原因不明の腎性血尿の臨床的検討

Abstract

Clinical investigations were made of renal hematuria of unknown etiology in a series of patients who were seen at the Department of Urology, Hiroshima University Hospital during the 8-year period from 1968 through 1975. The results are summarized as follows: 1) Of the entire 13, 328 outpatients studied, 217 (1.6%) were found to have renal hematuria of unknown etiology. The male-to-female ratio in these 217 patients was 1.4 : 1; both men and women between the ages of 20 and 40 were most frequently affected. Diagnosis as to the affected side could be made in 142 (65%) of these 217 cases. 2) Complications were noted to exist in 66 (30.4%) of the 217 cases and included focal infections, allergic diseases, hepatitis, urinary tract diseases and others. 3) A retrospective study of these 217 cases with regard to pyelorenal backflow noted on retrograde pyelography revealed that venous backflow was of most frequent occurrence but there was no statistically significant difference between the normal and affected side in the frequency of pyelorenal backflow. 4) The urokinase activity in urine was significantly higher in the group with renal hematuria of unknown etiology than in normal controls. However, the enzyme activity level in urine fell as the hematuria disappeared with treatment. 5) Treatment methods were totally conservative, and comprised rest, elimination of sources of focal infection and drug therapy mainly with anti-fibrinolytic agents. Intractable cases were given intrapelvic instillation of silver nitrate solution. Complete cure was attained in approximately 80% of cases. A similar figure of therapeutic success was obtained in follow-up study.