Zakoji Hidenori, Miyamoto Tatsuya, Kamiyama Manabu, Inuzuka Hideyasu, Tsuchida Takayuki, Araki Isao, Takeda Masayuki
Department of Urology, Faculty of Medicine, University of Yamanashi.
Nihon Hinyokika Gakkai Zasshi. 2010 Jan;101(1):29-33. doi: 10.5980/jpnjurol.101.29.
We report on 2 infants with acute renal failure caused by bilateral obstructive ureteral stones associated with rotavirus gastroenteritis. A 28-month boy and a 13-month boy with several days history of watery diarrhea and vomiting were referred to our hospital because of anuria. They were diagnosed acute post-renal failure due to obstructive bilateral ureteral stones based on the findings of ultrasound scan and computed tomography. Immediately, percutaneous nephrostomy tubes were inserted for urinary drainage, serum levels of creatinine and uric acid returned to normal within several days. Sandy stones were excreted through the nephrostomy tubes with urine after urinary alkalization, which were proved to be mainly ammonium acid urate. Ammonium acid urate is rare in developed countries, but some cases of bilateral urolithiasis causing acute renal failure in infants with rotavirus gastroenteritis were reported in recent years. It has been known that the cause of acute renal failure is renal azotemia resulting from sustained hypovolemia, but post-renal causes due to ammonium acid urate stones should be taken into consideration.
我们报告了2例因双侧输尿管梗阻性结石合并轮状病毒胃肠炎导致急性肾衰竭的婴儿病例。一名28个月大的男孩和一名13个月大的男孩，有几天的水样腹泻和呕吐病史，因无尿被转诊至我院。根据超声扫描和计算机断层扫描结果，他们被诊断为双侧输尿管梗阻性结石导致的急性肾后性肾衰竭。立即进行了经皮肾造瘘管置入以引流尿液，血清肌酐和尿酸水平在数天内恢复正常。尿液碱化后，沙样结石随尿液通过肾造瘘管排出，经证实主要为尿酸铵。尿酸铵在发达国家较为罕见，但近年来有报道称，一些轮状病毒胃肠炎婴儿因双侧尿路结石导致急性肾衰竭。已知急性肾衰竭的病因是持续低血容量导致的肾性氮质血症，但也应考虑尿酸铵结石导致的肾后性病因。
