腎動脈撮影法の研究 第2編: 腎動脈内径及びネフログラムと腎機能との関係

Abstract

Relationship between internal diameter of renal artery and renal function and that between nephrogram and renal function have been studied in 75 cases out of 206 cases to whom translumbar aortography was performed during the period of April 1953 through March 1960 at the department of Urology, Kyoto University Hospital. 1) Maluf's method was employed for measurement of internal diameter of renal artery. If more than two renal arteries were branched off from the aorta, diameters were calculated by Poiseuiille's equation. D = Di44-Th4H-D34+••+• D n4 where D is internal diameter of renal artery. 2) Average internal diameter of b oth sides of renal artery with normal kidneys was 5.5 mm with standard deviation of 1.01mm for the right and 0.68 mm for the left. The author considered this average 5.5 mm as normal value which is less than normal value of 6.5-6.7 mm by Maluf, though it might be due to difference of species. 3) Average diameter of renal arteries with renal tumor was 6.3 m m -±1.79 mm, and that of normal side was 5.4 mm±0.91 mm. The diameter of tumor side was markedly larger than that of normal side. 4) In renal stone and u reteral stone, average diameter of renal artery of ill side was 5.2 mm±2.3mm and that of normal side was 5.9 mm±1.2 mm. The diameter of ill side was slightly smaller than that of normal side. 5) In renal tuberculosis, average diameter of renal artery of tuberculous side was 3.9 m m-±4.4 m m, and that of normal side was 5.6 m m±1.5 mm. The diameter of tub erculous side was markedly smaller than that of normal side. 6) In hydronephrosis average diameter of renal a rtery of ill side was 3.2 mm± 3.6 m m, and that of normal side was 5.1 m m±0.6mm. The diameter of ill side was markedly smaller than that of normal side. 7) In the above mentioned cases of renal tumor, renal stone, renal tuberculosis, and hydronephrosis, the average diameter of renal artery of ill side was larger than normal side only in renal tumor, which may be due to increased vascularity in the tumor and the diameter was smaller in the other three diseases, which may be due to renal dysfunction of ill side and consequent decrease in the diameter. 8) Nephrogram in the above mentioned disorders produce d the similar shadow contrast to that of normal side if both renal functions were within normal limits. However, nephrogram produced less shadow contrast as renal function was disturbed and in complete renal dysfunction nephrogram could not be obtained. 9) In such hydronephrosis and urolithiasis com p licated by hydronephrosis that renal function was markedly or completely disturbed, the internal diameter of renal artery of ill side was within normal range and satisfactory nephrogram was obtained. In these cases renal arteriogram and nephrogram may tell us the possibility of palliative therapy to the kidney. On the contrary, in such cases that renal arteriogram was not obtained, or artery was markedly small in diameter even if the arteriogram was obtained, or nephrogram lacked its clearness, the arteriogram and nephrogram may clearly tell us the indication of nephrectomy. Therefore, they can be of great help in decision of surgical treatment of renal disorders. 10) Measurement of inte r n al diameter of renal artery was performed in congenital malformation of the kidney. The diameter wa s small in the arteriogram and nephrogram was not obtained in the typical polycystic kidney. However, the diameter in the arteriogram was close to normal value in the early stage of this disease. In the solitary cyst of the kidney, both arteriogram and nephrogram were not obtained if the cyst was extremely large. However, in most case the diameter was rather larger than normal value in nephrogram. In the majority of nephroptosis t h e both diameters were smaller than normal value. This may be due to skinny physique of the patient. In horseshoe kidney the both diameter w ere smaller than the normal value. This may be due to abnormal vascularity in the isthmus. The diameter of normal side in the patien t s with renal aplasia and renal hypoplasia was larger only in one case, and in the others the diameter was slightly smaller than the normal value. This author's results were different from the diameter by Maluf which was greater than that of the artery going to one kidney of a normal pair.