Salifu M O, Gordon D H, Friedman E A, Delano B G
Department of Medicine, Division of Nephrology, State University of New York Health Sciences, Brooklyn, NY 11203, USA.
Am J Kidney Dis. 2000 Jul;36(1):184-9. doi: 10.1053/ajkd.2000.8292.
We report a case of bilateral renal infarction in a patient with medial fibrous dysplasia of both renal arteries and a thrombosed aneurysmal dilatation of the right renal artery. A previously healthy 40-year-old black man presented to the emergency department with acute onset of bilateral flank pain. Computerized tomography of the abdomen showed bilateral renal infarction, predominantly affecting the anterior distribution of both renal arteries. Estimated loss of renal mass was 50% on the right and 25% on the left. The patient was treated with intravenous heparin, oral warfarin, and antihypertensive therapy with labetolol and long-acting nifedipine. By day 3, his abdominal pain resolved; however, the serum creatinine level increased to a maximum value of 2.6 mg/dL. The serum creatinine level slowly improved and stabilized at 1.9 mg/dL, and he was subsequently discharged on the seventh hospital day. Magnetic resonance angiography performed 2 months later showed "beading2 of both renal arteries consistent with medial fibromuscular dysplasia, a finding confirmed by conventional angiography. To our knowledge, bilateral renal infarction complicating medial fibrous dysplasia of the renal arteries has not been previously reported, nor has medial fibrous dysplasia been reported in blacks.
我们报告了一例双侧肾梗死病例，该患者患有双侧肾动脉内侧纤维发育不良以及右侧肾动脉血栓形成的动脉瘤样扩张。一名此前健康的40岁黑人男性因双侧胁腹疼痛急性发作就诊于急诊科。腹部计算机断层扫描显示双侧肾梗死，主要影响双侧肾动脉的前部分布。估计右侧肾实质损失50%，左侧为25%。患者接受了静脉注射肝素、口服华法林以及使用拉贝洛尔和长效硝苯地平进行降压治疗。到第3天时，他的腹痛缓解；然而，血清肌酐水平升至最高值2.6mg/dL。血清肌酐水平缓慢改善并稳定在1.9mg/dL，随后他在住院第7天出院。2个月后进行的磁共振血管造影显示双侧肾动脉呈“串珠样”改变，符合内侧纤维肌发育不良，这一发现经传统血管造影证实。据我们所知，双侧肾梗死并发肾动脉内侧纤维发育不良此前未见报道，黑人中也未见内侧纤维发育不良的报道。
