Josephson S, Larsson E
Department of Paediatric Surgery, St. Göran's Children's Hospital, Karolinska Institute, Stockholm, Sweden.
Urol Int. 1996;57(3):135-40. doi: 10.1159/000282898.
In unilateral kidney disease, it has been suggested that the ipsilateral state could be estimated by measuring contralateral kidney size; thus, a contralateral increase should reflect an ipsilateral impairment and vice versa. This could easily be performed using ultrasound. In our experiments with partial obstruction of one ureter (created in 1- to 3-day-old rats), a consistent and stable contralateral kidney hypertrophy occurred. However, after unobstruction, the hypertrophy persisted for at least a 6-week observation period, despite the disappearance of hydronephrosis and presence of a normal weight of the ipsilateral kidney. This would undeniably hamper the diagnostic utility of kidney size determination. To find out whether or not the hypertrophy ever disappears, we have performed studies after 6, 9 and 15 weeks. (1) The weight of the unobstructed kidney was found normal except after 15 weeks. The microstructure was normal except for some minor changes. (2) The contralateral kidney was significantly heavier than controls at all checkpoints (+10, +13 and +6%). No significant regression occurred over the observation period. (3) Furthermore, the weights of both kidneys were interrelated, but the slopes were positive; thus, the contralateral hypertrophy was not greater the lesser the ipsilateral kidney weight. The reasons for the persistence of contralateral hypertrophy are discussed. The present findings do not support the idea of documenting improvement by measuring contralateral kidney size. However, repeat studies in the same individual may prove to be more sensitive and are therefore recommended until further notice.
在单侧肾病中,有人提出可以通过测量对侧肾脏大小来评估同侧肾脏的状况;因此,对侧肾脏增大应反映同侧肾脏受损,反之亦然。这可以很容易地通过超声检查来实现。在我们对1至3日龄大鼠进行的单侧输尿管部分梗阻实验中,对侧肾脏出现了持续且稳定的肥大。然而,梗阻解除后,尽管肾积水消失且同侧肾脏重量正常,但肥大在至少6周的观察期内仍然持续。这无疑会妨碍通过测量肾脏大小来进行诊断的实用性。为了弄清楚这种肥大是否会消失,我们在6周、9周和15周后进行了研究。(1)除了15周后,未梗阻侧肾脏的重量均正常。微观结构除了有一些细微变化外也正常。(2)在所有检查点,对侧肾脏均明显比对照组重(分别增加10%、13%和6%)。在观察期内没有出现明显的恢复。(3)此外,两侧肾脏的重量相互关联,但斜率为正;因此,同侧肾脏重量越小,对侧肾脏的肥大并不越明显。本文讨论了对侧肾脏肥大持续存在的原因。目前的研究结果不支持通过测量对侧肾脏大小来记录病情改善情况的观点。然而,在同一个体中进行重复研究可能会更敏感,因此在进一步通知之前建议进行重复研究。