Klein R M, Niehues R, Hollenbeck M, Horstkotte D, Fürst G, Strauer B E
Abteilung für Kardiologie, Pneumologie und Angiologie, Universität Düsseldorf.
Dtsch Med Wochenschr. 1992 Jul 31;117(31-32):1185-90. doi: 10.1055/s-2008-1062429.
A 33-year-old previously completely healthy man developed severe, at first colicky then persisting, pain in the left flank. The blood pressure was 190/110 mm Hg and he had pain over the left kidney on percussion. There was a mild leucocytosis (10,300/microliters), serum creatinine of 1.5 mg/dl and a rise in lactate dehydrogenase level to 395 U/l, while the urine was unremarkable. The pyelogram demonstrated on the left the upper calyceal system only and this very weakly. Colour Doppler ultrasound showed a massively reduced blood flow in the left renal vein while the artery was not visible. Digital subtraction angiography demonstrated eccentric narrowing of the left renal artery by an intravascular thrombus, providing the diagnosis of spontaneous renal artery dissection with thrombosis. Complete recanalization occurred after local thrombolysis with 500,000 IU urokinase over 7 hours, and subsequent administration of four times 40 mg tissue plasminogen activator over 4 hours. But the scintigram still demonstrated impaired renal function with decrease in clearance to 10% of total. The patient was still symptom-free on re-examination 16 months later, serum creatinine concentration was stable at 1.3 mg/dl and the blood pressure was normal.
一名33岁既往完全健康的男性出现左侧腰部严重疼痛，起初为绞痛，随后持续存在。血压为190/110 mmHg，叩诊左肾区有疼痛。有轻度白细胞增多（10300/微升），血清肌酐为1.5 mg/dl，乳酸脱氢酶水平升至395 U/l，而尿液无异常。肾盂造影显示左侧仅见上肾盏系统，且显影非常淡。彩色多普勒超声显示左肾静脉血流大幅减少，而动脉未见显示。数字减影血管造影显示左肾动脉被血管内血栓偏心性狭窄，诊断为自发性肾动脉夹层伴血栓形成。经7小时局部溶栓500000 IU尿激酶，随后4小时内四次给予40 mg组织纤溶酶原激活剂后实现完全再通。但肾闪烁扫描仍显示肾功能受损，清除率降至总量的10%。16个月后复查患者仍无症状，血清肌酐浓度稳定在1.3 mg/dl，血压正常。
