異所性自家腎移植の1例 大動脈炎症候群に合併した腎血管性高血圧症

Abstract

A 22-year-old female was admitted to the Hospital of Osaka City University on July 14th, 1967, complaining of headache, palpitation and severe hypertension with a blood pressure of 220/ 0 mmHg. At her age of 17, she suffered from rheumatoid arthritis and was treated for one year. There was no history of cardiovascular disease in her family. On admission, blood pressure was 210-220/0-40 mmHg. Blood sedimentation rate was 35mm/ 60 min., and 80 mm/120 min. Wasserman's reaction was negative. The left ventricular hypertrophy was isuggested from the electrocardiogram. The fundi showed no abnormal findings. Blood picture was normal except for a mild leukocytosis. Blood chemistry showed a decrease of A/G ratio and positive CRP. Endocrinological findings were normal. Total renal function was good, but the right kidney was worse than left in the split renal function test. Routine urinalysis was normal. The renogram suggested the right renovascular hypertension. Intravenous pyelography showed the hypo concentration of the right kidney in early film and the hyperconcentration in late. Aortography revealed aortic insufficiency, hypertrophy of descending and abdominal aortic wall and severe stenosis at the origin of the right renal artery. The left renal artery was slightly narrowed at its origin. Aortography suggested that the hypertension was of renovascular origin, and plasma rennin activity from both renal vein was estimated by Helmer and Judson's technique. It was 390 ng/ml/24 hours incubation on the right renal vein and 80 ng/ml on the left. Since the lesion was bilateral a revascularisation procedure was indicated. On July 1st, 1968, operation was performed under a clinical diagnosis of renovascular hypertension caused by aortitis syndrome with aortic insufficiency. The right kidney was removed from the body and autotransplanted into the right iliac fossa after having been washed out for 10 minutes. The postoperative course was satisfactory and blood pressure fell rapidly down to the range of 130-150/0-40 mmHg. The literatures were briefly reviewed and discussions were made on the revascularization procedure in renovascular hypertension, especially in one caused by aortitis syndrome.