腎腫瘍の全身症状

抄録

In most patients with renal tumor, so-called three main symptoms such as hematuria, a palpable mass and flank pain develop and their diagnosis usually present little difficulty. However, in a significant number of cases, such symptoms are not present at the onset of this disease, and internist rather than urlogist is consulted for explanation for a fever of unknown origin, unexplained weakness, anorexia, loss of body weight and anemia. Besides these symptoms and signs, renal tumor, especially hypernephroma, may present with polycythemia, hypertension, high serum level of alkali-phosphatase, hypercalcemia, amyloidis and exanthema of the skin etc.
Recently we experienced a case of hypernephroma accompanied with fever which continued one year its origin unknown. The patient was a 60 year old female and in February, 1962, because of fever (38-39°C) visited few hospitls where many kinds of examinations were carried out.
But no pathological finding except acceleration of blood sedimentation rate was disclosed and under presumptive diagnosis of pneumonia and others, she was treated with antibiotics, antipyretica and/or cortison. Neverthless her fever continued until nephrectomy which was performed by us in February, 1963, under the diagnosis of left renal tumor. Her blood count and blood chemistry were normal. After discharge her fever maintained normal level, but unfortunately she died in July, 1963 at her home and autopsy was not carried out.
There are a lot of literatures discussing on the relation between renal tumr and fever, polycythemia, anemia, hypertension and several literatures on hypercalcemia, amyloidosis, high serum level of alkali-phosphatase and exanthema of the skin.
In this paper we reviewed those literatures and discussed possibility and pathogenesis that hypernephroma presens with systemic manifestations such as fever etc.
Because of the often onset with non-urological or atypical symptoms in case of this disease, a considerable period of time elapses and a delayed rather than an early diagnosis is made. Accordingly it is advisable to take intravenous pyelogram when a patient complains unexplained above mentioned systemic symptoms and manifestations. Then it will bring about more instances of correct diagnosis at an earlier stage of this disease and thereby improves the present poor end-results.