腎血管性高血圧

Abstract

腎血管性高血圧(RVH)は片側または両側の腎動脈の閉塞あるいは狭窄による腎虚血のために生じる二次性高血圧である.1958年から1999年の42年間に著者らの施設で経験した95例のRVHの治療法について検討した.年齢は3～64歳(平均31.8歳)で, 三大原因は線維筋性異型性34例(35.8%), 動脈硬化26例(27.4%), 第動脈炎12例(12.6%)であった.95症例中79例92腎に対して治療が行われ, 主な治療法は血行再建術6例(7.6%), 腎摘除術21例(26.6%), 自家腎移植術26例(32.9%), 経皮経管血管形成術25例(31.6%)であった.治療効果では, 術後に降圧薬が不要となった症例を治癒, 降圧薬が減量できた症例を改善とすると, 治癒ないし改善した症例は, 腎摘除術で100%, 自家腎移植術が92.3%, 経皮経管血管形成術が72.0%であった.RVH治療法は大きく変遷しており, 初期にはバイパスによる血行再建術, 1974年以降は自家腎移植術, 1981年以降は経皮経管血管形成術が第一選択として行われていた

Renovascular disease is one of the most common causes of secondary hypertension. Recent technical advances have changed the management principles, which include a more aggressive approach to the diagnosis and treatment of renovascular hypertension (RVH). We experienced a total of 95 cases with RVH between 1958 and 1999. The mean age of all patients was 31.8 years old, ranging from 3 to 64 years. The three major basal diseases that caused RVH were fibromuscular dysplasia (34/95), arteriosclerosis (26/95), and aortitis (12/95). Ninety-two kidneys were treated in 79 of the 95 patients. The major therapeutic modalities performed were reconstruction of renal artery (6/79), nephrectomy (21/79), autotransplantation (26/79), and percutaneous transluminal angioplasty (PTA) (25/79). PTA is now the treatment of choice for the initial management of patients with RVH. Surgical treatment is generally reserved for patients in whom PTA fails. Pharmacotherapy is used on patients awaiting angioplasty or revascularization, those who are too ill for intervention, and those who have failed to respond to intervention.