Boubaker Ariane, Meyrat Blaise, Frey Peter, Bischof Delaloye Angelika
Department of Nuclear Medicine, University Hospital, Lausanne, Switzerland.
Urology. 2003 Jun;61(6):1224-8; discussion 1228-9. doi: 10.1016/s0090-4295(03)00233-4.
To evaluate the renal function outcome in children with unilateral hydronephrosis and urinary flow impairment at the pelviureteral junction with respect to the therapeutic strategy.
We retrospectively selected 45 children with iodine-123-hippuran renography performed at diagnosis and after 3 or more years of follow-up. All children had bilateral nonobstructive pattern findings on diuretic renography at follow-up. Eleven children were treated conservatively, and 34 underwent unilateral pyeloplasty. Split and individual renal function, measured by an accumulation index, was computed from background-corrected renograms for the affected and contralateral kidneys at diagnosis and the follow-up examination.
Of 11 children treated conservatively, 9 had normal bilateral function at diagnosis, all had reached normal function at follow-up. Of the 34 operated kidneys, 12 (38%) had initially normal function that remained normal at the follow-up examination, and 22 had impaired function that had normalized at the follow-up examination in 15 (68%). The function of the contralateral kidneys was increased in 5 of 8 children with persistently abnormal affected kidneys. Pyeloplasty was performed in 23 children (68%) and 11 children (32%) younger and older than 1 year, respectively. The function of the affected kidneys increased in both groups, but normalization occurred only in the younger children.
Of the children selected for conservative treatment, 82% had normal bilateral renal function at diagnosis that was normal in all at the follow-up examination. Of the children treated surgically, 65% had initially impaired function of the affected kidney that improved in 87% after pyeloplasty. Normalization of function was observed only in children who were younger than 1 year old at surgery. Persistently low function of the affected kidney was compensated for by the contralateral one regardless of the age at surgery.
评估单侧肾盂积水且肾盂输尿管连接处存在尿流障碍的儿童，其肾功能转归与治疗策略的关系。
我们回顾性选取了45例儿童，这些儿童在诊断时及随访3年或更长时间后接受了碘-123-马尿酸肾图检查。所有儿童在随访时利尿肾图检查均显示双侧无梗阻表现。11例儿童接受保守治疗，34例接受了单侧肾盂成形术。通过累积指数测量的分肾功能和单个肾功能，是根据诊断时及随访检查时患侧和对侧肾脏经背景校正的肾图计算得出的。
11例接受保守治疗的儿童中，9例诊断时双侧功能正常，随访时均达到正常功能。34例接受手术的肾脏中，12例（38%）最初功能正常，随访检查时仍保持正常，22例功能受损，其中15例（68%）在随访检查时功能恢复正常。8例患侧肾脏持续异常的儿童中，5例对侧肾脏功能增强。接受肾盂成形术的儿童中，23例（68%）年龄小于1岁，11例（32%）年龄大于1岁。两组患侧肾脏功能均增强，但仅年龄较小的儿童功能恢复正常。
在选择保守治疗的儿童中，82%诊断时双侧肾功能正常，随访检查时全部正常。在接受手术治疗的儿童中，65%患侧肾脏最初功能受损，肾盂成形术后87%功能改善。仅手术时年龄小于1岁的儿童功能恢复正常。无论手术时年龄如何，患侧肾脏功能持续低下均由对侧肾脏代偿。
