Luger A M, Bauer J H, Neviackas J A, Lee H T, Nichols W K
Am J Nephrol. 1981;1(3-4):168-72. doi: 10.1159/000166534.
Presented is a unique case of accelerated hypertension in a 26-year-old black man. Clinically, the patient was found to have a left renal artery lesion and lateralizing renal vein renins. At surgery, a stenosing lesion was found in the artery supplying the upper pole of the left kidney. This was caused by a densely fibrotic mass involving the main renal artery. Microscopy revealed a necrotizing arteritis with no other arteries involved. This case of primary necrotizing arteritis of the main renal artery appears to represent a new entity because of its pathological and clinical differences with the known forms of large vessel arteritis. It is possible that this may represent a particularly acute and necrotizing stage of Takayasu's aortitis, or an extremely rare case of classical periarteritis nodosa confined solely to the main renal artery. The renin tissue assays document the hyperreninemia produced by arterial stenosis. The differential diagnosis of the lesion is considered, and the pathophysiology of hypertension due to large vessel arteritis is discussed.
本文介绍了一名26岁黑人男性的加速性高血压罕见病例。临床上，该患者被发现有左肾动脉病变及肾静脉肾素侧移。手术中，在供应左肾上极的动脉中发现了一个狭窄病变。这是由一个累及主肾动脉的致密纤维化肿块引起的。显微镜检查显示为坏死性动脉炎，无其他动脉受累。主肾动脉原发性坏死性动脉炎这一病例似乎代表了一种新的疾病实体，因为它在病理和临床方面与已知的大血管动脉炎形式存在差异。这可能代表了高安动脉炎的一个特别急性和坏死阶段，或者是仅局限于主肾动脉的极为罕见的经典结节性多动脉炎病例。肾素组织检测证明了动脉狭窄导致的高肾素血症。文中考虑了该病变的鉴别诊断，并讨论了大血管动脉炎所致高血压的病理生理学。
