Gedroyc W M, Chaudhuri R, Saxton H M
Guy's Hospital, London.
Clin Radiol. 1988 Nov;39(6):615-9. doi: 10.1016/s0009-9260(88)80068-0.
Distorted, clubbed calices associated with focal renal scars or areas of more diffuse parenchymal loss make up the accepted urographic diagnostic criteria of chronic reflux nephropathy. It is widely believed that this diagnosis should not be suggested in the absence of the above findings and that scarring with normal calices indicates a vascular aetiology. This study describes five children with marked renal parenchymal loss all of whom have normal or near normal calices underlying the areas of parenchymal thinning and all of whom show severe vesico-ureteric reflux on micturating cystography. We suggest that these patients represent examples of true reflux nephropathy and that normal or near normal caliceal patterns may be seen underlying areas of renal parenchymal damage in this condition. No localised scars were seen in association with normal calices and we suggest that the marked tissue distortion caused by localised indented scars plays a significant part in producing the caliceal appearances more usually seen in reflux nephropathy. Other possible mechanisms responsible for the maintenance of relatively normal caliceal architecture are also discussed.
与局灶性肾瘢痕或更弥漫性实质丢失区域相关的变形、杵状肾盏构成了公认的慢性反流性肾病的尿路造影诊断标准。人们普遍认为，在没有上述表现时不应做出这一诊断，并且肾盏正常的瘢痕形成提示血管病因。本研究描述了5例有明显肾实质丢失的儿童，他们肾实质变薄区域下方的肾盏均正常或接近正常，且排尿性膀胱尿道造影均显示严重膀胱输尿管反流。我们认为这些患者代表了真正的反流性肾病病例，并且在这种情况下，肾实质损伤区域下方可能会见到正常或接近正常的肾盏形态。未发现与正常肾盏相关的局限性瘢痕，我们认为局限性凹陷瘢痕引起的明显组织变形在产生反流性肾病中更常见的肾盏表现方面起重要作用。还讨论了维持相对正常肾盏结构的其他可能机制。
