The Korean Association of Internal Medicine
348 32nd World Congress of Internal Medicine (October 24-28, 2014)
PS 1371 Nephrology
Emphysematous Pyelonephritis Initially Presenting as Spontaneous Subcapsular Hematoma in a Diabetic Patient
Hyeon Jeong Lee1, Su Jin Choi1, Young Soo Kim1, Sun Ae Yoon1, Young Ok Kim1 The Catholic University of Korea, Uijeongbu St. Mary`s Hospital, Korea1
Emphysematous pyelonephritis is a life-threatening infection characterized by the for- mation of gas. Its complications are septic shock, acute renal failure and disseminated intravascular coagulation. Spontaneous subcapsular hematoma has also been reported as a very rare complication, but there has been no report-to-date of a spontaneous subcapsular hematoma that occurred before the presentation of emphysematous pyelonephritis. We herein report a case of emphysematous pyelonephritis that initially presented as spontaneous subcapsular hematoma. The patient was admitted for left fl ank pain and her initial CT revealed a subcapsular hematoma without any air shad- ows. Her lab fi ndings and clinical symptoms suggested the presence of a urinary tract infection and she was started on antibiotics. Fever developed 24 hours after admis- sion. On a follow-up CT scan 7 days later, emphysematous pyelonephritis was newly observed and a percutaneous drain was inserted. Blood, urine and drainage cultures, all revealed growth of extended-spectrum beta-lactamase negative Escherichia coli.
PS 1372 Nephrology
A Case of Renal Infarction Following Spontaneous Re- nal Vein Thrombosis
Jong Man Park1, Min Ji Shin1 Pusan National University Hospital, Korea1
Major risk factor of renal infarction is cardiac thromboemboli due to either arrhyth- mias or valvular problems. Autoimmune diseases and hypercoagulable status can also contribute to renal infarction. The causes of renal infarction are usually thought to cardiogenic problems, coagulation diseases, hematologic diseases, trauma and so on.
Hereby, we report a case of a 32 yr-old man with renal infarction associated with renal vein thrombosis. He was referred to the emergency room with acute right fl ank pain on April 03, 2013. The first symptom, right flank pain was developed 7 days before admission and had not received any treatment and evaluation for 7 days. A diagnosis of renal infarction and renal vein thrombosis was made based on clinical manifestation, blood lab and contrast-enhanced abdominal computed tomography (CT) scan. DMSA scan was followed for confi rming renal infarction. We evaluated the cause of renal infarction. Heart related exam revealed none specifi c fi ndings and the labs associated with other risk factors were not abnormal range. Detailed work up did not reveal any specifi c factors. After admission, anticoagulation therapy with intrave- nous heparinization was immediately initiated. Anticoagulation therapy with warfarin was given after discharge. On December 16, 2013, a follow-up CT showed complete resolution of thrombus at right renal vein and scarred change at right kidney lower pole. We believe that renal vein thrombosis can be the cause of renal infarction. And if the diagnosis of renal infarction is delayed, the risk of renal infarction secondary to renal vein thrombosis can be higher.
PS 1373 Nephrology
A Deep Vein Thrombosis and Pulmonary Thromboem- bolism Caused by Vessel Compression in Autosomal Dominant Polycystic Kidney Diesease
Chei Won Kim1, Si Nae Lee1, Moon Jae Kim1, Seoung Woo Lee1, Joon Ho Song1 Inha University Hospital, Korea1
Autosomal dominant polycystic kidney disease is an inherited disorder with major renal manifestations and abnormalities in the liver, the pancreas, the brain, and the arterial blood vessels. The complications of the disease include hypertension, infec- tion, renal insuffi ciency, and so on. However, there were rare evidences suggesting a venous thromboembolism as a considerable complications. In this case, 42-year old female who had been diagnosed polycystic kidney disease in 1995 and had a history of taking oral pills, was feeling a sudden attack of dyspnea after 4-hour fl ight from Russia, motherland. As venous thromboembolism was suspected, lung ventilation/
perfusion scan and echocardiogram were conducted primarily, and 3-Dimensional CT angiography was conducted afterward, considering an insult to renal function. Her diagnostic tests resulted in bilateral pulmonary embolism and deep vein thrombosis in left internal iliac vein. She had no obvious risk factor provoking thromboembolism, we focused on the causes of making emboli on her condition. There were many pos- sibilities, such as compression of IVC or iliac vessel by a large renal cyst. Oral pill or a fl ight might play an additional role. Although she had to be treated in hospital due to showing right ventricular dysfuction, she went back to her country, Russia from her economic problem. We suggest that the venous thromboembolism including deep vein thrombosis and pulmonary embolism should be considered as one of the complications of polycystic kidney disease when the patients have such symptoms.
PS 1374 Nephrology
Renal Outcomes of Patients with Acute Renal Infarc- tion
Min Young Seo1, Jihyun Yang1, Sun Chul Kim1, Myung-Gyu Kim1, Sang-kyung Jo1, Wonyong Cho1
Department of Internal Medicine, Division of Nephrology, Korea University Medical College, Korea1
Background: Renal infarction (RI) is uncommon disease which is diffi cult to be diag- nosed without clinician’s suspect. Although underlying hypercoagulable state is known to be a risk factor and the consequent renal mass reduction can affect its renal out- comes, little is known about the clinical characteristics or long term renal outcome.
Methods: This is a single center and retrospective study including 86 patients with newly diagnosed acute RI between January 2002 and March 2014. Clinical features, possible etiologies and long term renal outcome data were reviewed.
Results: At the time of diagnosis, acute kidney injury (AKI) was accompanied in 30.2% of patients. In univariate analysis, male sex, alcohol, smoking, high CRP, leukocytosis and the presence of more than two underlying cause were signifi cant risk factors for the development of AKI. However, in multivariate analysis, only the presence of two or more underlying disease was found to be a risk factor predicting the development of AKI. When the progression to chronic kidney disease (CKD) was defi ned as eGFR < 60 mL/min/1.73m2 over 3 months after diagnosis, CKD developed in 30.2% during follow up period. In univariate analysis, development of CKD was associated with old age, hypertension, smoking, leukocytosis, history of AKI and the presence of more than two underlying disease. In cox-regression analysis, old age and the presence of multiple underlying disease were the independent risk factors for the development of CKD.
Conclusion: We found that idiopathic cases comprised about one fi fth of overall cas- es of RI and also that both AKI and CKD were relatively common complications of re- nal infarction. Because old age, presence of multiple risk factors were associated with the development of AKI and also with CKD, more careful attention should be paid for the improvement of patients outcomes.
