Renal hypoplasia and postnatally acquired cortical loss in children with vesicoureteral reflux
Renal hypoplasia and postnatally acquired cortical loss in children with vesicoureteral reflux
复制标题
膀胱输尿管反流儿童的肾发育不全和出生后获得性皮质丢失
DOI：
--
复制
发表时间：
1992
期刊：
影响因子：
--
通讯作者：
D. Velzen
中科院分区：
文献类型：
--
作者：
S. Hinchliffe;Y. Chan;H. Jones;N. Chan;A. Kreczy;D. Velzen
我们从组织学上回顾了86例膀胱输尿管反流（伴或不伴输尿管膀胱梗阻）患者的肾切除术标本，以探讨共存的发育不全与出生后获得性皮质损伤之间的关系。利用髓质射线肾小球计数独立评估发育不全与获得性皮质损失。86例患者中有47例出现严重发育不全（肾小球数量<正常人的25%）。这些患者接受肾切除术的年龄明显低于轻度或无发育不全患者（P<0.01）。发育不全的严重程度与是否存在梗阻之间没有明显的关系。86例患者中有68例出现严重的后天性皮层丧失。皮质丧失的严重程度与是否存在梗阻、切除时的年龄或共存的发育不良程度之间没有显著的关联。研究结果提示发育不全与膀胱输尿管反流密切相关。因此，出生后早期出现肾功能极差不一定反映治疗失败，而是预先存在的肾功能限制。此外，在有尿路异常超声证据的相当大比例胎儿中，肾脏病理可能在考虑宫内手术干预之前就存在。
We reviewed histologically 86 nephrectomy specimens from patients with vesicoureteral reflux (with or without ureterovesical obstruction) to investigate the relationship between coexisting hypoplasia and postnatally acquired cortical damage. Hypoplasia was assessed independently of the acquired cortical loss using medullary ray glomerular counting. Severe hypoplasia (glomerular number <25% of normal) was detected in 47 of 86 patients. These patients underwent nephrectomy at a significantly younger age than those with minimal or no hypoplasia (P<0.01). There was no significant relationship between the severity of hypoplasia and the presence or absence of obstruction. Severe acquired cortical loss was found in 68 of 86 patients. There was no significant association between the severity of cortical loss and the presence or absence of obstruction, age at nephrectomy or degree of coexisting hypoplasia. The findings suggest a strong association of hypoplasia and vesicoureteral reflux. Therefore, early postnatal presentation with minimal renal function need not necessarily reflect a failure of management but rather a pre-existing limitation of renal capacity. Further-more, in a significant proportion of fetuses with ultrasonographic evidence of urinary tract abnormality, renal pathology may be present prior to the time at which in utero surgical intervention may be considered.