Bishop M C, Moss S W, Oliver D O, Dunnill M S, Morris P J
Clin Nephrol. 1977 Aug;8(2):354-62.
Vesicoureteric reflux was found unexpectedly during routine investigations before renal transplantation in 12 patients with chronic glomerulonephritis and in one with hypertensive nephrosclerosis. They had all received long term hemodialysis treatment for nine to 106 months (mean 47 months) at the time of micturating cystourethrography (MCU). Four of the patients had previously had a normal MCU indicating that reflux developed after onset of end stage renal failure. The cause of reflux is obscure. It was not related directly to defunctioning of the urinary tract as several patients had daily urine volumes in excess of 300 ml. Infection, another potential cause, was uncommon in patients with reflux. Histology of the excised ureters showed abnormality in most cases with loss of the normal mucosal folds and submucosal cellular infiltrate and fibrosis. These changes are also unexplained. In this group of patients nephroureterectomy for reflux in anticipation of renal transplantation was associated with considerable morbidity. A minimal estimate of the incidence of reflux in chronic glomerulonephritis was 11%. We suggest that in this group and in patients with renal diseases other than chronic pyelonephritis reflux alone does not constitute sufficient indication for nephroureterectomy before transplantation to warrant the risks of major surgery.
在12例慢性肾小球肾炎患者和1例高血压性肾硬化患者进行肾移植前的常规检查中，意外发现膀胱输尿管反流。在进行排尿性膀胱尿道造影（MCU）时，他们均已接受了9至106个月（平均47个月）的长期血液透析治疗。其中4例患者此前MCU检查正常，表明反流是在终末期肾衰竭发病后出现的。反流的原因尚不清楚。由于部分患者每日尿量超过300 ml，所以反流与尿路功能障碍并无直接关联。感染作为另一个潜在原因，在反流患者中并不常见。切除输尿管的组织学检查显示，大多数病例存在异常，表现为正常黏膜皱襞消失、黏膜下细胞浸润和纤维化。这些变化也无法解释。在这组患者中，为准备肾移植而因反流进行肾输尿管切除术会带来相当高的发病率。慢性肾小球肾炎中反流的最低发病率估计为11%。我们认为，在这组患者以及除慢性肾盂肾炎以外的其他肾病患者中，单纯反流并不足以构成移植前进行肾输尿管切除术的充分指征，不值得冒大手术的风险。
