Fusamae Juri, Nishino Tomoya, Uramatsu Tadashi, Obata Yoko, Furusu Akira, Sakamoto Ichiro, Kohno Shigeru
Second Department of Internal Medicine, Nagasaki University Hospital, Nagasaki, Japan.
Nihon Jinzo Gakkai Shi. 2011;53(8):1164-9.
A 48-year-old man was admitted to the Department of Cardiovascular Surgery in our hospital after developing Stanford type B acute aortic dissection with a patent false lumen in July 2008. Conservative treatment involving rest and antihypertensive therapy was provided following admission. Urine volume decreased from day 9, and serum creatinine increased to 7.7 mg/dL. As it was suspected that the reduced renal blood flow was caused by progression of aortic dissection, contrast-enhanced computed tomography (CT)was performed. The left kidney showed reduced enhancement and the right kidney was heterogeneously enhanced. The dissection had extended to the left renal artery, and the reduced renal blood flow caused by narrowing of the left renal artery was thought to have caused the renal dysfunction. As elevated urea nitrogen and serum creatinine levels and hyperkalemia persisted, hemodialysis was performed a total of four times. Although the patient was subsequently withdrawn from dialysis, he continued to display severe renal dysfunction and was transferred to our department on day 28 for the treatment of renal failure. Conservative treatment was continued, but the maximum diameter of the thoracic aorta gradually increased, and stent placement at the entry of aortic dissection was indicated. On day 86, two stent-grafts were placed for entries at the distal site of the descending aorta and the distal site of the aortic arch. Postoperative abdominal contrast-enhanced CT showed expansion of the true lumen, and blood flow and contrast enhancement improved in both kidneys. Postoperatively, serum creatinine gradually decreased, improving to 1.16 mg/dL on day 96. Renography in the third month after stent-graft placement showed improved renal function in both kidneys. These findings suggest that even at approximately 2 months after the onset of acute renal failure associated with aortic dissection, renal function can be improved by restoring blood flow in the renal arteries.
一名48岁男性于2008年7月发生Stanford B型急性主动脉夹层且假腔通畅后，入住我院心血管外科。入院后给予包括休息和降压治疗在内的保守治疗。从第9天起尿量减少，血清肌酐升至7.7mg/dL。由于怀疑肾血流量减少是由主动脉夹层进展所致，遂行增强计算机断层扫描（CT）。左肾强化减弱，右肾强化不均匀。夹层已延伸至左肾动脉，左肾动脉狭窄导致的肾血流量减少被认为是造成肾功能障碍的原因。由于尿素氮和血清肌酐水平升高以及高钾血症持续存在，共进行了4次血液透析。尽管患者随后停止透析，但仍表现出严重的肾功能障碍，并于第28天转至我科治疗肾衰竭。继续进行保守治疗，但胸主动脉最大直径逐渐增大，遂决定在主动脉夹层入口处放置支架。在第86天，在降主动脉远端和主动脉弓远端入口处放置了两个覆膜支架。术后腹部增强CT显示真腔扩张，双肾血流及强化改善。术后血清肌酐逐渐下降，在第96天降至1.16mg/dL。覆膜支架置入后第三个月的肾图显示双肾功能均有改善。这些结果表明，即使在与主动脉夹层相关的急性肾衰竭发病约2个月后，通过恢复肾动脉血流仍可改善肾功能。
