彩色多普勒超声评价经皮肾镜技术围手术期肾脏血流动力学

目的探讨经皮肾镜技术（PCNL）对围手术期肾脏血流动力学的影响。方法应用CDFI观察30例接受单侧、单通道PCNL患者术前1天及术后5-7天患侧各级肾动脉血流参数,并进行统计学分析。结果术后各级肾动脉阻力指数（RI）均低于术前,肾门处主肾动脉、叶间动脉、小叶间动脉舒张末期血流速度（Vmin）升高（P〈0.05）。重度积水患者术后段动脉、叶间动脉RI降低（P〈0.05）,叶间动脉Vmin增加（P〈0.05）;中度积水患者术后各级肾动脉RI降低（P〈0.05）,主肾动脉、小叶间动脉Vmin增加（P〈0.05）;轻度积水患者术后主肾动脉、段动脉RI降低（P〈0.05）,段动脉Vmin增加（P〈0.05）;无积水患者术后段动脉、叶间动脉RI降低（P〈0.05）。结论 PCNL术后短期内患侧肾脏肾动脉舒张期灌注改善,RI降低。CDFI可观察肾内血流灌注,并量化肾内血流动力学信息。     

行标准通道经皮肾镜碎石清石术患者肾内血流动力学变化的临床观察

目的 探讨标准通道经皮肾镜碎石清石术(PCNL)对患者肾血流动力学的近远期影响.方法 选取行标准通道经皮肾镜碎石清石术的43例患者,采用彩色多普勒超声对其各级肾动脉的血流参数进行评估,并于术后1d、1周、1个月进行复查,统计分析其手术前后的血流动力学变化规律.结果 术后1d,患者肾主动脉、段间动脉、叶间动脉及小叶间动脉的收缩期最高流速(PSV)、舒张期最低流速(EDV)及平均血流速度(Vm)较术前显著降低(P＜0.05);阻力指数(RI)较术前显著升高(P＜0.05).术后1周,患者各级肾动脉的PSV、EDV及Vm有所回升,RI有所下降,基本恢复至术前水平(P＞0.05);术后1个月,患者各级肾动脉的PSV、EDV及Vm显著高于术前水平(P＜0.05),RI显著低于术前水平(P＜0.05).结论 基于微创标准通道PCNL术对肾脏血流灌注有短暂的抑制效应;然而,随着术后时间的延长和血运障碍的缓解,患者各项血流动力学参数均可得到有效改善.     

肾内阻力指数对梗阻性积水肾功能的评估

目的探讨多普勒超声肾内阻力指数和阻力指数差在诊断单侧梗阻性肾积水及对积水肾功能可复性评估的临床应用价值。方法用多普勒超声检测53例单侧梗阻性肾积水患者主肾动脉、肾段动脉及叶间动脉的多普勒频谱,检测指标为收缩期最大峰值流速(Vmax)、舒张末最低流速(Vmin)、阻力指数(RI)、波动指数(PI)和阻力指数差(ΔRI),并且进行术前、术后3个月和6个月的动态观察,同时分静脉尿路造影(IVU)对比。正常对照组36例。结果53例单侧梗阻性肾积水患者中,轻度肾积水、中度肾积水和重度肾积水的RI及ΔRI均升高,以中度肾积水和重度肾积水更为显著(P<0.01),轻度肾积水ΔRI较RI更具有显著性;动态观察RI和ΔRI进行性下降。结论RI和ΔRI为单侧梗阻性肾积水的诊断及积水肾功能的可复性评估提供了一种简便有效的方法。     

标准经皮肾镜取石术对结石并肾积水患者早期肾血流的影响!

目的探讨标准经皮肾镜取石术对上尿路结石合并肾积水患者肾血管阻力指数的影响。方法 60例单侧上尿路结石并对侧肾功能正常患者按患肾积水程度分为轻度(15例)、中度(32例)、重度(13例)。采用标准通道超声联合气压弹道经皮肾镜碎石,其中单通道52例、双通道8例。应用彩色多普勒血流显像测定术前24h和术后0、48、120h双肾肾血管阻力指数。比较手术前后各组肾血管阻力指数的差异。结果经皮肾镜取石术术后各组患侧肾脏肾血管阻力指数即刻升高,并维持至术后48h,与术前比较有显著性统计学差异(P0.01),术后5d恢复至术前水平(P0.05);各组健侧肾脏术后肾血管阻力指数变化特点与患肾相同。结论标准经皮肾镜取石术可造成早期双肾血流降低,而双肾血流改变与术前肾积水程度无关。     

彩色多普勒超声在移植肾排异反应及其治疗中的应用

目的：探讨彩色多普勒血流图(CDFI)在早期移植肾排异反应诊断及治疗监测中的应用价值。方法：应用CDFI对19例移植肾患和20例正常人的肾脏声像图表现进行对照分析。结果：(1)移植肾患肾功能稳定期，肾脏CDFI表现与正常人相似，各级肾动脉血流信号丰富，呈连续性树枝状；(2)急性排异反应患，移植肾实质血流信号稀少，以舒张期更为显，主肾动脉和段动脉血流呈连续性，叶间动脉血流呈断续的闪烁状，弓形动脉几乎无血流信号；(3)慢性排异反应患，主肾动脉和段动脉血流束变细，信号减少，叶间动脉仅部分显示且呈点状或短条状，弓形动脉不显示或仅有散在点状闪烁血流信号；(4)无论急性还是慢性排异反应，给予有效治疗后，临床症状减轻，实验室检查结果改善，CDFI检查移植肾实质血流灌注情况也相应改善，这种变化早于实验室检查结果的改善。结论：CDFI不仅能够提示移植肾排异反应而且能够监测治疗效果，指导临床用药。     

硅胶外支架与双J管在小儿肾积水手术中的应用比较

目的比较硅胶外支架与双J管在小儿肾积水手术中的应用效果。方法肾积水患儿160例,依据随机数字表法分为对照组和研究组,每组80例,均予以肾盂离断成形术治疗,对照组采用硅胶外支架引流,研究组采用双J管引流,比较两组手术时间、住院时间,手术前后患肾动脉流速和阻力情况,肾功能,并发症和肾积水恢复情况。结果研究组和对照组手术时间分别为(91.85±12.96)分钟和(102.22±15.93)分钟,住院时间分别为(7.95±1.14)天和(14.22±1.63)天,两组比较差异有统计学意义(P0.05)。术前,两组患肾叶间动脉、肾门动脉流速及阻力和肾功能比较差异无统计学意义(P0.05);术后,两组患肾叶间动脉、肾门动脉流速和分肾功能均上升,阻力、血肌酐、尿素氮均下降,组间比较差异无统计学意义(P0.05)。研究组和对照组总并发症发生率分别为2.50%和11.25%,两组比较差异有统计学意义(P0.05)。两组术后6个月肾盂前后径测量截断值(AP,anteriorposterior)值分别为(1.66±0.27)cm和(1.73±0.21)cm,完全缓解率分别为36.25%和28.75%,两组比较差异无统计学意义(P0.05)。结论小儿肾盂离断成形术留置硅胶外支架和双J管均可充分引流,但双J管引流更能有效防止相关并发症的发生。     

肾脏疾病叶间动脉血流参数与肾功能及叶间动脉RI与肾活检病理的相关性

目的：探讨叶间动脉阻力指数（RI）与临床所见及肾活检病理变化的关系。方法：应用彩色多普勒超声诊断仪,对72例各种肾脏病患者分别测量叶间动脉收缩期峰值流速（Vmax）,舒张期末流速（Vmin）及阻力指数（RI）,同时进行了病理学的观察。分析叶间动脉血流速度及RI与肌酐清除率（Ccr）的相关性,观察叶间动脉RI与临床所见的关系及RI和肾穿刺病理变化的关系。结果：与对照组及肾功能正常组相比较,Vmax和Vmin在肾功能轻度-中度减退组和严重减退组降低差异有统计学意义（P〈0.05或P〈0.01）。肾功能严重减退组RI升高差异有统计学意义（P〈0.05）。Vmax（r=0.56）和Vmin（r=0.66）与Ccr呈正相关关系（P〈0.01）,RI与Ccr呈负相关,但相关性比较弱（r=-0.39,P〈0.01）。在RI升高组,Ccr降低和血清肌酐（Scr）升高差异有统计学意义（P〈0.01）。在RI正常组和RI升高组,肾小球病理变化积分（7.4±3.2,12.5±4.2）差异无统计学意义,但是在肾小管间质病变积分（9.3±2.6,14.7±4.8）和血管病变积分（6.8±3.1,10.8±2.7）方面,RI升高组增加差异有统计学意义（P〈0.05）,肾小管-间质病变积分和血管病变积分的合计（16.1±5.9,25.5±4.7）及整体病理病变积分（23.5±8.9,38.0±6.2）均为RI升高组增加差异有统计学意义（P〈0.01）。结论：Vmax和Vmin与Ccr呈正相关关系,RI与Ccr呈负相关,但相关性比较弱;在RI升高的病例,肾功能损害严重,肾小管-间质病变及血管病变与肾功能的严重受损有关。通过彩色超声多普勒法测定叶间动脉血流可以用来评价肾功能和把握肾脏疾病的状态。     

彩色多普勒超声对糖尿病患者肾脏大小与肾血流动力学关系的分析

目的:应用彩色多普勒超声观察对糖尿病患者肾脏大小形态、结构及各级肾动脉阻力指数(RI)的改变,分析肾脏大小与阻力指数之间的关系,以期寻找更早期的、无创性的糖尿病肾病(DN)辅助诊断方法.方法:选择120例糖尿病(DM)患者,病程＜5年为DM1组60例,病程＞5年为DM2组60例,排除合并心衰、泌尿系感染、结石、肾血管疾病及其他原因致肾脏原发、继发病变,所有患者尿常规蛋白阴性,血尿素氮、肌酐正常.同时选择120例健康者作为对照组.应用彩色多普勒超声仪检查受试者肾脏大小、各级肾动脉阻力指数.应用SPSS统计软件包进行统计处理.结果:DN2组糖尿病患者肾脏较正常对照组及DM1组者大,两者比较有统计学意义.DM2组RI较DM1组及正常组高.DM2组肾脏大小与肾各级动脉RI之间有线性关系,呈正相关(r=0.85,P＜0.05).结论:彩色多普勒超声(CDFI)检测能提示DM患者肾脏大小和肾血流动力学情况,对早期DN的诊断是有价值的.     

青少年腰椎间盘突出症与下肢血流动力学关系的初探

目的 初步探讨青少年腰突症患侧下肢动脉血流动力学的变化.方法 应用CDFI检测了1 2例青少年腰突症患肢与健肢胴动脉、胫后动脉及足背动脉血流动力学指标阻力指数(RI)及收缩期峰值/舒张期峰值(S/D值)进行检测、对照分析.结果 除足背动脉外,患肢血流动力学指标均高于健肢(P<0.01).结论 与健侧下肢相比,青少年腰突症患侧下肢胭动脉及胫后动脉血流动力学指标存在明显变化,提示患侧下肢存在血循环障碍.     

肾积水患儿超声检测肾容积和肾积水容积与残余肾功能的关系分析

目的探究肾积水患儿三维超声体积自动测量(VOCAL)技术定量评估残余肾功能的可行性。方法选取2014年6月至2017年6月徐州市儿童医院泌尿外科收治的单侧肾积水患儿74例,行VOCAL测量肾容积(RV)、肾实质容积(RPV)、肾实质容积比率(RPVR),行肾核素动态显像测定肾小球滤过率(GFR)。对比患肾与健肾、不同程度肾积水超声测量参数并分析其与GFR的相关性。结果与健侧肾相比,患侧肾RV增大,GFR降低,差异有统计学意义(P0.05),RPV差异无统计学意义(P0.05)。不同肾积水程度VOCAL相关参数及GFR比较,2级肾积水容积比率(HVR)较1级升高,差异有统计学意义(P0.05),GFR、RV、RPV差异无统计学意义(P0.05);3级较2级和4级较3级GFR、RPV均降低,RV、HVR均升高,差异有统计学意义(P0.05)。Pearson相关性分析显示,RV与GFR无线性相关(r=0.191,P0.05),RPV与GFR呈低度线性相关(r=0.342,P0.05),HVR与GFR呈高度线性相关(r=0.783,P0.05)。当HVR≥0.45时,GFR下降至50%以下,ROC曲线下面积为0.88,灵敏度为98.4%,特异度为73.3%。结论VOCAL技术在肾积水患儿残余肾功能评估中具有可行性。     

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。     

Pulsed Doppler sonography of the hilar renal artery: differentiation of obstructive from nonobstructive hydronephrosis in children

BACKGROUND/PURPOSE: It is difficult to detect the arcuate or cortical renal arteries when performing pulsed Doppler sonography (PDS) for congenital hydronephrosis. This study was undergone to assess the usefulness of PDS of the hilar renal artery to differentiate obstructive from nonobstructive hydronephrosis. METHODS: The authors performed PDS of the hilar renal artery in 80 normal children: 20 aged 0 to 1 months (group I), 20 aged 1 to 12 months (group II), 20 aged 1 to 6 years (group III), and 20 aged 7 to 15 years (group IV). Based on diuretic renography findings, 22 kidneys from 19 children with a ureteropelvic junction (UPJ) stricture were divided into 7 dilated obstructed and 15 dilated nonobstructed kidneys. The peak-systolic velocity (PSV), end-diastolic velocity (EDV), mean average velocity (Vm) and the resistive index (RI = [PSV - EDV]/PSV) were measured at the hilar renal artery. RESULTS: There was a significant difference in the RI of the hilar renal artery between obstructive and nonobstructive hydronephrosis. CONCLUSION: A pulsed Doppler evaluation of the hilar renal artery is useful for detecting an obstructive UPJ stricture compared with assessing arcuate or cortical renal arteries.     

先天性积水肾脏组织中水通道蛋白mRNA表达与肾实质厚度变化的相关性研究

目的 观察先天性肾积水肾组织水通道蛋白1～4(AQP1～4)mRNA表达及与肾实质厚度变化之间的关系.方法 采用逆转录聚合酶链反应法检测37例先天性肾盂输尿管连接处狭窄患儿[年龄(60.3±48.8)个月]和6例正常对照组[年龄(62.7±17.1)个月]肾组织标本中AQP1～4 mRNA的相对表达量.术前B超检测积水肾实质厚度,并与术中测定结果比较.AQP1～4 mRNA相对表达量与肾实质厚度之间进行相关性分析.结果 积水肾组织中AQP1～4 mRNA表达量分别为0.39±0.22、0.42±0.20、0.52±0.22、0.30±0.18,正常对照组分别为0.90±0.10、0.92±0.09、0.98±0.12、0.74±0.21,2组比较差异均有统计学意义(P<0.01).B超测定积水肾实质厚度平均(5.01±2.38)mm,肾盂放水后肾实质厚度平均(5.12±1.81)mm,差异无统计学意义(P0.05).梗阻肾脏实质厚度与AQP1～4 mRNA相对表达量呈正相关(r分别为0.773、0.772、0.557、0.625,P<0.01).结论 积水肾实质厚度变化与AQP1～4 mRNA表达量下降有一定相关性.     

多层螺旋CT（MSCT）灌注成像评价梗阻性积水肾肾功能的临床研究

目的：探讨多层螺旋CT（MSCT）灌注成像评价梗阻性积水肾肾功能的价值.方法：对36例单侧梗阻性重度肾积水、对侧肾显影正常的患者,按IVU结果分为显影组和不显影组,在梗阻解除前行MSCT灌注扫描,测量积水肾与对侧肾皮质的血流量（BF）、血容量（BV）值,并对两组间积水肾的BF和BV值进行比较.结果：36例中,显影组20例,MSCT检查显示积水肾皮质BF、BV值分别为（412.58±217.56）ml·100 g-1·min-1,（28.66±10.96）ml/100 g;不显影组16例,积水肾皮质BF、BV值分别为（185.24±189.30）ml·100g-1·min-1、（15.6±11.8）ml/100g.两组间积水肾肾皮质BF、BV值比较差异均有统计学意义（P＜0.01）,组内积水肾与对侧肾肾皮质BF、BV值差异显著（P＜0.01）,组间对侧肾肾皮质BF、BV值差异无显著性（P〉0.05）.结论：MSCT灌注成像较IVU能更准确地反映肾功能,在评价单侧梗阻性积水肾肾功能中具有一定价值.     

Time-dependent changes of resistive index in acute renal obstruction during nonsteroidal drug administration

OBJECTIVE: To evaluate Doppler ultrasonography (DUS) and assess time-dependent changes of the renal resistive index (RI) in acute unilateral renal obstruction during treatment with nonsteroidal analgesic for the relief of renal colic. PATIENTS AND METHODS: In 31 patients with symptoms of renal colic, treated with ketoprofen, unilateral obstruction was confirmed by intravenous urography. The patients were divided into four groups according to the duration of their symptoms, i.e. < 23 h, 24-47 h, 48-72 h and > 72 h. In each patient, the RI was measured over the arcuate, segmental and renal arteries of both kidneys using DUS. The values obtained in the obstructed kidney were compared with those for the contralateral kidney. RESULTS: The mean (sd) RIs for all 31 patients were 0.71 (0.05) for the obstructed and 0.60 (0.05) for the contralateral kidney (P < 0.001), the mean difference (dRI) being 0.12 (0.07). In those with obstruction for < 23 h the mean RI of the obstructed kidney was 0.70 (0.05) and of the contralateral healthy one 0.62 (0.07). Values of RI were similar in the group with obstruction for 24-47 h and 48-71 h. In those with obstruction for > 72 h the mean RI of the obstructed kidney was 0.69 (0.07) and of the contralateral one 0.60 (0.04), with a dRI of 0.09 (P < 0.005). The RI was 87% sensitive and 90% specific for detecting renal obstruction. CONCLUSION: Although the patients were given ketoprofen, their mean RI for the obstructed kidney remained above the discriminatory threshold (> 0.70) during the first 71 h of obstruction. Only in those obstructed for > 72 h was the mean RI on the obstructed side slightly below the threshold, but the difference between the kidneys was significant. The measurement of RI is a reliable diagnostic method for detecting acute renal obstruction. With a longer duration of symptoms, the difference in RI between the kidneys becomes clinically more relevant.     

Renal pelvis volume during diuresis in children with hydronephrosis: implications for diagnosing obstruction with diuretic renography

PURPOSE: We measured the volume of the renal pelvis during diuretic renography (DR) in children with normal and hydronephrotic kidneys to determine if changes in pelvic volume could affect the accuracy of DR in diagnosing obstruction. MATERIALS AND METHODS: We studied 18 patients 1 month to 10 years old with unilateral hydronephrosis ultimately proved to be either obstructive or nonobstructive. Simultaneous DR and ultrasound were performed with patients supine using the gamma camera. Ultrasound measurements of the renal pelvis in 3 dimensions, obtained before and at intervals after diuretic injection, were used to calculate renal pelvic volume. The contralateral normal kidneys were used as controls. RESULTS: Between 15 and 60 minutes after diuretic injection the renal pelvis enlarged to a maximum volume in all hydronephrotic and normal kidneys and then gradually decreased in size. Mean average increase in volume for hydronephrotic kidneys ranged from 46% in obstructed kidneys to 88% in nonobstructed kidneys. Volume expansion caused dilution of isotope within the renal pelvis, which resulted in prolongation of elimination half-time (T1/2) in 42% of nonobstructed hydronephrotic kidneys sufficient to register an obstructed washout pattern. However, there were no differences in the initial pelvic volume or the rate or extent of increases or decreases in pelvic volume that would permit nonobstructed hydronephrotic kidneys to be distinguished from obstructed ones. CONCLUSIONS: The renal pelvis enlarges during diuresis in children with hydronephrosis. This enlargement causes dilution of isotope within the renal pelvis during DR, which prolonged the isotope washout rate or T1/2 sufficiently to produce an obstructed washout pattern in more than 40% of hydronephrotic kidneys that were ultimately proved to be nonobstructed. This misdiagnosis of obstruction is particularly likely to occur in children younger than 2 years because pelvic volume expansion is so exaggerated. Consequently, T1/2 appears to be particularly vulnerable to inaccuracy in diagnosing obstruction in this age group, and, therefore, it should not be relied on as an operative determinant.     

穴位电刺激对薄型子宫内膜的治疗效果初探

目的探讨穴位电刺激对薄型子宫内膜的治疗效果。方法收集南京医科大学第一附属医院2014年1月至2016年11月拟行冻胚移植的薄型子宫内膜患者96人为研究对象,共计145个周期。记录患者的年龄、体重指数(BMI)及不孕年限等情况。根据子宫内膜厚度将其分为3组,A组:子宫内膜厚度≤3mm,共12个周期;B组:3mm<子宫内膜厚度≤5mm,共60个周期;C组:5mm<子宫内膜厚度≤7mm,共73个周期。所有患者均于月经第5~7天应用PHENIX系列神经肌肉刺激治疗仪U8,予以阴道及"中极"、"关元"、"子宫"、"足三里"、"三阴交"、"太冲"及"肾俞"等部位低频脉电刺激治疗(交流电,频率:40 Hz,脉宽:250μs,每次30min),1次/d,5~8次为1周期。观察治疗前后子宫内膜厚度、子宫动脉血流阻力指数(RI)的变化情况。结果 3组患者年龄、BMI及不孕年限比较无显著性差异(P>0.05)。A组子宫内膜厚度治疗前后无显著性差异(P=0.09);治疗前后双侧子宫动脉RI亦无显著变化(P>0.05)。B组与C组治疗后内膜厚度均显著增加[B组:(3.91±0.07)mm vs.(6.32±0.15)mm,C组:(5.39±0.07)mm vs.(7.77±0.12)mm,P均<0.01],双侧子宫动脉RI则显著下降[左侧RI:B组(0.90±0.04)vs.(0.87±0.05),C组(0.88±0.04)vs.(0.84±0.05);右侧RI:B组(0.90±0.04)vs.(0.87±0.05),C组(0.88±0.05)vs.(0.84±0.05),P均<0.01]。结论低频穴位电刺激对内膜厚度为3~7mm薄型子宫内膜患者的治疗安全有效,值得临床推广,但其长期的临床治疗效果及相关机制还有待于进一步研究。     

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.     

Cystic lesions of the fetal kidney: diagnosis and prediction of postnatal function by fetal urine biochemistry.

Fetal urine was aspirated under ultrasound control from 21 large cystic renal masses in 18 pregnancies of 20 to 35 weeks gestation. None were associated with bladder or ureteric dilatation. At postnatal investigation, 12 kidneys were demonstrated to be hydronephrotic (5 with no or poor function) and 9 multicystic. Urinary concentrations of sodium (Na+), calcium (Ca++), and phosphate (PO4--) were significantly higher in the multicystic group than in the hydronephrotic, whereas urea and creatinine levels were lower. Determination of urinary PO4-- enabled differential diagnosis with no false-positive or false-negative cases. Among hydronephrotic kidneys, no biochemical parameter accurately predicted postnatal function, although creatinine was increased in all three nonfunctioning kidneys. In hydronephrotic kidneys, urinary Na+ concentration increased with advancing gestational age (r = .66; P < .02), suggesting that the duration of hydronephrosis has a negative effect on renal function.