A case of nephrotic syndrome associated with renovascular hypertension
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A 38 year-old man complained of headache visited a physician Hypertension, 160/90 mmHg, was pointed ont, and no findings were revealed in urinalysis at that time. The blood pressure was decreased to 130/80 mmHg with 3-month administration of hydrochlo-romethiazide (50 mg/day)., proteinuria was first mentioned, and the blood pressure was 180/120mmHg. He was referred to the Hospital on, with chief complaints of severe headache and edema on lower extremities. Hypertension ranged 240/150 to 160/120 mmHg. Laboratory findings showed urine protein 10-50g/day, plasma albumin 2.4g/100ml, plasma cholesterol 356mg/100ml, plasma potassium 3.1mEq/L, plasma renin activity 14.0ng/ml/h and plasma aldosterone concentration 58ng/100m1. Intravenous pyelogram, renogram and renoscintigram showed that the right kidney was working poorly, and retrograde transfemoral aortogram revealed stenosis of right main renal artery. Hypertension could not be improved with α-methyldopa, spinorolactone, hydralazine, pindolol and trichloromethiazide, so that right nephrectomy was performed. About three weeks post operatively, the blood pressure fell to 146/90 mmHg and proteinuria decreased to 1.0-2.5 g/day. Plasma renin activity and plasma aldosterone concentration fell to 1.2 ng/ml/h and 6.0 ng/100 ml, respectively. Hypercholesteremia, hypoalbuminemia and hypokalemia were improved. Microscopic examination of the right kidney revealed that most glomeruli were completely hyalinized, arterioles showed a great increase in medial width and neither infiltration of small round cells nor necrosis was found around the arterioles. The pathologic diagnosis was renal atrophy followed by artery stenosis due to arteriosclerosis. It is suspected that the nephrotic syndrome was induced by hypertension and high renin-angiotensin-aldosterone.
- 社団法人 日本腎臓学会の論文
社団法人 日本腎臓学会 | 論文
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