Vaidyanathan S, Singh G, Soni B M, Hughes P, Watt J W, Dundas S, Sett P, Parsons K F
Regional Spinal Injuries Centre, District General Hospital, Southport, Merseyside, UK.
Spinal Cord. 2000 Nov;38(11):661-8. doi: 10.1038/sj.sc.3101053.
A study of four patients with spinal cord injury (SCI) in whom a diagnosis of hydronephrosis or pyonephrosis was delayed since these patients did not manifest the traditional signs and symptoms.
To learn from these cases as to what steps should be taken to prevent any delay in the diagnosis and treatment of hydronephrosis/pyonephrosis in SCI patients.
Regional Spinal Injuries Centre, Southport, UK.
A retrospective review of cases of hydronephrosis or pyonephrosis due to renal/ ureteric calculus in SCI patients between 1994 and 1999, in whom there was a delay in diagnosis.
A T-5 paraplegic patient had two episodes of urinary tract infection (UTI) which were successfully treated with antibiotics. When he developed UTI again, an intravenous urography (IVU) was performed. The IVU revealed a non-visualised kidney and a renal pelvic calculus. In a T-6 paraplegic patient, the classical symptom of flank pain was absent, and the symptoms of sweating and increased spasms were attributed to a syrinx. A routine IVU showed non-visualisation of the left kidney with a stone impacted in the pelviureteric junction. In two tetraplegic patients, an obstructed kidney became infected, and there was a delay in the diagnosis of pyonephrosis. The clinician's attention was focused on a co-existent, serious, infective pathology elsewhere. The primary focus of sepsis was chest infection in one patient and a deep pressure sore in the other. The former patient succumbed to chest infection and autopsy revealed pyonephrosis with an abscess between the left kidney and left hemidiaphragm and xanthogranulomatous inflammation of perinephric fatty tissue. In the latter patient, an abdominal X-ray did not reveal any calculus but computerised axial tomography showed the presence of renal and ureteric calculi.
The symptoms of hydronephrosis may be bizarre and non-specific in SCI patients. The symptoms include feeling unwell, abdominal discomfort, increased spasms, and autonomic dysreflexia. Physicians should be aware of the serious import of these symptoms in SCI patients.
对4例脊髓损伤（SCI）患者进行研究，这些患者因未表现出传统的体征和症状，肾盂积水或脓肾的诊断被延误。
从这些病例中了解应采取哪些措施来防止SCI患者肾盂积水/脓肾的诊断和治疗出现延误。
英国南港地区脊髓损伤中心。
对1994年至1999年间SCI患者因肾/输尿管结石导致肾盂积水或脓肾且诊断延误的病例进行回顾性研究。
一名T-5截瘫患者发生了两次尿路感染（UTI），经抗生素治疗成功。当他再次发生UTI时，进行了静脉肾盂造影（IVU）。IVU显示一侧肾脏不显影及肾盂结石。一名T-6截瘫患者没有典型的胁腹疼痛症状，出汗和痉挛加重的症状被归因于脊髓空洞症。常规IVU显示左肾不显影，结石嵌顿在肾盂输尿管连接处。在两名四肢瘫患者中，梗阻的肾脏发生感染，脓肾诊断出现延误。临床医生的注意力集中在其他部位同时存在的严重感染性病变上。脓毒症的主要病灶在一名患者为胸部感染，在另一名患者为深部压疮。前一名患者死于胸部感染，尸检显示脓肾，左肾与左半膈之间有脓肿，肾周脂肪组织有黄色肉芽肿性炎症。后一名患者腹部X线未显示任何结石，但计算机断层扫描显示存在肾和输尿管结石。
SCI患者肾盂积水的症状可能怪异且不具特异性。症状包括感觉不适、腹部不适、痉挛加重和自主神经反射异常。医生应意识到这些症状对SCI患者的严重影响。
