Newhouse J H, Amis E S
Department of Radiology, Columbia-Presbyterian Medical Center, New York, NY 10032.
AJR Am J Roentgenol. 1988 Dec;151(6):1153-6. doi: 10.2214/ajr.151.6.1153.
The urographic findings of focal clubbing of the renal calices and associated parenchymal scarring usually prompt a diagnosis of chronic pyelonephritis, which is frequently thought to be due to ongoing or previous vesicoureteral reflux. However, we noticed that upper tract stone disease appeared to be the condition that most often preceded or accompanied caliceal clubbing and parenchymal scarring in adults. To test the hypothesis that stones were the most common cause of this renal abnormality, we analyzed the IV urograms in 1500 consecutive patients for evidence of upper tract stone disease, vesicoureteral reflux, and caliceal clubbing and scarring. Of 39 patients with clubbing and scarring, 67% had stone disease, but only 8% had a history of reflux. Of 90 patients with stone disease, 29% had clubbing and scarring. We conclude that, in adults, upper tract stone disease may be the most important etiologic factor in the production of renal caliceal clubbing and scarring.
肾盂肾盏局灶性杵状变及相关实质瘢痕形成的尿路造影表现通常提示慢性肾盂肾炎的诊断，该病常被认为是由于持续性或既往存在的膀胱输尿管反流所致。然而，我们注意到上尿路结石病似乎是成人中最常先于或伴随肾盂肾盏杵状变及实质瘢痕形成的疾病。为了验证结石是这种肾脏异常最常见病因的假设，我们分析了1500例连续患者的静脉尿路造影，以寻找上尿路结石病、膀胱输尿管反流以及肾盂肾盏杵状变和瘢痕形成的证据。在39例有杵状变和瘢痕形成的患者中，67%患有结石病，但只有8%有反流病史。在90例有结石病的患者中，29%有杵状变和瘢痕形成。我们得出结论，在成人中，上尿路结石病可能是导致肾盂肾盏杵状变和瘢痕形成的最重要病因。
