繰り返す心不全と維持透析導入から離脱しえた腎動脈狭窄症の一例

A ７２-year-old woman with chronic renal failure and hypertension was admitted to Tokushima University Hospital due to progressive dyspnea. The patient had a history of right nephrectomy for renal tubular carcinoma two years before admission. The patient was diagnosed as acute left ventricular decompensation with pulmonary edema, and dyspnea was improved by means of mechanical ventilation. Although diuretics and antihypertensive agent were given intensively, acute pulmonary edema easily recurred with deterioration of renal function, and continuous hemodiafiltration（ CHDF）was required. Abdominal ultrasound showed marked increase of blood flow velocity of left renal artery, suggesting renal artery stenosis. Renal angiography with ultrasound guidance revealed narrowing of left renal artery ostia, and percutaneous transluminal renal angioplasty（ PTRA）with stenting placement was performed. Renal dysfunction and blood pressure control were improved immediately after PTRA, and the patient became asymptomatic.