Schramek A, Better O S, Adler O, Tuma S, Hashmonai M, Barzilai A, Chaimowitz C
Lancet. 1975 Jan 11;1(7898):70-1. doi: 10.1016/s0140-6736(75)91073-9.
Two patients with kidney transplants had hypertensive encephalopathy and rapidly progressive kidney failure 10 weeks and 18 months postoperatively. In one patient renal failure was associated with erythrocytosis. Absence of proteinuria, despite progressive renal insufficiency in both patients, suggested that these abnormalities were not due to rejection episodes. Subsequently, angiography proved that each of these patients had renal-artery stenosis. Surgical repair of this lesion increased creatinine clearance at least threefold, and the hypertension and erythrocytosis disappeared. Apparent "rejection" episodes in which there is no proteinuria should alert clinicians to the possiblity of renal-artery stenosis of the graft. Restoration of kidney function and amelioration of hypertension may follow revascularisation, even after many months of renal ischaemia producing severe uraemia.
两名肾移植患者在术后10周和18个月出现高血压脑病和快速进展的肾衰竭。其中一名患者的肾衰竭与红细胞增多症有关。尽管两名患者均有进行性肾功能不全，但无蛋白尿，提示这些异常并非由排斥反应引起。随后，血管造影证实这两名患者均有肾动脉狭窄。手术修复该病变使肌酐清除率至少提高了三倍，高血压和红细胞增多症也消失了。无蛋白尿的明显“排斥”发作应提醒临床医生注意移植肾动脉狭窄的可能性。即使在肾缺血导致严重尿毒症数月之后，血管重建后肾功能仍可恢复，高血压也可改善。
