Recoverability of renal function after treatment of adult patients with unilateral obstructive uropathy and normal contralateral kidney: a prospective study.

obstruction [4]. The reason for the lack of correlation Introduction between the experimental data and the clinical situation is that the complete occlusion of the ureter by ligation Obstructive uropathy with resultant hydronephrosis is the eventual outcome of many urological disorders. obtained in animals is not comparable with the incomplete occlusions that are more likely to occur in clinical Apart from accidental ligation or ureteric calculus, obstruction in humans is nearly always chronic and types of hydronephrosis. partial. The accurate prediction of the recoverability of kidney function after the release of chronic partial Function of the contralateral kidney obstruction is of great clinical value to the urologist and nephrologist. If restoration or improvement of renal In the past, theories of renal counterbalance and renal function appears probable, surgical relief of obstruction atrophy of disuse have considerably aCected the treatmay be indicated, even though there has been a considerment options of prolonged unilateral ureteric obstrucable initial loss of function. In patients whose kidney tion. It was commonly believed that once hypertrophy function is irreversibly damaged by the underlying of the contralateral healthy kidney had fully developed obstructive process, it may be preferable to apply nonsurthe damaged kidney would not regain its function [5]. gical management or total removal of the disordered Hydronephrotic atrophy was considered complete in system by nephrectomy. The aim of the present paper is 6 months, while compensatory hypertrophy was conto discuss the diCerent factors that may potentially aCect sidered complete in 4–6 weeks [5]. Animal as well as recoverability and to review the currently available tests human studies challenged this theory and now it is well that have been proposed to predict recovery of renal established that recovery of even a poorly functioning function upon relief of chronic partial obstruction. kidney is possible, despite compensatory hypertrophy of its partner. Nevertheless, the degree of recovery of the damaged kidney is influenced by the functional status of Factors that may aVect recovery of renal the contralateral kidney. Prominent recovery occurs function under the stimulus of impaired function or removal of the opposite kidney [6–8]. Duration of obstruction Schirmer and Hendricks [9], studying metabolic The degree of recovery of renal function after the release aspects of unilateral hydronephrosis, reported that of unilateral ureteric obstruction correlates inversely oxygen consumption in the obstructed kidney fell to with the duration of the obstruction [1,2]. In dogs there 30% of that in the control after 2 weeks of complete was rarely any return of renal function with release of ureteric occlusion. If the obstruction was then released, unilateral complete ureteric obstruction after 40 days the oxygen consumption of the hydronephrotic tissue [3]. However, the situation in humans is largely recovered to 70% of control values. However, if the unknown. Function has been reported to return in contralateral ureter was subsequently obstructed, the clinical cases after more than 150 days of complete recovery of the previously hydronephrotic kidney was further enhanced to 87% of the control.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1464-410x.1999.00889.x

Recoverability of renal function after relief of chronic partial upper urinary tract obstruction.

Experimental Partial Ureteric Obstruction in Newborn Rats. VII. Are the Long Term Effects on Renal Morphology Avoided by Release of the Obstruction

Radionuclide imaging of the urinary tract.

Scintillation camera renograms were recorded in six patients without a history of bladder function disturbances and in eight patients with caecal urinary reservoir. Each patient was studied once with empty bladder/reservoir and once with full bladder/reservoir. Renograms were obtained from parenchyma, pelvis and whole kidney. Time was measured from injection of isotope to peak of the renogram curve (Tmax) and to the point corresponding to the centre of gravity of the area under the curve (Tg). A full reservoir gave longer Tmax and Tg for both parenchyma and pelvis than an empty reservoir. With full bladder the only significant change was Tg increase for renal pelvis. In the patients with full caecal reservoir, the elimination of radioisotope from the renal pelvis was significantly slower, reflected as longer Tmax and Tg, than in the subjects with full bladder. In comparisons between empty and full bladder/reservoir, Tg permitted clearer separation between the groups than did Tmax. The higher Tmax and Tg values for full than for empty reservoir indicated obstruction to urinary flow and could be ascribed to the high intrareservoir pressure. Regularly occurring pressure waves with amplitudes of 30-65 cm H2O were recorded in the reservoirs, sometimes reflected as transient increases in radioisotope activity in the renograms. In some patients the two kidneys differed considerably in their response to a full urinary bladder or reservoir. The cause may have been difference in the dynamics of the two ureterovesical junctions or of the ureterointestinal anastomoses.(ABSTRACT TRUNCATED AT 250 WORDS)

ACUTE EFFECTS OF FULL URINARY BLADDER AND FULL CAECAL URINARY RESERVOIR ON REGIONAL RENAL FUNCTION A Study with Scintillation Camera Renography

Radionuclide determination of individual kidney function in the treatment of chronic renal obstruction

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Radionuclide determination of individual kidney function in the treatment of chronic renal obstruction