特異なレ線像を呈した腎盂軟結石症2例

Abstract

The simple roentgenogram of two adult men who had come to us o n account of the remarkable renal colic pain showed the figures of renal pelvis and ureter similarly obtainable by the pyelography. Their symptoms, after a few days, improved by the urinary excretion of the soft stone mass containing the oxalate and phosphate respectively, when the shadow in the roentgenogram disappeared. Case 1. 31-year-old Chief complaints : hematuria and periodic pain fit at the right abdominal region, January 3, 1957 Family a nd previous medical history not descriptive History of the present ailment : In the early morning on December 29 in 1956 the severe pain fit suddenly occurred from the right abdominal region to the epigastric region without any cause. This pain was not disappeared even with use of analgetic treatment, and the hematuria and the urination at every one hour still remained. Present status : The intensive defence and the press pa i n at the right renal region were observed. The left kiney was intact. Cystoscopically, the content was 200 cc, the mucous membrane was reddish and hyperemic, the right ureter opening elevated edematously, and the caliculus sands were seen in fundus. The excretion of indigo carmine was negative for about ten minutes after injection in the right side, while that was first seen about 4 minutes after, in the left side. The simple roentgenography : T h e figure resembling the shadow due to the shadow drug was observed at the junction of the pelvis and the ureter in the right side in the simple roentgenography (Figure 1). Progress after admission : At about seconds week after the start of the disease the foliate mass containing the oxalate crystal shown in Figures 3 and 4 was excreted without any treatment. Then, the subjective symptoms were disappeared, the excretory state of indigo carmine in the right kidney became normal, and the shadow in the simple roentgenogram was also vanished. Case 2 : 28-year-old men Chief complaints : Colic pain fit at the right abdominal region and the frequent urination, September 22, 1958 Family and previous medical history : not significantly History of the present ailment : He came t o us because of the colic fit and the frequent urination thought he had been treated under the diagnosis of the renal caliculus on account of the pain at the right abdominal region a week before. Present status : The right kidney swelled and so proba b le. Press pain was intensively. The neutral phostphate crystal was observed in the soft caliculus sand in urine. The reddish elevation and the small hemorrhage spot were seen at the right ureter opening. The indigo carmine in the right kidney was negative till 10 minutes while that in the left kidney was positive after about 3 minutes. The simple roentgenogram. T h e shadow similar to that due to the shadow driig was seen at the junction between the right pelvis and the ureter (Figure 5). Progress after the admission: The administration of the alminum gel with daily dose of 5 g. for a few days caused the intraurinary excretin of many caliculus sands, and the roentgenographical shadow were disappeared. After the application of 5 g. o f alminum gel, intraurinary inorganic phosphate and pH of urine were determined. pH gradually moved toward acid side (minimum was 5.0). The amount of inorganic phosphate which did not exceed 500 mg/day gradually increased above that value in 5 g. of alminum gel. Thought, as a cause, the disturban c e of urinary colloidal state can be considered, first the dysfunction of tubuli of affected kidney is thought from the fact that pH of the urine isolated from affected side (7.4) is markedly different from that from normal side (6.2) and PSP test in affected side is very lower in the second case, and second the mechanism similar to Bould's report that calcium sedimentation is resulted from the hypercalcemia in acidosis or in low phosphate diet is assumed from the estimation of Ca and P in blood and urine. But there is no most reasonable explanation.