Kumar Kaushal, Ahmad Ahsan, Kumar Shailendra, Choudhry Vijyanand, Tiwari Rajesh Kumar, Singh Mahendra, Muzaffar Mohammad Ali
Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna, India.
Department of Pathology, Indira Gandhi Institute of Medical Sciences, Patna, India.
Nephrourol Mon. 2015 Jul 29;7(4):e28051. doi: 10.5812/numonthly.28051. eCollection 2015 Jul.
Pyeloplasty is a widely accepted treatment for ureteropelvic junction obstruction (UPJO). However, the renal function recoverability after pyeloplasty is still a matter of debate. Different parameters have been used to predict renal functional recoverability after corrective surgery, with conflicting results.
In this study, renal biopsy was carried on a series of cases of UPJO, during pyeloplasty, to study the extent of histological alterations in renal parenchyma, as a result of obstruction, and its predictive value in renal function recoverability after pyeloplasty.
We retrospectively analyzed the renal biopsy obtained during pyeloplasty in 53 adult patients. Histopathological changes were graded on a scale of 1 to 3, according to their severity, and compared with the differential renal function (DRF) revealed on the preoperative and postoperative follow up diethylene triamine pentaacetic acid (DTPA) renal scan. A Fischer's t test was used to evaluate statistical differences between values.
This study showed a linear relationship between the severity of histological changes and renal function recovery, after pyeloplasty. Out of 24 obstructed renal units (ORU), with minimal histopathological changes (grade I), 21 ORU (87.5%), with > 35% DRF preoperatively, showed significant improvement in renal function after 12 months of pyeloplasty (P < 0.05). On the other hand, all kidneys (n = 29) with moderate to severe obstructive changes (grade II and III) had minimal improvement in DRF, after pyeloplasty, which was clinically insignificant (P > 0.05). Renal function deterioration after pyeloplasty was not observed in any of the cases.
The severity of pathological changes in renal parenchyma, due to UPJO, is a good predictor of renal function recoverability, after pyeloplasty. The ORUs, with DRF > 35%, usually have normal (grade I) renal biopsy and might be expected to present better functional recoverability after pyeloplasty.
肾盂成形术是治疗输尿管肾盂连接部梗阻（UPJO）广泛接受的方法。然而，肾盂成形术后肾功能的可恢复性仍是一个有争议的问题。不同参数已被用于预测矫正手术后肾功能的可恢复性，但结果相互矛盾。
在本研究中，对一系列UPJO病例在肾盂成形术期间进行肾活检，以研究梗阻导致的肾实质组织学改变程度及其对肾盂成形术后肾功能可恢复性的预测价值。
我们回顾性分析了53例成年患者在肾盂成形术期间获得的肾活检结果。根据组织病理学变化的严重程度分为1至3级，并与术前和术后随访二乙三胺五乙酸（DTPA）肾扫描显示的分肾功能（DRF）进行比较。采用Fischer t检验评估数值之间的统计学差异。
本研究显示肾盂成形术后组织学改变的严重程度与肾功能恢复之间存在线性关系。在24个梗阻性肾单位（ORU）中，组织病理学变化最小（I级），术前DRF>35%的21个ORU（87.5%）在肾盂成形术后12个月肾功能有显著改善（P<0.05）。另一方面，所有有中度至重度梗阻性改变（II级和III级）的肾脏（n=29）在肾盂成形术后DRF改善最小，临床上无显著意义（P>0.05）。所有病例均未观察到肾盂成形术后肾功能恶化。
由于UPJO导致的肾实质病理变化的严重程度是肾盂成形术后肾功能可恢复性的良好预测指标。DRF>35%的ORU通常肾活检正常（I级），可能预期在肾盂成形术后有更好的功能恢复。
