線溶療法(tPA : 組織プラスミノーゲンアクチベーター全身投与)を施行した腎梗塞の1例

Abstract

55歳女.突然の右側背部痛を自覚し, 次第に増強して嘔吐も出現した.検査所見で白血球, GOT, GPT, LDHの高値を認め, 造影CTで右腎の上半分に境界不鮮明な造影不良像を認めた.右腎梗塞と診断し, 緊急に血管造影を考慮したが拒否され, 全身投与による線溶療法を選択した.直ちにアクチバシン(tPA)1200万単位を1時間かけて静注し, 更にウロキナーゼ(UK)12万単位を24時間持続静注投与した.tPAは3日間, UKは8日間使用した.第3病日以降GOT, GPT, LDHは低下傾向を示し, 第6病日にはGOT, GPTは正常化し, LDHも低下を続けた.画像所見も梗塞巣に造影効果を認め, 梗塞血管が再開通したものと判断した.第14病日に退院し, その後異常はない

A 55-year-old woman affected by mitralism presented with severe right flank pain of sudden onset. Biochemical examinations showed elevated serum lactate dehydrogenase, and abdominal enhanced computed tomography (CT) demonstrated hypoperfusion of the right kidney. Infarction of the right kidney was highly suspected, and she was immediately treated by systemic intravenous injection of 12, 000, 000 units of tissue plasminogen activator (tPA) per day for 3 days and 120, 000 units of urokinase per day for 8 days. After the thrombolytic therapy, abdominal enhanced CT revealed marked improvement of enhancement of right renal parenchyma and decrease of serum LDH. Although thrombolytic therapy with selective intraarterial infusion is considered to be a useful treatment modality for renal infarction, systemic administration of tPA may also be effective judging from the clinical course of the present case.