Cheskis A L, Severgina E S, Leonova L V, Ostapko M S
Urologiia. 2002 Jul-Aug(4):39-43.
Development of the kidneys after correction of hydronephrosis was studied in 40 patients operated at the age of 8 months-12 years. Follow-up lasted 10-25 years. X-ray control showed efficiency of correction of the uretheropelvic segment (UPS). Roentgenoplanimetric study demonstrated a uniform 50-100% increase in renal area and its parenchyma in 28 patients (32 kidneys). In 9 patients parenchyma increased 2.5-4-fold, renal area by 50-100%. In three cases parenchyma diminished by 3-10% in growth of the kidney by 24-80%. This evidenced of nephrosclerosis progress. UPS correction favoured renal growth and development. There were only few cases when correction of UPS was positive but nephrosclerosis aggravated. Development of the kidney may depend on many factors such as preoperative condition of the kidney, severity of UPS obstruction, the patient's age, duration and severity of pyelonephritis, dysplasia and age-related immaturity of renal parenchyma, immune status of the organism, microorganism virulence, etc. But decisive was the condition of renal parenchyma before the operation. In 3 patients with progressive nephrosclerosis renal parenchyma affection was additionally characterized by advanced sclerosis and inflammatory infiltration of the intertitium which ended in a poor outcome. The above observations suggest the necessity of long-term postoperative follow-up of the patients to design effective measures aimed at the treatment and prevention of nephrosclerosis.
对40例年龄在8个月至12岁接受手术的患者，研究了肾盂积水矫正术后肾脏的发育情况。随访持续了10至25年。X线检查显示输尿管肾盂段（UPS）矫正有效。X线平面测量研究表明，28例患者（32个肾脏）的肾面积及其实质均匀增加了50%至100%。9例患者的实质增加了2.5至4倍，肾面积增加了50%至100%。3例患者肾脏生长24%至80%时，实质减少了3%至10%。这证明了肾硬化的进展。UPS矫正有利于肾脏的生长发育。只有少数情况下，UPS矫正虽为阳性，但肾硬化加重。肾脏的发育可能取决于许多因素，如术前肾脏状况、UPS梗阻的严重程度、患者年龄、肾盂肾炎的持续时间和严重程度、肾实质发育异常和与年龄相关的不成熟、机体免疫状态、微生物毒力等。但决定性因素是手术前肾实质的状况。3例进行性肾硬化患者的肾实质病变还表现为间质的晚期硬化和炎性浸润，最终预后不良。上述观察结果表明，有必要对患者进行长期术后随访，以制定有效的治疗和预防肾硬化的措施。
