心臓カテーテル検査に続発したアテローマ腎塞栓症の1例

A Case of Athroembolic Renal Disease after Cardiac Catheterization

　症例は74歳，男性．主訴は呼吸困難，下腿浮腫．冠危険因子は糖尿病，喫煙，高血圧．1992年1月急性心筋梗塞発症．経皮的冠動脈血栓溶解療法（PTCR）施行後より腎機能悪化．クレアチニンが6ヵ月間で徐々に1.4mg／dlから6.8mg／dlまで上昇．尿量も漸減し，胸水が貯留．呼吸困難と下腿浮腫が出現．心機能の低下は認められなかった．4月には両下腿に紫斑を認めた．7月，利尿剤には全く反応しなくなり透析導入．腎生検にて小細動脈にコレステロール結晶を示した．カテーテル操作時の大動脈壁の擦過が内膜剥離を引き起こし，その後，アテローマシャワーが長期にわたり存在し腎不全と紫斑を発症させたものと考えられた．

The patient was a 74-year-old male with diabetes, and hypertension, who smoked heavily. He was admitted to our hospital because of acute myocardial infarction. After PTCR (Percutaneous Tansluminal Coronary Recanalization) , renal function deteriorated progres-sively, serum creatinine level rose from 1.4 mg/dl to 6.8 mg/dl over 6 months. Urine volume decreased, and chest X-ray revealed pleural effusion in both lung fields. Despite aggressive medical treatment, the patient had to be kept on regular dialysis. Petechiae was found on both legs.