급성 신기능상실이 합병된 급성 A형간염의 임상상
Clinical Features of Acute Viral Hepatitis A Complicated with Acute Renal Failure
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배경: 급성 A형간염은 대부분의 경우 저절로 회복되나 일부 환자들에서 합병증이 나타난다. 본 연구는 급성 A형간염에서 발생한 급성 신기능상실의 임상 특징에 대해 알아보고자 하였다. 방법: 급성 A형간염으로 진단되었던 404명의 의무기록을 조사하여 급성 신기능상실이 발생한 환자들(A군)의 임상양상을 신기능상실이 발생하지 않은 환자들(B군)과 비교하였다. 결과: 급성 신기능상실은 11명(3%)에서 발생하였다. 성비와 연령은 A군과 B군 사이에 차이가 없었다. A군에서는 현미경 혈뇨(7예), 단백뇨(7예), 대사성 산증(4예), 핍뇨(4예), 폐부종(3예), 고칼륨혈증(2예) 등이 발생하였다. 음주력(64% vs 3%, P<0.001)과 당뇨병(18% vs 1%, P=0.01)의 빈도는 A군이 B군보다 각각 더 높았다. ALT 최고치(median; 4,290 IU/L vs 1,266 IU/L, P=0.006)와 총 빌리루빈의 최고치(median; 10.8 mg/dL vs 6.0 mg/dL, P=0.001)는 A군이 B군보다 더 높았다. 입원기간은 A군이 B군보다 더 오랜 기간 입원하였다(median; 14일 vs 5일, P< 0.001). A군에 속하는 4명의 환자는 신대체요법을 시행하여 회복되었고 나머지 7명의 환자들은 보존 치료로 회복되었다. 결론: 급성 A형간염에서 급성 신기능상실은 당뇨병과 음주력이 있는 환자에서 호발하며 신기능상실이 동반되지 않은 A형간염 환자들에 비해 간염이 더 심하였으나 적절한 치료로 예후는 양호하였다.
Abstract
Background: Most patients with acute viral hepatitis A (AVHA) spontaneously recover, but a few patients experience complications. This study was carried out to examine clinical features of AVHA complicated with acute renal failure (ARF). Method: Medical records of 404 patients with AVHA were reviewed. Clinical features of AVHA patients with ARF (group A) were compared with those of AVHA patients without ARF (group B). Result: ARF complication was present in 11 patients (3%). There were no differences between group A and B in sex ratio and age. Microscopic hematuria (7 cases), proteinuria (7 cases), metabolic acidosis (4 cases), oliguria (4 cases), pulmonary edema (3 cases) and hyperkalemia (2 cases) were found in group A. The prevalence of heavy alcohol drinking (64% vs 3%, p<0.001) and diabetes mellitus (18% vs 1%, p=0.01) was higher in group A than B. The peak value of ALT (median: 4,290 IU/L vs 1,266 IU/L, p=0.006) and total bilirubin (median: 10.8 mg/dL vs 6.0 mg/dL, p=0.001) was higher in group A than B. Duration of admission was longer in group A than B (median: 14 days vs 5 days, p<0.001). Four patients of group A recovered with renal replacement therapy, while 7 patients recovered with conservative treatment. Conclusions: The AVHA patients with ARF experienced more severe hepatitis than those without ARF, but they had a good prognosis with the proper treatment. (Korean J Hepatol 2007;13:166-173)
참고문헌 (35)
- Sjogren MH, "Hepatitis A", pp.1639~1646 (2006), Philadelphia: Saunders
- Cuthbert JA, "Hepatitis A: old and new", 14, pp.38~58 (2001)
- Zikos D, "Nephrotic syndrome and acute renal failure associated with hepatitis A virus infection", 90, pp.295~298 (1995)
- Phillips AO, "Acute renal failure associated with non-fulminant hepatitis A", pp.156~157
- Faust RL, "Pimstone N. Acute renal failure associated with nonfulminant hepatitis A viral infection", 91, pp.369~372 (1996)
- Shroff GR, "Acute renal tubular injury with acute hepatitis A infection: is it just a coincidence?", 9, pp.44~46 (2004)
- McCann UG 2nd, "Acute renal failure complicating nonfulminant hepatitis A", 165, pp.308~310 (1996)
- Adas M, "Acute renal failure associated with nonfulminant hepatitis A virus infection", 24, pp.97~102 (2002)
- Vaboe AL, "Interstitial nephritis, acute renal failure in a patient with non-fulminant hepatitis A infection", 57, pp.149~153 (2002)
- Jamil SM, "Acute anuric renal failure in nonfulminant hepatitis A infection", 18, pp.329~332 (1998)
- Nachbaur K, "Acute renal failure complicating non-fulminant hepatitis A", 45, pp.398~400 (1996)
- Brncic N, "Acute renal failure complicating nonfulminant hepatitis a in HLA-B27 positive patient", 22, pp.635~640 (2000)
- Malbrain ML, "Another case of acute renal failure (ARF) due to acute tubular necrosis (ATN), proven by renal biopsy in non-fulminant hepatitis A virus (HAV) infection", 12, pp.1543~1544 (1997)
- al-Homrany M, "Immunoglobulin A nephropathy associated with hepatitis A virus infection", 14, pp.115~119 (2001)
- Lee DK, "Guillain-Barre like syndrome associated with acute renal failure and thrombocytopenia following acute viral hepatitis A", 12, pp.151~156 (1997)
- Lee SM, "A case of acute renal failure and IgA nephropathy associated with acute hepatitis A", 67, pp.804~808 (2004)
- Kim SE, "Two cases of acute renal failure associated with non-fulminant acute hepatitis A", 48, pp.421~426 (2006)
- Wilkinson SP, "Renal failure in otherwise uncomplicated acute viral hepatitis", pp.338~341
- Lin CC, "Acute renal failure in non-fulminant hepatitis A", 11, pp.2061~2066 (1996)
- Eng C, "Acute renal failure in nonfulminant hepatitis A", pp.717~718
- Mitch WE, "Acute renal failure", pp.703~708 (2004), Philadelphia: Saunders
- Oren R, "Review of 14 cases and literature survey", pp.14~23
- Gordon SC, "Prolonged intrahepatic cholestasis secondary to acute hepatitis A", pp.635~637
- Keeffe EB, "Is hepatitis A more severe in patients with chronic hepatitis B and other chronic liver diseases?", 90, pp.201~205 (1995)
- Chu CM, "Increased incidence of fulminant hepatic failure in previously unrecognized HBsAg carriers with acute hepatitis independent of etiology", 33, pp.136~139 (2005)
- Pramoolsinsap C, "Acute hepatitis A and acquired immunity to hepatitis A virus in hepatitis B virus (HBV) carriers and in HBV- or hepatitis C virus-related chronic liver diseases in Thailand", 7, pp.11~12 (2000)
- Ohba S, "Differential localization of s and e antigens in hepatitis B virus-associated glomerulonephritis", 48, pp.44~47 (1997)
- Johnson RJ, "Renal manifestations of hepatitis C virus infection", pp.1255~1263 (1994)
- Brady HR, "Acute Renal Failure", pp.1215~1292 (2004), Philadelphia: Saunders
- Morita M, "Glomerulonephritis associated with arteritis in marmosets infected with hepatitis A virus", pp.103~113
- Green J, "Systemic hypotension and renal failure in obstructive jaundice-mechanistic and therapeutic aspects", 5, pp.1853~1871 (1995)
- Badr KF, "Roles for thromboxane A2 and leukotrienes in endotoxin-induced acute renal failure", pp.474~480
- Mahmood MA, "Acute renal failure in non-fulminant hepatitis A infection", pp.213~215
- Jain S, "Effect of renal dysfunction in fulminant hepatic failure", 21, pp.118~120 (2000)
- Vesely DL, "Hepatitis A-induced diabetes mellitus, acute renal failure, and liver failure", 317, pp.419~424 (1999)