신증후군 환자에서 발생한 뇌정맥혈전증 1예
Cerebral sinovenous thrombosis associated with nephrotic syndrome
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저자들은 두통을 주소로 내원한 미세변화 신증후군 환자에서는 드물게 발생하는 뇌정맥혈전증을 진단하고 항응고 요법을 통해 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. 본 환자의 경우 혈전 재발을 예방하기 위하여, 급성기 치료가 종결된 이후에도 단백뇨 감소 및 혈청 알부민이 유지될 때까지 항응고제의 지속적 투여가 필요하다. 또한 비만 및 흡연 등의 혈전의 고식적인 위험요소 조절도 동반되어야 할 것이다. 결론적으로 신증후군 환자에서 신경학적 이상을 동반하지 않더라도 두통 및 오심, 구토 등 증세가 발생하는 경우 뇌 혈전증을 고려하여 조기 검사 및 치료가 필요할 것으로 생각된다.
Abstract
Nephrotic syndrome is associated with proteinuria, hypoalbuminemia, edema, hyperlipidemia, and thromboembolic complications. Thromboembolic complications of nephrotic syndrome are common, especially in the renal vein, while cerebral venous thrombosis is a less frequent complication of minimal change nephrotic syndrome. The pathophysiology remains unclear, but various changes in coagulant and anticoagulant factors may be responsible. We report a case of cerebral venous thrombosis associated with nephrotic syndrome. A 19-year-old man was admitted with a headache and nausea. Cerebral thrombosis was diagnosed on brain computed tomography and magnetic resonance imaging. He recovered gradually after treatment with anticoagulants and achieved control of the nephrotic syndrome. A discussion of this case, coupled with a review of the literature, emphasizes that an early diagnosis is essential for anticoagulation therapy and a successful outcome.
참고문헌 (20)
- Orth SR, "The nephrotic syndrome", N Engl J Med, 338, pp.1202~1211 (1998)
- Singhal R, "Thromboembolic complications in the nephrotic syndrome: pathophysiology and clinical management", Thromb Res, 118, pp.397~407 (2006)
- 전성철, "뇌정맥혈전증을 동반한 미세변화 신증후군 1예", 대한신경과학지, 17, pp.289~293 (1999)
- Mehls O, "Hemostasis and thromboembolism in children with nephrotic syndrome: differences from adults", J Pediatr, 110, pp.862~867 (1987)
- Bellomo R, "Membranous nephropathy and thromboembolism: is prophylactic anticoagulation warranted?", Nephron, 63, pp.249~254 (1993)
- Fluss J, "Cerebral sinovenous thrombosis and idiopathic nephrotic syndrome in childhood: report of four new cases and review of the literature", Eur J Pediatr, 165, pp.709~716 (2006)
- Ehtisham A, "Cerebral venous thrombosis: a review", Neurologist, 12, pp.32~38 (2006)
- Llach F, "Hypercoagulability, renal vein thrombosis, and other thrombotic complications of nephrotic syndrome", Kidney Int, 28, pp.429~439 (1985)
- Sirolli V, "Platelet activation markers in patients with nephrotic syndrome: a comparative study of different platelet function tests", Nephron, 91, pp.424~430 (2002)
- Schieppati A, "The metabolism of arachidonic acid by platelets in nephrotic syndrome", Kidney Int, 25, pp.671~676 (1984)
- Pirogovsky A, "Superior sagittal sinus thrombosis: a rare complication in a child with nephrotic syndrome", Pediatr Radiol, 31, pp.709~711 (2001)
- Rabelink TJ, "Thrombosis and hemostasis in reanl disease", Kidney Int, 46, pp.287~296 (1994)
- Rodrigues MM, "Cerebral sinovenous thrombosis in a nephrotic child", Arq Neuropsiquiatr, 61, pp.1026~1029 (2003)
- Shroff M, "Sinovenous thrombosis in children", Neuroimaging Clin N Am, 13, pp.115~138 (2003)
- Lafitte F, "MRI and MRA for diagnosis and follow up of cerebral venous thrombosis", Clin Radiol, 52, pp.672~679 (1997)
- Akatsu H, "Cerebral venous thrombosis in nephrotic syndrome", Clin Nephrol, 48, pp.317~320 (1997)
- Farooq V, "Serious adverse incidents with the usage of low molecular weight heparins in patients with chronic kidney disease", Am J Kidney Dis, 43, pp.531~537 (2004)
- de Bruijn SF, "Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis", Stroke, 30, pp.484~488 (1999)
- Glassock RJ, "Prophylactic anticoagulation in nephrotic syndrome: a clinical conundrum", J Am Soc Nephrol, 18, pp.2221~2225 (2007)
- Charlesworth JA, "Adult nephrotic syndrome: non-specific strategies for treatment", Nephrology, 13, pp.45~50 (2008)