Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Kidney Res Clin Pract. 2016 Jun;35(2):119-22. doi: 10.1016/j.krcp.2015.08.006. Epub 2015 Sep 2.
Renal artery stenosis (RAS) is commonly presented with hypertension and chronic kidney disease. We report a rare case of RAS occurring in a 78-year-old man who presented with nephrotic-range proteinuria. Renal biopsy on the left side was performed, and results showed mesangiopathic glomerulonephritis, which was not compatible with the cause of nephrotic-range proteinuria. Proteinuria was decreased by angiotensin receptor blocker, but azotemia was aggravated. Therefore, angiotensin receptor blocker was discontinued inevitably and thorough evaluation for the possibility of RAS was performed. Computed tomography angiography revealed significant RAS on the left side and a renal artery stent was inserted. After stenting, aortic dissection developed and progressed despite tight control of blood pressure. After inserting another stent graft through the true lumen of the left renal artery, the patient's renal function and proteinuria improved markedly.
肾动脉狭窄（RAS）常表现为高血压和慢性肾脏病。我们报告了一例罕见的 RAS 病例，发生在一名 78 岁男性，表现为肾病范围蛋白尿。对左侧肾脏进行了活检，结果显示为系膜性肾小球肾炎，这与肾病范围蛋白尿的原因不相符。血管紧张素受体阻滞剂可减少蛋白尿，但血氮质升高。因此，不可避免地停用了血管紧张素受体阻滞剂，并对 RAS 的可能性进行了彻底评估。计算机断层血管造影显示左侧存在显著的 RAS，并置入了肾动脉支架。支架置入后，尽管严格控制血压，仍发生并进展为主动脉夹层。通过左肾动脉真腔插入另一个支架移植物后，患者的肾功能和蛋白尿明显改善。
