両側腎動脈狭窄を伴った腎血管性高血圧症の外科的治療

I. 臨床的検討

抄録

Of 15 patients with renovascular hypertension having stenotic lesions of both renal arteries, the effects of surgical treatment on blood pressure were analyzed in relation to renal function studies performed preoperatively.
Rapid sequence intravenous pyelography showed abnormalities in 14 of 15 patients. The results of split renal function studies successfully performed showed the finding consistent with the positive criteria for unilateral renal ischemia in 5 of 7 patients. Bilateral renal venous and peripheral venous renin assays were performed in 10 patients. Five of them had a similar pattern of the PRA ratio to that noted in a group of patients with hypertension caused by unilateral renal artery stenosis; the renal venous renin level from the more severely affected side was higher than that from the less severely affected side, which was the same as the peripheral venous renin level.
Four of 5 patients with positive split renal function studies and 3 of 5 patients with positive renal venous renin assays underwent unilateral operation on the positive side. All of them were cured or improved.
Therefore, it is reasonable to expect that unilateral renal vascular repair or unilateral nephrectomy based on the physiological information provided by the ratio of three different vein renins and split renal function studies as above mentioned is sufficient of correct renovascular hypertension associated with bilateral renal artery stenosis.