Picatoste y Patiño J, González Tutor A, Martín García B, Hernández Rodríguez R, Calabria de Diego A, Pagola Serrano M A, Portillo Martín J A
Arch Esp Urol. 1979 Mar-Apr;32(2):125-42.
Massive kidney infarct, due to total occlusion of the main artery, is not a frequent process in clinical urology. The most frequent causes are endocarditis, arteritis, atheromatosis and traumatisms. The complete blockage of the renal artery means that the tissue irrigated by the same is bloodless and prone to necrosis and it must be taken into account that although the renal parenchyma cannot withstand for more than 1 to 2 hours the lack of a blood supply, the obstructions or ischemias of shorter duration cause tissue disorders of greater or lesser importance, affecting more quickly and more intensely the cells of the tubules, than those of the glomerules and later the connecting tissue. Clinically, kidney infarcts may sometimes go unobserved and on many other occasions their symptoms are by no means typical although the most characteristic feature is a more intense, sharp, acute pain with macroscopic hematuria, proteinuria and cylindruria and, in the radiological exploration, kidney "silence" but with the excretory duct intact shown by means of retrograde uretero-pyelography. The kidney angiography will reveal the existence of the arterial obstruction, with the resulting avascular image. Extrapremature surgical treatment would be ideal in the cases of massive infarct but this would also require an extrapremature diagnosis, which would enable the embolectomy (where necessary to be carried out, thereby saving the kidney. However, under normal working conditions, taking into account the period of time which inevitably elapses between the patient feeling pain in the kidney and his reaching the Emergency Department and the necessary examinations being carried out which enable the correct diagnosis to be made, the number of hours which have passed make attempts at conservative surgery completely useless. The authors present the case of a 37-year old patient who, 15 days after presenting a picture of right kidney colic, went to the Emergency Department in our Centre where the doctor on duty merely performed a symptomatic treatment and the patient was not admitted to our Department until several days later. In the different radiourographic examinations carried out, right kidney mutism was observed, as well as the permeability of the excretory duct. The aortography revealed the total occlusion of the right renal artery. As more than 20 days had elapsed since the patient first presented the colic pain and before we examined him, there was no other therapeutic solution but the performing of a nephrectomy. The examination of the organ removed confirmed the diagnosis but the origin of the arterial obstruction could not be clarified for sure.
由于主肾动脉完全闭塞导致的大面积肾梗死，在临床泌尿外科中并非常见病症。最常见的病因是心内膜炎、动脉炎、动脉粥样硬化和外伤。肾动脉的完全阻塞意味着由其供血的组织缺血，易于坏死，必须考虑到，尽管肾实质无法耐受超过1至2小时的血液供应缺乏，但持续时间较短的梗阻或缺血会导致程度不同的组织紊乱，与肾小球细胞相比，肾小管细胞受到的影响更快、更强烈，随后是结缔组织。临床上，肾梗死有时可能未被察觉，在许多其他情况下，其症状也绝非典型，尽管最具特征性的表现是更剧烈、尖锐、急性的疼痛，并伴有肉眼血尿、蛋白尿和管型尿，在放射学检查中，肾脏“无功能”，但逆行输尿管肾盂造影显示排泄管道完整。肾血管造影将揭示动脉阻塞的存在以及由此产生的无血管影像。对于大面积梗死病例，过早的手术治疗是理想的，但这也需要过早的诊断，以便能够进行栓子切除术（必要时进行），从而挽救肾脏。然而，在正常工作条件下，考虑到患者感到肾痛到抵达急诊科以及进行必要检查以做出正确诊断之间不可避免地会经过一段时间，已经过去的小时数使得保守手术尝试完全无用。作者介绍了一名37岁患者的病例，该患者在出现右肾绞痛症状15天后前往我们中心的急诊科，值班医生仅进行了对症治疗，几天后该患者才被收入我们科室。在进行的不同放射学检查中，观察到右肾无功能，以及排泄管道通畅。主动脉造影显示右肾动脉完全闭塞。由于自患者首次出现绞痛症状以来已经过去了20多天，在我们对他进行检查之前，除了进行肾切除术外没有其他治疗方案。切除器官的检查证实了诊断，但动脉阻塞的起源无法确切查明。
