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급성 신우신염 환자에서 패혈성 쇼크와 관련 있는 신장 전산화단층촬영 소견

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Author(s)
권순성진상찬최우익김성진
Keimyung Author(s)
Jin, Sang ChanChoi, Woo IkKim, Sung Jin
Department
Dept. of Emergency Medicine (응급의학)
Journal Title
대한중환자의학회지
Issued Date
2013
Volume
28
Issue
4
Keyword
Acute pyelonephritisComputed tomography, Septic shock
Abstract
Background: Clinical findings, medical history and laboratory findings in patients with acute pyelonephritis are insufficient to predict
the occurrence of septic shock and to assess its severity and prognosis. Early imaging may not only aid in diagnosing acute pyelonephritis,
but also help in assessing the risk factors associated with septic shock.
Methods: In this retrospective study, we reviewed the medical records and collected the data of 200 patients from January to December,
2011. All patients were over 18 years old; showed symptoms of fever, chills, muscle pain and flank pain; demonstrated more than 10
white blood cells in urinalysis; and were diagnosed with acute pyelonephritis after computed tomography (CT) scan. Patients were classified
into two groups: patients with septic shock (group 1) and patients without septic shock (group 2), and the clinical, laboratory and
CT findings of the two groups were then compared.
Results: Out of all 200 patients, there were 32 patients (16%) who had acute pyelonephritis with septic shock. The acute pyelonephritis
with septic shock group (group 1) showed increased bacteremia compared with the other group (53.1% vs. 24.4%, p = 0.002).
Laboratory findings showed that group 1 patients had higher serum creatinine (1.67 ± 1.03 mg/dl vs. 1.14 ± 0.98 mg/dl, p = 0.022)
and hsCRP (8.36 ± 5.29 mg/dl vs. 5.27 ± 3.53 mg/dl, p = 0.000) than group 2 patients. The findings of kidney CT showed statistically
significant differences in global renal enlargement (31.3% vs. 18.7%, p = 0.005), pelvicalyceal wall thickening (37.5% vs.
13.1%, p = 0.005) and poor excretion of contrast (25% vs. 2.4%, p = 0.000). The results of the logistic regression test showed that
there were significant differences in bacteremia serum creatinine, C-reactive protein, pelvicalyceal wall thickening and poor excretion
of contrast.
Conclusions: Computed tomography can predict the possibility of septic shock by identifying the range of renal lesions in patients with
acute pyelonephritis. It can therefore allow initial aggressive treatment that can contribute to decreases in mortality and morbidity in patients
with acute pyelonephritis.
Alternative Title
Analysis of Kidney Computed Tomographic Findings in Patients with Acute Pyelonephritis and Septic Shock
Keimyung Author(s)(Kor)
진상찬
최우익
김성진
Publisher
School of Medicine
Citation
권순성 et al. (2013). 급성 신우신염 환자에서 패혈성 쇼크와 관련 있는
신장 전산화단층촬영 소견. 대한중환자의학회지, 28(4), 272–279. doi: 10.4266/kjccm.2013.28.4.272
Type
Article
ISSN
1229-4802
DOI
10.4266/kjccm.2013.28.4.272
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/39627
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학)
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