最近経験した腎血管性高血圧症例 - ことに,術前・術後の左右腎機能の変化と血圧降下効果について -

Abstract

Sixteen patients with renovascular hypertension were treated in our clinic during the nine year period. These patients were divided into three groups; Group I consisted of six patients with vascular repairs, Group II six patients with nephrectomy and Group III four patients without surgery. 1. Age of the patients was older and the duration of hypertension was longer in Group II than Group I 2. Ten among twelve patients with surgery showed good results. Although the cured and /or improved rate was not greatly different between Group I and Group II, the reduction of diastolic blood pressure was greater in Group I. 3. Preoperative RPF ratio (uninvolved side vs. involved side) was significantly higher in Group II (3.7) than Group I (1.4). This RPF ratio of Group I significantly reduced to 1.2 postoperatively. Apparently, the kidney function of the involved side was recovered by vascular repairs. 4. When divided renal functions in Group I and changes of residual kidney function of the healthy side in Group II were evaluated postoperatively, the followings were predicated: (i) The postoperative increment of RPF of the healthy side in Group II was greater than that of the non-operative side in Group I. (ii) The postoperative increment of total RPF was greater in Group I than Group II. (iii) There was no significant difference between the increment of RPF of the repaired side in Group I and that of the residual healthy side in Group II. 5. There was a good correlation between the postoperative recovery of renal function and the postoperative reduction by blood pressure. The patient, who showed good recovery of renal function of the operated side in Group I and good increase of the remaining kidney function in Group II, returned to normal blood pressure. 6. The criteria that renal vein renin ratio should be greater than 1.5 was useful in predicting the effect of surgery on blood pressure.