右腎髄質と下大静脈（IVC）が造影されていないので，かなり早期（動脈相）の造影CTである．図５と図６の△の部分以外の左腎が全く造影されない，すなわち血流がないことを意味し腎梗塞である．図５と図６でSMAと右腎動脈は造影されているが，図６の左腎静脈と図７の左腎動脈（▲）は造影されず，左腎動脈の閉塞，心房細動があるのですなわち塞栓症である．図Aと図Bが血管造影で，↑が腎動脈で△が閉塞部位．腎動脈に閉塞があるために，大動脈のかなり頭側まで造影剤が逆流している（図A：※）．ウロキナーゼ24万単位をbolusで2回動注した．図Cと図Dは溶解剤投与後の血管造影で，大部分の血管が再開通したが，既に18時間経過していたためか6日後の造影CT（図E〜図G）で左腎の造影効果は不良であった．

参考症例（右腎部分梗塞）：心房細動のある79歳女性．数時間前に発症した右側腹部痛のため来院した．体温：36.2℃，右側腹部に圧痛を認める．
▲は部分梗塞を示している．

参考文献
1)Medicine (Baltimore). 1999 Nov;78(6):386-94.
Acute renal infarction. Clinical characteristics of 17 patients.
Domanovits H, Paulis M, Nikfardjam M, Meron G, Kurkciyan I, Bankier AA, Laggner AN.

We analyzed the medical records of patients with an established diagnosis of acute renal infarction to identify predictive parameters of this rare disease. Seventeen patients (8 male) who were admitted to our emergency department between May 1994 and January 1998 were diagnosed by contrast-enhanced computed tomography (CT) as having acute renal infarction (0.007% of all patients). We screened the records of the 17 patients for a history with increased risk for thromboembolism, clinical symptoms, and urine and blood laboratory results known to be associated with acute renal infarction. A history with increased risk for thromboembolism with 1 or more risk factors was found in 14 of 17 patients (82%); risk factors were atrial fibrillation (n = 11), previous embolism (n = 6), mitral stenosis (n = 6), hypertension (n = 9), and ischemic cardiac disease (n = 7). All patients reported persisting pain predominantly from the flank (n = 11), abdomen (n = 4), and lower back (n = 2). On admission, elevated serum lactate dehydrogenase was found in 16 (94%) patients, and hematuria was found in 12 (71%) of 17 patients. After 24 hours all patients showed an elevated serum lactate dehydrogenase, and 14 (82%) had a positive test for hematuria. Our findings suggest that in all patients presenting with the triad--high risk of a thromboembolic event, persisting flank/abdominal/lower back pain, elevated serum levels of lactate dehydrogenase and/or hematuria within 24 hours after pain onset--contrast-enhanced CT should be performed as soon as possible to rule out or to prove acute renal infarction.　PMID: 10575421

2)Eur Urol. 2000 Sep;38(3):339-43.
Local thrombolytic treatment for renal arterial embolism.
Gluck G, Croitoru M, Deleanu D, Platon P.

OBJECTIVE: To determine the utility of local thrombolysis in the treatment of acute renal arterial occlusion. METHODS: We used local thrombolytic treatment in a female patient, aged 76, with 72 h of anuria, right lumbar and flank pain. She had a 3-year history of ischemic heart disease and atrial fibrillation controlled with digital treatment. Also, she was nephrectomized on the left side 33 years ago for lithiasic pyonephrosis. A normal right urinary tract was demonstrated with ultrasound examination, KUB radiography and retrograde pyelography. The next step was diagnostic abdominal angiography and local thrombolytic treatment with streptokinase. RESULT: Thrombolysis with streptokinase was successful following 72 h of renal artery occlusion. After 24 months the patient is doing well. CONCLUSION: Local intra-arterial thrombolysis is the treatment of choice in renal artery occlusion.　PMID: 10940710