최소변화콩팥병증에서 합병된 정맥 혈전증의 전신적 혈전용해술 1예
Successful systemic thrombolysis of both the inferior vena cava and a renal vein thrombi that complicated nephrotic syndrome
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신증후군에 의한 과응고상태는 여러 혈관에 혈전증을 유발한다. 신정맥과 하대정맥 등의 광범위한 혈전증은 신부전과 색전증을 유발할 수 있으며 현재 항응고제 치료가 우선 선택된다. 혈전용해술은 빠르고 완벽한 혈관 재관류를 유도할 수 있으나 출혈위험으로 광범위한 혈전증에 국한되어 시도되고 있다. 특히 혈전용해제의 전신적 투여는 침습적이지 않다는 장점이 있으나 출혈합병증의 위험이 있어 신중히 고려해야 한다. 본 증례는 하대정맥과 양측 신정맥 혈전으로 신부전이 동반된 신증후군 환자에서 출혈합병증 없이 성공적인 전신적 혈전용해술을 경험하였기에 문헌고찰과 함께 보고하는 바이다.
Abstract
Nephrotic syndrome has been considered a hypercoagulable state because thromboembolic events of the venous or the arterial circulations occur on occasion. There are various risk factors for thromboembolism in patients with nephrotic syndrome (membranous nephropathy, severe hypoalbuminemia, hemoconcentration and medications such as steroid and diuretics). As thromboembolism is often fatal, early detection and proper management are important. Although anticoagulation is the preferred therapy, thrombolysis may be considered for an extensive thrombosis, for inferior vena cava (IVC) thrombosis, for recurrent pulmonary thromboembolism and for bilateral renal vein thrombosis in conjunction with acute renal failure. We report here on a case of renal vein and IVC thrombosis in a 24-year-old male with nephrotic syndrome, and this patient was treated with intravenous thrombolytics rather than anticoagulation and local thrombolytic infusion. He complained of left flank pain and his CT scan revealed left renal vein thrombosis and IVC thrombosis. After urokinase infusion, his thrombi were resolved successfully without bleeding complications.(Korean J Med 73:448-452, 2007)
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