Reflux nephropathy in children submitted to unilateral nephrectomy: a clinicopathological study.
Reflux nephropathy in children submitted to unilateral nephrectomy: a clinicopathological study.
复制标题
接受单侧肾切除术的儿童反流性肾病：一项临床病理学研究。
作者：
R. Risdon;C. Yeung;P. Ransley
本文回顾了接受单侧肾切除术的儿童原发性膀胱输尿管反流（VUR）的临床表现和肾脏组织病理学。42名儿童回顾，部分肾切除标本可在36。在该系列中，34例患者为男性，8例为女性。这些男孩中有7个是通过胎儿超声检查发现肾积水的。男性患者往往出现较早，肾切除术比女性年轻。节段性瘢痕在男性和女性中均常见，但肾发育不良的证据仅限于男性患者，并且发生在大多数患者中（63%）。诱导节段性肾瘢痕形成的获得性机制，包括VUR、肾内反流（IRR）和尿路感染，在年龄较大的儿童中表现出重要性，在婴儿期明显起作用。然而，这项研究强调，先天性肾脏畸形是在这个年轻的年龄组，特别是在男性反流性肾病（RN）的发展的一个关键因素。推测肾发育不良和RN之间的关联的意义进行了讨论，在有关男性下尿路的胚胎发育的观察。
The clinical findings and renal histopathology have been reviewed in children with gross primary vesicoureteric reflux (VUR) submitted to unilateral nephrectomy. Of the 42 children reviewed, sections of the nephrectomy specimens were available in 36. In this series, 34 patients were male and eight were female. The boys included seven in which hydronephrosis was identified by fetal ultrasound. The male patients tended to present earlier and had nephrectomies younger than the females. Segmental scarring was frequent in both males and females, but evidence of dysplastic renal development was confined to the male patients and occurred in the majority (63%). Acquired mechanisms for the induction of segmental renal scarring, involving VUR, intrarenal reflux (IRR) and urinary infection, shown to be important in older children, clearly operate in infancy. However, this study emphasizes that congenital malformation of the kidney is a crucial factor in the development of reflux nephropathy (RN) in this younger age group, particularly in males. Speculation on the significance of the association between renal dysplasia and RN is discussed in relation to observations on the embryological development of the male lower urinary tract.