Korean Journal of Nephrology 1999;18(5):700-706.

급성기 신증후 출혈열 환자에서 저알부민혈증의 원인 인자로서 장내 단백 소실의 임상적 의의 (Intestinal Loss of Plasma Protein is Associated with Hypoalbuminemia in Patients with Hemorrhagic Fever with Renal Syndrome)

김영옥(Young Ok Kim),양철우(Chul Woo Yang),송호철(Ho Cheol Song),윤선애(Sun Ae Yoon),김용수(Yong Soo Kim),김석영(Suk Young Kim),최의진(Euy Jin Choi),장윤식(Yoon Sik Chang),방병기(Byung Kee Bang)

Abstract

Objective: Hemorrhagic fever with renal syndrome(HFRS) is characterized by acute renal failure and increased vascular permeability. Hypoalbumi-nemia is frequently observed in the acute stage of HFRS, but its pathogenesis is not well known. In this study, we investigated intestinal loss of plasma protein in patients with HFRS. Methods: First, we evaluated the incidence of proteinuria and measured the amount of urine protein in 20 patients during clinical course of HFRS. Second, GI loss of plasma protein was evaluated using Tc-human serum albumin(Tc-HSA) scan and fecal clearance of a l-antitrypsin(Cz). Results: Seventeen(85%) of 20 patients demonstrated hypoalbuminemia(serum albumin level <3.5 g/dL) during admission and its lowest level was 3.0 0.3g/dL. Urine protein during admission was 1.9 +- 1.3g/day and most of them showed negative con- version within 7days(7 6days). Tc-HSA scan revealed 65% positivity(13/20) in the acute stage and increased CAJ was observed 13 out of 20 patients (65%). In these patients, CAf in the recovery stage was significantly decreased compared to that in the acute stage(9.2 +- 4.2ml/day vs 40.5>24.lml/day, p< 0.01). The mean serum albumin level in the patients with increased CAp was lower than that in the patients with normal CAy(2.80.1g/dL vs 3.4+0.2 g/dL, p<0.01). In the patients who had increased CA J', hypotensive episodes were more frequent, number of patients who needed hemodialysis was more, and thrombocytopenia was severer compared with the patients with normal CAp. But there was no difference in the amount of proteinuria between two groups. Conclusion: Our study suggests that intestinal loss of plasma protein is in part associated with hypoalbuminemia occurred in the acute stage of HFRS.