Pascual L, Oliva J, Vega-P J, Príncipi I, Vallés P
Urology (Pathology Department), Hospital de Niños H. J. Notti, Mendoza, Argentina.
J Urol. 1998 Sep;160(3 Pt 2):976-9; discussion 994.
There are few reports of pathological kidney findings in ureteropelvic junction obstruction in pediatric patients. The role of hyperfiltration in the genesis and progression of these changes has been a matter of debate. We determine whether segmental sclerosis is evidence of hyperfiltration and renal damage in children who underwent surgery for ureteropelvic junction obstruction.
We retrospectively analyzed the clinical records of 38 children with a mean age of 4.4 years with ureteropelvic junction obstruction. Histological changes in biopsies (39 renal units) and nephrectomy specimens (2 renal units) were compared with clinical history, imaging studies and urinary protein excretion.
Renal histology was essentially normal in 75% of the biopsies. Focal dilatation of Bowman's space and occasionally of the collecting tubules was noted in a third of this group. Abnormal changes consistent with renal damage were present in 25% of the biopsies, including variable degrees of interstitial chronic inflammation, eosinophilic acellular material within Bowman's space and focal concentric glomerulosclerosis. Severe changes, chronic interstitial fibrosis and inflammation, and diffuse glomerulosclerosis were only found in nephrectomy specimens, while eosinophilic acellular material and glomerulosclerosis were observed in 7 biopsies. In all of these renal units there was evidence of hyperfiltration with bilateral or unilateral ureteropelvic junction obstruction with a contralateral multicystic dysplastic kidney. Urinary protein excretion in 19 patients was increased in obstructed compared with normal contralateral kidneys (p < 0.05).
Hyperfiltration should be considered a mechanism involved in the progression of histological changes in kidneys with ureteropelvic junction obstruction. We suggest that early surgical correction be considered in obstructed kidneys at risk for hyperfiltration.
关于小儿患者输尿管肾盂连接部梗阻的肾脏病理表现的报道较少。超滤在这些改变的发生和进展中的作用一直存在争议。我们确定节段性硬化是否是接受输尿管肾盂连接部梗阻手术的儿童超滤和肾损伤的证据。
我们回顾性分析了38例平均年龄4.4岁的输尿管肾盂连接部梗阻患儿的临床记录。将活检标本（39个肾单位）和肾切除标本（2个肾单位）的组织学变化与临床病史、影像学检查及尿蛋白排泄情况进行比较。
75%的活检标本肾脏组织学基本正常。在这组标本的三分之一中发现了鲍曼间隙局灶性扩张，偶尔集合小管也有扩张。25%的活检标本存在与肾损伤一致的异常变化，包括不同程度的间质慢性炎症、鲍曼间隙内的嗜酸性无细胞物质和局灶性同心性肾小球硬化。严重变化、慢性间质纤维化和炎症以及弥漫性肾小球硬化仅在肾切除标本中发现，而在7例活检标本中观察到嗜酸性无细胞物质和肾小球硬化。在所有这些肾单位中，均有双侧或单侧输尿管肾盂连接部梗阻伴对侧多囊性发育不良肾导致超滤的证据。19例患者梗阻侧肾脏的尿蛋白排泄量较对侧正常肾脏增加（p<0.05）。
超滤应被视为输尿管肾盂连接部梗阻肾脏组织学变化进展的一种机制。我们建议对有超滤风险的梗阻性肾脏考虑早期手术矫正。
