10年以上血液透析の患者の超音波診断による腎嚢胞形成様式とrenin-angiotensin-aldosterone (R-A-A) 系の考察

• 鈴木 好夫

  虎の門病院腎センター

• 三浦 雅弘

  虎の門病院腎センター

• 原 茂子

  虎の門病院腎センター

• 葛原 敬八郎

  虎の門病院腎センター

• 二瓶 宏

  虎の門病院腎センター

• 三村 信英

  虎の門病院腎センター

• 原 満

  虎の門病院病理学科

書誌事項

タイトル別名

• Ultrasonically diagnosed polycystic changes in the kidney of patients undergoing hemodialysis for more than 10 years and their possible relationship to the renin-angiotensin-aldosterone system

抄録

In 33 using the ultasonic tomography (Echo) and patients who had undergone hemodialysis for more than 10 years in our hospital, we investigated, by using the ultrasonic tomography (Echo) and CT scan methods, the influence of long-term hemodialysis on the polycystic changes in the kidneys and further studied the possible relationship of the changes to the renin-angiotensin-aldosterone system and to the occurrence of hypotension by means of the angiotensin II infusion test. Polycystic changes in the atrophic kidneys were observed in 31 of the cases (94%) and were classified from the morphological standpoint by Echo into 5 types, I to V.<br>In Type I the kidney has a normal length of 8 to 9cm and the whole kidney is replaced by multiple large cysts measuring 1 to 3cm in diameter. In Type II the kidney is shorter (less than 6cm) and is replaced by multiple large cysts 1 to 3cm in diameter. In Type I and II, hardly any normal renal tissue is detected by Echo. The kidney in Type III is less than 6cm in length and only a few cysts measuring less than 1cm in diameter are found. Echo revealed that there is no cyst in Type IV. In Type V, the kidney size and cyst formation differ in the left and right kidneys.<br>There was no correlation between laboratory data underlying kidney disease and the morphological classification as Type I through V.<br>Predialysis plasma renin activity (PRA) in Group A (n=21), consisting of Types I and II, was statistically significantly higher than that in Group B (n=10), consisting of Types III and IV (p<0.01). The post/predialysis PRA ratio was markedly higher in Group A than in Group B. The renin secretion due to hemodialysis was found to be greater in Group A than in Group B.<br>There was no difference in plasma aldosterone concentration in Types I through V.<br>There were 7 cases of hypotension defined by the WHO standard. All these 7 patients were hyperreninemic and hyperaldosteronemic. There was no significant difference in predialysis PRA between hypotensive cases and normal and hypotensive cases. However, when the mean postdialysis/mean predialysis PRA ratios were compared, the value in hypotensive cases was found to be significantly greater than that in normal and hypertensive cases, suggesting that the influence of hemodialysis on renin secretion was greater in hypotensive cases.<br>Critical doses estimated by the angiotensin II infusion test were more than 30ng/kg/min in all 7 hypotensive cases, seeming to suggest that hyperreninemia is a compensatory mechanism for this low vascular responsiveness. However, as the percentage of hypotensive cases in Group A was nearly equal to that in Group B, further study is necessary to determine if the cyst has a direct role in the compensatory mechanism in renin secretion.

収録刊行物

• 人工透析研究会会誌

  人工透析研究会会誌 18 (3), 237-245, 1985

  社団法人 日本透析医学会

キーワード

• hemodialysis
• ultrasonic tomography
• polycystic kidney
• plasma renin activity
• plasma aldosterone concentration

詳細情報

• CRID: 1390001205341976192
• NII論文ID: 130003853863
• DOI: 10.4009/jsdt1968.18.237
• ISSN: 18846203
• ISSN: 02887045
• 本文言語コード: ja
• データソース種別:
  • JaLC
  • Crossref
  • CiNii Articles
• 抄録ライセンスフラグ: 使用不可