異時性両側性腎梗塞の1例

Abstract

57歳男.異時性両側性に発生した腎梗塞の1例を経験した.左腎梗塞は血栓症によるもの, 右腎梗塞は左側への診断治療目的のカテーテル操作に起因した血栓の播種によるものと推察された.両側とも動脈内注入血栓溶解療法で再開通がえられたが, 治療開始の遅れと残存狭窄の為, 左側腎機能低下を残した

A 57-year-old man was admitted with aching pain in his left frank. Left renal infarction was revealed by CT scan and arteriogram. Intra-arterial thrombolytic therapy was performed, and resulted in a recanalization of the occluded artery and elimination of frank pain, but residual stenosis was recognized. At 27 hours after the onset of left renal infarction, in spite of the systemic anti-coagulant and thrombolytic therapy to prevent the recurrence of the thrombosis, right renal infarction occurred. Immediate intra-arterial thrombolytic therapy for right renal infarction was performed successfully. Subsequently the serum creatinine level increased from 0.8-0.9 to 1.2-1.3 mg/dl due to the functional loss of the left kidney, which was confirmed by follow-up renoscintigraphy. Conservative intra-arterial thrombolytic therapy seems to be the most effective treatment for renal infarction, but left renal salvage failed due to the prolonged time of occlusion and residual stenosis. Also, catheterization for diagnosis and therapy or thrombolytic therapy itself may induce an additional infarction.