固有腎癌を生じた死体腎移植の1例

Abstract

44歳男.1993年に死体腎移植術を施行し, 移植腎機能はS-Crで1.0mg/dl前後と安定していたが, 腎移植前からの高血圧が増悪し降圧剤が無効であった.腹部CT検査で右腎に一部不整な部分を有する嚢胞性病変と左萎縮腎を認めた.移植腎動脈造影では移植腎動脈に狭窄は認められなかった.以上の結果から, 左腎由来の腎性高血圧と診断し, 右腎についても悪性腫瘍が否定できない為, 1995年11月, 両側固有腎摘除術を施行し, 右腎は根治的に摘除した.右腎嚢胞壁の不整な部分は, 組織学的に腎細胞癌, 透明細胞亜型, grade 1, pT2, pV0であった.又, 左腎は荒廃腎であった

A case of renal cell carcinoma of the right native kidney following cadaveric renal transplantation is reported. A 44-year old male underwent cadaveric renal transplantation in 1993 and had stable graft function, but he had suffered from hypertension before the renal transplantation and multiple antihypertensive medications were not effective. Abdominal computed tomography demonstrated bilateral contracted kidneys, but we could not rule out renal cell carcinoma of the right kidney, completely. Angiography of the graft artery revealed no stenosis and venous sampling suggested that plasma renin activity was increased in the left renal vein. Thus we performed bilateral native nephrectomy. Histology of the right kidney was renal cell carcinoma, clear cell subtype, grade 1, pT2, and the left kidney was end stage of renal disease. Because of high incidence of malignant neoplasia after renal transplantation, routine careful examination is quite important.