心臓カテーテル検査後に腎性尿崩症を来した虚血性心疾患の1例

Nephrogenic Diabetes Insipidus after Cardiac Catheterization and Intervention in a Patient with Ischemic Heart Disease

　非イオン性低浸透圧造影剤により著明な多尿を来したとの報告は極めて稀である．患者は80歳女性で，不安定狭心症の診断で緊急カテーテル検査を行い，左冠動脈回旋枝＃12，＃14に経皮的冠動脈形成術，ステント留置を行った．術中に使用した造影剤は230mlであった．術後より尿量が増加し輸液療法で対処していたが，1時間尿量が1l以上となり，術後24時間の尿量は18lであった．3日目には1日尿量は29lと著増した．1日目の尿浸透圧は281mOsm／kgH₂O，血漿浸透圧は282mOsm／kgH₂Oで，血中バゾプレッシン濃度は正常であった．尿検査に異常なく，血液生化学では尿素窒素，クレアチニンは正常であった．発症3日後のレノグラムにも異常はなかった．1—deamino−8—D-arginine vasopressin（DDAVP）投与でも尿量・尿浸透圧は不変であった．輸液などの治療により，尿浸透圧は281-467mOsm／kgH₂O，血漿浸透圧は279-286mOsm／kgH₂Oと変動したが，10日後に尿量は正常となった．

We encountered a rare case of unstable angina pecto-ris associated with remarkable polyuria after cardiaccatheterization and intervention. The patient was an 80-year-old female who underwent cardiac catheteriza-tion including percutaneous transluminal coronary an-gioplasty and stenting for an unstable angina pectoris(#12 and # 14 on AHA classification). Contrast volumeused during cardiac catheterization and interventionwas 230ml. Soon after cardiac catheterization, thepatient had polyuria (over 1liter per hour), totaling 18liters of urine volume per day after cardiac catheteriza-tion. She had 29 liters of urine volume on the third dayafter cardiac catheterization. Urine osmolarity was 281mOsm/kg H₂O and plasma osmolarity was 282 mOsm/kg･H₂O. Plasma vasopressin concentration was nor-mal. Urinalysis revealed no remarkable findings. Bloodurea nitrogen and creatinine in blood chemistry werenormal, and she had a normal renogram on the thirdday. Urine volume and osmolarity was not changed bythe administered DDAVP. Urine osmolarity was 281-467mOsm/kg･H₂O and plasma osmolarity was 279-286mOsm/kg･H₂O. Urine volume was normalized underconservative therapy.