Institute of Nephro-urology, Victoria Hospital campus, Bangalore, Karnataka, India.
Urology. 2012 Feb;79(2):321-5. doi: 10.1016/j.urology.2011.10.018. Epub 2011 Dec 14.
To prospectively evaluate per operative renal biopsy as a predictor of outcome of pyeloplasty in cases of unilateral pelviureteric junction obstruction in adults.
We conducted a prospective study on 24 patients with unilateral UPJ obstruction undergoing pyeloplasty between November 2005 and August 2006 and followed them until December 2010. Intraoperative renal wedge biopsy was obtained in these patients and this was correlated with preoperative DRF on diuretic renogram. Outcome of pyeloplasty was assessed at 1 and 3 years by diuretic renograms and the renal biopsy as a predictive tool was compared with preoperative DRF.
Histology suggestive of obstructive damage to kidneys, such as significant glomerulosclerosis, widened Bowman's capsule, interstitial fibrosis, and tubular atrophy on renal biopsy was the highly significant predictor of poor outcome of pyeloplasty with a P value=.001 compared with preoperative DRF.
Renal biopsy is better predictor of outcome of pyeloplasty compared with preoperative DRF in UPJ obstruction. In the presence of severe obstructive changes in renal biopsy, recoverability of renal function despite achievement of successful drainage is significantly decreased.
前瞻性评估术中肾活检作为成人单侧肾盂输尿管连接部梗阻行肾盂成形术结果的预测指标。
我们对 2005 年 11 月至 2006 年 8 月期间行肾盂成形术的 24 例单侧 UPJ 梗阻患者进行了前瞻性研究，并随访至 2010 年 12 月。这些患者术中均行肾楔形活检，并与利尿肾图术前 DRF 相关联。术后 1 年和 3 年通过利尿肾图评估肾盂成形术的结果，将肾活检作为预测工具与术前 DRF 进行比较。
肾活检提示有明显的肾小球硬化、增宽的 Bowman 囊、间质纤维化和肾小管萎缩等梗阻性肾损伤，是肾盂成形术不良结局的高度显著预测指标，与术前 DRF 相比，P 值为.001。
与术前 DRF 相比，肾活检是 UPJ 梗阻行肾盂成形术结果的更好预测指标。在肾活检中存在严重的梗阻性改变的情况下，尽管实现了成功引流，但肾功能的恢复能力显著降低。
