特発性腎出血に対する硝酸銀溶液注入療法で腎内外に広範囲壊死を合併した1例

Abstract

A 69-year-old woman was referred to our hospital for evaluation of pyuria and renal dysfunction. Twenty days earlier, the patient had undergone silver nitrate retrograde instillations for essential renal bleeding. Routine laboratory findings showed renal dysfunction with a serum creatinine concentration of 7.2 mg/dl and blood urea nitrogen concentration of 68 mg/dl. The urine contained numerous red cells and white cells. The plain X-ray film of the abdomen revealed right renal calcification. Computed tomographic scan confirmed the calcifications in the right renal collecting systems and parenchyma. The most likely diagnosis was argyrosis of the upper urinary tract. The patient underwent a right nephrectomy. Histopathological examination of the specimen showed that the renal pelvis was filled with blood clots. Laboratory evaluation including serum creatinine concentration and urinalysis revealed normal parameters postoperatively. We conclude that this patient developed argyrosis of the urinary tract, and review previously published papers concerning complications of silver nitrate instillation.