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Ⅰ．緒言
腎のfatty replacementは尿路結石症，腎結核などの症例にまれにみられるもので，欧米諸国および本邦においていくつかの優れた報告がなされている。われわれはX線上特異な像を呈した腎盂結石を合併する馬蹄鉄腎を剔除したところ，術後に慢性腎盂腎炎による萎縮腎に生じたfatty replace-mentを認めることができた。本症例は本邦18例目であるが，結石をともなつた馬蹄鉄腎に生じたfatty replacementは初めてである。ここにその症例を報告し，fatty replacementの病態生理につき文献的考察を行ない，あわせて類似疾患の鑑別につき述べてみたい。
A 44-year-old man, who had been suffered from fatigue for one year, was admitted to a nearby hospital, and urological examination revealed horseshoe kidney with renal stones. He was referred to Keio Univ. Hosp. for surgical intervention.
Under general anesthesia left nephrolithotomy and division of the isthmus of horseshoe kidney were planned. However left kidney was so much enlarged with moderate adhesion to surrounding tissues that left half of the kidney was dissected at the midportion of the isthmus.
Removed specimen containing two stones and looked like a large lipoma with 17×9×7 cm in size and 830g in weight.
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