抄録
A 42 aged male who had an onset of speech disturbance and was diagnosed as cerebral thrombosis in Sept., 1970, was found to have hypertension and polycythemia. Ten months later, he was refered to our clinic for a thorough examination of erythrocytosis.
Physical examination on admission revealed a soft, uneven, palm-sized tumor palpable in the right abdomen. Liver and spleen were not palpable. Hematological examination showed RBC 6.8 million, Hb 19.8gm/dl, Ht 61%, WBC 5000, pl. 270×103. Bone marrow aspirate showed an increased erythroblasts but no atypical cells. Liver function tests and electrolytes values were within normal limits. Total red cell volume (TRCV) and erythropoietin activity in urine (59Fe-uptake method in starveted rats) were markedly increased.
On plain x-ray film multiple small calcified shadows were found in the right abdomen. Intravenous and retrograde pyelogram, aortogram, selective renal angiogram and renogram suggested a right giant renal tumor probably due to obstructive nephropathy.
The right extirpated kidney was 27×16×9 cm. in size and weighed 2000 gm. The pelves were occupied with caseous mass, and consequently the renal parenchyma was atrophied. The preoperative diagnosis of tuberculous pyonephrosis was confirmed.
Three weeks after nephrectomy the blood counts were RBC 5.2 million, Hb 16.1 gm/dl, Ht 47%. The TRCV was 47.6ml/kg, and erythropoietin activity in urine was markedly decreased. Three months later, the hematological findings were still within normal limits, and no tendency of erythrocytosis was seen.
