Imaging in urinary tract infection.

The relationship of vesicoureteric reflex (VUR) and renal scarring was studied in 94 children (188 kidneys) with proved urinary tract infection in a district general hospital. There were 61 girls and 33 boys, with nine girls and 17 boys aged less than 1 year, 31 girls and nine boys aged between 1 and 5 years, the remaining 28 children were over 5 years of age. All children had a micturating cystourethrogram and a 99mTc (technetium) dimercaptosuccinic acid (DMSA) scan. Forty two of the 188 kidneys were scarred and 70 of the kidneys had VUR. Only 37.1% of the kidneys with reflux were scarred but 61.9% of the scarred kidneys had VUR. In children of less than 1 year, 48% of kidneys with VUR were scarred whereas 70.6% of scarred kidneys had reflux. In children between 1 and 5 years of age only 36.4% of kidneys with VUR were scarred but 63.2% of scarred kidneys had VUR. There is good correlation between the detection of a scarred kidney on DMSA and the presence of vesicoureteric reflux. However the detection of reflux particularly in children over 1 year of age shows poor correlation with renal scarring. This suggests that the primary imaging in children over 1 year of age presenting with a urinary tract infection should be of the kidney: a cystogram should be performed only if the DMSA scan is abnormal.     

小儿先天性发育不良肾的临床特点和治疗

目的 探讨小儿先天性发育不良肾的临床特点、诊断和治疗.方法 总结分析1988年至2009年我科收治的83例单侧先天发育不良肾的临床资料.所有患儿术前均行多普勒超声、静脉肾盂照影和99mTc-DTPA肾脏扫描.35例患儿行增强CT检查,39例行IVP后延迟CT检查三维重建.所有病例均行发育不良肾切除,肾切除的指征包括无功能发育不良肾脏合并临床症状55例,无临床症状的无功能多囊发育不良肾,随访不消退或增大27例,无功能发育不良肾合并肾输尿管积水1例.结果 各项术前检查中IVP后延迟CT三维重建技术阳性诊断率最高,达100%.术后病理均提示为发育不良肾脏.4例因高血压行发育不良肾切除的患儿,术后2例仍然有高血压,其他患儿术后临床症状消失,没有恶变者.结论 儿童先天发育不良肾脏发育不良程度不一,合并畸形不同,临床表现各异.IVP后延迟CT检查三维重建技术诊断发育不良肾脏阳性率高.合并临床症状的无功能发育不良肾、多囊发育不良肾长期随访不消退者可手术治疗,随访过程中有明显消退的多囊发育不良可定期观察,有功能的非多囊发育不良肾可以保留.近19%发育不良肾脏可合并对侧肾脏畸形,应密切监测对侧肾脏功能及血压.     

Is renal ultrasound a reliable indicator of a nonobstructed duplication anomaly?

Twelve kidneys which had a non-obstructed duplication anomaly on excretory urography were studied sonographically. Ten of the twelve kidneys had a single central renal sinus echo complex; only two kidneys had a split sinus complex typical of duplication. Sonography is not a reliable technique to identify a nonobstructed duplication anomaly.     

小儿先天性发育不良肾的临床特点和治疗

目的 探讨小儿先天性发育不良肾的临床特点、诊断和治疗.方法 总结分析1988年至2009年我科收治的83例单侧先天发育不良肾的临床资料.所有患儿术前均行多普勒超声、静脉肾盂照影和99mTc-DTPA肾脏扫描.35例患儿行增强CT检查,39例行IVP后延迟CT检查三维重建.所有病例均行发育不良肾切除,肾切除的指征包括无功能发育不良肾脏合并临床症状55例,无临床症状的无功能多囊发育不良肾,随访不消退或增大27例,无功能发育不良肾合并肾输尿管积水1例.结果 各项术前检查中IVP后延迟CT三维重建技术阳性诊断率最高,达100%.术后病理均提示为发育不良肾脏.4例因高血压行发育不良肾切除的患儿,术后2例仍然有高血压,其他患儿术后临床症状消失,没有恶变者.结论 儿童先天发育不良肾脏发育不良程度不一,合并畸形不同,临床表现各异.IVP后延迟CT检查三维重建技术诊断发育不良肾脏阳性率高.合并临床症状的无功能发育不良肾、多囊发育不良肾长期随访不消退者可手术治疗,随访过程中有明显消退的多囊发育不良可定期观察,有功能的非多囊发育不良肾可以保留.近19%发育不良肾脏可合并对侧肾脏畸形,应密切监测对侧肾脏功能及血压.     

Unenhanced helical CT in the evaluation of the urinary tract in children and young adults following urinary tract reconstruction: comparison with sonography

Purpose. To compare the accuracy of unenhanced, helical CT with sonography for the detection of complications of urinary tract reconstruction. Materials and methods. Forty-six kidneys in 24 patients were examined with CT and sonography. All scans were assessed for ease of renal visualization, presence of renal, ureteral, and bladder calculi, renal scars, hydronephrosis, and abdominal wall hernia. The results of both imaging modalities were independently reported. Results. CT provided excellent visualization of all 46 kidneys, while sonography provided poor visualization of 8 kidneys (17 %) (P < 0.001). CT detected calculi in 10 kidneys, 1 ureter, and 7 bladders. Sonography detected calculi in only 2 kidneys, and 2 bladders. Overall, CT detected significantly more calculi than US (18 vs 4, P = 0.01). CT detected scarring in 15 kidneys, while sonography detected scarring in 10. Hydronephrosis was detected in 6 kidneys by CT and in 8 kidneys by sonography. Three abdominal wall hernias were seen at CT that were not seen at sonography. Conclusion. CT is superior to sonography for the detection of urinary tract calculi and renal scarring. CT will demonstrate abdominal wall hernias that are unsuspected. Received: 18 April 2000 Accepted: 14 August 2000     

Renal ultrasound in the neonatal period

Ultrasound was used for imaging the kidneys in 55 neonates. The normal kidney in a neonate is characterized by prominent medulla and fetal lobulation, the main renal vessels are frequently demonstrated. Of 29 infants with normal kidneys by ultrasound, 4 had renal disease (3 acute tubular necrosis, one partial renal artery thrombosis) and one had a pelvic kidney. In 24 infants congenital abnormalities or acquired renal disease was diagnosed. Multicystic dysplastic kidney and hydronephrosis were the most frequently observed abnormalities. Polycystic kidneys at the early stage (both adult type and infantile) appeared as enlarged hyperechoic kidneys. In 2 neonates the kidneys were normal but they had adrenal mass lesions.Based on the paper presented at the 50th Annual Meeting of the American Academy of Pediatrics, Detroit, Michigan, October 1980     

Infantile polycystic disease. Renal pseudotumoral growth in the postnatal period

In the most common clinical expression of infantile polycystic disease, the kidneys are greatly enlarged in the neonatal period. When the child gets older the kidneys become smaller. In this case report, both kidneys kept growing after birth causing abdominal distention and respiratory distress. The differential diagnosis was a bilateral massive nephroblastomatosis, but the renal pathology showed characteristic features of infantile polycystic disease.     

Time course of transient cortical scintigraphic defects associated with acute pyelonephritis

BACKGROUND: Acute pyelonephritis is distinguished from renal scarring using repeat cortical scintigraphy. The defects of acute pyelonephritis resolve, while those of scars persist. OBJECTIVE: To determine the duration of reversible cortical defects following acute pyelonephritis and the time interval required to differentiate infection from scars. MATERIALS AND METHODS: An observational prospective study of 193 children (386 kidneys) aged less than 5 years following their first proven urinary tract infection (UTI). Renal cortical scintigraphic defects were detected in 112 (29%) kidneys within 15 days of diagnosis. Of these, 95 underwent repeat renal cortical scans 2 years after the UTI, including 50 with additional scans performed within 2-6 months of infection. RESULTS: Of the 50 kidneys undergoing a second renal cortical scan within 2-6 months of the first UTI, 22 (44%) had persistent defects. A third scan was performed on 17 (77%) kidneys after 2 years, by which time defects had resolved in another 8 (47%) kidneys. The predictive value of defects detected within 2-6 months of UTI representing scars is 53% (95% CI 28, 77). Overall, nine (18%) kidneys with initial renal cortical abnormalities had permanent defects. In the 45 kidneys undergoing a second cortical scan more than 6 months after the UTI, 11 (24%) had persistent defects. None of the 95 kidneys undergoing serial scans developed new or larger defects. CONCLUSIONS: Renal scars may not be reliably diagnosed by cortical scintigraphy performed within 6 months of UTI because the inflammatory lesions may not have fully resolved.     

胎羊单侧输尿管不完全性梗阻后肾脏足细胞表型转化及PAX2、VEGF的表达

目的 研究胎羊单侧输尿管不完全性梗阻后肾脏的组织学改变,探讨梗阻性肾病的发生机制.方法 以16只胎羊为研究对象.实验分两组:①梗阻组,对12只孕75～85 d的胎羊实行宫内手术,F6 C形硅胶环环套在胎羊一侧输尿管上段以造成输尿管不完全性梗阻;②对照组,对4只胎羊实行宫内手术但不结扎输尿管.待胎羊出生后,取其肾脏标本检测病理改变,足细胞表型转化以及配对盒基因2(PAX2)和VEGF的表达变化.结果 梗阻组12只胎羊,其中9只顺利生产;对照组4只胎羊,均顺利生产.与对照组羔羊肾脏相比,梗阻组羔羊梗阻侧肾脏,表现为皮质囊性改变,间质纤维化,肾小球数目显著减少;足细胞足突广泛融合[(4.20±1.08)%比(86.79±1.66)%];PAX2表达显著升高(1.43±0.09比2.44±0.09);而VEGF表达明显减少(0.80±0.15比0.33±0.14).结论 在胎羊模型中,通过观察单侧输尿管不完全性梗阻后肾脏的组织学改变,说明足细胞表型转化以及PAX2和VEGF表达的变化可能在梗阻所致的肾脏损伤性改变中占有重要作用.     

Bilateral adrenal hemorrhage in a neonatal kidney donor

EKT from neonatal donors remains rare despite successful outcome being reported. The surgical aspects of neonatal abdominal organ recovery remain unfamiliar to the vast majority of abdominal organ recovery teams and renal transplant surgeons. BAH is not uncommon in newborn babies suffering distress in the perinatal period. BAH is often also associated with RVT and will impact on utilization of kidneys for transplantation. We present a case of a neonatal kidney donor with massive BAHs discovered at the time of organ recovery. This made the procurement challenging. Both kidneys were recovered en bloc with pancreas and the liver with aorta and inferior vena cave as vascular conduits. The kidneys were successfully implanted into an adult recipient with good function at 1‐year follow‐up. Association between adrenal hemorrhage and RVT needs to be considered before utilizing such kidneys. This case exemplifies successful outcome after careful assessment and transplantation of such kidneys.     

小儿肾积水病肾血流动力学改变与临床意义

目的了解小儿肾积水肾血流动力学改变与病肾损害程度的关系。方法采用彩色超声多普勒（CDFI）测量小儿肾积水病肾肾主动脉（MRA）、叶间动脉（IRA）及弓状动脉（ARA）的阻力指数（RI），并与健肾测值进行比较；同时行病肾组织学检查分级，然后与病肾RI作相关分析。结果本组共检测78例小儿肾积水，检测发现：病肾各级肾血管（MRA、IRA、ARA）的RI明显升高，与健肾相应动脉RI比较，差异有显著性意义（P〈0．05）；病肾各级血管的RI均随病理分级的增加而递增，且叶间动脉的RI在不同病理分级组间比较，差异均有显著性意义（P〈0．05）；病肾各级血管的RI与病理分级密切正相关，差异有显著性意义（P〈0．05），其中病肾叶间动脉的RI与病理分级相关性最密切，相关系数r=0．715、P〈0．01。结论小儿肾积水病肾各级肾血管的RI明显升高，与病肾损害程度密切正相关，特别是叶间动脉的RI与病肾损害的相关性最密切（P〈0．01）。因此证实利用简单、准确无创的CDFI检测肾血流动力学改变可作为术前判定病肾损害程度的有效方法之一。     

HSP70在缺血再灌注大鼠肾脏中的表达及意义

目的观察大鼠肾脏缺血及缺血再灌注(I/R)诱导热休克蛋白70(HSP70)的表达及意义。方法制作大鼠肾脏缺血及I/R模型,缺血组于缺血5、15和30min,I/R组于再灌注2、5、8、24、48、72h不同时间摘取肾脏,采用免疫组化方法检测肾脏HSP70的表达,同时采用HE染色,观察肾脏病理改变。结果在缺血组各时间点肾脏HSP70的表达无明显差异(P>0·05);肾脏I/R后,随时间延长,HSP70表达明显增强(P<0·05);肾脏病理显示,缺血时肾组织呈现局灶性及弥散性血管周围水肿,I/R后随时间延长肾脏损伤加重,损伤部位主要在肾小管,表现为空泡样变、小管萎缩、上皮细胞脱落及肾小球囊腔扩张等。结论HSP70在I/R后表达增强,但肾脏仍损伤严重,提示HSP70在肾脏I/R过程中没有起到主要的保护作用。     

Aneurysmal dilatation associated with arteriovenous fistula in a transplanted kidney after renal biopsies

AVF is a known complication of renal biopsy in both native and transplanted kidneys. A 20‐yr‐old woman with bilateral hypoplastic kidneys due to branchio‐oto‐renal syndrome had received living‐donor renal transplantation from her father at the age of 11. She had undergone allograft renal biopsies six times and all puncture sites were at the lower pole of her kidney from the first to the fifth biopsy. AVF with aneurysmal dilation (30 mm) had developed at the puncture site after the fifth biopsy. TAE was successfully performed with 11 platinum coils in the branch of the renal artery feeding the aneurysm. According to a review of the literature, the incidence of AVF is higher in transplanted kidneys than in native kidneys (7.5% vs. 2.1%) because transplanted kidneys, as single kidneys, are likely to be punctured repeatedly at the same site. When renal biopsy of a transplanted kidney is performed, previous biopsy puncture sites should be considered and the biopsy should be performed at a different site, if possible, to prevent the development of AVF.     

Ureteropelvic junction obstruction in children: 10 years’ experience in one institution

We reviewed our experience over 10 years with pyeloplasty for ureteropelvic junction obstruction. Preoperative and postoperative isotope renal scans were performed to assess the surgical outcome, with particular emphasis on the postoperative change in renal function (RF). We retrospectively reviewed the medical records of 137 consecutive children with ureteropelvic obstruction operated between January 1994 and December 2003. A total of 109 kidneys in 102 patients were evaluated with renal echo and ^99mTc-diethylenetriaminepentaacetic renography both before and after Anderson–Hynes dismembered pyeloplasty. The improvement of RF >5% was noted in 67 kidneys (61.5%), the function remained stable in 30 kidneys (27.5%), and it deteriorated (>5%) in 12 kidneys (11.0%). Five patients (4.6%) required repeat pyeloplasty for either prolonged urine leakage or reobstruction with deterioration in RF. Dismembered pyeloplasty in children with ureteropelvic junction obstruction is safe. The renal functional improvement can be expected in the majority of kidneys that have impaired function at presentation.     

On the importance of B-scan-ultrasound for the diagnosis of nephrological and urological diseases in childhood (author's transl)]

Kidneys of 118 children of all age groups, and of 2 adults were investigated by means of senography. Normal kidneys could be identified on account of a typical echo-pattern. Deviations from this pattern were interpreted as evidence for pathological changes in the kidneys; they were correlated to the radiological and in some cases to the pathologic-anatomical findings. Typical deviations of the echo-pattern were found in cases of hydronephrosis, duplex kidneys, duplex kidneys in combination with hydronephrosis, polycystic renal diseases and other renal diseases. It was even possible to demonstrate decrease and increase of hydronephrosis by means of sonography. Indications for the application of this method are pointed out. In addition its accuracy and importance in relation to other diagnostics methods are discussed.     

新生鼠输尿管不全梗阻后肾盂压力和肾脏形态变化的观察

目的 了解新生鼠输尿管不全梗阻后肾盂压力和肾脏形态的变化。方法 65只新生鼠用腰大肌包埋不同长度的左侧输尿管，制成轻（n=31)、重（n=34)度输尿管不全梗阻。对照组仅进行剖腹探查。术后8周和24周分别用核磁共振检查肾脏形态变化，术后分别于24周和30周进行肾盂测压和组织学检查。结果 梗阻肾脏均有不同程度积水。严重梗阻组除积水较严重外，发现4例肾脏肾发育不全，其平均肾实质重量仅是对照组的35％。轻度梗阻组和对照组未见发育不良的肾脏。严重梗阻组的肾脏灌注压明显高于轻度梗阻组和正常对照组。结论 新生鼠输尿管不全梗阻后均产生明显肾积水。严重梗阻组可产生肾脏发育不良，可能与严重梗阻组肾盏灌注压明显增加有关。     

Intrauterine growth restriction modifies the normal gene expression in kidney from rabbit fetuses

The aim of this work was to study the effect of intrauterine growth restriction (IUGR) on fetal kidneys. The IUGR was induced by uteroplacental vessels ligature in a model of pregnant rabbit. We centralized the study in the gene expression of essential proteins for fetal kidney development and kidney protection against hypoxia, osmotic stress, and kidney injury. The gene expression of HIF-1α, NFAT5, IL-1β, NGAL, and ATM were studied by qRT-PCR and Western blot in kidneys from control and IUGR fetuses. Experimental IUGR fetuses were significantly smaller than the control animals (39 vs. 48 g, p < 0.05). The number of glomeruli was decreased in IUGR kidneys, without morphological alterations. IUGR increased the gene expression of HIF-1α, NFAT5, IL-1β, NGAL, and ATM (p < 0.05) in kidneys of fetuses undergoing IUGR, suggesting that fetal blood flow restriction produce alterations in gene expression in fetal kidneys.     

Crossed renal ectopia in children

Five cases of crossed ectopic kidneys are presented, four in males and one in female, four fused and one unfused. All were on the right side; in four cases the kidneys were positioned inferiorly and in one superiorly. Urological malformations and accompanying anomalies were observed in most of our cases. Vesicoureteral reflux was demonstrated in the three children in whom cystography was performed. In the presence of anorectal malformations and vertebral anomalies or on diagnosis of crossed ectopic kidneys, early and thourough urological investigation is indicated.     

Experimental focal segmental glomerulosclerosis: correlation with protein excretion, glomerular filtration rate, and renal plasma flow

A rat model of focal segmental glomerulosclerosis (FSGS) produced by repeated injections of aminonucleoside (AMN) of puromycin was used to evaluate the relative roles of hemodynamic alterations and AMN-induced glomerular visceral epithelial cell injury in the development of FSGS. Twenty rats received three intraperitoneal injections of AMN on days 1, 21, and 28 and developed significant proteinuria. On day 50, 14 rats (group 1) underwent selective left renal perfusion with AMN and six rats (group 2) received left renal perfusion with saline. At sacrifice on day 70 or 110, group 2 rats had similar values in left and right kidneys for glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and the amount of FSGS (13.1 +/- 5.6% in left and 12.9 +/- 7.8% in right). In contrast, group 1 rats manifested a significantly higher amount of FSGS in right kidneys as compared to left kidneys (3.1 +/- 1.3% in left and 6.3 +/- 2.0% in right, as well as significantly diminished GFR and ERPF in left as compared to right kidneys. A higher degree of FSGS was seen in kidneys with a higher GFR and ERPF. A positive correlation was observed between the mean 24-h protein excretion of the rats and the percentage of FSGS in left and right kidneys (r = 0.66, p less than 0.01).     

Outcome of the kidney with vesico-ureteral reflux. Apropos of 129 cases

The final status of the kidneys of 129 children suffering from vesico-ureteric reflux was studied. The growth of the kidneys was comparable in the surgically treated and in the medically treated group. However, growth was better when the kidneys had been normal initially than when they presented renal scars. New scars were more frequent in the medically treated group, and/or when scars were already present at diagnosis of vesico-ureteric reflux. Our results are in agreement with those in the literature.