Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Acta Paediatr. 2019 Jan;108(1):50-57. doi: 10.1111/apa.14482. Epub 2018 Jul 24.
Congenital ureteral obstruction is a fairly common condition in infants, and its clinical management has been long debated during the last decade. The long-term physiological consequences of today's conservative non-surgical management in many asymptomatic hydronephrotic children are unclear.
Experimental studies in rats and mice, retrospective studies in children and adults, as well as prospective studies in children are included in this mini review.
Experimental models of hydronephrosis in rats and mice have demonstrated that partial ureteropelvic junction obstruction (UPJO) is casually linked with development of hypertension and renal injuries in later life. The mechanisms are multifactorial and involve increased activity of the renin-angiotensin-aldosterone system and renal sympathetic nerve activity. Furthermore, oxidative stress and nitric oxide deficiency in the affected kidney appear to play important roles in the development and maintenance of hypertension. Clinical case reports in adults and recent prospective studies in children have associated hydronephrosis with elevated blood pressure, which could be reduced by surgical management of the obstruction.
Based on current experimental and clinical knowledge regarding the link between partial UPJO and changes in blood pressure, it is proposed that today's non-operative management of hydronephrosis should be reconsidered to reduce the risk of developing elevated blood pressure or hypertension in later life.
先天性输尿管梗阻在婴儿中较为常见，其临床管理在过去十年中一直存在争议。目前，对于许多无症状肾积水患儿采用保守的非手术治疗，其长期的生理后果尚不清楚。
本综述纳入了大鼠和小鼠的实验研究、儿童和成人的回顾性研究以及儿童的前瞻性研究。
大鼠和小鼠的肾积水实验模型表明，部分肾盂输尿管连接部梗阻（UPJO）与成年后高血压和肾脏损伤的发生具有相关性。其机制是多因素的，涉及肾素-血管紧张素-醛固酮系统和肾交感神经活性增加。此外，受影响肾脏中的氧化应激和一氧化氮缺乏似乎在高血压的发生和维持中发挥重要作用。成人的临床病例报告和最近的儿童前瞻性研究表明，肾积水与血压升高有关，梗阻的手术治疗可降低血压。
基于目前关于部分 UPJO 与血压变化之间关联的实验和临床知识，建议重新考虑目前对肾积水的非手术治疗，以降低成年后患高血压或高血压的风险。
