해면신에 발생한 요석의 대사적 위험요인과 체외충격파쇄석술의 치료효과
Metabolic Risk Factors and Treatment Effects of Extracorporeal Shock Wave Lithotripsy in the Medullary Sponge Kidney with Nephrocalcinosis
김상철, 문영태,
소속 상세정보
김상철 ( Kim Sang-Chul )
중앙대학교 의과대학 비뇨기과학교실
문영태 ( Moon Young-Tae )
중앙대학교 의과대학 비뇨기과학교실
KMID : 0358320070480101022
Abstract
해면신은 신수질의 집합관에 낭포성 확장이 생기는 선천성 질환으로 발생률이 일반 인구 중 5,000명당 1명에서 20,000명당 1명 정도이다.1 이 질환은 소수의 신추체에 국한되거나 일측 신장 전체에 걸쳐 발생하며 때로는 양측 신장 모두에서 발생할 수도 있다.2 정확한 병인은 아직 밝혀져 있지 않으며 대부분 무증상이고, 혈뇨, 동통, 농뇨 등과 같은 요로감염이나 요석과 관련된 증상들이 나타날 때 시행한 배설성 요로조영술에서 우연히 발견되는 경우가 대부분이다. 확장된 낭포에 인산 칼슘석이나 수산 칼슘석이 형성되고 이 결석들이 집합관에 미란을 일으키거나 배출되면서 증상을 유발하게 된다.
Purpose:The medullary sponge kidney(MSK) is a congenital anomaly of the renal medulla characterized by fusiform and cystic dilatation of the collecting tubules confined to the renal pyramids. The aim of this study is to evaluate the metabolic risk factors and effect of extracorporeal shock wave lithotripsy(ESWL) and complications in an MSK with nephrocalcinosis.
Materials and methods: We compared stone metabolic studies between 45 patients with MSK and 279 non-MSK patients. We evaluated the effect of ESWL for MSK. Group A patients received ESWL and follow-up within 3 months and Group B patients had a period of cessation for more than 6 months. The frequency of complications between group A and group B patients was compared.
Results:There were no statistically differences between the MSK group and non-MSK group of patients in the stone metabolic studies. Among the 45 patients with MSK, 26(58%) had one or several of the following metabolic disorders: hypocitraturia(36.7%), hypercalciuria(18.3%), hyperoxaluria(16.3%), hyperuricosuria(16.3%), low urine volume(12.4%). The percentage of patients that experienced more than 75% of a reduction of stone burden on plain films was 48.8%, 25?75% of the reduction was 35.6%, and less than 25% of the reduction was 15.6%. The most common complication was renal colic(17.7%). Renal colic and stone re-growth was shown to have a more significant association with group B patients as compared to group A patients.
Conclusions:ESWL reduced the stone burden more than 75% in 48.8% of MSK patients with nephrocalcinosis, and prevented flank pain, and obstructive uropathy. Therefore, we plan to develop treatments that are more effective. (Korean J Urol 2007;48:1022-1026)
키워드
Medullary sponge kidney;Extracorporeal shockwave lithotripsy;Risk factors
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