痛風症における腎血管障害特に腎動脈撮影所見について

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  • 中村 昭
    東京大学医学部内科物理療法学教室

書誌事項

タイトル別名
  • Vascular Impairment in the Kidney of Gouty Patients with Special Reference to the Renal Angiographic Findings
  • ツウフウショウ ニ オケル ジンケッカン ショウガイ トクニ ジンドウミャク サツエイ ショケン ニ ツイテ

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The pathogenesis of renal damage in gout is yet a controversial subject. The author investigated renal vascular impairments through renal function tests, renal biopsy and renal angiography in 13 gouty patients. And similar study as in gouty patients was performed in several other renal diseases for the sake of comparison. Renal angiographic findings in 13 cases of gouty patients were analyzed and divided into four groups, namely normal type. pyelonephritic type, glomerulonephritic type and arteriosclerotic type. Renal angiography has been evaluated as an excellent diagnostic method for surgical renal diseases. However, the author would like to emphasize that it is a method which can also offer valuable informations on medical renal diseases. Vascular changes in the kidney of collagen diseases were confirmed in broader e rtent in renal angiography than were presumed from findings of renal biopsy or renal function tests. But the definite conclusion could not be drawn as only a few cases of collagen diseases were included in this series. The concept that arteritis or arteriosclerosis develops in the kidney secondary to glomerulonephritis or pyelonephritis seems worth while to emphasize. Vascular changes in the kidney of gouty patients are supposed to derive from such systemic factors as hyperuricemia and disturbances of lipid metabolism in one hand and such local factors as urate deposition and pyelonephritis in the other hand. Therefore, vascular changes may precede renal parenchymal changes, but sooner or later the former will be promoted and lead to arteriosclerosis by local changes. Not a little portion of the etiologic factors mentioned above can be now influenced by medical control. Therefore, careful effort should be paid to avoid deterioration of renal or vascular complication to improve prognosis in gout.

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