小儿肾积水肾盂压力变化对肾结构的影响

摘要

Pyelomanometry and histological study of renal cortex with light and electron microscope were carried out in 36 patients (39 kidneys)with congenital hydronephrosis.The basic intrapelvic pressure (BPP) ranged from 0.049kPa to 3.72kPa(50-380mmH2O).The renal parenchyma became thinner as the BPP increased.When the BPP was greater than 1.47kPa,the average thickness of renal parenchyma would be about 3.24 ± 0.45mm with glomaruli fibrosis,tubules atrophy and connective tissue proliferation.All the glomeruli were damaged if excretory urography showed nonfunctioning and BPP revealed less than 0.49kPa.The Whitaker test may prove an obstructed ureter in children if the maximum intra-pelvic pressure is over 2.156kPa.%作者对36例(39侧肾)先天性肾积水进行肾盂压力测定和肾脏组织学检查.结果显示肾盂压力变化范围0.049kPa～3.724kPa.压力越高肾实质破坏越重.肾盂压力＞1.470kPa时,肾实质厚度平均为3.2mm,大部分肾小球纤维化,肾小管萎缩,但肾脏仍有一定功能.当静脉肾盂造影不显影,肾盂压力＜0.490kPa时,肾小球全部破坏.肾盂压力容积测定能准确地判断儿童输尿管梗阻.Whitaker试验肾盂最大压力＞2.156kPa时提示输尿管有梗阻存在.