Korean Journal of Nephrology 1996;15(3):355-364.

Yersinia pseudotuberculosis에 의한 급성 신부전증

구자욱 , 조종래 , 정철영 , 박혜원 , 정해일 , 최용

Abstract

YP can cause a wide range of clinical problems such as mesenteric lymphadenitis, erythema nodo- sum, reactive arthritis, and sepsis. We have experi- enced 70 cases of YP infection in children diagnosed by stool culture (46 cases) and/or serology (24 cases) since 1987, A history of drinking or contact with untreated well or mountain water was detected in 67 cases. YP was also isolated from 5 samples of mountain spring water which was thought to be the sources of infection. The most prevalent serotypes were 5b(37/70) and 4b(24/70). During the course of illness, ARF developed in 18 cases(25.796). Addi- tionally, serogroups for those from the water sam- ples were 5 in 4 cases. The disease began with sudden onset of fever, rash, abdominal pain some- times mimicking acute appendicitis. Periungual des- quamaton, which was prominent in the ARF group, developed later in the course. Thrombocytosis and hypoalbuminemia were noticieable, and mild degrees of proteinuria, microscopic hematuria, and sterile pyuria were common in the ARF group. ARF developed between the 2nd and 17th days(mean 8.9 days) after the onset of fever, and oliguria (<400ml/ m/day) developed in 12 patients(12/18) immediately after their fevers had subsided. ARF underwent a benign course of complete recovery within 4 weeks at most(mean 10.2 days), with two exceptional cases requiring hemodialysis. Kgh FeNa, glucouria, decreased tubular reabsorption of phosphate(<85%) and increased urinary 52 microglobulin excretion, were suggesting proximal tubular damage. Renal biopsy showed evidence of tubulointerstitial nephritis. YP should be included as one of the causes of acute interstitial nephritis causing ARF in children, especially when the children have histories of drinking untreated water in endemic areas.