Ureteral obstruction as a complication of renal transplantation: a review.
Ureteral obstruction as a complication of renal transplantation: a review.
复制标题
DOI：
--
复制
发表时间：
1998
影响因子：
3.4
通讯作者：
P. M. Berger;J. R. Diamond
中科院分区：
文献类型：
--
作者：
P. M. Berger;J. R. Diamond
由于多种病因，同种异体肾移植物中的输尿管梗阻是一种具有挑战性的诊断和治疗疾病。由于肾移植受者的输尿管梗阻通常表现为氮质血症，因此还必须与急性排斥反应相鉴别。尽管超声是非侵入性的且易于使用，但最明确的诊断工具是经皮肾造口管置入顺行肾造口造影。有多种治疗方法可用于治疗同种异体肾移植物中的输尿管梗阻。这些手术可以是开放性的（例如，重复输尿管膀胱切开术）或利用腔内泌尿外科方法（例如，经腔内输尿管扩张术）。从实验的角度来看，实验性肾积水啮齿动物模型的最新数据表明，梗阻肾脏和经历慢性排斥过程的同种异体移植物中存在相似的病理生物学事件。为此，需要进行调查以评估同种异体移植物中未识别的部分输尿管梗阻是否会加速慢性排斥反应的发展。这将进一步强调输尿管梗阻的重要性，它不仅是同种异体移植物中急性氮质血症的原因，而且也是肾移植功能慢性恶化的原因。
Ureteral obstruction in a renal allograft, due to a variety of etiologies, is both a challenging diagnostic and therapeutic disorder. Since ureteral obstruction in a renal transplant recipient usually presents as azotemia, it must also be distinguished from acute rejection. Although ultrasound is non-invasive and readily available, the most definitive diagnostic tool is percutaneous nephrostomy tube placement with antegrade nephrostogram. A variety of therapeutic approaches are available to treat ureteral obstruction in a renal allograft. These procedures can be open (e.g., repeat ureteroneocystotomy) or utilize an endourological approach (e.g., transluminal ureteral dilatation). From an experimental standpoint, recent data in rodent models of experimental hydronephrosis demonstrate similar pathobiologic events in both the obstructed kidney and an allograft undergoing the chronic rejection process. To this end, investigation needs to be conducted to assess whether partial, unrecognized ureteral obstruction in an allograft hastens the development of chronic rejection. This would further underscore the importance of ureteral obstruction as a cause for not only acute azotemia in an allograft, but also chronic deterioration in renal transplant function.