Hall S K
Department of Emergency Medicine, Kaiser Permanente Medical Center, Sacramento, CA 95865-2115.
J Emerg Med. 1993 Nov-Dec;11(6):691-700. doi: 10.1016/0736-4679(93)90628-k.
Two adult patients with acute renal vascular occlusion with infarction are described. Both patients were believed to have ureteral colic. In each instance, the correct diagnosis was overlooked at the initial emergency department visit. An uncommon clinical entity that continues to go undiagnosed, acute vascular occlusion of the kidney must be considered in the differential diagnosis of acute flank pain. Absence of the nephrogram phase on an intravenous pyelogram (IVP) should alert emergency physicians to this possible diagnosis and to the need for further work-up. Subsequent diagnostic evaluation should begin with renal ultrasonography to rule out obstructive uropathy. If hydroureteronephrosis is not present, follow-up perfusion studies are necessary to confirm the absence of renal perfusion. Greater awareness of this uncommon clinical entity and its potential morbidity is essential to correct diagnosis and management.
本文描述了两名患有急性肾血管闭塞伴梗死的成年患者。两名患者最初均被认为患有输尿管绞痛。在每例病例中，首次急诊就诊时均忽略了正确诊断。急性肾血管闭塞是一种仍未得到诊断的罕见临床病症，在急性腰痛的鉴别诊断中必须考虑到这一病症。静脉肾盂造影（IVP）中肾图期缺失应提醒急诊医生注意这一可能的诊断以及进一步检查的必要性。后续诊断评估应首先进行肾脏超声检查以排除梗阻性尿路病。如果不存在输尿管肾盂积水，则有必要进行后续灌注研究以确认肾脏灌注是否缺失。提高对这种罕见临床病症及其潜在发病率的认识对于正确诊断和管理至关重要。
