小儿肾积水经皮肾造瘘后的形态学恢复

目的研究小儿肾积水经皮肾造瘘后肾形态学恢复的规律,探讨造瘘后手术时间的选择。方法对14例小儿重度肾积水,共15侧积水的肾脏,采用超声引导下经皮穿刺肾造瘘的方法引流尿液,并使用彩色多普勒超声动态观察解除梗阻后肾形态的恢复过程。结果所有病例的肾积水在经皮肾造瘘后肾形态均有恢复。肾积水解除梗阻后,患肾长径和宽径同步恢复,患肾外形与患肾肾盂的也是同步恢复,患肾皮质厚度增加。这一过程在1周内最显著,4周后趋于稳定。结论小儿肾积水经皮肾造瘘4周后,肾形杰恢复趋于稳定,可能是进行下一步手术比较恰当的时机。     

小儿巨大肾积水保留肾脏手术疗效观察

目的探讨小儿巨大肾积水保留肾脏手术的疗效。方法回顾性分析我院1995年3月至2006年8月收治的16例小儿巨大肾积水临床资料。男6例,女10例。平均年龄3岁（4个月～12年）。术前均行KUB,IVU,超声或CT确诊。肾盂输尿管连接部梗阻14例,下腔静脉后输尿管1例,输尿管异位开口1例。术中排出积水后测量肾皮质厚度和肾盂尿PH值,同时手术治疗原发病,患肾实质行内翻折叠成形术。结果16例均手术成功,术中测患。肾尿液PH〈6．1的1例1侧,PH在6．1～7．1的15例16侧。术后6-8d拔除输尿管支架管,术后2周拔除肾造瘘管。16例患儿均获得随访,随访时间中位数6年（6个月～11年）。所有患儿患肾功能有不同程度改善。无1例患儿因患肾功能丧失需再次行。肾切除术。结论小儿巨大肾积水不能作为。肾切除的指征,应结合肾皮质厚度和。肾盂尿PH值等选择外科手术治疗方法,尽可能保留肾脏。手术治疗原发病并行。肾实质折叠缝合是治疗小儿巨大肾积水的有效方法之一。     

小儿先天性重度肾积水的外科治疗

目的：探讨小儿先天性重度肾积水保存肾脏行肾盂输尿管成形术的指征及疗效。方法;对32例先天 肾积水患者,术前行X线腹部平片,B超,IVU,CT,肾图检查,术中排出积水后观察肾形态及其皮质的厚度和色泽,结果：B超及CT诊断巨大肾积水,而常规IVU造影28例中14例未显,6 肾图检查中3例无功能曲线,但32例中30例术中排出积水后,肾脏体积明显缩小,其皮质厚度大部分在0．3－0．5cm以上,皆有一定泌尿功能,结论：小儿先天性肾积水常规IVU检查不显影及术前肾图的无功能曲线皆不能作为肾切除的指征,应依据肾皮质之厚度,肾脏的病理改变及对侧肾功能情况选择外科手术方法。     

超声诊断胎儿肾积水20例分析

目的探讨超声方法检测胎儿肾积水出生前后的病理、生理演化过程。方法选择2008～2009年在笔者所在医院定期做产前检查和住院分娩的孕妇,应用超声检查筛选并随访肾积水胎儿20例,首次检查发现肾积水后每周复查1次B超,临产前及胎儿出生排尿后各复查1次,对出生后仍有肾积水的婴儿,每1个月复查1次。最长观察时间为1年。结果本组20例孕妇21只肾脏,其中16例17只肾脏肾盂肾盏扩张,经随访最晚至出生后7个月肾积水征象全部消失。3例患者3只肾脏呈重度积水,为不可复性肾积水,经手术证实为泌尿系统先天发育异常。结论大部分胎儿肾积水在随访观察过程中积水变化较轻直至消失,可完全恢复,预后良好。少数重度肾积水出现加重情况,预后差,需采取紧急措施。     

慢性不全梗阻性肾积水多普勒参数与肾盂形态学指标相关性…

目的：探讨慢性不全梗阻性肾积水多普勒参数与肾盂形态学指标的相关性。方法：在慢性不全梗阻性肾积水动物模型上，用彩色多普勒Ｂ超检测肾血清多普勒参数在梗阻解除前后的动态变化，分析了血管阻力指数（ＲＩ）与积水肾形态学指标的相关性。结果：１．积水肾ＲＩ值随梗阻时间延长而逐渐升高，积水肾肾盂容积（ｖ）、前后径（ＡＰＤ）逐渐增大，肾皮质厚度（ＲＣＴ）逐渐变薄。梗阻解除后，原积水肾ＲＩ值逐渐降低，Ｖ、ＡＰＤ逐渐减     

积水性肾萎缩

积水性肾萎缩（Ｈｙｄｒｏｎｅｐｈｒｏｓｔｉｃａｔｒｏｐｈｙ）是肾积水的最终病理改变，可能与肾盂压力、肾血管改变及细胞凋亡有关。本文介绍了近年来积水性肾萎缩的原因及其病理转归的研究进展，简述了积水性肾萎缩时对侧肾脏增生以及小儿肾积水的手术问题。     

MRI在胎儿肾积水诊断中的应用

目的:探讨磁共振成像(MRI)对胎儿肾积水的诊断价值.方法:回顾性分析60例肾积水随访胎儿的MRI,孕龄21～37周,平均29周,并将MRI、US结果与引产后或出生后随访结果对照.结果:双侧11例、单侧49例;轻度肾积水31例,中度肾积水12例,重度肾积水17例,其中双侧重度肾积水2例引产,余58例均出生,轻度积水的胎儿中有22例产后随访积水消失.结论:MRI是胎儿肾积水较有价值的产前影像诊断方法.能提供超声以外的信息,发挥超声的重补充作用,尤其是超声显示不清时.     

脊髓栓系综合征致上尿路积水的手术疗效观察

目的　探讨脊髓栓系综合征 (TCS)引起上尿路积水去栓手术的疗效。　方法　对 2 0例TCS伴有上尿路积水患者进行去栓手术 ,观察比较手术前后膀胱剩余尿、肾和输尿管积水、肾皮质厚度及肾功能的变化。　结果　膀胱剩余尿恢复正常 5例 ,减少 10例 ,总有效率 83%。肾积水明显减少 6例 ,轻度减少 7例 ,无改变 7例 ,总有效率 6 5 %。输尿管积水明显减少 7例 ,好转 4例 ,无变化7例 ,总有效率 6 1%。肾皮质厚度明显增加 5例 ,轻度增加 2例 ,无改变 13例 ,总有效率 35 %。肾功能中度尿毒症转为轻度 2例 ,轻度转为正常 4例 ,14例同术前正常。　结论　去栓手术治疗TCS伴发上尿路积水和尿毒症有效。     

慢性不全梗阻性肾积水多普勒参数与肾盂形态学指标相关性的实验研究

目的:探讨慢性不全梗阻性肾积水多普勒参数与肾盂形态学指标的相关性.方法:在慢性不全梗阻性肾积水动物模型上,用彩色多普勒B超检测肾血流多普勒参数在梗阻解除前后的动态变化.分析了血管阻力指数(RI)与积水肾形态学指标的相关性.结果:1.积水肾RI值随梗阻时间延长而逐渐升高,积水肾肾盂容积(v)、前后径(APD)逐渐增大,肾皮质厚度(RCT)逐渐变薄.梗阻解除后,原积水肾RI值逐渐降低,V、APD逐渐减小,RCT逐渐增厚.2.在梗阻解除前后,APD与RI呈密切正相关,RCT与PI呈负相关.结论:将积水肾肾形态学指标与肾血流多普勒参数(RI)综合考虑.有助于判断积水肾功能及预后.     

积水性肾萎缩

积水性肾萎缩是肾积水的最终病理改变，可能与肾盂压力，肾血管改变及细胞凋亡有关，本文介绍了近年来积水性肾萎缩的原因及其病理转归的研究进展，简述了积水性萎缩时对肾脏增生以及小儿肾积水的手术问题。     

Postnatal management of infants with antenatally detected hydronephrosis

With the increasing use of antenatal sonography, fetal hydronephrosis has been reported more frequently. Because of the lack of consensus regarding treatment of these infants, the postnatal approach toward fetal renal pelvis enlargement remains controversial. The aim of this prospective study is to demonstrate the postnatal investigation, treatment, and outcome of infants with prenatally diagnosed hydronephrosis. Infants whose antenatal ultrasound scan showed a fetal renal pelvis of 5 mm or greater were investigated postnatally using ultrasound (US) and voiding cystourethrography. When indicated, isotope studies and intravenous urograms were also performed. We followed prospectively neonates with antenatally diagnosed hydronephrosis and recommended management guidelines on the basis of our findings. In 156 neonates (193 kidney units) that were found to have hydronephrosis, the average gestational age at which the diagnosis was made was 32.94±5.10 weeks. The mean duration of postnatal follow-up was 26.3±13.56 months (range 3–60 months). The mean APPD of the fetal renal pelvis was 10.35±3.24 mm (5–9 mm in 84 kidneys, 10–14 mm in 96 kidneys and 15 mm in 13 kidneys). Of the 193 kidney units, 145 units were found to be pathological. The most common detected underlying abnormalities were ureteropelvic junction obstruction (in 91 kidneys; 62.7%) and vesicoureteral reflux (in 24 kidneys; 16.6%). Postnatally, 23 (45%) of 51 patients whose first US was normal were diagnosed postnatally as having urinary tract abnormality. There was a negative correlation between APPD and the rate of spontaneous resolution and positive correlation between APPD and the rate of surgery (P<0.01). In conclusion, because it is not possible to determine an upper limit of normal for the antenatal renal pelvis, any baby with AH should not be considered clinically insignificant. Infants with antenatal renal pelvis measurements 5 mm should be investigated postnatally. A normal postnatal ultrasound scan does not preclude the presence of urinary tract abnormality.     

Effects of experimental obstructive hydronephrosis on the immature nephrons in newborn rats

Partial obstruction of the left ureter was created in rats less than 36 h of age and its effects were studied at the age of 2-6 days. A considerable hydronephrosis with distension of the kidney developed within 1 day after obstruction, but there was no parenchymal weight reduction. The thickness of the mature, inner cortical layer was significantly decreased, suggesting a delay in the differentiation of the cortex. The parenchymal weight reduction, previously documented in our laboratory after long-standing ureteric obstruction, may thus be caused by a retardation of renal growth, which is never caught up, rather than by an atrophy of renal parenchyma or other destructive tissue lesions.     

Renal parenchymal function evaluated by scintillation camera renography before and after pyeloplasty for hydronephrosis.

Scintillation camera renography with Tc-DTPA was performed before and after pyeloplasty on 16 kidneys with urographic signs of pelviureteric obstruction causing hydronephrosis. Regional parenchymal renograms were generated, and the passage of Tc-DTPA through the parenchyma was measured and correlated to the change in separate glomerular filtration rate. Preoperative parenchymal passage of DTPA was significantly slower (p = 0.02) in kidneys with improved glomerular filtration rate after pyeloplasty than in those without such improvement. Postoperative passage of DTPA in parenchyma was almost identical with that in a reference series. This method seems to be clinically useful for evaluating cases of hydronephrosis and for predicting the outcome of pyeloplasty.     

Long-term effects of percutaneous nephrolithotomy on renal morphology and arterial vascular resistance as evaluated by color Doppler ultrasonography: preliminary report

We evaluated the long-term effects of percutaneous nephrolithotomy (PNL) on renal morphology and vascular resistance. Parenchyma thickness, echogenicity and resistive index (RI) of upper, middle and lower poles of operated and contralateral kidneys of 41 patients with 82 renal units who underwent unilateral PNL with single pole access between 2000 and 2002 were examined separately by color Doppler ultrasonography. Mean patient age and duration between PNL and evaluation time were 38.29±11.53 years and 46.44±10.9 months, respectively. In operated kidney, mean RI, parenchyma thickness and echogenicity of the access pole were not statistically different than those of the adjacent two poles (0.608±0.053 vs. 0.608±0.052 for RI, P=0.895; 11.46±2.58 vs. 11.41±2.68 mm for parenchyma thickness, P=0.838; 0.049±0.31 vs. 0.073±0.33 for parenchyma echogenicity, P=0.160, respectively). Although mean RI and parenchyma thickness of access pole were statistically significantly different than the mean values of contralateral kidney (0.562±0.032 and 14.31±1.37 mm, respectively), no statistical difference was found between mean parenchyma echogenicities of both of them (echogenicity of contralateral kidney was 0, P=0.317). No significant difference was found between the average echogenicities of the three poles of the operated and contralateral kidneys (0.063±0.32 vs. 0, P=0.080). In 14 patients RI decreased from 0.694±0.058 to 0.602±0.056 in operated kidney (P=0.001) and from 0.604±0.06 to 0.559±0.031 in contralateral kidney (P=0.018) following PNL. It seems that PNL does not cause renal scarring, renal parenchymal loss or increase in renal vascular resistance in the long term. However, prospective studies must be performed for more definitive conclusions.     

Are preoperative parameters of unilateral pyelo-ureteric junction obstruction in children predictive of postoperative function improvement?

OBJECTIVES: Surgery on the pyelo-ureteric junction obstruction (PUJO) has long been thought to affect postoperative renal function. However, preoperative assessment of which kidneys will benefit from such surgery remains unreliable. MATERIAL AND METHODS: Pre- and postoperative data relating to renal function were obtained by renal scan for 69 patients who were operated upon for PUJO. These patients were divided into two groups: group A (improved differential renal function) and group B (unimproved or decreased differential renal function). The two groups were then compared with regard to age at operation and presence or absence of clinical symptoms. Ultrasound (anteroposterior diameter of the pelvis, parenchymal thickness) and renal scan (glomerular filtration rate, differential renal function of the affected kidney, obstructive pattern) parameters were also taken into consideration. Some variables were also made dichotomous (pelvic diameter < or > 15 mm, parenchymal thickness < or > 5 mm, differential renal function < or > 40%). Statistical correlation was sought with parametric and non-parametric tests. RESULTS: No correlation whatsoever was found between the two groups for any of the parameters under consideration, so that any attempt at logistical regression analysis failed. CONCLUSIONS: None of the currently adopted diagnostic tests can be used to indicate which renal units will benefit from surgery through an improved renal function. The presence or absence of clinical symptoms does not appear to affect renal function either. There is evidence that parents should be provided with such information when giving their informed consent to pyeloplasty.     

Renal parenchymal damage on DMSA-scintigraphy in pelviureteric obstruction

During a 1.5 year period 21 children were investigated with 99-m-technetium dimercaptosuccinic acid (DMSA) before operation for hydronephrosis due to pelviureteric obstruction. The age at investigation was 0.2-11.5 years. Fourty-two kidneys were examined. Hydronephrosis existed on the right side in 8 cases, left side in 9 and bilateral in 4 cases. Seventeen kidneys had no obstruction. The scintigraphy was interpreted as normal in 19 kidneys. Decreased isotope uptake was found in 23 kidneys and localized to the upper pole area in 19 kidneys, middle-lateral part in 7, lower pole area in 15 and the middle-medial part in 12 kidneys. There were no predominance for any part of the kidney to be affected by parenchymal damage. In 8 children investigated before the age of 1 year, 4 of 10 hydronephrotic kidneys revealed normal DMSA scintigram. DMSA scintigraphy delineates functioning renal parenchyma. DMSA scintigraphy delineates functioning renal parenchyma. It can be recommended as a routine method for evaluation of the renal parenchyma before surgery and for follow up studies in all ages of childhood.     

Management of the fetus with congenital hydronephrosis II: Prognostic criteria and selection for treatment

Selecting appropriate management for the fetus with bilateral congenital hydronephrosis depends on our ability to accurately assess the severity of existing renal damage and to predict the potential for recovery of renal and pulmonary function if the obstruction is relieved. We reviewed our experience with 20 fetuses with congenital bilateral hydronephrosis to determine the prognostic value of various criteria used to assess functional potential, including temporary catheter exteriorization to measure fetal urine output and composition. Based on autopsy, biopsy, or clinical outcome, ten fetuses were classified retrospectively as "poor function," and ten fetuses as "good function." The good function group could be distinguished from the poor function group by the following criteria: Amniotic fluid (AF) status at presentation (P less than .001), ultrasound appearance of the fetal kidneys (P less than .05), fetal urine sodium and chloride concentration and osmolarity (P less than .001), and hourly urine output (P less than .02), but not by fetal urine iothalamate excretion or potassium and creatinine concentrations (P greater than .05). Based on these results, we have identified prognostic criteria that accurately identify the fetus with "good function" from the fetus with "poor function." We also reviewed the clinical management of our last 12 unreported cases. Ten fetuses had undergone diagnostic catheter placement and in utero renal function testing. This led to placement of a therapeutic indwelling catheter-shunt in seven fetuses (three required multiple shunts) and a suprapubic vesicostomy in another. Catheter related complications, including three cases of chorioamnionitis, emphasize the need for better methods of in utero decompression in selected cases. Our ability to select appropriate management has improved markedly.     

Renal parenchymal thickness and urinary protein levels in patients with ureteropelvic junction obstruction after nephrostomy placement

Objective: To assess recovery of renal parenchymal thickness and urinary protein levels in patients with severely hydronephrotic kidneys after nephrostomy placement. Methods: Fourteen patients (median age 1 year, range 6 months–7 years) who underwent nephrostomy placement for unilateral ureteropelvic junction obstruction at our hospital between May 2007 and January 2009 were included in a retrospective analysis. All patients had severe hydronephrosis, with a median parenchymal thickness of 1.8 mm (range 1–2.5 mm). Kidney morphology was examined by ultrasound before the procedure and 1, 2, 3, 4, 6 and 8 weeks after. Urinary proteins (including albumin, immunoglobulin [IgG], α2‐macroglobulin, α1‐microglobulin, β2‐microglobulin [β2‐MG] and kappa chain) and creatinine levels were also tested during these follow‐up visits. Fifteen healthy children were assessed for urinary protein levels as well and made up the control group. Results: Parenchymal thickness increased within 4 weeks of nephrostomy placement. Kidney volumes were significantly decreased within 2 weeks. No further changes in morphology were detected after 4 weeks. Urinary α1‐microglobulin and β2‐MG levels decreased to baseline within 1 and 4 weeks, respectively. Urinary albumin, IgG, α2‐macroglobulin and kappa chain levels decreased gradually after nephrostomy, but did not return to baseline within 8 weeks. Conclusions: After nephrostomy placement, parenchymal thickness increases within 4 weeks, tubular function returns to normal earlier than glomerular function and glomerular membrane repair is inversely correlated with the severity of damage.     

Renal function in experimental chronic hydronephrosis. II. Backflow studies with radionuclides.

Studies of backflow in experimental unilateral chronic hydronephrosis in dogs with a known residual renal function and renal pelvic volume were performed with radioactively labelled substances with molecular weights of ca. 600, 5 200 and 68 000 placed in the hydronephrotic renal pelvis. Three different pressure levels in the renal pelvis were used. Isotope concentrations were determined in the thoracic duct lymph, 0lood and urine from the contralateral kidney. The greater part of the test substances appeared to pass to the blood circulation, while a smaller part was found in the lymphatic ducts. The largest molecule, however, was only able to leave the renal pelvis to any appreciable extent at the highest pressure. In kidneys with a low grade of hydronephrosis and well preserved function, a relatively large amount of test substance left the renal pelvis (ca. 10-15%). In more advanced grades of hydronephrosis with greater impairment of renal function, the backflow was considerably less.     

Usefulness of ultrasonography in follow-up of postoperative pelviureteric dilatation in children

To determine the availability of ultrasonography in follow-up of postoperative pelviureteric dilatation, 35 children, who had previously been operated on in some part of the urinary tract, were examined by both excretory urography and ultrasonography. Of 59 kidneys shown to be with a dilated collecting system on excretory urography, 58 were correctly detected by ultrasonography, with a sensitivity of 98.3%. The grade of dilatation of the collecting system diagnosed by ultrasonography was corresponded to that by excretory urography in 99 of 123 kidneys [80.5%). At the level of the lower calyx, 40 of 43 ureters which measured 5 mm or greater in diameter on excretory urogram, were detected by ultrasonography. Thirty of 36 ureters posterior to the bladder with a diameter of over 5 mm were also detected by ultrasonography. The diameters of the ureters measured by ultrasonography were well correlated with those on excretory urogram. These results suggest that the availability of ultrasonography is so high that it could substitute for excretory urography in follow-up of postoperative hydronephroureter in children.