肾动脉狭窄漏诊报告1例并文献复习

李妮; 孟琦

doi:10.16766/j.cnki.issn.1674-4152.003010

肾动脉狭窄漏诊报告1例并文献复习

doi: 10.16766/j.cnki.issn.1674-4152.003010

李妮,
孟琦^,

昆明医科大学第一附属医院全科医学科，云南昆明 650032

详细信息

通讯作者:
孟琦，E-mail: ling_grape@hotmail.com

中图分类号: R544.14 R692.16
计量
- 文章访问数: 130
- HTML全文浏览量: 43
- PDF下载量: 24
- 被引次数: 0
出版历程
- 收稿日期: 2022-05-17

Missed diagnosis of renal artery stenosis: a case report and literature review

LI Ni,
MENG Qi^,

Department of General Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China

摘要

摘要: 肾动脉狭窄(RAS)是继发性高血压的独立危险因素之一，发病率较低，临床诊断困难，误诊、漏诊率较高。本文对曾漏诊的1例肾动脉狭窄病例的诊治经过进行回顾性分析，并复习相关文献。
- 肾动脉狭窄 /
- 肾血管性高血压 /
- 漏诊
Abstract: Renal artery stenosis (RAS) is one of the independent risky factors for secondary hypertension. The incidence is relatively low and the clinical diagnosis is difficult, so the misdiagnosis rate and missed diagnosis rate is high. This study aims to conduct a retrospective analysis on one missed diagnosis case of renal artery stenosis, and review the relevant literature.
- Renal artery stenosis /
- Renovascular hypertension /
- Missed diagnosis
利益冲突 无

HTML全文

图 1 肾血管CTA三维重建成像

Figure 1. Three-dimensional reconstruction of renal vascular CTA

下载: 全尺寸图片幻灯片

图 2 肾血管CTA成像

Figure 2. Renal vascular CTA imaging

下载: 全尺寸图片幻灯片

图 3 DSA下肾动脉狭窄部位

Figure 3. Renal artery stenosis site under DSA

下载: 全尺寸图片幻灯片

图 4 左肾动脉主干远端狭窄

Figure 4. Distal stenosis of the main left renal artery

下载: 全尺寸图片幻灯片

参考文献(16)

[1]	蒋雄京, 邹玉宝. 肾动脉狭窄的诊断和处理中国专家共识[J]. 中国循环杂志, 2017, 32(9): 835-844. doi: 10.3969/j.issn.1000-3614.2017.09.002 JIANG X J, ZOU Y B. Chinese expert consensus on diagnosis and management of renal artery stenosis[J]. Chinese Journal of Circulation, 2017, 32(9): 835-844. doi: 10.3969/j.issn.1000-3614.2017.09.002
[2]	赵鹏. 肾动脉狭窄的临床诊治进展[J]. 当代医学, 2020, 26(31): 190-192. https://www.cnki.com.cn/Article/CJFDTOTAL-DDYI202031084.htm ZHAO P. Progress in clinical diagnosis and treatment of renal artery stenosis[J]. Contemporary Medicine, 2020, 26(31): 190-192. https://www.cnki.com.cn/Article/CJFDTOTAL-DDYI202031084.htm
[3]	LENZ T. Treatment of renal artery stenosis in the year 2021[J]. Internist (Berl), 2021, 62(3): 252-262. doi: 10.1007/s00108-020-00935-5
[4]	崔云英, 王芬, 童安莉, 等. 纤维肌性发育不良致肾血管性高血压的临床特征及诊断治疗[J]. 基础医学与临床, 2019, 39(3): 381-384. doi: 10.3969/j.issn.1001-6325.2019.03.017 CUI Y Y, WANG F, TONG A L, et al. Clinical characteristics and treatment in patients with renovascular hypertension caused by fibromuscular dysplasia[J]. Basic & Clinical Medicine, 2019, 39(3): 381-384. doi: 10.3969/j.issn.1001-6325.2019.03.017
[5]	傅林峰, 白骏, 徐丹君, 等. 肌纤维发育不良影像学特征及误诊分析[J]. 临床放射学杂志, 2020, 39(1): 124-128. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFS202001029.htm FU L F, BAI J, XYU D J, et al. Fibromuscular Dysplasia: Imaging Findings and Analysis of Misdiagnosis[J]. Journal of Clinical Radiology, 2020, 39(1): 124-128. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFS202001029.htm
[6]	蒋雄京, 何际宁, 陈阳, 等. 纤维肌性发育不良诊断及处理首个国际共识的述评[J]. 中华高血压杂志, 2020, 28(6): 501-504. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGZ202006001.htm JIANG X J, HE J N, CHEN Y, et al. Review of the first international consensus on the diagnosis and management of fibromuscular dysplasia[J]. Chinese Journal of Hypertension, 2020, 28(6): 501-504. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGZ202006001.htm
[7]	翟若男, 郑丽阳, 薛瑞, 等. 肾性高血压的发病机制及诊治研究进展[J]. 世界临床药物, 2017, 38(5): 305-310. https://www.cnki.com.cn/Article/CJFDTOTAL-GWHH201705004.htm ZHAI R N, ZHENG L Y, XUE R, et al. Research progress on renal hypertension pathogenesis and its diagnosis and treatment[J]. World Clinical Drugs, 2017, 38(5): 305-310. https://www.cnki.com.cn/Article/CJFDTOTAL-GWHH201705004.htm
[8]	许晓明, 李超, 程康. 纤维肌性发育不良性肾动脉狭窄诊治进展[J]. 中国全科医学, 2017, 20(36): 4581-4584. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX201736027.htm XYU X M, LI C, CHENG K. Recent Advancesin the Management of Renal Artery Stenosis Caused by Fibromuscular Dysplasia[J]. Chinese General Practice, 2017, 20(36): 4581-4584. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX201736027.htm
[9]	TEXTOR S C. Management of renovascular hypertension[J]. Curr Opin Cardiol, 2020, 35(6): 627-635.
[10]	张秋平, 李青. 肾性高血压的诊治进展[J]. 医学综述, 2018, 24(22): 4385-4389. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS201822004.htm ZHANG Q P, LI Q. Progress in Diagnosis and Treatment of Renal Hypertension[J]. Medical Recapitulate, 2018, 24(22): 4385-4389. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS201822004.htm
[11]	TIAN Y, YUAN B, ZHANG N, et al. Outcomes following the endovascular treatment of renal artery stenosis caused by fibromuscular dysplasia: a systematic review and meta-analysis[J]. Ann Vasc Surg, 2022, 78: 362-372.
[12]	方荔菁. 肾动脉狭窄患者腔内治疗近远期血压控制与肾脏参数相关性的前瞻性观察研究及肾动脉型大动脉炎患者术式的比较和预后的探索[D]. 北京: 北京协和医学院, 2021. FANG L J. Prospective observation of the correlation between short-term and long-term blood pressure control and renal parameters in patients with renal artery stenosis and comparison of surgical methods and prognostic exploration in patients with renal arterial macroarteritis[D]. Beijing: Peking Union Medical College, 2021.
[13]	明慧, 余辉, 陈援浩. 肾血管性高血压的诊疗研究新进展[J]. 标记免疫分析与临床, 2021, 28(4): 713-716. https://www.cnki.com.cn/Article/CJFDTOTAL-BJMY202104039.htm MING H, YU H, CHEN Y H, et al. Advances in the Diagnosis and Treatment of Renovascular Hypertension[J]. Labeled Immunoassays and Clinical Medicine, 2021, 28(4): 713-716. https://www.cnki.com.cn/Article/CJFDTOTAL-BJMY202104039.htm
[14]	ROSSI G P, BISOGNI V, ROSSITTO G, et al. Practice recommendations for diagnosis and treatment of the most common forms of secondary hypertension[J]. High Blood Press Cardiovasc Prev, 2020, 27(6): 547-560.
[15]	LOUIS R, LEVY-EREZ D, CAHILL A M, et al. Imaging studies in pediatric fibromuscular dysplasia (FMD): a single-center experience[J]. Pediatr Nephrol, 2018, 33(9): 1593-1599.
[16]	廖莹, 高阳旭, 张清友, 等. 以心力衰竭起病的婴幼儿肾血管性高血压3例并文献复习[J]. 中华全科医学, 2020, 18(11): 1974-1978. doi: 10.16766/j.cnki.issn.1674-4152.001667 LIAO Y, GAO Y X, ZHANG Q Y, et al. Three cases of infant renal vascular hypertension with heart failure onset and literature review[J]. Chinese Journal of General Practice, 2020, 18(11): 1974-1978. doi: 10.16766/j.cnki.issn.1674-4152.001667