Korean Journal of Nephrology 1989;8(1):85-93.
편측성 육안적 혈뇨에 관한 연구
한진석 , 윤형진 , 엄재호 , 김윤구 , 김성권 , 이정상 , 이종욱 , 김승협 , 이현순 , 김용일
Abstract
The 17 patients presenting with gross hematuria had diagnosed unilateral essential hematuria and followed by angiographic evaluation of renal arteries and veins. The diagnostic criteria for unilateral gross hematuria included normal findings on intravenous or retrograde pyelography, unilateral bleeding without intrinsic blad- der lesion at cystoscopic examination, absence of infec- tion or stone, and a negative history for bleeding ten- dency, drug abuse and renal trauma including renal surgery. Of these patients, vascular abnormalities were found in the renal angiography to be the cause of hematuria in the 8 patients. In the 9 patients with negative angiogra- phy we performed renal biopsy to find the cause of hematuria. 1) The vascular abnormalities were found in the 8 patients; 5 with nutcracker phenomenon of left renal vein with collaterals, 2 with renal arteriovenous fistula and 1 with right renal vein varices associated with liver cirrhosis. 1) All the 5 patients with nutcracker phenomenon showed marked dilatation of lateral side of left renal vein to aorta compared to immediate front side of aorta. And in the all patients compression of left renal veins by superior mesenteric arteries and well-developed collat- eral veins were found in the renal arterio-and venogra- phy. After tranxenamic acid was given in the 5 patients, all the patients showed clear-up of gross hematuria and the 3 among them showed no urinary abnormality over 3 months during follow-up. 3) In the 9 patients performed renal biopses, there were 2 cases of IgA nephropathy, 1 case of focal glomer- ulosclerosis and 5 cases of minor change. Of these, 6 patient who could be followed up had no evidence of progression in renal diseases. Thus we concluded that renal angiographic examina- tion and renal biopsy be mandatory in the diagnosis of unilateral gross hematuria, and in case of vascular abnormality epsilon aminocaproic acid and tranx- enamic acid be effective in the control of hematuria, and the clinical significance of glomerular lesion should require further evaluation.
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