대한신장학회

논문분류	춘계학술대회 초록집
제목	End Stage Renal Disease Caused by Thromboangiitis Obliterans (Buerger's Disease)
저자	Hyo-Jin Yun1, Dong-Il Kim1, Kyung-Ho Lee1, Seong-Joo Lim2, Se-Hee Yoon1, Won-Min Hwang1, Sung-Ro Yun1
출판정보	2015; 2015(1):
키워드	버거씨병,말기 신부전,허혈성 장 질환
초록	Introduction: Thromboangiitis obliterans (Buerger’s disease) is nonatherosclerotic, segmental, inflammatory vasculitis strongly associated with tobacco products, which commonly affects small and medium sized arteries of upper and lower extremities. However, the disease can rarely involve large central or visceral arteries. We report here the first Korean case of end stage renal disease caused by thromboangiitis obliterans. Case presentation: A 51-year-old man was admitted to the nephrology department because of acute left flank pain and anuria for 3 days. He was diagnosed as thromboangiitis obliterans 10 years ago. At that time his both first toes were amputated. Since then he didn’t visit hospital anymore and he confessed that he couldn’t quit smoking until now. He showed severe tenderness in left costovertebral angle area. Laboratory findings disclosed the followings: white blood cell (WBC) 9700/uL, hemoglobin 12.7 g/dL, platelet 201×103/uL, serum blood urea nitrogen (BUN) 82mg/dL, serum creatinine 14.02 mg/dL and serum lactate dehydrogenase (LDH) 1687 IU/L. Autoantibodies associated with coagulation were all negative or within the normal range. Contrast enhanced abdominal CT demonstrated left kidney multifocal infarction combined with poor visualization of both renal artery. Abdominal aortography revealed total occlusion of superior mesenteric artery, inferior mesenteric artery, both renal artery, without visible collateral vessels. Lower extremity angiography showed occlusion with collateral formation at left common iliac artery, left superficial femoral artery and bilateral tibial and peroneal arteries. Thus he diagnosed as having renal infarction caused by both renal artery thrombosis associated with Thromboangiitis obliterans. His renal function was not recovered. He began dialysis with quitting of smoking. Conclusion: Renal failure due to both renal artery thrombosis and mesenteric ischemia represents an unusual manifestation of thromboangiitis obliterans. But once it occurs, it can be life threatening. When we care for thromboangiitis obliterans patient, we should pay attention to this rare disease course, and encourage smoking cessation.
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