小兒腎血管性高血壓：二病例報告

Renovascular Hypertension in Childhood: A Report of Two Cases

張美惠(Mei-Hwei Chang) ； 呂鴻基(Hung-Chi Lue)

《Acta Paediatrica Sinica》 17卷4期 (1976/12) Pp. 246-252

摘要

腎血管性高血壓在兒童雖爲罕見的疾病，但由於其可藉外科手術根治，所以早期診斷與治療是非常重要的。本文報告兩個近8年來在臺灣大學醫學院附設醫院小兒科所發現的病例，均經腎血管攝影發現右腎動脈近端有阻塞現象。病倒一且併有上腸系膜動脈的部分阻塞。兩例經右腎切除手術後，血壓均回復正常。病例一所發生的高血壓性腦病變及病例二所發生的心臓衰竭，在手術後完全消失。著者等強調，當測量兒童的血壓，若懷疑有腎血管性高血壓，應做靜脈腎盂攝影，腎血管攝影及腎高血壓蛋白酶的定量，即可確定診斷。

並列摘要

Renovascular hypertension in childhood is a curable disease. It is rare, but is important. During the eight years, from 1968 to 1975, we have encountered two cases at the Department of Pediatrics of the National Taiwan University Hospital. Case 1 is a 14-year-old girl who presented symptoms and signs of hypertensive encephalopathy. Renoarteriograms revealed a narrowing at the stem of the right renal artery. A renoaortal bypass surgery using a Teflon graft was carried out, which failed to relieve the hypertension. Nephrectomy was, therefore performed, followed by dramatic decrease of the blood pressure. The blood pressure remained of normal limits for 7 years by the time of this writing. Case 2 is a 3.5-year-old girl who was brought to us because of congestive heart failure. Hypertension was found in a routine pressure measurement. Renoarteriograms revealed no trace of the right renal artery, but a hump protruding from the aorta. Significant elevations of the renin and aldosterone values were noted. Right nephrectomy was done and the blood pressure returned to normal, and the signs and symptoms of heart failure disappeared. The endocrine levels related to the hypertension also returned to normal.