In order to assess the glomerular filtration responses to acute ureteral obstruction in the dog we employed an established method that does not require timed urine collections. Our results show a 57 per cent increase in renal blood flow (baseline: 203.8 +/- 50.9 vs. 319 +/- 69.4 ml./min. at 105 minutes; no. = 7) that was associated with a monophasic decrease in filtration fraction to -70 per cent at 120 minutes (0.26 +/- 0.025 vs. 0.08 +/- 0.007) and an increase in ureteral pressure to 63.1 +/- 6.1 mm. Hg at 120 minutes. A biphasic GFR response was noted with an initial small increase (baseline: 32.5 +/- 7.5 vs. 36.3 +/- 11.0 ml./min. at 2 minutes) followed by a continual decline to -55 per cent at 120 minutes (to 14.5 +/- 2.6 ml./min.). This investigation has confirmed the results of micropuncture studies showing maintenance of GFR early after complete ureteral ligation.
The diagnosis and appropriate management of patients with renal trauma have remained controversial. From July 1981 to June 1984 we evaluated with computerized tomography 22 selected patients suspected of sustaining major renal trauma. Of these patients 17 were managed successfully with conservative therapy and 5 underwent surgical exploration. Only 2 patients required arteriography because of excellent renal delineation provided by computerized tomography scanning. Computerized tomography provides the most precise anatomical detail of renal injuries as well as valuable information regarding other retroperitoneal and intra-abdominal structures, often resulting in the identification of associated and unsuspected injuries. We advocate the use of computerized tomography as the primary diagnostic modality in patients suspected of sustaining major renal injury and/or other organ injuries. This change in diagnostic studies has facilitated greatly the diagnosis and treatment of kidney injuries.
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