抄録
Five cases with hypertension due to unilateral renal diseases which were submitted to nephrectomy are presented in this report.
Case 1. 24 years old male, arteriosclerotic stenosis of the right main renal artery.
Case 2. 20 years old female, stenosis of the right renal artery due to fibromuscular hypertrophy.
Case 3. 31 years old male, hypoplasia of the left kidney.
Case 4. 28 years old male, renal impairment due to 60Co irradiation to the left kidney region, where a metastatic tumor of seminoma had been palpated.
Case 5. 37 years old female, stenosis of the right renal artery due to arteritis as a manifestation of the “aortitis syndrome”.
In no cases of these 5, vascular murmur over the abdomen was heard.
A Keith-Wagener 4 ocular fundus was transiently observed in Case 4, in which the development of the disease process was very rapid.
In all of the 5 cases, findings of routine intravenous urograms such as delayed excretion and smaller vertical diameter (difference greater than 2 cm) of the impaired kidney played an important role as the initial diagnostic clue.
Radioisotope renography, renoscintigraphy, aortography and divided renal function tests were valuable as ancillary diagnostic methods.
Among others, aortography seems to have greater importance in view of the greater incidence of the so called “aortitis syndrome”, particularly involving the abdominal aorta, in this country. Seldinger's percutaneous catheterization method for aortography seemed to permit better visualization of the arterial tree compared to the translumbar needle puncture method.
Some correlation seems to be present between the histological findings of the removed kidney and the post-operative blood pressure levels.Therefore, bilateral renal biopsy is recommended to be carried out preoperatively for prediction of operative effectiveness or ineffectiveness for lowering the elevated blood pressure.
A significant lowering of blood pressure after nephrectomy was observed in Case 2 only. In Case 1 and 5, increased responsiveness to hypotensive drugs was observed. In Case 4, lowering of blood pressure was observed prior to the operation.
