Fukushima T, Saiki T, Jyo Y, Sasaki T, Satoh T, Nomura S, Hirano H, Osawa G
Kawasaki Medical School, Division of Nephrology, Okayama, Japan.
Nihon Jinzo Gakkai Shi. 1995 Oct;37(10):595-9.
A 68-year-old male patient with renovascular hypertension (RVHT) and nephrotic syndrome (NS) is described. He was admitted to our hospital for detailed investigation of severe hypertension and massive proteinuria. After admission, a diagnosis of RVHT with a right non-functional kidney and NS was made. Nephrectomy and contralateral renal biopsy were performed for refractory hypertension and detailed investigation of the NS, respectively. The renal biopsy showed focal segmental glomerulosclerosis (FGS) in the left kidney, whereas the nephrectomised kidney exhibited only ischemic change. After the operation, his blood pressure became stable without anti-hypertensive agents, but proteinuria remained in the nephrotic range. Six months later, proteinuria had disappeared and his renal function was stable. These findings suggest that NS and FGS might have resulted from an activated renin-angiotensin-axis and that the prolonged NS was due to severe glomerular injury. Although there have been many reports describing the relationship between RVHT and FGS in an experimental environment, this relationship is very rare in clinical cases. Therefore we present this case to increase understanding of the cause of FGS.
本文描述了一名68岁患有肾血管性高血压（RVHT）和肾病综合征（NS）的男性患者。他因严重高血压和大量蛋白尿入院接受详细检查。入院后，诊断为右肾无功能的RVHT和NS。分别对难治性高血压进行了肾切除术，对NS进行了对侧肾活检。肾活检显示左肾局灶节段性肾小球硬化（FGS），而切除的肾脏仅表现出缺血性改变。术后，他的血压在未使用抗高血压药物的情况下变得稳定，但蛋白尿仍处于肾病范围。六个月后，蛋白尿消失，肾功能稳定。这些发现表明，NS和FGS可能是由激活的肾素-血管紧张素轴引起的，而长期的NS是由于严重的肾小球损伤所致。尽管有许多报道描述了实验环境中RVHT与FGS之间的关系，但这种关系在临床病例中非常罕见。因此，我们展示此病例以增进对FGS病因的理解。
