[原著]右萎縮腎,左腎動脈狭窄による高血圧症の1例
| Autor: | Ooura, Takashi, Yonamine, Tsuyoshi, Sakumoto, Seiki, Gushiken, Masamichi, Irei, Motoharu, Mimura, Goro, China, Takaaki, Koyama, Yuzo, Osawa, Akira |
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| Jazyk: | japonština |
| Zdroj: | 琉球大学保健学医学雑誌＝Ryukyu University Journal of Health Sciences and Medicine. 3(1):36-44 |
| ISSN: | 0285-9270 |
| Popis: | We reported a case of hypertension and discussed it's etiology. A 52-year-old female was admitted to our clinic for closer examination of hypertension discovered 7 years ago during a mass-examination. Thereafter she took drugs occationally but complained of occational headache and palpitation. She noticed facial edema after overworking but there were no episodes of urinary tract infection. In physical examination, her B.P. was 190/130mmHg, face was slightly puffy and cardiac dullness was enlarged, but there was no abdominal bruit and no edema in legs. In laboratory data, proteinuria was negative but there was many WBC in the urinary sediment. Renal function was almost normal; psp in 15min. was 25.5%; creatinine clearance was 101.2ml/min. Peripheral plasma renm activity was as low as 0.35ng/ml/hr and did not responded to furosemide load and standing position, plasma aldosterone was slightly elevated at 185.5pg/ml and 3 fractions of urinary catecholamine were within normal limits. IVP revealed a right sided contracted kidney, dilatation of the pelvis and deformities of the calyx, but the left sided kidney was almost normal. Angiography revealed left sided renal artery stenoses but no stenosis of the right sided renal artery but the right sided main renal artery and peripheral arteries were very narrow. For examination of the cause of the right sided contracted kidney, we performed a cystography, which revealed a right sided vesicoureteric reflux (VUR). We then suspected this was the cause of right sided contracted kidney. Indivisual renal function test was done but provided unreasonable data, so we considered this an improper test in this case. We performed angiotensin II analogue infusion test for differential diagnosis of hypertension. There was no response to this test and we speculated there was no role of reninangiotensin system causing this hypertension. We began treatment with diuretica, and diuresis occured and facial edema disappeared. B.P. was controlled at a good level. 論文 |
| Databáze: | OpenAIRE |
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