Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Renal Manifestations and Imaging Studies of Kawasaki Disease

가와사키 질환에서의 신증상과 영상 검사 소견

  • Oh, Ji Young (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Park, Se Jin (Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine) ;
  • Kim, Sun Jung (Department of Nuclear Medicine, National Health Insurance Corporation Ilsan Hospital) ;
  • Jang, Gwang-Cheon (Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital) ;
  • Kim, Uria (Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital) ;
  • Shin, Jae Il (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Kim, Kee Hyuck (Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital)
  • 오지영 (연세대학교 의과대학 소아청소년과) ;
  • 박세진 (아주대학교 의과대학 소아청소년과) ;
  • 김선정 (국민건강보험 일산병원 핵의학과) ;
  • 장광천 (국민건강보험 일산병원 소아청소년과) ;
  • 김유리아 (국민건강보험 일산병원 소아청소년과) ;
  • 신재일 (연세대학교 의과대학 소아청소년과) ;
  • 김기혁 (국민건강보험 일산병원 소아청소년과)
  • Received : 2013.09.20
  • Accepted : 2013.10.08
  • Published : 2013.10.31
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Abstract

Purpose: The aim of this study was to verify renal inflammation following Kawasaki disease (KD) using single photon emission computed tomography along with Technetium-99m dimercaptosuccinic acid scintigraphy (DMSA renal SPECT). Methods: From March 2011 to October 2011, 15 patients diagnosed with KD at the National Health Insurance System Ilsan Hospital were enrolled in the study. All patients underwent DMSA renal SPECT to evaluate renal involvement during the acute phase of KD. Urine ${\beta}2$-microglobulin (${\beta}2$-MG), a marker of renal proximal tubular dysfunction, was also measured to assess renal damage. Results: All 15 patients had normal renal function test results. However, microscopic hematuria and pyuria were observed in 13% and 33% of the patients, respectively. Moreover, urine ${\beta}2$-MG was elevated in 46% of the patients. In addition, patients were divided into two groups based on ${\beta}2$-MG level: those with an increased ${\beta}2$-MG level, and those with a normal ${\beta}2$-MG level. No significant differences were found between these two groups in clinical characteristics, laboratory, sonography, and echocardiography findings. All patients' DMSA renal SPECT scans were normal. Conclusion: Our study showed that mild abnormalities in the urinalysis and elevated urine ${\beta}2$-MG were the only findings of renal involvement in KD. However, no aggressive renal manifestations were detected on DMSA renal SPECT.

목적: 본 연구는 가와사키 질환의 신장 침범에 대하여 비교적 덜 침습적이며, 특이도와 민감도가 높은 검사인 Technetium-99m dimercaptosuccinic acid scintigraphy (DMSA renal SPECT)을 통하여 밝혀보고자 한다. 방법: 2011년 3월부터 10월까지 국민건강보험 일산병원에서 가와사키로 진단된 15명의 환아들을 대상으로 진행하였다. 15명의 환아 모두 가와사키의 급성기에 DMSA renal SPECT를 시행하였다. 또한 신장 세뇨관 손상 지표인 요중 ${\beta}2$-microglobulin (${\beta}2$-MG)을 측정하여 이를 통한 가와사키 환아에서 신장 손상의 조기 진단 가능 여부를 연구해보았다. 결과: 환아 15명 모두의 신기능 검사는 정상이었다. 소변 검사상 현미경적 혈뇨와 농뇨가 각각 13%, 33%에서 관찰되었다. 요중 ${\beta}2$-MG는 46%에서 증가된 소견을 보였다. 또한 환아들을 요중 ${\beta}2$MG를 기준으로 증가되어 있는 군과 증가되지 않은 군으로 나누어 비교, 분석해 보았으며, 두군간에 임상 증상, 임상 검사, 초음파 검사 및 심초음파 검사에서 유의한 차이를 보이지 않았다. 모든 환아에서 DMSA renal SPECT는 정상 소견을 보였다. 결론: 본 연구에서 가와사키 질환의 신장 침범은 경한 소변 검사 이상 및 일부 환아에서의 요중 ${\beta}2$-MG의 상승 소견을 보였으며, DMSA renal SPECT에서 관찰될 정도의 신장 침범은 보이지 않았다.

Keywords

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