Ureteral obstruction in the neonatal guinea pig: Interaction of sympathetic nerves and angiotensin

The contribution of sympathetic nerves to the hemodynamic effects of unilateral ureteral obstruction (UUO) was investigated in the neonatal guinea pig. The left ureter was partially constricted (or sham-operated) at birth, and sympathetic innervation was inhibited by guanethidine and compared with saline vehicle-treated animals. At 15–20 days of age, blood presure, cardiac output, total vascular resistance (TVR), renal blood flow, and renal vascular resistance (RVR) were determined before and after infusion of enalapril. UUO reduced cardiac output, increased TVR, and increased RVR of the ipsilateral kidney, whereas guanethidine treatment had no additional effects. Enalapril decreased RVR only in obstructed kidneys and not in intact opposite kidneys of animals with UUO. This was not affected by guanethidine administration. In contrast, enalapril decreased RVR only in guanethidine-treated (but not saline-treated) sham-operated guinea pigs. Therefore, UUO increases angiotensin-dependent vascular tone of the ipsilateral kidney independent of renal innervation. However, UUO decreases angiotensin-mediated vascular tone of the contralateral kidney, an effect unmasked by sympathectomy.     

Renal candidiasis in the rat: effects of ureteral obstruction and diabetes

Summary The effect of ureteral obstruction on the course of renal candidiasis in a rat model was studied, using both normal and diabetic Sprague-Dawley rats, and a clinical isolate of Candida albicans. Diabetes was induced by streptozotocin injection 1 week prior to inoculation and transabdominal ligation of the left ureter. On day 9 post inoculation, mean titers of Candida were similar in right and left kidneys of obstructed rats. Mean left renal titers for obstructed and control rats were similar (log₁₀ 2.68 CFU/g±0.73 (SE) vs. log₁₀ 2.21±0.09, P>0.01). Diabetes produced higher renal titers of Candida, regardless of the presence of ureteral obstruction (log₁₀ 5.74 CFU/g±0.57 (SE) vs. log₁₀ 2.21±0.09, P<0.01). Animals treated for one week with amphotericin B showed a marked difference in Candida titers between obstructed and control animals (log₁₀ 4.14 CFU/g±0.45 (SE) vs. 1.57±0.38) for both kidneys, and between obstructed and nonobstructed kidneys in the same animals.     

Ureteral obstruction due to endometriosis

The authors reports a rare case of ureteral endometriosis with hydronephrosis. Endometriosis was not proven by urological means but was found during open surgery. The value of ureteroscopy in cases of suspected endometriosis is discussed.     

直肠癌术后复发致输尿管下段梗阻的处理

目的总结直肠癌术后并发输尿管下段梗阻的处理方法。方法采用血液透析,输尿管皮肤造口术,输尿管支架术,输尿管记忆合金支架,膀胱壁瓣输尿管成形术,输尿管Ｔ管引流术及肾盂造瘘７种方法,处理２０例此类病人。结果２０例患者尿液引流通畅,全身情况及尿毒症症状迅速改善。结论以上处理方法对提高病人的生活质量,延长病人生命有积极作用。     

Compensatory renal growth due to neonatal ureteral obstruction: implications for clinical studies

In response to unilateral ureteral obstruction (UUO), the contralateral kidney undergoes compensatory renal growth, which is enhanced in early development. We investigated the renal growth response to UUO in the neonatal rat. Within 2 days of birth, animals were subjected to sham-operation, complete UUO, or variable partial UUO, and kidneys were harvested 3–60 days later. Contralateral kidney weight increased after only 7 days of complete UUO. Increase in contralateral kidney weight was not significant for partial UUO until 45 days, but kidney/body weight ratio increased after only 14 days of 0.3 mm partial UUO. The rate of contralateral renal growth increased with age and with increasing severity of UUO. In rats subjected to 45 days UUO, glomerular area was proportional to kidney/body weight ratio (r =0.61, p <0.01). We conclude that the rate of compensatory renal growth is dependent on the severity and duration of obstruction, and takes place at the single nephron level. The results suggest that biologic variability limits the early detection of compensatory renal growth, which is compounded by limitations in measuring renal size by clinical imaging. Factoring kidney length (or volume) by intervertebral length (or body surface area) should improve the precision of tracking renal growth.     

骨调素和单核细胞趋化蛋白在大鼠梗阻性肾病中的表达及可能作用

目的:探讨骨调素(OPN)和单核细胞趋化蛋白(MCP-1)在大鼠梗阻性模型中的表达及其在肾脏纤维化发病机制中的作用.方法:采用-单侧输尿管结扎制造梗阻性肾病模型,分别于造模后7 d、14 d取肾组织,应用HE染色观察肾脏病理改变,免疫组化方法检测肾组织畔OPN和MCP-1蛋白的表达,应用逆转录-聚合酶链式反应(RT-PCR)法观察肾组织中OPN mRNA和MCP-1 mRNA的变化.结果:OPN、MCP-1表达主要位于肾小管上皮细胞,随着梗阻时间的延长,肾组织中OPN、MCP-1蛋白和mRNA表达明显增加.结论:OPN、MCP-1蛋白和mRNA在梗阻性肾病大鼠肾组织表达明显增加介导炎症过程,参与肾间质纤维化.     

大黄酸对单侧输尿管梗阻大鼠肾脏的抗氧化保护作用

目的观察大黄酸（RH）对单侧输尿管梗阻（UUO）大鼠肾间质损伤的抗氧化保护作用。方法将30只雄性SD大鼠分成假手术组（Sham组）6只;UUO模型组（UUO组）和RH干预组（UUO＋RH组）各12只。除Sham组外,UUO组和UUO＋RH组分别在第3、7天测定大鼠左肾皮质匀浆中脂质过氧化物标志物丙二醛（MDA）及抗氧化酶过氧化氢酶（CAT）和超氧化物歧化酶（SOD）含量。结果UUO组较Sham组肾脏病理改变加重、肾组织MDA含量升高（P〈0.05）、SOD和CAT含量下降（P〈0.05）;UUO＋RH组较UUO组肾间质纤维化程度减轻、。肾组织MDA含量降低（P〈0.01）、SOD和CAT含量升高（P〈0.01）。结论RH能减少单侧输尿管梗阻侧肾皮质脂质过氧化物的产生,同时增加抗氧化酶的含量,通过改善UUO大鼠肾脏氧化应激来发挥肾脏保护作用。     

双J管内引流术治疗输尿管梗阻

目前输尿管梗阻性疾病的发病率明显增加,其中恶性肿瘤晚期、腹膜后纤维化以及动力因素等所致的输尿管梗阻患者增多尤为显著。本研究采用双J管内引流术对55例此类患者进行治疗,效果比较满意,报告如下。     

小鼠输尿管梗阻后肾脏间质病变及抗细胞间粘附分子1单克隆抗体的治疗作用

利用单侧输尿管梗阻制备小鼠肾间质病变模型，观察了肾间质中细胞间粘附分子－１（ＩＣＡＭ－１）及Ｍａｃ－１阳性细胞的变化，并利用抗小鼠ＩＣＡＭ－１单克隆抗体对此模型进行了治疗。结果发现在单侧输尿管梗阻后第一天，梗阻侧肾间质小血管附近及近端肾小管上即有ＩＣＡＭ－１及ＩＣＡＭ－１ｍＲＮＡ的表达，第３～５天达高峰，第７天时开始下降。与此同时，肾间质内Ｍａｃ－１阳性的巨噬细胞也于梗阻后第３天开始出现，第７天达高峰。经抗ＩＣＡＭ－１单克隆抗体治疗后，ＩＣＡＭ－１及Ｍａｃ－１的表达均延迟出现并明显减弱，肾间质病理改变亦有所减轻。     

姜黄素对单侧输尿管梗阻大鼠肾间质纤维化的影响

目的 探讨姜黄素对单侧输尿管梗阻(UUO)大鼠模型的影响及其可能机制.方法 将30只大鼠随机分为3组,每组10只:假手术组、模型组、姜黄素组.模型组和姜黄素组行右侧输尿管接扎术,假手术组只游离不接扎.术后第14天处死各组中的大鼠,股动脉取血,检测血清肌酐、尿素氮;留取梗阻侧肾脏,Maason染色观察肾间质纤维化程度,免疫组织化学方法测定TGF-β1、CTGF的表达情况,RT-PCR技术榆测肾组织TGF-β1 mRNA、CTGF mRNA表达.结果 姜黄素降低了BUN、Scr的含量,同时姜黄素显著减少了大鼠肾间质TGF-β1、CTGF的表达,并有效改善了肾脏的病理学损伤.结论 姜黄素对单侧输尿管梗阻大鼠有较明显的保护作用,这可能与其能减少大鼠肾间质TGF-β1、CTGF的表达有关.     

依普利酮对大鼠单侧输尿管梗阻模型肾间质纤维化的影响

目的：研究依普利酮对大鼠单侧输尿管梗阻（UUO）模型肾间质纤维化的影响,探讨依普利酮的抗肾间质纤维化作用机制。方法：42只雄性Wistar大鼠随机分成假手术（SO）组、UUO组和UUO＋依普利酮治疗组（T-UUO组,依普利酮100mg.kg-1.d-1）。于术后7d、14d分别处死各组7只大鼠。免疫组织化学法测定α-平滑肌肌动蛋白（α-smoothmuscle actin,α-SMA）、单核细胞趋化蛋白-1（monocyte chemoattractant protein-1,MCP-1）、单核细胞/巨噬细胞-1（monocytes/macrophages-1,ED-1）,及增殖细胞核抗原（proliferative cell nuclear antigen,PCNA）的表达。结果：UUO组肾间质α-SMA、MCP-1、ED-1、PCNA的表达较SO组增加（P〈0.05）;在术后各时间点,使用依普利酮治疗的T-UUO组大鼠肾间质α-SMA、MCP-1、ED-1、PCNA的表达较UUO组显著减少（P〈0.05）,但仍高于SO组（P〈0.05）。结论：依普利酮可通过降低α-SMA和MCP-1表达、抑制单核/巨噬细胞浸润和和系膜细胞增生,减轻肾间质纤维化。     

Renal hemodynamic response to ureteral obstruction during converting enzyme inhibition

Acute unilateral obstruction (UUO) of the pig kidney is associated with an increased secretion of intrarenally generated angiotensin II (ANG II). In order to clarify the importance of this intrarenal ANG II generation during acute UUO, ipsilateral and contralateral renal blood flow and renal secretion rate of ANG II were determined in pigs during continuous infusion of an angiotensin I converting enzyme (ACE) inhibitor. Pigs were operatively equipped with electromagnetic flow probes and catheters in the renal veins and aorta. Intravenous administration of the ACE inhibitor SQ 14 225 (captopril), 1 mg/kg per hour, resulted in a significant increase in renal blood flow in the contralateral kidney from 340±28 ml/min to 435±36 ml/min (P<0.01), whereas renal blood flow in the ipsilateral kidney was significantly reduced from 388±23 ml/min to 248±24 ml/min, similar to the reduction in controls. Captopril reduced mean aortic blood pressure, renal vascular resistance consistently on both sides, and plasma concentrations of ANG II and aldosterone from all sample sites. Renal secretion rate of ANG II showed a clear tendency to be reduced from the ipsilateral kidney. The results suggest that in UUO a compensatory increase in renal blood flow may be inhibited in part due to an enhanced secretion of ANG II in the ipsilateral kidney. However, a captopril-mediated inhibition of bradykinin breadown may also explain some of the observed changes.     

近期移植肾输尿管狭窄的原因探讨及防治

目的：探讨肾移植术后近期移植肾输尿管狭窄的原因及其防治。方法：收治肾移植术后近期输尿管狭窄患者8例，通过B超及手术探查了解狭窄梗阻的发生部位，并根据狭窄周围探查情况，推断造成狭窄的原因。结果：经手术探查发现，造成狭窄的原因多样，且多与手术操作不当有关。8例患者经手术重建输尿管膀胱通道，病情改善，移植肾功能恢复。术后观察10个月无复发。结论：肾移植术后近期移植肾输尿管狭窄的原因多与术中操作不当有关；若在输尿管膀胱吻合术中注意某些环节，则可减少部分输尿管狭窄的发生。     

JAK-STAT通路在小鼠单侧输尿管梗阻模型肾间质纤维化中的作用

目的 探讨Janus蛋白酪氨酸激酶-信号转导子和转录激活子(JAK-STAT)通路在小鼠单侧输尿管梗阻(UUO)模型.肾间质纤维化过程中的作用.方法 选用30只雄性Balb/c小鼠建立小鼠UUO模型(n=24)和假手术小鼠(n=6),术后第1、4、7和14天检测JAK-STAT磷酸化情况.另把18只雄性Balb/c小鼠随机分为假手术组、UUO模型组和治疗组,每组各6只.治疗组在建模前2 h开始给予选择性JAK2抑制剂AG490治疗,每天1次;模型组仅注射溶媒.术后第14天处死动物.组织学评估肾小管损伤和.肾间质纤维化程度;免疫组化检测肾脏巨噬细胞浸润和α-SMA表达;RT-PCR检测Ⅲ型胶原和单核细胞趋化蛋白(MCP)1 mRNA表达;Western印迹检测JAK2和STATl磷酸化.结果 JAK2-STAT1在UUO模型中被激活,其磷酸化水平与病情、肾小管组织学损害以及.肾间质纤维化相一致.AG490能显著抑制JAK2和STAT1的磷酸化(P＜0.01).AG490治疗显著减轻肾小管损害[(21.7±1.7)%比(49.4±1.0)%]和肾间质纤维化(1.0±0.1比2.3±0.2)、α-SMA表达(0.9±0.1比2.1±0.2)和巨噬细胞积聚[(13.3±1.6)细胞/HPF比(34.4±1.0)细胞/HPF](均P＜0.01).AG490治疗显著抑制Ⅲ型胶原和MCP-1 mRNA表达.结论 JAK-STAT信号通路在肾小管间质炎性反应和纤维化中发挥重要作用.     

经皮肾镜联合输尿管镜一期治疗输尿管结石合并肾结石(附78例报告)

目的探讨经皮肾镜联合输尿管镜一期治疗输尿管结石合并肾结石的安全性和有效性。方法 2007年8月～2009年3月,采用经皮肾镜联合输尿管镜一期治疗78例输尿管结石合并肾结石。其中一侧输尿管结石合并另一侧肾结石24例,双侧输尿管结石合并一侧肾结石8例,单侧输尿管结石合并同侧肾结石46例。结果 78例均一期成功碎石。无严重并发症发生。手术时间40～200min(平均105min),术中出血30～400ml(平均90ml),术后住院时间6～10d(平均7d)。结石清除率91.1%(71/78),3例残余结石直径≥0.6cm,体外冲击波碎石治疗,4例残余结石直径0.6cm,口服药物排石。78例均随访3个月,复查彩超无明显结石残留。结论经皮肾镜联合输尿管镜一期治疗输尿管结石合并肾结石效率高,创伤小,残石率低,并发症少,安全可行。     

输尿管镜在输尿管梗阻中的诊治价值

目的探讨输尿管镜在输尿管梗阻诊治中的价值.方法应用输尿管镜对52例非结石性输尿管梗阻进行诊治.结果输尿管狭窄35例(行输尿管镜硬性扩张19例,气囊扩张13例,腹腔镜下输尿管成形术3例),输尿管息肉13例行钬激光切除,输尿管癌3例改行开放手术,腔静脉后输尿管1例改行输尿管成形术.手术并发黏膜明显裂伤或黏膜下假道2例,输尿管穿孔1例,其它并发症.结论输尿管镜术能明确输尿管梗阻的病因,并能采取相应治疗.     

开放手术治疗肾移植术后输尿管梗阻的技术探讨

目的探讨肾移植术后移植肾输尿管狭窄的开放手术技巧与效果。方法首都医科大学附属北京友谊医院泌尿外科于2019年1月—2020年1月共行166例单肾移植,共发生5例肾移植术后输尿管狭窄,根据梗阻部位的不同采用了不同的开放手术术式进行治疗,回顾性分析这组患者的临床资料及预后。结果5例患者中,男性3例,女性2例,平均年龄42.6岁。其中2例患者原发病为Ⅱ型糖尿病,3例患者为肾小球肾炎。输尿管梗阻确诊的平均时间为肾移植术后143.8 d,行开放手术平均时间为肾移植术后209.8 d,确诊梗阻时平均血肌酐水平为271.94μmol/L。所有患者均因出现移植肾积水合并血肌酐进行性升高经影像学检查确诊,首先采取内支架或经皮肾造瘘紧急挽救肾功能。待肾功能恢复稳定后,根据梗阻段位置,3例患者行移植输尿管-膀胱再吻合术,1例患者行原输尿管-移植肾输尿管端端吻合术,1例患者行膀胱皮瓣翻转代输尿管术。5例患者开放手术平均时间为2.6 h,术中平均出血量为32 ml。开放手术后,5例患者均预后良好,开放手术后平均血清肌酐恢复至111.5μmol/L,尿量正常,无外科并发症发生。随访半年后,5例患者均未再发生输尿管梗阻。结论移植肾输尿管梗阻是肾移植术后常见外科并发症之一,腔内治疗中远期效果有限,根据不同梗阻部位选择不同术式进行开放手术,是治疗移植肾输尿管狭窄的有效方案。     

Counterbalance in functional adaptation to ureteral obstruction during development

Renal counterbalance, as described by Hinman in 1923, is the phenomenon of increased function of the intact kidney in proportion to the loss of function resulting from unilateral ureteral obstruction (UUO). In the neonatal guinea pig, chronic partial UUO results in severe vasoconstriction and growth arrest of the ipsilateral kidney. Angiotensin II appears to contribute significantly to the vasoconstriction, and the renin-angiotensin system is also involved in the hemodynamic response of the intact opposite kidney to UUO and to relief of UUO. Immunolocalization of renin following complete UUO in the neonatal rat revealed extension of renin-containing cells along the length of the afferent arteriole in both the obstructed and the intact opposite kidney. The proportion of juxtaglomerular apparatuses with detectable renin and renin messenger ribonucleic acid (mRNA) (identified by in situ hybridization), as well as renal renin content (a measure of active renin), were increased in the obstructed kidney compared with the intact opposite kidney. Chemical sympathectomy by chronic guanethidine administration reduced the total renin mRNA in the obstructed kidney (determined by Northern blot analysis) and prevented the increased renin immunostaining in both kidneys. Thus, renal counterbalance in the developing kidney subjected to UUO is mediated or modulated by the renal nerves and involves marked alterations in gene expression and cellular processing of renin.     

经尿道输尿管口切开术治疗输尿管壁段梗阻(附40例报告)

目的 总结经尿道输尿管口切开术治疗输尿管壁段梗阻的经验。方法 经尿道途径用电刀或冷刀对输尿管壁段结石性梗阻２２例、慢性炎症性梗阻７例及其他原因梗阻１例行输尿管口切开治疗。结果 ４０例患者均一次手术解除梗阻,３１例获随访１～４２个月,平均１４个月,３例发生轻度膀胱输尿管返流,无输尿管口狭窄发生。结论 该术式治疗输尿管壁段梗阻创伤小、操作精确、效果确切、简单易行。