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최대은 ( Choe Dae Eun ),이상주 ( Lee Sang Ju ),장윤경 ( Jang Yun Gyeong ),나기량 ( Na Gi Lyang ),이강욱 ( Lee Gang Ug ),신영태 ( Sin Yeong Tae ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.1
배 경 : 신경색증은 신동맥이나 분지의 폐쇄로 신기능의 장애를 유발할 수 있는 중요한 원인 중의 하나이며 발생빈도가 드물고 임상증상이 비특이적인 경우가 많아서 조기 진단과 적절한 치료가 늦어지는 경우가 많다. 신경색증의 치료방법의 선택에도 아직 확실한 적응증이 확립되어 있지 않다. 저자들은 신경색증의 임상상과 신기능 변화와 관계 있는 검사실 소견에 대해서 분석 하였다. 방 법 : 1995년 1월부터 2002만 8월까지 병원에서 신경색증으로 진단을 받은 26명을 대상으로 임상상과 검사결과와 진단방법 및 치료경과를 후향적으로 분석하였다. 신경색의 정도는 복부 CT 검사방법으로 25% 미만, 25-50%, 50% 초과로 나누어 분석하였다. 결 과 : 신경색증은 40세 이상 (19명, 73%)의 남자 (남:여 비, 2.7:1)환자가 많았다. 환자들의 기저질환으로 심혈관계 질환이 없는 경우가 15명 (58%)으로 많았으며, 기저질환이 없는 경우도 5명(19%)이었다. 주 증상 및 증후로는 모든 환자에서 늑골척추각부위에 압통이 있었고, 배부통이 73%, 소화기계 증상이 30%, 발열이 27%에서 있었다. 혈액화학검사에서 LDH 치가 모든 환자에서 매우 높게 증가되었으며, AST, ALT, CPK 치가 각각 81%, 91% 및 40%에서 증가되었다. 경과 중 혈청 크레아티닌 치가 1.4 ㎎/dL 이상 증가한 경우는 대상환자 중 11명 (42%)이었으며, 혈뇨 및 단백뇨가 각각 92%와 58%에서 발생하였다. 혈청 LDH 치의 증가는 단백뇨와 함께 혈청 크레아티닌 치의 상승과 통계적으로 유의한 상관이 있었다 (p<0.05). 대상환자의 복부 CT 검사상 신경색의 범위는 혈청 크레아티닌 치의 상승을 보였던 환자들에서 유의하게 넓은 경향을 보였다 (p<0.05). 복부 CT 검사상 신경색의 범위가 50% 이내인 경우에는 치료 경과중 신기능이 정상으로 회복되었으나, 신경색의 범위가 50%를 넘었던 2명 중 1명은 지속적으로 혈청 크레아티닌이 상승하였다. 과거에 고혈압의 병력이 없었던 환자들 중 12명 (48%)에서 고혈압이 발생하였다. 결 론 : 신경색증 환자의 대부분은 기저질환이 있으나, 상당수의 환자 (19%)에서 기저질환이 없이 발생하였다. 복수 CT에서 신경색의 범위가 25% 이상, 혈청 LDH의 상승과 단백뇨의 존재는 혈청 크레아티닌 치의 증가와 관련이 있었다. Background : Renal infarction is an infrequent but one of the important causes of functional renal loss. However, due to its rarity and nonspecific presentation, clinical diagnosis is often delayed and occasionally missed. Furthermore, proper therapeutic intervention is not well established yet. We studied clinical feature of renal infarction, factors that related with renal function. Methods : In order to evaluate the clinical characteristics and renal functional outcome of the patients with acute renal infarction, we analyzed the medical records of 26 patients who were diagnosed as renal infarction and admitted to Chungnam National University Hospital From March, 1995 to April, 2002. Results : The median age of the patients was 47 years (range 4-75) and male to female ratio was 2.7:1. Underlying diseases of the patients with acute renal infarction were cardiovascular disease (n=16), trauma (n=4), and systemic lupus erythematosus (n=1). However, five patients did not have any underlying diseases. Initial presenting symptoms and signs were severe tenderness on costovertebral angle (100%), abdominal or flank pain (73%), gastrointestinal symptoms (30%), fever (27%) and gross hematuria (15%). Initial abnormal laboratory findings were elevated serum level of LDH (100%), AST (81%), ALT (91%), CK (40%) and creatinine (>1.4 mg/dL, 42%) and were hematuria (62%) and proteinuria (38%). Maximal value of serum creatinine level was positively correlated with the magnitude of renal infarction area on abdominal CT and serum LDH level (p<0.05). Twelve patients who were normotensive previously, presented hypertension. Most patients with elevated serum creatinine level initially recovered. However, the renal dysfunction progressed in patients showing more than 50% of renal infarction area on abdominal CT. Conclusion : There were underlying conditions in most of acute renal infarction. However, there was no specific underlying condition in 5 patients out of 26 patients with acute renal infarction. The magnitude of renal infarction (≥25%), elevated serum LDH, proteinuria were significantly correlated with maximal value of serum creatinine level. (Korean J Nephrol 2004;23(1):57-65)
기저질환이 없는 건강한 성인에서 발생한 특발성 신경색증 3예
최대은 ( Choe Dae Eun ),장윤경 ( Jang Yun Gyeong ),나기량 ( Na Gi Lyang ),신병석 ( Sin Byeong Seog ),이강욱 ( Lee Gang Ug ),신영태 ( Sin Yeong Tae ) 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.4
Renal infarction usually occurs in patients with atrial fibrillation, valvular heart, disease, trauma, renal artery stenosis, atherosclerosis and coagulopathy. However it may occur rarely in patients without such underlying disease. We report on 3 patiens who developed renal infarction and had no underlying disease. In two cases, renal artery thrombosis occured. And in the other case, renal artery dissection occured. All patients of the renal infarction experienced severe flank pain. And increased serum LDH, ALT and ALP was noted. The differential diagnosis of renal artery dissection and renal artery thrombosis was established by renal artery angiography. In two patients with renal artery thrombosis, anticoagulation therapy was performed. In the other patient with renal artery dissection, only conservative therapy was performed. All 3 patients of renal infarction preserved normal renal function. but developed hypertension. Two patients were given anti-hypertensive agents. In the other patient, hypertension was normalized spontaneously. (Korean J Nephrol 2003;22(4):457-463)
장윤경 ( Jang Yun Gyeong ),최대은 ( Choe Dae Eun ),양종오 ( Yang Jong O ),구영선 ( Gu Yeong Seon ),강민규 ( Kang Min Gyu ),황평주 ( Hwang Pyeong Ju ),성인환 ( Seong In Hwan ),이강욱 ( Lee Gang Ug ),신영태 ( Sin Yeong Tae ) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.6
Thrombosis is one of the important complications of nephrotic syndrome. Still, the mechanism of thrombosis of nephrotic syndrome is under debate, but the presence of hypercoagulable state in nephrotic syndrome is regarded as the principal contributing factor to that. Venous thrombosis in nephrotic syndrome has been increasingly reported, but arterial thrombosis is relatively rare and has been reported mainly in nephrotic children. Authors experienced a 35-year old male patient with frequently relapsing nephrotic syndrome of focal segmental glomerulosclerosis, who complained sudden onset of claudication, cold sensation, numbness and cyanosis of right lower extremity. A diagnosis of thrombosis in right common iliac artery and thromboses in septal and distal branch of left anterior descending coronary artery was made by arterial angiography. The patient fully recovered after emergent thrombectomy and anticoagulation therapy.