혈장교환술 치료를 받은 신장내과 환자들의 임상적 고찰
Clinical outcomes of renal patients treated with therapeutic plasma exchange
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목적 : 연구자는 1995년 1월부터 2005년 6월까지 충남대학교병원 신장내과에서 치료적 혈장교환술을 시행받은 신장질환 환자들을 대상으로 질환명과 이에 따른 임상양상 및 치료 결과를 알아보고자 하였다. 방법 : 1995년 1월부터 2005년 6월까지 충남대학교 병원 신장내과에 입원하여 혈장교환술을 시행한 23명의 환자를 대상으로 환자들의 의무기록을 후향적으로 검토하여 내원 시 주소, 기저질환, 임상경과, 병용치료 내용, 치료 결과를 조사하였다. 결과 : 환자의 성별은 남자가 8예, 여자가 15예가 있었다. 질환별로는 혈전성 혈소판감소성 자반증 11예, 현미경적 다발성혈관염 7예, 루프스 신염 2예, 신이식후 급성체액성거부반응 2예, 세균성 심내막염에 병발된 급속 진행성 사구체신염 1예. 11명의 혈전성 혈소판감소성 자반증 환자중 6명이 호전되었으며, 3명은 사망하였고, 2명은 ESRD로 진행하였다. 현미경적 다발성혈관염 7예 및 루프스 신염 2예 에서는 치료적 혈장교환술을 시행할 당시 폐출혈이 있었으며 혈장교환술을 시행후에 1예를 제외하고 모두 폐출혈의 호전이 있었다. 신이식후 급성체액성거부반응 2명 중 1명은 혈장교환술 후에 호전되었고, 1명은 반응이 없어서 이식신을 제거하였다. 세균성 심내막염에 병발된 급속 진행성 사구체신염환자는 치료 후에 호전되었다. 부작용으로는 저혈압 3예, 소양증 2예, 오한 1예가 있었다. 결론 : 혈장교환술은 혈전성 혈소판감소성 자반증 뿐만 아니라 폐출혈을 동반한 ANCA 양성 혈관염과 루프스 신염의 치료에 효과가 있으며, 신이식 후 발생한 초급성 체액성 거부반응 및 이차성 급속 진행성 사구체신염의 치료로 고려할 수 있다.
Abstract
Background : Therapeutic plasma exchange (TPE) is a procedure by which plasma is removed from whole blood and this can be used in the treatment of some renal diseases. Methods : We reviewed the medical records for the chief complaints, underlying diseases, clinical courses and treatment outcomes of 23 patients who had been treated with TPE at the Renal Division of Chungnam National University Hospital from January 1995 to June 2005. Results : Patients with thrombotic thrombocytopenic purpura (TTP), microcopic polyangitis, lupus nephritis, hyperacute humoral rejection after kidney trasnplantation and rapidly progressive glomerulonephritis (RPGN) secondary to subacute bacterial endocarditis were included in this study. Among the 11 patients with TTP, six patients improved and two patients progressed to end-stage renal disease (ESRD). Three patients with TTP died. Seven patients with microscopic polyangitis and two patients with lupus nephritis had pulmonary hemorrhage at the time of TPE. Eight of the 11 TTP patients showed improvement of their pulmonary hemorrhage after TPE. One of the two patients with hyperacute humoral rejection after kidney transplantation and one patient with secondary RPGN were improved after TPE. Hypotension (three cases) was the most common adverse effect of TPE, followed by two cases of itching sensation and one case of fever with chills. Conclusions : Therapeutic plasma exchange was an effective treatment for patients with TTP, microscopic polyangitis, lupus nephritis with pulmonary hemorrhage and hyperacute humoral rejection after kidney transplantation. (Korean J Med 73:176-182, 2007)
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