结石致孤立肾急性肾功能不全的诊治探讨

目的：探讨结石致孤立肾急性肾功能不全的诊断及治疗体会。方法：上尿路结石致孤立肾急性肾功能不全的患者36例,病程12h～10d。ESWL4例。输尿管镜下钬激光碎石12例。微创经皮肾镜碎石术19例。1例行输尿管切开取石术。结果：31例72h内急诊解除梗阻患者3～14d内血Cr降至58～171μmol/L;尿量增加,肾功能恢复,临床症状消失。结论：孤立肾急性梗阻性肾衰的治疗原则是尽早解除梗阻,最大限度地保护肾功能,同时有效防止感染等并发症,促进机体恢复。微创经皮肾镜及输尿管镜钬激光碎石术是治疗输尿管上段结石的首选术式。磁共振尿路成像检查和B超对结石梗阻所致急性肾功能不全的诊断具有重要价值。

TO summarize and analyze the emergency management for acute renal deficiency of solitory kidney by urinary calculi

Objective： To summarize and analyze the emergency management for acute renal deficiency of solitory kidney by urinary calculi. Methods： A total of 36 cases of renal deficiency of solitary kidney induced by urinary calculi.The mean course was 2.6 days （range 12 hours to 10 days）. ESWL 4 cases.12 cases of ureteral calculi treated via ureteroscope with Ho：YAG laser lithotripsy .MPCNL 19 cases, 1 case with emergent open surgery. Results： In 31 cases treated within 72 hours after obstruction, the serum Cr level decreased to 58-17μmol/L after urgent treatment during a period of 3-14 days, and the renal functions recovered. Conclusions： The principles of management for this acute condition should be diagnosing early and promptly, releasing obstruction as soon as possible, preventing complications effectively and reserving renal functions. Ho：YAG laser lithotripsy is the first choice of emergent treatment of upper urinary calculi. MRU and B-ultrasound have important value in the diagnosis of acute renal deficiency by upper urinary calculi.