Tranexamic Acid 투여 후 발생한 양측성 급성 신피질 괴사 1예

A Case of Bilateral Acute Renal Cortical Necrosis Complicated by Tranexamic Acid Administration

  • 박주호 (건양대학교 의과대학 내과학교실) ;
  • 강민규 (건양대학교 의과대학 내과학교실) ;
  • 나운태 (건양대학교 의과대학 내과학교실) ;
  • 송인걸 (건양대학교 의과대학 내과학교실) ;
  • 정장한 (건양대학교 의과대학 내과학교실) ;
  • 윤세희 (건양대학교 의과대학 내과학교실) ;
  • 윤성로 (건양대학교 의과대학 내과학교실)
  • Park, Joo-Ho (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Kang, Min-Kyu (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Na, Woon-Tae (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Song, In-Girl (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Jung, Jang-Han (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Yoon, Se-Hee (Department of Internal Medicine, College of Medicine, Konyang University) ;
  • Yun, Sung-Ro (Department of Internal Medicine, College of Medicine, Konyang University)
  • 발행 : 2011.06.01

초록

저자들은 Tranexamic acid 투여 후 갑작스런 혈소판 수 저하를 보이면서 발생한 양측성 급성 신피질 괴사 환자 1예를 경험하였기에 보고하는 바이다.

Acute renal cortical necrosis is an anuric form of acute renal failure. We experienced a case of renal cortical necrosis complicated by tranexamic acid administration. To our knowledge, only three cases of renal cortical necrosis have been reported worldwide. A 49-year-old man was referred with hemothorax and multiple bone fractures following a traffic accident. Tranexamic acid, and hemocoagulase were injected three times a day. After the 4th dose of hemostatics, anuria developed abruptly, the platelet count decreased to 84,000 /${\mu}L$, and the serum creatinine was increased to 2.56 from 1.06 mg/dL. On the 4th Intensive Care Unit (ICU) day, computed tomography (CT) showed bilateral renal cortical necrosis with normal renal arteries and aorta. The oliguria persisted for 14 days and temporary hemodialysis was performed. The serum creatinine had decreased to 2.12 mg/dL 8 months after discharge.

키워드

참고문헌

  1. Kim HJ. Bilateral renal cortical necrosis with the changes in clinical features over the 15 years (1980-1995). J Korean Med Sci 1995;10:132-141. https://doi.org/10.3346/jkms.1995.10.2.132
  2. Kleinknecht D, Grunfeld JP, Gomez PC, Moreau JF, Garcia-Torres R. Diagnostic procedures and long-term prognosis in bilateral renal cortical necrosis. Kidney Int 1973;4:390-400. https://doi.org/10.1038/ki.1973.135
  3. Chugh KS, Jha V, Sakhuja V, Joshi K. Acute renal cortical necrosis: a study of 113 patients. Ren Fail 1994;16:37-47. https://doi.org/10.3109/08860229409044846
  4. Manley HJ, Bailie GR, Eisele G. Bilateral renal cortical necrosis associated with cefuroxime axetil. Clin Nephrol 1998;49:268-270.
  5. Schneider PD. Nonsteroidal anti-inflammatory drugs and acute cortical necrosis. Ann Intern Med 1986;105:303-304.
  6. Kim HJ, Cho OK. CT scan as important diagnostic tool in the initial phase of diffuse bilateral renal cortical necrosis. Clin Nephrol 1996;45:125-130.
  7. Kim W, Park SK, Kang SK. A case of diffuse cortical necrosis after glue sniffing. Korean J Nephrol 2000;19:523-527.
  8. Yun JC, Baek JE, Jung EY, et al. Acute bilateral renal cortical necrosis associated with diclofenac sodium. Korean J Nephrol 2006;25:317-320.
  9. Mannucci PM. Hemostatic drugs. N Engl J Med 1998;339:245-253. https://doi.org/10.1056/NEJM199807233390407
  10. Bergin JJ. The complications of therapy with epsilon-aminocaproic acid. Med Clin North Am 1966;50:1669-1678. https://doi.org/10.1016/S0025-7125(16)33112-1
  11. Mekontso-Dessap A, Collet JP, Lebrun-Vignes B, Soubrie C, Thomas D, Montalescot G. Acute myocardial infarction after oral tranexamic acid treatment initiation. Int J Cardiol 2002;83: 267-268. https://doi.org/10.1016/S0167-5273(02)00047-5
  12. Taparia M, Cordingley FT, Leahy MF. Pulmonary embolism associated with tranexamic acid in severe acquired haemophilia. Eur J Haematol 2002;68:307-309. https://doi.org/10.1034/j.1600-0609.2002.01607.x
  13. Koo JR, Lee YK, Kim YS, Cho WY, Kim HK, Won NH. Acute renal cortical necrosis caused by an antifibrinolytic drug (tranexamic acid). Nephrol Dial Transplant 1999;14:750-752. https://doi.org/10.1093/ndt/14.3.750
  14. Odabas AR, Cetinkaya R, Selcuk Y, Kaya H, Coskun U. Tranexamic-acid-induced acute renal cortical necrosis in a patient with haemophilia A. Nephrol Dial Transplant 2001;16:189-190. https://doi.org/10.1093/ndt/16.1.189
  15. Levin MD, Betjes MG, V d Kwast TH, Wenberg BL, Leebeek FW. Acute renal cortex necrosis caused by arterial thrombosis during treatment for acute promyelocytic leukemia. Haematologica 2003;88:ECR21.
  16. Lee HY, Lee BH, Kang MS, et al. Two cases of acute renal cortical necrosis diagnosed by contrast-enhanced computerized tomography. Kor J Nephrol 2007;26:758-761.
  17. Hashimoto S, Shiroshita K, Sakurai T, et al. Unilateral renal cortical necrosis with contralateral hydronephrosis after surgery for uterus carcinoma. Clin Exp Nephrol 2003;7:72-76. https://doi.org/10.1007/s101570300011
  18. Jordan J, Low R, Jeffrey RB Jr. CT findings in acute renal cortical necrosis. J Comput Assist Tomogr 1990;14:155-156. https://doi.org/10.1097/00004728-199001000-00034