腎血管性高血圧症における病因と予後

Abstract

Eleven cases of renovascular hypertension treated by the authors during the 10-year period from 1974 to 1984 are summarized in this paper, referring particularly to its etiology and prognosis. The causative diseases included 3 cases of atherosclerosis, 4 cases of fibromuscular dysplasia, 1 case of aortitis syndrome, 1 case of abdominal aneurysm, 1 case of renovascular thrombosis, and 1 case of unknown origin. Operations were given in 10 of the 11 cases i.e., 7 cases of nephrectomy and 3 cases of reconstructive surgery for renal blood-flow. The results of operations at discharge were 7 cases of blood pressure normalization, 2 cases of its improvement and 1 case of no change. There was no operative mortality. The outcome of long followup revealed that 2 of the 3 patients with atherosclerosis died in 9 months and 1 year and 10 months, respectively, due to cerebral hemorrhage and renal failure. However, the patients with other diseases maintained their health for 5 years and 5 months (mean observation period), with normal blood pressure or a mild hypertension. Sometimes, in patients with atherosclerosis in whom severe arteriosclerotic lesions already exist in the cardiovascular system, conservative therapy is better than surgical therapy. The indication for surgical therapy, should be made after considering the results of the angiotensin II analogue test.