Journal of JCIC

Online edition: ISSN 2432–2342
JCIC学会事務局 JCIC学会事務局
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Journal of JCIC 6(1): 5-11 (2021)


小児腎血管性高血圧における経皮的腎動脈形成術による患側腎のリバースリモデリングMorphological and functional reverse remodeling of the affected kidney after percutaneous transluminal angioplasty in a child with renovascular hypertension

1昭和大学医学部小児科学講座Showa University School of Medicine, Department of Pediatric

2昭和大学病院小児循環器・成人先天性心疾患センターPediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital

3東京衛生アドベンチスト病院小児科Tokyo Adventist Hospital,Department of Pediatric

受付日:2021年2月18日Received: February 18, 2021
受理日:2021年5月10日Accepted: May 10, 2021
発行日:2021年8月31日Published: August 31, 2021

腎血管性高血圧症および患側腎萎縮を伴った限局性の高度腎動脈狭窄に対し,経皮的腎動脈形成術が著効した1歳男児例を経験した.右腎動脈は最狭窄部径0.4 mm(参照血管径2.0 mm)と高度に狭窄し,患側腎は萎縮と機能低下を認めていた.高血圧は難治性で降圧薬の効果は不十分であった.SHIDEN 2 mm/2 cm(カネカメディックス,大阪)を用いて経皮的腎動脈形成術を施行,7ヶ月後に狭窄部の形態は正常化,1年2ヶ月後に降圧薬も中止でき,加えて患側腎の萎縮・機能とも改善した.小児の腎血管性高血圧症は成人と比較して経皮的腎動脈形成術の効果が乏しいとされる.本症例は,患側腎萎縮を伴った高度腎動脈狭窄であったが,経皮的腎動脈形成術により,腎血管性高血圧のみならず,患側腎の形態的,機能的なリバースリモデリングが観察しえた点で,非常に貴重な報告である.

We successfully performed percutaneous transluminal angioplasty (PTRA) to treat renovascular hypertension with renal atrophy in a one-year-old infant. He had a severe right renal artery stenosis, the narrowest diameter was 0.4 mm (the normal diameter proximal to the stenosis was 2.0 mm), associated with a right renal atrophy and dysfunction in the affected kidney. The renovascular hypertension was refractory to multiple antihypertensive drugs introduction. We performed PTRA using SHIDEN 2 mm/2 cm (KANEKA MEDIX, Osaka). The stenosis completely disappeared at seven months after PTRA. The blood pressure decreased gradually and have been maintained normal range without antihypertensive drugs at 14 months after PTRA. The improvement of the right renal atrophy and dysfunction was also identified, the size of the affected kidney was normalized at 31 months of follow-up. In children, PTRA has been reported less effective than in adults. Meanwhile, there was no previous report which described the efficacy of PTRA in infants who have severe stenosis associated with renal atrophy and dysfunction. This is the first report of morphological and functional reverse remodeling of the affected kidney, beside improvement of blood pressure, by PTRA.

Key words: Renovascular hypertension; renal artery stenosis; renal atrophy; percutaneous transluminal angioplasty; children

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