Renovascular hypertension: A unique cause of unilateral focal segmental glomerulosclerosis
Renovascular hypertension: A unique cause of unilateral focal segmental glomerulosclerosis
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DOI：
10.1291/hypres.29.203
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发表时间：
2006-03-01
影响因子：
5.4
通讯作者：
Gejyo, Fumitake
中科院分区：
文献类型：
--
作者：
Alchi, Bassam;Shirasaki, Arimasa;Gejyo, Fumitake
一位48岁男性因恶性高血压和大量蛋白尿而就诊。肾血管造影显示左肾动脉完全阻塞，Tc-99 m-巯基乙酰甘氨酸（MAG（3））肾造影显示左肾无功能。左肾动脉的经皮腔内肾血管成形术不成功;因此，患者因无法控制的高血压和蛋白尿接受左肾切除术。右肾组织学检查发现局灶节段性肾小球硬化伴良性肾硬化。相反，左肾的组织学显示典型的缺血性肾伴小动脉平滑肌细胞肥大。患者对肾切除术反应良好，因为他的血压和尿蛋白急剧下降，没有抗高血压药物。本病例说明了单侧肾动脉狭窄引起的肾血管性高血压患者的肾脏中，肾素-血管紧张素系统的异质效应。
A 48-year-old man presented with malignant hypertension and massive proteinuria. Renal angiography showed complete obstruction of the left renal artery and Tc-99m-mercaptoacetylglycine (MAG(3)) renography showed a nonfunctioning left kidney. Percutaneous transluminal renal angioplasty of the left renal artery was unsuccessful; hence, the patient underwent left nephrectomy because of uncontrolled hypertension and proteinuria. Histological examination of a right kidney specimen revealed lesions of focal segmental glomerulosclerosis with benign nephrosclerosis. In contrast, histology of the left kidney showed typical ischemic kidney with hypertrophy of arteriolar smooth muscle cells. The patient responded favorably to the nephrectomy, as his blood pressure and urinary protein dramatically decreased with no antillypertensive medication. This case illustrates the heterogeneous effect of the renin-angiotensin system on either kidney in patients with renovascular hypertension due to unilateral renal artery stenosis.