Defective Bone Microstructure in Hydronephrotic Mice: A Histomorphometric Study in ICR/Mlac‐hydro Mice

Chronic renal impairment can lead to bone deterioration and abnormal bone morphology, but whether hydronephrosis is associated with bone loss remains unclear. Herein, we aimed to use computer‐assisted bone histomorphometric technique to investigate microstructural bone changes in Imprinting Control Region (ICR) mice with a spontaneous mutation that was associated with bilateral nonobstructive hydronephrosis (ICR/Mlac‐hydro). The results showed that 8‐week‐old ICR/Mlac‐hydro mice manifested decreases in trabecular bone number and thickness, and an increased trabecular separation, thereby leading to a reduction in trabecular bone volume compared with the wild‐type mice. Furthermore, histomorphometric parameters related to both bone resorption and formation, that is, eroded surface, osteoclast surface, and osteoblast surface, were much lower in ICR/Mlac‐hydro mice than in the wild type. A decrease in moment of inertia was found in ICR/Mlac‐hydro mice, indicating a decrease in bone strength. In conclusion, ICR/Mlac‐hydro mice exhibited trabecular bone loss, presumably caused by marked decreases in both osteoblast and osteoclast activities, which together reflected abnormally low bone turnover. Thus, this mouse strain appeared to be a valuable model for studying the hydronephrosis‐associated bone disease. Anat Rec, 297:208–214, 2014. © 2013 Wiley Periodicals, Inc.     

彩色多普勒超声评价肾积水患者肾功能可复性临床研究

目的 探讨运用彩色多普勒超声预测肾积水患者肾功能可复性的临床价值.方法 临床收治的重度肾积水患者62例,共70只患肾,静脉尿路造影(IVU)2 h均不显影,利用彩色多普勒超声分别测定梗阻解除术前及术后2～3个月内的肾内动脉血流阻力指数(RI)和肾实质厚度,根据梗阻解除术后2～3个月内IVU2 h内患肾有无显影,分为肾显影组(55只)、肾无显影组(15只),分析彩色多普勒超声指标与肾积水肾功能可复性之间的关系.结果 梗阻解除术前肾显影组、肾无显影组RI分别为0.73±0.06、0.82±0.01,肾实质厚度分别为(0.45±0.08)、(0.23±0.09) cm,2组间各项指标比较差异均有统计学意义(P＜0.05).采用正态分布法进行界值判断,以95%上限为界,肾皮质厚度为3 mm(准确度为84.5%、灵敏度92%、特异性80.9%),RI值为0.81(准确度为81.4% 、灵敏度67%、特异性87.6%).结论 彩色多普勒超声指标RI和肾实质厚度可以反映积水肾的肾功能损害程度并可作为临床上预测肾功能可复性的客观指标.     

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。     

SonoVue用子单侧肾积水肾功能变化的实验研究

目的 经静脉声学造影并进行声学定量检测兔单侧积水肾皮质的血流参数，旨在找出肾积水后肾功能变化特点，为更好地评价肾积水肾功能状况及治疗提供依据。方法将16只健康的新西兰大白兔制成右肾积水模型。采用超声造影剂SonoVue、Technos DU6超声仪和CnTI适时造影成像技术进行造影增强超声检测积水肾皮质的皮质的峰值强度时间（PIT）、灌注曲线下面积（AUC）、肾实质造影增强平均通过时间（MTT）。分别于手术前及手术后2、4、6、8、10、12周通过造影测量肾皮质血流参数，第10、12周分别给第2、7号兔解除梗阻，1周后作相同检测。分别于4、8、10、12周时各处死16、15、14、13号实验兔。采集右肾组织病理检查。结果以手术前血流参数为基础对照：4、8、12周时AUC、MTT均降低（P〈0．05），PIT延长（P〈0.05）。组间对照结果：除2、4周组间对照AUC、MTT、PIT没有差别外（P〉0．05）），其余各组间对照的AUC、MTT、PIT均有统计学意义。第10周时解除梗阻1周后，AUC、MTT较同期均增高，PIT缩短；第12周时解除梗阻1周后，参数AUC、MTT、PIT与12周时相比无变化。结论完全性尿路梗阻导致。肾盂积水经SonoVue超声造影剂检测发现AUC小于15、PIT大于64s及MTT小于153s时，患肾功能进入不可逆期。尿路梗阻导致肾盂积水小于12周，应该尽早解除梗阻，有恢复患肾功能的机会。完全性尿路梗阻导致肾盂积水大于12周者，预后不良。     

IVIM-MRI监测白兔肾积水肾功能损害的研究

目的 探讨体素内不相干运动磁共振成像(IVIM-MRI)监测肾积水肾功能改变的价值.方法 动态分析新西兰大白兔左侧输尿管不全梗阻肾积水模型成模后4、8、12、16周的左肾IVIM-MRI定量参数[表观扩散系数(ADC)值、纯扩散系数(D)值、假性扩散系数(D*)值、灌注分数(f)值]变化特点,并将该参数与核素肾小球滤过率(GFR)值做相关分析.结果 成模后4、8、12、16周白兔左侧积水肾的皮髓质D值、D*值、f值、ADC值随着肾功能受损程度加重数值逐步下降,其中D值、f值及ADC值组间两两LSD对比:12周、16周与对照组、4周,8周与16周组间差异有统计学意义(P<0.05);D*值组间两两LSD对比:8周、12周、16周与对照组、4周,12周、16周与8周间差异有统计学意义(P<0.05);左侧积水肾成模后不同时间点的D值、D*值、f值、ADC值与核素GFR呈中度正相关.结论 IVIM-MRI能有效动态监测肾积水肾功能的变化.     

Contrast enhanced spiral computerized tomography in patients with chronic obstructive uropathy and normal serum creatinine: a single session for anatomical and functional assessment

PURPOSE: We evaluated contrast enhanced spiral computerized tomography (CT) as a single session for the anatomical and functional assessment of patients with chronic obstructive uropathy and normal serum creatinine. MATERIALS AND METHODS: The study included 65 patients with unilateral or bilateral chronic renal obstruction and normal serum creatinine. Five patients had bilateral obstruction and the remaining 60 had unilateral obstruction and a normal contralateral kidney. Therefore, the total number of renal units was 130, that is 70 obstructed and 60 normal. All patients underwent contrast enhanced spiral CT together with excretory urography (IVP) and Tc-mercaptoacetyltriglycine renal scan. CT was used to identify the cause of obstruction and selectively determine the glomerular filtration rate (GFR) of the 2 kidneys. The diagnostic accuracy of CT for identifying the cause of hydronephrosis was compared with that of IVP. Moreover, a correlation was made between CT GFR and isotope GFR. RESULTS: Obstruction was caused by ureteropelvic junction narrowing in 25 cases, ureteral stones in 21, ureteral stricture in 20 and extrinsic ureteral obstruction in 4. Contrast enhanced spiral CT identified the cause of hydronephrosis in all obstructed kidneys (100% sensitivity), while IVP identified the cause in 52 (74% sensitivity), which was a significant difference (p <0.05). CT and IVP excluded obstruction in all normal kidneys (100% specificity). A comparison between the isotope GFR of obstructed kidneys with the corresponding CT GFR showed a perfect correlation (r = 0.78, p <0.0001). Moreover, a similar comparison between isotope GFR and CT GFR of normal kidneys showed an excellent correlation (r = 0.73, p <0.0001). In obstructed and normal kidneys mean isotope clearance was not significantly different from that of mean CT clearance. CONCLUSIONS: Contrast enhanced spiral CT is more sensitive than IVP for identifying the cause of chronic obstructive uropathy. Moreover, it is as accurate as radioisotope renal scan for calculating the total and separate kidney function. We recommend spiral CT with contrast medium as a single radiological diagnostic modality for the assessment of patients with chronic renal obstruction and normal serum creatinine.     

巨大积水肾后腹腔镜下肾切除术56例经验总结

【目的】总结巨大积水肾行后腹腔镜下肾切除术的经验。【方法】分析了2004年至2008年56例因巨大肾积水接受了后腹腔镜下肾切除术的病例资料。[结果]56例均在腹腔镜下完成手术。手术时间为70～180min，平均121min。所有患者均未输血，术中及术后未发生明显并发症。检查标本发现36例存在肾盂输尿管交界处梗阻，另20例巨大肾积水继发于输尿管上段结石。【结论】尽管巨大积水肾占据了大部分腹膜后腔，后腹腔镜下肾切除术仍可以安全有效地完成。     

转录因子E2F-1在梗阻性肾组织中的表达及其意义

目的 探讨转录因子E2F-1在梗阻性肾病的发病机制中作用。方法 应用免疫组化方法检测E2F-1和增殖细胞核抗原（PCNA）在43例梗阻性肾组织和12例正常肾组织中的表达。分析E2F-1表达与梗阻性肾积水和肾纤维化程度之间关系。结果 正常肾组织中E2F-1阳性表达率为41．7％，显著低于梗阻肾组织的79．1％（P〈0．05）。梗阻肾组织E2F-1表达与肾纤维化程度及PCNA指数密切相关（P〈0．05）。但与肾积水程度无显著相关性（P〉0．05）。结论 E2F-1异常表达参与梗阻性肾病的发病过程，尤其在肾纤维化过程中发挥重要作用。