特発性腎動脈解離の1例

Abstract

65歳, 女。間質性膀胱炎の内服治療開始3週間後に嘔気, 微熱, 動悸, 左上腹部痛が出現した。検査所見では軽度の肝酵素上昇, 腎機能障害を認めた。循環器内科で洞不全症候群による心不全と考えられ, ペースメーカー挿入術が施行された。自覚症状は軽快したが血清Cr値は上昇し, CTにて左腎の萎縮を認めた。左腎動脈造影で大動脈分岐部から第2分岐部まで腎動脈内に長い透亮像を認めた。腎動脈血管内超音波で血管中膜に及ぶ解離を認めた。特発性腎動脈解離と診断し, ステント留置術を施行した。術後良好な拡張が得られ, 偽腔消失を確認した。術後3ヵ月には血清Cr値は低下し, 現在経過観察中である。

A 65-year-old female was admitted to our hospital complaining of left upper abdominal pain. Although the symptom improved with observation, serum creatinine rose to 2.0 mg/dl. Slight atrophy of the left kidney was seen on abdominal plain computed tomography. In order to examine the possibility of renal infarction from thrombosis with angiography, we consulted the department of cardiovascular medicine. Even though we did not detect thrombosis with left renal angiography or intravascular ultrasound, there was a dissection finding localized at the left renal artery. Based on this finding, we made a diagnosis of spontaneous renal artery dissection and performed stent placement. Spontaneous renal artery dissection is extremely rare and the frequency of occurrence is reported to be less than 0.05%. Recently, however the frequency of detection has risen with the development of clinical imaging. We must keep in mind that the condition has the possibility of leading to renal blood circulation disorders.