Paltiel H J, Mulkern R V, Perez-Atayde A, Connolly L P, Zurakowski D, Treves S T, Atala A
Department of Radiology, Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
Radiology. 2000 Nov;217(2):507-15. doi: 10.1148/radiology.217.2.r00nv18507.
To study the effects of chronic, low-pressure, sterile vesicoureteral reflux (VUR) on renal growth and function in a porcine model.
Unilateral VUR was created in five pigs, with the contralateral kidney serving as a control. Preoperatively, and 1 year later, ultrasonography, technetium 99m-dimercaptosuccinic acid (DMSA) scintigraphy, contrast material-enhanced computed tomography (CT), and contrast-enhanced magnetic resonance (MR) imaging were performed. Morphologic abnormalities and relative uptake of (99m)Tc-DMSA were recorded. The postcontrast enhancement ratios for parenchymal regions of interest at CT and MR imaging were determined. Ruthenium 103-labeled microspheres were used to determine regional blood flow. After the pigs were sacrificed, the kidneys were excised, weighed, and analyzed pathologically.
Two of five refluxing kidneys had less than 45% function at scintigraphy. One of these two kidneys was small at postmortem examination. There were no other imaging or gross pathologic abnormalities. There was no significant difference in regional blood flow between the refluxing and nonrefluxing kidneys. In all of the operated on kidneys, histologic examination showed focal chronic inflammation and fibrosis.
Low-pressure sterile reflux into previously normal kidneys led to mild, focal, chronic interstitial inflammation and fibrosis after 1 year. Imaging findings were normal apart from a subtle decrease in tubular function in two refluxing kidneys.
在猪模型中研究慢性、低压、无菌性膀胱输尿管反流（VUR）对肾脏生长和功能的影响。
对5头猪建立单侧VUR，对侧肾脏作为对照。术前及1年后，进行超声检查、锝99m - 二巯基丁二酸（DMSA）闪烁扫描、对比剂增强计算机断层扫描（CT）和对比增强磁共振（MR）成像。记录形态学异常及（99m）Tc - DMSA的相对摄取情况。测定CT和MR成像中感兴趣实质区域的对比后增强率。使用钌103标记的微球测定局部血流。猪处死后，切除肾脏，称重并进行病理分析。
5个反流肾脏中有2个在闪烁扫描时功能低于45%。这2个肾脏中有1个在尸检时体积较小。没有其他影像学或大体病理异常。反流肾脏与非反流肾脏之间的局部血流无显著差异。在所有手术的肾脏中，组织学检查显示局灶性慢性炎症和纤维化。
1年后，向先前正常的肾脏内低压无菌反流导致轻度、局灶性慢性间质性炎症和纤维化。除2个反流肾脏的肾小管功能有轻微下降外，影像学表现正常。
