College of Medicine, Mayo Clinic, Rochester, MN, USA.
Ren Fail. 2010;32(10):1226-9. doi: 10.3109/0886022X.2010.517343.
The syndrome of non-dilated obstructive uropathy (NDOU) and acute renal failure (ARF) is well reported. However, the literature suggests that this syndrome is rare, accounting for less than 5% of cases of urinary obstruction. Our recent experience with three cases of NDOU seen within a space of months implies otherwise. Between March 2009 and October 2009, in a small Midwestern American town Nephrology practice, we successfully managed three cases of NDOU. They all presented with newly symptomatic ARF. Renal imaging revealed no dilatation in both kidneys in one, only unilateral dilatation in the second, and dilatation was absent in a single functioning kidney in the third. They comprised of two males and one female, mean age 61 years (peak creatinine: 320-880 μmol/L). Despite the absence of dilatation on renal imaging, strong suspicion for NDOU led to decompression procedures with prompt recovery of kidney function in all three patients - two required percutaneous nephrostomy tube placements and/or ureteric stents and one responded to simple Foley catheter drainage. One required temporary hemodialysis. We submit that NDOU may be more common than previously speculated. A high index of suspicion is warranted as significant renal salvage can often be achieved by timely decompression procedures.
非扩张性梗阻性尿路病（NDOU）和急性肾衰竭（ARF）的综合征已有相关报道。然而，文献表明，这种综合征较为罕见，不到尿路梗阻病例的 5%。我们最近在几个月内遇到了三例 NDOU，这表明事实并非如此。在 2009 年 3 月至 2009 年 10 月期间，在美国中西部的一个小镇的肾病实践中，我们成功地治疗了三例 NDOU。他们均表现为新发症状性 ARF。肾脏影像学检查显示一例肾脏无扩张，第二例仅单侧扩张，第三例单侧功能正常的肾脏无扩张。他们包括两例男性和一例女性，平均年龄 61 岁（峰值肌酐：320-880 μmol/L）。尽管肾脏影像学检查无扩张，但强烈怀疑存在 NDOU，导致对所有三名患者进行了减压治疗，肾功能迅速恢复——两名患者需要经皮肾造瘘管放置和/或输尿管支架，一名患者对单纯 Foley 导管引流有反应。一名患者需要临时血液透析。我们认为，NDOU 可能比以前推测的更为常见。由于及时减压治疗通常可以实现显著的肾脏挽救，因此需要高度怀疑。
