髂总动脉狭窄致移植肾失功病例研究  

A case study of renal allograft dysfunction secondary to common iliac artery stenosis

作　　者：张晶[1] 焦红梅[1] 刘梅林[1] 周福德[2] 孟圆峰[3] 佟小强[4] ZHANG Jing;JIAO Hong-mei;LIU Mei-lin;ZHOU Fu-de;MENG Yuan-feng;TONG Xiao-qiang(Department of Geriatrics,Peking University First Hospital,Beijing 100034,China;不详)

机构地区：[1]北京大学第一医院老年病内科,北京100034 [2]北京大学第一医院肾内科,北京100034 [3]北京大学第一医院超声医学科,北京100034 [4]北京大学第一医院介入血管外科,北京100034

出　　处：《中国实用内科杂志》2022年第3期242-246,共5页Chinese Journal of Practical Internal Medicine

基　　金：中央保健科研基金(W2013BJ29);北京大学第一医院交叉临床研究专项基金(2019CR40)。

摘　　要：目的探讨移植肾同侧髂总动脉狭窄致移植肾失功的临床特征及诊治思路。方法对2018年4月26日北京大学第一医院老年病内科重症监护室收治的1例因移植肾同侧髂总动脉狭窄致移植肾失功患者的诊治过程进行分析并复习相关病例文献,总结该病的临床特征及早期识别方法。结果患者肾移植术后13年,以尿路感染起病,后出现急性肾损伤,经控制感染和血压、恢复容量、心功能改善后肾功能不恢复,最终发现移植肾同侧髂总动脉重度狭窄,置入支架后肾功能完全恢复。检索共10篇英文文献符合入选条件,报道移植肾同侧髂总动脉狭窄病例13例,均经血管造影确诊,2例行球囊成形术,11例行支架置入术,短期预后良好。结论移植肾同侧髂总动脉狭窄致移植肾失功十分少见,临床表现与移植肾动脉狭窄相似,超声筛查易漏诊,临床医生应提高诊断意识。Objective To investigate the clinical characteristics and diagnostic procedure of renal allograft dysfunction secondary to common iliac artery stenosis on the same side.Methods The diagnosis and treatment process of a case of renal allograft dysfunction secondary to common iliac artery stenosis in Peking University First Hospital on April 26 of 2018 was analyzed and the literatures were reviewed to summarize the clinical characteristics of the disease and how to make an early identification.Results 13 years after kidney transplantation,the patient was admitted to our hospital due to urinary tract infection and later developed acute kidney injury.Although infection and hypertension were effectively controlled and the cardiac function was improved,the patient still persisted with anuria.Left common iliac artery stenosis severely was confirmed by angiography and the graft function was recovered after the stent implantation.Only 13 cases were published in 10 relevant medical literatures.All cases were diagnosed through angiography.Percutaneous transluminal angioplasty was performed in 2 cases,and stents were implanted in 11 cases;the short-term prognosis was good.All cases was diagnosed through angiography.Percutaneous transluminal angioplasty was performed in 2 cases,and stents were implanted in 11 cases;the short-term prognosis was good.Conclusion Renal allograft dysfunction secondary to common iliac artery stenosis on the same side is a rare condition and the clinical manifestations are similar to those of renal allograft artery stenosis,which is likely to be missed in the diagnosis by ultrasound,so clinicians should improve their diagnostic awareness.

关 键 词：移植肾 髂总动脉狭窄 高血压 血肌酐升高 

分 类 号：R692.5[医药卫生—泌尿科学]