Introduction:In Japan, renal vascular hypertension based on renal artery stenosis (RAS) accounts for 1% of all hypertensive patients, and RAS is present in approximately 10% of autopsy cases of coronary artery disease and cerebrovascular disease. As ischemic nephropathy and complications of cardiovascular disease (CVD) due to RAS are common, early diagnosis and treatment for RAS is important. However, results of several large clinical trials have not shown the efficacy of percutaneous transluminal renal angioplasty (PTRA) for atherosclerotic RAS.Case:51-year-old woman who diagnosed as Takayasu's arteritis (TA) 35 years ago, had been treated with 5 mg daily of prednisone. She presented with hypertension and edema in both legs a year before admission. Her examination at that time revealed increased serum creatinine from 1.0 to 1.7 mg/dL, high proteinuria (7.3 g/gCr), high renin activity (47.0 ng/mL/hr) and right RAS. Eight months before admission, she had an operation for ruptured descending aorta. She had recurrent episodes of dyspnea on exertion, worsening leg edema and severe hypertension and was admitted to the hospital for the treatment.Clinical course:In addition to severe hypertension (190/80 mmHg) and progression of RAS, she had pulmonary congestion, high brain natriuretic peptide (BNP) level (1149.5 pg/mL), increasing creatinine levels (Cr 3.1 mg/dL), and left non-functioning kidney on admission. Despite taking 8 types of antihypertensive drugs and diuretics without renin-angiotensin system inhibitors, blood pressure and fluid retention were poorly controlled, and thus we decided to perform PTRA for the right RAS. After the PTRA, edema, hypertension and pleural effusion had been dramatically improved. In addition, we could observe decrease of serum creatinine (Cr 1.6 mg/dL), proteinuria (0.5 g/gCr) and plasma renin activity (1.9 ng/mL/hr). Therefore, we reduced the antihypertensive drugs from 8 to 2.Discussions:Although the benefit of PTRA for RAS associated with TA remains unclear, the clinical course suggests that the success of PTRA in this case may be related to the fact that the RAS was complicated by TA. It also suggests that we should consider PTRA in cases of hypertension and pulmonary congestion associated with RAS which are difficult to control like this case.Conclusion:We have experienced a case of RAS associated with TA that was successfully treated with PTRA.

Keywords： eosinophilic pneumonia, peritoneal dialysis, hemodialysis, allergy 〈Abstract〉 A 79 year old male with end stage renal disease due to IgA nephropathy was admitted to hospital so that peritoneal dialysis (PD) could be initiated. He had undergone PD catheter insertion four months earlier. An exit site was created, and he started undergoing PD using glucose based PD solutions. Ten days after the initiation of PD, he developed a cough and fever. He was diagnosed with pneumonia, but antibiotics were ineffective. Bronchoscopy revealed marked eosinophilia (67％) in his bronchoalveolar lavage fluid, and a diagnosis of eosinophilic pneumonia (EP) was confirmed. It was considered unlikely that the EP had been caused by drugs or environmental factors. Instead, we suspected that the dialysate or PD catheter had triggered the onset of EP. Non invasive positive pressure ventilation and transient hemodialysis (HD) were needed. However, after high dose steroid therapy, his symptoms immediately improved, although he still needed home oxygen therapy. After his condition improved, he hoped to resume PD until he was discharged. He resumed PD without any recurrence of the EP until discharge. He was subsequently readmitted for vertebral compression fractures. His pneumonia relapsed during steroid tapering. He died of respiratory failure despite intensive treatment. Only four cases of PD associated EP have been reported. In all of these cases, the patients were successfully treated with steroids or the removal of the suspected cause, and PD was resumed without the EP going into remission. However, when such patients are in incomplete remission, we should consider transitioning from PD to HD because relapsed pneumonia can be fatal.