所謂特発性腎出血について
1961 年 52 巻 2 号 p. 189-215
詳細
1961 年 52 巻 2 号 p. 189-215
From animal experiments and clinical studies on patients with so-called essential renal bleeding, the following results were obtained;
1) In animal experiments, macroscopic hematuria developed following repeated anaphylactic shock. Histological examination of the kidney of these animals with macrohematuria revealed such abnormal findings as interstitial edema and hemorrhage, dilatation of capillary, degenerative changes in tubular cells, and hemorrhage into the tubular lumen. These morphological changes were interpreted as the expression of allergic phenomena. Macrohematuria also developed following stimulation of autonomic nerve.
2) There have been 46 inpatients and 35 outpatients with so-called essential renal bleeding among 21169 patients visited our clinic during the last 13years. Nineteen inpatients were treated with nephrectomy and 12 inpatients with nephropexy. The other 15 inpatients were treated conservatively.
3) Histological examination was carried out on the kidneys from 13 cases treated with nephrectomy. Histological diagnosis of circumscribed interstitial nephritis was made in six cases, among which one was complicated with glomerulonephritis and another with varix. A diagnosis of glomerulonephritis was made in one case and allergic inflammation in one case. In the other 5 ceses, virtually no inflammatory changes were found histologically, although hemorrhage to the tubular lumen was seen.
4) Capillary congestion and dilatation, hyalinization of capillary wall, diapedic hemorrhage in the surrounding tissue of vein, or hemorrhage to the Bowmans capusule, to the glomerulus and to the tubular lumen were most commonly found in the kidneys from both experimental animals and clinical cases. It was suggested that that these changes resulted from congenital and acquired vulnerability of the local vascular wall. This acquired vulnerability seemed to result from local inflammatory process, circulatory disturbances due to overloading or abnormality of innervation.
5) Twelve cases with so-called essential renal bleeding were following nephropexy.
6) Erect posture pyelography revealed a stenosis at the pyelo-ureteral junction or displacement of the kidney in 6out of 12 cases treated with nephropexy.
7) It was suggested that erect posture pyelography was inportant procedure in making diagnosis of so-called essential renal bleeding, since it was possible from the findings obtaind by the procedure to differential the hematuria due to movable kidney from that due to so-called essential renal bleeding.
