Capelouto C C, Saltzman B
Division of Urology, Brigham and Women's Hospital, Boston, MA.
J Endourol. 1993 Apr;7(2):93-103. doi: 10.1089/end.1993.7.93.
Ureteral obstruction can have a variety of causes intrinsic or extrinsic to the kidney. The effects of obstruction are examined from the perspectives of duration, severity, totality, and the presence of complicating factors. There is a difference in the postobstructive pathophysiology depending on whether one or both ureters were obstructed. Atrial natriuretic peptide may be important in postobstructive diuresis, and preliminary evidence suggests a role for it as protection against nephron ischemia in acute obstruction. The potential for recovery of renal function after relief of obstruction depends on the duration and degree of obstruction, the condition of the contralateral kidney, and the presence or absence of infection. Ability to acidify the urine to pH < 6.0 preoperatively may be a good predictor of the recovery potential of an obstructed kidney. Urine concentrations of lysosomal enzymes such as N-acetylglucosaminidase also may be useful for this purpose, as may measurement of creatinine clearance in urine obtained from a nephrostomy tube.
输尿管梗阻可由肾脏内部或外部的多种原因引起。从梗阻的持续时间、严重程度、完全性以及是否存在复杂因素等角度来研究梗阻的影响。根据单侧或双侧输尿管是否梗阻，梗阻后病理生理学存在差异。心房利钠肽在梗阻后利尿中可能起重要作用，初步证据表明其在急性梗阻中对防止肾单位缺血具有保护作用。梗阻解除后肾功能恢复的可能性取决于梗阻的持续时间和程度、对侧肾脏的状况以及是否存在感染。术前将尿液酸化至pH < 6.0的能力可能是梗阻肾脏恢复潜力的良好预测指标。尿液中溶酶体酶如N - 乙酰葡糖胺酶的浓度也可用于此目的，从肾造瘘管获取的尿液中肌酐清除率的测量也可能有用。
