Fujii S, Kasahara H, Oguchi H
Department of Cardiology, Hatano Red Cross Hospital, Japan.
Nihon Jinzo Gakkai Shi. 1991 Oct;33(10):1017-24.
A 66-year-old male patient of renovascular hypertension with nephrotic syndrome was described. Besides, focal segmental glomerulosclerosis like lesion was accompanied in the contralateral kidney. On admission, his blood-pressure amounted to 220/140 mmHg. Laboratory investigation included; urinary protein 10.5 g/day, serum creatinine 1.8 mg/dl, creatinine clearance 71.4/day, plasma renin activity 10.0 ng/ml/hr, angiotensin I 890 pg/ml and angiotensin II 40.0 pg/ml. Renogram and renal scintigram showed non-functioning pattern of left kidney. Arteriography disclosed approximately more than 95% stenosis of left main artery. Administration was discontinued because of poor control both in blood pressure and in proteinuria. After the left nephrectomy, the former normalized and the latter decreased. Microscopic examination of the right kidney revealed focal segmental glomerulosclerosis like lesion. So far as we know, this report is the first designed to elucidate renovascular hypertension with nephrotic syndrome accompanied by focal segmental glomerulosclerosis like lesion. The relationship between renovascular hypertension and nephrotic syndrome, and microscopic findings has been briefly discussed. It is suggested that the etiology of focal segmental glomerulosclerosis like lesion may be based on compensatory glomerular hyperfiltration caused by renovascular hypertension.
本文描述了一位66岁患有肾血管性高血压并伴有肾病综合征的男性患者。此外，对侧肾脏伴有局灶节段性肾小球硬化样病变。入院时，他的血压为220/140 mmHg。实验室检查结果如下：尿蛋白10.5 g/天，血清肌酐1.8 mg/dl，肌酐清除率71.4/天，血浆肾素活性10.0 ng/ml/hr，血管紧张素I 890 pg/ml，血管紧张素II 40.0 pg/ml。肾图和肾闪烁扫描显示左肾无功能。动脉造影显示左主动脉狭窄约95%以上。由于血压和蛋白尿控制不佳，治疗中断。左肾切除术后，血压恢复正常，蛋白尿减少。右肾的显微镜检查显示局灶节段性肾小球硬化样病变。据我们所知，本报告是首例旨在阐明伴有局灶节段性肾小球硬化样病变的肾血管性高血压合并肾病综合征的报告。本文简要讨论了肾血管性高血压与肾病综合征之间的关系以及显微镜下的表现。提示局灶节段性肾小球硬化样病变的病因可能基于肾血管性高血压引起的代偿性肾小球高滤过。
