偏側性腎萎縮症に関する臨床的研究 第2編: 急速静注法による排泄性腎孟撮影法の診断的価値について

Abstract

Excretory pyelography by means of rapid intravenous inje c tion was performed in 8 patients with unilateral main renal artery obstruction (8 females with the mean age of 34.6 years old) and 8 patients with unilateral atrophic pyelonephritis (3 males and 5 females with the mean age of 26.9 years old). Control subjects consisted of hypertensive group (48 males and 20 females with the mean age of 30.5 years old) and normotensive group (29 males and 30 females with the mean age of 31.7 years old) were similarly studied. The contrast media used was 76% urografin, of which 20 to 30m1 was injected intravenously within 10 seconds. On X-ray films, the kidney length (KL), kidney width (KW), calyceal span (CS) and cortical thickness (CT) were measured, by which the ratios were calculated for CS/KL, CT/KL and CT/KW. The time specific excretion of the contrast media was also observed. The results obtained are summarized as follows. 1) For KL, KW and CS , no significant difference between the both sides was noted in the control groups both of hypertensives and normotensives. In particular, difference of the both sides was the least on KL, in which more than 1 cm and 1.5 cm difference suggested of possible and heavily probable unilateral renal atrophy, respectively. 2) In both of atrophic pyelonephritis and renal a r tery obstruction, the affected kidney became atrophic, although the grade of atrophy was less in the latter. This atrophy was attributed to mainly reduction of renal parenchyma in atrophic pyelonephritis and to similar degree of reduction of renal parenchyma and pelvocalyceal system in renal artery obstruction. 3) In few instances of atrophic pylonephritis, the not-affected kidney, which is interpreted as having normal pyelogram, also showed thin CT, increased CS/KL and decreased CT/KL. This suggested that, even in the kidney of the healthy side, atrophy of renal parenchyma is progressing or dormant in facts. 4) In the healthy kidne y , the rapidly injected contrast media was found to appear in the calyx within 3 minutes, followed by simultaneous excretion in the both sides. In atrophic pyelonephritis, the affected kidney showed marked delay of excretion. In renal artery obst ruction, excretion of the contrast media was varied by cases from non-delayed to non-functioning types. 5) In renal artery obstruction, the ureteral notching was observed to be positive in 50% and negative in the others, while in the control groups it was false positive in 1.6%. 6) The paradoxical concentration was found to be positive in 78% of rena l artery obstruction, and was never observed in the control groups. This positivity became predominant in overhydration status. 7) Reproducib l i ty of the above results was excellent except for ureteral notching.