Flechner S M, Gow J G
J Urol. 1980 Jun;123(6):822-5. doi: 10.1016/s0022-5347(17)56149-2.
We reviewed 300 consecutive cases of genitourinary tuberculosis at Wrightington Hospital from 1961 to 1978. There were 73 patients with non-functioning or poorly functioning kidneys who underwent nephrectomy after at least 6 weeks of intensive chemotherapy with 3 antituberculous drugs. Three of 4 patients with unilateral non-functioning kidneys who did not have a primary nephrectomy had delayed complications. Late complications of in situ non-functioning tuberculous kidneys included draining flank sinuses, abscesses and hypertension. These complications can occur years after completion of chemotherapy, even in sterile organs. The incidence of hypertension in this series was 11.3 per cent. The incidence of hypertension in patients with unilateral non-functioning or poorly functioning tuberculous kidneys was 23.2 per cent (p less than 0.005). Two-thirds of the hypertensive patients with severe unilateral tuberculous nephropathy benefited by a decrease in blood pressure after nephrectomy. Removal of these kidneys does not cause a significant loss of renal function. The perioperative morbidity and mortality of the procedure should be minimal in a generally younger population. It is concluded that primary nephrectomy is an important adjunct in the comprehensive management of the unilateral non-functioning kidney.
我们回顾了1961年至1978年间在赖廷顿医院连续收治的300例泌尿生殖系统结核病例。其中73例肾功能丧失或功能不佳的患者，在接受了至少6周的三种抗结核药物强化化疗后接受了肾切除术。4例未进行一期肾切除术的单侧肾功能丧失患者中有3例出现了延迟并发症。原位无功能结核肾的晚期并发症包括侧腹引流窦、脓肿和高血压。这些并发症可在化疗结束数年之后发生，甚至在无菌器官中也会出现。本系列病例中高血压的发生率为11.3%。单侧无功能或功能不佳结核肾患者中高血压的发生率为23.2%（p<0.005）。三分之二患有严重单侧结核性肾病的高血压患者在肾切除术后血压下降，病情得到改善。切除这些肾脏不会导致肾功能的显著丧失。在总体较为年轻的人群中，该手术的围手术期发病率和死亡率应降至最低。结论是，一期肾切除术是单侧无功能肾综合治疗中的一项重要辅助措施。
