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Klinische Wochenschrift

, Volume 47, Issue 12, pp 621–628 | Cite as

Die arteriovenöse Nierenfistel

Ein Überblick über 109 Fälle
  • Sheldon G. Sheps
  • Jorge E. Maldonado
Übersichten

Zusammenfassung

Zunehmende Kenntnis pathologischer Veränderungen der Nierengefäße in der Pathogenese des Hochdrucks hat die Aufmerksamkeit auf arteriovenöse Nierenfisteln gelenkt, ein in der Literatur bis ins letzte Jahrzehnt selten erwähntes Krankheitsbild. Diese Art von arteriovenöser Verbindung zeigt, wenn sie auf der Seite einer funktionstüchtigen Niere besteht, bei einer signifikanten Zahl der Fälle ein charakteristisches Syndrom, welches die Kombination von highoutput-failure, diastolischem Hochdruck und einem kontinuierlichen Geräusch im Abdomen einschließt. Es konnte gezeigt werden, daß der Hypertonus wahrscheinlich durch die sekundäre Nierenischämie distal der Fistel bedingt ist. Die Bedeutung einer sorgfältigen Auskultation über den Nierengegenden für die Entdeckung von Nierengefäßveränderungen wird betont.

Eine arteriovenöse Nierenfistel kann in Gestalt eines Nierencarcinoms vorhanden sein. Die Diagnose einer Nierenfistel kann zur Beseitigung eines Hochdrucks und einer Herzinsuffizienz führen und möglicherweise zu einer frühzeitigen Beseitigung eines malignen Tumors.

Asymptomatische Fisteln wurden mit der sich mehr und mehr ausbreitenden Durchführung angiographischer Untersuchungen in zunehmender Häufigkeit beobachtet. Andererseits wurde auch ein häufigeres Vorkommen als Folge der percutanen Nierenbiopsie gefunden.

Die Behandlung der arteriovenösen Nierenfistel ist in den meisten Fällen chirurgisch.

Summary

Increasing awareness of renovascular pathology in the pathogenesis of hypertension has brought attention to renal arteriovenous fistula, a condition rarely mentioned in the literature until the past decade. This type of arteriovenous communication, when present on the same side as a functioning kidney, results, in a significant number of cases, in a characteristic syndrome that includes the association of high-output cardiac failure, diastolic hypertension, and the presence of a continuous bruit within the abdomen. The hypertension has been demonstrated as probably being secondary to renal ischemia distal to the fistula. The importance of careful auscultation over the renal areas in an attempt to detect renovascular lesions is emphasized.

A renal arteriovenous fistula may present in the manner of a renal carcinoma. Proper diagnosis of a renovascular fistula might lead to correction of hypertension and of congestive heart failure and perhaps to early removal of a malignant tumor.

Increased detection of asymptomatic fistulas with the more widespread use of angiographic studies has been noted. On the other hand, more common occurrence in association with the performance of percutaneous renal biopsy has also been observed.

The treatment of renal arteriovenous fistula is surgical in most instances.

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Copyright information

© Springer-Verlag 1969

Authors and Affiliations

  • Sheldon G. Sheps
    • 1
  • Jorge E. Maldonado
    • 1
  1. 1.Mayo Clinic und Mayo Foundation: Section of MedicineRochesterU.S.A.

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