신증후군의 재발과 함께 발생된관상동맥 혈전증에 의한 급성 심근경색 (A Case of Acute Myocardial Infarction Due to Coronary Artery Thrombosis During the Relapse ofNephrotic Syndrome)

서지정보

· 발행기관 : 대한신장학회
· 수록지 정보 : Kidney Research and Clinical Practice / 22권 / 5호 / 597 ~ 601페이지
· 저자명 : 백은기, 박정우, 김영남, 문인성, 이현희, 이준승, 정우경, 신익균, 이종호, 박문향

초록

혈전색전증은 신증후군의 주요한 합병증의 하나로 알려져 있으며 그 발생기전은 혈액응고계에 관여하는 여러 단백질의 변화에 의한 과응고 (hypercoagulability)로 설명되고 있다1-17). 혈전증은 주로 정맥계에서 발생하는데, Llach 등은 신증후군 중 신정맥 혈전증의 발병률이 5-62.5%이며, 신정맥을 제외한 말초정맥 혈전증은 8.5-44%로 보고한 바 있다2). 동맥 혈전증의 발생률은 약 3%로 비교적 드물며3), 국내에서는 상장간동맥1), 대퇴동맥6,8), 총장골동맥9), 대동맥6,10), 신동맥과 슬와부동맥6), 뇌동맥6), 액와동맥13) 등의 혈전증이 보고 된 바 있다. 한편, 관상동맥에 발생한 혈전에 대한 보고는 그동안 세계적으로 3예가3,11,14) 있었으나 국내에서는 아직 보고가 없었다.

영어초록

Vascular thrombosis is one of the most serious complications in patients with nephrotic syndrome, but thrombosis occurs mainly in venous system. Arterial thrombosis is much less common and coronary artery thrombosis is rarely reported worldwide. We experienced a case of an acute myocardial infarction due to coronary artery thrombosis in a young male with minimal change disease during nephrotic relapse. This 35 year-old male was diagnosed to have minimal change nephrotic syndrome 15 years before admission. Two days before admission, he was found to have heavy proteinuria and edema which led to impression of relapse of nephrotic syndrome. Acute myocardial infarction was developed one day before admission and emergency thrombolytic therapy was performed. After admission, coronary angiography was performed and multiple thrombi were identified in distal left anterior descending artery without marked atherosclerotic changes. The formation of intracoronary thrombi in this patient appeared to be due to the hypercoagulable state associated with the relapse of nephrotic syndrome.

참고자료

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