Mayor G, Genton N, Torrado A, Guignard J P
Pediatrics. 1975 Nov;56(5):740-7.
Renal function was studied in 24 children with chronic hydronephrosis and renal insufficiency. The follow-up period after reconstructive surgery was 1 to 12 years. Glomerular filtration rate (GFR) was assessed by the clearance of endogenous creatinine or inulin. Effective renal plasma flow was assessed by the clearance of PAH. Reconstructive surgery was performed during the first year of life in 12 out of 24 patients, between one and two years of life in 6 patients, and after two years of life in 6 patients. Three different patterns of evolution could be observed after relief of obstruction: (1) An improvement or a normalization of renal function only occurred in patients operated upon before one year of life. (2) A stabilization of renal function without normalization was observed in patients operated upon between one and two years of life. (3) A progressive deterioration of renal function towards terminal renal failure was observed in five out of six patients operated upon after two years of age. This deterioration could not be explained by recurrence of detectable urinary tract infection or urinary stasis. The changes in GRF in four patients with a solitary kidney followed the same pattern. We conclude that it is essential to correct severe chronic hydronephrosis associated with renal insufficiency before one year of age if a lasting improvement of renal function is to be expected.
对24例患有慢性肾积水和肾功能不全的儿童的肾功能进行了研究。重建手术后的随访期为1至12年。通过内源性肌酐或菊粉清除率评估肾小球滤过率（GFR）。通过对氨马尿酸清除率评估有效肾血浆流量。24例患者中，12例在1岁前进行了重建手术，6例在1至2岁之间进行了手术，6例在2岁后进行了手术。梗阻解除后可观察到三种不同的演变模式：（1）仅在1岁前接受手术的患者中出现肾功能改善或恢复正常。（2）在1至2岁之间接受手术的患者中观察到肾功能稳定但未恢复正常。（3）6例2岁后接受手术的患者中有5例出现肾功能逐渐恶化直至终末期肾衰竭。这种恶化无法用可检测到的尿路感染复发或尿路淤积来解释。4例单肾患者的肾小球滤过率变化遵循相同模式。我们得出结论，如果期望肾功能得到持久改善，那么在1岁前纠正与肾功能不全相关的严重慢性肾积水至关重要。
