초록
신증후군에서는 혈전증이 흔히 동반된다고 알려져 있으며, 이는 예후와 연관이 되는 중요한 합병증이다. 혈전은 주로 정맥에 발생하지만, 동맥에서 생기는 경우도 있으며, 본 증례와 같이 대동맥에 발생하는 경우도 드물게 보고되고 있다. 국내에서 보고되었던 3 예의 복부 대동맥 혈전증은 주로 급성으로 발생하거나 스테로이드와 면역억제제로 치료하던 중 발생하였으며 모두 말초 순환부전증상을 보여 혈전제거술과 혈전용해제로 치료하였다. 저자는 고혈압에 대한 검사도중 특별한 증상 없이 신증후군에 동반한 복부 대동맥 및 신동맥 혈전증을 발견하였고, 보존적 치료로 추적관찰 중인 증례를 경험하였기에 이를 보고한다.
Nephrotic syndrome has frequently been associated with complications of thrombosis. Hypercoagulability is known as the principal contributing factor in the pathophysiologic mechanism, but the precise mechanism is unclear. Venous thrombosis is frequently recognized, but arterial thrombosis is rare, especially in the abdominal aorta. Most cases of arterial thrombosis present with acute ischemic symptoms and develop into a relapsing phase of nephrotic syndrome. The mainstream treatment for all abdominal aortic thrombosis patients is an emergency thrombectomy and thrombolytic therapy. We report on a 63-year-old male patient who was referred for malignant hypertension. The patient had no symptoms of claudication or peripheral ischemia. We diagnosed nephrotic syndrome using the laboratory data and detected a thrombosis involving the abdominal aortic, left renal and both iliac arteries. Because the patient had a single functioning kidney, we did not perform a kidney biopsy. We consider that the hypercoagulability state in nephrotic syndrome was caused by the abdominal aorta and peripheral arterial thrombosis. The patient's symptoms improved after anticoagulation and conservative therapy.