Elder J S, Stansbrey R, Dahms B B, Selzman A A
Department of Urology, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
J Urol. 1995 Aug;154(2 Pt 2):719-22. doi: 10.1097/00005392-199508000-00102.
The treatment of children with apparent ureteropelvic junction obstruction is controversial. In an asymptomatic infant or child the decision to recommend pyeloplasty usually is based on interpretation of the renal scan. We retrospectively analyzed the renal biopsy obtained during pyeloplasty in 55 children. Histological changes were compared to the differential renal function revealed on the preoperative renal scan. Histological changes were graded on a scale of I to V; I--normal, II--mild dilatation of the collecting tubules or Bowman's space and III to V--progressively severe changes of obstructive uropathy, including reduced glomerular number, glomerular hyalinization, cortical cysts and interstitial inflammation. Patient age ranged from 4 days to 19 years (mean 4.8 years). Mean differential function according to histological grade was I--49%, II--43%, III--42%, IV--30% and V--25%. Of 33 patients with a differential function of 40% or greater 26 (79%) had a grade I or II biopsy, while 21% had a more significant alteration in renal histology. In contrast when the differential function was less than 40% 6 of 18 patients (33%) had grade I or II disease on biopsy. In conclusion, in approximately 25% of children with ureteropelvic junction obstruction there is a disparity between preoperative differential renal function computed during diuretic renography and renal biopsy.
对明显存在肾盂输尿管连接处梗阻的儿童进行治疗存在争议。对于无症状的婴儿或儿童，推荐进行肾盂成形术的决定通常基于对肾脏扫描结果的解读。我们回顾性分析了55例接受肾盂成形术患儿术中获取的肾活检组织。将组织学变化与术前肾脏扫描显示的分肾功能进行比较。组织学变化按I至V级分级；I级——正常，II级——集合小管或鲍曼间隙轻度扩张，III至V级——梗阻性肾病逐渐加重的变化，包括肾小球数量减少、肾小球玻璃样变、皮质囊肿和间质炎症。患者年龄从4天至19岁不等（平均4.8岁）。根据组织学分级，平均分肾功能分别为：I级——49%，II级——43%，III级——42%，IV级——30%，V级——25%。在33例分肾功能为40%或更高的患者中，26例（79%）肾活检为I级或II级，而21%的患者肾脏组织学有更明显改变。相比之下，当分肾功能低于40%时，18例患者中有6例（33%）肾活检为I级或II级疾病。总之，在大约25%的肾盂输尿管连接处梗阻患儿中，利尿肾图检查计算出的术前分肾功能与肾活检结果存在差异。
