レニン依存性を証明した高血圧を伴う巨大じん動脈りゅうの１例

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  • Renin-Dependent Hypertension in a Case with a Giant Renal Artery Aneurysm
  • レニン イゾンセイ オ ショウメイシタ コウケツアツ オ トモナウ キョダイ

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We report a case with a giant aneurysm of the renal artery presenting hypertension which was successfully normalized after surgical removal of aneurysm. We demonstrated the renin-dependency of the hypertension using inhibitors of the renin-angiotensin system, such as angiotensin II analogue and coverting enzyme inhibitor.<BR> The case is a 37 year old female, who was admitted because of hypertension (178/100 mmHg), abdominal pulsating tumor, macroscopic hematuria, fever, ane right flank pain. A huge aneurysm was detected by abdominal CT-scan and selective renal angiography, extending from the origin of the right renal artery to the hilus of the right kidney. Plasma renin activity and aldosterone concentration at rest were 4.7 ng/ml/hr and 107 pg/ml, respectively, which were slightly higher than normal values. Both the infusion of angitensin II analogue ([Sar1, Ile8] AII) after sodium depletion and oral administration of 100 mg of captopril while on normal sodium diet caused significant reduction of mean blood pressure by 28 mmHg and 38 mmHg, respectively. Blood pressure was well controlled preoperatively by captopril 37.5 mg t. i, d. After the right nephrectomy and the closure of the orifice of the aneurysm blood pressure was lowered to 120/70 mmHg. Fever and the right flank pain disappeared.<BR> The case is of interest in two points. First, the size of the aneurysm was extremely large. Second, the renin-dependency of the hypertension was demonstrated.

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