Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Successful Renal Autotransplantation for the Treatment of Severe Renovascular Hypertension in a 14-year-old Boy

신 자가이식을 통한 14세 소년에서 발생한 심한 신성 고혈압의 성공적인 치료

  • Ji, Min-Chul (The Institute of Kidney Disease, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Park, Se-Jin (The Institute of Kidney Disease, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Choi, Jae-Young (Department of Pediatric Cardiology, Yonsei University College of Medicine) ;
  • Ko, Young-Guk (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Myoung-Soo (Department of Surgery and The Research Institute for Transplantation, Yonsei University College of Medicine) ;
  • Kim, Ji-Hong (The Institute of Kidney Disease, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Shin, Jae-Il (The Institute of Kidney Disease, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
  • 지민철 (연세대학교 의과대학 세브란스 어린이병원 소아청소년과 신장질환 연구소) ;
  • 박세진 (연세대학교 의과대학 세브란스 어린이병원 소아청소년과 신장질환 연구소) ;
  • 최재영 (연세대학교 의과대학 소아심장과) ;
  • 고영국 (연세대학교 의과대학 내과학교실) ;
  • 김명수 (연세대학교 의과대학 외과학 교실, 장기이식 연구소) ;
  • 김지홍 (연세대학교 의과대학 세브란스 어린이병원 소아청소년과 신장질환 연구소) ;
  • 신재일 (연세대학교 의과대학 세브란스 어린이병원 소아청소년과 신장질환 연구소)
  • Received : 2010.09.17
  • Accepted : 2010.09.28
  • Published : 2010.10.31
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Abstract

Percutaneous transluminal renal angioplasty (PTRA) is the current treatment of choice for renal artery revascularization, but renal autotransplantation has been an alternative treatment for complex cases. Here we report a 14-year-old boy with severe hypertension successfully treated with PTRA and renal autotransplantation. Doppler ultrasonography and computed tomography (CT) angiography revealed slight narrowing in the right renal artery ostium and complete obstruction in the left renal artery ostium with multiple collaterals. PTRA with stent insertion was performed for the treatment of the right renal artery, but it was impossible for the left renal artery due to the total obstruction. Therefore, left nephrectomy for autotransplantation was done with the peritoneal approach and the left kidney was autotransplanted to the ipsilateral iliac fossa. Postoperatively, Doppler ultrasonography and mercapto-acetyl-triglycine (MAG-3) renogram were performed, which showed normal renal artery blood flow and kidney function. Blood pressure was normalized and anti-hypertensive drugs were gradually tapered. Fibromuscular dysplasia was suspected to be responsible for the renal artery stenosis based on clinical aspects. In conclusion, renal autotransplantation is also a good treatment option for children with severe renovascular hypertension when endovascular treatment has failed or is not possible.

신성 고혈압은 신동맥의 협착 혹은 폐색으로 인해 유발되는 전신성 고혈압이다. 최근에는 신동맥의 재개통을 위해 PTRA가 선호되고 있지만, 복잡한 경우에 있어서는 신 자가이식이 대안적인 치료방법으로서 시행되어 왔다. 저자들은 심각한 고혈압 증상을 보인 14세 남자 환아를 PTRA 및 신 자가이식을 시행하여 성공적으로 치료하였기에 보고하는 바이다. 도플러 초음파 검사와 CT 혈관조영술상 우측 신동맥 기시부에서 약간의 좁아짐과 다발적인 측부순환을 동반한 좌측 신동맥 기시부의 완전폐색이 확인되었다. 우측 신동맥 협착의 치료를 위해 PTRA와 스텐트 삽입술을 시행하였으나 좌측 신동맥은 완전폐색으로 인해 시술이 불가능하여 좌측 신장을 절제한 후 동측 장골와에 자가이식하였다. 수술 후 시행한 도플러 초음파 검사와 MAG-3 신주사 검사상 신혈류와 신기능은 정상이었다. 혈압은 정상화되었으며 항고혈압제 투여도 점차 중단하였다. 임상적인 특성을 고려할 때 신성 고혈압의 원인은 섬유근성 형성이상으로 생각되었다. 결론적으로 신 자가이식은 혈관내 중재적 시술이 실패하였거나 불가능한 경우에 선택할 수 있는 치료방법이다.

Keywords

References

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