対側矮小腎を合併した片側巨大水腎症の1例

Abstract

54歳女性.尿量減少, 左下腹部鈍痛を主訴とした.単純CTで右矮小腎と左巨大水腎症を認め, MRIT2強調画像で左腎盂と腎盂外溢流を認めた.MR尿路撮像では左腎盂の拡張と尿管膀胱移行部(UVJ)付近で狭窄のある左拡張尿管を認めた.腎後性腎不全と診断し, 緊急に経皮的左腎瘻造設術を施行した.その後症状, 炎症反応, 腎機能の改善を認め, 左腎瘻造影と膀胱鏡検査を施行した.その所見より左UVJ狭窄による左水腎水尿管症と診断し, 左尿管膀胱新吻合術を施行した.病理学的に悪性所見や腫瘍性変化は認めなかった.術後の経過は良好で, 左腎瘻の抜去後も腎盂腎炎, 腎機能の悪化を認めず, 術後1年半の現在も経過は良好である

A 54-year-old woman was admitted to our hospital for oliguria and left lower abdominal pain. She had renal dysfunction with a serum creatinine of 9.1 mg/dl and blood urea nitrogen of 96.5 mg/dl. Plain computed tomography and magnetic resonance imaging revealed right dwarf kidney and left giant hydronephrosis with extravasation of urine. MR-urography revealed left dilated ureter caused by ureterovesical junction (UVJ) stenosis. Therefore, percutaneous nephrostomy was immediately performed to treat postrenal failure, with resulting collection of approximately 1, 650 ml of urine. Subsequently, left ureterocystoneostomy was performed for the treatment of UVJ stenosis because improvement of left UVJ stenosis had not been confirmed by nephrostography during follow-up. Judging from the past history of myoma operated and reactive fibrosis of stump of left ureter histopathologically, it was considered that acquired UVJ stenosis had led to giant hydronephrosis.