ステロイド療法が奏効した後腹膜線維症の1例

Abstract

73歳男.左側腹部痛を主訴に近医を受診し, 超音波検査で両側水腎症を認め, 急性腎不全を呈した為入院となった.入院時, 軽度貧血と腎不全及び血膿尿を認め, 画像所見より, 後腹膜線維症と診断した.両側腎瘻を増設し, 膿尿に対し抗生物質の投与を行ったところ, 急性腎不全から離脱し, ステロイド治療を開始した.その後, 後腹膜軟部組織陰影の縮小を認め, 左側尿管の通過が良好となった.右腎瘻と左腎瘻を順に閉鎖し, 両側の尿管の良好な通過性を確認した.その後も, 軟部組織陰影は更に縮小し, 退院となった.退院後3ヵ月現在再発の徴候はない

A 73-year-old man presented with acute renal failure due to bilateral hydronephroses. Urography and CT scan revealed stenosis and medial deviation of the bilateral ureters surrounded by a soft tissue mass at the level of the 4-5th lumber vertebrae. Under a diagnosis of retroperitoneal fibrosis, bilateral nephrostomies were temporarily placed and prednisolone administration was initiated at a dose of 20 mg/day. Ureteral passage markedly improved within 2 weeks in association with a decrease in size of the retroperitoneal soft tissue mass. The steroid therapy was continued for 4 months with decreasing dosing schedule. The patient has been doing well without any signs of recurrence for 3 months after the cessation of the steroid therapy.