Childhood Kidney Diseases

  • 제15권2호
  • /
  • Pages.179-183
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  • 2011
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  • 2384-0242(pISSN)
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  • 2384-0250(eISSN)
대한소아신장학회 (Korean Society of Pediatric Nephrology)
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고등급의 방광요관역류가 있는 환아에서 급격히 진행된 신반흔

A Case with Abrupt Progression of Renal Scarring or Abrupt Deterioration of Renal Function Associated with Vesicoureteral Reflux

  • 김문규 (차의과학대학교 분당차병원 소아청소년과) ;
  • 박성은 (차의과학대학교 분당차병원 소아청소년과) ;
  • 이준호 (차의과학대학교 분당차병원 소아청소년과)
  • Kim, Moon-Kyu (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Park, Sung-Eun (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Lee, Jun-Ho (Department of Pediatrics, CHA Bundang Medical Center, CHA University)
  • 투고 : 2011.07.29
  • 심사 : 2011.09.01
  • 발행 : 2011.10.31
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초록

영아때 방광요관역류 환아로 진단된 남아중 2세가 넘어 후천적으로 신반흔이 급격히 악화되는 경우는 드물다. 본 증례는 생후 4개월 때 첫 열성 요로감염으로 입원하여, 왼쪽 5등급 방광요관역류로 진단되었고, 부모가 수술을 원치 않아 2년간 예방적 항생제 요법만 시행받았다. 생후 29개월 때 열성 요로감염이 한 차례 재발하였고, 이후 3년간 추적관찰되지 않았다. 이 후, 5세 때 본원을 방문하여 신장초음파, DMSA 신스캔, 배뇨성 방광요도조영술을 재시행받았다. 추적 DMSA 신스캔에서 왼쪽 신상대섭취율이 생후 2세경 38%였으나, 8%까지 떨어졌으며, 왼쪽 방광요관역류는 4등급으로 남아있었다. 현재 방광요관역류의 수술적 요법이 신기능의 예후와 관련이 없다고 알려져 있으나, 이런 증례를 볼 때, 아직은 신반흔을 동반한 고등급의 방광요관역류 환자들에게 수술적 요법을 권유하는 것이 임상의들에겐 타당하다고 볼 수 있으며, 어떤 치료요법이 선택되어지든 상관없이 첫 요로감염 이후 환자를 장기적인 추적 관찰하는 것이 중요하다고 사려된다.

Abrupt progression of renal scarring associated with vesicoureteral reflux (VUR) is rare in males over 2 years old of age. We report a 5 year old boy with sustained unilateral high grade VUR who experienced abrupt progression of renal scarring; he had a relative renal radionuclide uptake of 38% at 2 years of age that dropped to 8% after three years. Per his parent's wishes, he took prophylactic antibiotics for 25 months after his first febrile urinary tract infection (UTI) at 4 months old without surgical management. One episode of recurrent breakthrough infection occurred at the age of 2 years. This observation reminds us that a recommending surgical management for sustained high grade VUR associated with renal scarring might be needed. Close follow up of DMSA for renal scanning, and long term follow up of patients after the first febrile UTI are important.

키워드

참고문헌

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