대한신장학회

논문분류	춘계학술대회 초록집
제목	ANCA associated vasculitides in a patient with positive serologic test for Hantan virus
저자	Kyung Pyo Kang, Jeong Sang Ku, Hyeong Wan Kim, Kyoung Min Kim, Sik Lee, Won Kim, Sung Kwang Park
출판정보	2019; 2019(1):
키워드	ANCA-associated vasculitis \| tubulointerstitial nephritis \| Acute kidney injury \| Hantan virus
초록	"Antineutrophil cytoplasmic antibhody (ANCA)-asscociated vasculitides (AAV) are a group of pauci-immue small vessle vasculitides that often involve the kidney manifesting as rapidly progressive glomerulonephritis. Here, we report a rare case of ANCA-asscociated vasculitides in a patient with positive serologic test for Hantan virus. A 60-year-old previous healthy man was admitted to the hospital for fever with productive sputum and skin rashes. On admission, HRCT shows multifocal bronchopneumonia in the both lung. However, despite of proper intravenous antibiotics therapy, fever was persist with increase of eosinophils counts. After treatment of low-dose steroid, fever was subsided and discharged from the hospital. One weeks after hospital discharge, follow-up laboratory findings show increase of serum creatinine level. Physical examination revealed coarse breathing sound with rhonchi on both lower lung fields and 2+pretibial pitting edema. Laboratory findings revealed a white blood cell count of 24,930 /mm3, hemoglobin of 9.6 g/dL, platelet count of 325,000/mm3, blood urea nitrogen level of 52 mg/dL, and serum creatinine level of 4.0 mg/dL. Urinalysis showed 1+ proteinuria with hematuria. Urine protein/creatinine ratio was 2623 mg/g creatinine. Serologic tests for C3 and C4 were 47.1 and 7.5 mg/dL, respectively. p-ANCA was positive of 73.7 U/ml. Other autoantibodies were negative. There was also positive test for Hantan virus antibody with 4-fold increase of follow-up antibody titers. We performed renal biopsy. Findings are consistent with ANCA-associated vasculitis with chronic tubuloniterstitial nephritis. We prescribed the 30 mg of predinisolone with 200 mg of cyclophosphamide. However, immunosuppressive treatment, his renal function was deterionated and we started renal replacement therapy. The ANCA associated vasculitides was rare clinical condition especially, coincidently positive for Hantan virus. In this case, we have difficult to have clinical diagnosis, however, proper histologic diagnosis might have helpful to managing the patient with unknown acute kidney injury."
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