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￭ S-515 ￭
골다공증 치료제로서 Zoledronic acid 1회 투여 후 발생한 급성 신부전 1예
서남대학교 의과대학 내과학교실
*임 현, 최혜민, 오동진, 권영은
Introduction: Zoledronic acid has been used to treat osteoporosis and it is infused once a year; therefore, it is widely prescribed to improve treatment compliance. Acute kidney injury (AKI) due to repeated bisphosphonate injection in cancer patients has been reported occasionally. However, we experi- enced a case of AKI after single dose of bisphosphonate injection for treating osteoporosis. Case: A 91-year-old woman with hypertension, middle cer- ebral artery infarction, and osteoporosis visited emergency room presented with myalgia and general weakness for 3 weeks. Zoledronic acid was in- jected for 30 minutes for treating osteoporosis three weeks ago, and she experienced severe myalgia for three days after the injection. Baseline crea- tinine (Cr) level was 1.3 mg/dL, and laboratory findings at admission revealed markedly elevated blood urea nitrogen of 58.8 mg/dL and Cr of 5.7 mg/dL. Arterial blood gas analysis showed a pH of 7.27, bicarbonate of 11.5 mmol/L, PaCO2 of 25 mmHg and PaO2 of 126 mmHg. Serum calcium and phosphorus levels were 6.1 mg/dL and 2.2 mg/dL, and parathyroid hormone was elevated to 299.5 pg/mL, 25-hydroxyvitamin D level was decreased to 5.3 ng/mL. In addition, creatine kinase (CK) was 5550 U/L. Telmisartan, celecoxib and rosuvastatin, which could be associated with AKI and CK ele- vation, were discontinued. Intravenous calcium gluconate was infused, and calcitriol and cholecalciferol were prescribed to correct symptomatic hypocalcemia. Furthermore, normal saline was administered to treat rhabdomyolysis. When she was discharged on the 13th day of hospitalization, CK was normalized and serum Cr levels improved to 2.4 mg/dL. Electrolyte imbalance such as hypocalcemia and hypokalemia were controlled with oral medication. After 2 months of discharge, serum Cr levels were improved to 1.7 mg/dL. Conclusion: Zoledronic acid-induced AKI usually occurs when bisphosphonate are given repeatedly. However, it can be arisen in chronic kidney disease patients with taking nephrotoxic drugs. Thus, physicians should be paid attention to AKI even if they are given zoledronic acid only once, especially in chronic kidney disease patients or taking nephrotoxic agents.
￭ S-516 ￭
Gastric Mucormycosis Followed by Severe Acute Kidney Injury in an Immunocompetent Patient
가톨릭의대 대전성모병원 신장내과 및 병리과
*성예규, 남이슬, 김주리, 신가영, 김종옥, 장윤경, 김석영, 홍유아
Mucormycosis is a life-threatening disease associated with opportunistic fungal infection usually reported from immunocompromised patients and those with diabetic mellitus. The most common site of mucormycosis is rhino-orbital-cerebral and pulmonary system, and gastrointestinal mucormycosis is a very rare presentation. Here, we report an uncommon case of invasive gastric mucormycosis in an immunocompetent patient with severe acute kidney injury due to alcoholic ketoacidosis. A 57-year man visited the emergency department suffering from hematemesis and decreased mental status. He was a heavy drinker and had diabetes mellitus. His glucose level at the time of admission was 59 mg/dL and serum creatinine level was 3.89 mg/dL. Due to severe metabolic acidosis, he received cardiopulmonary resuscitation for ten minutes, renal replacement therapy (CRRT) and mechanical ventilation for 5 days. After discontinuation of CRRT, he still showed decreased renal function and underwent hemodialysis for a while. To evaluate the cause of hem- atemesis, we conducted gastrofibroscopy and multiple gastric ulcers and erythemas were noted. Histopathology revealed non-septate, broad, obtuse an- gled fungal hyphae in Periodic acid-Schiff and Gomori′s methenamine silver stains, and invasive gastric mucormycosis was diagnosed. The patient has been successfully treated after administration of intravenous antifungal agent without surgical debridement and his renal function has completely recovered. Invasive gastric mucormycosis needs a prompt diagnosis, metabolic support, elimination of predisposing factors, aggressive surgical de- bridement of involved tissues and antifungal therapy. In our case, the patient had several predisposing factors including diabetes mellitus and chronic alcoholism. Nevertheless, to our knowledge, this is the first case to report the successful treatment of gastric murcomycosis revealed by upper gastro- intestinal bleeding in a patient with severe acute kidney injury due to alcoholic ketoacidosis.
