The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Clinical Differences in Acute Kidney Injury between Unilateral Acute Pyelonephritis and Bilateral Acute Pyelonephritis

급성 신우신염의 일측성/양측성에 따른 급성 신 손상 발생의 임상적 차이

  • Jang, Suk-Hyun (Division of Nephrology, Department of Internal Medicine, Konyang University College of Medicine) ;
  • Lee, Chung-Seop (Division of Nephrology, Department of Internal Medicine, Konyang University College of Medicine) ;
  • Lee, Mi-Young (Division of Nephrology, Department of Internal Medicine, Konyang University College of Medicine) ;
  • Hwang, Won-Min (Division of Nephrology, Department of Internal Medicine, Konyang University College of Medicine) ;
  • Yun, Sung-Ro (Division of Nephrology, Department of Internal Medicine, Konyang University College of Medicine)
  • 장석현 (건양대학교 의과대학 내과학교실 신장내과) ;
  • 이충섭 (건양대학교 의과대학 내과학교실 신장내과) ;
  • 이미영 (건양대학교 의과대학 내과학교실 신장내과) ;
  • 황원민 (건양대학교 의과대학 내과학교실 신장내과) ;
  • 윤성로 (건양대학교 의과대학 내과학교실 신장내과)
  • Published : 2012.06.01
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Abstract

Background/Aims: Acute pyelonephritis (APN) can involve a single kidney or both kidneys. The aim of this study was to define the clinical characteristics of unilateral and bilateral APN and compare their differences in acute kidney injury (AKI). Methods: This was a retrospective study of patients admitted to Konyang University Hospital from January, 2006 to December, 2010 with APN diagnosed by the presence of definitive APN lesions on abdominal CT. Patients with a history of renal disease or anatomical predisposing factors were excluded. The patients were divided into two groups: unilateral and bilateral APN. BUN, creatinine, MDRD eGFR, and FENa were evaluated. Results: Of the 177 patients, 130 had unilateral APN and 47 had bilateral APN. Significant differences were noticed in BUN, creatinine, and MDRD eGFR between the two groups. According to RIFLE criteria, 51 patients were at "risk" and six were in "failure." Compared with unilateral APN, bilateral APN patients had lower eGFR (65.2 vs. 61.7, p = 0.042) and higher FENa (0.81 vs. 1.43, p = 0.04), and "failure" was more frequent (4 vs. 2, p = 0.044). Conclusions: Our study showed a significant correlation between bilateral APN and decreased renal function. AKI in bilateral APN was more likely than AKI in unilateral APN to result in severe renal dysfunction. The pathophysiology of AKI may differ between unilateral and bilateral APN.

목적: 급성 신우신염은 일측성 신우신염과 양측성 신우신염으로 침범할 수 있다. 이 연구의 목적은 일측성 급성 신우신염과 양측성 급성 신우신염 사이의 임상상의 차이를 규명하고, 나아가 급성 신 손상 발생에 있어서 차이점이 있는지를 비교 연구해 보기 위함이다. 방법: 2006년 1월부터 2010년 12월까지 급성 신우신염으로 본원에 입원했던 환자 중 CT로 급성 신우신염 병터가 확인된 177명 환자를 대상으로 후향적 조사를 하였다. BUN, sCreatinine, MDRD eGFR, FENa 등을 조사하였으며, 대상을 양측성군과 일측성군으로 분류하였다. 결과: 연구에 포함된 대상은 177명이었으며, 이 중 일측성군이 130명, 양측성군이 47명이었다. 일측성군과 양측성군사이에서 BUN, sCreatinine, MDRD eGFR 모두 차이를 보였다. 신 기능에 따라 분석하여 급성 신 손상을 받은 환자는 risk 이상이 51명, failure 이상이 6명이었으며, 양측성군에서 일측성군보다 failure 이상의 심한 신부전이 동반되었고(4 vs. 2, p = 0.044), eGFR도 낮고(65.2 vs. 61.7, p = 0.042), FENa는 높았다(0.81 vs. 1.43, p = 0.042). 결론: 양측성 신우신염은 일측성 신우신염에 비해 신 기능의 저하가 두드러졌다. 특히 양측성 신우신염에서 발생한 급성 신 손상은 일측성 신우신염에서 발생한 급성 신 손상보다 신 기능 감소가 심했다. 또한 양측성 신우신염과 일측성 신우신염 사이에서 급성 신 손상의 발생 기전이 서로 다를 수 있음을 알 수 있었다.

Keywords

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  2. Clinical Usefulness of Unenhanced Computed Tomography in Patients with Acute Pyelonephritis vol.33, pp.38, 2012, https://doi.org/10.3346/jkms.2018.33.e236
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