Perfusion pressure flow study in the upper urinary tract

Hydronephrosis with an undetermined pathology is a common condition detected in imaging studies. In urological clinical practice, it is a persistent dilemma to predict whether this condition will progress to result in the deterioration of renal function. Perfusion pressure flow study of the upper urinary tract, known as the Whitaker test, provides an alternative diagnostic tool for solving this condition. Perfusion pressure flow study has been criticized for its invasiveness, nonphysiological approach, and inconsistency in predicting outcomes. However, it continues to be used to evaluate difficult or equivocal cases and to provide an objective assessment of the upper urinary tract.     

Minimum incision endoscopic nephrectomy for giant hydronephrosis

Five consecutive patients with symptomatic giant hydronephrosis underwent minimum incision endoscopic nephrectomy. The originally huge renal specimen was retroperitoneally mobilized using both of endoscopy and direct vision, without the use of trocar ports or gas insufflation, via a single minimum incision that narrowly permitted extraction of the specimen. The specimen was successfully extracted from the incision in all patients. Technically, proper deflation of the hydronephrotic sac facilitates mobilization and enables extraction of the specimen. Median (range) size of incision, operative time, and estimated blood loss were 4 cm (3-5), 205 min (156-222), and 210 mL (110-350), respectively. No patient required blood transfusion or encountered operative complications. Postoperative convalescence was short and uneventful; all patients resumed oral intake and ambulance on the day following surgery, and were physically dischargeable from hospital after 2-3 postoperative days. Thus, this technique is a feasible, minimally invasive and safe procedure for symptomatic giant hydronephrosis.     

Acro-pectoro-renal field defect with contralateral ureteropelvic junction obstruction

Ureteropelvic junction obstruction was noted in a newborn male infant with acro-pectoro-renal field defect. To our knowledge, this association has not previously been reported. Ultrasonography of the urinary tract should be performed on all children with aplasia of the pectoralis major muscle.     

Down-regulation of inducible nitric oxide synthase (iNOS) in rat with congenital hydronephrosis

BACKGROUND: Most of our knowledge concerning obstructive uropathy has been derived mainly from surgically manipulated animal models, and the pathogenesis of congenital obstructive hydronephrosis is not fully elucidated. Nitric oxide (NO) acts as an important biological modulator with diverse physiological functions, which can be either toxic or protective depending on the situation. NO is synthesized from l-arginine by nitric oxide synthase, and in the kidney iNOS is expressed spontaneously. The aim of our study is to investigate the expression of iNOS protein and its relationship with tubulointerstitial fibrosis and tubular cell apoptosis in congenital hydronephrosis. METHODS: We conducted histological studies on 18 kidneys of six-week-old-rats from an inbred colony of congenital hydronephrosis with reference to the histological grading of the affected kidney, tubulointerstitial fibrosis, renal tubular atrophy, and tubular cell apoptosis. Renal transforming growth factor-beta1 (TGF-beta1) level was determined by a sandwich ELISA assay and the expression of iNOS was analyzed by western blotting. RESULTS: Most of the hydronephrotic kidneys were markedly enlarged with dilatation of the collecting system, parenchymal thinning, tubular atrophy, interstitial infiltration and fibrosis. Renal TGF-beta1 level was higher in hydronephrotic kidneys than normal control kidneys (364.81 +/- 52.60 vs. 221.19 +/- 22.53 pg/mg protein, P < 0.05). Tubular apoptotic score in hydronephrotic kidneys was also significantly higher than in the normal control kidneys (1.97 +/- 0.42 vs. 0.14 +/- 0.02/HPF, P < 0.01). The expression of iNOS protein was lower in the affected kidneys compared with the normal control kidneys (8.79 +/- 0.78 vs. 14.00 +/- 0.83 arbitrary unit, P < 0.01). There was a negative correlation between iNOS expression and histological grading in congenital hydronephrosis. The iNOS expression also correlated negatively with renal interstitial fibrosis, TGF-beta1 level and tubular cell apoptosis. CONCLUSION: Our study confirmed the down-regulation of iNOS expression in affected kidneys from rats with congenital hydronephrosis, in which the cytoprotective effect of NO may be lost or weakened.     

58例脊髓损伤合并轻中度肾积水的临床分析

目的探讨脊髓损伤（SCI）肾积水的临床表现特点、发病机理和最佳治疗途径。方法对58例轻、中度脊髓损伤肾积水患者进行回顾性分析，观察肾积水缓解所需的治疗时间和复发情况。结果留置尿管、间歇导尿加药物、综合疗法3种治疗方法所需的治疗时间无差异；其中有效56例（96．55％）；3个月内复发28例（48．28％）；逼尿肌反射亢进合并括约肌痉挛（DSD）的复发率（57．14％）高于逼尿肌反射亢进者（28．57％）和低下者（14．29％）；肾积水复发与患者不能坚持治疗有关。结论SCI肾积水的病程隐匿且易复发；长期坚持间歇导尿和药物治疗能有效预防肾积水的复发。     

Body growth in early diagnosed vesicoureteric reflux

Body growth was studied in 32 subjects with vesicoureteric reflux (VUR), diagnosed following the prenatal finding of urinary tract dilatation, who had normal renal filtration function and who received antibacterial prophylaxis by the first few days of life. They were followed for 1–5 years (mean 2.3 years). Most had persistent VUR during the 1st year of life. Body growth performance was compared with that of 94 subjects with VUR diagnosed and treated by us after the neonatal period. During the follow-up period, none of the patients with prenatally detected VUR had a height Z score below –2, nor a weight-for-height index below 90%, and 1 had variations in height Z score ≥1. The difference in the percentage of patients with prenatally detected VUR (1/32) and those with VUR diagnosed and treated after the neonatal period (20/94) who had variations in height Z score ≥1 was significant (P=0.035). Patients with prenatally detected VUR and normal renal filtration function, given antibacterial prophylaxis by the first few days of life, have normal body growth, although VUR still persists. Received: 19 March 1998 / Revised: 10 February 1999 / Accepted: 10 February 1999     

An Unusual Cause of Anuria and Hydronephrosis in a 12-Year-Old Girl

Abstract

A 12-year-old girl was admitted for abdominal pain and signs of acute kidney injury. Physical examination showed abdominal distension and a tumefaction in the lower abdomen. Laboratory and clinical findings were consistent with acute kidney injury. Abdominal ultrasonography showed an oval mass, which corresponded with hematometrocolpos, and right-sided hydronephrosis. Catheterization followed by cruciate hymenectomy was performed. The patient recovered completely. Imperforate hymen is an obstructive anomaly of the female reproductive tract of unknown etiology that can cause a variety of symptoms. It is a rare, but possible cause of acute kidney injury. Patient history data and genital examination findings are sufficient to establish the diagnosis. Abdominal ultrasonography is the most useful diagnostic modality.     

小儿肾积水肾功能损害检测探究

目的探讨小儿肾积水肾功能损害检测的方法与价值,探究病肾功能损害程度评定的客观指标与有效方法。方法回顾性分析湖南航天医院2010年1月-2012年4月收治的67例小儿肾积水患者的临床资料。结果在67例小儿肾积水患者中,病理分级为:I级4例,Ⅱ级19例,Ⅲ级9例,Ⅳ级19例,Ⅴ级16例。通过共同检测尿β2-MG/Cr、THP/Cr、Alb/Cr及IgG/Cr,准确、客观地评定病肾。结论病理组织学检测、尿蛋白检测、肾血流动力学检测、病肾组织MCP-1mRNA表达检测等方法,是检测小儿肾积水肾功能损害的有效方法,在临床实践中应当根据患者病情综合运用,以提高小儿肾积水肾功能损害检测的准确性。     

小儿肾积水围手术期护理

肾盂输尿管连接处梗阻（Pyeloureteric junctionobstruction,PUJO）是小儿肾积水的常见原因[1]。随着积水程度的增加,肾盂积水加重,肾皮质变薄,患儿肾功能和尿液浓缩稀释功能受到严重影响,如治疗不及时可导致尿路感染而引起全身症状,甚至出现肾实质萎缩发生肾功能衰竭。     

18F-FDG PET/CT features of ureteral metastases from breast cancer: a case report

Breast cancer metastasis to the ureter is rare. Fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/computed tomography (CT) is widely used to identify primary lesions of metastatic tumours, however, 18F-FDG PET/CT imaging features of ureteral metastasis from breast cancer are rarely reported. Herein, the case of a 46-year-old woman with recurrent left flank pain for 5 months, who was admitted to the Cancer Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, is described. She had undergone right radical mastectomy 5 years previously and had received tamoxifen treatment for 5 years. Assessment by 18F-FDG PET/CT revealed tumours on the ureter presenting as a long segmental lesion, radioactive concentrations, and a low maximum standardized uptake value (SUVmax), with no radioactive concentrations in the urine and no significant change in the ureteral contour. The severity of the ureteral lesion was not consistent with the severity of hydronephrosis. A tumour biopsy was performed laparoscopically, and postoperative pathological examination confirmed a primary breast cancer tumour. The patient did not consent to treatment and was lost to follow-up.