CAJ | 학술논문

目的探讨肾脏疾病患儿合并头孢曲松相关假性胆结石的临床特点.方法回顾性分析3例合并头孢曲松相关假性胆结石的肾脏疾病患儿临床资料.结果病例1,男,11岁,诊断"肾病综合征",因"胃肠炎"予头孢曲松2g/d[50 mg/(kg·d)]抗感染,3 d后发现胆囊内泥沙样沉积,伴纳差、恶心;停药16 d后胆囊结石消失.病例2,男,10岁,诊断"急性链球菌感染后肾小球肾炎、肾功能不全",因"胃肠炎"予头孢曲松1.5 g/d[30 mg/(kg·d)],疗程6 d时发现胆囊结石,伴恶心、呕吐和腹痛,Murphy's征阳性;停药18 d后胆囊结石消失.病例3,男,12岁,诊断"肾病综合征",因"胃肠炎?"给予头孢曲松2g/d[40 mg/(kg·d)]联合甲硝唑抗感染、疗程2周,感染控制,但有中上腹压痛,停药3 d后发现胆囊结石;停药2个月后复查结石回声消失.结论上述3例患儿出现胆囊结石时头孢曲松治疗剂量较低、结石出现早、临床表现相对重,可能与肾脏疾病患儿同时存在血液浓缩、高凝状态、肾功能不全或补充钙剂等高危因素有关.
목적 탐토신장질병환인합병두포곡송상관가성담결석적림상특점.방법 회고성분석3례합병두포곡송상관가성담결석적신장질병환인림상자료.결과 병례1,남,11세,진단"신병종합정",인"위장염"여두포곡송2g/d[50 mg/(kg·d)]항감염,3 d후발현담낭내니사양침적,반납차、악심;정약16 d후담낭결석소실.병례2,남,10세,진단"급성련구균감염후신소구신염、신공능불전",인"위장염"여두포곡송1.5 g/d[30 mg/(kg·d)],료정6 d시발현담낭결석,반악심、구토화복통,Murphy's정양성;정약18 d후담낭결석소실.병례3,남,12세,진단"신병종합정",인"위장염?"급여두포곡송2g/d[40 mg/(kg·d)]연합갑초서항감염、료정2주,감염공제,단유중상복압통,정약3 d후발현담낭결석;정약2개월후복사결석회성소실.결론 상술3례환인출현담낭결석시두포곡송치료제량교저、결석출현조、림상표현상대중,가능여신장질병환인동시존재혈액농축、고응상태、신공능불전혹보충개제등고위인소유관.
Objective To study the clinical characteristics of ceftriaxone-associated biliary pseudolithiasis in children with renal diseases.Method Three children with renal diseases developed biliary pseudolithiasis when they were treated with ceftrriaxone.Their clinical and laboratory data were retrospectively analyzed.Results Case one was an 11-year-old boy.The initial diagnosis was primary nephrotic syndrome.Ceftriaxone was administered intravenously at a dose of 2 g/d[50 mg/(kg·d)]for gastroenteritis.After that the boy complained of nausea and loss of appetite.Abdominal sonogram obtained on day 3 of ceftriaxone therapy revealed gallbladder sludge.After cessation of ceftriaxone treatment,symptoms and ultrasound abnormalities gradually disappeared,with complete sonographic resolution after 16 days.Cage two was a 10-year-old boy.The primary diagnosis was post-streptococcal glomerulonephritis with acute renal failure.The child was treated with 1.5 g/d[30 ms/(kg·d)]intravenous ceftriaxone for gastroenteritis.After that,the boy complained of nausea and abdominal pain with positive Murphy's sign.Gallstone was detected by uhrasonographic examination on day 6 of ceftriaxone therapy.After cessation of ceftriaxone treatment,symptoms and sonographic abnormalities gradually disappeared,with complete sonographic resolution after 18 days.Case three was a 12-year-old boy.The primary diagnosis was nephrotic syndrome.He was treated with 2g/d[40mg/(kg·d)]ceftriaxone for gastroenteritis.Gallbladder lithiasis was detected 17 days after the initiation of ceftriaxone therapy(3 days after cessation of ceftriaxone treatment).Gallbladder sonogram was found to be normal two months after the discontinuation of the therapy.Conclusions Biliary pseudolithiasis occurred in 3 cases with renal diseases receiving low doses of ceftriaxone.The risk of developing ceftriaxone-associated biliary pseudolithiasis might increase in patients with renal diseases who are treated with ceftriaxone.