RESUMO
Forty-seven patients with unilateral obstructive calculi (12 males and 35 females) were submitted to 99mTc-diethylene triamine pentaacetic acid (DTPA) or 99mTc-dimercaptosuccinic acid (DMSA) scans for assessment of renal function. The scans revealed unilateral functional deficit in 68 and 66 per cent of the patients, respectively. A calculus size of 1.1 to 2.0 cm was significantly associated with deficit detected by DTPA, but duration of obstruction and calculus localization were not. After relief of the obstruction, the mean percent renal function of the affected kidney was found to be significantly increased from 25 + or - 12 per cent to 29 + or - 12 per cent in DTPA and from 21 + or - 15 per cent to 24 + or - 12 per cent in DMSA. Initial Doppler ultrasonography performed in 35 patients detected an increased resistive index in 10 (29 per cent). In the remaining patients with a normal resistive index, ureteral urinary jet was observed, indicating partial obstruction. The high frequency of renal function impairment detected by DTPA and of tubulointerstitial damage detected by DMSA as well as the slight amelioration of unilateral renal function after relief of obstruction suggest that scintigraphy assessment may help evaluate the unilateral percentage of renal function and monitor renal function recovery when it occurs. The presence of a urinary jet detected by Doppler ultrasonography further indicates the severity of obstruction and the recovery prognosis.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Obstrução Ureteral/diagnóstico , Cálculos Urinários/diagnóstico , Rim/fisiopatologia , Compostos Radiofarmacêuticos , Ácido Dimercaptossuccínico Tecnécio Tc 99m , Pentetato de Tecnécio Tc 99m , Ultrassonografia Doppler/métodos , Obstrução Ureteral , Obstrução Ureteral , Cálculos Urinários , Cálculos UrináriosRESUMO
Pacientes com história de hematúria devem ser submetidos a detalhado protocolo de investigaçäo para a obtençäo de um diagnóstico preciso. Assim, relatamos um caso de hematúria macroscópica e a seqüência de exames complementares que nos levaram ao diagnóstico desta patologia rara. Em uma breve revisäo de literatura, salientamos: classificaçäo (etiológica ou morfológica), diagnóstico, indicaçöes cirúrgicas e o tratamento (embolizaçäo ou cirúrgico). O diagnóstico de certeza é obtido através de arteriografia renal digital, após avaliaçäo morfológica do trato urinário (UGE e US renal) normal e a constataçäo de sangramento unilateral (cistoscopia)