小児腎血管性高血圧症に対するPTRAの1例

Percutaneous Transluminal Renal Artery Angioplasty in a 3-year-old Hypertensive boy

　1964年，Dotter,Judkins^1）によりバルーンカテーテルによる末梢血管形成術（PTA）が初めて報告されて以来，今日では，この経皮的血管形成術は，ことに成人領域において末梢血管は言うにおよばず冠動脈，腎動脈の閉塞性病変に対して広く応用され，その有効性が示されている。今回我々は川崎病の既往のある3歳男児の腎血管性高血圧に対して経皮的腎動脈形成術（PTRA）を行い良好な結果を得たので報告する。

We present a case of successful transluminal balloon dilatation of renal artery stenosis in a pediatric patient.

A 3-year-old boy was noted on the treatment of otitis media to have a blood pressure of 290/180mmHg. Subsequent repeat measurements in all extremities ranged from 200 to 290mmHg systolic with diastolic values from 100 to 180mmHg. Past history was negative except for MCLS, for which he underwent coronary arteriography which revealed no significant organic stenosis. There was no history of hypertension in the immediate family.

Laboratory studies including urinalysis, blood count, blood chemistry, 24-houre VMA and catecholamines were all within normal limite except for plasma renin activity and serum aldosterone levels. Renogram revealed malfunction of right kidney with slight degree.

Renal arteriogaphy showed 80% stenosis of right renal ventral artery and we performed Percutaneous Trans-luminal Renal Angioplasty (PTRA) with Judkins tech-nique. A repeat abdominal aortogram following PTRA showed the right renal artery to be of almost normal caliber.

After PTRA, blood pressure, plasma renin activity and angiotensin I level were normalized without me-dicine.