The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Acute Kidney Injury Associated with Disseminated Intravascular Coagulation that Developed after a Hysterectomy in a Patient with Probable Catastrophic Antiphospholipid Syndrome

파국 항인지질 증후군 의증 환자의 파종혈관내응고 관련 급성 신손상 1예

  • Kim, Jo-Eun (Department of Internal Medicine, Bundang CHA Medical Center, CHA University) ;
  • Yoon, Har-Ry (Department of Internal Medicine, Bundang CHA Medical Center, CHA University) ;
  • Lee, Jeong-Guil (Department of Internal Medicine, Bundang CHA Medical Center, CHA University) ;
  • Shin, Dae-Kyu (Department of Internal Medicine, Bundang CHA Medical Center, CHA University) ;
  • Park, Ji-Soo (Department of Internal Medicine, Bundang CHA Medical Center, CHA University) ;
  • Seo, Seong-Eun (Department of Internal Medicine, Bundang CHA Medical Center, CHA University) ;
  • Kim, Hyung-Jong (Department of Internal Medicine, Bundang CHA Medical Center, CHA University)
  • 김조은 (CHA 의과학대학교 분당차병원 내과학교실) ;
  • 윤해리 (CHA 의과학대학교 분당차병원 내과학교실) ;
  • 이정길 (CHA 의과학대학교 분당차병원 내과학교실) ;
  • 신대규 (CHA 의과학대학교 분당차병원 내과학교실) ;
  • 박지수 (CHA 의과학대학교 분당차병원 내과학교실) ;
  • 서성은 (CHA 의과학대학교 분당차병원 내과학교실) ;
  • 김형종 (CHA 의과학대학교 분당차병원 내과학교실)
  • Published : 2012.06.01
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Abstract

Acute kidney injury associated with disseminated intravascular coagulation (DIC) and a coagulation factor defect may develop with infection, malignancy, severe trauma, or obstetric complications. However, a gynecological etiology, such as hysterectomy, in a patient with adenomyosis has rarely been reported. We describe a case of a 42-year-old women who presented with DIC and acute kidney injury after a total hysterectomy. We thought that the cause for the acute kidney injury might be small vascular thrombosis and acute tubulointerstital nephritis due to probable catastrophic antiphospholipid syndrome with DIC. The patient was successfully treated with steroid therapy.

본 증례의 환자는 수술 전 응고 검사 결과가 정상이었으나 수술 후 파종혈관내응고와 응고 인자 결핍이 발생하였고 그 결과 급성 신손상이 발생한 경우로 명확하지는 않으나 파국 항인지질 증후군이 선행되었을 것으로 생각된다. 본 증례와 같이 수술 등의 선행 요소 후에 파종혈관내응고가 발생하고 빠른 속도로 다발성 장기 부전이 발생하는 환자들에서 파국 항인지질 증후군을 감별해야 할 것으로 생각된다.또한 선행 요인 후 발생한 파종혈관내응고와 관련된 급성신손상인 경우, 감염에 의한 파종혈관내응고가 아니라면 스테로이드 치료가 신장기능 및 파종혈관내응고 호전에 도움이 될 것으로 생각된다.

Keywords

References

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