柴苓湯が奏効した後腹膜線維化症

Retroperitoneal fibrosis successfully treated with Kampo medicine Saireitou：A case report

症例は76歳，男性。全身倦怠感を主訴に当院内科を受診し，Cr 10.7mg/dlにて入院した。その後，両側水腎症による腎後性腎不全と考えられ泌尿器科へ転科し，左腎瘻造設と右尿管ステントを留置した。腎盂造影，CT，MRIなどにて後腹膜線維化症による腎後性腎不全と診断し，柴苓湯の投与を5か月間行うと，大動脈周囲の線維化はやや縮小し水腎症は消失した。治療終了後3か月後の現在，再発なく経過観察している。

A 76-year-old man presented with the chief complaint of general malaise. He was admitted to our hospital because of postrenal acute renal failure due to bilateral hydronephrosis. Percutaneous nephrostomy on the left side and indwelling of a right ureteral stent were performed,and his renal function recovered. Bilateral pyelography and CT scan revealed stenosis and medial deviation of the bilateral ureters surrounded by a soft tissue mass at the level of the 4-5th lumbar vertebrae. MRI demonstarated that the mass was low intensity on T1 weighted image and slightly high intensity on T2 weighted image. Based upon the above findings,we made the diagnosis of the retroperitoneal fibrosis. Sai-reitou 9.0g per day was administrated for about 5months. The retroperitoneal mass decreased slightly in size on CT scan. Bilateral hydronephrosis disappeared completely on excretory urogram. He has been doing well without any signs of recurrence for 3months after the cessation of this therapy.