Clinical aspects of polycystic disease of the kidneys.

Seventy-eight patients were treated for polycystic disease of the kidneys. An analysis of the interval between the onset of symptoms and end-stage renal failure made it possible to give and accurate prognosis in individual cases. Pregnancy and urinary infection did not appear to accelerate deterioration of renal function, but Rovsing'' operation precipitated renal failure in some cases. Forty-two patients needed replacement treatment for end-stage renal failure, and 24 patients received 29 renal allografts. Transplant function at all times was better than a matched group of 70 patients indications for removal of polycystic kidneys in graft recipients were persistnet or recurrent infection, erythraemia that failed to respond to conservative treatment, and to make room for the transplant.     

Prevalence of renal urolithiasis in a large, captive white-tailed deer herd

Prevalence of renal urolithiasis in a large, captive white-tailed deer (Odocoileus virginianus) herd was examined over a two-year period of time. In 1973, 1.3% of 225 deer examined had calculi in the renal pelvis and 4.4% had kidney lesions, either independent or in combination with the calculi. In 1974, prevalence increased and 5.9% of 354 deer had calculi and 6.5% had kidney lesions. Calculi and lesions affected all sex and age-classes. Involvement was both unilateral and bilateral with 23.8% having stones in both kidneys and 30.4% having lesions in both kidneys. Lesions and calculi occurred together in 42.8% of cases. Etiology is unknown, but possible relationships are discussed.     

Biochemical and Molecular Responses to Loss of Renal Mass: Atpase and Cyclic Nucleotides: Evidence for Altered Cyclic Nucleotide Metabolism During Compensatory Renal Hypertrophy and Neonatal Kidney Growth

In adult male Sprague-Dawley rats contralateral nephrectomy was followed by an initial fall of the concentration of cGMP in renal cortical tissue followed by a rise to a peak level of 300 percent of the initial concentration within two hours. cGMP concentration in the remaining renal cortex remained at about 300 percent of the initial value during the subsequent 72 hours and slowly declined to 150-200 percent in the following two weeks. The changes in cGMP concentration were due to exactly parallel changes in the soluble fraction of renal cortical guanylate cyclase activity, while cGMP-phosphodiesterase activity remained unchanged. cAMP concentration after contralateral nephrectomy fell significantly by about 25 percent within two hours and remained below baseline level for up to eight hours. In the kidneys of newborn rats the concentration of cAMP was approximately one-half that found in adult kidneys: it slightly fell between the fourth and the seventh day after birth and subsequently continuously rose to reach adult values approximately two weeks after birth. The concentration of cGMP was significantly greater four days after birth than in adult rats, further rose between the fourth and the seventh day after birth and subsequently gradually declined to adult levels. The increased cGMP concentration appears to be due to an increase of guanylate cyclase activity in total kidney homogenates which, in turn, was mainly due to an increase of the particulate (membrane-bound) fraction of the enzyme. cGMP-phosphodiesterase activity, however, was also increased in respect to adult levels, one or three weeks after birth. Renal growth from the seventh day after birth to adulthood is accompanied by a continuous increase of the ratio cAMP/cGMP. Removal of one kidney four to seven days after birth resulted in a slower increase of this ratio. The data suggest that cGMP may trigger renal growth and that increases of cGMP concentration in the kidneys are the result of a primary increase in the activity of guanylate cyclase.     

复杂性结石患者术前应用3D数字打印肾脏仿真技术及手术过程模拟的效果分析

摘要 目的：探讨复杂性结石患者术前应用3D数字打印肾脏仿真技术及手术过程模拟的效果。方法：选入2020年9月至2021年5月在本院就诊的复杂性肾结石患者60例,分为对照组与研究组,各30例。对照组行经皮肾镜碎石术（PCNL）联合输尿管软镜手术,研究组在对照组基础上应用3D打印技术。评价并比较两组的围术期情况、肾功能指标、结石清石率、术后并发症情况等。结果：研究组总手术时间等围手术期指标较对照组低（P＜0.05）;研究组术后血清Scr水平明显低于对照组,BUN显著高于对照组（P＜0.05）,两组术后血清Cys-C水平无明显差异（P＞0.05）;研究组残留结石直径明显小于对照组,结石清除率显著高于对照组（P＜0.05）;两组并发症发生率无明显差异（P>0.05）。结论：术前应用3D数字打印肾脏仿真技术及手术过程模拟可帮助术者快速、准确定位结石位置,提高手术效率及一次性结石清除率,减轻肾脏损伤,降低手术风险。     

Application of Ureteroscope in Emergency Treatment with Persistent Renal Colic Patients during Pregnancy

Background

Although the application of ureteroscopy in the treatment of ureteral calculi during pregnancy has been on the rise, for persistent renal colic patients without ultrasound-detected ureteral calculi, it may represent a clinical dilemma due to the potential risks for both mother and fetus.

Objective

The aim of the present study is to present our experience with the application of the ureteroscope in the emergency treatment of persistent renal colic patients during pregnancy.

Methods

From March 2009 to September 2014, a total of 117 pregnant women who received ureteroscopy for persistent renal colic were retrospectively analyzed. Patients were divided into three groups according to duration of the persistent renal colic: Group A (within 12 hours; 24 cases); Group B (12 to 24 hours; 76 cases); and Group C (more than 24 hours; 17 cases). The stone-free rate, complications, and other qualitative data were analyzed.

Results

Of the 117 patients, 31 patients who were found not to have renal or ureteral calculi received ureteroscopic double-J (DJ) stent insertion, whereas 86 patients who were found with ureteral calculi received ureteroscopic lithotripsy (URSL) and DJ stent insertion. Among them, 24 patients (27.9%) were found with ureteral calculi by ureteroscopy rather than ultrasound. In addition, 73 patients (84.9%) had complete fragmentation of calculi; 12 patients (10.3%) had a threatened abortion (the rates of threatened abortion in Groups A, B and C were 8.3% vs. 6.5% vs. 29.4%; Group C compared with Groups A and B, p<0.05), and one patient (1.2%) had urosepsis (in Group C). However, these complications were cured with conservative treatment, without postpartum infant and maternal complications.

Conclusion

For pregnant patients with persistent renal colic/ureteral calculi and hydronephrosis, ureteroscopic DJ stent insertion and URSL are effective and safe options when conservative treatment fails, even if no urinary calculi were found by ultrasound. At the same time, for patients with persistent renal colic during pregnancy, early application of ureteroscopy may reduce the risk of preterm birth.     

Part II – Roentgenologic Aspects

Roentgen findings in 107 girls under the age of ten years who had proven recurrent urinary tract infections were analyzed. From the excretory urograms done on these children, renal and pelvocalyceal outlines were accurately traced. Subsequently, renal length and parenchymal thickness at multiple points were measured. The presence or absence and grade of reflux were determined by voiding cystourethrography. Finally, the clinical history was correlated with the roentgen findings.With three exceptions, scarring and clubbing in the presence of infection occurred only in refluxing renal units. Kidneys exposed to a higher grade of reflux more frequently showed scarring and clubbing (p<0.001). Seventeen out of 40 renal units either developed or had increase in clubbing and scarring while the patients were being followed. After surgical correction of reflux, 16 of 24 previously clubbed and scarred kidneys showed progression of the lesions, usually within 24 months after operation. All children whose kidneys showed progression after surgical operation had experienced an episode of acute urinary infection with chills and fever before operation.No significant difference existed in the age at clinical onset of infection in patients with ureteral reflux with or without roentgen evidence of clubbing and scarring. This study documents the close relationship between clubbing and scarring and reflux in the presence of urinary infection in infants and children.     

Ultrasonic Destruction of Kidney Stones

Kidney stones may be removed without using a surgical incision by a combination of techniques and skills recently developed in the fields of urology and radiology. Percutaneous access to the kidney is established under fluoroscopic control. A guide wire placed into the renal pelvis allows a nephroscope to be inserted and the collecting system visualized. A long hollow metal probe is advanced through the nephroscope and placed in contact with the stone. This probe conducts the ultrasonic energy. The stone absorbs the energy and breaks into fine granules, which are evacuated by suction.Twenty-three consecutively seen patients presenting with 27 upper urinary tract calculi for which removal was indicated underwent successful percutaneous ultrasonic lithotripsy. Fifteen stones were located in the renal pelvis, eight in a calix, three at the ureteropelvic junction and one in the upper ureter. One infected staghorn calculus was removed. Two complications resulted in extended hospital stays, but in no patients were surgical incisions required. Of the 23 patients, 9 had previously had a surgical lithotomy. The authors believe that most renal and upper ureteral calculi for which removal is indicated may be extracted percutaneously with the aid of the ultrasonic lithotriptor. The patients may expect a rapid convalescence with diminished pain.     

RPLU术对重度肾积水的上尿路结石患者尿ET-1、AQP-1、MCP-1水平的影响

摘要 目的：探讨后腹腔镜下输尿管切开取石术（RPLU）对重度肾积水的上尿路结石患者尿内皮素-1（ET-1）、水通道蛋白-1（AQP-1）、单核细胞趋化蛋白-1（MCP-1）水平的影响。方法：收集2018年4月~2019年11月我院收治的106例重度肾积水的上尿路结石患者为研究对象,按照随机数字表法分为对照组和研究组,每组53例,对照组采用输尿管镜取石术治疗,研究组采用RPLU术治疗,对比两组手术情况,手术前后血红蛋白、肾功能、尿ET-1、AQP-1、MCP-1水平,手术并发症发生情况。结果：研究组手术时间及住院时间多于对照组,结石清除率高于对照组,比较差异有统计学意义（P<0.05）;两组术中出血量、术后排气时间比较差异无统计学意义（P>0.05）。术后,两组血红蛋白较术前无显著差异（P>0.05）。术后,两组血肌酐及血尿酸氮均下降,两组比较差异无统计学意义（P>0.05）。术后,两组尿ET-1、AQP-1、MCP-1水平均下降,两组比较无统计学意义（P>0.05）。两组并发症总发生率比较无统计学意义（P>0.05）。结论：RPLU术是治疗重度肾积水的上尿路结石清除率高,创伤小,可作为重度肾积水伴上尿路结石安全、有效的术式。     

微创经皮肾镜碎石取石术治疗特殊肾结石的临床疗效观察

目的：研究微创经皮肾镜碎石取石术治疗特殊鹿角型或多发肾结石中的临床疗效和安全性。方法：回顾性分析2007年1月-2013年3月我院收治的37例采用微创经皮肾镜碎石取石术（PCNL）手术方式治疗的特殊鹿角形或多发肾结石患者的临床资料。结果：37例患者中,孤立肾9例、马蹄肾7例、海绵肾和多囊肾7例、儿童患者14例。成人结石直径（3．2±0．3）cm,儿童结石直径（2．2±0．2）cm。37例患者均一期单通道情况下顺利完成手术,单次手术成功率100％,结石清除率91．2％（34／37）,平均手术时间（94±21．6）min,平均出血量（62±12．3）mL,术后1月复查B超提示肾脏积水减轻,肾脏功能血肌酐较术前降低,术后一月复查KUB提示3例肾脏下盏少量残留结石,4例患者出现术后低热症状。结论：采用PCNL治疗特殊鹿角形或多发肾结石的安全性好、结石清除率高、并发症较少。     

Long-Term Responses to Loss of Renal Mass: Glomerular Changes: Compensatory Renal Hypertrophy in Dogs: Single Nephron Glomerular Filtration Rate

Kidney weight, length of superficial and juxtamedullary proximal tubules, glomerular diameter, kidney filtration rate and PAH clearance, sodium excretion and intrarenal distribution of filtration (with ¹⁴C-ferrocyanide) were measured in the remaining hypertrophic kidneys of dogs 10 days after unilateral nephrectomy. Whereas kidney weight increased to 75 percent of the original total renal mass, proximal tubule length and mean glomerular diameter remained unchanged. PAH and creatinine clearance, and absolute, but not fractional, sodium excretion, rose significantly. The ratio superficial/juxtamedullary filtration rate remained unchanged, indicating parallel increases of filtration in both cortical regions of hypertrophied kidneys.     

Conservative and Surgical Aspects of Disc Lesion Management: Follow-Up Review of 244 Cases

A follow-up study of 244 patients who were admitted to hospital with the diagnosis of discogenic disease between 1963 and 1970 was conducted to determine more precisely when conservative care should stop and a myelogram study followed by surgical decompression should be considered.The number of patients who had electromyography was separately tabulated and totaled (154). Of these, 87 (56.5 percent) had normal and 67 (43.5 percent) abnormal findings. It is significant that 29 of the total had positive myelograms and operation, yet 16 (59 percent) of the 29 had normal electromyograms. This raises a question about how much confidence to place in negative electromyographic findings when deciding for or against surgical operation. However, negative electromyograms are very helpful in reassuring patients who are emotional and resistant to resuming useful activities.     

Biochemical and Molecular Responses to Loss of Renal Mass: Atpase and Cyclic Nucleotides: Changes in Renal Cyclic Nucleotides as a Trigger to the Onset of Compensatory Renal Hypertrophy

In adult male Wistar rats contralateral nephrectomy was followed, within 10 minutes, by a nearly twofold rise of the content of cGMP in renal tissue. 20 and 40 minutes after contralateral nephrectomy cGMP fell to one half its control level to rise again to its normal level within 90 minutes. The initial rise of the concentration of cGMP was accompanied by a simultaneous fall of the concentration of cAMP by about 30 percent: the cAMP concentration remained 10-20 percent below control level for approximately two hours and rose again to its initial level after three hours. Cross-circulation of a nephrectomized rat with an intact animal led to a sharp increase of cGMP in the kidneys of the latter with a peak at 10 minutes after initiating cross-circulation and also to a fall of the cAMP concentration. When the same nephrectomized donor rat was subsequently cross-circulated with one, or even two, intact receiver animals, similar short-lasting changes of cyclic nucleotide concentrations were recorded in the kidneys of all the receivers. When a normal kidney was transplanted to the neck of a rat, subsequent removal of one of its own kidneys did not result in any change in cyclic nucleotide content in either the remaining or the transplanted kidney. The data are interpreted to indicate that renal tissue produces a factor inhibiting renal growth which counteracts a circulating humoral kidney growth stimulating factor of unknown origin. An initial rise of cGMP and a fall of cAMP may trigger the subsequent stimulation of protein synthesis responsible for hypertrophy.     

Changes in prostacyclin and thromboxane biosynthesis and their catabolic enzyme activity in kidneys of aging rats

The effects of aging on the prostacyclin and thromboxane biosynthesis and prostaglandin catabolic enzyme activity in rat kidney were investigated. The prostacyclin biosynthesis, using arachidonic acid as substrate, was the greatest in young kidneys (2 months old) and then progressively decreased in mature (12 months old) and old (24 months old) kidneys, while thromboxane biosynthetic activity showed no significant change as a function of age. When prostaglandin H2 was used as substrate, the prostacyclin and thromboxane biosynthesis showed similar results as when arachidonic acid was used as substrate; the prostacyclin biosynthesis progressively decreased and thromboxane biosynthesis showed no significant change as a function of age. The fatty acid cyclooxygenase in kidney was measured by a specific radioimmunoassay. No significant change in renal fatty acid cyclooxygenase as a function of age was found. Thus, we concluded that the progressive decrease in renal prostacyclin biosynthesis as a function of age is due to a defect in prostacyclin synthetase in aged kidneys. The prostaglandin catabolic enzyme, NAD+-dependent 15-hydroxyprostaglandin dehydrogenase, in kidneys was also investigated. The enzyme activity progressively decreased as a function of age, which suggested a decrease in the metabolism of thromboxane A2 in aged kidneys. The present results, indicating a decrease in renal prostacyclin biosynthesis and renal 15-hydroxyprostaglandin dehydrogenase activity with aging, might contribute to a plausible explanation of the progressive decrease in renal functions in the elderly.     

Influence of augmentation of excretory renal mass on renal function after alpha-receptor blockade

The effect of renal function of an augmentation of the excretory renal mass was investigated in 10 dogs without drug treatment and in 10 animals with alpha-receptor blockade. In the untreated group, augmentation of excretory renal mass by transplantation into the neck of one pair of kidneys isolated from another animal caused the following changes in the kidneys in situ: marked elevation in CPAH, slight decrease in Cinulin, slight diminution of urine excretion and a pronounced fall in sodium excretion. The amount of urine and sodium excreted by the four kidneys was identical with that previously excreted by the two kidneys in situ. In animals with alpha-receptor blockade, augmentation of the excretory renal mass had the following consequences in the in situ kidneys, CPAH, and Cinulin remained unchanged while urine and sodium excretion decreased to the same extent as in the untreated control group. The amount of urine and of sodium excreted by the four kidneys was the same as that excreted by the kidneys in situ, prior to transplantation of isolated kidneys, i.e. before the augmentation of excretory renal mass. It seems that the decrease in sodium excretion of the kidneys in situ was not due to the haemodynamic changes evoked by the load on the circulation; it was rather consequence of some quick, presumably humoral, regulation. The diminution of sodium excretion in the kidneys in situ after augmentation of the excretory renal mass has been ascribed to an increased utilization by the four kidneys of the natriuretic factor(s), i.e. to a diminution in the plasma level of the natriuretic hormone.     

Part III – Treatment of Ureterovesical Reflux

Of 134 girls with demonstrable ureterovesical reflux, 61 (105 ureters) had the reflux surgically corrected with an overall surgical cure rate of 97 percent. In the remaining 73 children (112 ureters), the reflux was treated conservatively with medical management alone. During the follow-up period no significant differences were demonstrated in the overall incidence of urinary tract infection; two years following corrective operation or medical treatment more than 50 percent of both medically and surgically treated children were still experiencing infections. A pronounced decrease, however, occurred in the incidence of clinical pyelonephritis among the surgically treated group. Following correction of reflux, the incidence of pyelonephritis was similar in both medically and surgically treated cases and was approximately the same as that found in a comparable group of children without reflux.In approximately two-thirds of refluxing renal units in which there was evidence of clubbing and scarring before medical or surgical therapy, deterioration progressed during the follow-up period. In most of these cases infection control was felt to be inadequate with episodes of clinical pyelonephritis occurring during the period of medical management, or, in the surgically treated group, occurring just before corrective operation and the scar appearing within two years after operation.The majority of renal units in which calyceal clubbing and parenchymal scarring was present had the most severe grades of reflux.     

Assessment of a test of renal viability.

A test of renal viability using the uptake of 125I-iodohippurate by kidney biopsy specimens has been developed. It is applicable to all kidneys irrespective of the method of storage. The uptake of 125I-iodohippurate in experimental kidneys correlated well with warm or cold ischaemia time and subsequent renal function. The test was used for human cadaver kidneys offered for transplantation and there was good correlation between iodohippurate uptake and warm ischaemic time. With this test, prediction of renal function was accurate in 85% of human cadaver kidneys transplanted. Pulsatile perfusion had no effect on cadaver kidneys as measured by this test.     

术中超声在复杂性肾结石手术的临床应用

目的：探讨术中超声在复杂性肾结石手术中的作用。方法：将56例复杂性肾结石手术患者分成实验组和对照组,前者术中使用超声检查,后者术中不使用超声检查,比较两组术后结石残存率、术中手术时间、出血量和肾功能。结果：实验组术后结石残存率、术中手术时间、出血量少于对照组（P〈0．05）,两组肾功能变化差异无统计学意义（P〉0．05）。结论：术中超声对肾切开取石有简便、精确、迅速、易掌握的优点,值得临床推广。     

Cadaver Renal Homotransplants: Initial Experiences

Four renal homotransplants were carried out between cadaver donors and four recipients, all of whom were in terminal chronic renal failure. Immune suppression was attempted with azathioprine (Imuran), actinomycin C and prednisone; no radiation was used, nor were the recipient''s kidneys, spleen or thymus removed. One patient died with disseminated histoplasmosis at two weeks; another with irreversible homograft rejection at 30 days; a third patient died of septicemia after 9½ weeks with stable renal function. The fourth patient, whose transplant had been ischemic for 190 minutes and had not functioned for 2½ weeks thereafter, eventually achieved good function which remained unchanged to 7½ months. Changes in urinary enzyme excretion and in the I¹³¹ renogram and meralluride scan were of value in assessing homograft rejection.     

Effects of short-term hypothermic perfusion and cold storage on function of the isolated-perfused dog kidney

The isolated-perfused dog kidney was used as a model to measure the effects of short-term hypothermic preservation on renal function and metabolism. Kidneys were cold-stored in Collins' solution, hypotonic citrate, or phosphate-buffered sucrose for 4 and 24 hr, or were continuously perfused for 4 and 24 hr with a synthetic perfusate. Following preservation kidneys were perfused with an albumin-containing perfusate at 37 degrees C for 60 min for determination of renal function. The results indicate that many of the effects of short-term preservation on renal function in dog kidneys are similar to results reported for rat and rabbit kidneys. Cold storage for 4 hr resulted in a large decrease in GFR (57%), but only a small decrease in Na reabsorption (from 97 to 87%). Cold storage for 24 hr caused a further decline in renal function (GFR = 95% decrease, Na reabsorption = 49-64%). Results were similar for all cold storage solutions tested. Perfusion for 4 hr was less damaging to renal function than cold storage. The GFR decreased only 14% and urine formation and Na reabsorption were practically normal. After 24 hr of hypothermic perfusion, the GFR was reduced by 79%, urine flow was normal, and Na reabsorption was 78%. There were no obvious biochemical correlates (adenine nucleotides, tissue edema, or electrolyte concentration) with the loss of renal function during short-term preservation. The results suggest that the isolated-perfused dog kidney can be used to test the effects of preservation on renal function, and yields results similar to those obtained using small animal models.(ABSTRACT TRUNCATED AT 250 WORDS)     

胎羊单侧输尿管梗阻模型的建立

目的建立胎羊单侧输尿管梗阻的动物模型,探讨其病理、影像学特点。方法取12只单胎妊娠75-85 d的健康山羊,采用宫内手术的方法造成胎羊左侧输尿管不完全梗阻。对羔羊进行影像、病理学研究。结果12只孕羊中有3只流产;有9只孕羊顺产羔羊。超声检查：梗阻后的第3周内胎羊左肾显著增大、积水及实质变薄。放射学检查：羔羊左肾积水并且功能受损害。病理学检查：左肾肾小球数目减少,肾小管扩张明显,未见肾发育不良。结论对山羊单胎妊娠中期胎羊进行宫内手术建立胎羊单侧输尿管梗阻的动物模型是可行的,该模型能很好地模拟肾盂输尿管连接部梗阻所致的胎儿肾积水。