亜急性期に施行した腎動脈インターベンションにより心不全が改善した急性腎動脈閉塞の1例

A Case of Acute Renal Artery Occlusion with Uncontrolled Heart Failure Successfully Treated using Percutaneous Renal Artery Intervention Performed at the Subacute Phase

要旨　患者は83歳，女性．無尿，呼吸困難を主訴に来院．血清クレアチニン 4.51mg/dlと高度腎機能低下の所見を認めた．入院後，無尿の状態が続き，急性腎不全として血液透析を施行，継続したが，コントロール困難な肺うっ血が持続した．第25病日に施行したアンギオにて左腎動脈に90%高度狭窄を認め，右腎動脈は近位部で閉塞していたが，側副血行を介して末梢が造影されるのが観察された．左腎は萎縮していたが，右腎は萎縮しておらず，右腎動脈の病変に対して腎動脈インターベンションを施行したところ，早期に尿量の増加を認め，心不全が改善した．腎のviabilityが残存している場合には，亜急性期であっても腎動脈閉塞に対して積極的にインターベンションなどの方法で血行再建を行うべきと考えられ報告した．

Summary

　An 83-year-old woman complaining of anuria and dyspnea was admitted to our hospital because of acute severe renal dysfunction with a serum creatinine concentration of 4.51 mg per deciliter. Since her anuric condition continued after admission, we performed hemodialysis for this unexplained acute renal failure, but uncontrollable pulmonary edema was persistent. Angiographic findings performed at the 25th hospital day showed 90% stenosis of the left renal artery and total occlusion at the proximal site of the right renal artery. Peripheral flow was observed via the collateral vessels. Because the left kidney was atrophic but the right kidney was not, percutaneous renal artery intervention was performed for the lesion of the right renal artery. Soon after the procedure, urine volume increased suffciently and congestive heart failure was soon improved. Revascularization such as that attained by percutaneous renal artery intervention should be carried out for occlusion of the renal artery in such cases even at the subacute phase.