The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Characteristics of Acute Pyelonephritis in the Elderly

노인에서 발생한 급성 신우신염의 특성

  • Jung, Sung-Woong (Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine) ;
  • Lee, Young-Ki (Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine) ;
  • Na, Dong-Kil (Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine) ;
  • Shin, Yun-Ho (Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine) ;
  • Lee, Seung-Min (Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine) ;
  • Kim, Jwa-Kyung (Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine) ;
  • Choi, Myung-Jin (Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine) ;
  • Song, Young-Rim (Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine) ;
  • Kim, Soo-Jin (Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine) ;
  • Park, Tae-Jin (Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine) ;
  • Yoon, Jong-Woo (Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine) ;
  • Noh, Jung-Woo (Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine)
  • 정성웅 (한림대학교 의과대학 내과학교실, 신장연구소) ;
  • 이영기 (한림대학교 의과대학 내과학교실, 신장연구소) ;
  • 나동길 (한림대학교 의과대학 내과학교실, 신장연구소) ;
  • 신윤호 (한림대학교 의과대학 내과학교실, 신장연구소) ;
  • 이승민 (한림대학교 의과대학 내과학교실, 신장연구소) ;
  • 김좌경 (한림대학교 의과대학 내과학교실, 신장연구소) ;
  • 최명진 (한림대학교 의과대학 내과학교실, 신장연구소) ;
  • 송영림 (한림대학교 의과대학 내과학교실, 신장연구소) ;
  • 김수진 (한림대학교 의과대학 내과학교실, 신장연구소) ;
  • 박태진 (한림대학교 의과대학 내과학교실, 신장연구소) ;
  • 윤종우 (한림대학교 의과대학 내과학교실, 신장연구소) ;
  • 노정우 (한림대학교 의과대학 내과학교실, 신장연구소)
  • Published : 2011.11.01
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Abstract

Background/Aims: Acute pyelonephritis is relatively common in women. It has been well studied in young adults, but rarely in geriatric patients. Given that the population of Korea is aging rapidly, this study examined the clinical characteristics of acute pyelonephritis in Korean geriatric patients. Methods: We retrospectively studied 499 patients diagnosed with acute community-acquired pyelonephritis from March 2002 to February 2005. All patients admitted to Hallym University Kangnam Sacred Heart Hospital from the emergency room or out-patient department were recruited. Pregnant women and hospital-acquired cases were excluded. Results: Ninety-nine subjects (19.8%) were aged 65 years or over (mean age $73.1\;{\pm}\;6.3$ years, range 65-93). Elderly patients had a greater male predominance, longer hospital stay, and higher rate of positive urine cultures than patients younger than 65 years. The presence of diabetes mellitus, complicated acute pyelonephritis, and a higher serum creatinine level were associated with geriatric patients. The distribution of infectious microorganisms was similar between the two groups. Old age (> 65 years) was an important risk factor for a long hospital stay, along with male gender, renal dysfunction, white blood count (WBC) and high serum alkaline phosphatase levels. Conclusions: Geriatric patients with acute pyelonephritis tended to be male, and have diabetes mellitus, renal dysfunction, complicated infections, and a longer duration of hospitalization.

목적: 급성 신우신염은 주로 여성에서 발생하는 질환으로, 젊은 성인에 비해 노인 환자의 급성 신우신염에 대해서는 잘 알려져 있지 않다. 통계청이 발표한 고령자 통계에 따르면 우리나라는 급속히 초고령사회에 도달할 것으로 예측되고 있다. 저자들은 우리나라 노인에서 발생한 급성 신우신염의 특성을 알아보고자 하였다. 방법: 2002년 3월부터 2005년 2월까지 급성 신우신염으로 한림대학교 강남성심병원에 입원한 환자 499명을 후향적으로 조사하였다. 대상 환자들은 외래 또는 응급실을 방문하여 급성 신우신염으로 진단받고 입원한 지역사회 획득성 급성신우신염 환자들이었고, 임산부와 다른 질환으로 입원해 있는 동안 발생한 병원 감염 환자는 제외하였다. 결과: 급성 신우신염 환자 중 65세 이상은 99명(19.8%)이었고, 이들 환자의 연령은 $73.1\;{\pm}\;6.3$세(범위: 65-93세)였다. 65세 이상의 환자군은 65세 미만에 비해 남성과 당뇨병의 동반 비율이 더 높았고, 입원 기간이 길었으며 소변 배양검사 결과 균 양성률이 더 높았다. 또한 합병된 급성 신우신염이 더 많았으며 혈청 크레아티닌 수치가 더 높았다. 원인균의 분포는 65세 이상과 미만에서 차이가 없었다. 급성 신우신염 환자에서 65세 이상의 고령은 7일 이상 장기 입원의 위험인자로 나타났으며, 그 밖에 남성, 신기능 부전, 혈액 백혈구 수와 혈청 ALP 수치 증가도 장기 입원과 관련이 있었다. 결론: 노인에서 발생하는 급성 신우신염은 남성과 당뇨병 동반 비율이 높았고, 신기능 감소 및 합병 감염이 많았으며, 입원기간이 더 길었다.

Keywords

References

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