生体腎移植後の高レニン性自己腎性高血圧に対する内視鏡下自己腎摘出術

Endoscopic Native Nephrectomy as a Potential Treatment for Post-transplant Patients with Uncontrolled Hypertension due to Excessive Renin Production from the Native Kidney

　生体腎移植後難治性高血圧に対して，内視鏡下に自己腎を摘出した．2症例とも静脈サンプリングにて末梢の2倍以上の自己腎静脈血レニン活性上昇を呈していた．症例1（35歳，男性）は生体腎移植前に自己腎レニン産生亢進を認め，腎移植と同時に右自己腎を摘出し，10か月後に腹腔鏡下に左自己腎を摘出した．症例2（26歳，男性）は生体腎移植後3年目に高血圧の増悪を認め，後腹膜鏡下両側自己腎摘出術を行った．両者とも術後速やかに降圧効果が得られた．腎移植後の高血圧環境を是正することは長期的な移植腎機能を良好に維持する上で重要であり，高レニン性高血圧を示す症例では積極的に内視鏡下手術にて低侵襲に自己腎摘出を行うことが望ましい．

We report two patients who underwent endoscopic native nephrectomy and who suffered from post-kidney transplant hypertension due to upregulated renin production from the native atrophic kidney. Their original dis-ease was chronic glomerulonephritis. Hypertension had occured from their dialysis period for 4 and 8 months, respectively. The first patient was a 35 years old male. Pre-transplant arteriography and venous sampling proved bilateral atrophic renal artery and excessive renin production from the native kidneys (right: 32.6>left: 29.1 ng/ml/h).