Korean Journal of Nephrology 1993;12(4):598-608.

신경색증의 임상상

이중건 , 주권욱 , 나기영 , 윤형진 , 안규리 , 한진석 , 김성권 , 이정상 , 김승협

Abstract

Renal infarction is a disease with diverse clinical features and laboratory findings. Because of the clinical diversity, the diagnosis of renal infarction could be often delayed or misdiagnosed. To evaluate the clinical fea- tures and to elucidate the diagnostic or therapeutic options, we analysed 27 cases retrospectively who were diagnosed as renal infarction. Patients were admitted to SNUH from 1982 to 1991, and were diagnosed to have renal infarction by isotope scan, radiologic image or pathologic finding. Male to female ratio was 14:13 and the mean age was 44 8 years (range 21-69). Underlying diseases were: valvular heart disease (21/27), arrhythmia (2/27), dissecting aneurysm (1/27) and trauma (1/27). Among these, 10 cases were diagnosed as bilateral infarct. Ini- tial symptoms were aMominal or flank pain of abrupt onset (92%), fever (41%), gross hematuria (42%,), oliguria (25%,) and nausea (33%). On examination, hyperten- sion (38%), aMominal tenderness (63%) and costoverte- bral angle tenderness (56%) were noticed. Leukocytosis (74%), elevated erythrocyte sedimentation rate (82%), proteinuria (84%) and microscopic hematuria (88%) were frequently found. Serum lactic dehydrogenase levels were elevated in all patients when it measured within 5 days (1, 949 IU/L, 948-3, 070; median, range) and showed flipped pattern in isoenzyme in all cases. Serum alkaline phosphatase (48%) and aspartate aminotransferase (75%) were also elevated. Serum creatinine level was elevated in 17/27 cases. Imaging diagnosis for renal infarction included renal angiography, isotope renal scan, computerized tomography or magnetic resonance image. MRI was done in 6 cases and infarcted areas showed low singal intensity in Tl and T2 weighted image and showed peripheral rim enhance- ment. Renal scan was found to be very useful for screen- ing, and MRI was useful for diagnosis and localization. Anticoagulation therapy was done in 20 cases showing normalization of serum creatinine, but delayed treatment or high initial serum creatinine value suggested poor response to anticoagulation therapy. Two cases were expired due to cerebrovascular accident and sepsis respecti vely.