儿童肾血管性高血压29例诊断方法的回顾性分析

目的探讨儿童肾血管性高血压（RVH）的早期诊断方法。方法回顾性分析北京大学第一医院1996年1月至2011年6月确诊的RVH患儿,分析贻误诊治情况,以及临床症状、影像学检查结果对RVH的诊断价值。结果①29例确诊RVH患儿进入分析,其中男18例,女11例。起病年龄0.5～15岁,平均年龄（7.0±4.4）岁。从首发症状出现至确诊时间为15d至7年,平均确诊时间11个月。9例（31.0%）患儿起病6个月后确诊,曾分别被误诊为胃肠炎、癫、肾脏和心脏疾病等。3例患儿以头痛伴呕吐起病,补液出现抽搐后发现高血压。首发症状以头痛（10例,34.5%）、呕吐（10例,34.5%）和抽搐（9例,31.0%）多见。起病时平均收缩压和舒张压分别为182和127mm Hg。②单侧肾动脉狭窄25例,双侧肾动脉狭窄4例。23例通过肾动脉造影确诊,其中17例单侧肾动脉狭窄患儿中10例超声检查显示双肾长径相差〉1.5cm;血管超声对肾动脉狭窄检出率为31.3%（5/16例）;CT对肾动脉狭窄检出率为50.0%（3/6例）;肾动态显像对肾功能受损检出率为93.8%（15/16例）。通过肾血管超声检查确诊4例,通过肾动脉超声检查及CT检查确诊1例,通过肾动脉超声检查和肾动脉MRA检查确诊1例。③16/18例（88.9%）卧位血浆肾素和血管紧张素水平增高。12/29例（41.4%）存在低钾血症。10/29例（34.5%）确诊为多发性大动脉炎。结论儿童RVH贻误诊断率较高,对于有头痛、呕吐和抽搐者应首先测量血压,尤其在补液治疗前。肾动态显像有助于早期发现患侧肾功能受损,血浆肾素和血管紧张素增高、低钾血症、双肾大小不对称对于诊断具有提示意义,肾血管超声和CT检查敏感度有限,可疑患儿应尽早行肾动脉造影检查。确诊RVH后应尽可能进行病因诊断,尤其应确定是否存在大动脉炎以指导治疗。     

孕中晚期胎儿泌尿系统畸形的超声诊断及临床价值

目的探讨孕中晚期胎儿泌尿系统畸形的超声诊断及临床价值。方法选取我院2016年3月-2018年5月妊娠中晚期胎儿泌尿系畸形孕妇60例作为研究对象,回顾性分析胎儿超声表现和随访结果,总结超声诊断及临床价值。结果本组60例胎儿泌尿系统畸形中,梗阻性尿路疾病居胎儿泌尿系统畸形首位,有28例,所占比例为46.67%,其中有14例为单纯肾盂积水,有5例重度肾积水,重复肾积水8例,1例膀胱明显扩张,伴有双侧输尿管及肾盂扩张;其次是肾缺如,有17例,占28.33%,其中有14例单侧肾缺如,3例双侧肾缺如,患侧肾脏图像不能显示;6例异位肾,占10%,为盆腔异位肾,盆腔发现肾脏回声,羊水量正常;9例肾脏囊性疾病,占15%,其中3例是双侧多囊肾,均伴有羊水过少,双侧肾脏呈对称性,回声增强,偶可见小囊结构,单侧多囊性发育不良肾6例,伴发羊水过少或偏多,一侧肾脏明显增大,可观察到大小不一的囊性无回声区,囊与囊之间互不相通,之间可见部分实质回声。超声诊断胎儿泌尿系统畸形的敏感度为96.67%,误漏诊率为8.3%。结论超声作为一种操作简单、重复性好、安全可靠的影像检测手段,可以为临床科学诊断提供依据,可作为孕中晚期胎儿泌尿系统畸形的常规检查手段。     

数字X射线断层融合技术在静脉肾盂造影中的应用研究

目的探讨数字X射线断层融合(DTS)在静脉肾盂造影(IVP)中的应用价值。方法选择2014年4月至8月在南方医科大学南方医院接受IVP检查87例患者,其中男性49例,女性38例;年龄20~68岁,中位年龄40岁。行IVP及DTS,回顾性分析图像特征。结果 87例常规IVP检查中发现泌尿系结石42例,其中肾结石22例,输尿管结石16例,尿道结石4例。IVP联合DTS检查发现泌尿系结石65例,其中肾结石32例,输尿管结石27例,尿道结石6例,肾囊肿3例。IVP、IVP联合DTS检出结石阳性检出率分别为48.3%、74.7%。DTS均能清晰显示肾脏位置、大小、形态、密度、边缘,降低肠道伪影干扰,减少重叠区。IVP只能显示重复肾盂肾盏结构紊乱,DTS清晰可见重复肾盂肾盏。DTS可清晰显示尿道结石和输尿管内<1 cm的结石,但IVP未能显示。结论 DTS的阳性检出率明显高于常规IVP,能更清晰地显示双肾盂、输尿管、膀胱,是对IVP一种重要补充。     

输尿管软镜技术在飞行员肾结石诊治中价值及应用策略

目的通过对输尿管软镜(FURL)技术鉴别诊断飞行员结石,提出FURL在处理该类特殊人群肾内游离结石的安全性和有效性。方法选择2017年3月至2019年3月在上海交通大学医学院附属新华医院经CT泌尿系统造影(CTU)显示肾内高密度影飞行员共35例,均为男性;年龄23~53岁,平均年龄38.93岁。分析FURL诊断情况,以及碎石清除率。结果35例患者均成功完成FURL,确诊结石30例(85.71%),肾乳头钙化8例;30例中一次碎石清除25例(清除率83.33%),另5例经二次手术实现结石完全清除,二期清理成功。未出现泌尿系统严重出血、感染、尿路撕裂损伤等并发症。35例患者停飞观察1~96周,均成功复飞,未出现结石复发。结论FURL能及时、准确鉴别飞行员肾内微小结石,结合术前CTU显像可提高结石定位,提高一次结石清除率,减少手术创伤、结石遗漏或残留,降低二次手术风险;FURL在鉴别和治疗飞行员肾内游离微小结石有较好的应用安全性和有效性。     

64排螺旋CT三维重建在肾脏移植中的价值

背景:目前应用相对无创的多排螺旋CT来替代有创的数字减影血管造影进行评价肾脏移植手术中肾脏解剖及功能情况,主要集中在16排螺旋CT及以下机型,鲜有关于64排螺旋CT应用在肾脏移植中的报道。目的:探讨64排螺旋CT三维重建技术在肾脏移植手术中供者肾脏及受者肾脏的检查价值。方法:对7例拟自愿捐献一侧肾脏给其亲属进行活体肾脏移植的供者肾脏及6例接受了肾脏移植的受者肾脏进行了CT平扫、动脉期、静脉期及延迟期增强扫描,并对增强扫描各期进行多平面重建、容积再现技术、最大密度投影及曲面重建等三维后处理。结果与结论:7例供者CT血管造影显示左右肾均为1条肾动脉者4例;左肾2条肾动脉,右肾1条肾动脉者1例;左肾3条肾动脉,右肾两条肾动脉者2例;所有供者左右肾均见1条肾静脉及1套肾盂输尿管。MPR重建显示左肾囊肿1例,CT尿路造影显示双肾功能均未见异常,与手术对照,符合率100%。6例受者中CT血管造影显示6例移植肾动脉、静脉及输尿管吻合口均未见狭窄及内瘘,其中4例移植肾大小形态及密度正常,增强扫描动脉期皮质髓质分界清晰,皮质CT值均在150HU以上,静脉期肾脏实质强化均匀,CT尿路造影显示肾脏泌尿功能正常;2例移植肾增强扫描动脉期皮质髓质分界不清,皮质CT值均小于100HU,静脉期肾脏实质强化较弱,延迟10min扫描仅见少量对比剂排泄,经过肾脏穿刺确诊为排斥反应。结果表明,64排螺旋CT三维重建技术能完成对肾实质、肾血管以及泌尿系统的综合评价,可作为肾脏移植前后评价肾脏解剖及功能的较好方法。     

一例膀胱内巨大结石的治疗与护理

泌尿系统结石是临床常见病症,我科曾成功治疗一例膀胱内巨大结石。现总结如下:患者女性,35岁,自诉腰腹部疼痛十余年,近四、五年时有加重,伴发烧、恶心呕吐及膀胱刺激症,近数月来腹痛加重,间有脓尿,均按尿路感染治疗后症状缓解。一周前上述症状加重,按消炎利尿治疗后效果欠佳,住院后常规B超检查:右肾正常,左肾体积增大,皮质变薄,集合系统大量液性暗区,输尿管全程扩张,于膀胱人口处探及一范围约14mm×8mm的强回声光团及其后伴声影,膀胱内探及一范围约31mm×22mm的弧形强回声区,后声影典型。临床诊断为膀胱结石,即行体外震波碎石。     

儿童期脑外动静脉畸形的CT评估价值

目的:分析儿童期脑外动静脉畸形的临床特点及计算机断层扫描(CT)影像表现,探讨CT增强检查对儿童期脑外动静脉畸形介入治疗前的评估价值。方法:回顾性分析47例经数字减影血管造影确诊的儿童期脑外动静脉畸形患者的临床及CT影像资料,对部位、形态、边界、血管构筑和骨的侵犯等表现进行分析。结果:病变位于胸壁1例,腹盆壁3例,四肢7例,口腔颌面部29例,耳部3例,眼眶1例,鼻部1例,头皮2例,伴有骨质受累5例。临床呈高流量的血管畸形表现,症状反复或进行性加重。特征性CT表现为强化的畸形血管团、粗大扭曲的引流静脉、增粗的供血动脉。结论:CT增强检查能准确显示动静脉畸形的畸形血管团、大部分供血动脉及引流静脉,是介入治疗前的有效评估方法。     

成人多囊肾一家系

先证者(Ⅳ1)18岁,女。因其父为多囊肾而要求进行检查。询问病史,无腰痛、血尿史、高血压史,体检无阳性体征发现。B型超声显示右肾体积增大12cm×7.2cm×5.6cm,肾内右上肾区有多发大小不等的无回声区,有的无回声区,可见分隔回声,肾实质变薄,肾血流信号减少。左肾无异常发现,临床诊断为多囊肾。家系调查(图1):其家系4代有11人患有多囊肾,均在40岁左右出现腰痛、血尿等症状,B型超声显示单侧或双侧肾区有多发性液性暗区。讨论成人多囊肾为常染色体显性遗传病,其发病率约为1/1000。症状及体征大多在30~40岁出现,表现为血尿、腰部或腹部包块,以及…     

肾实质剖开取石治疗孤立肾结石6例临床分析

我科自1990年11月至2001年8月采用不阻断肾蒂法行肾实质剖开取石治疗孤立肾鹿角形结及多发结石6例,疗效满意,报道如下。1资料与方法1.1一般资料本组6例,男4例、女2例,年龄26~58岁、平均42岁,均为孤立肾患者(后天性)。IVU或逆行插管造影显示:均为肾内型肾盂,鹿角形结石1例(6cm×4cm×3.5cm大小),多发性结石5例(每例结石5~12枚);6例均有不同程度的肾积水,肾实质变薄。B超监测肾实质厚度为1.4~1.8cm,平均1.6cm。血BUN:8~15.2mmol/L。1.2方法取侧卧位,经第12肋缘下斜切口,切开Gerota筋膜,游离肾脏及上段输尿管,细尿管牵引上段输尿管,防止结…     

输尿管软镜在髓质海绵肾结石治疗中的应用

目的探讨输尿管软镜钬激光碎石术治疗髓质海绵肾结石的临床疗效与安全性。方法经输尿管输送鞘(UAS)置入软镜至各肾盏,镜下找到结石所在部位,采用钬激光切开乳头黏膜,然后粉碎结石,冲洗或取出结石碎片。术后观察患者临床症状缓解及术中术后并发症等情况,复查尿路平片。结果 14例患者均发现结石并行碎石处理,切开黏膜及乳头管未导致大出血,部分患者腰疼症状在术后3~7 d内或拔除双J管后缓解,大部分结石碎片自行排出,术后3个月复查,多数患者结石数量明显减少。结论输尿管软镜下钬激光碎石技术治疗髓质海绵肾结石效果良好,可显著减轻患者结石负荷,术中术后无严重并发症,微创、有效、安全,值得临床推广应用。     

11例小儿慢性肾功能不全的病因及临床特点

目的了解小儿慢性肾功能不全的病因及临床特点。方法回顾了我院收治的11例慢性肾功能不全患儿,男7例,女4例,年龄最小4个月,最大14岁,平均5岁。大于5岁小儿5例,小于1岁小儿6例。结果6例小婴儿慢性肾功能不全中婴儿型多囊肾1例,双肾发育不全1例,先天性肾病综合征1例,双肾发育异常伴尿道瓣膜、室间隔缺损、胆总管囊肿各1例。多以肾外症状就诊如：生长发育迟缓、腹包块、抽风、贫血等。5例较大的小儿为膀胱输尿管尿液返流Ⅳ级伴返流型肾病1例,原发性肾病综合征伴肾衰2例,慢性间质性肾炎1例,肾固缩1例,肥胖相关性肾病1例。结论小婴儿慢性肾功能不全多由先天性肾发育畸形所致,且多以肾外症状为表现,应引起重视。较大的小儿慢性肾功能不全多由获得性肾脏疾患所致;这些患儿如若尿改变不明显,肾功能异常明显,排除肾前、肾后因素所致者,应做肾穿刺活检明确病因。     

Crossed renal ectopia with fusion: report of two patients

Crossed renal ectopia is one of the rarest urinary system anomalies. It is more often seen at autopsy than in clinical practice. Most cases of renal ectopia remain asymptomatic during life and are diagnosed incidentally. Renal ultrasonography, intravenous pyelography, computerized tomography, and renal scintigraphy (technetium-based tests) are the imaging methods used for diagnosis. Demonstration of crossed renal ectopia is important because it is a predisposing factor for obstruction, infection, and neoplasia of the urinary system. We report two male patients who had unremarkable clinical findings. Both had left-to-right inferior crossed renal ectopia with fusion. Additionally, the first patient had a history of surgery for a recurrent inguinal hernia, whereas the second had crossed fused renal ectopia associated with nephroptosis. Surgeons should be aware of ectopic and fused kidneys to minimize perioperative complications because of the uncertain anatomy.     

中、晚期肾结核40例临床分析

目的探讨中晚期肾结核的临床表现特征及其有效治疗方法。方法对40例中晚期肾结核患者的临床资料进行回顾性分析。对所有患者进行尿常规、红细胞沉降率、尿抗酸杆菌、尿结核杆菌-PCR（Tb—PCR）、B超、静脉尿路造影（IVU）、CT等检查，8例患者行药物治疗，32例患者行手术治疗。结果临床表现为腰痛18例（45％），膀胱刺激症24例（60％），血尿28例（70％）。尿常规检查异常38例（95％），红细胞沉降率异常升高36例（90％），尿抗酸杆菌阳性11例（27．5％），尿结核杆菌-PCR（Tb—PCR）阳性18例（45％）。B超检查肾积水、肾结石或／和肾结构异常40例（100％）；静脉尿路造影（IVU）确诊肾结核23例（57．5％），患肾不显影17例（42．5％）；CT确诊肾结核31例（77．5％）。肾结核合并膀胱结核16例，肺结核5例，附睾结核8例。8例患者药物治疗治愈，32例患者手术后经病理确诊为肾结核。结论中晚期肾结核的临床表现多不典型，其诊断应在结合临床表现的前提下以实验室检查与影像学诊断为主。尿沉渣染色查抗酸杆菌仍重要，尿Tb-PCR检查是术前确诊肾结核的主要手段．IVU和B超可作为泌尿系结核诊断首选的影像学检查，治疗仍以手术切除肾脏为主，应尽可能切除患侧全程输尿管。     

Branchio-oto-renal syndrome: further delineation of an underdiagnosed syndrome.

We report on a woman who was diagnosed with branchio-oto-renal (BOR) syndrome after 2 pregnancies complicated by oligohydramnios due to renal hypoplasia and agenesis. Both babies died neonatally of pulmonary hypoplasia. Histopathology of the temporal bones of the second child showed marked immaturity of the middle ear cleft, ossicles, facial nerve and canal, and cochlear nerve. Maternal renal ultrasound study was normal although intravenous pyelography indicated renal hypoplasia. The frequency of BOR syndrome among cases of recurrent fetal renal hypoplasia/dysplasia or agenesis is unknown, and parental renal ultrasonography may not identify a heritable renal defect. Investigations should include a family history, and examination of relatives to look for preauricular pits, lacrimal duct stenosis, and branchial fistulae and/or cysts. Hearing studies and IVP may be indicated.     

小儿常染色体隐性遗传多囊肾病临床分析

目的探讨小儿常染色体隐性遗传多囊肾病（autosomal recessive polycystic kidney disease，ARPKD）的临床特点。方法回顾我院1995年1月～2006年12月收治的16例小儿ARPKD的临床资料。结果16例ARPKD中，男11例，女5例，影像学诊断14例，病理学诊断2例，肾脏影像学显示囊肿广泛分布于皮质和髓质。起病时以泌尿系症状就诊仅7例（43．75％），以肾脏外症状就诊3例（18．75％），其他就诊原因包括早产1例，出生时重度窒息1例，血尿素氮-肌酐（Bun—Cr）升高2例，贫血1例，外伤后肾囊肿破裂性腹痛1例。确诊时有12例（75％）肾衰竭，8例（50％）生长迟缓，10例（62．5％）合并肾脏外病变。随诊8例，4例死亡（分别死于先天性肺发育不良、重度窒息后多器官功能衰竭、进行性肾衰竭以及终末期肾病合并胆管细胞癌肾脏转移），1例透析，1例肾移植，1例肾功能正常，1例肝硬化。结论ARPKD为先天遗传性、进行性的肾脏和肝脏损害，小儿期临床表现形式多样，产前诊断对减少ARPKD畸形儿的出生有重要意义。     

Branchio-Oto-Renal syndrome: Further delineation of an underdiagnosed syndrome

We report on a woman who was diagnosed with branchio-oto-renal (BOR) syndrome after 2 pregnancies complicated by oligohydramnios due to renal hypoplasia and agenesis. Both babies died neonatally of pulmonary hypoplasia. Histopathology of the temporal bones of the second child showed marked immaturity of the middle ear cleft, ossicles, facial nerve and canal, and cochlear nerve. Maternal renal ultrasound study was normal although intravenous pyelography indicated renal hypoplasia. The frequency of BOR syndrome among cases of recurrent fetal renal hypoplasia/dysplasia or agenesis is unknown, and parental renal ultrasonography may not identify a heritable renal defect. Investigations should include a family history, and examination of relatives to look for preauricular pits, lacrimal duct stenosis, and branchial fistulae and/or cysts. Hearing studies and IVP may be indicated. © 1992 Wiley-Liss, Inc.     

Congenital renal anomalies detected in adulthood

Objective

To document the types of congenital renal anomalies detected in adulthood, the clinical presentation and complications of these renal anomalies, and the most useful imaging modality in detecting a renal anomaly.

Materials and methods

This study was approved by the institutional review board and informed consent was waived. Between January 2007 and January 2011, the clinical data and imaging studies of 28 patients older than 18 years diagnosed with renal anomaly at the authors’ institution were retrospectively reviewed. Renal anomalies in this study included only those with abnormality in position and in form.

Results

Of these 28 patients, 22 underwent imaging studies and their results constituted the material of this study. Of the 22 patients, 14 had horseshoe kidneys (HSK), four had crossed renal ectopia and four had malrotation. Sixteen patients were men and six were women. The patients ranged in age from 19 to 74 years (mean age 51.1 years). Clinical presentations were abdominal pain (13), fever (13), haematuria (4), palpable mass (2), asymptomatic (2), polyuria (1) dysuria (1), blurred vision (1), and headache with weakness of left extremities (1). Imaging studies included abdominal radiograph (15), intravenous pyelography (IVP) (8), retrograde pyelography (RP) (4), ultrasonography (US) (7), and computed tomography (CT) (9). Associated complications included urinary tract stones (17), urinary tract infection (16), hydronephrosis (12), and tumours (2). Abdominal radiograph suggested renal anomalies in nine out of 15 studies. IVP, RP, US and CT suggested anomalies in all patients who had these studies performed. However, CT was the best imaging modality to evaluate anatomy, function and complications of patients with renal anomalies.

Conclusion

HSK was the most common renal anomaly, with abdominal pain and fever being the most common presentations. UTI and stones were the most common complications. IVP, RP, US and CT can be used to diagnose renal anomalies but CT is the best imaging modality to evaluate renal anatomy, function and its complications.     

Chest computed tomography findings in severe influenza pneumonia occurring in neutropenic cancer patients

OBJECTIVE:

To describe the chest computed tomography findings for severe influenza H1N1 infection in a series of hospitalized neutropenic cancer patients.

METHODS:

We performed a retrospective systematic analysis of chest computed tomography scans for eight hospitalized patients with fever, neutropenia, and confirmed diagnoses of influenza H1N1. The clinical data had been prospectively collected.

RESULTS:

Six of eight patients (75%) developed respiratory failure and required intensive care. Prolonged H1N1 shedding was observed in the three mechanically ventilated patients, and overall hospital mortality in our series was 25%. The most frequent computed tomography findings were ground-glass opacity (all patients), consolidation (7/8 cases), and airspace nodules (6/8 cases) that were frequently moderate or severe. Other parenchymal findings were not common. Five patients had features of pneumonia, two had computed tomography findings compatible with bronchitis and/or bronchiolitis, and one had tomographic signs of chronicity.

CONCLUSION:

In this series of neutropenic patients with severe influenza H1N1 infection, chest computed tomography demonstrated mainly moderate or severe parenchymatous disease, but bronchiolitis was not a common feature. These findings associated with febrile neutropenia should elicit a diagnosis of severe viral infection.     

Effects of intravenous urography using sodium and meglumine ioxitalamate (Telebrix 38) on blood creatinine and urinary excretion of N-acetyl-beta-D-glucosaminidase

We evaluated the effect of intravenous pyelography (IVP) with sodium ioxitalamate and meglumine (Telebrix 38) on serum creatinine levels and urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG). Both values were significantly elevated 24 and 48 hours following intravenous pyelography. The increase of urinary NAG however, was much greater than that of the serum creatinine level. In patients with normal serum creatinine levels prior to the IVP, urinary NAG was very elevated at 24 hours and had returned to almost normal values 48 hours after intravenous pyelography. On the contrary, urinary NAG was increased at 48 hours as well as at 24 hours in patients with chronic renal failure following administration of Telebrix 38. It was not possible to demonstrate any correlation between NAG urinary excretion and the amount of iodinated contrast material administered, even in patients with normal renal function.     

Pheochromocytoma of the urinary bladder

The case of a 65-year-old male with pheochromocytoma arising in the urinary bladder is presented. Clinical evaluation included ultrasonography, intravenous pyelography and computerized tomography (CT) scan. Transurethral resection of an exophytic tumor 1 cm in diameter was performed. The histological diagnosis was pheochromocytoma of the bladder. The evaluation and management of this type of tumor is discussed.