冠動脈バイパス術後,急速に透析療法に移行した末期腎不全の1例

Abstract

The patient was a 68-year-old woman with a 28-year history of hyperten- sion. She complained of frequent episodes of exertional chest pain in about January 1981, and was admitted to a local hospital for investigation of her chest pain. She was diagnosed as having angina pectoris (three-vessel disease) and underwent coronary artery bypass grafting (CABG), with double aorto-coronary bypass (saphenous vein graft to the left anteior descending artery and saphenous vein graft to the posterior descending artery) in May 1981. She subsequently complained of precordial oppression again and was treated with isosorbide dinitrate. Her symptoms was worsened in January 1997. Coronary angiography (CAG) was done in May 1997, and administered contrast medium (Iopamidol 2.72 ml/kg). Before CAG, the serum creatinine was 1.2mg/dl and after CAG it was 3.6 mg/dl. She underwent minimally invasive direct coronary artery bypass grafting (MID- CAB) on June 23, 1997. After MIDCAB, she complained of severe abdominal pain, appearance of severe hypertension, and her renal function worsened (serum creatinine : 7.0 mg/dl) and hemodialysis was started. When renal function worsens after CAG, in associa- tion with the effect of contrast medium and the onset of atheroembolic renal disease, atheroembolism can occur after CABG. In conclusion, a case of renal insufficiency progressing to end-stage renal disease that required dialysis after CAG and MIDCAB is reported.