Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Acute Kidney Injury and Postobstructive Diuresis Caused by a 4 mm Urinary Calculus

작은 요로 결석에 의한 급성 신후성 신부전 및 폐쇄 후 이뇨 1례

  • Jung, Eui Seok (Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Yang, Eun Mi (Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Kim, Chan Jong (Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School)
  • 정의석 (전남대학교 의과대학 소아청소년과) ;
  • 양은미 (전남대학교 의과대학 소아청소년과) ;
  • 김찬종 (전남대학교 의과대학 소아청소년과)
  • Received : 2012.12.04
  • Accepted : 2013.06.09
  • Published : 2013.10.31
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Abstract

Urinary obstructions from ureteral calculi are one of the causes of postrenal acute kidney injury (AKI). Here we present a case of AKI caused by a 4 mm ureteral calculus with postobstructive diuresis following the spontaneous passage of the calculus. A 13-year-old girl who underwent nephrectomy for the removal of a neuroblastoma eight years previously, visited our institution because anuria had developed over the preceding five days. The serum creatinine level was elevated at 13.4 mg/dL. Radiological examinations showed the right solitary kidney with moderate hydronephrosis and a 4 mm calculus in the upper right ureter. The patient immediately underwent hemodialysis. After the ureteral calculus was passed spontaneously on day 2 of hospitalization, urinary output increased to more than 5,200 mL per day. Intravenous fluid replacement with careful monitoring of weight, intake, output, and serum and urine electrolytes was performed. On day 5 of hospitalization, the patient's condition stabilized.

결석으로 인한 요관 폐쇄는 신후성 신부전의 주요한 원인으로 즉각적인 치료가 필요하다. 폐색 후 이뇨는 폐쇄성 요로 질환의 막힘 제거될 때 흔히 나타날 수 있는 증상으로 특별한 치료 없이 회복되는 경우가 많으나 저혈압이나 전해질 이상 등의 소견이 나타날 경우에는 수액 요법을 통한 치료가 필요하다. 단일신 환아에서 4 mm 크기의 작은 결석으로 인한 신후성 신부전이 발생하였으며 결석이 배출되고 발생한 폐쇄 후 이뇨는 보존적 치료로 회복되었다. 대부분의 4 mm 미만의 작은 결석은 저절로 배출 된다고 알려져 있으나 저자들은 4 mm 크기의 결석으로 생긴 신후성 신부전 및 폐쇄 후 이뇨가 발생한 예를 경험하였기에 보고하는 바이다.

Keywords

References

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