小儿肾积水肾盂成形术后尿理化性质和尿水通道蛋白2改变的研究

目的 探讨小儿单侧先天性肾盂输尿管连接处梗阻(pyeloureteric junction obstruction,PUJO)肾积水术后1周内尿理化性质和尿水通道蛋白2(aquaporins-2.AQP2)的变化.方法 选取14例符合Grignon法四、五级标准的小儿单侧先天性PUJO.肾积水患儿;经肾盂成形术后给予严格设定的补液标准,收集术后第一、三、五、七天积水侧肾脏和对侧无积水肾脏24 h尿液,分别测定排尿量、渗透压、Na+和肌酐,并用酶联免疫吸附法(ELISA)测定尿液中AQP2水平.结果 相对于对侧无积水肾脏,积水侧肾脏梗阻解除术后1周内尿液AQP2显著降低.尿量明显增多.尿渗透压显著降低,Na+排泄分数显著增加;同时术后1周内双侧肾脏尿液AQP2、排尿量和尿渗透压有升高趋势,而积水侧肾脏Na+排泄分数有减少的趋势;积水侧.肾脏术后第五、七天的尿液AQP2.排尿量和尿渗透压较第一天均显著增加(P<0.05).对侧无积水肾脏术后第五、七天的尿液AQP2和尿渗透压较第一天也显著增加(P<0.05).其余指标在术后小同天数之间差异无统计学意义(P>0.05).结论小儿单侧先天性PUJO解除术后1周内积水侧.肾脏的尿液AQP2和尿渗透压均较对侧尤积水肾脏尿液显著减少.提示梗阻解除后尿液中AQP2可能和尿液浓缩能力改变有关.

Correlations between urinary aquaporins-2 and urine parameters after pyeloplasty in children with congenital hydronephrsis

Objective To investigate the correlation between the urinary aquaporins 2(AQP2) and urine physiological and chemical parameters in the first week after releasing ureteral obstruction on children with pyeloureteral junction obstruction (PUJO). Methods Fourteen children with congenital unilateral PUJO were included in this study. All patients presented with hydronephrosis of grade Ⅳ and Ⅴ according to Grignon's grading system. Fluid infusion after operation was under strictly control, and 24-hour urine was collected separately from hydronephrotic and contralateral non-hydronephrotic kidneys on the first, third, fifth and seventh day after operation. The urine output, osmolality, sodium and creatinine were measured. AQP2 was detected by enzyme-linked immunosorbent assay (ELISA). Results In the first week after operation, AQP2 and urine osmolality were lower, urine output and sodium excretion fraction were higher than those of the contralateral healthy kidney. Meanwhile, it had an increasing trend in AQP2 content, urine output and osmolality in bilateral kidneys. For the hydronephrotic kidney, AQP2, urine osmolality and output on the fifth and seventh day in- creased significantly compared with those on the first day (P<0. 05). And for the contralateral kid- ney, both of the AQP2 content and urine osmolality on the fifth and seventh day increased significantly compared with those on the first day(P<0.05).Sodium excretion fraction had a decreasing trend in hydronephrotic kidney. There is no statistical difference between the other parameters on different days after operation (P>0. 05). Conclusions AQP2 content of urine may be related to the change of concentration ability of collecting duct in the first week after releasing ureteral obstruction on children with PUJO.