, 그들의 상관성을 알아보고자 하였다. 대상 및 방법 : 1997년 1월부터 2001년 6월까지 부산 대학 병원에 내원한 환자들 중에서 정상 혈압을 보이고, 현성단백뇨가 없는 제2형 당뇨병 환자군 112명과 정상 대조군 30명을 대상으로 단면 연구를 하였다. 환자군은 24시간 뇨 알부민 배설률에 따라, 정상단백뇨군과 미세단백뇨군으로 구분하고, 사구체 여과율은 99mTc-DTPA 신장 스캔을 이용하여 측정하였다. 환자군과 대조군의 임상적 특징은 ANOVA를 이용하여 비교하였고, 환자군에서 뇨 알부민 배설률과 사구체 여과율 및 뇨 알부민 배설에 영향을 주는 위험 인자들은 Pearson correlation test를 이용하여 비교하였다. 결과 : 세 군에서 성별, 연령, 체질량지수는 비슷한 분포를 보였다. 또한, 정상단백뇨군과 미세단백뇨군의 평균 유병 기간 (8.3±8.0년 vs 9.1±5.9년, p>0.05)과 인슐린의 사용 비율 (57.5% vs 66%, p>0.05)은 의미 있는 차이가 없었다. 또한, 정상단백뇨군과 비교해서, 미세단백뇨군에서 당뇨병성 망막증의 유병율 (26.7% vs 58.8%, p<0.05)과 사구체 여과율 (102.9±15.5 vs 124.0±17.6 mL/min/1.73 m2, p<0.05)은 의미 있게 높은 것으로 나타났다. 또한, 제2형 당뇨병 환자군 전체에서 뇨 알부민 배설률과 사구체 여과율을 포함한 위험 인자들 사이의 상관관계를 살펴보았을 때, 사구체 여과율만이 의미 있는 양의 상관관계를 보였다 (r=0.303, p<0.05). 결론 : 제1형 당뇨병 환자에서와 같이, 정상 혈압을 보이고, 미세단백뇨를 특징으로 하는 초기 당뇨병성 신증을 가진 제2형 당뇨병 환자에서도 사구체 여과율의 증가는 뇨 알부민 배설률과 유의한 상관관계를 보였다. Background : Diabetic nephropathy is one of the major causes of end-stage renal disease. Microalbuminuria predicts not only progressive renal disease, but also increased cardiovascular morbidity and mortality. But, the relationship between urinary albumin excretion rate (UAER) and glomerular filtration rate (GFR) remains an unresolved issue. In order to investigate the early renal function abnormalities, UAER and GFR were assessed and their relationship was examined in normotensive patients with type 2 diabetes mellitus (DM). Methods : Between January 1997 and June 2001, in a cross sectional study of 112 normotensive patients with type 2 DM not showing overt proteinuria and thirty healthy subjects served as control group. According to UAER, type 2 DM patients were divided into normoalbuminuria group and microalbuminuria group. The GFR was measured using 99mTc-DTPA renal scan. Clinical values in type 2 DM patients and control subjects were compared using one-way analysis of variance (ANOVA) with Scheffe's F test. In type 2 DM patients, Univariate Chi-square analysis was used to evaluate the prevalence of diabetic retinopathy and the differences in anti-diabetic treatment. Pearson correlation coefficients were used to demonstrate a strength of an association between UAER and other variables including GFR. Results : Three groups were well matched with regard to gender, age and body mass index. There were no significant differences in disease duration and anti-diabetic treatment in type 2 DM patients. The GFR in microalbuminuric patients was significantly higher than in normoalbuminuric patients (124.0 17.6 vs 102.9±15.5 mL/min/1.73 m2, p<0.05). The prevalence of diabetic retinopathy in microalbuminuric patients was significantly higher than in normoalbuminuric patients (53.8% vs 24.7%, p<0.05). Only there was significant positive correlation between log UAER and GFR (r=0.303, p<0.05). Conclusion : As in type 1 DM patients, there was a significant relationship between UAER and GFR in normotensive type 2 DM patients without overt proteinuria.(Korean J Med 62:436-443, 2002)

신기능 저하 환자에서 99mTc - DMSA 신장 스캔을 이용한 신 섭취율과 사구체 여과율의 상관성

이수봉(Soo Bong Lee),정현철(Hyun Chul Jung),곽임수(Ihm Soo Kwak),나하연(Ha Yeon Rha),안승재(Seoung Jae An),정유석(Yoo Suck Jung) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.4

배 경 : 신기능 저하 환자에서 신기능을 정확히 평가하는 것은 중요하고, 다양한 방법으로 사구체 여과율(GFR)을 구하고 있다. 임상에서 흔히 ^99mTc-DTPA 신장 스캔과 99mTc-DMSA 신장 스캔이 개별 신기능의 평가에 많이 이용되고 있다. 본 연구에서는 99mTc-DMSA 신장 스캔을 이용하여 신피질 영상을 위한 1시간 상대적 신 섭취율과 사구체 여과율 사이의 상관성을 검토하고자 하였다. 방 법: 1998년 1월부터 2001년 3월까지 부산대학교병원 신장내과에 내원한 환자들 중 ^99mTc-DMSA 신장 스캔, ^99mTc-DTPA 신장 스캔, 혈청 크레아티닌, 24시간 요 중 크레아티닌을 검사한 65명의 환자들 중에서, 중증 및 중등도 신기능 저하 환자 42명을 대상으로 하였다. ^99mTc-DTPA 신장 스캔을 이용한 사구체 여과율(DTPA-GFR)에 따라 중증 신기능 저하군(A)과 중 등도 신기능 저하군(B)으로 나누었다(A군 : ≤20 mL/min/1.73㎡, n=20명, B군 : 20-50 mL/min/1.73㎡, n=22명). 99mTc-DMSA 신장 스캔을 이용하여 1시간 상대적 신 섭취율(DMSA-%uptake, TRUR)을 구하고, 이것을 99mTc-DTPA 신장 스캔을 이용한 사구체 여과율(DTPAGFR), 내인성 크레아티닌 청소율(Ccr), Cockcroft와 Gault가 고안한 추정 크레아티닌 청소율(C & G Ccr)과 Spearman rank correlation test를 이용하여 상관성을 비교하였다. 결 과 : 전체 42명의 대상 환자들 중에서 15명은 남자였고, 27명은 여자였다. 평균 나이는 54 세(28-80세)였다. 두 군에서 평균 DTPA-GFR과 평균 TRUR은 각각 통계적으로 유의한 차이 를 보였다(14.8±4.7 vs 34.9±8.4 mL/min/1.73㎡, p<0.05; 8.9±3.7 vs 16.3±7.4%, p< 0.05). 그러나 TRUR의 DTPA-GFR에 대한 상관성을 보았을 때, A군에서는 유의한 상관관계는 없었으나, B군에서는 유의한 상관관계를 보였다(0.263, p>0.05 vs 0.731, p<0.01). 또한 TRUR의 혈청 크레아티닌, Ccr, C & G Ccr에 대한 상관성을 보았을 때, 두 군 모두에서 통계적으로 유의한 상관관계를 보였다. 결 론 : ^99mTc-DMSA 신장 스캔에서 신피질 영상으로 사용되는 1시간 상대적 신 섭취율은 실제 사구체 여과율을 정확하게 측정할 수는 없지만, 신기능이 중증이하로 감소되지 않은 경우에는 사구체 여과율을 간접적으로 반영하였다. Background : Glomerular filtration rate(GFR) is an important parameter for the evaluation and monitoring of renal function. The aim of this study was to investigate the correlation between the relative 1 hour uptake of 99mTc-DMSA renal scan(DMSA-%uptake, TRUR) and GFR which was estimated by 99mTc-DTPA, serum creatinine and 24 hour-urinary creatinine excretion. Methods : Between January 1998 and March 2001, 65 patients had undergone ^99mTc-DMSA renal scan, ^99mTc-DTPA renal scan, serum creatinine and 24 hour-urinary creatinine excretion. Of them, 42 patients had moderately or severely reduced renal function(DTPA-GFR ≤50 mL/min/1.73㎡). According to the DTPA-GFR level, patients were divided into two groups : Group A(n=20) with DTPA-GFR ≤20 mL/min/1.73㎡(mean±S.D. 14.8±4.7), Group B(n=22) with DTPA-GFR 20-50 mL/min/1.73㎡(mean±S.D. 34.9±8.4). Between the TRUR and other methods to estimate renal function such as DTPA-GFR, 24 hour-urinary creatinine clearance(Ccr) and Cockcroft & Gault`s formula(C & G Ccr), the correlation coefficient was measured by Spearman rank correlation test. Results : Of 42 patients, 15 were men and 27 were women(mean age 54 years; range 28-80 years). there were significant differences between mean DTPA-GFR and mean TRUR in both groups(14.8±4.7 vs 34.9±8.4 mL/min/1.73㎡, p<0.05; 8.9±3.7 vs 16.3±7.4%, p<0.05). In group A, TRUR(mean±S.D. 8.9±3.7%) was not significantly correlated with DTPA-GFR(r=0.263, p>0.05). In group B, TRUR (mean±S.D. 16.3±7.4%) was significantly correlated with DTPA-GFR(r=0.731, p<0.01). In both group, serum creatinine, Ccr and C & G Ccr were significantly correlated with TRUR. Conclusion : Although the relative 1 hour uptake of the ^99mTc-DMSA renal scan, as a method of renal cortical image could not estimate the true GFR, it showed a good correlation with GFR in patients with moderately reduced renal function. 99mTc-DMSA renal scan seems to be helpful to evaluate the renal function in patients with moderately reduced renal function.

말기 신질환 환자에서 심기능 지표들의 혈액 투석에 따른 변화

이동원(Dong Won Lee),김용범(Yong Beom Kim),안승재(Seoung Jae An),정유석(Yoo Suck Jung),곽임수(Ihm Soo Kwak),신영우(Yung Woo Shin),나하연(Ha Youn Rha) 대한내과학회 2001 대한내과학회지 Vol.60 No.6

N/A Background : It is absolutely necessary to evaluate cardiac function at starting and during hemodialysis in patients with end stage renal disease. In this study, we tried to determinate the changes of cardiac function associated with hemodialysis. Methods : Twenty patients with end stage renal disease were enrolled , who had been in hemodialysis program from February, 1997 to August, 1999 in Pusan National University Hospital. They were examined with echocardiography and gated blood pool scintigraphy at starting hemodialysis and after follow-up. The data were analyzed by paired T-test. Results : The patients were 46.2±16.8 years old and male to female ratio was 8 : 12. The underlying diseases were diabetes mellitus(n=10), hypertension(7), glomerulonephritis (2) and others(1). The duration of symptoms associated with end stage renal dis- ease and underlying diseases was 3.4±2.6 years, and the duration of hemodialysis was 13.8±7.0 months. The LVEDID, LVESID and RVC decreased significantly (-6.10, -7.80 and -20.00%, respectively, p<0.05) with no significant changes for LAD, IVS, PWT and EF (p>0.05). In ten cases associated with diabetes, LVEDID decreased (-7.90%, p<0.05). In twelve cases associated with cardiac diseases, LVEDID and LVESID decreased (-8.60 and -10.50%, respectively, p<0.05). In four cases associated with diabetes without cardiac diseases, LAD decreased (-5.10%, p<0.05). And in four cases associated with cardiac diseases without diabetes, there were no significant changes in cardiac dimensions and EF. In seven cases associated with diabetes and cardiac diseases, LVEDID decreased (-10.50%, p<0.05). The EF on gated blood pool scintigraphy decreased (-0.9%, p<0.05) as a whole, while increased (5.90%, p<0.05) in the cases associated with diabetes and cardiac diseases. Conclusion : During the early hemodialysis stage of end stage renal disease, we found a change of concentric left ventricular hypertrophy and relatively preserved left ventricular function. Furthermore we can expect that adequate hemodialysis -with dry-weight as low as possible - may prevent progression to eccentric left ventricular hypertrophy and dilated cadiomyopathy. (Korean J Med 60:567-573, 2001)

혈액투석 환자에서 중심 정맥 도관의 세균 집락과 균혈증에 관한 연구

김용범(Yong beom Kim),이동원(Dong Won Lee),안승재(Seoung Jae An),정유석(Yoo Suck Jung),이수봉(Soo Bong Lee),곽임수(Ihm Soo Kwak),나하연(Ha Youn Rha) 대한내과학회 2001 대한내과학회지 Vol.61 No.2

N/A Background : Central venous hemodialysis is often used and is respectively safe in hemodialysis patients. But, many complications have been reported. Peripheral bacteremia after insertion of central venous hemodialysis catheter is a major cause of morbidity. We undertook a prospective study to investigate the colonization of central venous hemodialysis catheter and subsequent related episodes of peripheral bacteremia. Methods : Twenty-nine patients were enrolled ; who had been in hemodialysis program from July, 1999 to June, 2000 in Pusan National University Hospital. Blood cultures were taken from the catheter weekly after insertion. When the result of blood cultures through the central venous catheter became positive, indicating the colonization in the central venous catheter, peripheral venous blood cultures were taken before starting dialysis to detect the peripheral bacteremia. The data were analyzed by Mann-Whitney test. Results : The mean age of patients was 53 years old and a prospective study of 29 central venous hemodialysis catheter was performed. Seven catheters (24%) became colonized on their instrumental surface. The mean time to colonization was 21 days after insertion. The colonizing organisms were Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus. Four catheters (13%) developed peripheral bacteremia with the same organism of colonization in the central venous catheter. The mean time to bacteremia was 19 days after insertion. The organisms of peripheral bacteremia were Staphylococcus epidermidis (n=2), Staphylococcus aureus (1), Enterococcus (1). Bacteremia only occurred when blood drawn through the catheter cultured more than 1000 colony forming units per mL. The risk of subsequent bacteremia is not related to time left in. Conclusion : Bacterial colonization in the central venous catheter often led to bacteremia in hemodialysis patients. The risk of subsequent bacteremia is not related to time left in situ but to degree of colonization. In future, prospective study is needed in more patients.(Korean J Med 61:121-126, 2001)

Chlorpromazine의 副作用과 Sustained Trihexiphenidyl Hcl(Antane)에 依한 錐體外路系 反應의 調節

南命錫,金石植,鄭有碩 大韓神經精神醫學會 1966 신경정신의학 Vol.5 No.1

The authors tried to study on the side effects of Chlorpromazine, evaluate the effect of Artane(Trihexyphenidyl Hcl) and observe the recurrence rate of extrapyramidal reaction after the withdrawal of maintenance doses of Artane. This study includes 28 patients who were hospitalized in Psychiatric ward SNUH and 55 patients in Kaejoug Mental Hospital, Cholla Pukdo Province. (Total; 83 patients) The results are as follows. 1. Most of patients showed muscular weakness and drowsiness, though they were rarely volunteered symptoms. Dizziness and dryness of mouth were observed in more than an half of cases. Nasal stuffness and extrapyramidal reactions were developed among 49% of cases. 2. Extrapyramidal symptoms were appeared one days later the initial administration of chiorpromazine. The authors could observe that torticollis was relatively early appeared symptom and tremor tended to be appeared later. 3. The authors were impressed that the amount of chlorpromazine did not determined the appearance of extrapyramidal symptoms. 4. Artane was administered to 44 cases. But 3 cases of neurologic illness, 5 cases, from whom significant data were not obtainable because of discharge within 10 days without being managed, and 4 cases, for whom Artane was supplied irregularly, were excluded from this study. 5. 85% of extrapyramidal symptoms were managed successfully with Artane. To manage them, successive 4 days of Artane administration (5-10㎎ daily) were needed. 6. Artane was more effective in rigidity than in tremor and especially highly effective in the management of torticollis and oculogyric crises. 7. The side effects of Artane were not significant. 8. Extrapyramidal symptoms were reappeared in 11 cases among 15 cases within 20 days after the withdrawal of daily maintenance doses of Artane (5-10㎎). 9. Among three neurological cases, two cases revealed the much improvement.

Nutcracker 증후군 : 혈관내 스텐트 삽입술을 이용한 치료 treatment with an intravascular stent

정유석,안승재,이동원,이수봉,곽임수,나하연,김창원 대한내과학회 2003 대한내과학회지 Vol.64 No.2

Nutcracker 증후군은 좌측 신정맥이 대동맥과 상장간막동맥 사이에서 압박을 받아 발생하는 임상적 증후군으로 정계 정맥류 혹은 요관 주위 정맥류를 형성한다. 이 증후군은 드물기는 하나 혈뇨의 알려진 원인 중의 하나이다. 저자는 신정맥 혈관 조영술과 정맥 압력 측정을 하기 전에 전산화단층촬영 혈관 조영술로 진단된 Nutcracker 증후군에서 혈관내 스텐트 삽입술로 성공적인 치료를 경험한 1예를 보고하고자 한다. 47세 여자가 교통 사고 후 한달 뒤 발생한 육안적 혈뇨를 주소로 시행한 요검사에서 혈뇨는 있었으나 단백뇨는 없었고 적혈구 이형성 검사도 음성이엇다. 신손상 의심하에 시행한 전산화단층촬영에서 좌측 신정맥이 대동맥과 상장간막동맥사이에서 압박을 받고 있었고 다면영상 전산화단층촬영 혈관 조영술상 상장간막동맥이 대동맥으로부터 좁은 각도로 분지하는 것이 보였다. 신정맥 혈관 조영술상 역시 좌측 신정맥이 압박을 받고, 있었으며, 이로 인한 원위부 신정맥의 확장과 여러 측부 순환을 확인하였고, 좌측 신정맥과 하대정맥사이의 압력차가 4mmHg로 측정되어 좌측 신정맥내 스텐트 삽입술을 시행하였다. 본 증례처럼 Nutcracker 증후군이 의심되는 환자에서 신정맥 혈관 조영술을 시도해 볼 수 있으며 침습적인 수술 방법 대신 비침습적인 혈관내 스텐트 삽입술로 생리적 개선을 시도해 볼 수 있을 것이다. The nutcracker syndrome refers to compression of the left renal vein between the aorta and the superior mesenteric artery, which results in renal vein and left gonadal vein varices. This is an unusual, but well accepted cause of hematuria. We report a case of the nutcracker syndrome which is diagnosed by CT angiography before venography and pressure measurement of the left renal vein and managed by intravascular stent placement. A 47-year-old female patient was presented with gross hematuria. Urinalysis revealed hematuria with only 1% of dysmorphism. Abdominal spiral CT and 3D CT angiography revealed compression of the left renal vein between the aorta and superior mesenteric artery because of an acute branching angle of superior mesenteric artery from the aorta. Renal venography showed compression of the left renal vein and collateral circulations to the left overian vein and lumbar vein. The pressure gradient between the left renal vein and inferior vena cava was 4 mmHg. Intravascular stent was placed in this patient. We conclude that in patients with the nutcracker syndrome, CT angiography could e considered before venography and venous pressure measurements. when this syndrome leads to clinical symptoms, Intravascular stent placement should be considered. Well designed stent offers minimal invasiveness and physiologic relief as in the present case. (Korean J Med 64:230-234, 2003)