Korean Journal of Nephrology 1993;12(4):573-578.

성인 원발성 신증후군에 동반된 신정맥 혈전증에 대한 임상적 고찰

나득영 , 안재형 , 이태원 , 임천규 , 김명재

Abstract

The coexistence of nephrotic syndrome and renal vein thrombosis has been of medical interest since Rayer description in 1840. It has been known that thromboem- bolic complication remains one of the most serious complications in patients with nephrotic syndrome. The precise mechanism for this complication is not clear yet, but several coagulation abnormalities in nephrotic syn- drome may operate in combination with predisposing factors to induce the hypercoagulable state. The clinical and radiologic findings of renal vein thrombosis are variable, but diagnosis can be easily established by modern angiographic techniques. We reviewed the clinical results of 200 patients with idiopathic nephrotic syndrome, including 21 patients who were performed renal vein angiography. The results were as follows; 1) The positive renal vein thrombosis was 9 in 21 cases that were performed renal vein angiography. 2) The positivity of renal vein therombosis was 7 in 15 cases of proteinuria (>10 g) persistent over 6 months, 1 in 4 cases of increased proteinuria (>5g/day) after partial remission, and 1 in 1 case of acute flank pain. 3) The 24 hours urine protein excretion in positive renal vein thrombosis was 15 6±1,7g, which was higher than 10 2±1.6 g in negative renal vein thrombosis of renal vein angiography (p<0,05). 4) The renal pathology in 9 patients with renal vein thrombosis was as follows; membranous glomerulone- phritis 3(33.3%,), membranoproliferative glomerulone- phritis 2(22.2%), focal segmental glomerulosclerosis 2(22. 2%), minimal change disease 1(11. 1%). 5) After treatment with anticoagulant and anti- platelet agents, 24-hours urine protein excretion (15. 6±1.7 vs 6. 0± 2. 7; p <0 05) was decreased, and the serum albumin (2.4±0.3 g/dl vs 3. 6±0. 3 g/dl) was increased. In conclusion, it may be necessary to give attention to detect renal vein thrombosis in persistent heavy proteinuria unresponsive to immunosuppressive therapy in idiopathic nephrotic syndrome and to treat with anticoagulants and antiplatelet agents intenisively in confirmed case.