透析患者に発生したタンパク結石による膿腎症の1例

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56歳男.主訴は発熱,右腰背部痛.右上部尿路の感染が疑われたため,右逆行性腎盂造影及びシングルJカテーテル留置を施行した.右腎盂内溶液は膿状で悪臭を伴っており,細胞診は陰性,培養でEnterococcus faecalisが検出された.逆行性腎盂造影では,腎杯及び腎盂内に複数の陰影欠損を認めた.抗生剤(イミペネム)投与により発熱は軽快し,白血球・CRPも正常化した.右腎摘除術を施行し,腎杯,腎盂内に黒色・泥炭状物質を認めた.術後経過は良好で12日目に退院となったWe report a case of pyonephrosis caused by a protein calculus in a patient on hemodialysis. A 56-year-old man had been treated with dialysis for five years because of end-stage renal failure. The patient complained of right lumbar back pain and fever. Computed tomography and an ultrasonography revealed right hydronephrosis. Pyonephrosis was strongly suspected. A single-J catheter was indwelt, cloudy pus with a terrible smell was discharged. After reducing inflammation, a right nephrectomy was performed. The analysis of stone component revealed mostly a protein calculus, which was a black and turf-like substance in the calices. Patients undergoing dialysis often develop urinary calculi. Some calculi are composed of beta2-microglobulin-origin amyloid, which is very difficult to find with diagnostic imaging.