ABSTRACT
To determine the renal arterial hemodynamic changes induced by obstructive uropathy using Doppler ultrasonography.
60 adult subjects with suspected obstructive uropathy and 60 asymptomatic apparently healthy controls with normal renal ultrasound features were evaluated.
B-mode sonography of the kidneys and spectral Doppler examination of the renal interlobar arteries of all the participants were performed. The mean resistive indices (mRI) of both interlobar arteries were obtained and compared to that of the controls. The mRI of bilaterally obstructed kidneys were also compared with the mRI of unilaterally obstructed kidneys.
The mRI of the right and left kidneys of subjects were 0.72±0.04 and 0.69±0.06 while those of the controls were 0.64±0.04 and 0.63±0.03 respectively. The mRI for the grades of caliectasis increased from grade I (0.72±0.03) to grade II (0.73±0.03) and grade III (0.73±0.02) but fell within the most severe levels of obstruction (0.69±0.07). There was no statistically significant relationship between the grades of caliectasis and unilateral or bilateral obstruction for both kidneys. The results show a sensitivity and specificity of 86.7% and 90% respectively when mRI≥0.7 was used to determine presence of obstruction.
Renal duplex sonography is highly sensitive and specific for diagnosis of obstructive uropathy. Increased resistive index of the obstructed kidney may be a useful diagnostic tool in situations where intravenous urography cannot be done or is contraindicated.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Hemodynamics/physiology , Kidney Calices , Renal Artery , Ureteral Obstruction , Dilatation, Pathologic , Epidemiologic Methods , Kidney Calices/pathology , Kidney/blood supply , Nigeria , Reproducibility of Results , Renal Artery/pathology , Renal Artery/physiopathology , Ultrasonography, Doppler/methods , Ureteral Obstruction/physiopathologyABSTRACT
Congenital obstructive nephropathy is the primary cause of end-stage renal disease in children. Rapid diagnosis and initiation of the treatment are vital to preserve function and/or to slow down renal injury. Obstructive uropathy effects -decline in the plasmatic renal flow and glomerular filtration rate, interstitial infiltrate of leukocytes, significant decrease of the urine concentration, loss of the capacity to concentrate urine as well as fibrosis and apoptosis- are a consequence of a variety of factors that work in complex ways and are still not fully understood. Mediators as angiotensin II, transforming growth factor-beta(TGF-beta) and nitric oxide (NO) have been implicated in congenital obstructive nephropathy. The renin-angiotensin system is regulated in different ways, affecting both renal structure and function, and that it in turn depends upon the duration of the obstruction. On the other hand, the role of nitric oxide in renal injury remains somewhat controversial due to the fact that it can exert opposite effects such as cytoprotective and prooxidant / proapoptotic efects as well as proinflammatory and anti-inflammatory effects. In addition, reactive oxidative species (ROS) might contribute to the progression of renal disease. During unilateral ureteral obstruction induced uncoordinated and aberrant growth may lead to the loss of cellular phenotype and apoptosis. Promoting inflammatory responses, the oxidizers can regulate the adherence of certain molecules and proinflammatory mediators, transcription factors and fibrogenic cytokines, that are clearly involved in the progression of renal disease. The congenital obstructive nephropathy is characterized by tubular atrophy, cellular proliferation, apoptosis and fibrosis; immature kidney is more susceptible than adult kidney to showing the above mentioned alterations.
Subject(s)
Humans , Animals , Child , Adult , Angiotensin II/metabolism , Angiotensin II/urine , Kidney Failure, Chronic/metabolism , Kidney Failure, Chronic/pathology , Intercellular Adhesion Molecule-1/metabolism , Intercellular Adhesion Molecule-1/urine , Nitric Oxide/metabolism , Nitric Oxide/urine , Apoptosis Regulatory Proteins/metabolism , Apoptosis Regulatory Proteins/urine , Apoptosis , Reactive Oxygen Species/metabolism , Reactive Oxygen Species/urine , Biomarkers/metabolism , Oxidative Stress , Ureteral Obstruction/physiopathology , Ureteral Obstruction/metabolism , Ureteral Obstruction/urineABSTRACT
We present the results obtained with a ureterovesical implant after ipsilateral ureteral obstruction in the rat, suitable for the study of renal function after deobstruction in these animals. Thirty-seven male Wistar rats weighing 260 to 300 g were submitted to distal right ureteral ligation and divided into 3 groups, A (N = 13, 1 week of obstruction), B (N = 14,2 weeks of obstruction) and C (N = 10, 3 weeks of obstruction). The animals were then submitted to ureterovesical implantation on the right side and nephrectomy on the left side. During the 4-week follow-up period serum levels of urea and creatinine were measured on the 2nd, 7 th, 14th, 21st and 28th day and compared with preoperative levels. The ureterovesical implantation included a psoas hitch procedure and the ureter was pulled into the bladder using a transvesical suture. During the first week of the postoperative period 8 animals died, 4/13 in group A (1 week of obstruction) and 4/14 in group B (2 weeks of obstruction). When compared to preoperative serum levels, urea and creatinine showed a significant increase (P<0.05) on the 2nd postoperative day in groups A and B, with a gradual return to lower levels. However, the values in group B animals were higher than those in group A at the end of the follow-up. In group C,2/10 animals (after 3 weeks of obstruction) were sacrificed at the time of ureterovesical implantation due to infection of the obstructed kidneys. The remaining animals in this group were operated upon but all of them died during the first week of follow-up due to renal failure. This technique of ureterovesical implantation in the rat provides effective drainage of the upper urinary tract, permitting the development of an experimental model for the study of long-term renal function after period of ureteral obstruction.
Subject(s)
Rats , Animals , Male , Disease Models, Animal , Kidney Function Tests/methods , Ureteral Obstruction/physiopathology , Urologic Diseases/physiopathology , Rats, WistarABSTRACT
Se revisaron 2184 expedientes de losw ingresos al servicio de urología y nefrología del Hospital General de México SS durante 1988 y se encontraron historias clínicas de 58 pacientes (2.65 porciento) con diagnóstico de obstrucción ureteropiélioca. Fueron 14 individuos (24 porciento) con afección de vasos aberrantes, a todos ellos se les solicitaron exámenes de laboratorio y gabinete, así como prueba de Whitaker. Según el tipo de vaso aberrante, arterial o venoso, y del lugar de urgencia se efectuó el tratamiento quirúrgico pertinente. El tratamiento postoperatorio se hizo con antimicrobianos y el promedio de días de hospitalización fue de seis. Los pacientes fueron citados a consulta externa; transcurridos tres meses se repitieron los exámenes de laboratorio, la urografía excretora y se practicó la prueba de Whitaker.
Subject(s)
Humans , Male , Female , Adult , Congenital Abnormalities/diagnosis , Epidemiology , Ureteral Obstruction/physiopathology , Urethral Obstruction/physiopathology , Blood Vessels/abnormalities , Urinary DiversionABSTRACT
Os autores analisam cinco casos de síndrome da veia ovariana direita, quanto à etiopatogenia, diagnóstico e tratamento. O tratamento cirúrgico desses pacientes consistiu na ligadura do plexo venoso ovariano e ureterólise. Em um dos casos foi necessário uma segunda intervençäo cirúrgica com resultado satisfatório