급성신감염: 최근 경험 및 신초음파검사의 임상적 가치
Acute Renal Infection: Recent Experience and Clinical Value of Renal Ultrasonography
소속 상세정보
박원희/Won Hee Park
허영철/이정행/이상린/최윤찬/심희영/Yeong Cheol Heo/Jeong Heng Lee/Sang Lin Lee/Yun Chan Choi/Hei Young Shim
KMID : 0358319980390060524
Abstract
서론
급성신감염은 일반적으로 고열과 오한, 측복부통과 압통, 방광자극증상 그리고 전신증상을
주 증상으로 그리고, 전신증상을 주 증상으로 하고 검사소견으로 백혈구 증가증, 농뇨 또는
세균뇨를 보이는 질환군으로 급성신우신염, 급성국소성세균성신염(acute focal bacterial
nephritis), 신농양, 신주의농양, 신낭종내감염 등으로 나뉘어진다. 최근 진단장비의 발달로
급성세균성신염 , 신농양, 또는 신주위 농양과 같은 질환의 진단이 쉬워졌고, 또한 항생제
및 내비뇨기과적 처치가 발달하면서 치료도 비교적 잘되는 편이다. 그러나 국내에 초음파진
단장비가 보편화되면서 거의 모든 신감염질환에 대해 선별 없이 초음파검사를 실시하고 있
으며, 또한 항생제의 과용 및 남용으로 인하여 이에 대한 저항성 균주가 증가되고 있는 추
세이다. 이에 저자들은 초음파검사의 결과에 따른 임상경과를 비교 분석하여 모든 신감염에
서 초음파검사를 일상화 하는데에 대한 타당성을 평가하고, 또한 기존의 급성신감염에서 일
차 치료제로 제시된 약물들이 현재에도 일차적 약제로 사용될 수 있는가에 대해서 알아보고
자 하였다.
#초록#
Purpose : We investigated if there are some differences in characteristic of recent
renal infection from the past one and evaluated the need of ultrasonography in acute
renal infection and the efficiency of antibiotics that have been used primarily in
treatment of past renal infection.
Materials and Methods : We reviewed charts of 232 patients with acute renal infection
retrospectively, who took admission treatment from 1991 to 1995 at our hospital. The
laboratory tests such as complete blood count, urinalysis and urine culture with
sensitivity and radiologic evaluations such as abdominal ultrasonography, excretory
urography or voiding cystourethrography were performed.
Results : The most common age groups were 3rd decade(26.7%) and 4th
decade(24.1%). Female was predominant in all age groups(M:F=1:8.7) except 1st
decade(M:F=1.6:1). Acute pyelonephritis was the most common disease (87.1%) and then
followed by acute focal bacterial nephritis(8.2%), renal abscess(4.3%) and perirenal
abscess(0.4%). Five cases(2.2%) were accompanied by vesicoureteral reflux. Abdominal
ultrasonography was done in 90.5%, but 74.8% of them were completely normal and
most of abnormal findings at abdominal ultrasonography were clinically insignificant.
Result of ultrasonography did not affect the outcome of the disease or the treatment
plan. The significant bacterial isolation(more than 10 5CFU/ml) in urine
culture was 46.6%. Among them, E. coli was the most common organism(92.6%) and
others were Enterobacter, Klebsiella or Pseudomonas. Causative agents were resistant to
some drugs such as ampicillin or bactrim which have been usually used for urinary
tract infection.
Conclusions : Routine ultrasonography in renal infections without urinary tract
obstruction was not helpful in treatment plan or outcome of this disease and selection of
antibiotics in treatment of recent renal infection should be changed from the past one.
(Korean J Urol 1998; 39: 524∼9)
키워드
Acute renal infection; Ultrasonography;
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