@article{oai:gunma-u.repo.nii.ac.jp:00008037,
 author = {Hagiwara, Shuichi and Kaneko, Minoru and Murata, Masato and Aoki, Makoto and Kanbe, Masahiko and Arakawa, Naoya and Nakamura, Takuro and Ohyama, Yoshio and Tamura, Jun'ichi and Kiyohiro, Oshima and 萩原, 周一 and 金子, 稔 and 村田, 将人 and 青木, 誠 and 神戸, 将彦 and 荒川, 直哉 and 中村, 卓郎 and 大山, 良雄 and 田村, 遵一 and 大嶋, 清宏},
 issue = {2},
 journal = {The Kitakanto medical journal = 北関東医学},
 month = {May},
 note = {Journal Article, 症例は63歳女性.腎細胞癌に対して腎摘出後,糖尿病・糖尿病性腎症のため前医に通院中だった.初診2週間程前から感冒様症状があった. 初診4日前から排尿が無くなった. 初診前日深夜, 全身倦怠感・呼吸困難感が増強し前医に救急搬送された. 低酸素血症と腎機能の悪化およびアシドーシスを認めたが対応困難のため,初診日未明に当院へ転院搬送された. 来院時, 両側胸部に湿性ラ音酸素聴取し, 全身の浮腫を認めた. 血液ガス分析(酸素: フェイスマスで5L/分投与)ではpH 7.247,pCO2 32.5mmHg,pO2 82.4mmHg,BE -12.3mmol/L であった. 胸部単純レントゲンおよびCT 検査で胸水, 心囊液貯留があり, 腎不全による溢水と考え,noninvasive positive pressure ventilation (NPPV)と血液透析を開始した.白血球数やCRP値が高値であったが発熱なく, 抗菌化学療法は行わず経過観察した. 第3病日に左胸腔ドレナージを行った. 胸水の培養検査・細胞診に何れも特記すべきことはなかった. 血液培養検査で病原体は検出されず, 自己免疫疾患を示す抗体価の上昇もなかった. 第4病日NPPV離脱. 除水を進めたところ全身状態およびCRP値は改善した. 第8病日前医に転院した.本症例では来院時炎症反応の上昇がみられたが感染症や膠原病は否定的で透析のみで改善した. また, 胸水は滲出性であることから尿毒症性胸膜炎を呈していたと考えられた. 本邦における本症の報告は維持透析中の報告が多いが,腎不全のいずれの時期にも発症しうるため留意して診療に当たる必要がある.（Kitakanto Med J 2014；64：149～152）, A 63 year-old female with past histories of diabetic nephropathy and unilateral nephrectomy for renal cell carcinoma was transferred to our hospital. Edema was observed in her whole body and arterial blood gas analysis showed metabolic acidosis(pH 7.247,base excess-12.3mmol/L).White blood cell counts and c-reactive protein were also increased. Chest X-ray and computed tomography showed pleural and pericardial effusion. Noninvasive positive pressure ventilation (NPPV) and renal replacement therapy(RRT)were introduced after admission. Left thoracic drainage was performed on the 3rd day and the pleural effusion was exudative with no bacteria and no malignancy. Both her blood culture and autologous antibodies were also negative. The pleural and pericardial effusion decreased and her general condition and inflammatory parameters gradually improved as RRT was continued. NPPV was removed on the 4th day,and she was transferred to the previous hospital on the 8th day. It was supposed that the cause of this course was uremic pleuritis because her pleural effusion was exudative and her condition was improved by repeated RRT. We should pay attention to this disease because it can develop in any phase of renal failure.（Kitakanto Med J 2014；64：149～152）},
 pages = {149--152},
 title = {尿毒症性胸膜炎の１例},
 volume = {64},
 year = {2014}
}