血栓溶解療法を施行した腎動脈塞栓症

RENAL ARTERY EMBOLISM:A SUCCESSFUL LYSIS WITH AN INTRA-ARTERIAL INFUSION OF UROKINASE

　58歳，男性。発作性心房細動による頻脈発作の翌日，左側腹部激痛が出現。血液検査で乳酸脱水素酵素高値，CTで左腎は造影不良であり，腎動脈塞栓症と診断。発症より22時間後に腎動脈造影を施行し，腎動脈内の血栓を確認し，ウロキナーゼの腎動脈内迅速大量投与および低容量持続動注療法を施行した。24時間の持続動注療法後には血栓は完全に溶解した。治療後のCTでは下極背側の梗塞巣以外にはほぼ正常に造影効果が認められるようになった。

A 58-year-old man who had been treated for hyperten-sion and paroxysmal atrial fibrillation was admitted to our hospital with severe flank pain. There was an episode of tachycardia attack two days before the admission. The serum LDH level was elevated and CT scan revealed markedly reduced arteial perfusion of the left kidney. A diagnosis of left renal artery embolism was made and selective intra-arterial infusion of urokinase was started 20 hours after the onset of symptoms. A continuous infusion of urokinase for 24 hours was added and result-ed in a complete clot lysis and restoration of the affected kidney.