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。     

Reflux nephropathy in the 1st year of life — the role of infection

The importance of infection and vesico-ureteric reflux in the development of reflux nephropathy is generally accepted. Widespread use of antenatal ultrasound scanning has identified dilated fetal urinary tracts, allowing prompt investigation and treatment in the early post-natal period; some of these children have vesico-ureteric reflux. This study compares renal parenchymal damage, demonstrated by uptake of technetium ^99m dimercaptosuccinic acid (DMSA) in two groups. The first included babies less than 6 months old who had presented with their first urinary tract infection and had vesico-ureteric reflux. The second included those in whom a dilated urinary tract had been identified at antenatal ultrasound and post-natal investigation revealed vesico-ureteric reflux, but who had no evidence of urinary tract infection. Renal damage was present in 68% of group 1 and 29% of group 2 when DMSA scanning was used to detect scarring (P = <0.05). Our results support the proposal that infection is a major factor in development of renal damage in patients with vesico-ureteric reflux. Identification by antenatal ultrasound scanning allows early therapeutic intervention before renal damage occurs. Offprint requests to: D. C. S. Gough     

Uretero-vesical junction obstruction presenting as gaint hydronephrosis

A rare case of giant hydronephrosis due to ureterovesical junction obstruction is presented.     

Partial unilateral ureteral obstruction in rats

This review comprises an overview of the current knowledge on experimental partial unilateral ureteral obstruction (PUUO) and a summary of our latest original experimental PUUO studies in rats. Neonatal PUUO is the type of obstruction that is most often encountered in pediatric clinical practice. However, the pathogenesis of PUUO is still incompletely understood. Most of our knowledge on PUUO has been derived from experimental studies in a variety of animal models. Although progress has been made, the natural history of congenital hydronephrosis is still incompletely described. The effects on kidney functions of long-term urinary tract obstruction, especially PUUO, have been less intensively studied. Recently, we created models with mild and severe PUUO in young rats by embedding the upper one fourth or the upper two thirds of the left ureter into the psoas muscle, respectively. Thereafter, the technique was used to create mild and severe PUUO in newborn rats and magnetic resonance imaging studies showed that both mild and severe obstruction caused a time-dependent decrease in renal blood flow. Compensatory increase in total kidney volume and renal vein blood flow in contralateral non-obstructed kidneys was not detectable when functional deterioration in the partially obstructed kidneys was present. Finally, we investigated the dynamic changes in renal relative signal intensity (RSI) of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) using magnetic resonance imaging in rats with partial, complete unilateral ureteral obstruction and sham-operated controls. The results showed that changes in Gd-DTPA RSI are compatible with the known physiological and anatomical changes in kidneys in response to ureteral obstruction and useful for distinguishing an obstructed from a non-obstructed collecting system and also for differentiating a partially obstructed from a completely obstructed collecting system.     

Urinary concentration and tissue messenger RNA expression of monocyte chemoattractant protein-1 as an indicator of the degree of hydronephrotic atrophy in partial ureteral obstruction

PURPOSE: To find a potential prognostic marker of the induction of hydronephrotic atrophy in congenital hydronephrosis we investigated whether the messenger (m)RNA expression and urinary concentration of monocyte chemoattractant protein-1 (MCP-1) correlated with the degree of partial ureteral obstruction, and subsequent hydronephrotic atrophy and interstitial fibrosis. MATERIALS AND METHODS: We created left partial ureteral obstruction in 96 juvenile Wistar rats and complete ureteral obstruction in 18, while 16 underwent sham operation. Depending on excretion of contrast medium into the renal pelvis after 3 days we defined 2 degrees of hydronephrosis. Renal mRNA expression of MCP-1, and renal pelvic and bladder urinary concentrations of MCP-1 were measured after 1, 2 and 3 weeks, and compared with the degree of hydronephrotic atrophy. RESULTS: Grade 1 partial ureteral obstruction resulted in mild histological changes. Grade 2 partial and complete obstruction resulted in significant hydronephrotic atrophy. MCP-1 mRNA expression in the kidney remained unchanged in grade 1 partial obstruction but was moderately increased in grade 2 partial obstruction and clearly over expressed in complete ureteral obstruction. The renal pelvic urinary concentration of MCP-1 was not higher in rats with grade 1 partial obstruction than in sham operated animals but it was significantly increased in those with grade 2 partial and complete obstruction. CONCLUSIONS: mRNA expression and the urinary concentration of MCP-1 correlate with the degree of obstruction and subsequent renal damage in hydronephrosis. They may serve as prognostic markers in children with congenital hydronephrosis.     

A comparison of unenhanced helical computerized tomography findings and renal obstruction determined by furosemide 99m technetium mercaptoacetyltriglycine diuretic scintirenography for patients with acute renal colic

PURPOSE: We assessed unenhanced helical computerized tomography (CT) secondary findings as predictors of renal obstruction as determined by diuretic scintirenography, and determined their reproducibility. MATERIALS AND METHODS: We performed a retrospective review of the records of 77 consecutive patients with unenhanced helical CT findings (stones and secondary findings, including renal parenchymal edema, hydronephrosis, hydroureter, perinephric fat stranding, periureteral fat stranding and extravasation) of urinary lithiasis who had also undergone concomitant diuretic scintirenography during the initial emergency room evaluation during a 1-year period. Unenhanced helical CT films were independently reviewed by 2 attending radiologists (blinded to clinical outcome) to determine interobserver variability. The results were compared to those of diuretic scintirenography. RESULTS: Considerable interobserver variability, as evidenced by kappa values ranging from 0.26 to 0.60, existed for the diagnosis of secondary findings associated with urinary lithiasis on unenhanced helical CT. There was no significant difference in terms of CT findings between patients diagnosed by diuretic scintirenography as having high grade/complete obstruction and those with partial obstruction (p values 0.24 to 0.85 for the 6 unenhanced helical CT findings analyzed). Analyses of variance followed by Tukey's pairwise comparisons showed no significant difference in average number of unenhanced helical CT findings between patients with high grade/complete obstruction (mean plus or minus standard deviation 4.4 +/- 1.31), partial obstruction (4.4 +/- 1.30), and decompression/no obstruction (4.2 +/- 1.16). However, the mean number of unenhanced helical CT findings for patients with normal scintirenography/no obstruction (1.9 +/- 1.41) was significantly different from each of the other 3 diuretic scintirenography groups. Separate logistic regression analyses showed that each unenhanced helical CT finding, except for renal parenchymal edema and urinary extravasation, was a significant predictor of "any degree of obstruction" (high grade and partial obstruction groups) compared to "no obstruction" (decompressed and no obstruction groups). Odds ratios (95% confidence interval) ranged from 6.15 (2.25, 16.82) for perinephric fat stranding to 3.41 (1.30, 8.97) for hydroureter. When these analyses were repeated after exclusion of 8 patients with bladder/passed stones, only perinephric fat stranding and periureteral fat stranding remained significant predictors of "any degree of obstruction," with respective odds ratios of 4.21 (1.49, 11.91) and 4.08 (1.31, 12.65). CONCLUSIONS: Measures of agreement between trained, independent radiologists with respect to unenhanced helical CT secondary findings show considerable variability. The average number of CT consensus findings is not helpful in differentiating patients with variable degrees of obstruction, except for those with normal scintirenography/no obstruction. Unenhanced helical CT findings, except for renal parenchymal edema and urinary extravasation, are significant predictors of "any degree of obstruction" (high grade or partial obstruction) compared to "no obstruction" (decompressed or no obstruction). Therefore, unenhanced helical CT findings may be useful for identifying patients with any degree of obstruction but do not differentiate between those with high grade and partial obstruction.     

Evaluation of renal function in children with moderate or severe hydronephrosis after operation

Objective To evaluate postoperative renal function in children with congenital moderate or severe hydronephrosis.Methods (99m) Tc- labeled diethylenetriaminepenta- acetic acid scintigraphy was performed in 50 children with unilateral moderate or severe hydronephrosis to d etermine postoperative renal function. We also analyzed the factors influencing renal function recovery. Results Average postoperative renal function in 50 cases was 40. 62%±10. 09%. Among th em, 32% of patients had nearly normal renal function and differentiated renal f unction reached up to 45%. Average preoperative and postoperative renal functio n in 25 cases was 23. 89%±11. 65% and 39. 33%±8. 59% respectively and the incr ease of renal function was about 15. 44%±11. 18% (P=0. 0003). Renal parenc hyma thickness was negatively correlated with postoperative renal function (r =-0. 62, P=0. 0009). The follow- up period was positively correlated with postoperative renal function (r=0. 58, P=0. 0026). The patients’age ha d no correlation with renal function recovery (r=-0. 05, P=0. 80). Reco very of renal function in hydronephrosis with extrarenal pelvis was greater than that in hydronephrosis with intrarenal pelvis (P=0. 016). Conclusions Postoperative renal function in children with moderate or severe hydronephrosis can recover to normal. Recovery of renal function was more obvious in hydroneph rosis with thinner renal parenchyma, longer follow- up period and extrarenal pel vis.     

儿童肾积水肾脏动态增强MRI检查

目的：了解动态增强MRI技术评价儿童肾积水肾脏形态及功能的价值。方法：单侧先天性肾盂输尿管连接部狭窄(PUJO)所致肾积水男性患儿7例，均经B超、静脉尿路造影(IVU)及病理证实。观察并记录动态增强MRI注射对比剂Gd-DTPA前和注射后1min，3min，5min，10min，15min，30min，45min和60min肾实质和集合系统相对信号强度(RSI)。均以对侧正常肾脏作为对照。结果：平扫示积水肾脏皮、髓质分界不清，集合系统信号强度较低；动态扫描示积水肾实质和集合系统。RSI逐渐增大，正常肾脏则逐渐减小。结论：动态增强MRI可对儿童肾积水肾脏的功能和形态进行联合评估。     

Patients at high risk for upper tract urothelial cancer: evaluation of hydronephrosis using high resolution magnetic resonance urography

PURPOSE: We assessed the potential of magnetic resonance urography (MRU) in the evaluation of hydronephrosis not explained by standard investigation in patients at high risk for upper tract urothelial cancer. MATERIALS AND METHODS: A total of 23 consecutive patients in a specialist urological unit with unexplained hydronephrosis prospectively underwent MRU which comprised overview heavily T2-weighted MR urographic images followed by focused high resolution turbo spin echo T2-weighted sequences obtained in an axial and coronal oblique plane through the level of urinary obstruction. All were at high risk for urothelial cancer and had either contraindications to or problems with standard investigations including poor contrast excretion due to obstruction or renal failure, failed ureteral cannulation or contrast allergy. Clinical events and imaging followup, subsequent endoscopic/surgical findings and histopathology validated MR findings. RESULTS: In 23 patients with a high clinical suspicion of upper tract transitional cell tumors (TCC), 8 ureteral and 5 renal pelvic TCCs (2 bilateral) were diagnosed by MR, and confirmed histologically. In a further 5 patients benign causes for the hydronephrosis were found. No intrinsic or extrinsic pathology was demonstrable in 5 patients whose imaging findings were stable during 1 year of followup. CONCLUSIONS: MRU is a valuable noninvasive investigation for evaluating hydronephrosis in this group of patients with suspected urothelial cancer in which routine investigation had failed to provide clinically important information. Focused high resolution T2-weighted images were reliable in the diagnosis of ureteral and renal pelvic TCCs, and were valuable in excluding these and other mass lesions as the cause of hydronephrosis.