Han S W, Lee S E, Kim J H, Jeong H J, Rha K H, Choi S K
Department of Urology, Yonsei University College of Medicine, Seoul, Korea.
J Urol. 1998 Sep;160(3 Pt 2):984-8. doi: 10.1097/00005392-199809020-00004.
We studied histopathological changes in kidneys with demonstrable ureteropelvic junction obstruction in relation to patient age, differential renal function and urinary tract infection.
Renal biopsy was performed in 42 children (44 kidneys) with a mean age of 3 years 6 months who underwent open pyeloplasty due to ureteropelvic junction obstruction. Each specimen was examined for reversible inflammatory cell infiltration and irreversible change, including interstitial fibrosis, arteriolar thickening and glomerular sclerosis. Each pathological finding was scored 0 to 3 in increasing grades of severity, and correlated with patient age, differential renal function and history of urinary tract infection.
Of the 44 kidneys 20 (45%) had irreversible change. Correlation study revealed no association between patient age and histological findings, and there was no statistically significant difference in any histopathological category regardless of age. Differential renal function correlated with inflammatory cell infiltration and interstitial fibrosis. There were significantly worse histopathology scores in all categories when differential renal function was less than 30 versus 40% or greater. Interstitial fibrosis was significantly worse in the 30 to 40% group than in the greater than 40% group. The histopathological score of interstitial fibrosis was significantly higher in patients with than without urinary tract infection.
Early correction in infants with ureteropelvic junction obstruction may not be necessary when initial differential renal function is greater than 40%. However, any decrease in differential renal function or recurrent urinary tract infections despite antibiotic prophylaxis warrant surgical correction of obstruction.
我们研究了存在可证实的肾盂输尿管连接处梗阻的肾脏的组织病理学变化，及其与患者年龄、肾分肾功能和尿路感染的关系。
对42例儿童（44个肾脏）进行了肾活检，这些儿童平均年龄为3岁6个月，因肾盂输尿管连接处梗阻接受了开放性肾盂成形术。对每个标本进行检查，以确定是否存在可逆性炎性细胞浸润和不可逆性改变，包括间质纤维化、小动脉增厚和肾小球硬化。对每个病理结果按严重程度递增分为0至3级，并与患者年龄、肾分肾功能及尿路感染病史进行相关性分析。
44个肾脏中，20个（45%）存在不可逆性改变。相关性研究显示患者年龄与组织学结果之间无关联，且无论年龄大小，任何组织病理学类别均无统计学显著差异。肾分肾功能与炎性细胞浸润和间质纤维化相关。当肾分肾功能小于30% 与40% 或更高时，所有类别的组织病理学评分均显著更差。30% 至40% 组的间质纤维化明显比大于40% 组更严重。有尿路感染的患者间质纤维化的组织病理学评分显著高于无尿路感染的患者。
如果初始肾分肾功能大于40%，对于肾盂输尿管连接处梗阻的婴儿可能无需早期纠正。然而，尽管进行了抗生素预防，肾分肾功能出现任何下降或反复发生尿路感染，均需对梗阻进行手术纠正。
